Voluntary Medical Male Circumcision: A Qualitative Study Exploring the Challenges of Costing Demand Creation in Eastern and Southern Africa

BACKGROUND: This paper proposes an approach to estimating the costs of demand creation for voluntary medical male circumcision (VMMC) scale-up in 13 countries of eastern and southern Africa. It addresses two key questions: (1) what are the elements of a standardized package for demand creation? And (2) what challenges exist and must be taken into account in estimating the costs of demand creation? METHODS AND FINDINGS: We conducted a key informant study on VMMC demand creation using purposive sampling to recruit seven people who provide technical assistance to government programs and manage budgets for VMMC demand creation. Key informants provided their views on the important elements of VMMC demand creation and the most effective funding allocations across different types of communication approaches (e.g., mass media, small media, outreach/mobilization). The key finding was the wide range of views, suggesting that a standard package of core demand creation elements would not be universally applicable. This underscored the importance of tailoring demand creation strategies and estimates to specific country contexts before estimating costs. The key informant interviews, supplemented by the researchers' field experience, identified these issues to be addressed in future costing exercises: variations in the cost of VMMC demand creation activities by country and program, decisions about the quality and comprehensiveness of programming, and lack of data on critical elements needed to "trigger the decision" among eligible men. CONCLUSIONS: Based on this study's findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions. However, further work is needed to better understand core components of a demand creation package and how to cost them. Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving estimates of the total costs for VMMC scale-up in eastern and southern Africa

Estimating Fire Background Temperature at a Geostationary Scale-An Evaluation of Contextual Methods for AHI-8

An integral part of any remotely sensed fire detection and attribution method is an estimation of the target pixels background temperature. This temperature cannot be measured directly independent of fire radiation, so indirect methods must be used to create an estimate of this background value. The most commonly used method of background temperature estimation is through derivation from the surrounding obscuration-free pixels available in the same image, in a contextual estimation process. This method of contextual estimation performs well in cloud-free conditions and in areas with homogeneous landscape characteristics, but increasingly complex sets of rules are required when contextual coverage is not optimal. The effects of alterations to the search radius and sample size on the accuracy of contextually derived brightness temperature are heretofore unexplored. This study makes use of imagery from the AHI-8 geostationary satellite to examine contextual estimators for deriving background temperature, at a range of contextual window sizes and percentages of valid contextual information. Results show that while contextual estimation provides accurate temperatures for pixels with no contextual obscuration, significant deterioration of results occurs when even a small portion of the target pixels surroundings are obscured. To maintain the temperature estimation accuracy, the use of no less than 65% of a target pixels total contextual coverage is recommended. The study also examines the use of expanding window sizes and their effect on temperature estimation. Results show that the accuracy of temperature estimation decreases significantly when expanding the examined window, with a 50% increase in temperature variability when using a larger window size than 5×5 pixels, whilst generally providing limited gains in the total number of temperature estimates (between 0.4%4.4% of all pixels examined). The work also presents a number of case study regions taken from the AH

Terrestrial laser scanning: an operational tool for fuel hazard mapping?

Fuel hazard estimates are vital for the prediction of fire behaviour and planning fuel treatment activities. Previous literature has highlighted the potential of Terrestrial Laser Scanning (TLS) to be used to assess fuel properties. However, operational uptake of these systems has been limited due to a lack of a sampling approach that balances efficiency and data efficacy. This study aims to assess whether an operational approach utilising Terrestrial Laser Scanning (TLS) to capture fuel information over an area commensurate with current fuel hazard assessment protocols implemented in South-Eastern Australia is feasible. TLS data were captured over various plots in South-Eastern Australia, utilising both low- and high-cost TLS sensors. Results indicate that both scanners provided similar overall representation of the ground, vertical distribution of vegetation and fuel hazard estimates. The analysis of fuel information contained within individual scans clipped to 4 m showed similar results to that of the fully co-registered plot (cover estimates of near-surface vegetation were within 10%, elevated vegetation within 15%, and height estimates of near-surface and elevated strata within 0.05 cm). This study recommends that, to capture a plot in an operational environment (balancing efficiency and data completeness), a sufficient number of non-overlapping individual scans can provide reliable estimates of fuel information at the near-surface and elevated strata, without the need for co-registration in the case study environments. The use of TLS within the rigid structure provided by current fuel observation protocols provides incremental benefit to the measurement of fuel hazard. Future research should leverage the full capability of TLS data and combine it with moisture estimates to gain a full realisation of the fuel hazard

