Outcomes of a remote, decentralized health center-based HIV/AIDS antiretroviral program in Zambia, 2003 to 2007

A cross-sectional study of patients living with HIV/ AIDS treated during 2003 to 2007 in decentralized, rural health centers in Zambia was performed to measure virological outcomes after 12 months of antiretroviral therapy and identify factors associated with virological failure. Data from 228 patients who started antiretroviral therapy >12 months prior were analyzed. In all, 93% received stavudine + lamivudine + nevirapine regimens, and median antiretroviral therapy duration was 23.5 months (interquartile range 20-28). Of the 205 patients tested for viral load, 177 (86%) had viral load <1000 copies/mL. Probability of developing virological failure (viral load >1000 copies/mL) was 8.9% at 24 months and 19.6% at 32 months. Predictors for virological failure were <100% adherence, body mass index <18.5 kg/m(2), and women <40 years old. Of those with virological failure who underwent 3 to 6 months of intensive adherence counseling, 45% obtained virological success. In a remote, resource-limited setting in decentralized health centers, virological and immunological assessments of patients on antiretroviral therapy >12 months showed that positive health outcomes are achievable

The Future of Outsourcing in the Asia-Pacific Region: Implications for Research and Practice—Panel Report from PACIS 2014

This paper summarizes a panel discussion held at the 18th Pacific Asia Conference on Information Systems (PACIS) in Chengdu, China, 2014, with the same title. The panel discussed the future of outsourcing in the Asia-Pacific region (specifically the importance of outsourcing, new trends, and issues in outsourcing). This paper provides directions for future research that surpasses regional specificity (i.e., the Asia-Pacific region), and contributes to research interests on outsourcing in general

Cost effective housing with modular forms

It is a significant challenge to provide houses meeting certain basic standard to majority of the population, especially those who would not be able to raise sufficient funds for construction activities. For such segment of the society, various government sponsored schemes can be carried out generally with emphasis on multi storey blocks when dealing with cities. However, providing houses for rural population would need houses that could be constructed in a cost effective manner with least impact on environment. This research describes such a solution developed with housing consisting of a modular arrangement and also constructed with alternative building materials and methods

Access to Drinking-water and Arsenicosis in Bangladesh

The discovery of arsenic contamination in groundwater has challenged efforts to provide safe drinking-water to households in rural Bangladesh. Two nationally-representative surveys in 2000 and 2002 investigated water-usage patterns, water-testing, knowledge of arsenic poisoning, and behavioural responses to arsenic contamination. Knowledge of arsenicosis rose between the two surveys among women from 42% to 64% but awareness of consequences of arsenic remained limited; only 13% knew that it could lead to death. Behavioural responses to arsenic have been limited, probably in part because of the lack of concern but also because households are uncertain of how best to respond and have a strong preference for tubewell water even when wells are known to be contaminated. Further work conducted by the survey team highlighted the difficulties in providing alternative sources of water, with many households switching back to their original sources of water

Design of Alkali-Activated Slag-Fly Ash Concrete Mixtures Using Machine Learning

So far, the alkali activated concrete has primarily focused on the effect of source material properties and ratio of mix proportions on the compressive strength development. A little research has focused on developing a standard mix design procedure for alkali activated concrete for a range of compressive strength grades. This study developed a standard mix design procedure for alkali activated slag‒fly ash (low calcium, class F) blended concrete using two machine learning techniques, Artificial Neural Networks (ANN) and Multivariate Adaptive Regression Spline (MARS). The algorithm for the predictive model for concrete mix design was developed using MATLAB programming environment by considering the five key input parameters; water/solid ratio, alkaline activator/binder ratio, Na-Silicate /NaOH ratio, fly ash/slag ratio and NaOH molarity. The targeted compressive strengths ranging from 25–45 MPa (3.63–6.53 ksi) at 28 days were achieved with laboratory testing, using the proposed machine learning mix design procedure. Thus, this tool has the capability to provide a novel approach for the design of slag-fly ash blended alkali activated concrete grades matching to the requirements of in-situ field constructions

