Improving the prospects for sustainable ICT projects in the developing world

Projects that bring information and communications technology (ICT) to the developing world -and especially to rural areas -have the potential to empower the disenfranchised, foster economic opportunity, and narrow the digital divide that threatens to widen global disparity between the haves and the have-nots. However, given the remarkable growth of such undertakings around the world, there has been little corresponding effort made to address the vital issues of long term project sustainability and the diverse motivations and incentives facing the actors involved. As a result, these projects continue to be implemented sporadically and in a piecemeal fashion, which in turn hinders our ability to define success and recommend best practices for implementing and/or scaling them. Through an analysis of public-private partnerships (PPPs), the prevailing vehicle for project implementation today, the article addresses the issue of sustainability through partnerships, and also asserts that developing world technology recipients must be considered as stakeholders, as they hold the key to project sustainability. Following an overview of both theory and the current state of ICT-related development projects, the article provides a case study of a Sri Lankan-based pilot project involving multiple stakeholders. This case reveals important success factors that can be applied to future developing world ICT projects

Holocene Paleoflood Hydrology of the Lower Deschutes River, Oregon

Flood deposits at four sites along the lower Deschutes River, Oregon, were analyzed to determine magnitude and frequency of late Holocene flooding. Deposit stratigraphy was combined with hydraulic modeling at two sites to determine ranges of likely discharges for individual deposits. Combining these results with gaged flood data provides improved flood frequency estimates at the Axford site. The completeness and age spans of preserved flood chronologies differed among the four sites, but results were consistent for the largest floods of the last 5000 years. Single floods exceeded 2860-3800 mVs -4600 cal yr BP, 1060-1810 mVs -1300 cal yr BP, and 1210-2000 m3/s \u3c290 cal yr BP (corresponding to the historic flood of 1861). No floods have exceeded 2860-3770 mVs since the flood of -4600 cal yr BP. Incorporating these results into a flood frequency analysis based on maximum likelihood estimators gives slightly higher flood quantile estimates and narrower confidence limits compared with analysis of gage data alone. Discharge and 2(5 uncertainty for the 100-yr flood calculated using combined paleoflood and gaged records is 1120 +310/-240 mVs, compared with 930 +650/-250 m3/s from analysis of only gaged floods. This revised estimate for the 100-yr flood is slightly greater than our estimate of 1060 m3/s for the February 1996 flood at Axford, a finding consistent with historical records of two floods comparable to the 1996 flood in the last 140 years and with stratigraphic records of several like floods during the last ~1000 years

A comparison of the diagnostic value of MRI and ¹⁸F-FDG-PET/CT in suspected spondylodiscitis.

Purpose The purpose of this study was to evaluate the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT scan) and magnetic resonance imaging (MRI) in diagnosing spondylodiscitis and its complications, such as epidural and paraspinal abscesses.Methods From January 2006 to August 2013 patients with a clinical suspicion of spondylodiscitis, with an infection, or with fever of unknown origin were retrospectively included if 18F-FDG-PET/CT and MRI of the spine were performed within a 2-week time span. Imaging results were compared to the final clinical diagnosis and follow-up data were collected.Results Sixty-eight patients were included of whom 49 patients were diagnosed with spondylodiscitis. MRI showed an overall sensitivity of 67 % and specificity of 84 %. Diagnostic accuracy was 58 %, when MRI was performed within 2 weeks after the start of symptoms and improved to 82 %, when performed more than 2 weeks after onset of symptoms. 18F-FDG-PET/CT showed a sensitivity of 96 % and a specificity of 95 %, with no relation to the interval between the scan and the start of symptoms.Conclusions As compared to MRI, 18F-FDG-PET/CT has superior diagnostic value for detecting early spondylodiscitis. After 2 weeks both techniques perform similarly

Neurological recovery after traumatic spinal cord injury:what is meaningful? A patients' and physicians' perspective

