WorldWideScience

Sample records for common limited resources

  1. Limited Income and Resources

    Data.gov (United States)

    U.S. Department of Health & Human Services — Information for those with limited income and resources (those who may qualify for or already have the Low Income Subsidy to lower their prescription drug coverage...

  2. Sustainability of common pool resources

    OpenAIRE

    Timilsina, Raja Rajendra; Kotani, Koji; Kamijo, Yoshio

    2017-01-01

    Sustainability has become a key issue in managing natural resources together with growing concerns for capitalism, environmental and resource problems. We hypothesize that the ongoing modernization of competitive societies, which we refer to as "capitalism," affects human nature for utilizing common pool resources, thus compromising sustainability. To test this hypothesis, we design and implement a set of dynamic common pool resource games and experiments in the following two types of Nepales...

  3. Resource Limitations Influence Growth and Vigor of Idaho Fescue, a Common Understory Species in Pacific Northwest Ponderosa Pine Forests

    Directory of Open Access Journals (Sweden)

    Craig A. Carr

    2016-12-01

    Full Text Available Alterations in under-canopy resource availability associated with elevated ponderosa pine (Pinus ponderosa Dougl. abundance can negatively influence understory vegetation. Experimental evidence linking under-canopy resource availability and understory vegetation is scarce. Yet this information would be beneficial in developing management strategies to recover desired understory species. We tested the effects of varying nitrogen (N and light availability on Idaho fescue (Festuca idahoensis Elmer, the dominant understory species in ponderosa pine/Idaho fescue plant associations in eastern Oregon. In a greenhouse experiment, two levels of N (50 kg∙N∙ha−1 and 0 kg∙N∙ha−1 and shade (80% shade and 0% shade were applied in a split-plot design to individual potted plants grown in soil collected from high abundance pine stands. Plants grown in unshaded conditions produced greater root (p = 0.0027 and shoot (p = 0.0017 biomass and higher cover values (p = 0.0378 compared to those in the shaded treatments. The addition of N had little effect on plant growth (p = 0.1602, 0.5129, and 0.0853 for shoot biomass, root biomass, and cover, respectively, suggesting that soils in high-density ponderosa pine stands that lack understory vegetation were not N deficient and Idaho fescue plants grown in these soils were not N limited. Management activities that increase under-canopy light availability will promote the conditions necessary for Idaho fescue recovery. However, successful restoration may be constrained by a lack of residual fescue or the invasion of more competitive understory vegetation.

  4. Sustainability of common pool resources.

    Science.gov (United States)

    Timilsina, Raja Rajendra; Kotani, Koji; Kamijo, Yoshio

    2017-01-01

    Sustainability has become a key issue in managing natural resources together with growing concerns for capitalism, environmental and resource problems. We hypothesize that the ongoing modernization of competitive societies, which we refer to as "capitalism," affects human nature for utilizing common pool resources, thus compromising sustainability. To test this hypothesis, we design and implement a set of dynamic common pool resource games and experiments in the following two types of Nepalese areas: (i) rural (non-capitalistic) and (ii) urban (capitalistic) areas. We find that a proportion of prosocial individuals in urban areas is lower than that in rural areas, and urban residents deplete resources more quickly than rural residents. The composition of proself and prosocial individuals in a group and the degree of capitalism are crucial in that an increase in prosocial members in a group and the rural dummy positively affect resource sustainability by 65% and 63%, respectively. Overall, this paper shows that when societies move toward more capitalistic environments, the sustainability of common pool resources tends to decrease with the changes in individual preferences, social norms, customs and views to others through human interactions. This result implies that individuals may be losing their coordination abilities for social dilemmas of resource sustainability in capitalistic societies.

  5. Common Property Resource Management, Institutional Change and ...

    African Journals Online (AJOL)

    Common Property Resource Management, Institutional Change and ... Most contemporary discussions on African development since independence forty ... theories on CPR Resource Management in a specific ecological and political setting.

  6. Controlling percolation with limited resources

    Science.gov (United States)

    Schröder, Malte; Araújo, Nuno A. M.; Sornette, Didier; Nagler, Jan

    2017-12-01

    Connectivity, or the lack thereof, is crucial for the function of many man-made systems, from financial and economic networks over epidemic spreading in social networks to technical infrastructure. Often, connections are deliberately established or removed to induce, maintain, or destroy global connectivity. Thus, there has been a great interest in understanding how to control percolation, the transition to large-scale connectivity. Previous work, however, studied control strategies assuming unlimited resources. Here, we depart from this unrealistic assumption and consider the effect of limited resources on the effectiveness of control. We show that, even for scarce resources, percolation can be controlled with an efficient intervention strategy. We derive such an efficient strategy and study its implications, revealing a discontinuous transition as an unintended side effect of optimal control.

  7. Gulf Canada Resources Limited 1998 annual report

    International Nuclear Information System (INIS)

    1999-01-01

    A review of operations in 1998 and financial information from Gulf Canada Resources Limited is provided to keep shareholders abreast of company performance. Gulf Canada Resources Limited explores for, develops, produces and markets conventional and synthetic crude oil, natural gas and natural gas liquids. In 1998, the company's main operating centres were in western Canada (where it owns a nine per cent interest in the Syncrude Joint Venture), Indonesia, the North Sea and Australia. The report summarizes the company's energy resource activities, presents a detailed review of operations, and provides consolidated financial statements, and common share information. Although Gulf Canada Resources sold $ 1.2 billion worth of non-producing assets during the year, year end proved reserves of 838 million barrels of oil equivalent were less than ten per cent lower than a year earlier, reflecting reserve additions of 100 million barrels of oil equivalent. tabs., figs

  8. Prospective Optimization with Limited Resources.

    Science.gov (United States)

    Snider, Joseph; Lee, Dongpyo; Poizner, Howard; Gepshtein, Sergei

    2015-09-01

    The future is uncertain because some forthcoming events are unpredictable and also because our ability to foresee the myriad consequences of our own actions is limited. Here we studied how humans select actions under such extrinsic and intrinsic uncertainty, in view of an exponentially expanding number of prospects on a branching multivalued visual stimulus. A triangular grid of disks of different sizes scrolled down a touchscreen at a variable speed. The larger disks represented larger rewards. The task was to maximize the cumulative reward by touching one disk at a time in a rapid sequence, forming an upward path across the grid, while every step along the path constrained the part of the grid accessible in the future. This task captured some of the complexity of natural behavior in the risky and dynamic world, where ongoing decisions alter the landscape of future rewards. By comparing human behavior with behavior of ideal actors, we identified the strategies used by humans in terms of how far into the future they looked (their "depth of computation") and how often they attempted to incorporate new information about the future rewards (their "recalculation period"). We found that, for a given task difficulty, humans traded off their depth of computation for the recalculation period. The form of this tradeoff was consistent with a complete, brute-force exploration of all possible paths up to a resource-limited finite depth. A step-by-step analysis of the human behavior revealed that participants took into account very fine distinctions between the future rewards and that they abstained from some simple heuristics in assessment of the alternative paths, such as seeking only the largest disks or avoiding the smaller disks. The participants preferred to reduce their depth of computation or increase the recalculation period rather than sacrifice the precision of computation.

  9. Prospective Optimization with Limited Resources.

    Directory of Open Access Journals (Sweden)

    Joseph Snider

    2015-09-01

    Full Text Available The future is uncertain because some forthcoming events are unpredictable and also because our ability to foresee the myriad consequences of our own actions is limited. Here we studied how humans select actions under such extrinsic and intrinsic uncertainty, in view of an exponentially expanding number of prospects on a branching multivalued visual stimulus. A triangular grid of disks of different sizes scrolled down a touchscreen at a variable speed. The larger disks represented larger rewards. The task was to maximize the cumulative reward by touching one disk at a time in a rapid sequence, forming an upward path across the grid, while every step along the path constrained the part of the grid accessible in the future. This task captured some of the complexity of natural behavior in the risky and dynamic world, where ongoing decisions alter the landscape of future rewards. By comparing human behavior with behavior of ideal actors, we identified the strategies used by humans in terms of how far into the future they looked (their "depth of computation" and how often they attempted to incorporate new information about the future rewards (their "recalculation period". We found that, for a given task difficulty, humans traded off their depth of computation for the recalculation period. The form of this tradeoff was consistent with a complete, brute-force exploration of all possible paths up to a resource-limited finite depth. A step-by-step analysis of the human behavior revealed that participants took into account very fine distinctions between the future rewards and that they abstained from some simple heuristics in assessment of the alternative paths, such as seeking only the largest disks or avoiding the smaller disks. The participants preferred to reduce their depth of computation or increase the recalculation period rather than sacrifice the precision of computation.

  10. Achieving excellence with limited resources

    International Nuclear Information System (INIS)

    Anson, L.W.; Spinney, R.W.

    1985-01-01

    The achievement of excellence in safety of nuclear power plant operation is dependent in part upon establishment of a performance-based training program. Developing such a program can be a laborious, time-consuming, and very expensive effort. Conducting job and task analyses, designing course outlines from learning objectives, developing training materials, evaluating program effectiveness and managing the training process and program through the out-years will exhaust any utility's training budget and staff. Because the achievement of excellence implies that training become in part performance-based, the question arises of how best to attain quality training yet still maintain a reasonable budget and staff workload. The answer lies not just in contracting the support necessary but making use of all available resources - training staff, contractor personnel in INPO

  11. Providing anesthesia in resource-limited settings.

    Science.gov (United States)

    Dohlman, Lena E

    2017-08-01

    The article reviews the reality of anesthetic resource constraints in low and middle-income countries (LMICs). Understanding these limitations is important to volunteers from high-income countries who desire to teach or safely provide anesthesia services in these countries. Recently published information on the state of anesthetic resources in LMICs is helping to guide humanitarian outreach efforts from high-income countries. The importance of using context-appropriate anesthesia standards and equipment is now emphasized. Global health experts are encouraging equal partnerships between anesthesia health care providers working together from different countries. The key roles that ketamine and regional anesthesia play in providing well tolerated anesthesia for cesarean sections and other common procedures is increasingly recognized. Anesthesia can be safely given in LMICs with basic supplies and equipment, if the anesthesia provider is trained and vigilant. Neuraxial and regional anesthesia and the use of ketamine as a general anesthetic appear to be the safest alternatives in low-resource countries. Environmentally appropriate equipment should be encouraged and pulse oximeters should be in every anesthetizing location. LMICs will continue to need support from outside sources until capacity building has made more progress.

  12. Declarative and Procedural Working Memory: Common Principles, Common Capacity Limits?

    Directory of Open Access Journals (Sweden)

    Klus Oberauer

    2010-10-01

    Full Text Available Working memory is often described as a system for simultaneous storage and processing. Much research – and most measures of working-memory capacity – focus on the storage component only, that is, people's ability to recall or recognize items after short retention intervals. The mechanisms of processing information are studied in a separate research tradition, concerned with the selection and control of actions in simple choice situations, dual-task constellations, or task-switching setups. both research traditions investigate performance based on representations that are temporarily maintained in an active, highly accessible state, and constrained by capacity limits. In this article an integrated theoretical framework of declarative and procedural working memory is presented that relates the two domains of research to each other. Declarative working memory is proposed to hold representations available for processing (including recall and recognition, whereas procedural working memory holds representations that control processing (i. e., task sets, stimulus-response mappings, and executive control settings. The framework motivates two hypotheses: Declarative and procedural working memory have separate capacity limits, and they operate by analogous principles. The framework also suggests a new characterization of executive functions as the subset of processes governed by procedural working memory that has as its output a change in the conditions of operation of the working-memory system.

  13. Sharing a common resource with concave benefits

    OpenAIRE

    Ambec, S.

    2006-01-01

    A group of agents enjoy concave and single-peak benefit functions from consuming a shared resource. They also value money (transfers). The resource is scarce in the sense that not everybody can consume its peak. The paper characterizes the unique (resource and money) allocation that is efficient, incentive compatible and equal-sharing individual rational. It can be implemented (i) by selling the resource or taxing extraction and redistributing the money collected equally, or (ii) by assigning...

  14. Common challenge in resource efficiency improvement

    International Nuclear Information System (INIS)

    La Motta, Sergio; Peronaci, Marcello

    2015-01-01

    Energy efficiency and technology improvements on their own will not achieve the Low Carbon Societies (LCS) goals. Thus, resource efficiency and a circular economy are keys to a low carbon society. Resource efficiency improvement potential has been analysed from the industrial and territorial management perspectives. Exploring synergies between LCS and the larger area of sustainable development and green economy, highlighting co-benefits and trade-offs, is of utmost importance to pave the way to a more equitable and largely participated low carbon transition.

  15. Design principles for global commons: Natural resources and emerging technologies

    Directory of Open Access Journals (Sweden)

    Paul C. Stern

    2011-09-01

    Full Text Available Ostrom’s design principles for managing common pool resources were developed largely by examining local commons involving natural resources. This paper enumerates several key characteristics that distinguish such commons from more complex commons involving global resources and the risks of emerging technologies. It considers the degree to which the design principles transfer to those commons and concludes that although they have considerable external validity, the list needs some modification and elaboration to apply to global resources and risk commons. A list of design principles is offered for global resource commons and the risks of emerging technologies. Applying Ostrom’s approach to global resources and emerging technologies can improve understanding and expand the solution set for these problems from international treaties, top-down national regulation, and interventions in market pricing systems to include non-governmental institutions that embody principles of self-governance.

  16. Intergroup Cooperation in Common Pool Resource Dilemmas.

    Science.gov (United States)

    Sadowski, Jathan; Spierre, Susan G; Selinger, Evan; Seager, Thomas P; Adams, Elizabeth A; Berardy, Andrew

    2015-10-01

    Fundamental problems of environmental sustainability, including climate change and fisheries management, require collective action on a scale that transcends the political and cultural boundaries of the nation-state. Rational, self-interested neoclassical economic theories of human behavior predict tragedy in the absence of third party enforcement of agreements and practical difficulties that prevent privatization. Evolutionary biology offers a theory of cooperation, but more often than not in a context of discrimination against other groups. That is, in-group boundaries are necessarily defined by those excluded as members of out-groups. However, in some settings human's exhibit behavior that is inconsistent with both rational economic and group driven cooperation of evolutionary biological theory. This paper reports the results of a non-cooperative game-theoretic exercise that models a tragedy of the commons problem in which groups of players may advance their own positions only at the expense of other groups. Students enrolled from multiple universities and assigned to different multi-university identity groups participated in experiments that repeatedly resulted in cooperative outcomes despite intergroup conflicts and expressions of group identity. We offer three possible explanations: (1) students were cooperative because they were in an academic setting; (2) students may have viewed their instructors as the out-group; or (3) the emergence of a small number of influential, ethical leaders is sufficient to ensure cooperation amongst the larger groups. From our data and analysis, we draw out lessons that may help to inform approaches for institutional design and policy negotiations, particularly in climate change management.

  17. Establishing Medical Schools in Limited Resource Settings.

    Science.gov (United States)

    Tsinuel, Girma; Tsedeke, Asaminew; Matthias, Siebeck; Fischer, Martin R; Jacobs, Fabian; Sebsibe, Desalegn; Yoseph, Mamo; Abraham, Haileamlak

    2016-05-01

    One urgent goal of countries in sub-Saharan Africa is to dynamically scale up the education and work force of medical doctors in the training institutions and health facilities, respectively. These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical education done in the context of limited resources is thus compromising the quality of graduates. In the future, a collaborative and need-based approach involving major stakeholders such as medical educators concerned, ministries, planners and policy makers is needed. This article identifies the challenges of establishing medical schools and sustaining the quality of education through rapid scale-up in Sub-Saharan Africa in the settings of limited resources. It also outlines the minimum requirements for establishing medical schools. A consensus building workshop was conducted in Bishoftu, Ethiopia, from Nov 8-12, 2013. Participants were professionals from 13 Ethiopian medical schools, and representatives of medical schools from South Sudan, Somaliland, Somalia, and Mozambique. Participants are listed in Appendix 1. The governments and stakeholders should jointly develop strategic plans and a roadmaps for opening or expanding medical schools to scale up educational resources. It is advisable that medical schools have autonomy regarding the number of student-intake, student selection, curriculum ownership, resource allocation including for infrastructure and staff development. Health science and medical curricula should be integrated within and harmonized nationally. An educational evaluation framework needs to be embedded in the curricula, and all medical schools should have Health Science Education Development Centers.

  18. Voracious transformation of a common natural resource into productive capital

    NARCIS (Netherlands)

    van der Ploeg, F.

    2010-01-01

    I analyze a power struggle where competing factions have private financial assets and deplete a common stock of natural resources with no private property rights. I obtain a feedback Nash equilibrium to the dynamic common-pool problem and obtain political variants of the Hotelling depletion rule and

  19. The promise of common pool resource theory and the reality of commons projects

    Directory of Open Access Journals (Sweden)

    Fred P. Saunders

    2014-08-01

    Full Text Available Commons projects, such as community-based natural resource management, have widespread appeal, which has enabled them to shrug off a mixed performance in practice. This paper discusses how the theoretical assumptions of common pool resource (CPR theory may have inadvertently contributed to the unfulfilled expectations of commons projects. The paper argues that the individual ‘rational resource user’, encapsulated in the CPR design principles, struggles to provide clear direction for meaningful consideration of local norms, values and interests in commons projects. The focus of CPR theory on efficiency and functionality results in a tendency in commons projects to overlook how local conditions are forged through relations at multiple scales. Commonly politically complex and changing relations are reduced to institutional design problems based on deriving the incentives and disincentives of ‘rational resource users. The corollary is that CPR theory oversimplifies the project context that it is seeking to change because it offers little or no direction to deal with the social embeddedness of resource use or implications of different stratifications.

  20. Indoor climate optimization with limited resources

    DEFF Research Database (Denmark)

    Santos, A.; Gunnarsen, Lars Bo

    This report presents experimental data and models for optimisation of the indoor climate parameters temperature, noise, draught and window opening. Results are based on experiments with human subjects performed in climate chambers at University of the Philippines. The report may assist building...... designers to balance attention and resources between the parameters of the indoor climate when resources are less than optimal....

