Drill and Blast Performance Evaluation at the Obra Pit of Chirano Gold Mines Ltd, Ghana

This paper investigates the causes of inefficient fragmentation and formation of toes in the Obra pit of Chirano Gold Mines Ltd and recommends best practices in order to produce optimum fragmentation to feed the crusher at a reduced cost and to provide good working pit floors. The methods employed included: drilling performance analysis using statistical methods; fragmentation analysis of blasting performance using Kuz-Ram Model and Wipfrag software; determination of the velocity of detonation of the bulk explosive using MREL Micro Trap VOD/Data Recorder; and estimation of the cost of secondary drilling and blasting using Mine Management Reporting Software. From the analyses, it was observed that the blast designed parameters and blasting practices were acceptable to produce good fragmentation but the actual drilling parameters deviated from the designed parameters by about 25%, 24% and 26% in hole depth, burden and spacing respectively. It was concluded that the cause of the ineffective fragmentation leading to high cost of secondary breakage and uneven pit floors was due to operational errors during drilling. It is therefore recommended that in order to reduce excessive deviations in the drilling parameters, periodic training of operators must be conducted, supervision of drilling and blasting operations must be enhanced, and inclinometers should be used during drilling activities to ensure the accuracy and precision of all blast holes. Keywords: Drilling, Blasting, Fragmentation, Kuz-Ram Model, Wipfrag Softwar

A controlled study to assess the effects of a Fast Track (FT) service delivery model among stable HIV patients in Lusaka Zambia

Fast Track models—in which patients coming to facility to pick up medications minimize waiting times through foregoing clinical review and collecting pre-packaged medications—present a potential strategy to reduce the burden of treatment. We examine effects of a Fast Track model (FT) in a real-world clinical HIV treatment program on retention to care comparing two clinics initiating FT care to five similar (in size and health care level), standard of care clinics in Zambia. Within each clinic, we selected a systematic sample of patients meeting FT eligibility to follow prospectively for retention using both electronic medical records as well as targeted chart review. We used a variety of methods including Kaplan Meier (KM) stratified by FT, to compare time to first late pick up, exploring late thresholds at >7, >14 and >28 days, Cox proportional hazards to describe associations between FT and late pick up, and linear mixed effects regression to assess the association of FT with medication possession ratio. A total of 905 participants were enrolled with a median age of 40 years (interquartile range [IQR]: 34–46 years), 67.1% were female, median CD4 count was 499 cells/mm3 (IQR: 354–691), and median time on ART was 5 years (IQR: 3–7). During the one-year follow-up period FT participants had a significantly reduced cumulative incidence of being >7 days late for ART pick-up (0.36, 95% confidence interval [CI]: 0.31–0.41) compared to control participants (0.66; 95% CI: 0.57–0.65). This trend held for >28 days late for ART pick-up appointments, at 23% (95% CI: 18%-28%) among intervention participants and 54% (95% CI: 47%-61%) among control participants. FT models significantly improved timely ART pick up among study participants. The apparent synergistic relationship between refill time and other elements of the FT suggest that FT may enhance the effects of extending visit spacing/multi-month scripting alone. ClinicalTrials.gov Identifier: NCT02776254 https://clinicaltrials.gov/ct2/show/NCT02776254

Profiles of HIV care disruptions among adult patients lost to follow-up in Zambia: A latent class analysis

BACKGROUND: Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles. METHODS: We traced a probability sample of patients lost to follow-up (\u3e90 days late) as of July 31, 2015 from 64 clinics in Zambia. Among those found alive, we ascertained patient-reported reasons for care disruptions. We performed latent class analysis to identify patient subgroups with similar patterns of reasons reported and assessed the association between class membership and care status (ie, disengaged versus silently transferred to a new site). RESULTS: Among 547 patients, we identified 5 profiles of care disruptions: (1) Livelihood and Mobility (30.6% of the population) reported work/school obligations and mobility/travel as reasons for care disruptions; (2) Clinic Accessibility (28.9%) reported challenges with attending clinic; (3) Mobility and Family (21.9%) reported family obligations, mobility/travel, and transport-related reasons; (4) Doubting Need for HIV care (10.2%) reported uncertainty around HIV status or need for clinical care, and (5) Multidimensional Barriers to Care (8.3%) reported numerous (mean 5.6) reasons across multiple domains. Patient profiles were significantly associated with care status. The Doubting Need for HIV Care class were mostly disengaged (97.9%), followed by the Multidimensional Barriers to Care (62.8%), Clinic Accessibility (62.4%), Livelihood and Mobility (43.6%), and Mobility and Family (23.5%) classes. CONCLUSION: There are distinct HIV care disruption profiles that are strongly associated with patients\u27 current engagement status. Interventions targeting these unique profiles may enable more effective and tailored strategies for improving HIV treatment outcomes

Patient-reported reasons for stopping care or switching clinics in Zambia: A multisite, regionally representative estimate using a multistage sampling-based approach in Zambia

