Consequences of Missed Opportunities for HIV Testing during Pregnancy and Delayed Diagnosis for Mexican Women, Children and Male Partners

Introduction: HIV testing during pregnancy permits prevention of vertical (mother-to-child) transmission and provides an opportunity for women living with HIV to access treatment for their own health. In 2001, Mexico’s National HIV Action Plan committed to universal offer of HIV testing to pregnant women, but in 2011, only 45.6% of women who attended antenatal care (ANC) were tested for HIV. The study objective was to document the consequences of missed opportunities for HIV testing and counseling during pregnancy and late HIV diagnosis for Mexican women living with HIV and their families. Methods: Semi-structured-interviews with 55 women living with HIV who had had a pregnancy since 2001 were completed between 2009 and 2011. Interviews were analyzed thematically using a prioriand inductive codes. Results: Consistent with national statistics, less than half of the women living with HIV (42%) were offered HIV testing and counseling during ANC. When not diagnosed during ANC, women had multiple contacts with the health-care system due to their own and other family members’ AIDS-related complications before being diagnosed. Missed opportunities for HIV testing and counseling during antenatal care and health-care providers failure to recognize AIDS-related complications resulted in pediatric HIV infections, AIDS-related deaths of children and male partners, and HIV disease progression among women and other family members. In contrast, HIV diagnosis permitted timely access to interventions to prevent vertical HIV transmission and long-term care and treatment for women living with HIV. Conclusions: Omissions of the offer of HIV testing and counseling in ANC and health-care providers’ failure to recognize AIDS-related complications had negative health, economic and emotional consequences. Scaling-up provider-initiated HIV testing and counseling within and beyond antenatal care and pre-service and in-service trainings on HIV and AIDS for health-care providers can hasten timely HIV diagnosis and contribute to improved individual and public health in Mexico

A study to assess the exercise heart rate and the level of rate of perceived exertion responses to aerobic exercise training in post CABG individuals

INTRODUCTION: Coronary artery bypass graft surgery is one of the most frequently performed surgical procedure. Supervised exercise programme have been recommended to facilitate recovery immediately after surgery. Cardiac rehabilitation is a widely accepted form of management for patient with cardiac disease. Cardiac rehabilitation is a process of restoring psychological, physical and social functions in people with manifestations of a coronary artery disease. In past 40 years there has been a profound shift from the conservative approach that discouraged physical activity in cardiac patients to one which encourage as much activity as the patients symptoms and medical status allow. In patients who have undergone a coronary artery bypass graft surgery, activities can decrease post surgical stiffness and prevent complications and decrease the incidence of severity of depression and anxiety and also improve self esteem. AIM OF THE STUDY: To assess the exercise heart rate & the level of rate of perceived exertion responses to aerobic exercise in post CABG individuals. NEED FOR THE STUDY: Coronary artery disease is the most common problem being faced by the people in the modern materialistic world. Exercise training increases cardio vascular functional capacity and decreases myocardial oxygen demand at any level of physical activity in apparently healthy persons and in most individuals with cardiovascular with cardiovascular disease. Regular aerobic exercise is required to maintain these training effects. The main aim of the study is to assess the exercise heart rate & the level of rate of perceived exertion responses to aerobic exercise training in post CABG individuals. METHODOLOGY: STUDY SETTING: The study was conducted in the out patient physical therapy department of Government Rajaji Hospital, Madurai. STUDY SAMPLE: Fifteen male CABG patients were selected by purposeful sampling method from Government Rajaji Hospital, Madurai. RESEARCH APPROACH: This study is a prospective study with an experimental same subject research design. CRITERIA FOR SELECTION: Inclusion Criteria: Asymptomatic low risk, uncomplicated male CABG individuals between age groups of 55 -70 years were included who are medically stable, uncomplicated and should have undergone traditional aerobic training for twelve weeks. Exclusion Criteria: Women and patients with the recent symptoms of angina or ischemia are excluded. Smokers and alcoholic patients, and patients with uncontrolled hypertension, dysrythrmias, congestive heart failure, moderate and high risk patients and with other complications are also excluded. RESULTS: Table 1 shows the comparison of exercise heart rate in the first training session to the last training session after 8 weeks. The mean value for exercise heart rate during first training session is noted 86.4, the standard deviation 3.807. The mean value for exercise heart rate during the last training session is noted 83.46, the standard deviation 3.544. The ‘t’ value was calculated to be at highly significant level 11 (P < 0.05). This suggests there is significant difference in exercise heart rate while comparing the first and the last training session. The Bar graph I shows the mean value for the exercise heart rate in the first training session and the mean value in the last training session. The mean value has a significant reduction from 86.4 in the first training session to 83.46 in the last training session. Table II shows the comparison of RPE level in the first training session to the RPE level in last training session after 8 weeks. The mean value for RPE level during the first training session is 12.06 and the standard deviation is noted to be 1.077. The mean value for RPE level during last training session is 9.93 and the standard deviation noted to be 1.06. CONCLUSION AND RECOMMENDATION: To conclude, the study showed that there was significant reduction in exercise heart rate and RPE levels responses when aerobic exercise training was given to post CABG individuals under going cardiac rehabilitation. There are various evidences that support the effectiveness of aerobic exercise training to post CABG patients. But the efficiency and safety benefits to women, older patients with low aerobic fitness, severe left ventricular dysfunction remain still unclear. Owing to lack of data unavailable, routine application of aerobic exercise training in moderate to high risk cardiac patients cannot be recommended at this time and requires additional study. Further studies can be done to analyse their effects also. This study was done by giving aerobic exercise training 8 weeks initially to produce moderate fatigue and further studies can be done with progressive time & speed used to train patients to volitional fatigue. The period of study is 8 weeks. It can also be aimed to increase the weeks also walking only prescribed other exercise are also included