Study design: Cross-sectional survey. Objectives: Most studies on neurological recovery after traumatic spinal cord injury (tSCI) assess treatment effects using the American Spinal Injury Association Impairment Scale (AIS grade) or motor points recovery. To what extent neurological recovery is considered clinically meaningful is unknown. This study investigated the perceived clinical benefit of various degrees of neurological recovery one year after C5 AIS-A tSCI. Setting: The Netherlands. Methods: By means of a web-based survey SCI patients and physicians evaluated the benefit of various scenarios of neurological recovery on a scale from 0 to 100% (0% no benefit to 100% major benefit). Recovery to AIS-C and D, was split into C/C+ and D/D+, which was defined by the lower and upper limit of recovery for each grade. Results: A total of 79 patients and 77 physicians participated in the survey. Each AIS grade improvement from AIS-A was considered significant benefit (all p < 0.05), ranging from 47.8% (SD 26.1) for AIS-B to 86.8% (SD 24.3) for AIS-D+. Motor level lowering was also considered significant benefit (p < 0.05), ranging from 66.1% (SD 22.3) for C6 to 81.7% (SD 26.0) for C8. Conclusions: Meaningful recovery can be achieved without improving in AIS grade, since the recovery of functional motor levels appears to be as important as improving in AIS grade by both patients and physicians. Moreover, minor neurological improvements within AIS-C and D are also considered clinically meaningful. Future studies should incorporate more detailed neurological outcomes to prevent potential underestimation of neurological recovery by only using the AIS grade

Exploring recruitment, willingness to participate, and retention of low-SES women in stress and depression prevention

Contains fulltext : 90907.pdf (publisher's version ) (Open Access)Background Recruitment, willingness to participate, and retention in interventions are indispensable for successful prevention. This study investigated the effectiveness of different strategies for recruiting and retaining low-SES women in depression prevention, and explored which sociodemographic characteristics and risk status factors within this specific target group are associated with successful recruitment and retention. Methods The process of recruitment, willingness to participate, and retention was structurally mapped and explored. Differences between women who dropped out and those who adhered to the subsequent stages of the recruitment and retention process were investigated. The potential of several referral strategies was also studied, with specific attention paid to the use of GP databases. Results As part of the recruitment process, 12.1% of the target population completed a telephone screening. The most successful referral strategy was the use of patient databases from GPs working in disadvantaged neighborhoods. Older age and more severe complaints were particularly associated with greater willingness to participate and with retention. Conclusions Low-SES women can be recruited and retained in public health interventions through tailored strategies. The integration of mental health screening within primary care might help to embed preventive interventions in low-SES communities.8 p

Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty

Methods We reviewed the available literature on the influence of degradation products of MOM bearings in total hip arthroplasties on infection risk. Results Wear products were found to influence the risk of infection by hampering the immune system, by inhibiting or accelerating bacterial growth, and by a possible antibiotic resistance and heavy metal co-selection mechanism. Interpretation Whether or not the combined effects of MOM wear products make MOM bearings less or more prone to infection requires investigation in the near future

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

Since Böhler published the first categorization of spinal injuries based on plain radiographic examinations in 1929, numerous classifications have been proposed. Despite all these efforts, however, only a few have been tested for reliability and validity. This methodological, conceptual review summarizes that a spinal injury classification system should be clinically relevant, reliable and accurate. The clinical relevance of a classification is directly related to its content validity. The ideal content of a spinal injury classification should only include injury characteristics of the vertebral column, is primarily based on the increasingly routinely performed CT imaging, and is clearly distinctive from severity scales and treatment algorithms. Clearly defined observation and conversion criteria are crucial determinants of classification systems’ reliability and accuracy. Ideally, two principle spinal injury characteristics should be easy to discern on diagnostic images: the specific location and morphology of the injured spinal structure. Given the current evidence and diagnostic imaging technology, descriptions of the mechanisms of injury and ligamentous injury should not be included in a spinal injury classification. The presence of concomitant neurologic deficits can be integrated in a spinal injury severity scale, which in turn can be considered in a spinal injury treatment algorithm. Ideally, a validation pathway of a spinal injury classification system should be completed prior to its clinical and scientific implementation. This review provides a methodological concept which might be considered prior to the synthesis of new or modified spinal injury classifications