  1. Gulf Canada Resources Limited 1996 annual report - mission 2006: possible

    International Nuclear Information System (INIS)

    1997-01-01

    Gulf Canada Resources Limited, which trades under the symbol GOU, is a publicly traded company that explores, develops, produces and markets conventional and synthetic crude oil, natural gas and natural gas liquids. In 1996, the company's main operating centres were in western Canada, Indonesia, Algeria, Australia, and the United States. This report presents an operations review for all theatres of operation, a consolidated financial statement, revenues and expenditures by source and common share information. GOU's acquisition of Clyde Petroleum in early 1997 has added significant producing assets and exploration lands in the United Kingdom, the Netherlands, Indonesia, Australia, Libya, Syria, Yemen, the Falkland Islands and Argentina. tabs., figs

  2. Pediatric Sepsis Guidelines: Summary for resource-limited countries

    Science.gov (United States)

    Khilnani, Praveen; Singhi, Sunit; Lodha, Rakesh; Santhanam, Indumathi; Sachdev, Anil; Chugh, Krishan; Jaishree, M.; Ranjit, Suchitra; Ramachandran, Bala; Ali, Uma; Udani, Soonu; Uttam, Rajiv; Deopujari, Satish

    2010-01-01

    Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3–5 years as new body of evidence accumulates. PMID:20606908

  3. Human adaptive behavior in common pool resource systems.

    Directory of Open Access Journals (Sweden)

    Gunnar Brandt

    Full Text Available Overexploitation of common-pool resources, resulting from uncooperative harvest behavior, is a major problem in many social-ecological systems. Feedbacks between user behavior and resource productivity induce non-linear dynamics in the harvest and the resource stock that complicate the understanding and the prediction of the co-evolutionary system. With an adaptive model constrained by data from a behavioral economic experiment, we show that users' expectations of future pay-offs vary as a result of the previous harvest experience, the time-horizon, and the ability to communicate. In our model, harvest behavior is a trait that adjusts to continuously changing potential returns according to a trade-off between the users' current harvest and the discounted future productivity of the resource. Given a maximum discount factor, which quantifies the users' perception of future pay-offs, the temporal dynamics of harvest behavior and ecological resource can be predicted. Our results reveal a non-linear relation between the previous harvest and current discount rates, which is most sensitive around a reference harvest level. While higher than expected returns resulting from cooperative harvesting in the past increase the importance of future resource productivity and foster sustainability, harvests below the reference level lead to a downward spiral of increasing overexploitation and disappointing returns.

  4. Institutional property rights structure, common pool resource (CPR), tragedy of the urban commons: A Review

    International Nuclear Information System (INIS)

    Ling, G; Ho, C S; Ali, H M

    2014-01-01

    There have been a plethora of researches on the significance of public open space (POS) in contributing to societies' sustainability. However, by virtue of identified maladaptive policy-based-property rights structure, such a shared good becomes vulnerable to tragedy of the urban commons (overexploitation) that subsequently leads to burgeoning number of mismanaged POS e.g., degraded and unkempt urban public spaces. By scrutinising the literatures within property rights domain and commons resources, an objective is highlighted in this paper which is to insightfully discourse institutional property rights structure pertaining to the mechanism, roles and interrelationship between property-rights regimes, bundle of property rights and resource domains; types of goods on how they act upon and tie in the POS with the social quandary. In summary, urban POS tragedy can potentially be triggered by the institutional structure especially if the ownership is left under open-access resource regime and ill-defined property rights which both successively constitute the natures of Common Pool Resource (CPR) within the commons, POS. Therefore, this paper sparks an idea to policy makers that property rights structure is a determinant in sustainably governing the POS in which adaptive assignment of property regimes and property rights are impelled

  5. Institutional property rights structure, common pool resource (CPR), tragedy of the urban commons: A Review

    Science.gov (United States)

    Ling, G.; Ho, C. S.; Ali, H. M.

    2014-02-01

    There have been a plethora of researches on the significance of public open space (POS) in contributing to societies' sustainability. However, by virtue of identified maladaptive policy-based-property rights structure, such a shared good becomes vulnerable to tragedy of the urban commons (overexploitation) that subsequently leads to burgeoning number of mismanaged POS e.g., degraded and unkempt urban public spaces. By scrutinising the literatures within property rights domain and commons resources, an objective is highlighted in this paper which is to insightfully discourse institutional property rights structure pertaining to the mechanism, roles and interrelationship between property-rights regimes, bundle of property rights and resource domains; types of goods on how they act upon and tie in the POS with the social quandary. In summary, urban POS tragedy can potentially be triggered by the institutional structure especially if the ownership is left under open-access resource regime and ill-defined property rights which both successively constitute the natures of Common Pool Resource (CPR) within the commons, POS. Therefore, this paper sparks an idea to policy makers that property rights structure is a determinant in sustainably governing the POS in which adaptive assignment of property regimes and property rights are impelled.

  6. A common-pool resource experiment in acequia communities

    Directory of Open Access Journals (Sweden)

    Nejem Raheem

    2015-03-01

    Full Text Available Farmers and rural advocates in New Mexico assert that traditional irrigators are better adapted to water scarcity and variability than other communities. Data to actually test this are often scarce, but such information could be useful for planning the state’s water future, especially as climate change predictions tend toward less reliable supplies. This paper reports results from a common pool resource (CPR experiment that simulates irrigating behavior using two groups: rural irrigators and undergraduate students. Despite predictions to the opposite, there was no significant difference between mean withdrawals or predictions of other players’ behavior. On average, both groups withdrew above the social optimum but below the Nash equilibrium. This work appears to be the first example of a common pool resource experiment conducted with traditional New Mexican irrigators.

  7. Household-level heterogeneity of water resources within common-pool resource systems

    NARCIS (Netherlands)

    McCord, Paul; Dell'angelo, Jampel; Gower, Drew; Caylor, Kelly K.; Evans, Tom

    2017-01-01

    Prior work has demonstrated the ability of common property systems to sustain institutional arrangements governing natural resources over long periods of time. Much of this work has focused on irrigation systems where upstream users agree to management arrangements that distribute water resources

  8. Coping With Constraints: Achieving Effective Conservation With Limited Resources

    Directory of Open Access Journals (Sweden)

    Susan C. Walls

    2018-03-01

    Full Text Available Conservation resources have become increasingly limited and, along with social, cultural and political complexities, this shortfall frequently challenges effectiveness in conservation. Because conservation can be costly, efforts are often only initiated after a species has declined below a critical threshold and/or when statutory protection is mandated. However, implementing conservation proactively, rather than reactively, is predicted to be less costly and to decrease a species' risk of extinction. Despite these benefits, I document that the number of studies that have implemented proactive conservation around the world are far fewer than those that simply acknowledge the need for such action. I provide examples of proactive actions that can ameliorate shortfalls in funding and other assets, thus helping conservation practitioners and managers cope with the constraints that resource limitation imposes. Not all of these options are new; however, the timing of their implementation is critical for effective conservation, and the need for more proactive conservation is increasingly recognized. These actions are (1 strengthening and diversifying stakeholder involvement in conservation projects; (2 complementing time-consuming and labor-intensive demographic studies with alternative approaches of detecting declines and estimating extinction risk; and (3 minimizing future costly conservation and management by proactively keeping common species common. These approaches may not constitute a cure-all for every conservation crisis. However, given escalating rates of species' losses, perhaps a reminder that these proactive actions can reduce conservation costs, save time, and potentially thwart population declines is warranted.

  9. Coping with constraints: Achieving effective conservation with limited resources

    Science.gov (United States)

    Walls, Susan

    2018-01-01

    Conservation resources have become increasingly limited and, along with social, cultural and political complexities, this shortfall frequently challenges effectiveness in conservation. Because conservation can be costly, efforts are often only initiated after a species has declined below a critical threshold and/or when statutory protection is mandated. However, implementing conservation proactively, rather than reactively, is predicted to be less costly and to decrease a species' risk of extinction. Despite these benefits, I document that the number of studies that have implemented proactive conservation around the world are far fewer than those that simply acknowledge the need for such action. I provide examples of proactive actions that can ameliorate shortfalls in funding and other assets, thus helping conservation practitioners and managers cope with the constraints that resource limitation imposes. Not all of these options are new; however, the timing of their implementation is critical for effective conservation, and the need for more proactive conservation is increasingly recognized. These actions are (1) strengthening and diversifying stakeholder involvement in conservation projects; (2) complementing time-consuming and labor-intensive demographic studies with alternative approaches of detecting declines and estimating extinction risk; and (3) minimizing future costly conservation and management by proactively keeping common species common. These approaches may not constitute a cure-all for every conservation crisis. However, given escalating rates of species' losses, perhaps a reminder that these proactive actions can reduce conservation costs, save time, and potentially thwart population declines is warranted.

  10. Addition of multiple limiting resources reduces grassland diversity

    NARCIS (Netherlands)

    Harpole, W Stanley; Sullivan, Lauren L; Lind, Eric M; Firn, Jennifer; Adler, Peter B; Borer, Elizabeth T; Chase, Jonathan; Fay, Philip A; Hautier, Yann; Hillebrand, Helmut; MacDougall, Andrew S; Seabloom, Eric W; Williams, Ryan; Bakker, Jonathan D; Cadotte, Marc W; Chaneton, Enrique J; Chu, Chengjin; Cleland, Elsa E; D'Antonio, Carla; Davies, Kendi F; Gruner, Daniel S; Hagenah, Nicole; Kirkman, Kevin; Knops, Johannes M H; La Pierre, Kimberly J; McCulley, Rebecca L; Moore, Joslin L; Morgan, John W; Prober, Suzanne M; Risch, Anita C; Schuetz, Martin; Stevens, Carly J; Wragg, Peter D

    2016-01-01

    Niche dimensionality provides a general theoretical explanation for biodiversity-more niches, defined by more limiting factors, allow for more ways that species can coexist. Because plant species compete for the same set of limiting resources, theory predicts that addition of a limiting resource

  11. Reconceptualizing Value Creation with Limited Resources

    Directory of Open Access Journals (Sweden)

    Jim Hazy

    2008-09-01

    Full Text Available In traditional economics and finance the notion of value creation is virtually synonymous with the net present value of cash flows. Such a characterization implies that all of the uses of resource inputs, such as raw material and energy, are known and that their value is priced into commodities markets. It also fails to allow for the opportunity cost associated with the depletion of resources which, with advancing technology, might reasonably have future uses far greater in value than can be achieved at present with current technology. Stated differently, in traditional valuation analysis the option value associated with scarce resources—when new technology or knowledge can be applied to them—is not addressed. In the present work, we define technology leverage as representative of this effect. We then address the problem of sustainability of organizations by stating four propositions and examining their implications for government policy and for firm governance.

  12. Hemispheric resource limitations in comprehending ambiguous pictures.

    Science.gov (United States)

    White, H; Minor, S W

    1990-03-01

    Ambiguous pictures (Roschach inkblots) were lateralized for 100 msec vs. 200 msec to the right and left hemispheres (RH and LH) of 32 normal right-handed males who determined which of two previously presented words (an accurate or inaccurate one) better described the inkblot. Over the first 32 trials, subjects receiving each stimulus exposure duration were less accurate when the hemisphere receiving the stimulus also controlled the hand used to register a keypress response (RH-left hand and LH-right hand trials) than when hemispheric resources were shared, i.e., when one hemisphere controlled stimulus processing and the other controlled response programming. These differences were eliminated when the 32 trials were repeated.

  13. Nova Scotia Resources Limited annual report, 1992

    International Nuclear Information System (INIS)

    1992-01-01

    Nova Scotia Resources was established in 1981 by the provincial government to invest in and manage Nova Scotia's participation in petroleum, energy, and mineral development. The company and its subsidiaries hold interests in oil and gas discovery areas and producing fields in the Nova Scotia offshore, and owns producing oil and gas interests in western Canada. In June 1992, oil production began from the Cohasset project, representing Canada's first commercial offshore oil production. Nearly 4 million bbl of crude will be sold in the first production season. Work is continuing on additional producing wells; the production life of the Cohasset project is currently estimated at 6 y. Offshore exploration activity is also continuing under four exploration licenses. For the 12 months ending March 31, 1992, net earnings from western oil and gas production were $369,000. Total gross revenues from oil and gas producing properties for the year were ca $4.8 million. Other 1992 activities include active exploration for salt and potash sites with potential for underground storage of natural gas. Financial statements are included. 14 figs., 2 tabs

  14. Common accounting system for monitoring the ATLAS distributed computing resources

    International Nuclear Information System (INIS)

    Karavakis, E; Andreeva, J; Campana, S; Saiz, P; Gayazov, S; Jezequel, S; Sargsyan, L; Schovancova, J; Ueda, I

    2014-01-01

    This paper covers in detail a variety of accounting tools used to monitor the utilisation of the available computational and storage resources within the ATLAS Distributed Computing during the first three years of Large Hadron Collider data taking. The Experiment Dashboard provides a set of common accounting tools that combine monitoring information originating from many different information sources; either generic or ATLAS specific. This set of tools provides quality and scalable solutions that are flexible enough to support the constantly evolving requirements of the ATLAS user community.

  15. Common Fixed Point Theorems in Fuzzy Metric Spaces Satisfying -Contractive Condition with Common Limit Range Property

    Directory of Open Access Journals (Sweden)

    Sunny Chauhan

    2013-01-01

    Full Text Available The objective of this paper is to emphasize the role of “common limit range property” to ascertain the existence of common fixed point in fuzzy metric spaces. Some illustrative examples are furnished which demonstrate the validity of the hypotheses and degree of utility of our results. We derive a fixed point theorem for four finite families of self-mappings which can be utilized to derive common fixed point theorems involving any finite number of mappings. As an application to our main result, we prove an integral-type fixed point theorem in fuzzy metric space. Our results improve and extend a host of previously known results including the ones contained in Imdad et al. (2012.

  16. Employing Common Limit Range Property to Prove Unified Metrical Common Fixed Point Theorems

    Directory of Open Access Journals (Sweden)

    Mohammad Imdad

    2013-01-01

    Full Text Available The purpose of this paper is to emphasize the role of “common limit range property” to ascertain the existence of common fixed point in metric spaces satisfying an implicit function essentially due to the paper of Ali and Imdad (2008. As an application to our main result, we derive a fixed point theorem for four finite families of self-mappings which can be utilized to derive common fixed point theorems involving any finite number of mappings. Our results improve and extend a host of previously known results including the ones contained in the paper of Ali and Imdad (2008. We also furnish some illustrative examples to support our main results.

  17. Global Health: Preparation for Working in Resource-Limited Settings.

    Science.gov (United States)

    St Clair, Nicole E; Pitt, Michael B; Bakeera-Kitaka, Sabrina; McCall, Natalie; Lukolyo, Heather; Arnold, Linda D; Audcent, Tobey; Batra, Maneesh; Chan, Kevin; Jacquet, Gabrielle A; Schutze, Gordon E; Butteris, Sabrina

    2017-11-01

    Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships. Copyright © 2017 by the American Academy of Pediatrics.

  18. Infection control practice in countries with limited resources

    Directory of Open Access Journals (Sweden)

    Alp Emine

    2011-10-01

    Full Text Available Abstract Nosocomial infections and their control are a world-wide challenge. The prevalence of nosocomial infections is generally higher in developing countries with limited resources than industrialized countries. In this paper we aimed to further explain the differences with regard to infection control challenges between Turkey, a country with "limited" resources, and the Netherlands, a country with "reasonable" resources. Infrastructure of hospitals, low compliance of hand hygiene, understaffing, overcrowding, heavy workload, misuse of personal protective equipments, late establishment of infection control programme are major problems in limited-resources countries. These problems cause high infection rates and spread of multi-drug resistant pathogens. To improve the control and prevention of infections in countries with limited resources, a multi-facet approach is needed.

  19. Reclaiming deserted corridors: Rights of way as common property resources

    International Nuclear Information System (INIS)

    Brown, D.T.

    1993-01-01

    In Canada, power line transmission corridors are administered and maintained by provincial crown utilities. These corridors have fragmented natural habitats, destroyed biota, and disrupted geological and hydrologic systems. The practices used by utilities to maintain their rights-of-way tend to worsen the environmental and social context of the localities affected by the corridors. If the corridors are considered as common resources, and if co-management of these resources is undertaken involving the utilities and the communities affected by the corridors, public rights-of-way would be created which would have environmental benefits. These corridors would have a recreational potential and could be managed so as to reduce considerably the negative impacts presently generated by current right-of-way management practices. The use of local residents in this management process could ensure that the use of the corridors harmonizes with local needs. Among the obstacles to the co-management of these corridors are the badly defined policies of secondary land use, the restrictions on vegetation maintenance in utility corridors, lengthy approvals processes, and concerns about public liability. To make co-management of these corridors a reality, new policy structures and new procedures have to be developed in cooperation with the utilities and the affected communities. 14 refs., 1 fig

  20. Establishing Medical Schools in Limited Resource Settings | Girma ...

    African Journals Online (AJOL)

    Establishing Medical Schools in Limited Resource Settings. ... These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical ...

  1. Mental training affects distribution of limited brain resources.

    Directory of Open Access Journals (Sweden)

    Heleen A Slagter

    2007-06-01

    Full Text Available The information processing capacity of the human mind is limited, as is evidenced by the so-called "attentional-blink" deficit: When two targets (T1 and T2 embedded in a rapid stream of events are presented in close temporal proximity, the second target is often not seen. This deficit is believed to result from competition between the two targets for limited attentional resources. Here we show, using performance in an attentional-blink task and scalp-recorded brain potentials, that meditation, or mental training, affects the distribution of limited brain resources. Three months of intensive mental training resulted in a smaller attentional blink and reduced brain-resource allocation to the first target, as reflected by a smaller T1-elicited P3b, a brain-potential index of resource allocation. Furthermore, those individuals that showed the largest decrease in brain-resource allocation to T1 generally showed the greatest reduction in attentional-blink size. These observations provide novel support for the view that the ability to accurately identify T2 depends upon the efficient deployment of resources to T1. The results also demonstrate that mental training can result in increased control over the distribution of limited brain resources. Our study supports the idea that plasticity in brain and mental function exists throughout life and illustrates the usefulness of systematic mental training in the study of the human mind.

  2. Dynamic shifts of limited working memory resources in human vision.

    Science.gov (United States)

    Bays, Paul M; Husain, Masud

    2008-08-08

    Our ability to remember what we have seen is very limited. Most current views characterize this limit as a fixed number of items-only four objects-that can be held in visual working memory. We show that visual memory capacity is not fixed by the number of objects, but rather is a limited resource that is shared out dynamically between all items in the visual scene. This resource can be shifted flexibly between objects, with allocation biased by selective attention and toward targets of upcoming eye movements. The proportion of resources allocated to each item determines the precision with which it is remembered, a relation that we show is governed by a simple power law, allowing quantitative estimates of resource distribution in a scene.

