HIV prevention programmes for female sex workers in Andhra Pradesh, India: outputs, cost and efficiency

BACKGROUND: Female sex workers and their clients play a prominent role in the HIV epidemic in India. Systematic data on the outputs, cost and efficiency for HIV prevention programmes for female sex workers in India are not readily available to understand programme functioning and guide efficient use of resources. METHODS: Detailed output and cost data for the 2002–2003 fiscal year were obtained using standardised methods at 15 HIV prevention programmes for female sex worker in the state of Andhra Pradesh in southern India. The services provided and their relation to the total and unit economic costs were analysed using regression techniques. The trends for the number of sex workers provided services by the programmes since inception up to fiscal year 2004–2005 were examined. RESULTS: The 15 programmes provided services to 33941 sex workers in fiscal year 2002–2003 (range 803–6379, median 1970). Of the total number of contacts with sex workers, 41.6% were by peer educators and 58.4% by other programme staff. The number of sex worker contacts in a year by peer educators varied 74-fold across programmes as compared with a 2.7-fold variation in sex worker contacts by other programme staff. The annual economic cost of providing services to a sex worker varied 6-fold between programmes from Indian Rupees (INR) 221.8 (US$4.58) to INR 1369 (US$ 28.29) with a median of INR 660.9 (US$13.66) and mean of INR 517.8 (US$ 10.70). Personnel salaries made up 34.7% of the total cost, and recurrent goods made up 38.4% of which 82.1% was for condoms. The cost per sex worker provided services had a significant inverse relation with the number of sex workers provided services by a programme (p < 0.001, R(2 )= 0.75; power function). There was no correlation between the full time equivalents of programme staff and the number of sex workers provided services by the programmes, but there was a modest inverse correlation between the number of sex workers served and the average time spent with each sex worker in the year adjusted for the full-time equivalents of programme staff (p = 0.011, R(2 )= 0.40; exponential function). The average number of sex workers provided services annually by the first batch of 7 programmes started in early 1999 plateaued after the fourth fiscal year to 3500, whereas the 8 second-batch programmes started in late 2000 reached an average of 2000 sex workers in 2004–2005 with an increasing trend up to this fourth fiscal year. CONCLUSION: The HIV prevention efforts in this Indian state would benefit from standardisation of the highly variable services provided by peer educators, who form an important part of the sex worker programmes. The cost per sex worker served decreases with increasing number of sex workers served annually, but this has to be weighed against an associated modest trend of decrease in time spent with each sex worker in some programmes

Nagyszilárdságú acélok elektronsugaras hegesztett kötéseinek fáradásos repedésterjedéssel szembeni ellenállása

A kutatómunka az S960QL nemesített és az S960M termomechanikusan kezelt nagyszilárdságú szerkezeti acélok elektronsugaras hegesztett kötéseinek fáradásos repedésterjedéssel szembeni ellenállására irányult. A hegesztési kísérletek során 15 mm vastag alapanyagokat alkalmaztunk hozaganyag nélküli (autogén), I-varratos, hegesztett kötések létrehozásához. A repedésterjedési vizsgálatokhoz alkalmazott hárompontos hajlító (TPB) próbatesteket úgy munkáltuk ki, hogy azok a jellemző irányokra merőlegesek, illetve párhuzamosak legyenek, valamint a bemetszések helyzetét a hegesztett kötések jellemző részeinek (varrat, beolvadási vonal, hőhatásövezet) elemzése céljából is változtattuk. Ennek megfelelően a vizsgálataink során terjedő repedések a valós szerkezetekben előforduló, különböző repedés megjelenési helyeknek felelnek meg. A vizsgált S960M acél elektronsugaras hegesztett kötésének fáradásos repedésterjedéssel szembeni ellenállása a vizsgált irányokban szignifikánsan különbözőnek bizonyult, az S960QL acél esetében ilyen különbség nem mutatkozott. A vizsgált S960QL acél elektronsugaras hegesztett kötései, mindkét vizsgált irányban lényegesen érzékenyebbeknek bizonyultak a fáradással terjedő repedések elhelyezkedésére, mint a vizsgált S960M acél kötései

