Density of Healthcare Providers and Patient Outcomes: Evidence from a Nationally Representative Multi-Site HIV Treatment Program in Uganda

This study examined the association between density of healthcare providers and patient outcomes using a large nationally representative cohort of patients receiving combination antiretroviral therapy (cART) in Uganda.Objective: We examined the association between density of healthcare providers and patient outcomes using a large nationally representative cohort of patients receiving combination antiretroviral therapy (cART) in Uganda. Design: We obtained data from The AIDS Support Organization (TASO) in Uganda. Patients 18 years of age and older who initiated cART at TASO between 2004 and 2008 contributed to this analysis. The number of healthcare providers per 100 patients, the number of patients lost to follow-up per 100 person years and number of deaths per 100 person years were calculated. Spearman correlation was used to identify associations between patient loss to follow-up and mortality with the healthcare provider-patient ratios. Results: We found no significant associations between the number of patients lost to follow-up and physicians (p = 0.45), nurses (p = 0.93), clinical officers (p = 0.80), field officers (p = 0.56), and healthcare providers overall (p = 0.83). Similarly, no significant associations were observed between mortality and physicians (p = 0.65), nurses (p = 0.49), clinical officers (p = 0.73), field officers (p = 0.78), and healthcare providers overall (p = 0.73). Conclusions: Patient outcomes, as measured by loss to follow-up and mortality, were not significantly associated with the number of doctors, nurses, clinical officers, field officers, or healthcare providers overall. This may suggest that that other factors, such as the presence of volunteer patient supporters or broader political or socioeconomic influences, may be more closely associated with outcomes of care among patients on cART in Uganda

Coherent methods in the X-ray sciences

X-ray sources are developing rapidly and their coherent output is growing extremely rapidly. The increased coherent flux from modern X-ray sources is being matched with an associated rapid development in experimental methods. This article reviews the literature describing the ideas that utilise the increased brilliance from modern X-ray sources. It explores how ideas in coherent X-ray science are leading to developments in other areas, and vice versa. The article describes measurements of coherence properties and uses this discussion as a base from which to describe partially-coherent diffraction and X-ray phase contrast imaging, with its applications in materials science, engineering and medicine. Coherent diffraction imaging methods are reviewed along with associated experiments in materials science. Proposals for experiments to be performed with the new X-ray free-electron-lasers are briefly discussed. The literature on X-ray photon correlation spectroscopy is described and the features it has in common with other coherent X-ray methods are identified. Many of the ideas used in the coherent X-ray literature have their origins in the optical and electron communities and these connections are explored. A review of the areas in which ideas from coherent X-ray methods are contributing to methods for the neutron, electron and optical communities is presented.Comment: A review articel accepted by Advances in Physics. 158 pages, 29 figures, 3 table