Religion and HIV in Tanzania: Influence of Religious Beliefs on HIV stigma, Disclosure, and Treatment Attitudes.

Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes toward antiretroviral (ARV) treatment. A self-administered survey was distributed to a convenience sample of parishioners (n = 438) attending Catholic, Lutheran, and Pentecostal churches in both urban and rural areas. The survey included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about ARVs. Multivariate logistic regression analysis was performed to assess how religion was associated with perceptions about HIV, HIV treatment, and people living with HIV/AIDS. Results indicate that shame-related HIV stigma is strongly associated with religious beliefs such as the belief that HIV is a punishment from God (p < 0.01) or that people living with HIV/AIDS (PLWHA) have not followed the Word of God (p < 0.001). Most participants (84.2%) said that they would disclose their HIV status to their pastor or congregation if they became infected. Although the majority of respondents (80.8%) believed that prayer could cure HIV, almost all (93.7%) said that they would begin ARV treatment if they became HIV-infected. The multivariate analysis found that respondents' hypothetical willingness to begin ARV treatme was not significantly associated with the belief that prayer could cure HIV or with other religious factors. Refusal of ARV treatment was instead correlated with lack of secondary schooling and lack of knowledge about ARVs. The decision to start ARVs hinged primarily on education-level and knowledge about ARVs rather than on religious factors. Research results highlight the influence of religious beliefs on HIV-related stigma and willingness to disclose, and should help to inform HIV-education outreach for religious groups

Participatory development of decision support systems: which features of the process lead to improved uptake and better outcomes?

