Where does public funding for HIV prevention go to? The case of condoms versus microbicides and vaccines

This study analyses the priorities of public donors in funding HIV prevention by either integrated condom programming or HIV preventive microbicides and vaccines in the period between 2000 and 2008. It further compares the public funding investments of the USA government and European governments, including the EU, as we expect the two groups to invest differently in HIV prevention options, because their policies on sexual and reproductive health and rights are different. We use two existing officially UN endorsed databases to compare the public donor funding streams for HIV prevention of these two distinct contributors. In the period 2000-2008, the relative share of public funding for integrated condom programming dropped significantly, while that for research on vaccines and microbicides increased. The European public donors gave a larger share to condom programming than the United States, but exhibited a similar downward trend in favour of funding research on vaccines and microbicides. Both public donor parties invested progressively more in research on vaccines and microbicides rather than addressing the shortage of condoms and improving access to integrated condom programming in developing countries

A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students:Randomized Controlled Trial

BACKGROUND: Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. OBJECTIVE: In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. METHODS: We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient's experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students' skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. RESULTS: In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). CONCLUSIONS: The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture

Combining partial liver resection and local ablation of liver tumours: a preliminary Dutch experience

BACKGROUND: The combination of partial liver resection and radiofrequency ablation (RFA) is a novel concept in the treatment of unresectable liver malignancies. The aim of this study is to evaluate the results of this combined strategy in the Netherlands. METHODS: Thirty-five patients treated with a combination of partial liver resection and RFA were identified from a prospectively registered pooled multicentre database. All patients were operated between June 1999 and November 2003 in 8 medical centres in the Netherlands. Main outcome parameters were morbidity, mortality, local success rate, and survival. RESULTS: Thirty-seven operations were performed in 35 patients. The group consisted of 20 male and 15 female patients with a median age of 59 years (range 41–76). Seventy-six lesions were resected and RFA was performed to ablate 82 unresectable liver tumours. Twelve patients developed a total of 24 complications, resulting in an overall perioperative morbidity rate of 32%. In two patients major complications resulted in postoperative death (postoperative mortality rate 5.4%). Local success rate after RFA was 88% and the estimated 1-, 2- and 3-year overall survival rates were 84%, 70% and 43%, respectively. CONCLUSION: This strategy should only be performed following strict patient selection and within the context of prospective clinical trials

Demethylation and cleavage of dimethylsulfoniopropionate and reduction of dimethyl sulfoxide by sulfate-reducing bacteria

Many marine algae contain high concentrations of dimethylsulfoniopropionate (DMSP); most likely this compound functions mainly as an osmolyte. In anoxic marine sediments DMSP can be degraded in two ways: via an initial demethylation, or via a cleavage to dimethyl sulfide (DMS) and acrylate. Although the occurrence of these processes in sediments was known, the types of organisms responsible for them were not. Recent data from out laboratory, however, have shown that certain types of sulfate-reducing bacteria can carry out a demethylation of DMSP, whereas another sulfate reducer was found to cleave DMSP to DMS and acrylate, which was reduced to propionate. Thus, sulfate-reducing bacteria might be responsible for at least a part of the observed DMSP transformations in anoxic sediments. It was also shown that a well-known oxidation product of DMS, dimethyl sulfoxide, can function as an alternative electron acceptor in the metabolism of some marine sulfate reducers. These data are reviewed in the present article

Electromagnetic wave diffraction by periodic planar metamaterials with nonlinear constituents

We present a theory which explains how to achieve an enhancement of nonlinear effects in a thin layer of nonlinear medium by involving a planar periodic structure specially designed to bear a trapped-mode resonant regime. In particular, the possibility of a nonlinear thin metamaterial to produce the bistable response at a relatively low input intensity due to a large quality factor of the trapped-mode resonance is shown. Also a simple design of an all-dielectric low-loss silicon-based planar metamaterial which can provide an extremely sharp resonant reflection and transmission is proposed. The designed metamaterial is envisioned for aggregating with a pumped active medium to achieve an enhancement of quantum dots luminescence and to produce an all-dielectric analog of a 'lasing spaser'.Comment: 18 pages, 13 figure

