Evaluation of the Sustainability of an Intervention to Increase HIV Testing

BACKGROUND Sustainability—the routinization and institutionalization of processes that improve the quality of healthcare—is difficult to achieve and not often studied. OBJECTIVE To evaluate the sustainability of increased rates of HIV testing after implementation of a multi-component intervention in two Veterans Health Administration healthcare systems. DESIGN Quasi-experimental implementation study in which the effect of transferring responsibility to conduct the provider education component of the intervention from research to operational staff was assessed. PATIENTS Persons receiving healthcare between 2005 and 2006 (intervention year) and 2006 and 2007 (sustainability year). MEASUREMENTS Monthly HIV testing rate, stratified by frequency of clinic visits RESULTS The monthly adjusted testing rate increased from 2% at baseline to 6% at the end intervention year and then declined reaching 4% at the end of the sustainability year. However, the stratified, visit-specific testing rate for persons newly exposed to the intervention (i.e., having their first through third visits during the study period) increased throughout the intervention and sustainability years. Increases in the proportion of visits by patients who remained untested despite multiple, prior exposures to the intervention accounted for the aggregate attenuation of testing during the sustainability year. Overall, the percentage of patients who received an HIV test in the sustainability year was 11.6%, in the intervention year 11.1%, and in the pre-intervention year 5.0% CONCLUSIONS Provider education combined with informatics and organizational support had a sustainable effect on HIV testing rates. The effect was most pronounced during patients' early contacts with the healthcare system.Health Services Research & Development Service (SDP 06–001

Controlled incremental filtration: a simplified approach to design and fabrication of high-throughput microfluidic devices for selective enrichment of particles.

The number of microfluidic strategies aimed at separating particles or cells of a specific size within a continuous flow system continues to grow. The wide array of biomedical and other applications that would benefit from successful development of such technology has motivated the extensive research in this area over the past 15 years. However, despite promising advancements in microfabrication capabilities, a versatile approach that is suitable for a large range of particle sizes and high levels of enrichment, with a volumetric throughput sufficient for large-scale applications, has yet to emerge. Here we describe a straightforward method that enables the rapid design of microfluidic devices that are capable of enriching/removing particles within a complex aqueous mixture, with an unprecedented range of potential cutoff diameter (below 1µm to above 100µm) and an easily scalable degree of enrichment/filtration (up to 10-fold and well beyond). A simplified model of a new approach to crossflow filtration – controlled incremental filtration – was developed and validated for its ability to generate microfluidic devices that efficiently separate particles on the order of 1–10µm, with throughputs of tens of µL/min, without the use of a pump. Precise control of the amount of fluid incrementally diverted at each filtration “gap” of the device allows for the gap size (~20µm) to be much larger than the particles of interest, while the simplicity of the model allows for many thousands of these filtration points to be readily incorporated into a desired device design. This new approach should enable truly high-throughput microfluidic particle-separation devices to be generated, even by users only minimally experienced in fluid mechanics and microfabrication techniques

Design for 'domestication': the decommercialisation of traditional crafts

This paper explores the contribution of design to the 'domestication' of traditional crafts: the reframing and support of such practices as amateur activities. Informed by twelve examples, six design strategies for the domestication of traditional crafts are identified and discussed. This issue emerges from a research project investigating the role of design in developing and revitalising culturally significant designs, products and associated practices. Within this paper, we focus on strategies that seek to revitalise traditional crafts by supporting domestic activity. This topic is introduced through a discussion of commercialisation, a more common approach to revitalisation. Two contemporary social trends support domestication: the strong interest – particularly in post-industrial countries – in provenance, local distinctiveness and authenticity; and the growth of maker culture and its ethos of amateur creativity. We gather twelve examples of various formats – such as books, kits, online communities, videos, workshops and holidays – which support amateur activity. The examples are analysed via a matrix, which considers their characteristics in terms of two variables: the way in which knowledge is exchanged, and the degree of experimentation facilitated by the activity. By categorising the examples, we identify six domestication strategies, each of which involves a different combination of design activities. Finally, we discuss domestication in terms of skill and innovation, arguing that amateur practice has much to offer in both respects

Exploring the interplay between Buddhism and career development : a study of highly skilled women workers in Sri Lanka