  3. Crossing the quality chasm in resource-limited settings.

    Science.gov (United States)

    Maru, Duncan Smith-Rohrberg; Andrews, Jason; Schwarz, Dan; Schwarz, Ryan; Acharya, Bibhav; Ramaiya, Astha; Karelas, Gregory; Rajbhandari, Ruma; Mate, Kedar; Shilpakar, Sona

    2012-11-30

    Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm"--the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

  4. Microplastics ingestion by a common tropical freshwater fishing resource.

    Science.gov (United States)

    Silva-Cavalcanti, Jacqueline Santos; Silva, José Diego B; França, Elton José de; Araújo, Maria Christina Barbosa de; Gusmão, Felipe

    2017-02-01

    Microplastics pollution is widespread in marine ecosystems and a major threat to biodiversity. Nevertheless, our knowledge of the impacts of microplastics in freshwater environments and biota is still very limited. The interaction of microplastics with freshwater organisms and the risks associated with the human consumption of organisms that ingested microplastics remain major knowledge gaps. In this study, we assessed the ingestion of microplastics by Hoplosternum littorale, a common freshwater fish heavily consumed by humans in semi-arid regions of South America. We assessed the abundance and diversity of both plastic debris and other food items found in the gut of fishes caught by local fishermen. We observed that 83% of the fish had plastic debris inside the gut, the highest frequency reported for a fish species so far. Most of the plastic debris (88.6%) recovered from the guts of fish were microplastics (microplastics at the urbanized sections of the river, and that the ingestion of microplastics was negatively correlated with the diversity of other food items in the gut of individual fish. Nevertheless, microplastics ingestion appears to have a limited impact on H. littorale, and the consequences of human consumption of this fish were not assessed. Our results suggest freshwater biota are vulnerable to microplastics pollution and that urbanization is a major factor contributing to the pollution of freshwater environments with microplastics. We suggest the gut content of fish could be used as a tool for the qualitative assessment of microplastics pollution in freshwater ecosystems. Further research is needed to determine the processes responsible for the high incidence of microplastics ingestion by H. littorale, and to evaluate the risk posed to humans by the consumption of freshwater fish that ingested microplastics. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Natural Resources: Famine or Feast? A Question of Limits

    International Nuclear Information System (INIS)

    Desaunay, Cecile; Vidalenc, Eric

    2016-01-01

    Whereas for a decade many experts spoke of an imminent dearth pf hydrocarbons and prices reached record highs, the cost of oil has fallen appreciably over the last two years and talk of shortage has almost disappeared. Does this mean there are no longer grounds for concern about the overall level of consumption of these energy resources? Doubtless not, though these questions of dearth or abundance of energy resources - and, more broadly, of all natural resources -are not solely to be examined in terms of the reserves at our disposal, but also, increasingly, in terms of the limits that ensue from the impact of their consumption on the environment (environmental damage, pollution, climate change etc.), as Cecile Desaunay and Eric Vidalenc show here. Accordingly, they list a series of crucial key questions with regard to the future of our planet's natural resources: is the growth of global resource consumption sustainable? How might energy prices develop? Can we foresee an absolute decoupling of economic growth from material consumption? What are the impacts on our ecosystems of resource degradation; have we passed planetary limits? They go on to stress two deep-seated trends that will have to be taken into account in managing our natural resources sustainably over the coming years: the very great inertia of energy Systems and the possible substitution of alternative energies (and the limits to doing this). The equation is not getting any easier and the lever that is the control of consumption will doubtless have a crucial part to play in the sustainable management of our resources in the medium to long term. (authors)

  6. Resource Limitation, Controphic Ostracod Density and Larval Mosquito Development.

    Directory of Open Access Journals (Sweden)

    Raylea Rowbottom

    Full Text Available Aquatic environments can be restricted with the amount of available food resources especially with changes to both abiotic and biotic conditions. Mosquito larvae, in particular, are sensitive to changes in food resources. Resource limitation through inter-, and intra-specific competition among mosquitoes are known to affect both their development and survival. However, much less is understood about the effects of non-culicid controphic competitors (species that share the same trophic level. To address this knowledge gap, we investigated and compared mosquito larval development, survival and adult size in two experiments, one with different densities of non-culicid controphic conditions and the other with altered resource conditions. We used Aedes camptorhynchus, a salt marsh breeding mosquito and a prominent vector for Ross River virus in Australia. Aedes camptorhynchus usually has few competitors due to its halo-tolerance and distribution in salt marshes. However, sympatric ostracod micro-crustaceans often co-occur within these salt marshes and can be found in dense populations, with field evidence suggesting exploitative competition for resources. Our experiments demonstrate resource limiting conditions caused significant increases in mosquito developmental times, decreased adult survival and decreased adult size. Overall, non-culicid exploitation experiments showed little effect on larval development and survival, but similar effects on adult size. We suggest that the alterations of adult traits owing to non-culicid controphic competition has potential to extend to vector-borne disease transmission.

  7. Strengthening laboratory systems in resource-limited settings.

    Science.gov (United States)

    Olmsted, Stuart S; Moore, Melinda; Meili, Robin C; Duber, Herbert C; Wasserman, Jeffrey; Sama, Preethi; Mundell, Ben; Hilborne, Lee H

    2010-09-01

    Considerable resources have been invested in recent years to improve laboratory systems in resource-limited settings. We reviewed published reports, interviewed major donor organizations, and conducted case studies of laboratory systems in 3 countries to assess how countries and donors have worked together to improve laboratory services. While infrastructure and the provision of services have seen improvement, important opportunities remain for further advancement. Implementation of national laboratory plans is inconsistent, human resources are limited, and quality laboratory services rarely extend to lower tier laboratories (eg, health clinics, district hospitals). Coordination within, between, and among governments and donor organizations is also frequently problematic. Laboratory standardization and quality control are improving but remain challenging, making accreditation a difficult goal. Host country governments and their external funding partners should coordinate their efforts effectively around a host country's own national laboratory plan to advance sustainable capacity development throughout a country's laboratory system.

  8. Therapeutic drug monitoring of nevirapine in resource-limited settings.

    NARCIS (Netherlands)

    L'homme, R.F.A.; Muro, E.P.; Droste, J.A.H.; Wolters, L.R.; Ewijk-Beneken Kolmer, E.W.J. van; Schimana, W.; Burger, D.M.

    2008-01-01

    BACKGROUND: We developed a simple and inexpensive thin-layer chromatography (TLC) assay for semiquantitative detection of saliva concentrations of nevirapine in resource-limited settings. The method was validated in an African target population. METHODS: Paired plasma and saliva nevirapine

  9. The microbiological diagnosis of tuberculosis in a resource - limited ...

    African Journals Online (AJOL)

    The objective of this study is to audit the processes for the microbiological diagnosis of tuberculosis (TB) in our resource-limited setting. A total of 694 specimens were received from 333 patients. 129 (38.7%) of these patients were positive for TB. 78 (60.5%) were positive on AFB microscopy alone, 13 (10.0%) on culture ...

  10. Can the Teachers' Creativity Overcome Limited Computer Resources?

    Science.gov (United States)

    Nikolov, Rumen; Sendova, Evgenia

    1988-01-01

    Describes experiences of the Research Group on Education (RGE) at the Bulgarian Academy of Sciences and the Ministry of Education in using limited computer resources when teaching informatics. Topics discussed include group projects; the use of Logo; ability grouping; and out-of-class activities, including publishing a pupils' magazine. (13…

  11. Tuberculosis diagnosis in resource-limited settings: Clinical use of ...

    African Journals Online (AJOL)

    EB

    GeneXpert in the diagnosis of smear-negative PTB: a case report ... Background: The Xpert MTB/RIF test (GeneXpert) has recently been endorsed for use in resource-limited settings for the ... normochromic anemia (9.2g/dl), hypoalbuminemia.

  12. Infection control practice in countries with limited resources.

    NARCIS (Netherlands)

    Alp, E.; Leblebicioglu, H.; Doganay, M.; Voss, A.

    2011-01-01

    Nosocomial infections and their control are a world-wide challenge. The prevalence of nosocomial infections is generally higher in developing countries with limited resources than industrialized countries. In this paper we aimed to further explain the differences with regard to infection control

  13. The limited role of recombination energy in common envelope removal

    Science.gov (United States)

    Grichener, Aldana; Sabach, Efrat; Soker, Noam

    2018-05-01

    We calculate the outward energy transport time by convection and photon diffusion in an inflated common envelope and find this time to be shorter than the envelope expansion time. We conclude therefore that most of the hydrogen recombination energy ends in radiation rather than in kinetic energy of the outflowing envelope. We use the stellar evolution code MESA and inject energy inside the envelope of an asymptotic giant branch star to mimic energy deposition by a spiraling-in stellar companion. During 1.7 years the envelope expands by a factor of more than 2. Along the entire evolution the convection can carry the energy very efficiently outwards, to the radius where radiative transfer becomes more efficient. The total energy transport time stays within several months, shorter than the dynamical time of the envelope. Had we included rapid mass loss, as is expected in the common envelope evolution, the energy transport time would have been even shorter. It seems that calculations that assume that most of the recombination energy ends in the outflowing gas might be inaccurate.

  14. World Mineral resources and the Limits to Economic Growth

    Directory of Open Access Journals (Sweden)

    Bardi Ugo

    2014-03-01

    Full Text Available This presentation describes how the present economic situation can be described in terms of the system dynamics models developed in the series of studies that were titled “The Limits to Growth”. The result of this examination is that mineral depletion may be a major factor in causing the slowdown in economic growth in several countries. The effect is not the result of “running out” of any resource, but of the gradual increase in extraction costs which is forcing the economy to dedicate larger and larger resources to the production of mineral commodities.

  15. Vacuum-assisted closure of the open abdomen in a resource-limited ...

    African Journals Online (AJOL)

    Vacuum-assisted closure of the open abdomen in a resource-limited setting. ... Massive delays in presentation of patients with acute abdomen are common. Closure at initial laparotomy is not possible in many cases ... with an open abdomen. The management of these patients is particularly labour intensive for nursing staff.

  16. Content Integration: Creating a Scalable Common Platform for Information Resources

    Science.gov (United States)

    Berenstein, Max; Katz, Demian

    2012-01-01

    Academic, government, and corporate librarians organize and leverage internal resources and content through institutional repositories and library catalogs. Getting more value and usage from the content they license is a key goal. However, the ever-growing amount of content and shifting user demands for new materials or features has made the…

  17. Forming perceptions and the limits to public participation on ocean commons

    DEFF Research Database (Denmark)

    Hadjimichael, Maria; Delaney, Alyne

    2017-01-01

    Public views of, and public participation in, the management of commons are increasingly being recommended and sought after in environmental management processes. Yet, given the limits of today’s liberal democracy, what are the weaknesses? This article presents data from a citizens jury......-inspired deliberative workshop held to tease out stakeholder views of management priorities for a section of the North Sea: the Dogger Bank. As this article reveals, the lessons learned from the Dogger Bank workshop advocate not simply what is required for managing one particular ocean commons, but also highlight some...... of the public participation research design failings, taking public participation in resource management further by adding to the literature and theoretical discussions on the public sphere (Habermas 1989). Analysis of the citizens jury-inspired deliberative workshop also highlights the critical issue of power...

  18. Advantages and limitations of common testing methods for antioxidants.

    Science.gov (United States)

    Amorati, R; Valgimigli, L

    2015-05-01

    Owing to the importance of antioxidants in the protection of both natural and man-made materials, a large variety of testing methods have been proposed and applied. These include methods based on inhibited autoxidation studies, which are better followed by monitoring the kinetics of oxygen consumption or of the formation of hydroperoxides, the primary oxidation products. Analytical determination of secondary oxidation products (e.g. carbonyl compounds) has also been used. The majority of testing methods, however, do not involve substrate autoxidation. They are based on the competitive bleaching of a probe (e.g. ORAC assay, β-carotene, crocin bleaching assays, and luminol assay), on reaction with a different probe (e.g. spin-trapping and TOSC assay), or they are indirect methods based on the reduction of persistent radicals (e.g. galvinoxyl, DPPH and TEAC assays), or of inorganic oxidizing species (e.g. FRAP, CUPRAC and Folin-Ciocalteu assays). Yet other methods are specific for preventive antioxidants. The relevance, advantages, and limitations of these methods are critically discussed, with respect to their chemistry and the mechanisms of antioxidant activity. A variety of cell-based assays have also been proposed, to investigate the biological activity of antioxidants. Their importance and critical aspects are discussed, along with arguments for the selection of the appropriate testing methods according to the different needs.

  19. The Government Finance Database: A Common Resource for Quantitative Research in Public Financial Analysis.

    Science.gov (United States)

    Pierson, Kawika; Hand, Michael L; Thompson, Fred

    2015-01-01

    Quantitative public financial management research focused on local governments is limited by the absence of a common database for empirical analysis. While the U.S. Census Bureau distributes government finance data that some scholars have utilized, the arduous process of collecting, interpreting, and organizing the data has led its adoption to be prohibitive and inconsistent. In this article we offer a single, coherent resource that contains all of the government financial data from 1967-2012, uses easy to understand natural-language variable names, and will be extended when new data is available.

  20. Perinatal pathology: practice suggestions for limited-resource settings.

    Science.gov (United States)

    Roberts, Drucilla J

    2013-06-01

    The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

  1. Logical and physical resource management in the common node of a distributed function laboratory computer network

    International Nuclear Information System (INIS)

    Stubblefield, F.W.

    1976-01-01

    A scheme for managing resources required for transaction processing in the common node of a distributed function computer system has been given. The scheme has been found to be satisfactory for all common node services provided so far

  2. Optimising Mycobacterium tuberculosis detection in resource limited settings.

    Science.gov (United States)

    Alfred, Nwofor; Lovette, Lawson; Aliyu, Gambo; Olusegun, Obasanya; Meshak, Panwal; Jilang, Tunkat; Iwakun, Mosunmola; Nnamdi, Emenyonu; Olubunmi, Onuoha; Dakum, Patrick; Abimiku, Alash'le

    2014-03-03

    The light-emitting diode (LED) fluorescence microscopy has made acid-fast bacilli (AFB) detection faster and efficient although its optimal performance in resource-limited settings is still being studied. We assessed the optimal performances of light and fluorescence microscopy in routine conditions of a resource-limited setting and evaluated the digestion time for sputum samples for maximum yield of positive cultures. Cross-sectional study. Facility-based involving samples of routine patients receiving tuberculosis treatment and care from the main tuberculosis case referral centre in northern Nigeria. The study included 450 sputum samples from 150 new patients with clinical diagnosis of pulmonary tuberculosis. The 450 samples were pooled into 150 specimens, examined independently with mercury vapour lamp (FM), LED CysCope (CY) and Primo Star iLED (PiLED) fluorescence microscopies, and with the Ziehl-Neelsen (ZN) microscopy to assess the performance of each technique compared with liquid culture. The cultured specimens were decontaminated with BD Mycoprep (4% NaOH-1% NLAC and 2.9% sodium citrate) for 10, 15 and 20 min before incubation in Mycobacterium growth incubator tube (MGIT) system and growth examined for acid-fast bacilli (AFB). Of the 150 specimens examined by direct microscopy: 44 (29%), 60 (40%), 49 (33%) and 64 (43%) were AFB positive by ZN, FM, CY and iLED microscopy, respectively. Digestion of sputum samples for 10, 15 and 20 min yielded mycobacterial growth in 72 (48%), 81 (54%) and 68 (45%) of the digested samples, respectively, after incubation in the MGIT system. In routine laboratory conditions of a resource-limited setting, our study has demonstrated the superiority of fluorescence microscopy over the conventional ZN technique. Digestion of sputum samples for 15 min yielded more positive cultures.

  3. A cohort study of employees of Eldorado Resources Limited

    International Nuclear Information System (INIS)

    Howe, G.R.; Abbatt, J.D.

    1985-01-01

    This study has determined the mortality experience of Eldorado Resources Limited employees between 1950 and 1980. This crown corporation is involved in the mining and processing of uranium products. An initial analysis shows significant excesses of lung cancer deaths at Port Raduim and Beaverlodge mines and a smaller, nonsignificant excess at the Port Hope refinery. The lung-cancer mortality has been analyzed as a function of radon-daughter exposure. This initial analysis is currently being refined to further develop estimates of excess risk

  4. Human Resource and Nuclear Awareness Development: A Common Synergetic Approach

    International Nuclear Information System (INIS)

    Dreimanis, A.

    2016-01-01

    Full text: The nuclear education problem is treated as societal optimization task of nuclear energy management, with the key parameter of optimization—stakeholder awareness level. As the key principles of optimisation are chosen: a self-organization concept, the principle of the requisite variety, where as a primary source of growth of internal variety is information and knowledge. We have shown: public education, social learning and the use of mass media are efficient self-organization mechanisms, thereby forming a knowledge-creating community. Such a created knowledge could facilitate solution of key issues: a) public acceptance of novel nuclear objects, b) promotion of adequate risk perception, and c) fostering of interest to nuclear energy. Comprehensive knowledge management and informational support firstly is needed in: a) for increasing general nuclear awareness and confidence level to nuclear activities, b) personnel education and training, c) reliable staff renascence, d) public education and involvement of all stakeholder categories in decision making, e) risk management. A common approach to nuclear education should include also comprehensive research activities, thereby joining knowledge acquisition with the generation of novel advanced knowledge. (author

  5. Consequences of habitat change and resource selection specialization for population limitation in cavity-nesting birds

    Science.gov (United States)

    Martin, Thomas E.

    2015-01-01

    Resource selection specialization may increase vulnerability of populations to environmental change. One environmental change that may negatively impact some populations is the broad decline of quaking aspen Populus tremuloides, a preferred nest tree of cavity-nesting organisms who are commonly limited by nest-site availability. However, the long-term consequences of this habitat change for cavity-nesting bird populations are poorly studied.

