Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.

ObjectivePreexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes.DesignRigorous systematic review and meta-analysis.MethodsA comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis.ResultsEighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness.ConclusionPrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk

Training for lifestyle entrepreneurs: what works?

Principal Topic: Many developed countries have issues with the movement of populations away from rural areas. This is often caused by the lack of career opportunities for the young as a result of the decline in rural industries and the inability of farming to provide a sufficiently high standard of living. There has been an active move towards 'value adding' in rural areas and in particular the development of tourism activities, to counter this trend. There is an additional challenge, in that many rural entrepreneurs are what might be called 'lifestyle' entrepreneurs (Alsos, Ljunggren & Pettersen 2007), whose capacity to contribute to local economic development is not well documented. The purpose of this paper is to document the curriculum development process that was engaged in, in the design, delivery and outcomes of a programme designed to encourage and equip rural entrepreneurs to extend into the tourism and hospitality industries. These entrepreneurs operate in Hedmark Region of Norway and the training took place in Brisbane, Australia. The programme was substantially funded by Innovation Norway. Methodology/Key Propositions: The development and delivery of the training programme took place in Norway and Australia. The methodology is qualitative and it is hoped the research will lead to a longitudinal study of the impact of lifestyle entrepreneurs on local economic development in rural areas. Qualitative research has the strength of providing rich data, directly from the entrepreneurs themselves. The action research process that was engaged in means that the entrepreneurs themselves are active participants in the research and the quality of their feedback and willingness to discuss their changed behaviour are critical to both evaluating the impact of the programme and the potential for further study on the economic impact of their activities. The development process and the nature of the curriculum used for these entrepreneurs may well provide insights into effective training for lifestyle entrepreneurs in other contexts. The participants were asked to evaluate the programme immediately on its conclusion and six months after the programme when they were interviewed in their place of operation. Their insights into the benefits of the training received, including its location in an unfamiliar and exotic setting, provide an insight into the difficulties faced by micro-enterprises in rural areas, many of which were not identified by the participants prior to the training. The development process included two visits to the location in which the entrepreneurs were establishing their enterprises, discussion with local economic development staff and a group of local entrepreneurs. This provided the data for the design of the curriculum which included targeted classroom sessions, site visits, experiential learning and small group coaching. Results and Implications: Little is known about the potential for growth of lifestyle entrepreneurs, despite the growing number in rural areas of developed countries. Innovation Norway had an explicit desired outcome for the programme and that was to encourage individual entrepreneurs, known for their independence, to work together. The evaluations undertaken both immediately after the programme and 6 months later provide interesting reflections on what was considered the most effective learning strategy as well as the practical outcomes of the programme. - The experiential learning, that is being put in the place of their potential customers proved an effective way to learn. - Participants would have liked more coaching - that is being helped to relate their learning to their particular situations. - The greatest benefit from the programme was the social and business network that was established and which was having a multiplier effect in the community. - Participants were much more conscious of the need to be specific in identifying who their customer was and tailoring the products and services to particular markets. - Participants indicated an interest in being part of a longitudinal study into the impact of their businesses on local economic activity

The Effect of Ascending-Price Electric Power Tariffs on Consumption of Electricity

This thesis represents an attempt to evaluate the effects which would result from the inversion of electric power tariff structures. Tariff relationships are presently based upon both the cost and value of service. The unit price for electricity presently decreases as monthly consumption increases. Electric utilities are required to: (1) supply all reasonable demands for service by those who can pay for it, (2) provide service adequate to the needs of customers, (3) price such service at reasonable rates and without unjust discrimination. The demand for electricity is a segment of the demand for energy of all types. Growth in the demand for energy has been closely related to economic growth in general. Total annual sales of electricity have been roughly doubling every ten years since the 1920\u27s. Unit prices of electricity experienced a declining trend until 1970. In the late 1960\u27s, electric utilities began asking for general rate increases, which caused the reversal of this trend. Proponents of inverted rates assume that the demand for electricity is sufficiently elastic to respond noticeably to the price charged per kilowatt-hour. Factors which affect the elasticity of any product include: (1) the product\u27s cost in relation to the total family or business budget; (2) the availability of substitutes; (3) the degree of necessity attached to the product; (4) the extent to which the customer realizes how much he is paying for a given product or service; (5) the length of time a given price has been in effect. The basic conclusion drawn from this study is that the demand for electricity is not sufficiently elastic with respect to price to respond appreciably when an inverted rate is applied. The reasons for this conclusion are as follows: (1) The relative amount spent on electricity by both residential and industrial users is small. (2) It is possible to use substitute forms of energy for some uses of electricity. These substitute forms of energy are in shorter supply than is electricity, however, and the price of substitutes is expected to increase faster than is the price of electricity. (3) Consumers of electricity do not think in terms of cost per kilowatt-hour but in terms of dollars spent on electricity per month. They have little knowledge about the unit or monthly operating cost of various uses of electricity. Under the circumstances listed above, the inversion of electric tariffs appears to have little effect on the consumption of electricity

