Participatory design, beyond the local

This workshop aims at stimulating and opening a debate around the capacity of Participatory Design (PD) and other co-design approaches to deliver outcomes and methodologies that can have an impact and value for reuse well beyond the local context in which they were originally developed. This will be achieved by stimulating the submission of position papers by researchers from the PD community and beyond.These papers will be discussed during the workshop in order to identify challenges, obstacles but also potentials for scaling up PD processes and results from the local to the global.</p

The difficulty with responding to policy changes for HIV and infant feeding in Malawi

<p>Abstract</p> <p>Background</p> <p>When and how to wean breastfed infants exposed to HIV infection has provoked extensive debate, particularly in low-income countries where safe alternatives to breastfeeding are rarely available. Although there is global consensus on optimal infant-feeding practices in the form of guidelines, practices are sub-optimal in much of sub-Saharan Africa. Policy-makers and health workers face many challenges in adapting and implementing these guidelines.</p> <p>Methods</p> <p>This paper is based on in-depth interviews with five policy-makers and 11 providers of interventions to prevent mother-to-child transmission (PMTCT) of HIV, participant observations during clinic sessions and site visits.</p> <p>Results</p> <p>The difficulties with adapting the global infant-feeding guidelines in Malawi have affected the provision of services. There was a lack of consensus on HIV and infant-feeding at all levels and general confusion about the 2006 guidelines, particularly those recommending continued breastfeeding after six months if replacement feeding is not acceptable, feasible, affordable, sustainable and safe. Health workers found it particularly difficult to advise women to continue breastfeeding after six months. They worried that they would lose the trust of the PMTCT clients and the population at large, and they feared that continued breastfeeding was unsafe. Optimal support for HIV-infected women was noted in programmes where health workers were multi-skilled; coordinated their efforts and had functional, multidisciplinary task forces and engaged communities. The recent 2009 recommendations are the first to support antiretroviral (ARV) use by mothers or children during breastfeeding. Besides promoting maternal health and providing protection against HIV infection in children, the new Rapid Advice has the potential to resolve the difficulties and confusion experienced by health workers in Malawi.</p> <p>Conclusions</p> <p>The process of integrating new evidence into institutionalised actions takes time. The challenge of keeping programmes, and especially health workers, up-to-standard is a dynamic process. Effective programmes require more than basic resources. Along with up-to-date information, health workers need contextualized, easy-to-follow guidelines in order to effectively provide services. They also require supportive supervision during the processes of change. Policy-makers should ensure that consensus is carefully considered and that comprehensive perspectives are incorporated when adapting the global guidelines.</p

HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania

<p>Abstract</p> <p>Background</p> <p>Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania.</p> <p>Methods</p> <p>A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.'</p> <p>Results</p> <p>The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession.</p> <p>Conclusion</p> <p>The findings illuminate the immense burden placed on nurses in their role as infant feeding counsellors in pMTCT programmes and the urgent need to provide the training and support structure necessary to promote professional confidence and skills. The organisation of counselling services must to a larger extent take into account the local realities in which nurses construct their role as counsellors to HIV-positive childbearing women.</p

Welfare and macroeconomic policy in small open economies.

This thesis focuses on the analysis of welfare and macroeconomic policy in small open economies. The international dimension of monetary and fiscal policy is examined in a micro-founded New-Keynesian framework. The small open economy is characterized as a limiting case of a two-country dynamic general equilibrium model featuring imperfect competition and nominal rigidities. Under this specification, Chapter 1 formulates a utility-based loss function for a small open economy completely integrated with the rest of the world. The study investigates the role of the exchange rate in monetary policy and derives the optimal monetary policy rule. In this Chapter, the dynamics of the trade balance are shown to be crucial in determining the appropriate exchange rate regime. Chapter 2 analyses optimal monetary policy under alternative asset market structures; more specifically, it compares and contrasts the cases of incomplete asset markets, financial autarky and complete asset markets. Furthermore, the performance of standard monetary policy rules is evaluated under these different scenarios. The results show that the degree of substitutability between domestic and foreign goods and the level of risk sharing are important factors in determining the performance of policy rules. Finally, Chapter 3 incorporates fiscal policy in the general framework. This Chapter introduces distortionary taxation into the model and characterizes the optimal fiscal policy. In addition, a general monetary and fiscal policy problem is formulated in the presence of nominal rigidities. The Chapter demonstrates that the stabilization problem in an open economy is more complex than in a closed economy, even under flexible prices. Apart from the incentive to avoid the distortions implied by taxation, in a small open economy there is also an incentive to strategically affect the real exchange rate. That is, proportional taxation creates a distortion in the economy, but also introduces a policy instrument that can influence the terms of trade and the overall level of production and consumption in a welfare-improving manner

Bosonic String and String Field Theory: a solution using Ultradistributions of Exponential Type

In this paper we show that Ultradistributions of Exponential Type (UET) are appropriate for the description in a consistent way string and string field theories. A new Lagrangian for the closed string is obtained and shown to be equivalent to Nambu-Goto's Lagrangian. We also show that the string field is a linear superposition of UET of compact support CUET). We evaluate the propagator for the string field, and calculate the convolution of two of them.Comment: 30 page