Marginalised herders: social dynamics and natural resource use in the fragile environment of the Richtersveld National Park, South Africa

This research article published by Elsevier B.V., 2018In the contractual Richtersveld National Park (RNP), park officials and neighbouring communities jointly manage resources, with the aim to harmonize biodiversity conservation and human land use. Our socio-ecological approach compared herding practices and livelihoods of 36 livestock owners and 35 hired herders inside and outside RNP, and further assessed soil quality and vegetation characteristics under different livestock grazing patterns and access to natural resources. Hired herders were mainly in charge of animal movement patterns but were not included in formal agreements, which negatively impacted on natural resource management, livelihoods, animal well-being and communication amongst stakeholders. Soil properties and vegetation were generally negatively affected through grazing and herding practices in this fragile semi-arid biodiversity hotspot that encompasses many endangered and endemic species. Our research highlights the complex social relationships and dynamics between diverse stakeholders engaged in the contractual park and accentuates the need to improve herders’ social and economic status

Estimating health worker need to provide antiretroviral treatment in the developing world

Despite recent international efforts to increase antiretroviral treatment (ART) coverage, more than 5 million people who need ART in developing countries do not receive such treatment. Shortages of human resources to treat HIV/AIDS (referred to herein as HRHA) are one of the main constraints to further scaling up ART. Planning expansion of ART depends on the ability to predict how many HRHA will be needed in the future. We investigate whether taking into account positive feedback from the current supply of HRHA to future HRHA need substantially alters predictions. This feedback occurs because an increase in the number of HRHA implies an increase in the number of individuals receiving ART and – because ART is a lifelong treatment and is effective in prolonging the lives of HIV-positive people – a rise over time in the number of people requiring ART.Disease, control, global health, HIV/AIDS, Africa.

Health systems and HIV treatment in sub-Saharan Africa: Matching intervention and program evaluation strategies

Objectives International donors financing the delivery of antiretroviral treatment (ART) in developing countries have recently emphasized their commitment to rigorous evaluation of ART impact on population health. In the same time frame but different contexts, they have announced that they will shift funding from vertically-structured (i.e., disease-specific) interventions to horizontally-structured interventions (i.e., staff, systems and infrastructure that can deliver care for many diseases). We analyze likely effects of the latter shift on the feasibility of impact evaluation. Methods We examine the effect of the shift in intervention strategy on (i) outcome measurement, (ii) cost measurement, (iii) study-design options, and the (iv) technical and (v) political feasibility of program evaluation. Results As intervention structure changes from vertical to horizontal, outcome and cost measurement are likely to become more difficult (because the number of relevant outcomes and costs increases and the sources holding data on these measures become more diverse); study design options become more limited (because it is often impossible to identify a rigorously defined counterfactual in horizontal interventions); the technical feasibility of interventions is reduced (because lag times between intervention and impact increase in length and effect mediating and modifying factors increase in number); and political feasibility of evaluation is decreased (because national policymakers may be reluctant to support the evaluation). Conclusions In the choice of intervention strategy, policymakers need to consider the effect of intervention strategy on impact evaluation. Methodological studies are needed to identify the best approaches to evaluate the population health impact of horizontal interventions.Impact evaluation, health systems, HIV, antiretroviral treatment, Africa

A Mathematical Model for Estimating the Number of Health Workers Required for Universal Antiretroviral Treatment

Despite recent international efforts to increase antiretroviral treatment (ART) coverage, it is estimated that more than 5 million people who need ART in developing countries do not receive such treatment. Shortages of human resources to treat HIV/AIDS (HRHA) are one of the main constraints to scaling up ART. We develop a discrete-time Markovian model to project the numbers of HRHA required to achieve universal ART coverage, taking into account the positive feedback from HRHA numbers to future HRHA need. Feedback occurs because ART is effective in prolonging the lives of HIVpositive people who need treatment, so that an increase in the number of people receiving treatment leads to an increase in the number of people needing it in future periods. We investigate the steady-state behavior of our model and apply it to different regions in the developing world. We find that taking into account the feedback from the current supply of HRHA to the future HRHA need substantially increases the projected numbers of HRHA required to achieve universal ART coverage. We discuss the policy implications of our model.Mathematical model, health workers, universal antiretroviral treatment