An Approach to Assessing S960QL Steel Welded Joints Using EBW and GMAW

In recent years, ultra-high-strength structural (UHSS) steel in quenched and tempered (Q+T) conditions, for example, S960QL has been found in wider application areas such as structures, cranes, and trucks due to its extraordinary material properties and acceptable weldability. The motivation of the study is to investigate the unique capabilities of electron beam welding (EBW) compared to conventional gas metal arc welding (GMAW) for a deep, narrow weld with a small heat-affected zone (HAZ) and minimum thermal distortion of the welded joint without significantly affecting the mechanical properties. In this study, S960QL base material (BM) specimens with a thickness of 15 mm were butt-welded without filler material at a welding speed of 10 mm/s using the high-vacuum (2 &times; 10&minus;4 mbar) EBW process. Microstructural characteristics were analyzed using an optical microscope (OM), a scanning electron microscope (SEM), fractography, and an electron backscatter diffraction (EBSD) analysis. The macro hardness, tensile strength, and instrumented Charpy-V impact test were performed to evaluate the mechanical properties. Further, the results of these tests of the EBW joints were compared with the GMAW joints of the same steel grade and thickness. Higher hardness is observed in the fusion zone (FZ) and the HAZ compared to the BM but under the limit of qualifying the hardness value (450 HV10) of Q+T steels according to the ISO 15614-11 specifications. The tensile strength of the EBW-welded joint (1044 MPa) reached the level of the BM as the specimens fractured in the BM. The FZ microstructure consists of fine dendritic martensite and the HAZ predominantly consists of martensite. Instrumented impact testing was performed on Charpy-V specimens at &minus;40 &deg;C, which showed the brittle behavior of both the FZ and HAZ but to a significantly lower extent compared to GMAW. The measured average impact toughness of the BM is 162 J and the average impact toughness value of the HAZ and FZ are 45 &plusmn; 11 J and 44 &plusmn; 20 J, respectively

An Approach to Assessing S960QL Steel Welded Joints Using EBW and GMAW

In recent years, ultra-high-strength structural (UHSS) steel in quenched and tempered (Q+T) conditions, for example, S960QL has been found in wider application areas such as structures, cranes, and trucks due to its extraordinary material properties and acceptable weldability. The motivation of the study is to investigate the unique capabilities of electron beam welding (EBW) compared to conventional gas metal arc welding (GMAW) for a deep, narrow weld with a small heat-affected zone (HAZ) and minimum thermal distortion of the welded joint without significantly affecting the mechanical properties. In this study, S960QL base material (BM) specimens with a thickness of 15 mm were butt-welded without filler material at a welding speed of 10 mm/s using the high-vacuum (2 × 10−4 mbar) EBW process. Microstructural characteristics were analyzed using an optical microscope (OM), a scanning electron microscope (SEM), fractography, and an electron backscatter diffraction (EBSD) analysis. The macro hardness, tensile strength, and instrumented Charpy-V impact test were performed to evaluate the mechanical properties. Further, the results of these tests of the EBW joints were compared with the GMAW joints of the same steel grade and thickness. Higher hardness is observed in the fusion zone (FZ) and the HAZ compared to the BM but under the limit of qualifying the hardness value (450 HV10) of Q+T steels according to the ISO 15614-11 specifications. The tensile strength of the EBW-welded joint (1044 MPa) reached the level of the BM as the specimens fractured in the BM. The FZ microstructure consists of fine dendritic martensite and the HAZ predominantly consists of martensite. Instrumented impact testing was performed on Charpy-V specimens at −40 °C, which showed the brittle behavior of both the FZ and HAZ but to a significantly lower extent compared to GMAW. The measured average impact toughness of the BM is 162 J and the average impact toughness value of the HAZ and FZ are 45 ± 11 J and 44 ± 20 J, respectively

Hőhatásövezeti zónák fizikai szimulációja nagyszilárdságú szerkezeti acélok esetén

