Identifying gaps in HIV policy and practice along the HIV care continuum: evidence from a national policy review and health facility surveys in urban and rural Kenya

The last decade has seen rapid evolution in guidance from the WHO concerning the provision of HIV services along the diagnosis-to-treatment continuum, but the extent to which these recommendations are adopted as national policies in Kenya, and subsequently implemented in health facilities, is not well understood. Identifying gaps in policy coverage and implementation is important for highlighting areas for improving service delivery, leading to better health outcomes. We compared WHO guidance with national policies for HIV testing and counselling, prevention of mother-to-child transmission, HIV treatment and retention in care. We then investigated implementation of these national policies in health facilities in one rural (Kisumu) and one urban (Nairobi) sites in Kenya. Implementation was documented using structured questionnaires that were administered to in-charge staff at 10 health facilities in Nairobi and 34 in Kisumu. Policies were defined as widely implemented if they were reported to occur in > 70% facilities, partially implemented if reported to occur in 30–70% facilities, and having limited implementation if reported to occur in < 30% facilities. Overall, Kenyan national HIV care and treatment policies were well aligned with WHO guidance. Policies promoting access to treatment and retention in care were widely implemented, but there was partial or limited implementation of several policies promoting access to HIV testing, and the more recent policy of Option B+ for HIV-positive pregnant women. Efforts are needed to improve implementation of policies designed to increase rates of diagnosis, thus facilitating entry into HIV care, if morbidity and mortality burdens are to be further reduced in Kenya, and as the country moves towards universal access to antiretroviral therapy

Symmetry breaking perturbations and strange attractors

The asymmetrically forced, damped Duffing oscillator is introduced as a prototype model for analyzing the homoclinic tangle of symmetric dissipative systems with \textit{symmetry breaking} disturbances. Even a slight fixed asymmetry in the perturbation may cause a substantial change in the asymptotic behavior of the system, e.g. transitions from two sided to one sided strange attractors as the other parameters are varied. Moreover, slight asymmetries may cause substantial asymmetries in the relative size of the basins of attraction of the unforced nearly symmetric attracting regions. These changes seems to be associated with homoclinic bifurcations. Numerical evidence indicates that \textit{strange attractors} appear near curves corresponding to specific secondary homoclinic bifurcations. These curves are found using analytical perturbational tools

Computational Method for Phase Space Transport with Applications to Lobe Dynamics and Rate of Escape

Lobe dynamics and escape from a potential well are general frameworks introduced to study phase space transport in chaotic dynamical systems. While the former approach studies how regions of phase space are transported by reducing the flow to a two-dimensional map, the latter approach studies the phase space structures that lead to critical events by crossing periodic orbit around saddles. Both of these frameworks require computation with curves represented by millions of points-computing intersection points between these curves and area bounded by the segments of these curves-for quantifying the transport and escape rate. We present a theory for computing these intersection points and the area bounded between the segments of these curves based on a classification of the intersection points using equivalence class. We also present an alternate theory for curves with nontransverse intersections and a method to increase the density of points on the curves for locating the intersection points accurately.The numerical implementation of the theory presented herein is available as an open source software called Lober. We used this package to demonstrate the application of the theory to lobe dynamics that arises in fluid mechanics, and rate of escape from a potential well that arises in ship dynamics.Comment: 33 pages, 17 figure

Tecnologias sociais: as organizações não governamentais no enfrentamento das mudanças climáticas e na promoção de desenvolvimento humano

De acordo com o quarto relatório do Intergovernmental Panel on Climate Change (IPCC), as regiões semiáridas do mundo estarão entre as mais afetadas pelos impactos das mudanças climáticas globais. Estudos realizados pelo Ministério do Meio Ambiente (MMA), em 2007, confirmam que, no Nordeste brasileiro, não apenas choverá menos e mais irregularmente, mas, também, haverá mais secas, devido ao aquecimento da temperatura. Diante dos diversos impactos sociais, ambientais e econômicos possíveis nesses cenários, é de fundamental importância a verificação de alternativas sustentáveis para o semiárido brasileiro. Este artigo tem por objetivo avaliar o potencial de algumas das tecnologias sociais (TS) de convivência com o semiárido, desenvolvidas por diversas organizações, para a mitigação das mudanças climáticas e a promoção de desenvolvimento humano. Constata-se que as TS tem grande potencial para auxiliar na mitigação e na adaptação das mudanças climáticas, ao mesmo tempo que promovem melhorias na qualidade de vida das localidades onde estão sendo desenvolvidas

Holocene El Niño–Southern Oscillation variability reflected in subtropical Australian precipitation

