Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana

Introduction: Botswana's AIDS response included free antiretroviral treatment (ART) since 2002, achieving 80% coverage of persons with CD450% and >30% through 2011, while continuing to increase in older women. Conclusions: Adult mortality in Botswana fell markedly as ART coverage increased. HIV prevalence declines may reflect ART-associated reductions in sexual transmission. Triangulation of surveillance system data offers a reasonable approach to evaluate impact of HIV/AIDS interventions, complementing cohort approaches that monitor individual-level health outcomes

Standardizing bimanual vaginal examination using cognitive task analysis.

OBJECTIVE: To create a standardized universal list of procedural steps for bimanual vaginal examination (BVE) for teaching, assessment, and simulator development. METHODS: This observational study, conducted from June-July 2012 and July-December 2014, collected video data of 10 expert clinicians performing BVE in a nonclinical environment. Video data were analyzed to produce a cognitive task analysis (CTA) of the examination steps performed. The CTA was further refined through structured interviews to make it suitable for teaching or assessment. It was validated through its use as a procedural examination checklist to rate expert clinician performance. RESULTS: BVE was deconstructed into 88 detailed steps outlining the complete examination process. These initial 88 steps were reduced to 35 by focusing on the unseen internal examination, then further refined through interviews with five experts into 30 essential procedural steps, five of which are additional steps if pathology is suspected. Using the CTA as a procedural checklist, the mean number of steps performed and/or verbalized was 21.6 ± 3.12 (72% ± 10.4%; range, 15.9-27.9, 53%-93%). CONCLUSION: This approach identified 30 essential steps for performing BVE, producing a new technique and standardized tool for teaching, assessment, and simulator development

Os serviços públicos urbanos e a regulação: novo enfoque em políticas públicas

In the last decades Brazil has been through some deep changes, which affected both economic and political structures, the latter including the responsibilities of the public sector. The discussion of new models should not restricted to the mere management of urban public services, but must also include the need to come up with new ways of managing urban policies in general. Other participants in this process should also be given responsibilities and new technical solutions should be found, particularly involving existing institutions. Within this new scenario, areas dealing with infrastructure should be subject to criteria of efficiency and productivity, brought by new regulations that deal with key issues, such as (1) the management of public service rendering; (2) the safeguarding of the public interest; and (3) the role public services play in promoting urban development. s serviços públicos urbanos e a regulação: novo enfoque em políticas públicas o Jacqueline Low-Beer Orientadora: Profa. Dra. Sueli Ramos SchifferNas últimas décadas, o Brasil vem assistindo a profundas mudanças, tanto no que se refere à gestão econômica como no perfil da atuação do Estado e as responsabilidades do setor público. A discussão de novos modelos não se limita às formas de gestão dos serviços públicos urbanos, mas inclui a necessidade de “inventar” novas maneiras de gerir o urbano de modo geral, estendendo as responsabilidades a outros atores e recorrendo a novas soluções técnicas, sobretudo institucionais. Neste novo quadro, a criação de condições propícias a um ambiente de eficiência e produtividade nos setores de infra-estrutura repousa sobre o estabelecimento de um novo marco regulatório que trate de questões essenciais como: (1) a gestão da prestação dos serviços; (2) a defesa do interesse público; e (3) o papel indutor da regulação dos serviços públicos no desenvolvimento urbano

O ESTADO E AS POLÍTICAS PÚBLICAS: UMA REVISÃO HISTÓRICA (1950 a 1997)

During the last decades, Brazil has been through some great changes referring to economic and political structures, enclosing the role of the State and it’s responsibilities upon the public sector. This article presents a brief review of the economic and infrastructural policies and de main directives referring to urban development. Completing this panel, is the inclusion of the social policies and the recent environmental and sanitation policies that occurred from the 80’s on, when the establishing of development policies encompassed new issues like: sanitation, health and environment.O Brasil vem assistindo a profundas mudanças tanto na gestão econômica como na atuação do Estado e responsabilidades do setor público. O artigo apresenta uma revisão das políticas econômica, de infraestrutura e das diretrizes de desenvolvimento urbano bem como um rápido painel da inserção das políticas sociais. Completando a revisão, são apresentadas as políticas ambientais e a vertente sanitarista que, a partir dos anos 80 contribuíram para operar uma mudança substantiva nas políticas públicas observada na virada do milênio

