Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: findings from health facility surveys in six sub-Saharan countries.

INTRODUCTION: Despite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi-country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic-level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART. METHODS: Health facilities (n = 156) were sampled within 10 surveillance sites: Nairobi and Kisumu (Kenya), Karonga (Malawi), Agincourt and uMkhanyakude (South Africa), Ifakara and Kisesa (Tanzania), Kyamulibwa and Rakai (Uganda) and Manicaland (Zimbabwe). Structured questionnaires were administered to in-charge staff members of HIV testing, prevention of mother-to-child transmission (PMTCT) and ART units within the facilities. Forty-one indicators influencing uptake and patient retention along the continuum of HIV care were compared across sites using descriptive statistics. RESULTS: The number of facilities surveyed ranged from six in Malawi to 36 in Zimbabwe. Eighty percent were government-run; 73% were lower-level facilities and 17% were district/referral hospitals. Client load varied widely, from less than one up to 65 HIV testing clients per provider per week. Most facilities (>80%) delivered services or interventions that would support patient retention in care such as delivering free services, offering PMTCT within antenatal care, pre-ART monitoring and adherence counselling. Many facilities under-delivered in several areas, however, such as targeted testing for high-risk groups (21%) and mobile testing (36%). There were also intra-site and inter-site differences, including in the delivery of Option B+ (ranging from 6% in Kisumu to 93% in Kyamulibwa), and nurse-led ART initiation (ranging from 50% in Kisesa to 100% in Karonga and Agincourt). Only facilities in Malawi did not require additional lab tests for ART initiation. Stock-outs of HIV test kits and antiretroviral drugs were particularly common in Tanzania. CONCLUSION: We identified a high standard of health facility performance in delivering strategies that may support progression through the continuum of HIV care. HIV testing policy and practice was particularly weak. Inter- and intra-country differences in quality and coverage represent opportunities to improve the delivery of comprehensive services to people living with HIV

Unifying Theories of Reactive Design Contracts

Design-by-contract is an important technique for model-based design in which a composite system is specified by a collection of contracts that specify the behavioural assumptions and guarantees of each component. In this paper, we describe a unifying theory for reactive design contracts that provides the basis for modelling and verification of reactive systems. We provide a language for expression and composition of contracts that is supported by a rich calculational theory. In contrast with other semantic models in the literature, our theory of contracts allow us to specify both the evolution of state variables and the permissible interactions with the environment. Moreover, our model of interaction is abstract, and supports, for instance, discrete time, continuous time, and hybrid computational models. Being based in Unifying Theories of Programming (UTP), our theory can be composed with further computational theories to support semantics for multi-paradigm languages. Practical reasoning support is provided via our proof framework, Isabelle/UTP, including a proof tactic that reduces a conjecture about a reactive program to three predicates, symbolically characterising its assumptions and guarantees about intermediate and final observations. This allows us to verify programs with a large or infinite state space. Our work advances the state-of-the-art in semantics for reactive languages, description of their contractual specifications, and compositional verification

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Thermal Imaging for Facade Performance Evaluation: Informing Decisions for SRG’s PSU School of Business Renovation

This research serves to evaluate the current condition of existing building skins on The School of Business and The School of Education at Portland State University (PSU) through infrared thermography. The buildings were constructed at two different points: The School of Education in 1979 and The School of Business in 1986. Both have had minor renovations since their construction, and each are articulated in differing materiality. Infrared thermography is best suited for the researcher’s purposes as it is non-invasive and will allow them to produce a data analysis of building structures before any deconstruction is conducted. The research will inform the project currently being designed by SRG Partnership in collaboration with Behnisch Architekten. They will be renovating both existing buildings and designing a new addition for the School of Business. Their project aims to unify the two existing buildings and the new addition while upgrading the appearance and performance of the existing buildings. Primary stakeholders for this project wish to achieve a LEED Platinum certification set by the 2012 guidelines, with the possibility of addressing key components set by the Living Building Challenge. To achieve this will require an in-depth analysis of the existing structures as well as all future proposals early in the design stages. The results of infrared testing will contribute to this analysis. The results show the greatest opportunity for improvement would be to address the School of Education. Compared to the School of Business, the facade of the education building did not perform as well, with bridging occurring more frequently and in larger areas. One of the primary goals SRG Partnership and Behnisch Architekten is the unification of the two existing buildings and the new addition, any changes to improve the performance of the education building could simultaneously contribute to the design of a more cohesive, unified composition.https://pdxscholar.library.pdx.edu/research_based_design/1031/thumbnail.jp

