Three-dimensional modeling of a primary health care clinic in Ho, Ghana: its contribution to student engagement, fundraising, and program planning

Improvements in computer-based technologies can be leveraged to enhance engagement of remote stakeholders with the health needs of a geographically distant community. Three-dimensional (3D) modeling offers a platform to create detailed spatial representations through which stakeholders can experience improvements in shared understanding as well as increased involvement in community health projects occurring anywhere in the world. This case study describes the development of a 3D model of a community health clinic in rural Ghana used to encourage fundraising and sustain global engagement among students at Northwestern University. The resulting ‘virtual clinic’ was achieved quickly and at little cost, suggesting a broader utility of 3D modeling for global health practitioners for increasing donor engagement and resource mapping

STRATEGI REVITALISASI KAWASAN TERMINAL CICAHEUM

Terminal Cicaheum merupakan salah satu prasarana yang disediakan oleh pusat Kota Bandung yang mempunyai berbagai fungsi terutama memiliki fungsi pelayanan ekonomi daerah yang harus ditata atau direvitalisai sesuai peruntukan dan penggunaanya yang memiliki nilai keamanan dan kenyamanan dari kota tersebut. Isu yang muncul selama ini adalah bahwa terminal cicaheum sering menyebabkan kemacetan dan kemacetan tersebut terjadi disekitar lampu merah baik itu dari arah keluar maupun masuknya kendaraan berupa bus maupun angkutan umum lainya serta kendaraan pribadi yang disebabkan oleh kesemrawutan parkir kendaraan yang sedang menaikkan maupun menurunkan penumpang dan hal ini terbukti bahwa selama ini kemacetan yang sering terjadi sangat mengganggu aktivitas dan fungsi dari terminal itu sendiri. Persoalan yang timbul pada kawasan Terminal Cicaheum terutama adalah penurunan vitalitas kawasan secara keseluruhan hal ini bisa dilihat dari bentuk&struktur bangunan yang ada, fungsi kawasan yang tidak dimanfaatkan sesuai fungsinya yang menyebabkan menurunya tingkat pelayanan terminal yang ditunjukan dengan panjang antrian kendaraan, lamanya waktu antrian serta waktu pelayanan kendaraan umum yang terlalu lama. Dari semua persoalan yang terjadi di Kawasan Terminal Cicaheum maka langkah yang diambil adalah dengan melakukan suatu langkah yaitu dengan melakukan metode analasis yaitu Metode anaisis SWOT sehingga dapat di ketahui kekuatan, kelemahan, peluang serta ancaman yang terjadi di kawasan studi. Strategi perancangan revitalisasi kawasan terminal Cicaheum berdasarkan analisis SWOT guna mewujudkan kawasan yang aman, selamat dan menyenangkan bagi pengguna dengan mengindahkan karateristik kawasan. Strategi perancangan yang dilakukan yaitu dengan strategi umum dan khusus dengan tetap memperhatikan kesatuan dari setiap subkawasan tersebut. Strategi umum revitalisasi yang dapat diterapkan untuk kawasan studi adalah : 1) Peningkatan vitalitas Terminal Cicaheum agar tetap mempertahankan pola fungsinya 2) Perbaikan dan peningkatan sarana dan prasarana kawasan 3) Menata aktivitas modern maupun tradisional yang sudah ada dengan/tanpa menambah aktivitas baru yang sesuai 4) Menata kembali jalur pergerakan, parkir, jalur pejalan serta keberadaan angkutan kota dalam kawasan studi 5) Perbaikan terhadap bangunan dan fasilitas-fasilitas yang telah disediakan Berdasarkan studi analisis yang telah dilakukan dengan membandingkan tipologi terminal dengan kondisi eksiting saat ini maka Terminal Cicaheum dapat di kategorikan terutama dari segi fungsi dan statusnya adalah sebagai Terminal tipe C dan hanya akan melayani Angkutan Pedesaan sebagai pendukung hirarki terminal yang akan dipindahkan ke Gedebage

Study design and participant characteristics of a randomized controlled trial of directly administered antiretroviral therapy in opioid treatment programs