Technical Brief: Fulfilling the sexual and reproductive rights of women living with HIV, preventing coerced and forced sterilization

The purpose of this technical brief is to promote gender-transformative, rights-based and scientifically accurate information for advocacy and service-delivery to fulfil the sexual and reproductive rights of women, girls and people who have the capacity to become pregnant, who are living with HIV. In doing so, we also aim to provide sufficient evidence to prevent sexual and reproductive rights violations, especially coerced and/or forced sterilization against those living with HIV. The technical brief documents that coerced and/or forced sterilization of women living with HIV is a persistent and serious human rights violation requiring urgent action.The brief reviews components of comprehensive sexual and reproductive health (SRH) service delivery and international medical guidance to uphold and fulfil the sexual and reproductive health and rights of women living with HIV to choose if and when to have children. This brief is primarily intended to inform IPPF Member Associations, secretariat staff, and partners including other SRH service delivery organizations and stakeholders. The brief reinforces IPPF's position and commitment to person-centred and rights-based HIV care that is integrated within a comprehensive package of SRH services

Prevalence of low back pain and associated factors among taxi drivers in Johor Bahru

Low back pain is one of the common musculoskeletal disorders affecting taxi drivers in the transportation sector. The problem is frequently associated with prolonged sitting while driving, whole body vibration and manual handling of goods to be delivered. There are approximately 73,893 licences issued for taxi drivers in Malaysia and 10.5% of them are based in the Johor Bahru, most probably due to located in town and near to Singapore. The main objective of this study was to determine the prevalence of low back pain and associated factors among taxi drivers in Johor Bahru for the year 2012. The sample size required for this study was 228 respondents but only 224 respondents were managed to be approached for administration of assisted questionnaire. The response rate of this study was 98.2%. Results showed that the prevalence of low back pain in the past twelve months was 49.1%. Majority of the respondents were Malay (84.4%), and nonsmokers (90.2%). The prevalence of low back pain was higher among those who drove Wira taxis (55.5%), Indian and other ethnicities (56.0%). There was a significant association between low back pain and marital status. Abnormal Body Mass Index (BMI) status was significantly related to low back pain as well, supporting the postulated hypotheses. The study also revealed significant association between low back pain and manual handling, which includes lifting, bending and twisting the lower back. There was a higher prevalence of low back pain among taxi drivers who are not satisfied with their work (66.7%) and among those who lack support at work (53.8%). It was also found that the taxi drivers are highly aware of the low back pain problem and in need for early prevention and treatment. Therefore, necessary interventions need to be implemented to reduce the prevalence of low back pain among taxi drivers to retain them in the job and enhance productivit

Water Responsive Mechano-adaptive Elastomer Composites based on Active Filler Morphology