Bean Leaf Beetle (Ootheca spp.) (Coleoptera: Chrysomelidae) Management via Planting Timing and Insecticides

Bean leaf beetles (Ootheca spp.) (Coleoptera: Chrysomelidae) are one of Africa’s most important pests of the common bean (Phaseolus vulgaris L.). Roots, leaves, floral parts, and young pods are all attacked, leading to a considerable loss in grain yield. In Uganda, there are no comprehensive prescribed management strategies for bean leaf beetles, but farmers typically try to control the pest by delaying bean crop sowing, and to a lesser extent, using insecticides. Although farmers have consistently implemented the two approaches, there is no information on the effects of the approaches in Uganda. To assess the impact of planting timing and insecticide spray regimes on bean leaf beetle populations, concomitant foliar damage, and grain yield, we set up trials in three agro-ecological zones with known presence of the beetles during the second rainy season of 2016 (2016) and the first rainy season of 2017 (2017). The first planting, coinciding with early planting, was conducted within one week after the onset of rains. The second planting, coinciding with mid planting, followed two weeks later, while the third planting, considered late planting in this study, was conducted one month after the second planting. A foliar application of cypermethrin commencing at 7 days after emergence (DAE), 14 DAE, 21 DAE, 28 DAE, and 35 DAE; a soil drench of imidacloprid at planting combined with a foliar spray starting at 7 DAE; and an untreated control were among the insecticide spray regimes evaluated. Higher bean leaf beetle abundance was recorded from mid-planting, while higher foliar damage was recorded from late planting in two of the three agro-ecological zones. However, higher marketable grain yield was recorded from early planting in all agro-ecological zones, suggesting that delayed planting may not be beneficial. Insecticide application reduced foliar damage and increased marketable grain yield, with a combination of soil drench and foliar spray resulting in much less foliar damage and, as a result, higher grain yield. However, this did not result in economic benefits. Furthermore, marketable grain yield was higher when insecticide spray regimes were combined with early planting in all agro-ecological zones during both seasons. Our findings suggest that the common bean should be planted early and that the control of the bean leaf beetle should target both the adults and the juvenile stages in the soil. Therefore, there is a need for farmers to be able to access less-expensive soil treatments

Distribution and relative abundance of bean leaf beetles (Ootheca spp.) (Insecta: Coleoptera: Chrysomelidae) in Uganda

Bean leaf beetles (Ootheca spp.) (Insecta: Coleoptera: Chrysomelidae) are one of Africa’s most destructive pests of common bean and other leguminous crops. The beetles are widely distributed in Africa where they are estimated to cause annual crop yield losses of 116,400 tons of crop yields in sub-Saharan Africa. Despite their importance, little is known about the distribution, relative abundance and damage caused by bean leaf beetles in Uganda. As a result, the development of effective management methods has been hampered. We conducted surveys in six key Ugandan agro-ecological zones to determine the species distribution and relative abundance of bean leaf beetles. Findings indicate that leaf beetles belonging to 12 genera are present, including members of the genera Afrophthalma Medvedev, 1980, Buphonella Jacoby, 1903, Chrysochrus Chevrolat in Dejean, 1836, Diacantha Dejean, 1845, Exosoma Jacoby, 1903, Lamprocopa Hincks, 1949, Lema Fabricius, 1798, Nisotra Baly, 1864, Neobarombiella Bolz and Wagner, 2012, Ootheca Dejean, 1935, Parasbecesta Laboissière, 1940, and Plagiodera Dejean, 1835. We identified only three species belonging to the genus Ootheca: O. mutabilis, O. proteus, and O. orientalis. Seventy percent of all the beetles collected were O. mutabilis and these were present in all agro-ecological zones studied. The Northern Moist Farmlands (21.9%), West Nile Farmlands (12.9%), Central Wooded Savanna (4.4%) and Southern and Eastern Lake Kyoga Basin (1.4%) were the only agro-ecological zones where O. proteus was found. Only one specimen of O. orientalis was found at a single site in the Central Wooded Savanna. The Northern Moist Farmlands had a significantly (p < 0.05) higher bean leaf beetle density than the West Nile Farmlands and Southwestern Highlands. Similarly, the Northern Moist Farmlands had the highest beetle foliar damage per plant (1.15 - 0.05), while the Southwestern Highlands had the lowest (0.03 - 0.02). We provide the first information on Ootheca species distribution, abundance and damage in Uganda. Our findings provide a foundation for assessing the importance of Ootheca spp. as common bean pests in Uganda