Decision support systems (DSSs) are important in decision-making environments with conflicting interests. Many DSSs developed have not been used in practice. Experts argue that these tools do not respond to real user needs and that the inclusion of stakeholders in the development process is the solution. However, it is not clear which features of participatory development of DSSs result in improved uptake and better outcomes. A review of papers, reporting on case studies where DSSs and other decision tools (information systems, software and scenario tools) were developed with elements of participation, was carried out. The cases were analysed according to a framework created as part of this research; it includes criteria to evaluate the development process and the outcomes. Relevant aspects to consider in the participatory development processes include establishing clear objectives, timing and location of the process; keeping discussions on track; favouring participation and interaction of individuals and groups; and challenging creative thinking of the tool and future scenarios. The case studies that address these issues show better outcomes; however, there is a large degree of uncertainty concerning them because developers have typically neither asked participants about their perceptions of the processes and resultant tools nor have they monitored the use and legacy of the tools over the long term.The authors would like to thank COST Action FP0804-Forest Management Decision Support Systems (FORSYS) for financing a three month Short-Term Scientific Mission (STSM) in Forest Research (Roslin, UK) in 2012, making possible this research; Spanish Ministry of Economy and Competitiveness for supporting the project Multicriteria Techniques and Participatory Decision-Making for Sustainable Management (Ref. ECO2011-27369) where the leading author is involved; and the Regional Ministry of Education, Culture and Sports (Valencia, Spain) for financing a research fellowship (Ref. ACIF/2010/248).Valls Donderis, P.; Ray, D.; Peace, A.; Stewart, A.; Lawrence, A.; Galiana, F. (2013). Participatory development of decision support systems: which features of the process lead to improved uptake and better outcomes?. Scandinavian Journal of Forest Research. 29(1):71-83. https://doi.org/10.1080/02827581.2013.837950S7183291Arnstein, S. R. (1969). A Ladder Of Citizen Participation. Journal of the American Institute of Planners, 35(4), 216-224. doi:10.1080/01944366908977225Atwell, R. C., Schulte, L. A., & Westphal, L. M. (2011). Tweak, Adapt, or Transform: Policy Scenarios in Response to Emerging Bioenergy Markets in the U.S. Corn Belt. Ecology and Society, 16(1). doi:10.5751/es-03854-160110Barac, A., Kellner, K., & De Klerk, N. (2004). Land User Participation in Developing a Computerised Decision Support System for Combating Desertification. Environmental Monitoring and Assessment, 99(1-3), 223-231. doi:10.1007/s10661-004-4022-6Bennet, A., & Bennet, D. (2008). The Decision-Making Process in a Complex Situation. Handbook on Decision Support Systems 1, 3-20. doi:10.1007/978-3-540-48713-5_1Blackstock, K. L., Kelly, G. J., & Horsey, B. L. (2007). Developing and applying a framework to evaluate participatory research for sustainability. Ecological Economics, 60(4), 726-742. doi:10.1016/j.ecolecon.2006.05.014Breuer, N. E., Cabrera, V. E., Ingram, K. T., Broad, K., & Hildebrand, P. E. (2007). AgClimate: a case study in participatory decision support system development. Climatic Change, 87(3-4), 385-403. doi:10.1007/s10584-007-9323-7Bunch, M. J., & Dudycha, D. J. (2004). Linking conceptual and simulation models of the Cooum River: collaborative development of a GIS-based DSS for environmental management. Computers, Environment and Urban Systems, 28(3), 247-264. doi:10.1016/s0198-9715(03)00021-8Byrne, E., & Sahay, S. (2007). Participatory design for social development: A South African case study on community-based health information systems. Information Technology for Development, 13(1), 71-94. doi:10.1002/itdj.20052Cain, J. ., Jinapala, K., Makin, I. ., Somaratna, P. ., Ariyaratna, B. ., & Perera, L. . (2003). Participatory decision support for agricultural management. A case study from Sri Lanka. Agricultural Systems, 76(2), 457-482. doi:10.1016/s0308-521x(02)00006-9Chakraborty, A. (2011). Enhancing the role of participatory scenario planning processes: Lessons from Reality Check exercises. Futures, 43(4), 387-399. doi:10.1016/j.futures.2011.01.004Cinderby, S., Bruin, A. de, Mbilinyi, B., Kongo, V., & Barron, J. (2011). Participatory geographic information systems for agricultural water management scenario development: A Tanzanian case study. Physics and Chemistry of the Earth, Parts A/B/C, 36(14-15), 1093-1102. doi:10.1016/j.pce.2011.07.039Drew, C. H., Nyerges, T. L., & Leschine, T. M. (2004). Promoting Transparency of Long‐Term Environmental Decisions: The Hanford Decision Mapping System Pilot Project. Risk Analysis, 24(6), 1641-1664. doi:10.1111/j.0272-4332.2004.00556.xDriedger, S. M., Kothari, A., Morrison, J., Sawada, M., Crighton, E. J., & Graham, I. D. (2007). Using