How much can we gain from improved efficiency? An examination of performance of national HIV/AIDS programs and its determinants in low- and middle-income countries

<p>Abstract</p> <p>Background</p> <p>The economic downturn exacerbates the inadequacy of resources for combating the worldwide HIV/AIDS pandemic and amplifies the need to improve the efficiency of HIV/AIDS programs.</p> <p>Methods</p> <p>We used data envelopment analysis (DEA) to evaluate efficiency of national HIV/AIDS programs in transforming funding into services and implemented a Tobit model to identify determinants of the efficiency in 68 low- and middle-income countries. We considered the change from the lowest quartile to the average value of a variable a "notable" increase.</p> <p>Results</p> <p>Overall, the average efficiency in implementing HIV/AIDS programs was moderate (49.8%). Program efficiency varied enormously among countries with means by quartile of efficiency of 13.0%, 36.4%, 54.4% and 96.5%. A country's governance, financing mechanisms, and economic and demographic characteristics influence the program efficiency. For example, if countries achieved a notable increase in "voice and accountability" (e.g., greater participation of civil society in policy making), the efficiency of their HIV/AIDS programs would increase by 40.8%. For countries in the lowest quartile of per capita gross national income (GNI), a notable increase in per capita GNI would increase the efficiency of AIDS programs by 45.0%.</p> <p>Conclusions</p> <p>There may be substantial opportunity for improving the efficiency of AIDS services, by providing more services with existing resources. Actions beyond the health sector could be important factors affecting HIV/AIDS service delivery.</p

Health sector reform from first principles - An equanimous look at the evidence

Scattered radiation generated inside a specimen may significantly influence the flaw sensitivity by reducing the relative contrast of the flaw indication [1]. This statement holds if the scattered radiation produces a uniform intensity distribution in the film or detector plane, i.e. it is non-image forming while contributing to the radiographie projection. The introduction of built-up factors yields an appropriate description of the corresponding relative contrast reduction in the radiographie image [2]. In general, the underlying physical process can be treated as an X-ray or photon transport problem [3–6] based on a Boltzmann type equation. This approximation does not need the assumption of a uniform distributed field of scattered radiation. There are several attempts known to solve this problem for NDE applications in terms of Monte Carlo simulation [5, 7–8]. But this technique is only in a qualified sense applicable to practical testing problems with a large variety of factors like 3D object description, finite focal spot, energy dependence of source and interaction mechanisms, and others to be considered requiring a huge number of realizations to receive statistically significant results. Other techniques based on the solution of the corresponding integral transport equation [9–10] employing two stage algorithms. The first stage is known as transport stage where the photon flow resulting from the angular photon sources are computed. The second stage is known as the source computing stage where the scattering sources resulting from the Compton or coherent scattering are computed. Results from these calculations show, that for some cases the scattered radiation does not only decrease the contrast in a radiograph but shows a geometrical dependence which overlays the image from the direct radiation. Finally, an analytical simulation procedure to describe the scattered photon flux was developed which is based on the theory of Markovian processes with random structure [11–12]

Optimization of multiple response surfaces with secondary constraints for improving a radiography inspection process

10.1080/08982110601057203Quality Engineering19153-65QUEN

The clinical psychologist and the management of&nbsp;inpatient pain: a small case series

Susan R Childs,1,* Emma M Casely,2,* Bianca M Kuehler,1 Stephen Ward,1 Charlotte L Halmshaw,1 Sarah E Thomas,1 Ian D Goodall,1 Carsten Bantel1,3 1Pain Medicine, Chelsea and&nbsp;Westminster Hospital NHS Foundation Trust, London, 2Anaesthetic Department, Hillingdon Hospital, Uxbridge, 3Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK *These authors contributed equally to&nbsp;this manuscript Abstract: Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients&rsquo; pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize communication and to resolve a difficult and potentially risk-laden situation. This small case series discusses the benefits derived from the involvement of a clinical psychologist in the management of inpatient pain, and therefore illustrates the need for novel initiatives for inpatient pain services. However, future research is warranted to validate this approach. Keywords: acute pain, aggression, anxiety, borderline personality disorder, psycholog