The La Niña and El Niño phases of the El Niño-Southern Oscillation (ENSO) have major impacts on regional rainfall patterns around the globe, with substantial environmental, societal and economic implications. Long-term perspectives on ENSO behaviour, under changing background conditions, are essential to anticipating how ENSO phases may respond under future climate scenarios. Here, we derive a 7700-year, quantitative precipitation record using carbon isotope ratios from a single species of leaf preserved in lake sediments from subtropical eastern Australia. We find a generally wet (more La Niña-like) mid-Holocene that shifted towards drier and more variable climates after 3200 cal. yr BP, primarily driven by increasing frequency and strength of the El Niño phase. Climate model simulations implicate a progressive orbitally-driven weakening of the Pacific Walker Circulation as contributing to this change. At centennial scales, high rainfall characterised the Little Ice Age (~1450–1850 CE) in subtropical eastern Australia, contrasting with oceanic proxies that suggest El Niño-like conditions prevail during this period. Our data provide a new western Pacific perspective on Holocene ENSO variability and highlight the need to address ENSO reconstruction with a geographically diverse network of sites to characterise how both ENSO, and its impacts, vary in a changing climate

Third-Party Strategy under Plurality Rule: The British Liberal Democrats and the New Zealand Social Credit Party

This paper examines the strategic options facing small centrist third parties in two-party parliamentary systems operating under the single-member district plurality (SMDP) electoral system. It uses a spatial model to show that centrist third parties are better off targeting the 'safe' districts of a major party rather than marginal districts. Furthermore, it is optimal to target one party's districts, not both, to benefit from tactical and protest voting. The paper also questions the implicit conclusion of the median-legislator theorem that pivotality-seeking is the best strategy for a third party, at least under SMDP, because that would usurp voters' ability to select the executive directly, a key feature of two-partism. Finally, the paper shows that third parties can damage themselves if they 'flip' from opposition to one major party to support for it. Evidence is provided for the British Liberal Democrats and New Zealand?s historic Social Credit Party

A multi-component flood risk assessment in the Maresme coast (NW Mediterranean)

Coastal regions are the areas most threatened by natural hazards, with floods being the most frequent and significant threat in terms of their induced impacts, and therefore, any management scheme requires their evaluation. In coastal areas, flooding is a hazard associated with various processes acting at different scales: coastal storms, flash floods, and sea level rise (SLR). In order to address the problem as a whole, this study presents a methodology to undertake a preliminary integrated risk assessment that determines the magnitude of the different flood processes (flash flood, marine storm, SLR) and their associated consequences, taking into account their temporal and spatial scales. The risk is quantified using specific indicators to assess the magnitude of the hazard (for each component) and the consequences in a common scale. This allows for a robust comparison of the spatial risk distribution along the coast in order to identify both the areas at greatest risk and the risk components that have the greatest impact. This methodology is applied on the Maresme coast (NW Mediterranean, Spain), which can be considered representative of developed areas of the Spanish Mediterranean coast. The results obtained characterise this coastline as an area of relatively low overall risk, although some hot spots have been identified with high-risk values, with flash flooding being the principal risk process

The Relationship Between Gender and WASH Development Projects in Rural Uganda

The paper explores the relationship between gender roles and development infrastructure projects in the Water, Sanitation, and Hygiene (WASH) sector in rural Uganda, by looking at the influence of various factors such as education and governance. Men and women hold different roles and responsibilities within WASH in rural areas of developing countries, and, therefore, perform different duties. In Uganda, women are the primary managers of water resources at household level, and are the main drivers for sanitation and hygiene practice at household level; men are concerned with the commercial use of water. Insights into developing infrastructure that addresses the needs of communities could emerge from understanding the multiple dimensions of the intrinsic and extrinsic factors that affect the roles that men and women play within the WASH sector. Fieldwork has been undertaken in a number of rural communities in south Uganda, where group discussions and interviews were conducted with key players in the WASH sector, government representatives, and people from the communities. The qualitative data collected provide an understanding of how gender roles are influenced by other factors, as they are dependent on, and formed by, other social structures, and consequently how this relationship influences infrastructure. The findings highlight the importance of good leadership by both men and women at community level, which leads to improvements in WASH infrastructure provision. Moreover, there seems to be a strong relationship between educating women and improved sanitation and hygiene practices. Finally, cultural attributes seem to have a strong influence on the way men and women view water and sanitation tasks, how they perform them, and how they engage with and value the infrastructure. The paper gives an overview of the findings and suggests future research can lead to new evidence to support gender-sensitive infrastructure.EPSR

Discontinuous Maxwell–Rankine stress functions for space frames

© 2018, The Author(s) 2018. This article shows how bending and torsional moments in three-dimensional frames can be represented via a discontinuous Maxwell–Rankine stress function. The associated Rankine reciprocal contains polygonal faces whose areas represent forces. These faces are orthogonal to the member forces (which may include shear forces) and need not be orthogonal to the beams