Sphalerons and the Electroweak Phase Transition in Models with Higher Scalar Representations

In this work we investigate the sphaleron solution in a $SU(2)\times U(1)_X$ gauge theory, which also encompasses the Standard Model, with higher scalar representation(s) ($J^{(i)},X^{(i)}$). We show that the field profiles describing the sphaleron in higher scalar multiplet, have similar trends like the doublet case with respect to the radial distance. We compute the sphaleron energy and find that it scales linearly with the vacuum expectation value of the scalar field and its slope depends on the representation. We also investigate the effect of $U(1)$ gauge field and find that it is small for the physical value of the mixing angle, $\theta_{W}$ and resembles the case for the doublet. For higher representations, we show that the criterion for strong first order phase transition, $v_{c}/T_{c}>\eta$, is relaxed with respect to the doublet case, i.e. $\eta<1$.Comment: 20 pages, 5 figures & 1 table, published versio

Hydrometeorological multi-model ensemble simulations of the 4 November 2011 flash flood event in Genoa, Italy, in the framework of the DRIHM Project

The e-Science environment developed in the framework of the EU-funded DRIHM project was used to demonstrate its ability to provide relevant, meaningful hydrometeorological forecasts. This was illustrated for the tragic case of 4 November 2011, when Genoa, Italy, was flooded as the result of heavy, convective precipitation that inundated the Bisagno catchment. The Meteorological Model Bridge (MMB), an innovative software component developed within the DRIHM project for the interoperability of meteorological and hydrological models, is a key component of the DRIHM e-Science environment. The MMB allowed three different rainfall-discharge models (DRiFt, RIBS and HBV) to be driven by four mesoscale limited-area atmospheric models (WRF-NMM, WRF-ARW, Meso-NH and AROME) and a downscaling algorithm (RainFARM) in a seamless fashion. In addition to this multi-model configuration, some of the models were run in probabilistic mode, thus giving a comprehensive account of modelling errors and a very large amount of likely hydrometeorological scenarios (> 1500). The multi-model approach proved to be necessary because, whilst various aspects of the event were successfully simulated by different models, none of the models reproduced all of these aspects correctly. It was shown that the resulting set of simulations helped identify key atmospheric processes responsible for the large rainfall accumulations over the Bisagno basin. The DRIHM e-Science environment facilitated an evaluation of the sensitivity to atmospheric and hydrological modelling errors. This showed that both had a significant impact on predicted discharges, the former being larger than the latter. Finally, the usefulness of the set of hydrometeorological simulations was assessed from a flash flood early-warning perspective

Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa

Kelly Curran and colleagues conducted a program review to identify human resource approaches that are being used to improve voluntary medical male circumcision volume and efficiency, identifying several innovative responses to human resource challenges

Stereological analysis of liver biopsy histology sections as a reference standard for validating non-invasive liver fat fraction measurements by MRI

