An evaluation of the implementation of the 3-tiered ART monitoring system in South Africa

Background and Purpose: South Africa has the largest public antiretroviral (ART) service in the world but until recently it was unable to report from primary sources the numbers of patients on ART and was unable to monitor the program outcomes using routine data. In December 2010 the South Africa National Department of Health adopted a standardized ART monitoring strategy referred to as the 3-Tiered Strategy. The System provides facilities with different options for cohort monitoring based on the resources and infrastructure available. The technical design of the three tiers is pragmatic and appropriate to the facility-level context. The process to implement the System was articulated through an implementation plan. The health management information system was aligned to collate data produced by the System and standard operating procedures were produced to guide system use. Methods: The study comprised a mixed-methods approach to evaluate the implementation of the system in accordance with the implementation plan. Program data were analysed, program documents were reviewed and key informants were interviewed in order to capture the complex and multidimensional nature of the countrywide implementation activities. Results: By October 2014 full implementation had been achieved in 2,139 ART facilities, of a total 3,772 facilities that report ART data. And, of facilities that had reached full implementation, 87% of facilities had submitted data. At the time of analysis, the outcome data available were representative of 55% of active patients on ART. Qualitative results elicited facility-level challenges as well as structural barriers to effective implementation. The study demonstrated that South Africa's introduction of the 3-Tiered Strategy for ART monitoring was championed by senior management in the NDOH who fostered a collaborative environment and structured implementation approach which resulted in wide-scale uptake of the recommended systems, predominantly the electronic register. Conclusions: The implementation of a basics first health information system has yielded a complete set of enrolment and retention on ART data; however there are systemic and structural barriers to the sustainable production of these and additional cohort outcome data. The study has brought attention to the organizational restructuring and the holistic health system interventions required to implement such a system

Sensitivity Anaylsis and Detectability for Magnetic Resonance Elastography

This thesis is for a sensitivity analysis of magnetic resonance elastography, a hybrid imaging technique used in early-stage cancer screening. To quantitatively analyze the sensitivity, we introduce a notion of detectability, which is dened as a relative amplitude drop in a small sti tumor region. This analysis is accomplished in both the full elastic and viscoelastic models and compared with that of the simpler scalar model which is frequently used in the actual application. Some of the highlights are 1) a useful formula for detectability in terms of physical parameters, which will help the design of experiments; 2) the discrepancy between the full elastic model and the scalar model that provides a criterion when the simple scalar model is acceptable; 3) a theoretical limit of the smallest tumor that magnetic resonance elastography can reconstruct; 4) the existence of optimal frequency when the Voigt (viscoelastic) model is adopted; and 5) the limit behavior of the solution when the inclusion stiness or attenuation becomes innitely high. We expect that this detectability approach is extendable to many hybrid imaging techniques to quantify their sensitivities and cross-compare them to determine which modality is the most powerful in detecting early-stage cancer

Diversifying assessment across the ‘Two Cultures’: student-produced podcasts in Geography

Since 2008, following growing collective interest in learning technologies and pedagogy, Geography and History departments at Northumbria and Newcastle Universities have successfully incorporated student-generated podcasting into a mixture of science, humanities and social science modules across all undergraduate levels. This paper presents a number of innovative examples using this approach, with the aim of promoting student creativity and analytical skills in ways different from traditional report- or essay-based assessments. It goes on to consider some of the advantages and challenges of this alternative assessment mode, from both student and tutor perspectives, across the science-humanities divide

Internal Controls and Regulation of the Not-for-Profit Sector: Increasing Transparency for Churches

Regulation of for-profit organizations and fraud within them are commonly researched areas; however, many overlook the need for adequate internal controls and regulation of the not-for-profit sector, particularly religious not-for-profit organizations. Fraud has been a problem in this sector for a while, but it is frequently neglected due to the false sense of security that people have when dealing with not-for-profits. The not- for-profit sector is much less regulated than the for-profit sector, and religious not-for- profit organizations are not subject to any of the regulations that other not-for-profit organizations face. In order to gather appropriate data for determining ways through which fraud can be better prevented in the not-for-profit sector, an understanding of types of fraud committed and reasons for committing fraud were found through research. Cases of fraud found through research were reviewed, and the financial departments of two different churches were analyzed through the questioning of the financial director and the overview of audited financial statements. Additionally, the requirements of not-for- profits set by the IRS were researched, and the new Form 990 was studied. It was found that internal controls in churches are often lacking, especially in small churches. It was also found that religious entities are exempt from all governmental regulation, and many argue that these exemptions are constitutional. In conclusion, it was decided that these exemptions are a violation of the First Amendment to the Constitution, and they provide more opportunities for fraud in such organizations through the lack of accountability. All not-for-profit organizations should be regulated equally

Customer Perspectives on Sales Strategies: A Relational Approach

Relationship marketing strategies have long been known to affect salespeople and the customers they serve. However, there is still much to learn about the mechanisms that drive such buyer-seller relationships. This research examines how a salesperson’s behavior, relational orientation, and individual disposition dynamically interact to influence customers in the business to business marketing environment. Data collected from the customers’ point of view reveal several unique salesperson competencies and strategies that affect the buyer-seller relationship. The final dataset (n = 206) included customers’ observations about their salesperson and perceptions of relationship quality. The key findings suggest that the perceived quality of buyer and seller relationships is highly dependent on selling strategies, behaviors, and relational factors enacted by salespeople. Partial Least Squares Structural Equation Modeling was used to uncover correlations between selling strategies and critical dimensions of the customer-seller relationship. Final results indicate that selling strategies enacted by salespeople affect critical dimensions of the buyer-seller relationship. Furthermore, the effects of customers’ perceptions of relationship quality were found to correlate strongly with salesperson performance outcomes. Managerial implications of this research are far-reaching as the results provide direction for sales organizations in the way of both training and management. The impact on overall selling performance is discussed and future research directions are examined

Men’s and women’s migration in coastal Ghana

This article uses life history calendar (LHC) data from coastal Ghana and event history statistical methods to examine inter-regional migration for men and women, focusing on four specific migration types: rural-urban, rural-rural, urban-urban, and urban-rural. Our analysis is unique because it examines how key determinants of migration—including education, employment, marital status, and childbearing—differ by sex for these four types of migration. We find that women are significantly less mobile than men overall, but that more educated women are more likely to move (particularly to urban areas) than their male counterparts. Moreover, employment in the prior year is less of a deterrent to migration among women. While childbearing has a negative effect on migration, this impact is surprisingly stronger for men than for women, perhaps because women’s search for assistance in childcare promotes migration. Meanwhile, being married or in union appears to have little effect on migration probabilities for either men or women. These results demonstrate the benefits of a LHC approach and suggest that migration research should further examine men’s and women’s mobility as it relates to both human capital and household and family dynamics, particularly in developing settings.event history analysis, Ghana, life history, migration, Sub-Saharan Africa, urbanization