Mechanically adaptable elastomer composites are a class of stimuli responsive polymer composites which can reversibly change its mechanical properties when it comes in contact with stimuli like electric field, light, water, solvents, ions and others. Mechanically adaptable composites are mainly inspired from the sea cucumber dermis which has the ability to change the stiffness of its dermis rapidly and reversibly (connecting tissue) when it is immersed in water. In this work, efforts have been made to develop mechano-adaptive elastomer composites using water as stimuli. In such a case, elastomer composite should absorb water significantly, in order to respond quickly to the stimuli. Therefore, as a first step, stable and repeatable water swellable elastomer composites have been developed by blending epichlorohydrin terpolymer (GECO) with an ethylene oxide based hydrophilic polymer resin (GEPO). Two different approaches have been thereafter explored to develop mechano-adapative composites based on the developed water swellable elastomer composite. In the first approach, the solid–liquid phase transition of the absorbed water is used to tune mechanical properties around 0 °C. The solidified absorbed water (ice crystals) below 0 °C, acts as reinforcing filler, enhancing the mechanical properties (hard state). The ice crystals liquefy above 0 °C and plasticize the polymer chain, thereby reducing the mechanical properties (soft state). In the second approach, the polymorphic transition of calcium sulphate (CaSO4) in presence of water/heat have been exploited by dispersing it as filler in the developed water swellable elastomer composite. Mechanical adaptability is realized by the reinforcement caused when the composite is exposed to water treatment process. Further, this mechanical strength (reinforcement) can be brought back to its initial soft state (unreinforced state) by the heat treatment process. This reversible reinforcing and non-reinforcing ability of the calcium sulphate filler is attributed to the differences in polymer–filler interaction, due to the in situ morphology transformation (micro to nano) of the filler particles. This study reveals the possibility of utilizing conventional rubber technology in developing mechanically adaptable composites with an easily accessible stimulus like water. The two strategies explored here present huge opportunities in developing future smart materials.:Contents 1 Introduction 1 1.1 General introduction 1 1.2 Aim and motivation of the work 3 1.3 Scope of the work 5 2 Literature review 7 2.1 Mechanically adaptive polymer composites 7 2.1.1 Mechanical adaptability triggered by different stimuli 7 2.1.2 Water induced mechano-adaptive composites 10 2.1.3 Possible future applications of mechanically adaptive systems 14 2.2 Water absorption in elastomer composites 16 2.2.1 Strategies used for developing water swellable elastomer composites 17 2.2.2 States of water present in the polymers 20 2.2.3 Effect of water absorption on the thermal and mechanical properties 22 2.2.4 Kinetics of diffusion of water in the hydrophilic polymers 24 2.2.5 Application of water swellable elastomer composites 25 2.3 Calcium sulphate and its polymorphic transition 26 3 Experimental 30 3.1 Materials 30 3.1.1 Polymers 30 3.1.2 Fillers 31 3.2 Preparation of rubber composites 32 3.2.1 Compounding and mixing 32 3.2.2 Curing study and molding 34 3.3 Characterization 35 3.3.1 Water swelling studies 35 3.3.2 Thermal analysis (DSC and TGA) 36 3.3.3 Dynamic mechanical analysis (DMA) 36 3.3.4 Stress–strain studies 37 3.3.5 Fourier transform infrared spectroscopy (FTIR) 38 3.3.6 Morphological analysis 39 3.3.7 X-ray diffraction (XRD) 40 3.3.8 Raman spectroscopy 40 4 Results and discussions 42 4.1 Development of novel water swellable elastomer composites based on GECO/GEPO 42 4.1.1 Miscibility of the polymer blend (GECO/GEPO) systems 42 4.1.2 Water absorption behavior of GECO/GEPO blends 49 4.1.3 Effect of water swelling on thermal and mechanical properties 54 4.1.4 Cyclic water swellable characteristics 58 4.2 Thermo-responsive mechano-adaptable composites based on solid–liquid phase transition of absorbed water. 60 4.2.1 Quantitative analysis of in situ formed ice crystals 61 4.2.2 Characterization of the filler (ice crystals) morphology 64 4.2.3 Polymer–filler interaction 68 4.2.4 Mechanical adaptability analysis 71 4.3 Utilization of in situ polymorphic alteration of the filler structure in designing mechanically adaptive elastomer composites 77 4.3.1 Process and conditions for mechanical adaptability 79 4.3.2 Investigation of phase transition characteristics of CaSO4 filler 83 4.3.3 In situ morphology transformation analysis 86 4.3.4 Mechanical adaptability investigations 89 5 Conclusions and outlook 96 5.1 Conclusions 96 5.2 Outlooks 99 6 References 100 7 Appendix 109 8 Abbreviations 111 9 Symbols 114 10 Figures 117 11 Tables 123 12 Publications 124Mechanisch-adaptive Elastomer-Verbundwerkstoffe sind eine Klasse von stimuli-responsiven Polymer-Verbundwerkstoffen, welche ihre mechanischen Eigenschaften reversibel verändern können, wenn