Globalization and the Digital Divide: The Roles of Structural Conduciveness and Global Connection in Internet Diffusion

The goal of this research is to examine the role of "modernization" (i.e., structural conduciveness) in the form of income, telephone price and structure, education, and political structures, and "global contact" in the form of world cities, trade, investment, activities of international nongovernmental organizations, and short-term exchanges of population in driving the worldwide diffusion of the Internet. Copyright (c) 2006 by the Southwestern Social Science Association.

Implementation of cervical cancer screening using visual inspection with acetic acid in rural Mozambique: successes and challenges using HIV care and treatment programme investments in Zambézia Province

Background: In order to maximize the benefits of HIV care and treatment investments in sub-Saharan Africa, programs can broaden to target other diseases amenable to screening and efficient management. We nested cervical cancer screening into family planning clinics at select sites also receiving PEPFAR support for antiretroviral therapy (ART) rollout. This was done using visual inspection with acetic acid (VIA) by maternal child health nurses. We report on achievements and obstacles in the first year of the program in rural Mozambique. Methods: VIA was taught to clinic nurses and hospital physicians, with a regular clinical feedback loop for quality evaluation and retraining. Cryotherapy using carbon dioxide as the refrigerant was provided at clinics; loop electrosurgical excision procedure (LEEP) and surgery were provided at the provincial hospital for serious cases. No pathology services were available. Results: Nurses screened 4651 women using VIA in Zambézia Province in year one of the program, more than double the Ministry of Health service target. VIA was judged positive for squamous intraepithelial lesions in 8% (n=380) of the women (9% if age ≥30 years (n=3154) and 7% if age <30 years (n=1497); p=0.02). Of the 380 VIA-positive women, 4% (n=16) had lesions (0.3% of 4651 total screened) requiring referral to Quelimane Provincial Hospital. Fourteen (88%) of these 16 women were seen at the hospital, but records were inadequate to judge outcomes. Of women screened, 2714 (58%) either had knowledge of their HIV status prior to VIA or were subsequently sent for HIV testing, of which 583 (21%) were HIV positive. Conclusions: Screening and clinical services were successfully provided on a large scale for the first time ever in these rural clinics. However, health manpower shortages, equipment problems, poor paper record systems and a limited ability to follow-up patients inhibited the quality of the cervical cancer screening services. Using prior HIV investments, chronic disease screening and management for cervical cancer is feasible even in severely resource-constrained rural Africa

The importance of scale to energy security

Energy security, once solely a local matter, has evolved into several scales of consideration – household, workplace, nation-state, and global systems. In result, energy policies addressing energy security must evolve as well. Based on discussions at a two-day workshop in Singapore, this paper summarizes four of the most important. First, in order for energy policies to embrace both efficacy and equity, they must be considered in terms of their scalar effects; second, energy security at the national level demands that each country initiate a diversity of energy supplies and an abundance of routes for energy delivery; third, establishing proper and effective policies for energy security must closely consider context if they are to be adequate and useful; fourth, energy security requires a non-linear approach to policy formation if threats and challenges are to be adequately conceptualized and addressed. All future research into energy security must explore the complex relationship between scale and energy security