This article adopts a socio cultural lens to examine the role of Buddhism in highly skilled women workers’ careers in Sri Lanka. While Buddhism enabled women’s career development by giving them strength to cope with difficult situations in work, it also seemed to restrict their agency and constrain their career advancement. Based on our findings, we argue that being perceived as a good Buddhist woman worked as a powerful form of career capital for the respondents in our sample, who used their faith to combat gender disadvantage in their work settings

Experiential learning in public health: evaluation of a health promotion campaign assessment for pharmacy students

Description: Students in small groups designed, delivered and evaluated real-life health promotion campaigns in the local community. A peer assessed component was included from the fifth cohort onwards. Evaluation: Six successive cohorts of pharmacy students anonymously completed an evaluation questionnaire after finishing the assessment. Descriptive and inferential statistical analyses were undertaken on the data. The results showed that consistently more respondents reported the assessment as a positive experience than a negative experience. Significantly more respondents reported peer assessment as being useful and group members equally contributing to campaign planning in the cohorts with peer assessment compared to the pre-peer assessment cohorts, but peer assessment did not significantly affect enjoyment ratings. Respondents’ reported enjoyment of the assessment was significantly associated with agreement that it prepared them for health promotion in practice. Conclusions: Pharmacy students perceived the health promotion campaign assessment as appropriately challenging and enjoyable preparation for health promotion in practice

The calibrated population resistance tool: standardized genotypic estimation of transmitted HIV-1 drug resistance

Summary: The calibrated population resistance (CPR) tool is a web-accessible program for performing standardized genotypic estimation of transmitted HIV-1 drug resistance. The program is linked to the Stanford HIV drug resistance database and can additionally perform viral genotyping and algorithmic estimation of resistance to specific antiretroviral drugs

Neural Circuitry of Novelty Salience Processing in Psychosis Risk: Association With Clinical Outcome

Psychosis has been proposed to develop from dysfunction in a hippocampal-striatal-midbrain circuit, leading to aberrant salience processing. Here, we used functional magnetic resonance imaging (fMRI) during novelty salience processing to investigate this model in people at clinical high risk (CHR) for psychosis according to their subsequent clinical outcomes. Seventy-six CHR participants as defined using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and 31 healthy controls (HC) were studied while performing a novelty salience fMRI task that engaged an a priori hippocampal-striatal-midbrain circuit of interest. The CHR sample was then followed clinically for a mean of 59.7 months (~5 y), when clinical outcomes were assessed in terms of transition (CHR-T) or non-transition (CHR-NT) to psychosis (CAARMS criteria): during this period, 13 individuals (17%) developed a psychotic disorder (CHR-T) and 63 did not. Functional activation and effective connectivity within a hippocampal-striatal-midbrain circuit were compared between groups. In CHR individuals compared to HC, hippocampal response to novel stimuli was significantly attenuated (P = .041 family-wise error corrected). Dynamic Causal Modelling revealed that stimulus novelty modulated effective connectivity from the hippocampus to the striatum, and from the midbrain to the hippocampus, significantly more in CHR participants than in HC. Conversely, stimulus novelty modulated connectivity from the midbrain to the striatum significantly less in CHR participants than in HC, and less in CHR participants who subsequently developed psychosis than in CHR individuals who did not become psychotic. Our findings are consistent with preclinical evidence implicating hippocampal-striatal-midbrain circuit dysfunction in altered salience processing and the onset of psychosis

Vortex lattice stability and phase coherence in three-dimensional rapidly rotating Bose condensates

We establish the general equations of motion for the modes of a vortex lattice in a rapidly rotating Bose-Einstein condensate in three dimensions, taking into account the elastic energy of the lattice and the vortex line bending energy. As in two dimensions, the vortex lattice supports Tkachenko and gapped sound modes. In contrast, in three dimensions the Tkachenko mode frequency at long wavelengths becomes linear in the wavevector for any propagation direction out of the transverse plane. We compute the correlation functions of the vortex displacements and the superfluid order parameter for a homogeneous Bose gas of bounded extent in the axial direction. At zero temperature the vortex displacement correlations are convergent at large separation, but at finite temperatures, they grow with separation. The growth of the vortex displacements should lead to observable melting of vortex lattices at higher temperatures and somewhat lower particle number and faster rotation than in current experiments. At zero temperature a system of large extent in the axial direction maintains long range order-parameter correlations for large separation, but at finite temperatures the correlations decay with separation.Comment: 10 pages, 2 figures, Changes include the addition of the particle density - vortex density coupling and the correct value of the shear modulu