participatory design to develop (public) health decision support systems through GIS. International Journal of Health Geographics, 6(1), 53. doi:10.1186/1476-072x-6-53Evers, M. (2008). An analysis of the requirements for DSS on integrated river basin management. Management of Environmental Quality: An International Journal, 19(1), 37-53. doi:10.1108/14777830810840354Iivari, N. (2011). Participatory design in OSS development: interpretive case studies in company and community OSS development contexts. Behaviour & Information Technology, 30(3), 309-323. doi:10.1080/0144929x.2010.503351Innes, J. E., & Booher, D. E. (1999). Consensus Building and Complex Adaptive Systems. Journal of the American Planning Association, 65(4), 412-423. doi:10.1080/01944369908976071Jakku, E., & Thorburn, P. J. (2010). A conceptual framework for guiding the participatory development of agricultural decision support systems. Agricultural Systems, 103(9), 675-682. doi:10.1016/j.agsy.2010.08.007Jessel, B., & Jacobs, J. (2005). Land use scenario development and stakeholder involvement as tools for watershed management within the Havel River Basin. Limnologica, 35(3), 220-233. doi:10.1016/j.limno.2005.06.006Kautz, K. (2011). Investigating the design process: participatory design in agile software development. Information Technology & People, 24(3), 217-235. doi:10.1108/09593841111158356Kowalski, K., Stagl, S., Madlener, R., & Omann, I. (2009). Sustainable energy futures: Methodological challenges in combining scenarios and participatory multi-criteria analysis. European Journal of Operational Research, 197(3), 1063-1074. doi:10.1016/j.ejor.2007.12.049Lawrence, A. (2006). ‘No Personal Motive?’ Volunteers, Biodiversity, and the False Dichotomies of Participation. Ethics, Place & Environment, 9(3), 279-298. doi:10.1080/13668790600893319Mao, J., & Song, W. (2008). Empirical study of distinct features and challenges of joint development of information systems: The case of ABC bank. Tsinghua Science and Technology, 13(3), 414-419. doi:10.1016/s1007-0214(08)70066-xMenzel, S., Nordström, E.-M., Buchecker, M., Marques, A., Saarikoski, H., & Kangas, A. (2012). Decision support systems in forest management: requirements from a participatory planning perspective. European Journal of Forest Research, 131(5), 1367-1379. doi:10.1007/s10342-012-0604-yMoote, M. A., Mcclaran, M. P., & Chickering, D. K. (1997). RESEARCH: Theory in Practice: Applying Participatory Democracy Theory to Public Land Planning. Environmental Management, 21(6), 877-889. doi:10.1007/s002679900074Peleg, M., Shachak, A., Wang, D., & Karnieli, E. (2009). Using multi-perspective methodologies to study users’ interactions with the prototype front end of a guideline-based decision support system for diabetic foot care. International Journal of Medical Informatics, 78(7), 482-493. doi:10.1016/j.ijmedinf.2009.02.008Pretty, J. N. (1995). Participatory learning for sustainable agriculture. World Development, 23(8), 1247-1263. doi:10.1016/0305-750x(95)00046-fReed MS. 2008. Stakeholder participation for environmental management: a literature review. Sustainability Research Institute, School of Earth and Environment, University of Leeds.Reed, M. S., & Dougill, A. J. (2010). Linking degradation assessment to sustainable land management: A decision support system for Kalahari pastoralists. Journal of Arid Environments, 74(1), 149-155. doi:10.1016/j.jaridenv.2009.06.016Rowe, G., & Frewer, L. J. (2000). Public Participation Methods: A Framework for Evaluation. Science, Technology, & Human Values, 25(1), 3-29. doi:10.1177/016224390002500101Schielen, R. M. J., & Gijsbers, P. J. A. (2003). DSS-large rivers: developing a DSS under changing societal requirements. Physics and Chemistry of the Earth, Parts A/B/C, 28(14-15), 635-645. doi:10.1016/s1474-7065(03)00109-8Sheppard, S. R. J., & Meitner, M. (2005). Using multi-criteria analysis and visualisation for sustainable forest management planning with stakeholder groups. Forest Ecology and Management, 207(1-2), 171-187. doi:10.1016/j.foreco.2004.10.032Thursky, K. A., & Mahemoff, M. (2007). User-centered design techniques for a computerised antibiotic decision support system in an intensive care unit. International Journal of Medical Informatics, 76(10), 760-768. doi:10.1016/j.ijmedinf.2006.07.011Webler, S. T., Thomas. (1999). Voices from the Forest: What Participants Expect of a Public Participation Process. Society & Natural Resources, 12(5), 437-453. doi:10.1080/089419299279524Van Meensel, J., Lauwers, L., Kempen, I., Dessein, J., & Van Huylenbroeck, G. (2012). Effect of a participatory approach on the successful development of agricultural decision support systems: The case of Pigs2win. Decision Support Systems, 54(1), 164-172. doi:10.1016/j.dss.2012.05.002Von Geibler, J., Kristof, K., & Bienge, K. (2010). Sustainability assessment of entire forest value chains: Integrating stakeholder perspectives and indicators in decision support tools. Ecological Modelling, 221(18), 2206-2214. doi:10.1016/j.ecolmodel.2010.03.02