sie mit Stimuli, wie z.B. einem elektrischem Feld, Licht, Wasser, Lösungsmitteln oder Ionen angeregt werden. Mechanisch anpassbare Verbundwerkstoffe sind hauptsächlich von der Haut der Seegurke inspiriert, welche in der Lage ist, die Steifigkeit ihrer Dermis (Bindegewebe) beim Eintauchen in Wasser schnell und reversibel zu verändern. Ziel dieser Arbeit war, mechanisch-adaptive Elastomer-Verbundwerkstoffe zu entwickeln, welche Wasser als Stimulus nutzen. Für diese Anwendung sollte das Elastomermaterial Wasser in einer signifikanten Menge aufnehmen können, um schnell auf den externen Reiz zu reagieren. Daher wurden in einem ersten Schritt stabile und reversibel wasserquellbare Elastomerblends hergestellt, indem ein Epichlorhydrin-Terpolymer (GECO) mit einem hydrophilen Polymerharz auf Ethylenoxidbasis (GEPO) verschnitten wurde. In der Folge wurden zwei verschiedene Ansätze zur Entwicklung mechanisch-adaptiver Verbundwerkstoffe auf Basis des so entwickelten wasserquellbaren Elastomerkomposites verfolgt. Beim ersten Ansatz wird der Fest-Flüssig-Phasenübergang des aufgenommenen Wassers genutzt, um die mechanischen Eigenschaften im‚ Bereich von 0 °C einzustellen. Das erstarrte absorbierte Wasser (Eiskristalle) wirkt unter 0 °C als verstärkender Füllstoff und verbessert die mechanischen Eigenschaften (harter Zustand). Die Eiskristalle verflüssigen sich oberhalb von 0 °C und plastifizieren das Polymer, wodurch die mechanische Verstärkung wieder herabgesetzt wird (weicher Zustand). Im zweiten Ansatz wurde der polymorphe Übergang von Calciumsulfat (CaSO4) in Gegenwart von Wasser bzw. Wärme genutzt, indem es als Füllstoff in einem wasserquellbaren Elastomerkomposit dispergiert wurde. Die mechanische Adaptierbarkeit wird durch die mechanische Verstärkung erreicht, welche bei der Wasseraufnahme des Verbundwerkstoffes entsteht. Anschließend kann diese mechanische Festigkeit (Verstärkung) durch eine Wärmebehandlung wieder in ihren ursprünglichen weichen Zustand (unverstärkter Zustand) zurückgeführt werden. Diese reversible Schaltbarkeit der Verstärkungswirkung des Calciumsulfat-Füllstoffes wird auf die Unterschiede in der Polymer-Füllstoff-Wechselwirkung aufgrund der Transformation der in situ-Morphologie (Mikro zu Nano) der Füllstoffpartikel zurückgeführt. Die vorliegende Arbeit verdeutlicht die Möglichkeiten des Einsatzes konventioneller Kautschuktechnologie bei der Entwicklung mechanisch anpassbarer Komposite mit einem leicht zugänglichen Stimulus wie Wasser. Die beiden hier untersuchten Strategien eröffnen enorme Perspektiven bei der Konzeption zukünftiger intelligenter Materialien.:Contents 1 Introduction 1 1.1 General introduction 1 1.2 Aim and motivation of the work 3 1.3 Scope of the work 5 2 Literature review 7 2.1 Mechanically adaptive polymer composites 7 2.1.1 Mechanical adaptability triggered by different stimuli 7 2.1.2 Water induced mechano-adaptive composites 10 2.1.3 Possible future applications of mechanically adaptive systems 14 2.2 Water absorption in elastomer composites 16 2.2.1 Strategies used for developing water swellable elastomer composites 17 2.2.2 States of water present in the polymers 20 2.2.3 Effect of water absorption on the thermal and mechanical properties 22 2.2.4 Kinetics of diffusion of water in the hydrophilic polymers 24 2.2.5 Application of water swellable elastomer composites 25 2.3 Calcium sulphate and its polymorphic transition 26 3 Experimental 30 3.1 Materials 30 3.1.1 Polymers 30 3.1.2 Fillers 31 3.2 Preparation of rubber composites 32 3.2.1 Compounding and mixing 32 3.2.2 Curing study and molding 34 3.3 Characterization 35 3.3.1 Water swelling studies 35 3.3.2 Thermal analysis (DSC and TGA) 36 3.3.3 Dynamic mechanical analysis (DMA) 36 3.3.4 Stress–strain studies 37 3.3.5 Fourier transform infrared spectroscopy (FTIR) 38 3.3.6 Morphological analysis 39 3.3.7 X-ray diffraction (XRD) 40 3.3.8 Raman spectroscopy 40 4 Results and discussions 42 4.1 Development of novel water swellable elastomer composites based on GECO/GEPO 42 4.1.1 Miscibility of the polymer blend (GECO/GEPO) systems 42 4.1.2 Water absorption behavior of GECO/GEPO blends 49 4.1.3 Effect of water swelling on thermal and mechanical properties 54 4.1.4 Cyclic water swellable characteristics 58 4.2 Thermo-responsive mechano-adaptable composites based on solid–liquid phase transition of absorbed water. 60 4.2.1 Quantitative analysis of in situ formed ice crystals 61 4.2.2 Characterization of the filler (ice crystals) morphology 64 4.2.3 Polymer–filler interaction 68 4.2.4 Mechanical adaptability analysis 71 4.3 Utilization of in situ polymorphic alteration of the filler structure in designing mechanically adaptive elastomer composites 77 4.3.1 Process and conditions for mechanical adaptability 79 4.3.2 Investigation of phase transition characteristics of CaSO4 filler 83 4.3.3 In situ morphology transformation analysis 86 4.3.4 Mechanical adaptability investigations 89 5 Conclusions and outlook 96 5.1 Conclusions 96 5.2 Outlooks 99 6 References 100 7 Appendix 109 8 Abbreviations 111 9 Symbols 114 10 Figures 117 11 Tables 123 12 Publications 12