  6. Global patient safety and antiretroviral drug-drug interactions in the resource-limited setting.

    Science.gov (United States)

    Seden, Kay; Khoo, Saye H; Back, David; Byakika-Kibwika, Pauline; Lamorde, Mohammed; Ryan, Mairin; Merry, Concepta

    2013-01-01

    Scale-up of HIV treatment services may have contributed to an increase in functional health facilities available in resource-limited settings and an increase in patient use of facilities and retention in care. As more patients are reached with medicines, monitoring patient safety is increasingly important. Limited data from resource-limited settings suggest that medication error and antiretroviral drug-drug interactions may pose a significant risk to patient safety. Commonly cited causes of medication error in the developed world include the speed and complexity of the medication use cycle combined with inadequate systems and processes. In resource-limited settings, specific factors may contribute, such as inadequate human resources and high disease burden. Management of drug-drug interactions may be complicated by limited access to alternative medicines or laboratory monitoring. Improving patient safety by addressing the issue of antiretroviral drug-drug interactions has the potential not just to improve healthcare for individuals, but also to strengthen health systems and improve vital communication among healthcare providers and with regulatory agencies.

  7. Caring for the injured child in settings of limited resource.

    Science.gov (United States)

    Stephenson, Jacob

    2016-02-01

    Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. Published by Elsevier Inc.

  8. Management of Common Resources and Reciprocity: the contributions of Elinor Ostrom to the Debate

    Directory of Open Access Journals (Sweden)

    Eric Sabourin

    2010-12-01

    Full Text Available This paper analyzes the importance of reciprocity in the processes and procedures recorded in the management of common resources. It examines first the role that E. Ostrom attributes to the norm of reciprocity in her approach to common property resources. A second part interprets economic and social relations in the management of common resources as seen by economic anthropology’s theory of reciprocity. Finally, the conclusion attempts to establish a dialogue between Ostrom’s proposals and the theory of reciprocity.

  9. IAEA Assistance on Decommissioning of Small Facilities with Limited Resources

    International Nuclear Information System (INIS)

    Batandjieva, B.; Warnecke, E.

    2008-01-01

    The number of facilities reaching their lifetime is increasing and drawing the attention of operators, regulators, public and other interested parties (potential users of the site after decommissioning) on the importance of adequate planning, funding and implementation of decommissioning activities in compliance with regulatory requirements and criteria. Specific attention is required for small facilities that have been used for research purposes and in most cases state owned by and dependent on state funding. With the current tendency for expansion of the nuclear industry such small facilities could become less of importance for the operators which can increase the probability that these facilities become abandoned, hazardous and imposing undue burden to future generations. This concern is more related to countries with limited human and financial resources at the operating organizations and the regulatory body. The International Atomic Energy Agency (IAEA) has been working on the; (i) establishment of internationally recognized safety standards on decommissioning and (ii) providing Member States with assistance on the application of these standards. The recent international conference on Lessons Learned from the Decommissioning of Nuclear Facilities and the Safe Termination of Practices (Athens, Greece, 2006) has demonstrated that the set of IAEA standards is almost complete and that the International Action Plan on Decommissioning (2004), that is addressing decommissioning of small facilities, is being successfully implemented. However the need for further assistance on decommissioning of small facilities in countries with limited resources was also recognized and the Agency is planning its future work in this field. The IAEA also addresses the needs of small nuclear countries that have only a limited number of nuclear facilities, e.g. a research reactor, in its R esearch Reactor Decommissioning Demonstration Project (R 2 D 2 P. The Philippine Research Reactor

  10. Internet-Based commons of intellectual resources : An exploration of their variety

    NARCIS (Netherlands)

    de laat, Paul B.; J. Berleur,; M.I. Nurminen,; J. Impaglizzo,

    2006-01-01

    During the two last decades, speeded up by the development of the Internet, several types of commons have been opened up for intellectual resources. In this article their variety is being explored as to the kind of resources and the type of regulation involved. The open source software movement

  11. Managing a Common Pool Resource: Real Time Decision-Making in a Groundwater Aquifer

    Science.gov (United States)

    Sahu, R.; McLaughlin, D.

    2017-12-01

    In a Common Pool Resource (CPR) such as a groundwater aquifer, multiple landowners (agents) are competing for a limited resource of water. Landowners pump out the water to grow their own crops. Such problems can be posed as differential games, with agents all trying to control the behavior of the shared dynamic system. Each agent aims to maximize his/her own personal objective like agriculture yield, being aware that the action of every other agent collectively influences the behavior of the shared aquifer. The agents therefore choose a subgame perfect Nash equilibrium strategy that derives an optimal action for each agent based on the current state of the aquifer and assumes perfect information of every other agents' objective function. Furthermore, using an Iterated Best Response approach and interpolating techniques, an optimal pumping strategy can be computed for a more-realistic description of the groundwater model under certain assumptions. The numerical implementation of dynamic optimization techniques for a relevant description of the physical system yields results qualitatively different from the previous solutions obtained from simple abstractions.This work aims to bridge the gap between extensive modeling approaches in hydrology and competitive solution strategies in differential game theory.

  12. Limited Resources, Limited Opportunities, and the Accumulation of Disadvantage: Evidence from the Global Survey of Physicists

    Science.gov (United States)

    Ivie, Rachel

    2012-03-01

    Using the results of the Global Survey of Physicists, which we conducted in collaboration with the International Union of Pure and Applied Physics Working Group on Women, we document the effect of limited resources and opportunities on women physicists' careers. We find that women respondents are less likely than men to report access to a variety of resources and opportunities that would be helpful in advancing a scientific career. These include access to funding, travel money, lab and office space, equipment, clerical support, and availability of employees or students to help with research. When asked about specific opportunities, women report fewer invited talks and overseas research opportunities. Women who responded are less likely to have been journal editors, acted as bosses or managers, advised graduate students, served on thesis or dissertation committees, and served on committees for grant agencies. We also show the disproportionate effects of children on women physicists' careers. Women who responded are more likely than men to have changed their work situations upon becoming parents. Mothers are more likely than men and women without children to report that their careers have progressed more slowly than colleagues who finished their degrees at the same time. Furthermore, women are more likely than men to report that their careers affected the decisions they made about marriage and children. The results of this survey draw attention to the need to focus on factors other than representation when discussing the situation of women in physics. 15,000 physicists in 130 countries answered this survey, and across all these countries, women have fewer resources and opportunities and are more affected by cultural expectations concerning child care. Cultural expectations about home and family are difficult to change. However, for women to have successful outcomes and advance in physics, they must have equal access to resources and opportunities.

  13. Sytemic lupus erythematosus presenting with protein losing enteropathy in a resource limited centre: a case report

    Directory of Open Access Journals (Sweden)

    Ratnayake Eranda C

    2012-01-01

    Full Text Available Abstract Introduction Systemic lupus erythematosus is a disease which may initially present with varying symptoms, most commonly a photosensitive rash and arthritis. Protein losing enteropathy is a recognized but rare presenting manifestation. Diagnosing protein losing enteropathy in resource limited centres is challenging but possible through the exclusion of other possible causes of hypoalbunaemia. Case Presentation We report a case of protein losing gastroenteropathy secondary to intestinal lymphangiectasia as the initial manifestation of systemic lupus erythematosus in a 57 year old Sri Lankan (South Asian male patient. The diagnosis was made by the exclusion of other causes of hypoalbuminaemia as the gold standard investigations for protein losing enteropathy were not available at this centre. Conclusions Protein losing enteropathy is a diagnosis of exclusion in resource limited centres in the world. Systemic lupus erythematosus should be considered in the differential diagnosis of protein losing enteropathy. Intestinal lymphangiectasia should also be recognized as a possible pathophysiological mechanism.

  14. Governing the management and use of pooled microbial genetic resources: Lessons from the global crop commons

    Directory of Open Access Journals (Sweden)

    Michael Halewood

    2010-01-01

    Full Text Available The paper highlights lessons learned over the last thirty years establishing a governance structure for the global crop commons that are of relevance to current champions of the microbial commons. It argues that the political, legal and biophysical situation in which microbial genetic resources (and their users are located today are similar to the situation of plant genetic resources in the mid-1990s, before the International Treaty on Plant Genetic Resources was negotiated. Consequently, the paper suggests that it may be useful to look to the model of global network of ex situ plant genetic resources collections as a precedent to follow – even if only loosely – in developing an intergovernmentally endorsed legal substructure and governance framework for the microbial commons.

  15. Palliative Oncologic Care Curricula for Providers in Resource-Limited and Underserved Communities: a Systematic Review.

    Science.gov (United States)

    Xu, Melody J; Su, David; Deboer, Rebecca; Garcia, Michael; Tahir, Peggy; Anderson, Wendy; Kinderman, Anne; Braunstein, Steve; Sherertz, Tracy

    2017-12-20

    Familiarity with principles of palliative care, supportive care, and palliative oncological treatment is essential for providers caring for cancer patients, though this may be challenging in global communities where resources are limited. Herein, we describe the scope of literature on palliative oncological care curricula for providers in resource-limited settings. A systematic literature review was conducted using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Med Ed Portal databases, and gray literature. All available prospective cohort studies, case reports, and narratives published up to July 2017 were eligible for review. Fourteen articles were identified and referenced palliative care education programs in Argentina, Uganda, Kenya, Australia, Germany, the USA, or multiple countries. The most common teaching strategy was lecture-based, followed by mentorship and experiential learning involving role play and simulation. Education topics included core principles of palliative care, pain and symptom management, and communication skills. Two programs included additional topics specific to the underserved or American Indian/Alaskan Native community. Only one program discussed supportive cancer care, and no program reported educational content on resource-stratified decision-making for palliative oncological treatment. Five programs reported positive participant satisfaction, and three programs described objective metrics of increased educational or research activity. There is scant literature on effective curricula for providers treating cancer patients in resource-limited settings. Emphasizing supportive cancer care and palliative oncologic treatments may help address gaps in education; increased outcome reporting may help define the impact of palliative care curriculum within resource-limited communities.

  16. Rethinking breast cancer screening strategies in resource-limited ...

    African Journals Online (AJOL)

    The incidence of breast cancer in sub-Saharan nations is increasing. There is a worsening scarcity of Human Resource for Health in Uganda in particular and Sub Saharan Africa in general. Resources available for health care are predominantly spent on infectious disease care such as (HIV/AIDS, Tuberculosis and ...

  17. Modelling inter-supply chain competition with resource limitation and demand disruption

    Science.gov (United States)

    Chen, Zhaobo; Teng, Chunxian; Zhang, Ding; Sun, Jiayi

    2016-05-01

    This paper proposes a comprehensive model for studying supply chain versus supply chain competition with resource limitation and demand disruption. We assume that there are supply chains with heterogeneous supply network structures that compete at multiple demand markets. Each supply chain is comprised of internal and external firms. The internal firms are coordinated in production and distribution and share some common but limited resources within the supply chain, whereas the external firms are independent and do not share the internal resources. The supply chain managers strive to develop optimal strategies in terms of production level and resource allocation in maximising their profit while facing competition at the end market. The Cournot-Nash equilibrium of this inter-supply chain competition is formulated as a variational inequality problem. We further study the case when there is demand disruption in the plan-execution phase. In such a case, the managers need to revise their planned strategy in order to maximise their profit with the new demand under disruption and minimise the cost of change. We present a bi-criteria decision-making model for supply chain managers and develop the optimal conditions in equilibrium, which again can be formulated by another variational inequality problem. Numerical examples are presented for illustrative purpose.

  18. Using the GlideinWMS System as a Common Resource Provisioning Layer in CMS

    Energy Technology Data Exchange (ETDEWEB)

    Balcas, J. [Vilnius U.; Belforte, S. [Trieste U.; Bockelman, B. [Nebraska U.; Colling, D. [Imperial Coll., London; Gutsche, O. [Fermilab; Hufnagel, D. [Fermilab; Khan, F. [Quaid-i-Azam U.; Larson, K. [Fermilab; Letts, J. [UC, San Diego; Mascheroni, M. [Milan Bicocca U.; Mason, D. [Fermilab; McCrea, A. [UC, San Diego; Piperov, S. [Brown U.; Saiz-Santos, M. [UC, San Diego; Sfiligoi, I. [UC, San Diego; Tanasijczuk, A. [UC, San Diego; Wissing, C. [DESY

    2015-12-23

    CMS will require access to more than 125k processor cores for the beginning of Run 2 in 2015 to carry out its ambitious physics program with more and higher complexity events. During Run1 these resources were predominantly provided by a mix of grid sites and local batch resources. During the long shut down cloud infrastructures, diverse opportunistic resources and HPC supercomputing centers were made available to CMS, which further complicated the operations of the submission infrastructure. In this presentation we will discuss the CMS effort to adopt and deploy the glideinWMS system as a common resource provisioning layer to grid, cloud, local batch, and opportunistic resources and sites. We will address the challenges associated with integrating the various types of resources, the efficiency gains and simplifications associated with using a common resource provisioning layer, and discuss the solutions found. We will finish with an outlook of future plans for how CMS is moving forward on resource provisioning for more heterogenous architectures and services.

  19. MDEP Common Position CP-DICWG-07. Common position on selection and use of industrial digital devices of limited functionality

    International Nuclear Information System (INIS)

    2014-01-01

    The nuclear power industry is increasingly interested in using industrial digital devices of limited functionality in systems important to safety, but that have not been developed specifically for use in nuclear power applications. These devices should meet certain specific requirements in order to be selected and used in systems important to safety at nuclear power plants. Typically, some of these devices are found embedded in plant components and actuating devices, e.g. sensing instrumentation, motors, pumps, actuators, breakers. The Digital Instrumentation and Controls Working Group (DICWG) has agreed that a common position on this topic is warranted given the increase of use of Digital I and C in new reactor designs, its safety implications, and the need to develop a common understanding from the perspectives of regulatory authorities. This action follows the DICWG examination of the regulatory requirements of the participating members and of relevant industry standards and IAEA documents. The DICWG proposes a common position based on its recent experience with the new reactor application reviews and operating plant issues

  20. Appropriation of common access natural resources through exploration: A differential game of a claiming rush

    Energy Technology Data Exchange (ETDEWEB)

    Mohr, E

    1985-10-01

    This paper provides a model of natural resource exploration, where the sole motivation to explore arises from a strategic incentive to preempt competitors. It is assumed that private ownership rights over a finite unexplored and commonly held resource stock can be established through a costly deterministic exploration process. The open-loop and the feedback Nash equilibrium is analysed. It is shown that in between intervals of soaring exploratory activities there may be an interval where exploration is declining over time.

  1. OGUMI-A new mobile application to conduct common-pool resource experiments in continuous time.

    Directory of Open Access Journals (Sweden)

    Gunnar Brandt

    Full Text Available OGUMI is an Android-based open source mobile application for conducting Common-Pool Resource Experiments, Choice Experiments, and Questionnaires in the field, in the laboratory, and online. A main feature of OGUMI is its capacity to capture real-time changes in human behaviour in response to a dynamically varying resource. OGUMI is simple (for example, likewise other existing software, it does not require expertise in behavioural game theory, stable, and extremely flexible with respect to the user-resource model running in the background. Here we present the motivation for the development of OGUMI and we discuss its main features with an example application.

  2. Games of corruption in preventing the overuse of common-pool resources.

    Science.gov (United States)

    Lee, Joung-Hun; Jusup, Marko; Iwasa, Yoh

    2017-09-07

    Maintaining human cooperation in the context of common-pool resource management is extremely important because otherwise we risk overuse and corruption. To analyse the interplay between economic and ecological factors leading to corruption, we couple the resource dynamics and the evolutionary dynamics of strategic decision making into a powerful analytical framework. The traits of this framework are: (i) an arbitrary number of harvesters share the responsibility to sustainably exploit a specific part of an ecosystem, (ii) harvesters face three strategic choices for exploiting the resource, (iii) a delegated enforcement system is available if called upon, (iv) enforcers are either honest or corrupt, and (v) the resource abundance reflects the choice of harvesting strategies. The resulting dynamical system is bistable; depending on the initial conditions, it evolves either to cooperative (sustainable exploitation) or defecting (overexploitation) equilibria. Using the domain of attraction to cooperative equilibria as an indicator of successful management, we find that the more resilient the resource (as implied by a high growth rate), the more likely the dominance of corruption which, in turn, suppresses the cooperative outcome. A qualitatively similar result arises when slow resource dynamics relative to the dynamics of decision making mask the benefit of cooperation. We discuss the implications of these results in the context of managing common-pool resources. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Helping HELP with limited resources: the Luquillo experience

    Science.gov (United States)

    F.N. Scatena; JR Ortiz-Zayas; J.F. Blanco-Libreros

    2008-01-01

    By definition the HELP approach involves the active participation of individuals from a wide range of disciplines and backgrounds, including representatives of industry, academics, natural resource managers, and local officials and community leaders. While there is considerable enthusiasm and support for the integrated HELP approach, a central problem for all HELP...

  4. Sharing common pool resources at the border of protected areas in the Romanian Carpathians

    Directory of Open Access Journals (Sweden)

    ANA-IRINA DINCA

    2014-10-01

    Full Text Available The common pool resources are a very actual topic a pproached by both scientists and practitioners preoccupied nowadays of gradually incr easing environmental problems. Protected areas in Romania and especially in Romanian Carpath ians of national and natural park type (IUCN II and V represent areas of particular interes t in the light of the common pool resources theory imposing conservation laws on areas meeting a n increased pressure from human communities around them. The important socio-econom ic and ownership changes that Romania met in the last decades changed its previous state unique ownership into a multiple stakeholder ownership. At the same time vulnerable human communi ties located in fragile mountain areas and depending to a high extent on natural resources met an increased stress when exploiting natural resources at the border of protected areas. Consequently sharing the common pool of resources in the buffer zone of protected areas in the Romanian Carpathians represents a very actual and important topic to be treated in the pre sent study.

  5. Managing common resources in local and global systems. Applying theory across scales

    Energy Technology Data Exchange (ETDEWEB)

    Karlsson, Sylvia [ed.

    1997-12-31

    The main point brought forward in this publication is the productiveness of applying theoretical elements, developed within common property resource (CPR) literature, to a broader field of cases on different scales. The common framework for the contributions is a series of seminars held at the Department of Water and Environmental Studies in the spring of 1996, covering expanding work during the last decade on common property resource (CPR) management. It is obvious that there were a broad range of definitions of the concept CPR in the literature. The common pool/property resource concepts are both used, often depending on the resource studied, and authors in this volume have used both terms accordingly. Certain points are raised from empirical cases presented in this volume that are partly missing or not thoroughly stressed in other work in the area of CPR management and which crystallized much clearer when contrasting the situation for cases from different scales. Separate abstracts have been performed for five of the seven contributions

  6. Managing common resources in local and global systems. Applying theory across scales

    Energy Technology Data Exchange (ETDEWEB)

    Karlsson, Sylvia [ed.