Comparison of patient comprehension of rapid HIV pre-test fundamentals by information delivery format in an emergency department setting

<p>Abstract</p> <p>Background</p> <p>Two trials were conducted to compare emergency department patient comprehension of rapid HIV pre-test information using different methods to deliver this information.</p> <p>Methods</p> <p>Patients were enrolled for these two trials at a US emergency department between February 2005 and January 2006. In Trial One, patients were randomized to a no pre-test information or an in-person discussion arm. In Trial Two, a separate group of patients were randomized to an in-person discussion arm or a Tablet PC-based video arm. The video, "Do you know about rapid HIV testing?", and the in-person discussion contained identical Centers for Disease Control and Prevention-suggested pre-test information components as well as information on rapid HIV testing with OraQuick^®. Participants were compared by information arm on their comprehension of the pre-test information by their score on a 26-item questionnaire using the Wilcoxon rank-sum test.</p> <p>Results</p> <p>In Trial One, 38 patients completed the no-information arm and 31 completed the in-person discussion arm. Of these 69 patients, 63.8% had twelve years or fewer of formal education and 66.7% had previously been tested for HIV. The mean score on the questionnaire for the in-person discussion arm was higher than for the no information arm (18.7 vs. 13.3, p ≤ 0.0001). In Trial Two, 59 patients completed the in-person discussion and 55 completed the video arms. Of these 114 patients, 50.9% had twelve years or fewer of formal education and 68.4% had previously been tested for HIV. The mean score on the questionnaire for the video arm was similar to the in-person discussion arm (20.0 vs. 19.2; p ≤ 0.33).</p> <p>Conclusion</p> <p>The video "Do you know about rapid HIV testing?" appears to be an acceptable substitute for an in-person pre-test discussion on rapid HIV testing with OraQuick^®. In terms of adequately informing ED patients about rapid HIV testing, either form of pre-test information is preferable than for patients to receive no pre-test information.</p

Flood fragility analysis for bridges with multiple failure modes

Bridges are one of the most important infrastructure systems that provide public and economic bases for humankind. It is also widely known that bridges are exposed to a variety of flood-related risk factors such as bridge scour, structural deterioration, and debris accumulation, which can cause structural damage and even failure of bridges through a variety of failure modes. However, flood fragility has not received as much attention as seismic fragility despite the significant amount of damage and costs resulting from flood hazards. There have been few research efforts to estimate the flood fragility of bridges considering various flood-related factors and the corresponding failure modes. Therefore, this study proposes a new approach for bridge flood fragility analysis. To obtain accurate flood fragility estimates, reliability analysis is performed in conjunction with finite element analysis, which can sophisticatedly simulate the structural response of a bridge under a flood by accounting for flood-related risk factors. The proposed approach is applied to a numerical example of an actual bridge in Korea. Flood fragility curves accounting for multiple failure modes, including lack of pier ductility or pile ductility, pier rebar rupture, pile rupture, and deck loss, are derived and presented in this study.ope

HIV Testing Practices by Clinical Service before and after Revised Testing Guidelines in a Swiss University Hospital

OBJECTIVES: To determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT). METHODS: Using 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service ('testing rate'). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication. RESULTS: Combining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9-1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations. CONCLUSIONS: Using a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach

New Jersey Center for Tourette Syndrome Sharing Repository: methods and sample description

<p>Abstract</p> <p>Background</p> <p>Tourette Syndrome is a neuropsychiatric disorder characterized by chronic motor and phonic tics. Affected individuals and their family members are at an increased risk for other neuropsychiatric conditions including obsessive-compulsive disorder and attention deficit hyperactivity disorder. While there is consistent evidence that genetic factors play a significant etiologic role, no replicable susceptibility alleles have thus far been identified.</p> <p>Description</p> <p>Here we discuss a sharing resource of clinical and genetic data, the New Jersey Center for Tourette Syndrome Sharing Repository, whose goal is to provide clinical data, DNA, and lymphoblastoid cell lines to qualified researchers.</p> <p>Conclusion</p> <p>Opening access to the data and patient material to the widest possible research community will hasten the identification of causal genetic factors and facilitate better understanding and treatment of this often impairing disorder.</p

Creating the Back Ward: The Triumph of Custodialism and the Uses of Therapeutic Failure in Nineteenth Century Idiot Asylums

My focus in this chapter is on the origin of the back ward rather than its demise. Where did the “back wards” that [Burton] Blatt and [Senator Robert] Kennedy witnessed come from in the first place? What 3 exactly were those “antecedents of the problems observed” that Blatt cited? This chapter reviews that history and argues that, in fact, there is a specific narrative to the evolution of the institutional “back ward” as an identifiable place where people with the most significant intellectual disabilities were to be incarcerated and largely forgotten.https://digitalcommons.chapman.edu/education_books/1006/thumbnail.jp