Scaling Up Towards International Targets for AIDS, Tuberculosis, and Malaria: Contribution of Global Fund-Supported Programs in 2011–2015

OBJECTIVE: The paper projects the contribution to 2011-2015 international targets of three major pandemics by programs in 140 countries funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest external financier of tuberculosis and malaria programs and a major external funder of HIV programs in low and middle income countries. DESIGN: Estimates, using past trends, for the period 2011-2015 of the number of persons receiving antiretroviral (ARV) treatment, tuberculosis case detection using the internationally approved DOTS strategy, and insecticide-treated nets (ITNs) to be delivered by programs in low and middle income countries supported by the Global Fund compared to international targets established by UNAIDS, Stop TB Partnership, Roll Back Malaria Partnership and the World Health Organisation. RESULTS: Global Fund-supported programs are projected to provide ARV treatment to 5.5-5.8 million people, providing 30%-31% of the 2015 international target. Investments in tuberculosis and malaria control will enable reaching in 2015 60%-63% of the international target for tuberculosis case detection and 30%-35% of the ITN distribution target in sub-Saharan Africa. CONCLUSION: Global Fund investments will substantially contribute to the achievement by 2015 of international targets for HIV, TB and malaria. However, additional large scale international and domestic financing is needed if these targets are to be reached by 2015

Cyclic loss of open solar flux since 1868: the link to heliospheric current sheet tilt and implications for the Maunder Minimum

Open solar flux (OSF) variations can be described by the imbalance between source and loss terms. We use spacecraft and geomagnetic observations of OSF from 1868 to present and assume the OSF source, S, varies with the observed sunspot number, R. Computing the required fractional OSF loss, χ, reveals a clear solar cycle variation, in approximate phase with R. While peak R varies significantly from cycle to cycle, χ is surprisingly constant in both amplitude and waveform. Comparisons of χ with measures of heliospheric current sheet (HCS) orientation reveal a strong correlation. The cyclic nature of χ is exploited to reconstruct OSF back to the start of sunspot records in 1610. This agrees well with the available spacecraft, geomagnetic, and cosmogenic isotope observations. Assuming S is proportional to R yields near-zero OSF throughout the Maunder Minimum. However, χ becomes negative during periods of low R, particularly the most recent solar minimum, meaning OSF production is underestimated. This is related to continued coronal mass ejection (CME) activity, and therefore OSF production, throughout solar minimum, despite R falling to zero. Correcting S for this produces a better match to the recent solar minimum OSF observations. It also results in a cycling, nonzero OSF during the Maunder Minimum, in agreement with cosmogenic isotope observations. These results suggest that during the Maunder Minimum, HCS tilt cycled as over recent solar cycles, and the CME rate was roughly constant at the levels measured during the most recent two solar minima

Taking the Pressure Off the Patient - Understanding Digital Rectal Examinations on a Real Subject.

Better understanding of palpation techniques during unsighted physical examinations has mostly been limited to qualitative and quantitative studies of performance of experts whilst conducting examinations on plastic benchtop models. However, little is known about their performance when conducting such examinations on real subjects. OBJECTIVE: The aim of this paper is to better understand palpation techniques of experts whilst conducting a Digital Rectal Examination on a real subject. METHODS: We recruited four consultants from relevant specialties and asked them to conduct two DREs on a Rectal Teaching Assistant whilst wearing small position and pressure sensors on their examining finger. We segmented the relevant anatomy from an MRI taken of the pelvic region, registered 3D models and analysed retrospectively performance in relation to executed tasks, supination/pronation, palpation convex hull and pressure applied. RESULTS: Primary care consultants examined the anatomy more holistically compared to secondary care experts, the maximum pressure applied across experiments is 3.3N, overall the pressure applied on the prostate is higher than that applied to rectal walls, and the urologist participant not only applied the highest pressure but also did so with the highest most prominent frequency (15.4 and 25.3 Hz). CONCLUSIONS: The results of our research allow for better understanding of experts' technical performance from relevant specialities when conducting a DRE, and suggest the range of pressure applied whilst palpating anatomy. SIGNIFICANCE: This research will be valuable in improving the design of haptics-based learning tools, as well as in encouraging reflection on palpation styles across different specialities to develop metrics of performance