    1998-12-31

    The main point brought forward in this publication is the productiveness of applying theoretical elements, developed within common property resource (CPR) literature, to a broader field of cases on different scales. The common framework for the contributions is a series of seminars held at the Department of Water and Environmental Studies in the spring of 1996, covering expanding work during the last decade on common property resource (CPR) management. It is obvious that there were a broad range of definitions of the concept CPR in the literature. The common pool/property resource concepts are both used, often depending on the resource studied, and authors in this volume have used both terms accordingly. Certain points are raised from empirical cases presented in this volume that are partly missing or not thoroughly stressed in other work in the area of CPR management and which crystallized much clearer when contrasting the situation for cases from different scales. Separate abstracts have been performed for five of the seven contributions

  7. Integrated Common Radio Resource Management with Spectrum Aggregation over Non-Contiguous Frequency Bands

    DEFF Research Database (Denmark)

    Cabral, Orlando; Meucci, Filippo; Mihovska, Albena D.

    2011-01-01

    This paper proposes an integrated Common Radio Resource Management (iCRRM). The iCRRM performs classic CRRM functionalities jointly with Spectrum Aggregation (SA), being able to switch users between non-contiguous frequency bands. The SA scheduling is obtained with an optimised General Multi...

  8. Cardiopulmonary Resuscitation in Resource-limited Health Systems-Considerations for Training and Delivery.

    Science.gov (United States)

    Friesen, Jason; Patterson, Dean; Munjal, Kevin

    2015-02-01

    In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a life-saving skill that can be taught successfully to the general public. Cardiopulmonary resuscitation can be considered a cost-effective intervention that requires minimal classroom training and low-cost equipment and supplies; it is commonly taught throughout much of the developed world. But, the simplicity of CPR training and its access for the general public may be misleading, as outcomes for patients in cardiopulmonary arrest are poor and survival is dependent upon a comprehensive "chain-of-survival," which is something not achieved easily in resource-limited health care settings. In addition to the significant financial and physical resources needed to both train and develop basic CPR capabilities within a community, there is a range of ethical questions that should also be considered. This report describes some of the financial and ethical challenges that might result from CPR training in low- and middle-income countries (LMICs). It is determined that for many health care systems, CPR training may have financial and ethically-deleterious, unintended consequences. Evidence shows Basic Life Support (BLS) skills training in a community is an effective intervention to improve public health. But, health care systems with limited resources should include CPR training only after considering the full implications of that intervention.

  9. Balancing public health and resource limitations: A role for ethical low-level risk communication

    International Nuclear Information System (INIS)

    McGinn, R.E.

    1991-01-01

    Recognition of the pervasiveness of risk in everyday life in modern industrial society has elicited calls for greater efforts to protect individual and public health. Yet, it is increasingly clear that decisions to do so must often be made in the context of significant limits in the amounts of financial resources available for achieving that protection. Achieving risk-free work, residential, and community environments may be so expensive as to render a private business unit uncompetitive or as to divert resources from or prelude commencing with other governmental projects with equal or greater health benefit potential. Ethical low-level risk communication (LLRC) is something risk-generating entities are morally obligated to do. However, such communication also offers important opportunities for such entities to move toward achieving better balances between health and the costs of protecting it. In this paper, the authors elaborate on several features of an ethically ideal LLRC process, focusing on those with aspects they hope are not obvious or common knowledge. In discussing these features, they provide examples of conflicts between health risks and resource limits at the level of the individual private firm, the local community, or the national government, such that LLRC with the feature in question provides an opportunity for mitigating or at least clarifying the conflict in question

  10. Management of Cervical Cancer: Strategies for Limited-Resource Centres - A Guide for Radiation Oncologists

    International Nuclear Information System (INIS)

    2013-01-01

    Cervical cancer remains a significant cause of morbidity and mortality among women globally, even though it is the cancer with the greatest demonstrated potential for secondary prevention. In some regions of the world the incidence is alarmingly high, such as in sub-Saharan Africa, some countries in Latin America, India and South-East Asia. This disease is highly preventable and curable at a relatively low risk and low cost when screening of asymptomatic women is available, together with appropriate diagnosis, treatment and follow-up. In developing clinical guidelines, the International Atomic Energy Agency (IAEA) has selected forms of cancer or clinical situations that are very common in low and middle income Member States and for which radiation oncologists consistently express a need for guidance. Clinical guidelines for the management of cervical cancer do exist in the published literature. However, these guidelines have usually been developed in and for affluent environments where all modern diagnosis and treatment modalities are available for the practitioner. In limited resource environments, the radiation oncologist is faced with the question, what would be the minimally acceptable line of action with the limited resources available? Clinical guidelines focusing on low and middle income countries provide a practical tool to these practitioners. This publication is aimed at the radiation oncologist working in centres with limited resources and treating a large number of patients with cervical cancer on a daily basis. The approach and techniques are intended to be simple, feasible and resource sparing to the extent that this is possible when dealing with a complex treatment modality. The Division of Human Health is placing special emphasis on the subject of cervical cancer, which is addressed not only in this guide but also in regional training courses and coordinated research projects on the subject

  11. The limits of the available land and other natural resources

    International Nuclear Information System (INIS)

    Sonnino, Andrea; )

    2015-01-01

    The world's agricultural production system can satisfy the global demand for food, but consumes natural resources on which it is based earth, soil, water and Biodiversity at a higher rate on their ability natural regeneration and it is therefore not sustainable in the long term. The planned expansion quali-quantitatively goes global demand for food will further exacerbate the scarcity of arable land and other natural resources on which agricultural production. The challenge we face is therefore to meet growing world food demand reducing the environmental impacts of three major systems me to be productive today: the destruction of eco- Natural-systems derived from the expansion of the border agricultural; climate change caused by meadows that agricultural and livestock and deforestation; and the reduction of reserves of fresh water, because both Extraction rates higher than those of reintegration, that pollution of aquifers [it

  12. Ecologically sustainable but unjust? Negotiating equity and authority in common-pool marine resource management

    Directory of Open Access Journals (Sweden)

    Sarah C. Klain

    2014-12-01

    Full Text Available Under appropriate conditions, community-based fisheries management can support sound resource stewardship, with positive social and environmental outcomes. Evaluating indigenous peoples' involvement in commercial sea cucumber and geoduck fisheries on the central coast of British Columbia, Canada, we found that the current social-ecological system configuration is relatively ecologically sustainable according to stock assessments. However, the current system also results in perceived inequities in decision-making processes, harvesting allocations, and socioeconomic benefits. As a result, local coastal resource managers envision a transformation of sea cucumber and geoduck fisheries governance and management institutions. We assessed the potential robustness of the proposed institutions using Elinor Ostrom's common-pool resource design principles. Grounded in the region's legal, political, and historical context, our analysis suggests that greater local involvement in these invertebrate fisheries and their management could provide more benefits to local communities than the status quo while maintaining an ecologically sustainable resource. Our research highlights the importance of explicitly addressing historical context and equity considerations in social-ecological system analyses and when renegotiating the institutions governing common-pool resources.

  13. Online Nutrition Education: Enhancing Opportunities for Limited-Resource Learners

    Science.gov (United States)

    Case, Patty; Cluskey, Mary; Hino, Jeff

    2011-01-01

    Delivering nutrition education using the Internet could allow educators to reach larger audiences at lower cost. Low-income adults living in a rural community participated in focus groups to examine their interest in, experience with, and motivators to accessing nutrition education online. This audience described limited motivation in seeking…

  14. HIV vaccine acceptability in seronaive patients in a resource limited ...

    African Journals Online (AJOL)

    Background: Current lifetime antiretroviral regimes are associated with clinically important toxicities, and have several limitations (eg. cost, development of resistance, complications). There is need for an alternative regime that must be acceptable, easy to administer and permanent for the eradication of HIV/AIDS.

  15. Intelligent self-organization methods for wireless ad hoc sensor networks based on limited resources

    Science.gov (United States)

    Hortos, William S.

    2006-05-01

    A wireless ad hoc sensor network (WSN) is a configuration for area surveillance that affords rapid, flexible deployment in arbitrary threat environments. There is no infrastructure support and sensor nodes communicate with each other only when they are in transmission range. To a greater degree than the terminals found in mobile ad hoc networks (MANETs) for communications, sensor nodes are resource-constrained, with limited computational processing, bandwidth, memory, and power, and are typically unattended once in operation. Consequently, the level of information exchange among nodes, to support any complex adaptive algorithms to establish network connectivity and optimize throughput, not only deplete those limited resources and creates high overhead in narrowband communications, but also increase network vulnerability to eavesdropping by malicious nodes. Cooperation among nodes, critical to the mission of sensor networks, can thus be disrupted by the inappropriate choice of the method for self-organization. Recent published contributions to the self-configuration of ad hoc sensor networks, e.g., self-organizing mapping and swarm intelligence techniques, have been based on the adaptive control of the cross-layer interactions found in MANET protocols to achieve one or more performance objectives: connectivity, intrusion resistance, power control, throughput, and delay. However, few studies have examined the performance of these algorithms when implemented with the limited resources of WSNs. In this paper, self-organization algorithms for the initiation, operation and maintenance of a network topology from a collection of wireless sensor nodes are proposed that improve the performance metrics significant to WSNs. The intelligent algorithm approach emphasizes low computational complexity, energy efficiency and robust adaptation to change, allowing distributed implementation with the actual limited resources of the cooperative nodes of the network. Extensions of the

  16. Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study.

    Science.gov (United States)

    Scott, John W; Lin, Yihan; Ntakiyiruta, Georges; Mutabazi, Zeta A; Davis, William Austin; Morris, Megan A; Smink, Douglas S; Riviello, Robert; Yule, Steven

    2018-03-01

    Safe surgery should be available to all patients, no matter the setting. The purpose of this study was to explore the contextual-specific challenges to safe surgical care encountered by surgeons and surgical teams in many in low- and middle-income countries (LMICs), and to understand the ways in which surgical teams overcome them. Optimal surgical performance is highly complex and requires providers to integrate and communicate information regarding the patient, task, team, and environment to coordinate team-based care that is timely, effective, and safe. Resource limitations common to many LMICs present unique challenges to surgeons operating in these environments, but have never been formally described. Using a grounded theory approach, we interviewed 34 experienced providers (surgeons, anesthetists, and nurses) at the 4 tertiary referral centers in Rwanda, to understand the challenges to safe surgical care and strategies to overcome them. Interview transcripts were coded line-by-line and iteratively analyzed for emerging themes until thematic saturation was reached. Rwandan-described challenges related to 4 domains: physical resources, human resources, overall systems support, and communication/language. The majority of these challenges arose from significant variability in either the quantity or quality of these domains. Surgical providers exhibited examples of resilient strategies to anticipate, monitor, respond to, and learn from these challenges. Resource variability rather than lack of resources underlies many contextual challenges to safe surgical care in a LMIC setting. Understanding these challenges and resilient strategies to overcome them is critical for both LMIC surgical providers and surgeons from HICs working in similar settings.

  17. Bush animal attacks: management of complex injuries in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Mitchell Katrina B

    2011-12-01

    Full Text Available Abstract Introduction Though animal-related injuries and fatalities have been documented throughout the world, the variety of attacks by wild animals native to rural East Africa are less commonly described. Given the proximity of our northwestern Tanzania hospital to Lake Victoria, Lake Tanganyika, and the Serengeti National Park, and presentation of several patients attacked by bush animals and suffering a variety of complex injuries, we sought to report the pattern of attacks and surgical management in a resource-limited setting. Materials and methods Four patients who were admitted to the northwestern Tanzania tertiary referral hospital, Bugando Medical Centre (BMC, in 2010-2011 suffered attacks by different bush animals: hyena, elephant, crocodile, and vervet monkey. These patients were triaged as trauma patients in the Casualty Ward, then admitted for inpatient monitoring and treatment. Their outcomes were followed to discharge. Results The age and gender of the patients attacked was variable, though all but the pediatric patient were participating in food gathering or guarding activities in rural locations at the time of the attacks. All patients required surgical management of their injuries, which included debridement and closure of wounds, chest tube insertion, amputation, and external fixation of an extremity fracture. All patients survived and were discharged home. Discussion Though human injuries secondary to encounters with undomesticated animals such as cows, moose, and camel are reported, they often are indirect traumas resulting from road traffic collisions. Snake attacks are well documented and common. However, this series of unique bush animal attacks describes the initial and surgical management of human injuries in the resource-limited setting of the developing world. Conclusion Animal attacks are common throughout the world, but their pattern may vary in Africa throughout jungle and bush environmental settings. It is

  18. Creating Online Training for Procedures in Global Health with PEARLS (Procedural Education for Adaptation to Resource-Limited Settings).

    Science.gov (United States)

    Bensman, Rachel S; Slusher, Tina M; Butteris, Sabrina M; Pitt, Michael B; On Behalf Of The Sugar Pearls Investigators; Becker, Amanda; Desai, Brinda; George, Alisha; Hagen, Scott; Kiragu, Andrew; Johannsen, Ron; Miller, Kathleen; Rule, Amy; Webber, Sarah

    2017-11-01

    The authors describe a multiinstitutional collaborative project to address a gap in global health training by creating a free online platform to share a curriculum for performing procedures in resource-limited settings. This curriculum called PEARLS (Procedural Education for Adaptation to Resource-Limited Settings) consists of peer-reviewed instructional and demonstration videos describing modifications for performing common pediatric procedures in resource-limited settings. Adaptations range from the creation of a low-cost spacer for inhaled medications to a suction chamber for continued evacuation of a chest tube. By describing the collaborative process, we provide a model for educators in other fields to collate and disseminate procedural modifications adapted for their own specialty and location, ideally expanding this crowd-sourced curriculum to reach a wide audience of trainees and providers in global health.

  19. Factors driving deforestation in common-pool resources in northern Mexico.

    Science.gov (United States)

    Perez-Verdin, Gustavo; Kim, Yeon-Su; Hospodarsky, Denver; Tecle, Aregai

    2009-01-01

    The theory of collective action has been extensively used to explain the relationship between common-based property regimes and the conservation of natural resources. However, there are two key components of the theory that literature reports as puzzles in which no consensus exists about their effect on the performance of common-pool resources. These are group size and heterogeneity. This study analyzes the effects of these two key components on the effectiveness of community-based forestry, called ejidos, to protect their forest resources in northern Mexico. We used a multinomial logit model to determine the contribution of 16 explanatory variables to the dependent variable, a measure of success of ejidos defined by the presence of deforested, degraded, or forested conditions. The results show that corn yield, marginality, percent of forest area, total population, a forest value index, distance to markets, roads and towns, were all statistically significant in driving deforested conditions. Deforestation becomes more attractive for poor communities and as corn yield and distance to towns, roads, and markets decrease. In general, group size and heterogeneity had no significant effects on the presence of deforested conditions. Deforestation is driven by resource-specific characteristics, such as location and soil productivity, not by ejidos' attributes, such as total area or number of members. We argue that current institutional policies focusing on the structure of property right arrangements should be shifted (1) to provide better technology for land cultivation; (2) to reduce the marginality problem in poor communities; and (3) to strengthen local institutions.

  20. A Semi-Preemptive Computational Service System with Limited Resources and Dynamic Resource Ranking

    Directory of Open Access Journals (Sweden)

    Fang-Yie Leu

    2012-03-01

    Full Text Available In this paper, we integrate a grid system and a wireless network to present a convenient computational service system, called the Semi-Preemptive Computational Service system (SePCS for short, which provides users with a wireless access environment and through which a user can share his/her resources with others. In the SePCS, each node is dynamically given a score based on its CPU level, available memory size, current length of waiting queue, CPU utilization and bandwidth. With the scores, resource nodes are classified into three levels. User requests based on their time constraints are also classified into three types. Resources of higher levels are allocated to more tightly constrained requests so as to increase the total performance of the system. To achieve this, a resource broker with the Semi-Preemptive Algorithm (SPA is also proposed. When the resource broker cannot find suitable resources for the requests of higher type, it preempts the resource that is now executing a lower type request so that the request of higher type can be executed immediately. The SePCS can be applied to a Vehicular Ad Hoc Network (VANET, users of which can then exploit the convenient mobile network services and the wireless distributed computing. As a result, the performance of the system is higher than that of the tested schemes.

  1. Cooperative institutions for sustainable common pool resource management: Application to groundwater

    Science.gov (United States)

    Madani, Kaveh; Dinar, Ariel

    2012-09-01

    Beneficiaries of common pool resources (CPRs) may select available noncooperative and regulatory exogenous institutions for managing the resource, as well as cooperative management institutions. All these institutions may increase the long-term gains, prolong the life of the resource, and help to escape the tragedy of the commons trap. Cooperative game theory approaches can serve as the backbone of cooperative CPR management institutions. This paper formulates and applies several commonly used cooperative game theoretic solution concepts, namely, the core, Nash-Harsanyi, Shapley, and nucleolus. Through a numerical groundwater example, we show how CPR users can share the gains obtained from cooperation in a fair and efficient manner based on these cooperative solution concepts (management institutions). Although, based on their fairness rationales, various cooperative management institutions may suggest different allocations that are potentially acceptable to the users, these allocation solutions may not be stable as some users may find them unfair. This paper discusses how different methods, such as application of the plurality rule and power index, stability index, and propensity to disrupt concepts, can help identify the most stable and likely solutions for enforcing cooperation among the CPR beneficiaries. Furthermore, how the noncooperative managerial characteristics of the CPR users can affect the stability and acceptability of the different cooperative CPR management institutions is discussed, providing valuable policy insights for cooperative CPR management at community levels.

  2. 75 FR 4469 - Food Distribution Program on Indian Reservations: Resource Limits and Exclusions, and Extended...

    Science.gov (United States)

    2010-01-28

    ... resource limits are insufficient for the target populations and serve as a barrier to participation. The... concern that the current FDPIR resource limit was insufficient for the target population and served as a... by the State agency or ITO. The current estimated annual reporting burden for the certification or...

  3. Resource management in energy-limited, bandwidth-limited, transceiver-limited wireless networks for session-based multicasting

    National Research Council Canada - National Science Library

    Wieselthier, Jeffrey E; Nguyen, Gam D; Ephremides, Anthony

    2001-01-01

    In this paper we consider source-initiated multicast session traffic in an ad hoc wireless network, operating under hard constraints on the available transmission energy as well as on bandwidth and transceiver resources...