Health plan administrative records versus birth certificate records: quality of race and ethnicity information in children

<p>Abstract</p> <p>Background</p> <p>To understand racial and ethnic disparities in health care utilization and their potential underlying causes, valid information on race and ethnicity is necessary. However, the validity of pediatric race and ethnicity information in administrative records from large integrated health care systems using electronic medical records is largely unknown.</p> <p>Methods</p> <p>Information on race and ethnicity of 325,810 children born between 1998-2008 was extracted from health plan administrative records and compared to birth certificate records. Positive predictive values (PPV) were calculated for correct classification of race and ethnicity in administrative records compared to birth certificate records.</p> <p>Results</p> <p>Misclassification of ethnicity and race in administrative records occurred in 23.1% and 33.6% children, respectively; the majority due to missing ethnicity (48.3%) and race (40.9%) information. Misclassification was most common in children of minority groups. PPV for White, Black, Asian/Pacific Islander, American Indian/Alaskan Native, multiple and other was 89.3%, 86.6%, 73.8%, 18.2%, 51.8% and 1.2%, respectively. PPV for Hispanic ethnicity was 95.6%. Racial and ethnic information improved with increasing number of medical visits. Subgroup analyses comparing racial classification between non-Hispanics and Hispanics showed White, Black and Asian race was more accurate among non-Hispanics than Hispanics.</p> <p>Conclusions</p> <p>In children, race and ethnicity information from administrative records has significant limitations in accurately identifying small minority groups. These results suggest that the quality of racial information obtained from administrative records may benefit from additional supplementation by birth certificate data.</p

Polypharmacy in psychiatric practice in the Canary Islands

BACKGROUND: Polypharmacy with psychoactive drugs is an increasingly common and debatable contemporary practice in clinical psychiatry based more upon experience than evidence. The objective of this study was to evaluate the prevalence and conditioners of polypharmacy in psychiatric patients. METHOD: A cross-sectional survey was carried out using the Canary Islands Health Service Clinical Records Database. A representative sample (n = 2,647) of patients with mental disorders receiving psychotropic medication was studied. RESULTS: The mean number of psychoactive drugs prescribed was 1.63 ± 0.93 (range 1–7). The rate of polypharmacy was 41.9%, with 27.8% of patients receiving two drugs, 9.1% receiving three, 3.2% receiving four, and 1.8% of the patients receiving five or more psychotropic drugs. Multiple regression analysis shows that variables sex and diagnosis have a predictive value with regard to the number of psychotropic drug used, being men and schizophrenic patients the most predisposed. Benzodiazepines were the more prevalent drugs in monotherapy, while anticonvulsants and antipsychotics were the more used in combination with other treatment. A questionable very high degree of same-class polypharmacy was evidenced, while multi-class, adjunctive and augmentation polypharmacy seem to be more appropriate. CONCLUSIONS: Almost half of the psychiatric patients are treated with several psychotropics. Polypharmacy is common and seems to be problematic, especially when same class of drugs are prescribed together. Some diagnoses, such as schizophrenia, are associated with an increase risk of Polypharmacy but there is a lack of evidence based indicators that allows for quality evaluation on this practice

Financial control, blame avoidance and Radio Caroline: Talkin’ ‘bout my generation

This research examines the use of financial mechanisms that simultaneously impose controls and facilitate blame avoidance by public office-holders. A qualitative historical examination is used to examine legislation designed to prevent Radio Caroline, a pirate radio station, from broadcasting into Britain in the 1960s. Radio Caroline made a mockery of the British Government’s power to manage radio through a monopolist, the British Broadcasting Corporation. In addition, Radio Caroline played the type of rock music the British Government sought to suppress as representing the undesirable side of youth culture. This research examines the suppression of Radio Caroline through the Marine & Broadcasting (Offences) Act (UK) 1967 and the legislative scapegoating of Radio Caroline by targeting its revenue-earning potential. Inter-generational conflict underpinned the legislative scapegoating of Radio Caroline. This research demonstrates how financial controls can mask scapegoating and blame avoidance strategies by governments