<p>Abstract</p> <p>Background</p> <p>HIV-infected drug users are at higher risk of non-adherence and poor treatment outcomes than HIV-infected non-drug users. Prior work from our group and others suggests that directly administered antiretroviral therapy (DAART) delivered in opioid treatment programs (OTPs) may increase rates of viral suppression.</p> <p>Methods/Design</p> <p>We are conducting a randomized trial comparing DAART to self-administered therapy (SAT) in 5 OTPs in Baltimore, Maryland. Participants and investigators are aware of treatment assignments. The DAART intervention is 12 months. The primary outcome is HIV RNA < 50 copies/mL at 3, 6, and 12 months. To assess persistence of any study arm differences that emerge during the active intervention, we are conducting an 18-month visit (6 months after the intervention concludes). We are collecting electronic adherence data for 2 months in both study arms. Of 457 individuals screened, a total of 107 participants were enrolled, with 56 and 51 randomly assigned to DAART and SAT, respectively. Participants were predominantly African American, approximately half were women, and the median age was 47 years. Active use of cocaine and other drugs was common at baseline. HIV disease stage was advanced in most participants. The median CD4 count at enrollment was 207 cells/mm³, 66 (62%) had a history of an AIDS-defining opportunistic condition, and 21 (20%) were antiretroviral naïve.</p> <p>Conclusions</p> <p>This paper describes the rationale, methods, and baseline characteristics of subjects enrolled in a randomized clinical trial comparing DAART to SAT in opioid treatment programs.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00279110">NCT00279110</a></p

Refugee and Migrant Women's Views of Antenatal Ultrasound on the Thai Burmese Border: A Mixed Methods Study

Antenatal ultrasound suits developing countries by virtue of its versatility, relatively low cost and safety, but little is known about women's or local provider's perspectives of this upcoming technology in such settings. This study was undertaken to better understand how routine obstetric ultrasound is experienced in a displaced Burmese population and identify barriers to its acceptance by local patients and providers.Qualitative (30 observations, 19 interviews, seven focus group discussions) and quantitative methods (questionnaire survey with 644 pregnant women) were used to provide a comprehensive understanding along four major themes: safety, emotions, information and communication, and unintended consequences of antenatal ultrasound in refugee and migrant clinics on the Thai Burmese border. One of the main concerns expressed by women was the danger of childbirth which they mainly attributed to fetal malposition. Both providers and patients recognized ultrasound as a technology improving the safety of pregnancy and delivery. A minority of patients experienced transitory shyness or anxiety before the ultrasound, but reported that these feelings could be ameliorated with improved patient information and staff communication. Unintended consequences of overuse and gender selective abortions in this population were not common.The results of this study are being used to improve local practice and allow development of explanatory materials for this population with low literacy. We strongly encourage facilities introducing new technology in resource poor settings to assess acceptability through similar inquiry

A descriptive model of patient readiness, motivators, and hepatitis C treatment uptake among Australian prisoners

Background: Hepatitis C virus infection (HCV) has a significant global health burden with an estimated 2%–3% of the world's population infected, and more than 350,000 dying annually from HCV-related conditions including liver failure and liver cancer. Prisons potentially offer a relatively stable environment in which to commence treatment as they usually provide good access to health care providers, and are organised around routine and structure. Uptake of treatment of HCV, however, remains low in the community and in prisons. In this study, we explored factors affecting treatment uptake inside prisons and hypothesised that prisoners have unique issues influencing HCV treatment uptake as a consequence of their incarceration which are not experienced in other populations. Method and Findings: We undertook a qualitative study exploring prisoners' accounts of why they refused, deferred, delayed or discontinued HCV treatment in prison. Between 2010 and 2013, 116 Australian inmates were interviewed from prisons in New South Wales, Queensland, and Western Australia. Prisoners experienced many factors similar to those which influence treatment uptake of those living with HCV infection in the community. Incarceration, however, provides different circumstances of how these factors are experienced which need to be better understood if the number of prisoners receiving treatment is to be increased. We developed a descriptive model of patient readiness and motivators for HCV treatment inside prisons and discussed how we can improve treatment uptake among prisoners.Conclusion: This study identified a broad and unique range of challenges to treatment of HCV in prison. Some of these are likely to be diminished by improving treatment options and improved models of health care delivery. Other barriers relate to inmate understanding of their illness and stigmatisation by other inmates and custodial staff and generally appear less amenable to change although there is potential for peer-based education to address lack of knowledge and stigma

Antiretroviral Outcomes in South African Prisoners: A Retrospective Cohort Analysis