  4. Limited resources of genome sequencing in developing countries: Challenges and solutions

    Directory of Open Access Journals (Sweden)

    Mohamed Helmy

    2016-06-01

    Full Text Available The differences between countries in national income, growth, human development and many other factors are used to classify countries into developed and developing countries. There are several classification systems that use different sets of measures and criteria. The most common classifications are the United Nations (UN and the World Bank (WB systems. The UN classification system uses the UN Human Development Index (HDI, an indicator that uses statistic of life expectancy, education, and income per capita for countries' classification. While the WB system uses gross national income (GNI per capita that is calculated using the World Bank Atlas method. According to the UN and WB classification systems, there are 151 and 134 developing countries, respectively, with 89% overlap between the two systems. Developing countries have limited human development, and limited expenditure in education and research, among several other limitations. The biggest challenge facing genomic researchers and clinicians is limited resources. As a result, genomic tools, specifically genome sequencing technologies, which are rapidly becoming indispensable, are not widely available. In this report, we explore the current status of sequencing technologies in developing countries, describe the associated challenges and emphasize potential solutions.

  5. Efficient medical image access in diagnostic environments with limited resources

    Directory of Open Access Journals (Sweden)

    José Eduardo Venson

    Full Text Available Abstract Introduction A medical application running outside the workstation environment has to deal with several constraints, such as reduced available memory and low network bandwidth. The aim of this paper is to present an approach to optimize the data flow for fast image transfer and visualization on mobile devices and remote stationary devices. Methods We use a combination of client- and server-side procedures to reduce the amount of information transferred by the application. Our approach was implemented on top of a commercial PACS and evaluated through user experiments with specialists in typical diagnosis tasks. The quality of the system outcome was measured in relation to the accumulated amount of network data transference and the amount of memory used in the host device. Besides, the system's quality of use (usability was measured through participants’ feedback. Results Contrarily to previous approaches, ours keeps the application within the memory constraints, minimizing data transferring whenever possible, allowing the application to run on a variety of devices. Moreover, it does that without sacrificing the user experience. Experimental data point that over 90% of the users did not notice any delays or degraded image quality, and when they did, they did not impact on the clinical decisions. Conclusion The combined activities and orchestration of our methods allow the image viewer to run on resource-constrained environments, such as those with low network bandwidth or little available memory. These results demonstrate the ability to explore the use of mobile devices as a support tool in the medical workflow.

  6. Microbiological water quality monitoring in a resource-limited urban area: a study in Cameroon, Africa

    Directory of Open Access Journals (Sweden)

    Andrew W. Nelson

    2012-10-01

    Full Text Available In resource-limited developing nations, such as Cameroon, the expense of modern water-quality monitoring techniques is prohibitive to frequent water testing, as is done in the developed world. Inexpensive, shelf-stable 3M™ Petrifilm™ Escherichia coli/Coliform Count Plates potentially can provide significant opportunity for routine water-quality monitoring in the absence of infrastructure for state-of-the-art testing. We used shelf-stable E. coli/coliform culture plates to assess the water quality at twenty sampling sites in Kumbo, Cameroon. Culture results from treated and untreated sources were compared to modern bacterial DNA pyrosequencing methods using established bioinformatics and statistical tools. Petrifilms were reproducible between replicates and sampling dates. Additionally, cultivation on Petrifilms suggests that treatment by the Kumbo Water Authority (KWA greatly improves water quality as compared with untreated river and rainwater. The majority of sequences detected were representative of common water and soil microbes, with a minority of sequences (<40% identified as belonging to genera common in fecal matter and/or causes of human disease. Water sources had variable DNA sequence counts that correlated significantly with the culture count data and may therefore be a proxy for bacterial load. Although the KWA does not meet Western standards for water quality (less than one coliform per 100 mL, KWA piped water is safer than locally available alternative water sources such as river and rainwater. The culture-based technology described is easily transferrable to resource-limited areas and provides local water authorities with valuable microbiological safety information with potential to protect public health in developing nations.

  7. Comment on "Dynamic shifts of limited working memory resources in human vision".

    Science.gov (United States)

    Cowan, Nelson; Rouder, Jeffrey N

    2009-02-13

    Bays and Husain (Reports, 8 August 2008, p. 851) reported that human working memory, the limited information currently in mind, reflects resources distributed across all items in an array. In an alternative interpretation, memory is limited to several well-represented items. We argue that this item-limit model fits the extant data better than the distributed-resources model and is more interpretable theoretically.

  8. Comment on “Dynamic Shifts of Limited Working Memory Resources in Human Vision”

    Science.gov (United States)

    Cowan, Nelson; Rouder, Jeffrey N.

    2009-01-01

    Bays and Husain (Reports, 8 August 2008, p. 851) reported that human working memory, the limited information currently in mind, reflects resources distributed across all items in an array. In an alternative interpretation, memory is limited to several well-represented items. We argue that this item-limit model fits the extant data better than the distributed-resources model and is more interpretable theoretically. PMID:19213899

  9. A microarchitecture for resource-limited superscalar microprocessors

    Science.gov (United States)

    Basso, Todd David

    1999-11-01

    microprocessor. The proposed microarchitecture is process independent and can be applied to low-cost, or transistor-limited applications. The proposed microarchitecture is implemented in the design of a 0.35 mum CMOS microprocessor, and the design of a 0.5 mum CGaAsTM micro-processor. The two technologies and designs are compared to ascertain the state of CGaAsTM for digital VLSI applications.

  10. Environmental Resource Management in Borderlands: Evolution from Competing Interests to Common Aversions

    Directory of Open Access Journals (Sweden)

    Patrick Henry Buckley

    2015-07-01

    Full Text Available Great enthusiasm is attached to the emergence of cross-border regions (CBRs as a new institutional arrangement for dealing with local cross-border environmental resource management and other issues that remain too distant from national capitals and/or too expensive to be addressed in the traditional topocratic manner requiring instead local adhocratic methods. This study briefly discusses the perceived value of CBRs and necessary and sufficient conditions for the successful and sustainable development of such places. Then, assuming that necessary conditions can be met, the study investigates an intriguing hypothesis concerning the catalyzing of sustainable consensus for cross-border resource management based on a game theoretical approach that employs the use of dilemma of common aversion rather than the more traditional dilemma of competing common interests. Using this lens to investigate a series of events on the Pacific northwestern Canadian-American border in a part of the Fraser Lowland, we look for evidence of the emergence of an active and sustainable CBR to address local trans-border resource management issues. Although our micro-level scale fails to conclusively demonstrate such evidence, it does demonstrate the value of using this approach and suggests a number of avenues for further research.

  11. Are gas exchange responses to resource limitation and defoliation linked to source:sink relationships?

    Science.gov (United States)

    Pinkard, E A; Eyles, A; O'Grady, A P

    2011-10-01

    Productivity of trees can be affected by limitations in resources such as water and nutrients, and herbivory. However, there is little understanding of their interactive effects on carbon uptake and growth. We hypothesized that: (1) in the absence of defoliation, photosynthetic rate and leaf respiration would be governed by limiting resource(s) and their impact on sink limitation; (2) photosynthetic responses to defoliation would be a consequence of changing source:sink relationships and increased availability of limiting resources; and (3) photosynthesis and leaf respiration would be adjusted in response to limiting resources and defoliation so that growth could be maintained. We tested these hypotheses by examining how leaf photosynthetic processes, respiration, carbohydrate concentrations and growth rates of Eucalyptus globulus were influenced by high or low water and nitrogen (N) availability, and/or defoliation. Photosynthesis of saplings grown with low water was primarily sink limited, whereas photosynthetic responses of saplings grown with low N were suggestive of source limitation. Defoliation resulted in source limitation. Net photosynthetic responses to defoliation were linked to the degree of resource availability, with the largest responses measured in treatments where saplings were ultimately source rather than sink limited. There was good evidence of acclimation to stress, enabling higher rates of C uptake than might otherwise have occurred. © 2011 Blackwell Publishing Ltd.

  12. Recent research in data description of the measurement property resource on common data dictionary

    Science.gov (United States)

    Lu, Tielin; Fan, Zitian; Wang, Chunxi; Liu, Xiaojing; Wang, Shuo; Zhao, Hua

    2018-03-01

    A method for measurement equipment data description has been proposed based on the property resource analysis. The applications of common data dictionary (CDD) to devices and equipment is mainly used in digital factory to advance the management not only in the enterprise, also to the different enterprise in the same data environment. In this paper, we can make a brief of the data flow in the whole manufacture enterprise and the automatic trigger the process of the data exchange. Furthermore,the application of the data dictionary is available for the measurement and control equipment, which can also be used in other different industry in smart manufacture.

  13. Universal mobile electrochemical detector designed for use in resource-limited applications.

    Science.gov (United States)

    Nemiroski, Alex; Christodouleas, Dionysios C; Hennek, Jonathan W; Kumar, Ashok A; Maxwell, E Jane; Fernández-Abedul, Maria Teresa; Whitesides, George M

    2014-08-19

    This paper describes an inexpensive, handheld device that couples the most common forms of electrochemical analysis directly to "the cloud" using any mobile phone, for use in resource-limited settings. The device is designed to operate with a wide range of electrode formats, performs on-board mixing of samples by vibration, and transmits data over voice using audio--an approach that guarantees broad compatibility with any available mobile phone (from low-end phones to smartphones) or cellular network (second, third, and fourth generation). The electrochemical methods that we demonstrate enable quantitative, broadly applicable, and inexpensive sensing with flexibility based on a wide variety of important electroanalytical techniques (chronoamperometry, cyclic voltammetry, differential pulse voltammetry, square wave voltammetry, and potentiometry), each with different uses. Four applications demonstrate the analytical performance of the device: these involve the detection of (i) glucose in the blood for personal health, (ii) trace heavy metals (lead, cadmium, and zinc) in water for in-field environmental monitoring, (iii) sodium in urine for clinical analysis, and (iv) a malarial antigen (Plasmodium falciparum histidine-rich protein 2) for clinical research. The combination of these electrochemical capabilities in an affordable, handheld format that is compatible with any mobile phone or network worldwide guarantees that sophisticated diagnostic testing can be performed by users with a broad spectrum of needs, resources, and levels of technical expertise.

  14. Effects of Common Factors on Dynamics of Stocks Traded by Investors with Limited Information Capacity

    Directory of Open Access Journals (Sweden)

    Songtao Wu

    2017-01-01

    Full Text Available An artificial stock market with agent-based model is built to investigate effects of different information characteristics of common factors on the dynamics stock returns. Investors with limited information capacity update their beliefs based on the information they have obtained and processed and optimize portfolios based on beliefs. We find that with changing of concerned information characteristics the uncertainty of stock price returns rises and is higher than the uncertainty of intrinsic value returns. However, this increase is constrained by the limited information capacity of investors. At the same time, we also find that dependence between returns of stock prices also increased with the changing information environment. The uncertainty and dependency pertaining to prices show a positive relationship. However, the positive relationship is weakened when taking into account the features of intrinsic values, based on which prices are generated.

  15. Limitations in imaging common conjunctival and corneal pathologies with fourier-domain optical coherence tomography.

    Science.gov (United States)

    Demirci, Hakan; Steen, Daniel W

    2014-01-01

    To describe the limitations of Fourier-domain optical coherence tomography (OCT) in imaging common conjunctival and corneal pathology. Retrospective, single-center case series of 40 patients with conjunctival and cornea pathology. Fourier-domain OCT imaged laser in situ keratomileusis (LASIK) flaps in detail, including its relation to other corneal structures and abnormalities. Similarly, in infectious or degenerative corneal disorders, Fourier-domain OCT successfully showed the extent of infiltration or material deposition, which appeared as hyper-reflective areas. In cases with pterygium, the underlying cornea could not be imaged. All cases of common conjunctival pathologies, such as nevus or pinguecula, were successfully imaged in detail. Nevi, scleritis, pterygium, pinguecula, and subconjunctival hemorrhage were hyper-reflective lesions, while cysts and lymphangiectasia were hyporeflective. The details of the underlying sclera were not uniformly imaged in conjunctival pathologies. Fourier-domain OCT imaged the trabeculectomy bleb in detail, whereas the details of structures of the anterior chamber angle were not routinely visualized in all cases. Light scatter through vascularized, densely inflamed, or thick lesions limits the imaging capabilities of Fourier-domain anterior segment OCT.

  16. Self-Governance and Sustainable Common Pool Resource Management in Kyrgyzstan

    Directory of Open Access Journals (Sweden)

    Tanja Baerlein

    2015-01-01

    Full Text Available How to best govern natural resources in order to enable a sustainable way of handling them is what both research and practice aim to achieve. Empirical findings from several studies indicate that resource users are able to successfully cooperate in the management of common pool resources and solve social dilemmas through self-governance arrangements. The authors explore the potential success of self-governance in irrigation systems, focusing primarily on the factors influencing compliance of irrigation water users under self-crafted and self-enforced rules in two Kyrgyz communities. A field experiment is employed to provide insights and some quantitative empirical data, further complemented by qualitative methods (questionnaires, group discussions and interviews to enhance the analysis of the findings about working rules in irrigation at the community level. The results show that Kyrgyz irrigation users of the selected communities generally respond better in a self-governance setting in terms of rules compliance, distribution efficiency and equity. Compliance and cooperative behavior depend on group as well as individual variables including communication, social norms and the legitimacy of rules.

  17. Competition explains limited attention and perceptual resources: implications for perceptual load and dilution theories

    Directory of Open Access Journals (Sweden)

    Paige E. Scalf

    2013-05-01

    Full Text Available Both perceptual load theory and dilution theory purport to explain when and why task-irrelevant information, or so-called distractors are processed. Central to both explanations is the notion of limited resources, although the theories differ in the precise way in which those limitations affect distractor processing. We have recently proposed a neurally plausible explanation of limited resources in which neural competition among stimuli hinders their representation in the brain. This view of limited capacity can also explain distractor processing, whereby the competitive interactions and bias imposed to resolve the competition determine the extent to which a distractor is processed. This idea is compatible with aspects of both perceptual load and dilution models of distractor processing, but also serves to highlight their differences. Here we review the evidence in favor of a biased competition view of limited resources and relate these ideas to both classic perceptual load theory and dilution theory.

  18. Competition explains limited attention and perceptual resources: implications for perceptual load and dilution theories.

    Science.gov (United States)

    Scalf, Paige E; Torralbo, Ana; Tapia, Evelina; Beck, Diane M

    2013-01-01

    Both perceptual load theory and dilution theory purport to explain when and why task-irrelevant information, or so-called distractors are processed. Central to both explanations is the notion of limited resources, although the theories differ in the precise way in which those limitations affect distractor processing. We have recently proposed a neurally plausible explanation of limited resources in which neural competition among stimuli hinders their representation in the brain. This view of limited capacity can also explain distractor processing, whereby the competitive interactions and bias imposed to resolve the competition determine the extent to which a distractor is processed. This idea is compatible with aspects of both perceptual load and dilution models of distractor processing, but also serves to highlight their differences. Here we review the evidence in favor of a biased competition view of limited resources and relate these ideas to both classic perceptual load theory and dilution theory.

  19. Building a model: developing genomic resources for common milkweed (Asclepias syriaca with low coverage genome sequencing

    Directory of Open Access Journals (Sweden)

    Weitemier Kevin

    2011-05-01

    Full Text Available Abstract Background Milkweeds (Asclepias L. have been extensively investigated in diverse areas of evolutionary biology and ecology; however, there are few genetic resources available to facilitate and compliment these studies. This study explored how low coverage genome sequencing of the common milkweed (Asclepias syriaca L. could be useful in characterizing the genome of a plant without prior genomic information and for development of genomic resources as a step toward further developing A. syriaca as a model in ecology and evolution. Results A 0.5× genome of A. syriaca was produced using Illumina sequencing. A virtually complete chloroplast genome of 158,598 bp was assembled, revealing few repeats and loss of three genes: accD, clpP, and ycf1. A nearly complete rDNA cistron (18S-5.8S-26S; 7,541 bp and 5S rDNA (120 bp sequence were obtained. Assessment of polymorphism revealed that the rDNA cistron and 5S rDNA had 0.3% and 26.7% polymorphic sites, respectively. A partial mitochondrial genome sequence (130,764 bp, with identical gene content to tobacco, was also assembled. An initial characterization of repeat content indicated that Ty1/copia-like retroelements are the most common repeat type in the milkweed genome. At least one A. syriaca microread hit 88% of Catharanthus roseus (Apocynaceae unigenes (median coverage of 0.29× and 66% of single copy orthologs (COSII in asterids (median coverage of 0.14×. From this partial characterization of the A. syriaca genome, markers for population genetics (microsatellites and phylogenetics (low-copy nuclear genes studies were developed. Conclusions The results highlight the promise of next generation sequencing for development of genomic resources for any organism. Low coverage genome sequencing allows characterization of the high copy fraction of the genome and exploration of the low copy fraction of the genome, which facilitate the development of molecular tools for further study of a target species

  20. Building a model: developing genomic resources for common milkweed (Asclepias syriaca) with low coverage genome sequencing.

