Strengthening Routine Data Systems to Track the HIV Epidemic and Guide the Response in Sub-Saharan Africa

The global HIV response has entered a new phase with the recommendation of treating all persons living with HIV with antiretroviral therapy, and with the goals of reducing new infections and AIDS-related deaths to fewer than 500,000 by 2020. This new phase has intensive data requirements that will need to utilize routine data collected through service delivery platforms to monitor progress toward these goals. With a focus on sub-Saharan African, we present the following priorities to improve the demand, supply, and use of routine HIV data: (1) strengthening patient-level HIV data systems that support continuity of clinical care and document sentinel events; (2) leveraging data from HIV testing programs; (3) using targeting data collection in communities and among clients; and (4) building capacity and promoting a culture of HIV data quality assessment and use. When fully leveraged, routine data can efficiently provide timely information at a local level to inform action, as well as provide information at scale with wide geographic coverage to strengthen estimation efforts

The Statistical Analysis of Roll Call

We develop a Bayesian estimation procedure for spatial models of roll call voting. We show how a Bayesian approach to roll call analysis overcomes shortcomings and idiosyncracies of NOMINATE (some of which are not widely recognized). Our Bayesian approach (a) applies to any legislative setting, irrespective of size, legislative extremism, or the number of roll calls available for analysis; (b) provides a mechanism for directly incorporating auxiliary information as to the dimensionality of the underlying policy space, the identity of extremist legislators, key votes and the evolution of the legislative agenda; (c) lets us integrate measurement of legislative preferences with the analysis of those preferences. Notes to NEMP, May 2002 This paper sets out our ‘‘basic setup’ ’ (a Bayesian statistical operationalization of the Euclidean spatial voting model with roll call data), and constrasts it with the NOMINATE algorithms of Poole and Rosenthal. In the talk I will be considering extensions to our model, so as to accommodate and/or test conjectures in the literature on legislative politics (most prominently, the ‘‘party discipline’ ’ hypothesis, and conjectures about legislative responsiveness to constituency interests)

NASA's Earth Science Use of Commercially Availiable Remote Sensing Datasets: Cover Image

The cover image incorporates high resolution stereo pairs acquired from the DigitalGlobe(R) QuickBird sensor. It shows a digital elevation model of Meteor Crater, Arizona at approximately 1.3 meter point-spacing. Image analysts used the Leica Photogrammetry Suite to produce the DEM. The outside portion was computed from two QuickBird panchromatic scenes acquired October 2006, while an Optech laser scan dataset was used for the crater s interior elevations. The crater s terrain model and image drape were created in a NASA Constellation Program project focused on simulating lunar surface environments for prototyping and testing lunar surface mission analysis and planning tools. This work exemplifies NASA s Scientific Data Purchase legacy and commercial high resolution imagery applications, as scientists use commercial high resolution data to examine lunar analog Earth landscapes for advanced planning and trade studies for future lunar surface activities. Other applications include landscape dynamics related to volcanism, hydrologic events, climate change, and ice movement

Candidate positioning and voter choice.

T his article examines a fundamental aspect of democracy: the relationship between the policy positions of candidates and the choices of voters. Researchers have suggested three "A key characteristic of democracy," Dahl (1971, 1) noted, is the "responsiveness of the government to the preferences of its citizens." Two mechanisms play central roles in promoting responsiveness, thereby fostering congruence between the preferences of voters and the policy positions of candidates. Voters in a democracy can select candidates that represent their views, and candidates can compete for votes by strategically taking positions that appeal to the electorate. Both mechanisms are important; each depends on the criteria voters use to judge politicians on the issues. A lively debate has focused on three theories about how voters judge the policy stances of candidates. The first, proximity theory, assumes that citizens prefer candidates whose positions are closest to their own. For example, a voter who favors a 5% increase in government spending on health care will be happiest with a candidate who advocates the same level of spending. The more a candidate's position diverges from the voter's, the less satisfied the voter will feel. The presumed positive relationship between proximity and satisfaction, Michael Tomz is Associate Professor

Polypharmacy among anabolic-androgenic steroid users: A descriptive metasynthesis

Background: As far as we are aware, no previous systematic review and synthesis of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic steroid(s) (AAS) users has been published. Method: We systematically reviewed and synthesized qualitative/descriptive literature gathered from searches in electronic databases and by inspecting reference lists of relevant literature to investigate AAS users' polypharmacy. We adhered to the recommendations of the UK Economic and Social Research Council's qualitative research synthesis manual and the PRISMA guidelines. Results: A total of 50 studies published between 1985 and 2014 were included in the analysis. Studies originated from 10 countries although most originated from United States (n = 22), followed by Sweden (n = 7), England only (n = 5), and the United Kingdom (n = 4). It was evident that prior to their debut, AAS users often used other licit and illicit substances. The main ancillary/supplementary substances used were alcohol, and cannabis/cannabinoids followed by cocaine, growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth, clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance classes were analgesics/opioids, dietary/nutritional supplements, and diuretics. Our classification of the various substances used by AAS users resulted in 13 main groups. These non-AAS substances were used mainly to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement. Conclusions: Our findings corroborate previous suggestions of associations between AAS use and the use of other licit and illicit substances. Efforts must be intensified to combat the debilitating effects of AAS-associated polypharmacy

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Democratic capital: the nexus of political and economic change

We study the dynamics of economic and political change, theoretically and empirically. Democratic capital measured by a nation's historical experience with democracy, and the incidence of democracy in its neighborhood, appears to reduce exit rates from democracy and raise exit rates from autocracy. Higher democratic capital stimulates growth by increasing the stability of democracies. Heterogeneous effects of democracy induce sorting of countries into political regimes, which helps explain systematic differences between democracies and autocracies. Our results suggest the possibility of a virtuous circle, where accumulation of physical and democratic capital reinforce each other, promoting economic development and consolidation of democracy