Scientific Respiratory Symposium, Paris June 2010

At a 2010 Respiratory Symposium in Paris, chaired by Professors Bousquet and Roche of the University of Paris, recent trends in research, therapy and treatment guidelines for asthma and chronic obstructive pulmonary disease (COPD) were reviewed and discussed by a faculty of expert European and US respiratory physicians. This article reviews five key clinical presentations with particular emphasis given to the importance of small airways in the pathology and treatment of asthma and COPD. Further analysis of the economics of treatment in Europe and the US shows a wide variance in direct and indirect costs

Future directions for reducing inequity and maximising impact of child health strategies.

Over the past two decades, the world has made considerable progress in reducing under 5 mortality, but not all children have benefitted, and stark inequities in coverage of interventions persist in nearly all countries. Integrated Management of Childhood Illness (IMCI) was designed by Unicef and the World Health Organization to reach all children in countries with under 5 mortality rates greater than 40 per 1000 live births and has been implemented in over 100 countries since the mid-1990s. In 2012 WHO and Unicef introduced integrated Community Case Management (iCCM) as a complementary strategy to IMCI to extend case management to children living in underserved areas (box 1). Although IMCI lacks an explicit mechanism to reach children unable to access health facilities owing to poverty, marginalisation, or lack of coverage, iCCM has a stated equity goal of reaching underserved children..

Conselho tutelar e proteção integral: impressões acerca da efetividade de atuação para defesa dos direitos da criança e do adolescente em situação de rua no Município de Natal/RN

The Federal Constitution of 1988 and the Statute of Children and Adolescents enshrined the principle of integral protection as a new paradigm focused on childhood and adolescence. In this sense, it instituted the Tutelary Councils, the body charged by society to ensure the rights of children and adolescents and to strengthen the dialogue between family, State and Society. Therefore, this work aims to understand minimally about the performance of these organs in the municipality of Natal/RN and thus to understand what factors and difficulties are encountered to effective the integral protection of children and adolescents in street situations. For this, we seek to present the concepts that engender the doctrine of integral protection, in addition to the functioning and legal structure of the permanent organ. It should be emphasized that the research adopted the method of deductive approach, using bibliographic research of national and international diplomas, seeking to analyze the historical evolution of the norms of protection for children. At another time, an online questionnaire was prepared to the Tutelary Councils of the North, South, East and West administrative regions in order to know about their actions and impressions about the subject. As a result of the analysis, we identified that there are enough normative diplomas to protect childhood and adolescence. However, the Tutelary Councils of the Municipality of Natal/RN still lack full effectiveness.A Constituição Federal de 1988 e o Estatuto da Criança e do Adolescente consagraram o princípio da proteção integral como novo paradigma voltado à infância e adolescência. Nesse sentido, instituiu os Conselhos Tutelares, órgão encarregado pela sociedade de zelar pelos direitos das crianças e adolescentes e de fortalecer a interlocução entre família, Estado e Sociedade. Portanto, este trabalho visa compreender minimamente sobre a atuação desses órgãos no Município de Natal/RN e dessa maneira perceber quais fatores e dificuldades são encontradas para efetivação da proteção integral à criança e adolescente em situação de rua. Para isso, procuramos apresentar os conceitos que engendram a doutrina da proteção integral, além do funcionamento e estrutura legal do órgão permanente. Cabe frisar, que a investigação adotou o método de abordagem dedutivo, utilizando-se de pesquisa bibliográfica de diplomas nacionais e internacionais, buscando analisar a evolução histórica das normas de proteção aos infantes. Em outro momento, foi elaborado um questionário on-line direcionado aos Conselhos Tutelares das regiões administrativas Norte, Sul, Leste e Oeste no intuito de conhecer sobre suas ações e impressões acerca do tema. Como resultado da análise, identificamos que existem diplomas normativos suficientes para proteção à infância e adolescência. Contudo, os Conselhos Tutelares do Município de Natal/RN ainda carecem de plena efetividade