    Science.gov (United States)

    Straub, Shannon C K; Fishbein, Mark; Livshultz, Tatyana; Foster, Zachary; Parks, Matthew; Weitemier, Kevin; Cronn, Richard C; Liston, Aaron

    2011-05-04

    Milkweeds (Asclepias L.) have been extensively investigated in diverse areas of evolutionary biology and ecology; however, there are few genetic resources available to facilitate and compliment these studies. This study explored how low coverage genome sequencing of the common milkweed (Asclepias syriaca L.) could be useful in characterizing the genome of a plant without prior genomic information and for development of genomic resources as a step toward further developing A. syriaca as a model in ecology and evolution. A 0.5× genome of A. syriaca was produced using Illumina sequencing. A virtually complete chloroplast genome of 158,598 bp was assembled, revealing few repeats and loss of three genes: accD, clpP, and ycf1. A nearly complete rDNA cistron (18S-5.8S-26S; 7,541 bp) and 5S rDNA (120 bp) sequence were obtained. Assessment of polymorphism revealed that the rDNA cistron and 5S rDNA had 0.3% and 26.7% polymorphic sites, respectively. A partial mitochondrial genome sequence (130,764 bp), with identical gene content to tobacco, was also assembled. An initial characterization of repeat content indicated that Ty1/copia-like retroelements are the most common repeat type in the milkweed genome. At least one A. syriaca microread hit 88% of Catharanthus roseus (Apocynaceae) unigenes (median coverage of 0.29×) and 66% of single copy orthologs (COSII) in asterids (median coverage of 0.14×). From this partial characterization of the A. syriaca genome, markers for population genetics (microsatellites) and phylogenetics (low-copy nuclear genes) studies were developed. The results highlight the promise of next generation sequencing for development of genomic resources for any organism. Low coverage genome sequencing allows characterization of the high copy fraction of the genome and exploration of the low copy fraction of the genome, which facilitate the development of molecular tools for further study of a target species and its relatives. This study represents a first

  1. Limited Cognitive Resources Explain a Trade-Off between Perceptual and Metacognitive Vigilance.

    Science.gov (United States)

    Maniscalco, Brian; McCurdy, Li Yan; Odegaard, Brian; Lau, Hakwan

    2017-02-01

    Why do experimenters give subjects short breaks in long behavioral experiments? Whereas previous studies suggest it is difficult to maintain attention and vigilance over long periods of time, it is unclear precisely what mechanisms benefit from rest after short experimental blocks. Here, we evaluate decline in both perceptual performance and metacognitive sensitivity (i.e., how well confidence ratings track perceptual decision accuracy) over time and investigate whether characteristics of prefrontal cortical areas correlate with these measures. Whereas a single-process signal detection model predicts that these two forms of fatigue should be strongly positively correlated, a dual-process model predicts that rates of decline may dissociate. Here, we show that these measures consistently exhibited negative or near-zero correlations, as if engaged in a trade-off relationship, suggesting that different mechanisms contribute to perceptual and metacognitive decisions. Despite this dissociation, the two mechanisms likely depend on common resources, which could explain their trade-off relationship. Based on structural MRI brain images of individual human subjects, we assessed gray matter volume in the frontal polar area, a region that has been linked to visual metacognition. Variability of frontal polar volume correlated with individual differences in behavior, indicating the region may play a role in supplying common resources for both perceptual and metacognitive vigilance. Additional experiments revealed that reduced metacognitive demand led to superior perceptual vigilance, providing further support for this hypothesis. Overall, results indicate that during breaks between short blocks, it is the higher-level perceptual decision mechanisms, rather than lower-level sensory machinery, that benefit most from rest. Perceptual task performance declines over time (the so-called vigilance decrement), but the relationship between vigilance in perception and metacognition has

  2. Pollen source and resource limitation to fruit production in the rare species Eremosparton songoricum (Fabaceae)

    Science.gov (United States)

    Eremosparton songoricum (Litv.) Vass. is a rare, central Asian desert species which shows lower fruit set and seed set (<16%) than most hermaphroditic species. We hypothesized that fruit production was limited by pollen and resources. To evaluate potential fruit abortion due to pollen limitation, su...

  3. Empiric treatment of acute meningitis syndrome in a resource-limited ...

    African Journals Online (AJOL)

    Background: Bacterial meningitis is a significant cause of morbidity and mortality in the developing world. However, limited research has focused on the diagnosis and management of meningitis in resource-limited settings. Methods: We designed a prospective case series of children admitted to a large, academic referral ...

  4. Defining the anesthesia gap for reproductive health procedures in resource-limited settings.

    Science.gov (United States)

    Anderson, R Eleanor; Ahn, Roy; Nelson, Brett D; Chavez, Jean; de Redon, Emily; Burke, Thomas

    2014-12-01

    In resource-limited settings, severe shortages of anesthetists and anesthesiologists lead to surgical delays that increase maternal and neonatal mortality and morbidity. To more clearly understand the individual components of the anesthesia gap pertaining to reproductive health surgeries and procedures in resource-limited settings. Medline, the Cochrane Library, CINAHL, Embase, and POPLINE were systematically searched for reports published before December 31, 2013. Search terms were related to obstetric surgery, resource-limited settings, and anesthesia. Studies that addressed the use of anesthesia in reproductive procedures in resource-limited settings were included. Reviewers independently evaluated the full text of identified studies, extracted information related to study objectives and conclusions, and identified the anesthesia gap. Overall, 14 publications met the inclusion criteria. A significant lack of infrastructure, equipment and supplies, and trained personnel were identified as key factors responsible for a lack of anesthesia services. A shortage of trained anesthesia providers, equipment, supplies, medications, and infrastructure, along with limitations in transportation in resource-limited settings have produced a wide gap between available anesthesia services and the demand for them for reproductive health surgeries and procedures. Safe, affordable, and scalable solutions to address the anesthesia gap are urgently needed. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Creating a data resource: what will it take to build a medical information commons?

    Science.gov (United States)

    Deverka, Patricia A; Majumder, Mary A; Villanueva, Angela G; Anderson, Margaret; Bakker, Annette C; Bardill, Jessica; Boerwinkle, Eric; Bubela, Tania; Evans, Barbara J; Garrison, Nanibaa' A; Gibbs, Richard A; Gentleman, Robert; Glazer, David; Goldstein, Melissa M; Greely, Hank; Harris, Crane; Knoppers, Bartha M; Koenig, Barbara A; Kohane, Isaac S; La Rosa, Salvatore; Mattison, John; O'Donnell, Christopher J; Rai, Arti K; Rehm, Heidi L; Rodriguez, Laura L; Shelton, Robert; Simoncelli, Tania; Terry, Sharon F; Watson, Michael S; Wilbanks, John; Cook-Deegan, Robert; McGuire, Amy L

    2017-09-22

    National and international public-private partnerships, consortia, and government initiatives are underway to collect and share genomic, personal, and healthcare data on a massive scale. Ideally, these efforts will contribute to the creation of a medical information commons (MIC), a comprehensive data resource that is widely available for both research and clinical uses. Stakeholder participation is essential in clarifying goals, deepening understanding of areas of complexity, and addressing long-standing policy concerns such as privacy and security and data ownership. This article describes eight core principles proposed by a diverse group of expert stakeholders to guide the formation of a successful, sustainable MIC. These principles promote formation of an ethically sound, inclusive, participant-centric MIC and provide a framework for advancing the policy response to data-sharing opportunities and challenges.

  6. Sensory Attribute Identification Time Cannot Explain the Common Temporal Limit of Binding Different Attributes and Modalities

    Directory of Open Access Journals (Sweden)

    Waka Fujisaki

    2011-10-01

    Full Text Available An informative performance measure of the brain's integration across different sensory attributes/modalities is the critical temporal rate of feature alternation (between, eg, red and green beyond which observers could not identify the feature value specified by a timing signal from another attribute (eg, a pitch change. Interestingly, this limit, which we called the critical crowding frequency (CCF, is fairly low and nearly constant (∼2.5 Hz regardless of the combination of attributes and modalities (Fujisaki & Nishida, 2010, IMRF. One may consider that the CCF reflects the processing time required for the brain to identify the specified feature value on the fly. According to this idea, the similarity in CCF could be ascribed to the similarity in identification time for the attributes we used (luminance, color, orientation, pitch, vibration. To test this idea, we estimated the identification time of each attribute from [Go/ No-Go choice reaction time – simple reaction time]. In disagreement with the prediction, we found significant differences among attributes (eg, ∼160 ms for orientation, ∼70 ms for pitch. The results are more consistent with our proposal (Fujisaki & Nishida, Proc Roy Soc B that the CCF reflects the common rate limit of specifying what happens when (timing-content binding by a central, presumably postdictive, mechanism.

  7. An analysis and comparison of commonly available United Kingdom prescribing resources.

    Science.gov (United States)

    Cox, A R; Butt, T F; Ferner, R E

    2010-08-01

    Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high-quality information to support their practice. Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end-users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their

  8. Influence of three common calibration metrics on the diagnosis of climate change impacts on water resources

    Science.gov (United States)

    Seiller, G.; Roy, R.; Anctil, F.

    2017-04-01

    Uncertainties associated to the evaluation of the impacts of climate change on water resources are broad, from multiple sources, and lead to diagnoses sometimes difficult to interpret. Quantification of these uncertainties is a key element to yield confidence in the analyses and to provide water managers with valuable information. This work specifically evaluates the influence of hydrological modeling calibration metrics on future water resources projections, on thirty-seven watersheds in the Province of Québec, Canada. Twelve lumped hydrologic models, representing a wide range of operational options, are calibrated with three common objective functions derived from the Nash-Sutcliffe efficiency. The hydrologic models are forced with climate simulations corresponding to two RCP, twenty-nine GCM from CMIP5 (Coupled Model Intercomparison Project phase 5) and two post-treatment techniques, leading to future projections in the 2041-2070 period. Results show that the diagnosis of the impacts of climate change on water resources are quite affected by the hydrologic models selection and calibration metrics. Indeed, for the four selected hydrological indicators, dedicated to water management, parameters from the three objective functions can provide different interpretations in terms of absolute and relative changes, as well as projected changes direction and climatic ensemble consensus. The GR4J model and a multimodel approach offer the best modeling options, based on calibration performance and robustness. Overall, these results illustrate the need to provide water managers with detailed information on relative changes analysis, but also absolute change values, especially for hydrological indicators acting as security policy thresholds.

  9. Strengths of common resources for managing emergencies in the Spanish nuclear power plants (CAE y UME)

    International Nuclear Information System (INIS)

    Blas, J. de

    2014-01-01

    Following the accident at the Fukushima-Daiichi power plants, the electrical sector of nuclear generation recognised the need to reinforce the capacities that the nuclear power plants already had and which they were developing in order to satisfy the requisites of the stress tests, with the additional support of equipment and human resources common to all of them. Thus the idea arose to create a Spanish emergency Support centre. Its scope included an intervention unit, pumping equipment and electrical generation, a centralised warehouse and transfer logistics. UNESA-UME Collaboration Protocol With the collaboration of the CSN as a mediator, the UME reached an agreement with the nuclear electrical sector (UNESA) in order to be able to increase knowledge about the Spanish nuclear power plants and establish a means of collaboration to be able to act with their own human and equipment resources at a site that might suffer an accident such as the one at the Japanese plants of Fukushima-Daiichi. (Author)

  10. Topography- and management-mediated resource gradients maintain rare and common plant diversity around paddy terraces.

    Science.gov (United States)

    Uematsu, Yuta; Ushimaru, Atushi

    2013-09-01

    Examining the causes of interspecific differences in susceptibility to bidirectional land-use changes (land abandonment and use-intensification) is important for understanding the mechanisms of global biodiversity loss in agricultural landscapes. We tested the hypothesis that rare (endangered) plant species prefer wet and oligotrophic areas within topography- and management-mediated resource (soil water content, nutrient, and aboveground biomass) gradients, making them more susceptible to both abandonment and use-intensification of agricultural lands. We demonstrated that topography and management practices generated resource gradients in seminatural grasslands around traditional paddy terraces. Terraced topography and management practices produced a soil moisture gradient within levees and a nutrient gradient within paddy terraces. Both total and rare species diversity increased with soil water content. Total species diversity increased in more eutrophied areas with low aboveground biomass, whereas rare species diversity was high under oligotrophic conditions. Rare and common species were differentially distributed along the human-induced nutrient gradient, with rare species preferring wet, nutrient-poor environments in the agricultural landscapes studied. We suggest that conservation efforts should concentrate on wet, nutrient-poor areas within such landscapes, which can be located easily using land-use and topography maps. This strategy would reduce the costs of finding and conserving rare grassland species in a given agricultural landscape.

  11. View Points of an Ecologist on Practical Environmental Ethic: Socioecology, Common-Pool Resources and Conservation.

    Science.gov (United States)

    Castilla, Juan Carlos

    2016-01-01

    The paper centers on environmental practical ethic point of views according to a professional ecologist. Ecology and the science of Socio-ecology are defined. The framework of the Millennium Ecosystem Assessment initiative (MA 2003), including the use of ecosystems as the environmental unit of analysis, ecosystem services and human well-being as the center for assessment are discussed. Common-pool resources (CPR) and the allegory of the tragedy of the commons are used to illustrate main scientific and ethical environmental approaches, and above all to highlight the case of climate change, considering ″air-atmosphere″ as a CPR. The need to adopt practical personal environmental ethical positions is highlighted. Furthermore, on climate change, a discussion on the need to develop environmental and socio-ecological polycentric approaches: top-down and bottom-up, is included. An updated discussion on the concept of conservation, including main scientific and ethic points of view, is presented. Pope Francis's Encyclical, Laudato Si', is used to highlight environmental, socio-ecological and ethical aspects behind the comprehensive concept of Integral Ecology. The paper ends with a short synthesis on Earth modern unseen and astonishing environmental and socio-ecological rates of changes, and identifying the main barriers for personal environmental engagement. A call is done regarding the urgent need for socio-environmental ethic personal engagement and collective actions.

  12. Managing physical therapy resources: an analogy to the freedom of the commons and the need for collective action.

    Science.gov (United States)

    Brennan, Gerard P

    2012-06-01

    Tragedy results when we each pursue our own best interest in a society that believes in the freedom of a commons, such as clean air, fresh water, or natural fishing grounds. The purpose of this editorial is to consider how resources related to healthcare, and specifically to the delivery of physical therapy, can suffer the tragedy of the commons, and to consider an alternative strategy by which we can manage physical therapy resources effectively through collective action.

  13. National Laboratory Planning: Developing Sustainable Biocontainment Laboratories in Limited Resource Areas

    OpenAIRE

    Yeh, Kenneth B.; Adams, Martin; Stamper, Paul D.; Dasgupta, Debanjana; Hewson, Roger; Buck, Charles D.; Richards, Allen L.; Hay, John

    2016-01-01

    Strategic laboratory planning in limited resource areas is essential for addressing global health security issues. Establishing a national reference laboratory, especially one with BSL-3 or -4 biocontainment facilities, requires a heavy investment of resources, a multisectoral approach, and commitments from multiple stakeholders. We make the case for donor organizations and recipient partners to develop a comprehensive laboratory operations roadmap that addresses factors such as mission and r...

  14. Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.

  15. Common constraints limit Korean and English character recognition in peripheral vision.

    Science.gov (United States)

    He, Yingchen; Kwon, MiYoung; Legge, Gordon E

    2018-01-01

    The visual span refers to the number of adjacent characters that can be recognized in a single glance. It is viewed as a sensory bottleneck in reading for both normal and clinical populations. In peripheral vision, the visual span for English characters can be enlarged after training with a letter-recognition task. Here, we examined the transfer of training from Korean to English characters for a group of bilingual Korean native speakers. In the pre- and posttests, we measured visual spans for Korean characters and English letters. Training (1.5 hours × 4 days) consisted of repetitive visual-span measurements for Korean trigrams (strings of three characters). Our training enlarged the visual spans for Korean single characters and trigrams, and the benefit transferred to untrained English symbols. The improvement was largely due to a reduction of within-character and between-character crowding in Korean recognition, as well as between-letter crowding in English recognition. We also found a negative correlation between the size of the visual span and the average pattern complexity of the symbol set. Together, our results showed that the visual span is limited by common sensory (crowding) and physical (pattern complexity) factors regardless of the language script, providing evidence that the visual span reflects a universal bottleneck for text recognition.

  16. Community household income and resource utilization for common inpatient pediatric conditions.

    Science.gov (United States)

    Fieldston, Evan S; Zaniletti, Isabella; Hall, Matthew; Colvin, Jeffrey D; Gottlieb, Laura; Macy, Michelle L; Alpern, Elizabeth R; Morse, Rustin B; Hain, Paul D; Sills, Marion R; Frank, Gary; Shah, Samir S

    2013-12-01

    Child health is influenced by biomedical and socioeconomic factors. Few studies have explored the relationship between community-level income and inpatient resource utilization for children. Our objective was to analyze inpatient costs for children hospitalized with common conditions in relation to zip code-based median annual household income (HHI). Retrospective national cohort from 32 freestanding children's hospitals for asthma, diabetes, bronchiolitis and respiratory syncytial virus, pneumonia, and kidney and urinary tract infections. Standardized cost of care for individual hospitalizations and across hospitalizations for the same patient and condition were modeled by using mixed-effects methods, adjusting for severity of illness, age, gender, and race. Main exposure was median annual HHI. Posthoc tests compared adjusted standardized costs for patients from the lowest and highest income groups. From 116,636 hospitalizations, 4 of 5 conditions had differences at the hospitalization and at the patient level, with lowest-income groups having higher costs. The individual hospitalization level cost differences ranged from $187 (4.1%) to $404 (6.4%). Patient-level cost differences ranged from $310 to $1087 or 6.5% to 15% higher for the lowest-income patients. Higher costs were typically not for laboratory, imaging, or pharmacy costs. In total, patients from lowest income zip codes had $8.4 million more in hospitalization-level costs and $13.6 million more in patient-level costs. Lower community-level HHI is associated with higher inpatient costs of care for 4 of 5 common pediatric conditions. These findings highlight the need to consider socioeconomic status in health care system design, delivery, and reimbursement calculations.

  17. The dual impact of ecology and management on social incentives in marine common-pool resource systems.

    Science.gov (United States)

    Klein, E S; Barbier, M R; Watson, J R

    2017-08-01

    Understanding how and when cooperative human behaviour forms in common-pool resource systems is critical to illuminating social-ecological systems and designing governance institutions that promote sustainable resource use. Before assessing the full complexity of social dynamics, it is essential to understand, concretely and mechanistically, how resource dynamics and human actions interact to create incentives and pay-offs for social behaviours. Here, we investigated how such incentives for information sharing are affected by spatial dynamics and management in a common-pool resource system. Using interviews with fishermen to inform an agent-based model, we reveal generic mechanisms through which, for a given ecological setting characterized by the spatial dynamics of the resource, the two 'human factors' of information sharing and management may heterogeneously impact various members of a group for whom theory would otherwise predict the same strategy. When users can deplete the resource, these interactions are further affected by the management approach. Finally, we discuss the implications of alternative motivations, such as equity among fishermen and consistency of the fleet's output. Our results indicate that resource spatial dynamics, form of management and level of depletion can interact to alter the sociality of people in common-pool resource systems, providing necessary insight for future study of strategic decision processes.