BACKGROUND: Understanding patient-reported reasons for lapses of retention in human immunodeficiency virus (HIV) treatment can drive improvements in the care cascade. A systematic assessment of outcomes among a random sample of patients lost to follow-up (LTFU) from 32 clinics in Zambia to understand the reasons for silent transfers and disengagement from care was undertaken. METHODS: We traced a simple random sample of LTFU patients (\u3e90 days from last scheduled visit) as determined from clinic-based electronic medical records from a probability sample of facilities. Among patients found in person, we solicited reasons for either stopping or switching care and predictors for re-engagement. We coded reasons into structural, psychosocial, and clinic-based barriers. RESULTS: Among 1751 LTFU patients traced and found alive, 31% of patients starting antiretroviral therapy (ART) between 1 July 2013 and 31 July 2015 silently transferred or were disengaged (40% male; median age, 35 years; median CD4 level, 239 cells/μL); median time on ART at LTFU was 480 days (interquartile range, 110-1295). Among the 544 patients not in care, median prevalences for patient-reported structural, psychosocial, and clinic-level barriers were 27.3%, 13.9%, and 13.4%, respectively, and were highly variable across facilities. Structural reasons, including, relocated to a new place were mostly cited among 289 patients who silently transferred (35.5%). We found that men were less likely to re-engage in care than women (odds ratio, .39; 95% confidence interval, .22-.67; P = .001). CONCLUSIONS: Efforts to improve retention of patients on ART may need to be tailored at the facility level to address patient-reported barriers

Longitudinal care cascade outcomes among people eligible for antiretroviral therapy who are newly linking to care in Zambia: A multistate analysis

BACKGROUND: Retention in human immunodeficiency virus (HIV) care is dynamic, with patients frequently transitioning in and out of care. Analytical approaches (eg, survival analyses) commonly used to assess HIV care cascade outcomes fail to capture such transitions and therefore incompletely represent care outcomes over time. METHODS: We analyzed antiretroviral therapy (ART)-eligible adults newly linking to care at 64 clinics in Zambia between 1 April 2014 and 31 July 2015. We used electronic medical record data and supplemented these with updated care outcomes ascertained by tracing a multistage random sample of patients lost to follow-up (LTFU, \u3e90 days late for last appointment). We performed multistate analyses, incorporating weights from sampling, to estimate the prevalence of 9 care states over time since linkage with respect to ART initiation, retention in care, transfers, and mortality. RESULTS: In sum, 23 227 patients (58% female; median age 34 years [interquartile range 28-41]) were ART-eligible at enrollment. At 1 year, 75.2% had initiated ART and were in care: 61.8% were continuously retained, 6.1% had reengaged after LTFU, and 7.3% had transferred. Also, 10.1% were LTFU within 7 days of enrollment, and 15.2% were LTFU at 1 year (6.7% prior to ART). One year after LTFU, 51.6% of those LTFU prior to ART remained out of care compared to 30.2% of those LTFU after initiating ART. Overall, 6.9% of patients had died by 1 year with 3.0% dying prior to ART. CONCLUSION: Multistate analyses provide more complete assessments of longitudinal HIV cascade outcomes and reveal treatment gaps at distinct timepoints in care that will still need to be addressed even with universal treatment

A systematic review of the relationship between rumination and suicidality

Rumination has been persistently implicated in the etiology of hopelessness and depression: proximal predictors of suicidality. As a result, research has started to examine the role of rumination in suicidality. This systematic review aims to: (i) provide a concise synopsis of the current progress in examining the relationship between rumination and suicidality; and (ii) highlight areas for future research. To this end, a search of the international literature was conducted using the three main psychological and medical databases (Psych Info [1887-October 2007], Medline [1966-October 2007] and Web of Knowledge [1981-October 2007]). Eleven studies were identified providing evidence, with one exception, of a relationship between rumination and suicidality. This systematic review has highlighted a considerable dearth of studies, specifically of case-control and prospective, clinical studies, in the worldwide literature. Key areas for future research are discussed

Democracy, Globalization and Private Investment in Ghana

The article examines the effects of democracy and globalization on private investment in Ghana for the period 1980–2012, using the autoregressive distributed lag (ARDL) bounds test for cointegration and the error correction model (ECM). Two models are used. In Model 1, democracy is proxy by an index for institutional quality (Polity 2), while Model 2 uses an index for civil liberties as proxy for democracy. The results for Model 1 show globalization and public investment increase private investment, while exchange rate volatility and trade openness decrease private investment in both the long and short run. In addition, national income and interest rate reduce private investment in the short run. In the case of Model 2, credit to the private sector and public investment increase private investment, while exchange rate volatility and trade openness decrease private investment in both the long and short run. Finally, national income and interest rate reduce private investment in the short run. The findings and policy recommendations of the article provide vital information for policy implementation in Ghana