Background and Methods: Little is known about antiretroviral therapy (ART) outcomes in prisoners in Africa. We conducted a retrospective review of outcomes of a large cohort of prisoners referred to a public sector, urban HIV clinic. The review included baseline characteristics, sequential CD4 cell counts and viral load results, complications and co-morbidities, mortality and loss to follow-up up to 96 weeks on ART. Findings: 148 inmates (133 male) initiated on ART were included in the study. By week 96 on ART, 73 % of all inmates enrolled in the study and 92 % of those still accessing care had an undetectable viral load (,400copies/ml). The median CD4 cell count increased from 122 cells/mm 3 at baseline to 356 cells/mm 3 by 96 weeks. By study end, 96 (65%) inmates had ever received tuberculosis (TB) therapy with 63 (43%) receiving therapy during the study: 28 % had a history of TB prior to ART initiation, 33 % were on TB therapy at ART initiation and 22 % developed TB whilst on ART. Nine (6%) inmates died, 7 in the second year on ART. Loss to follow-up (LTF) was common: 14 (9%) patients were LTF whilst still incarcerated, 11 (7%) were LTF post-release and 9 (6%) whose movements could not be traced. 16 (11%) inmates had inter-correctional facility transfers and 34 (23%) were released of whom only 23 (68%) returned to the ART clinic for ongoing follow-up. Conclusions: Inmates responded well to ART, despite a high frequency of TB/HIV co-infection. Attention should be directed towards ensuring eligible prisoners access ART programs promptly and that inter-facility transfers and release procedure

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

A systematic review conducted by Sanjay Basu and colleagues reevaluates the evidence relating to comparative performance of public versus private sector healthcare delivery in low- and middle-income countries

Barriers and facilitators to Hepatitis C (HCV) Screening and Treatment – A Prisoners’ Perspective

Background: Hepatitis C Virus (HCV) infection is a global epidemic with an estimated 71 million people infected worldwide. People who inject drugs (PWID) are over represented in prison populations globally and have higher levels of HCV infection than the general population. Despite increased access to primary health care while in prison, many HCV infected prisoners do not engage with screening or treatment. With recent advances in treatment regimes, HCV in now a curable and preventable disease and prisons provide an ideal opportunity to engage this hard to reach population. Aim: To identify barriers and enablers to HCV screening and treatment in prisons Methods: A qualitative study of four prisoner focus groups (n=46) conducted at two prison settings in Dublin, Ireland. Results: The following barriers to HCV screening and treatment were identified, lack of knowledge, concerns regarding confidentiality and stigma experienced and inconsistent and delayed access to prison health services. Enablers identified included; access to health care, opt-out screening at committal, peer support, and stability of prison life which removed many of the competing priorities associated with life on the outside. Unique blocks and enablers to HCV treatment reported were, fear of treatment and having a liver biopsy, the requirement to go to hospital and in-reach hepatology services and fibroscaning. Conclusion; The many barriers and enablers to HCV screening and treatment reported by Irish prisoners will inform both national and international public health HCV elimination strategies. Incarceration provides a unique opportunity to upscale HCV treatment and linkage to the community would support effectiveness

Nonhalogenated organic molecules from Laurencia algae

The marine red algae of the genus Laurencia have produced more 700 secondary metabolites and exhibited high molecular diversity and intriguing bioactivity. Since the halogenated structures have been comprehensively reviewed previously, this review, covering up to the end of 2012, mainly focuses on the source, structure elucidation, and bioactivity of nonhalogenated organic molecules from Laurencia spp. as well as the relationship between nonhalogenated and halogenated products. Overall, 173 new or new naturally occurring compounds with 58 skeletons, mainly including sesquiterpenes, diterpenes, triterpenes, and C15-acetogenins, are described.The marine red algae of the genus Laurencia have produced more 700 secondary metabolites and exhibited high molecular diversity and intriguing bioactivity. Since the halogenated structures have been comprehensively reviewed previously, this review, covering up to the end of 2012, mainly focuses on the source, structure elucidation, and bioactivity of nonhalogenated organic molecules from Laurencia spp. as well as the relationship between nonhalogenated and halogenated products. Overall, 173 new or new naturally occurring compounds with 58 skeletons, mainly including sesquiterpenes, diterpenes, triterpenes, and C-15-acetogenins, are described