Farmer perceptions and responses to soil degradation in Swaziland

Soil degradation is globally concerning due to its adverse effects on the environment and agricultural production. Much of Swaziland is at risk from degradation. This paper assesses farmer perceptions and responses to soil degradation in 2002 and 2014, focusing on two land uses that underpin rural livelihoods: arable land and rangeland areas. It uses repeat household surveys and semi-structured interviews, in two case study chiefdoms in the country’s middleveld (KaBhudla and Engcayini) in the first longitudinal study of its kind. We find that observations of land degradation are perceived mainly through changes in land productivity, with chemical degradation occurring predominantly on arable land and physical degradation and erosion mainly in rangeland areas. Changes in rainfall are particularly important in determining responses. While perceptions of the causes and impacts of degradation largely concur with the scientific literature, responses were constrained by poor land availability, shorter and more unpredictable cropping seasons because of changing rains and low awareness, access to or knowledge of agricultural inputs. We suggest that sustainable arable land management can be enhanced through improved access to alternative sources of water, use of management practices that retain soil and moisture and greater access to agricultural inputs and capacity building to ensure their appropriate use. We suggest collaborative management for settlement planning that integrates soil conservation and livestock management strategies such as controlled stocking levels and rotational grazing could improve land quality in rangeland areas. Together, these approaches can help land users to better manage change

Analysis of Transaction Logs from National Museums Liverpool

The websites of Cultural Heritage institutions attract the full range of users, from professionals to novices, for a variety of tasks. However, many institutions are reporting high bounce rates and therefore seeking ways to better engage users. The analysis of transaction logs can provide insights into users’ searching and navigational behaviours and support engagement strategies. In this paper we present the results from a transaction log analysis of web server logs representing user-system interactions from the seven websites of National Museums Liverpool (NML). In addition, we undertake an exploratory cluster analysis of users to identify potential user groups that emerge from the data. We compare this with previous studies of NML website users

Human Prion Diseases in The Netherlands (1998–2009): Clinical, Genetic and Molecular Aspects

Prion diseases are rare and fatal neurodegenerative disorders that can be sporadic, inherited or acquired by infection. Based on a national surveillance program in the Netherlands we describe here the clinical, neuropathological, genetic and molecular characteristics of 162 patients with neuropathologically confirmed prion disease over a 12-year period (1998–2009). Since 1998, there has been a relatively stable mortality of Creutzfeldt-Jakob disease (CJD) in the Netherlands, ranging from 0.63 to 1.53 per million inhabitants per annum. Genetic analysis of the codon 129 methionine/valine (M/V) polymorphism in all patients with sporadic CJD (sCJD) showed a trend for under-representation of VV cases (7.0%), compared with sCJD cohorts in other Western countries, whereas the MV genotype was relatively over-represented (22,4%). Combined PrPSc and histopathological typing identified all sCJD subtypes known to date, except for the VV1 subtype. In particular, a “pure" phenotype was demonstrated in 60.1% of patients, whereas a mixed phenotype was detected in 39.9% of all sCJD cases. The relative excess of MV cases was largely accounted for by a relatively high incidence of the MV 2K subtype. Genetic analysis of the prion protein gene (PRNP) was performed in 161 patients and showed a mutation in 9 of them (5.6%), including one FFI and four GSS cases. Iatrogenic CJD was a rare phenomenon (3.1%), mainly associated with dura mater grafts. Three patients were diagnosed with new variant CJD (1.9%) and one with variably protease-sensitive prionopathy (VPSPr). Post-mortem examination revealed an alternative diagnosis in 156 patients, most commonly Alzheimer's disease (21.2%) or vascular causes of dementia (19.9%). The mortality rates of sCJD in the Netherlands are similar to those in other European countries, whereas iatrogenic and genetic cases are relatively rare. The unusual incidence of the VV2 sCJD subtype compared to that reported to date in other Western countries deserves further investigation