Experimental and numerical evaluation of the compression behaviour of GFRP-wrapped infill materials

Glass Fibre Reinforced Polymer (GFRP) composite wrap has become an effective repair system for deteriorated structural columns. It is essential to provide an infill material in the gap between the retrofitted column and the GFRP wrap. So, the properties of the infill material can significantly influence the contribution of these wraps and thus, can affect the overall performance of the retrofitted structure. However, the research on the effect of GFRP confinement on infill materials with various properties is still limited. This study explores the effectiveness of the GFRP wrapping system and its contribution to the axial compression behaviour of concrete, grout and epoxy infill materials. A total of 18 unconfined and GFRP-wrapped cylindrical columns were cast and tested under concentric axial compression loading. A finite element (FE) modelling was implemented using ABAQUS software to analyse the compression behaviour of GFRP-wrapped infill materials. The experimental results demonstrated that the confinement effect of the GFRP wrapping system is highly influenced by the properties of the infill material. The compressive strength and modulus of elasticity significantly increased due to GFRP wrapping by 149 % and 77 %, respectively for concrete infill, and by 40 % and 72 %, respectively for grout infill whereas negligible confinement efficiency observed in wrapped epoxy infill. The FE analyses showed a good correlation with the experimental results in predicting the overall compressive behaviour of the various infill materials. This study demonstrates valuable insights on the confinement effect of GFRP wraps in the repair of columns involving infill materials which therefore could be employed to better understand the overall behaviour of columns retrofitted with GFRP wrapping systems

The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone

Background: Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone. Methods: We reconstructed transmission dynamics using a cross-sectional survey conducted in April 2015, and cross-referenced our results with surveillance, burial, and Ebola Management Centre (EMC) data. Factors associated with EVD transmission were assessed with Cox proportional hazards regression. Following the survey, qualitative semi-structured interviews explored views of community informants and households. Results: All households (n = 240; 1161 individuals) participated in the survey. 29 of 31 EVD probable/confirmed cases died (93·5% case fatality rate); six deaths (20·6%) had been missed by other surveillance systems. Transmission over five generations lasted 16 weeks. Although most households had ≤5 members there was a significant increase in risk of Ebola in households with > 5 members. Risk of EVD was also associated with older age. Cases were spatially clustered; all occurred in 15 households. EVD transmission was better understood when the community experience started to concord with public health messages being given. Perceptions of contact tracing changed from invading privacy and selling people to ensuring community safety. Burials in plastic bags, without female attendants or prayer, were perceived as dishonourable. Further reasons for low compliance were low EMC survival rates, family perceptions of a moral duty to provide care to relatives, poor communication with the EMC, and loss of livelihoods due to quarantine. Compliance with response measures increased only after the second generation, coinciding with the implementation of restrictive by-laws, return of the first survivor, reduced contact with dead bodies, and admission of patients to the EMC. Conclusions: Transmission occurred primarily in a few large households, with prolonged transmission and a high death toll. Return of a survivor to the village and more effective implementation of control strategies coincided with increased compliance to control measures, with few subsequent cases. We propose key recommendations for management of EVD outbreaks based on this experience.MSF funded this study as part of emergency response activities

Access to Drinking-water and Arsenicosis in Bangladesh

The discovery of arsenic contamination in groundwater has challenged efforts to provide safe drinking-water to households in rural Bangladesh. Two nationally-representative surveys in 2000 and 2002 investigated water-usage patterns, water-testing, knowledge of arsenic poisoning, and behaviouralresponses to arsenic contamination. Knowledge of arsenicosis rose between the two surveys among women from 42% to 64% but awareness of consequences of arsenic remained limited; only 13% knew that it could lead to death. Behavioural responses to arsenic have been limited, probably in part because of the lack of concern but also because households are uncertain of how best to respond and have a strong preference for tubewell water even when wells are known to be contaminated. Further work conducted by the survey team highlighted the difficulties in providing alternative sources of water, with many households switching back to their original sources of water