© 2016 St. Pierre et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background and Aims: Validation of non-invasive methods of liver fat quantification requires a reference standard. However, using standard histopathology assessment of liver biopsies is problematical because of poor repeatability. We aimed to assess a stereological method of measuring volumetric liver fat fraction (VLFF) in liver biopsies and to use the method to validate a magnetic resonance imaging method for measurement of VLFF. Methods: VLFFs were measured in 59 subjects (1) by three independent analysts using a stereological point counting technique combined with the Delesse principle on liver biopsy histological sections and (2) by three independent analysts using the HepaFat-Scan® technique on magnetic resonance images of the liver. Bland Altman statistics and intraclass correlation (IC) were used to assess the repeatability of each method and the bias between the methods of liver fat fraction measurement. Results: Inter-analyst repeatability coefficients for the stereology and HepaFat-Scan® methods were 8.2 (95% CI 7.7-8.8)% and 2.4 (95% CI 2.2-2.5)% VLFF respectively. IC coefficients were 0.86 (95% CI 0.69-0.93) and 0.990 (95% CI 0.985-0.994) respectively. Small biases (=3.4%) were observable between two pairs of analysts using stereology while no significant biases were observable between any of the three pairs of analysts using Hepa-Fat-Scan®. A bias of 1.4±0.5% VLFF was observed between the HepaFat-Scan® method and the stereological method. Conclusions: Repeatability of the stereological method is superior to the previously reported performance of assessment of hepatic steatosis by histopathologists and is a suitable reference standard for validating non-invasive methods of measurement of VLFF

Meta-ethnography of experiences of early discharge, with a focus on paediatric febrile neutropenia

PURPOSE (STATING THE MAIN PURPOSES AND RESEARCH QUESTION): Many children have no significant sequelae of febrile neutropenia. A systematic review of clinical studies demonstrated patients at low risk of septic complications can be safely treated as outpatients using oral antibiotics with low rates of treatment failure. Introducing earlier discharge may improve quality of life, reduce hospital acquired infection and reduce healthcare service pressures. However, the review raised concerns that this might not be acceptable to patients, families and healthcare professionals. METHODS: This qualitative synthesis explored experiences of early discharge in paediatric febrile neutropenia, including reports from studies of adult febrile neutropenia and from other paediatric conditions. Systematic literature searching preceded meta-ethnographic analysis, including reading the studies and determining relationships between studies, translation of studies and synthesis of these translations. RESULTS: Nine papers were included. The overarching experience of early discharge is that decision-making is complex and difficult and influenced by fear, timing and resources. From this background, we identified two distinct themes. First, participants struggled with practical consequences of treatment regimens, namely childcare, finances and follow-up. A second theme identified social and emotional issues, including isolation, relational and environmental challenges. Linking these, participants considered continuity of care and the need for information important. CONCLUSIONS: Trust and confidence appeared interdependent with resources available to families-both are required to manage early discharge. Socially informed resilience is relevant to facilitating successful discharge strategies. Interventions which foster resilience may mediate the ability and inclination of families to accept early discharge. Services have an important role in recognising and enhancing resilience

Summary and Recommendations from Working Group 1: model uncertainty representations in convection-permitting / shorter lead-time / limited-area ensembles

WG3 discussed both the pros and cons of existing schemes as Working group 1 considered the treatment of model uncertainty (MU) in high-resolution ensembles, at grid spacings of order 1-5 km. These systems are often run for regional weather forecasting, perhaps over a single country, and for lead times of up to 5 days. Looking ahead, ECMWF’s strategy seeks to deliver global medium-range ensemble forecasts with 3-4 km grid spacings by 2030. It is questionable for what grid spacing we should dispense with a deep convection parameterization, but it will be either switched off or damped in these systems, such that deep convection can be assumed to be dominated by explicit motions. One of the problems with limited-area ensemble systems at this scale is that spread depends not only on the modelling system itself but also on the variability inherited from the large-scale boundary conditions. There is often thought to be a lack of spread in our high-resolution EPS (ensemble prediction systems), but this could reflect a lack of diversity on larger scales. The relative importance of lateral-boundary diversity and the model uncertainty mechanisms is regime dependent. The lateral boundaries will generally be more important in midlatitude winter but less so for summertime convection in relatively weak synoptic flow