The relationship between human resource practices and job satisfaction among employees in credit union: A study of KKP (Koperasi Kredit Pekerja-Pekerja Berhad)

Job satisfaction among employees is an important element in any organization. Based on this agenda, this study looks upon the relationship between human resources practices and job satisfaction in non profit organization which is Koperasi Kredit Pekerja-Pekerja Berhad (KKP). The components of human resource practices such as training and development, performance appraisal, pay, promotion and career development, and benefits will be evaluated in appraising the existence of relationship between human resource practices and job satisfaction in Koperasi Kredit Pekerja-Pekerja Berhad. A total of 96 respondents were participated as sample of study by using questionnaires and the data was analyzed by “Statistical Package for Social Science” (SPSS Window) Version 20.0. The tests that involved are Pearson Correlation, Anova and Regression. The findings of the study show that components of human resources practices namely training and development, performance appraisal, pay, and promotion and career development have significant relationship over job satisfaction in Koperasi Kredit Pekerja-Pekerja Berhad. Furthermore, through regression analysis, the component of pay has been identified as the most influential instrument that determines the level of job satisfaction compared to other variables in Koperasi Kredit Pekerja-Pekerja Berhad. At the same time, it is suggested in this research that further study to be conducted in larger scale in order to provide an overall analysis of human resources practices and job satisfactions among credit unions in Malaysi

Drug induced bullous fixed drug eruption: a case report

Bullous fixed drug eruption, which is a cutaneous adverse drug reaction, is commonly seen with antimicrobials and analgesics. Bullous drug eruptions are infrequent, but because they pose a challenge both to affected patients and to treating physicians, they are considered to be the most severe cutaneous adverse reactions (SCAR). It is important to recognize these conditions and to differentiate them from other clinical entities involving blister formation. There may be early signs and symptoms that indicate a severe bullous drug eruption even before blisters and erosions of the skin and mucous membranes become obvious. Once the diagnosis is suspected, appropriate diagnostic procedures and adequate management must be initiated. The latter includes identification of the potentially inducing drug, although it should be taken into account that not all cases of bullous eruptions are drug-induced. In cases with drug causality the potentially culprit agent must be withdrawn, while in cases with other aetiology the underlying condition, e.g. an infection, must be treated appropriately. In addition to best supportive care, immunomodulating therapy may be considered. Here we report 64-year-old male with bullous fixed drug eruptions due to doxycycline administration