Napjainkban a járműipar egyre növekvő igényt mutat a nagy szilárdságú acélok szélesebb körű felhasználására. Az acélgyártók folyamatosan fejlesztik az új generációs nagy szilárdságú acélokat, így garantálva az egyre nagyobb szilárdsági és szívóssági tulajdonságokat. A fejlesztések által biztosítják a jó szilárdság-sajáttömeg arányt, megfelelő hegeszthetőséget, megnövekedett szívósságot, valamint megfelelő alakváltozó képességet. Mindezek ellenére a nagy szilárdságú acélok hegesztése még tartogat kihívásokat, pl.: hidegrepedési hajlam, a hőhatásövezet kilágyulási hajlama, hozaganyag-választás nehézségei. A nagy szilárdságú acélok hőhatásövezetében keményedett és kilágyult zónákat találhatunk, amelynek következtében az anyag nagymértékben elveszti kiemelkedő mechanikai tulajdonságait. A ténylegesen elkészített hegesztett kötésekben a hőhatásövezet tulajdonságai csak korlátozottan elemezhetők hagyományos anyagvizsgálatok segítségével. Többek között ezért is fejlesztették ki a fizikai szimulátorokat, amelyek segítségével megvizsgálhatjuk a különböző hőhatásövezeti zónákat. A fizikai szimulátorok fejlesztésének másik oka, hogy időt és anyagot takaríthassunk meg a valós hegesztési kísérletekhez képest. Kutatómunkánkban két nagy szilárdságú szerkezeti acél (S960QL és S960M) hegeszthetőségét, valamint a hegesztést követően kialakult hőhatásövezet tulajdonságait vizsgáljuk, majd hasonlítjuk össze. A vizsgált acélok azonos szilárdsági kategóriába tartoznak (Rp0,2=960 MPa) és azonos lemezvastagsággal (t=15 mm) rendelkeznek. A hőhatásövezeti szimulációk során a huzalelektródás védőgázos ívhegesztés két különböző technológiai változata esetén vizsgáltuk a hűtési idő hatását a kritikus hőhatásövezeti zónákban (Δt8/5=5 és 30 s esetén). A kiválasztott szemcsedurvulási, normalizálási, interkritikus és szubkritikus zónák tulajdonságit optikai mikroszkópos vizsgálat és keménységvizsgálat segítségével elemeztük

Challenges and opportunities in the arc welding of offshore steels

Offshore steels are required not only good strength properties but also outstanding toughness at low temperatures to ensure the safety of the structures in an extremely cold environment. The new generations of offshore steels, in the range of S420-S500 range, exhibit remarkable toughness characteristics which must be preserved as much as possible during welding. However, welding processes, can significantly reduce the toughness properties due to the welding heat input. Furthermore, it is a challenge to guarantee the impact energy level in the dendritic, mostly multi-pass weld, is the same as that in the fine-grained and micro-alloyed steel plate, which is rolled through specific rolling processes, including thermomechanical controlled process (TMCP). The welding process and its’ parameters, as well as the filler material selection, play a significant role in the formation of an ideal weld and heat-affected zone (HAZ) microstructure with appropriate strength and toughness properties. The effect of microalloying elements on the formation of acicular ferrite (AF) in weld and HAZ has a determining role in terms of the toughness properties. This paper provides a detailed literature review of the characteristics, processing routes and weldability of advanced offshore steels. Gas Metal Arc Welding (GMAW) and Submerged Arc Welding (SAW) are the most frequently used technologies for offshore steels. The research results demonstrate that special attention is needed during the welding process, parameter and filler material selection to ensure the high impact safety of the welded joints under low temperatures

Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India

<p>Abstract</p> <p>Background</p> <p>Control of sexually transmitted infections (STIs) is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services.</p> <p>Methods</p> <p>Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated.</p> <p>Results</p> <p>18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199). The economic cost of treating each STI varied 5-fold from Indian Rupees (INR) 225.5 (US$4.91) to INR 1201.5 (US$ 26.15) between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$53.94). The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88). Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p < 0.001, R²= 0.81; power function). With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$1.21) and for each follow-up visit was INR 3.75 (US$ 0.08). Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be handled, which could increase the total STI cases treated at the 14 clinics combined by 38% at an additional cost of only 3.5% for service provision.</p> <p>Conclusion</p> <p>There is un-utilised capacity in the public sector STI clinics in this Indian state. Efforts to facilitate utilisation of this capacity would be useful, as this would enable more poor patients with STIs to be served at minimal additional cost, and would also reduce the cost per STI treated leading to more efficient use of public resources.</p