Exploring C−H Functionalization Reactions with Theory and Experiment

C−H bond functionalization reactions are powerful, efficient, and potentially step-economic strategy for the construction of carbon−carbon and carbon−heteroatom bonds in organic synthesis. In recent years, novel Ni-catalyzed C−H bond functionalization reactions using N,N bidentate directing groups have been developed to selectively activate inert C−H bonds. However, the reaction mechanisms and origins of reactivity and selectivity of many of these organic transformations remain unclear. A detailed understanding of the molecular processes involved is essential for understanding and developing more efficient and diverse C−H functionalization reactions. Density functional theory (DFT) has emerged as a powerful tool to elucidate reaction mechanisms and intricate details of the elementary steps involved, and divergent reaction pathways in transition metal-catalyzed reactions. In this dissertation, the mechanisms of Ni-catalyzed C–H oxidative annulation, arylation, alkylation, benzylation and sulfenylation with N,N-bidentate directing groups are investigated using DFT calculations. Ni-catalyzed C–H functionalization reactions can be broadly divided into two distinct mechanistic steps: (i) C–H metalation (ii) C–C or C–heteroatom bond formation steps. Specifically, the C–H metalation may occur via either the concerted metalation-deprotonation (CMD) or σ-complex-assisted metathesis (σ-CAM) mechanism. The subsequent C–C and C–heteroatom bond formation steps may occur via closed-shell Ni(II) or Ni(IV) intermediates. Alternatively, radical pathways involving Ni(III) complexes are also possible. Our studies indicated that the reaction mechanism of Ni-catalyzed C–H functionalization is substrate-dependent. The mechanistic insights gained from the computational studies were employed to investigate a number of experimental phenomena including substituent effects on reactivity, chemo- and regioselectivity, ligand and directing group effects, and the effects of oxidants. Furthermore, a novel C(sp3)−H functionalization methodology was developed to synthesize biologically relevant vinyl sulfone-containing compounds of pharmacologically prevalent picolyl amides with allenic sulfones. The reaction conditions are mild. The starting materials can be prepared from readily available sources. The reaction has a broad functional group tolerance. Mechanistic studies suggested that the reaction likely operates via a rare pyridine-initiated and p-toluenesulfinate anion-mediated activation analogous to phosphine-triggered reactions and Padwa’s allenic sulfone chemistry

Medicine and Economics: Accounting for the full benefits of childhood vaccination in South Africa

While remarkable gains in health have been achieved since the mid-20th century, these have been unequally distributed, and mortality and morbidity burdens in some regions remain enormous. Of the almost 10 million children under 5 years of age who died in 2006, only 100 000 died in industrialised countries, while 4.8 million died in sub-Saharan Africa.1 In deciding whether to finance an intervention, policy makers commonly weigh the expected population health gains against its costs. Most vaccinations included in national immunisation schedules are inexpensive2 and health gains to costs are very favourable compared with other health interventions. Newer vaccinations, such as those with pneumococcal conjugate vaccine (PCV) or rotavirus vaccine, are also effective in averting child mortality and morbidity but are expensive relative to those commonly included in national immunisation schedules. Policy makers may therefore decide that – at current prices – the comparison of health gains with costs does not justify the free public provision of these vaccinations. The authors of this paper argue that in addition to the health benefits of vaccinations, their effects on education and income3 and benefits for unvaccinated community members are considerable and should be included in calculations to establish their value.Disease, control, global health, vaccination, HIV/AIDS, Africa.

Les remontées mécaniques et les technologies de l’information et de la communication

Ce travail a pour but premier de définir les meilleures pratiques liées aux technologies de l’innovation et de la communication dans le domaine des remontées mécaniques. Le second objectif est de proposer un plan d’actions à son mandant, la Société des remontées mécaniques de Nendaz et Veysonnaz, pour lui permettre de perfectionner sa communication digitale. Pour répondre à ces objectifs, les hypothèses reposent sur une revue littéraire définissant le contexte actuel et les changements auxquels sont confrontés les sociétés de remontées mécaniques, notamment en Valais. Par la suite, des entretiens avec des représentants de stations valaisannes permettent de connaître l’offre digitale mise en place dans les domaines respectifs. Ces dernières sont comparées avec d’autre stations internationales à l’aide d’un benchmarking. Finalement, un examen des meilleures pratiques renseigne des possibilités d’amélioration dans ce secteur

A new curriculum using active learning methods and standardized patients to train residents in smoking cessation

Physicians can play a key role in smoking cessation but often fail to advise smokers effectively, mainly because they lack counseling skills. We need effective training programs starting during residency to improve physicians' smoking cessation interventions and smokers' quit rates. To achieve this goal, we developed a curriculum using active learning methods and the stages-of-change model. A randomized trial demonstrated that this program increased the quality of physician's counseling and smokers' quit rates at 1 year. This paper describes the educational content and methods of this program. Participants learn to assess smokers' stage of change, to use counseling strategies matching the smoker's stage, and to prescribe pharmacological therapy. This 2 half-day training program includes observation of video-clips, interactive workshops, role plays, practice with standardized patients, and written material for physicians and patients. Participants reached learning objectives and appreciated the content and active methods of the progra