Methodology for development of drought Severity-Duration-Frequency (SDF) Curves

Drought monitoring and early warning are essential elements impacting drought sensitive sectors such as primary production, industrial and consumptive water users. A quantitative estimate of the probability of occurrence and the anticipated severity of drought is crucial for the development of mitigating strategies. The overall aim of this study is to develop a methodology to assess drought frequency and severity and to advance the understanding of monitoring and predicting droughts in the future. Seventy (70) meteorological stations across Victoria, Australia were selected for analysis. To achieve the above objective, the analysis was initially carried out to select the most applicable meteorological drought index for Victoria. This is important because to date, no drought indices are applied across Australia by any Commonwealth agency quantifying drought impacts. An evaluation of existing meteorological drought indices namely, the Standardised Precipitation Index (SPI), the Reconnaissance Drought Index (RDI) and Deciles was first conducted to assess their suitability for the determination of drought conditions. The use of the Standardised Precipitation Index (SPI) was shown to be satisfactory for assessing and monitoring meteorological droughts in Australia. When applied to data, SPI was also successful in detecting the onset and the end of historical droughts. Temporal changes in historic rainfall variability and the trend of SPI were investigated using non-parametric trend techniques to detect wet and dry periods across Victoria, Australia. The first part of the analysis was carried out to determine annual rainfall trends using Mann Kendall (MK) and Sen’s slope tests at five selected meteorological stations with long historical records (more than 100 years), as well as a short sub-set period (1949-2011) of the same data set. It was found that different trend results were obtained for the sub-set. For SPI trend analysis, it was observed that, although different results were obtained showing significant trends, SPI gave a trend direction similar to annual precipitation (downward and upward trends). In addition, temporal trends in the rate of occurrence of drought events (i.e. inter-arrival times) were examined. The fact that most of the stations showed negative slopes indicated that the intervals between events were becoming shorter and the frequency of events was temporally increasing. Based on the results obtained from the preliminary analysis, the trend analyses were then carried out for the remaining 65 stations. The main conclusions from these analyses are summarized as follows; 1) the trend analysis was observed to be highly dependent on the start and end dates of analysis. It is recommended that in the selection of time period for the drought, trend analysis should consider the length xvi of available data sets. Longer data series would give more meaningful results, thus improving the understanding of droughts impacted by climate change. 2) From the SPI and inter-arrival drought trends, it was observed that some of the study areas in Victoria will face more frequent dry period leading to increased drought occurrence. Information similar to this would be very important to develop suitable strategies to mitigate the impacts of future droughts. The main objective of this study was the development of a methodology to assess drought risk for each region based on a frequency analysis of the drought severity series using the SPI index calculated over a 12-month duration. A novel concept centric on drought severity-duration-frequency (SDF) curves was successfully derived for all the 70 stations using an innovative threshold approach. The methodology derived using extreme value analysis will assist in the characterization of droughts and provide useful information to policy makers and agencies developing drought response plans. Using regionalisation techniques such as Cluster analysis and modified Andrews curve, the study area was separated into homogenous groups based on rainfall characteristics. In the current Victorian application the study area was separated into six homogeneous clusters with unique signatures. A set of mean SDF curves was developed for each cluster to identify the frequency and severity of the risk of drought events for various return periods in each cluster. The advantage of developing a mean SDF curve (as a signature) for each cluster is that it assists the understanding of drought conditions for an ungauged or unknown station, the characteristics of which fit existing cluster groups. Non-homogeneous Markov Chain modelling was used to estimate the probability of different drought severity classes and drought severity class predictions 1, 2 and 3 months ahead. The non-homogeneous formulation, which considers the seasonality of precipitation, is useful for understanding the evolution of drought events and for short-term planning. Overall, this model predicted drought situations 1 month ahead well. However, predictions 2 and 3 months ahead should be used with caution. Many parts of Australia including Victoria have experienced their worst droughts on record over the last decade. With the threat of climate change potentially further exacerbating droughts in the years ahead, a clear understanding of the impact of droughts is vital. The information on the probability of occurrence and the anticipated severity of drought will be helpful for water resources managers, infrastructure planners and government policy-makers with future infrastructure planning and with the design and building of more resilient communities