  18. A comprehensive reference transcriptome resource for the common house spider Parasteatoda tepidariorum.

    Directory of Open Access Journals (Sweden)

    Nico Posnien

    Full Text Available Parasteatoda tepidariorum is an increasingly popular model for the study of spider development and the evolution of development more broadly. However, fully understanding the regulation and evolution of P. tepidariorum development in comparison to other animals requires a genomic perspective. Although research on P. tepidariorum has provided major new insights, gene analysis to date has been limited to candidate gene approaches. Furthermore, the few available EST collections are based on embryonic transcripts, which have not been systematically annotated and are unlikely to contain transcripts specific to post-embryonic stages of development. We therefore generated cDNA from pooled embryos representing all described embryonic stages, as well as post-embryonic stages including nymphs, larvae and adults, and using Illumina HiSeq technology obtained a total of 625,076,514 100-bp paired end reads. We combined these data with 24,360 ESTs available in GenBank, and 1,040,006 reads newly generated from 454 pyrosequencing of a mixed-stage embryo cDNA library. The combined sequence data were assembled using a custom de novo assembly strategy designed to optimize assembly product length, number of predicted transcripts, and proportion of raw reads incorporated into the assembly. The de novo assembly generated 446,427 contigs with an N50 of 1,875 bp. These sequences obtained 62,799 unique BLAST hits against the NCBI non-redundant protein data base, including putative orthologs to 8,917 Drosophila melanogaster genes based on best reciprocal BLAST hit identity compared with the D. melanogaster proteome. Finally, we explored the utility of the transcriptome for RNA-Seq studies, and showed that this resource can be used as a mapping scaffold to detect differential gene expression in different cDNA libraries. This resource will therefore provide a platform for future genomic, gene expression and functional approaches using P. tepidariorum.

  19. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings

    Science.gov (United States)

    Meyer, Ana-Claire L.; Dua, Tarun; Boscardin, John; Escarce, José J.; Saxena, Shekhar; Birbeck, Gretchen L.

    2013-01-01

    Purpose Epilepsy is one of the most common serious neurological disorders worldwide. Our objective was to determine which economic, healthcare, neurology and epilepsy specific resources were associated with untreated epilepsy in resource-constrained settings. Methods A systematic review of the literature identified community-based studies in resource-constrained settings that calculated the epilepsy treatment gap, the proportion with untreated epilepsy, from prevalent active epilepsy cases. Economic, healthcare, neurology and epilepsy specific resources were taken from existing datasets. Poisson regression models with jackknifed standard errors were used to create bivariate and multivariate models comparing the association between treatment status and economic and health resource indicators. Relative risks were reported. Key Findings Forty-seven studies of 8285 individuals from 24 countries met inclusion criteria. Bivariate analysis demonstrated that individuals residing in rural locations had significantly higher risks of untreated epilepsy [Relative Risk(RR)=1.63; 95% confidence interval(CI):1.26,2.11]. Significantly lower risks of untreated epilepsy were observed for higher physician density [RR=0.65, 95% CI:0.55,0.78], presence of a lay [RR=0.74, 95%CI:0.60,0.91] or professional association for epilepsy [RR=0.73, 95%CI:0.59,0.91], or post-graduate neurology training program [RR=0.67, 95%CI:0.55, 0.82]. In multivariate models, higher physician density maintained significant effects [RR=0.67; 95%CI:0.52,0.88]. Significance Even among resource-limited regions, people with epilepsy in countries with fewer economic, healthcare, neurology and epilepsy specific resources are more likely to have untreated epilepsy. Community-based epilepsy care programs have improved access to treatment but in order to decrease the epilepsy treatment gap, poverty and inequalities of healthcare, neurological and epilepsy resources must be dealt with at the local, national, and global

  20. Policy Design for Competitive Retail Electric Institutions: Artificial Intelligence Representations for a Common Property Resource Approach

    Science.gov (United States)

    Pandit, Nitin S.

    The U.S. electricity industry is being restructured to increase competition. Although existing policies may lead to efficient wholesale institutions, designing policies for the retail level is more complex because of intricate interactions between individuals and quasi-monopolistic institutions. It is argued that Hirshman's ideas of "exit" and "voice" (Hirshman, 1970) provide powerful abstractions for design of retail institutions. While competition is a known mechanism of "exit," a novel design of the "voice" mechanism is demonstrated through an artificial intelligence (AI) based software process model. The process model of "voice" in retail institutions is designed within the economic context of electricity distribution -- a common property resource (CPR), characterized by technological uncertainty and path-dependency. First, it is argued that participant feedback (voice) has to be used effectively to manage the CPR. Further, it is noted that the decision process, of using participant feedback (voice) to incrementally manage uncertainty and path-dependencies, is non-monotonic because it requires the decision makers to often retract previously made assumptions and decisions. An AI based process model of "voice" is developed using an assumption-based truth maintenance system. The model can emulate the non-monotonic decision making process and therefore assist in decision support. Such a systematic framework is flexible, consistent, and easily reorganized as assumptions change. It can provide an effective, formal "voice" mechanism to the retail customers and improve institutional performance.

  1. Nutrition Education Brings Behavior and Knowledge Change in Limited-Resource Older Adults

    Science.gov (United States)

    McClelland, Jacquelyn W.; Jayaratne, K.S.U.; Bird, Carolyn L.

    2013-01-01

    A prospective, controlled, randomized, crossover design was used to examine a nutrition education curriculum's effects on knowledge and behavior of 463 limited-resource older adults in 13 counties. Counties were randomized to begin with the treatment or control curriculum and then the remaining curriculum. Participants completed a pre-test…

  2. Reduced detrital resources limit Pycnopsyche gentilis (Trichoptera: Limnephilidae) production and growth

    Science.gov (United States)

    Susan L. Eggert; J. Bruce Wallace

    2003-01-01

    Leaf inputs in temperate forest streams may limit caddisfly production because leaf detritus serves both as a food and case-material resource. We estimated Pycnopsyche gentilis produdion in a stream experimentally decoupled fmm its riparian habitat and a reference stream for 8 y in the southern Appalachians. We also examined laboratory survivorship,...

  3. Decline of clear-water rotifer populations in a reservoir: the role of resource limitation

    Czech Academy of Sciences Publication Activity Database

    Devetter, Miloslav; Seďa, Jaromír

    2005-01-01

    Roč. 546, č. 1 (2005), s. 509-518 ISSN 0018-8158 Institutional research plan: CEZ:AV0Z60660521 Keywords : resource limitation * rotifers * birth rate Subject RIV: EH - Ecology, Behaviour Impact factor: 0.978, year: 2005

  4. Enhancing Teaching and Learning Wi-Fi Networking Using Limited Resources to Undergraduates

    Science.gov (United States)

    Sarkar, Nurul I.

    2013-01-01

    Motivating students to learn Wi-Fi (wireless fidelity) wireless networking to undergraduate students is often difficult because many students find the subject rather technical and abstract when presented in traditional lecture format. This paper focuses on the teaching and learning aspects of Wi-Fi networking using limited hardware resources. It…

  5. The small and rural academic library leveraging resources and overcoming limitations

    CERN Document Server

    Davis Kendrick, Kaetrena

    2016-01-01

    Through the use of case studies, research, and practical interviews, The Small or Rural Academic Library: Leveraging Resources and Overcoming Limitations explores how academic librarians in such environments can keep pace with, create, and improve modern library practices and services, network with colleagues, and access continuing education and professional development opportunities.

  6. Central-line-associated bloodstream infections in a resource-limited ...

    African Journals Online (AJOL)

    ... that reported from resource-limited settings, but exceeds that of high-income countries. Prolonged NICU stay and central-line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene are key ...

  7. Revising an Extension Education Website for Limited Resource Audiences Using Social Marketing Theory

    Science.gov (United States)

    Francis, Sarah L.; Martin, Peggy; Taylor, Kristin

    2011-01-01

    Spend Smart Eat Smart (SSES), a unique website combining nutrition and food buying education for limited resource audiences (LRAs), was revised using social marketing theory to make it more appealing and relevant to LRAs (25-40 years). Focus groups and surveys identified the needs and preferences of LRAs. Needs were cooking, basic health, and…

  8. Using game theory approach to interpret stable policies for Iran's oil and gas common resources conflicts with Iraq and Qatar

    Science.gov (United States)

    Esmaeili, Maryam; Bahrini, Aram; Shayanrad, Sepideh

    2015-12-01

    Oil and gas as the non-renewable resources are considered very valuable for the countries with petroleum economics. These resources are not only diffused equally around the world, but also they are common in some places which their neighbors often come into conflicts. Consequently, it is vital for those countries to manage their resource utilization. Lately, game theory was applied in conflict resolution of common resources, such as water, which is a proof of its efficacy and capability. This paper models the conflicts between Iran and its neighbors namely Qatar and Iraq between their oil and gas common resources using game theory approach. In other words, the future of these countries will be introduced and analyzed by some well-known 2 × 2 games to achieve a better perspective of their conflicts. Because of information inadequacy of the players, in addition to Nash Stability, various solution concepts are used based on the foresight, disimprovements, and knowledge of preferences. The results of mathematical models show how the countries could take a reasonable strategy to exploit their common resources.

  9. National Laboratory Planning: Developing Sustainable Biocontainment Laboratories in Limited Resource Areas.

    Science.gov (United States)

    Yeh, Kenneth B; Adams, Martin; Stamper, Paul D; Dasgupta, Debanjana; Hewson, Roger; Buck, Charles D; Richards, Allen L; Hay, John

    2016-01-01

    Strategic laboratory planning in limited resource areas is essential for addressing global health security issues. Establishing a national reference laboratory, especially one with BSL-3 or -4 biocontainment facilities, requires a heavy investment of resources, a multisectoral approach, and commitments from multiple stakeholders. We make the case for donor organizations and recipient partners to develop a comprehensive laboratory operations roadmap that addresses factors such as mission and roles, engaging national and political support, securing financial support, defining stakeholder involvement, fostering partnerships, and building trust. Successful development occurred with projects in African countries and in Azerbaijan, where strong leadership and a clear management framework have been key to success. A clearly identified and agreed management framework facilitate identifying the responsibility for developing laboratory capabilities and support services, including biosafety and biosecurity, quality assurance, equipment maintenance, supply chain establishment, staff certification and training, retention of human resources, and sustainable operating revenue. These capabilities and support services pose rate-limiting yet necessary challenges. Laboratory capabilities depend on mission and role, as determined by all stakeholders, and demonstrate the need for relevant metrics to monitor the success of the laboratory, including support for internal and external audits. Our analysis concludes that alternative frameworks for success exist for developing and implementing capabilities at regional and national levels in limited resource areas. Thus, achieving a balance for standardizing practices between local procedures and accepted international standards is a prerequisite for integrating new facilities into a country's existing public health infrastructure and into the overall international scientific community.

  10. Epidemiology, Diagnosis, and Treatment of HIV-Associated Non-Hodgkin Lymphoma in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Matthew Ulrickson

    2012-01-01

    Full Text Available Lymphoma was a common complication of HIV infection in the pre-antiretroviral era, and the incidence of HIV-associated lymphoma has dropped dramatically since the introduction of combination antiretroviral therapy (cART in resource-rich regions. Conversely, lymphoma is an increasingly common complication of HIV infection in resource-limited settings where the prevalence of HIV infection is high. Relatively little is known, however, about the true incidence and optimal treatment regimens for HIV-associated lymphoma in resource-poor regions. We review the epidemiology, diagnosis, and treatment of HIV-associated non-Hodgkin lymphoma in developing nations and highlight areas for further research that may benefit care in both settings. Examples include risk modification and dose modification of chemotherapy based on HIV risk factors, improving our understanding of the current burden of disease through national cancer registries, and developing cost-effective hematopathological diagnostic strategies to optimize care delivery and maximize use of available chemotherapy.

  11. Detection of T and B cells specific complement-fixing alloantibodies using flow cytometry: A diagnostic approach for a resource limited laboratory

    Directory of Open Access Journals (Sweden)

    Dharmendra Jain

    2017-01-01

    Conclusions: We postulate that this method incorporates most of the features of all the available modalities (i.e., National Institute of Health-complement dependent lymphocytotoxicity, FCXM, cytotoxic FCXM and C4d-flowPRA yet cost-effective and best suited for resource-limited laboratory/ies which is a common scenario in developing countries.

  12. An alternative policy evaluation of the British Columbia carbon tax: broadening the application of Elinor Ostrom's design principles for managing common-pool resources

    Directory of Open Access Journals (Sweden)

    Karine Lacroix

    2015-06-01

    Full Text Available Climate change is putting infrastructure, food supply, water resources, ecosystems, and human health at risk. These risks will be exacerbated depending on the degree of additional greenhouse gas emissions. Urgent action is needed to limit the severity of impacts associated with further warming. British Columbia (BC has taken action to reduce greenhouse gas emissions from carbon-based fuels by introducing a carbon tax in 2008. As an innovative approach to climate change mitigation, especially in North America, studies evaluating its effectiveness are valuable. We assessed the long-term viability potential of the BC carbon tax using common pool resource design principles, a novel application of the design principles to environmental policy. We found that the design principles can be applied productively to environmental policy and larger scale air pollution problems. With regard to the BC carbon tax, our findings suggest that closer monitoring of user behavior, further increases of the tax over time, and pursuing efforts for a more elaborate system of nested enterprises and interjurisdictional cooperation could increase the long-term success of the BC carbon tax. We also found that the design principles allowed us to more comprehensively reach conclusions regarding the broader effectiveness of the tax when compared to existing policy analysis. Traditionally, climate policy evaluation has focused on the end goal without considering broader constraints and issues of resource allocation. We suggest that common pool resource theory, which is based on strong theoretical principles and encourages reflexivity, will be able to address those limitations.

  13. Modified stretched exponential model of computer system resources management limitations-The case of cache memory

    Science.gov (United States)

    Strzałka, Dominik; Dymora, Paweł; Mazurek, Mirosław

    2018-02-01

    In this paper we present some preliminary results in the field of computer systems management with relation to Tsallis thermostatistics and the ubiquitous problem of hardware limited resources. In the case of systems with non-deterministic behaviour, management of their resources is a key point that guarantees theirs acceptable performance and proper working. This is very wide problem that stands for many challenges in financial, transport, water and food, health, etc. areas. We focus on computer systems with attention paid to cache memory and propose to use an analytical model that is able to connect non-extensive entropy formalism, long-range dependencies, management of system resources and queuing theory. Obtained analytical results are related to the practical experiment showing interesting and valuable results.

  14. Cooperation Is Not Enough—Exploring Social-Ecological Micro-Foundations for Sustainable Common-Pool Resource Use

    Science.gov (United States)

    Wijermans, Nanda; Schlüter, Maja; Lindahl, Therese

    2016-01-01

    Cooperation amongst resource users holds the key to overcoming the social dilemma that characterizes community-based common-pool resource management. But is cooperation alone enough to achieve sustainable resource use? The short answer is no. Developing management strategies in a complex social-ecological environment also requires ecological knowledge and approaches to deal with perceived environmental uncertainty. Recent behavioral experimental research indicates variation in the degree to which a group of users can identify a sustainable exploitation level. In this paper, we identify social-ecological micro-foundations that facilitate cooperative sustainable common-pool resource use. We do so by using an agent-based model (ABM) that is informed by behavioral common-pool resource experiments. In these experiments, groups that cooperate do not necessarily manage the resource sustainably, but also over- or underexploit. By reproducing the patterns of the behavioral experiments in a qualitative way, the ABM represents a social-ecological explanation for the experimental observations. We find that the ecological knowledge of each group member cannot sufficiently explain the relationship between cooperation and sustainable resource use. Instead, the development of a sustainable exploitation level depends on the distribution of ecological knowledge among the group members, their influence on each other’s knowledge, and the environmental uncertainty the individuals perceive. The study provides insights about critical social-ecological micro-foundations underpinning collective action and sustainable resource management. These insights may inform policy-making, but also point to future research needs regarding the mechanisms of social learning, the development of shared management strategies and the interplay of social and ecological uncertainty. PMID:27556175

  15. Cooperation Is Not Enough—Exploring Social-Ecological Micro-Foundations for Sustainable Common-Pool Resource Use [corrected].

    Directory of Open Access Journals (Sweden)

    Caroline Schill

    Full Text Available Cooperation amongst resource users holds the key to overcoming the social dilemma that characterizes community-based common-pool resource management. But is cooperation alone enough to achieve sustainable resource use? The short answer is no. Developing management strategies in a complex social-ecological environment also requires ecological knowledge and approaches to deal with perceived environmental uncertainty. Recent behavioral experimental research indicates variation in the degree to which a group of users can identify a sustainable exploitation level. In this paper, we identify social-ecological micro-foundations that facilitate cooperative sustainable common-pool resource use. We do so by using an agent-based model (ABM that is informed by behavioral common-pool resource experiments. In these experiments, groups that cooperate do not necessarily manage the resource sustainably, but also over- or underexploit. By reproducing the patterns of the behavioral experiments in a qualitative way, the ABM represents a social-ecological explanation for the experimental observations. We find that the ecological knowledge of each group member cannot sufficiently explain the relationship between cooperation and sustainable resource use. Instead, the development of a sustainable exploitation level depends on the distribution of ecological knowledge among the group members, their influence on each other's knowledge, and the environmental uncertainty the individuals perceive. The study provides insights about critical social-ecological micro-foundations underpinning collective action and sustainable resource management. These insights may inform policy-making, but also point to future research needs regarding the mechanisms of social learning, the development of shared management strategies and the interplay of social and ecological uncertainty.

  16. Cooperation Is Not Enough—Exploring Social-Ecological Micro-Foundations for Sustainable Common-Pool Resource Use [corrected].

    Science.gov (United States)

    Schill, Caroline; Wijermans, Nanda; Schlüter, Maja; Lindahl, Therese

    2016-01-01

    Cooperation amongst resource users holds the key to overcoming the social dilemma that characterizes community-based common-pool resource management. But is cooperation alone enough to achieve sustainable resource use? The short answer is no. Developing management strategies in a complex social-ecological environment also requires ecological knowledge and approaches to deal with perceived environmental uncertainty. Recent behavioral experimental research indicates variation in the degree to which a group of users can identify a sustainable exploitation level. In this paper, we identify social-ecological micro-foundations that facilitate cooperative sustainable common-pool resource use. We do so by using an agent-based model (ABM) that is informed by behavioral common-pool resource experiments. In these experiments, groups that cooperate do not necessarily manage the resource sustainably, but also over- or underexploit. By reproducing the patterns of the behavioral experiments in a qualitative way, the ABM represents a social-ecological explanation for the experimental observations. We find that the ecological knowledge of each group member cannot sufficiently explain the relationship between cooperation and sustainable resource use. Instead, the development of a sustainable exploitation level depends on the distribution of ecological knowledge among the group members, their influence on each other's knowledge, and the environmental uncertainty the individuals perceive. The study provides insights about critical social-ecological micro-foundations underpinning collective action and sustainable resource management. These insights may inform policy-making, but also point to future research needs regarding the mechanisms of social learning, the development of shared management strategies and the interplay of social and ecological uncertainty.

  17. Prehospital care practices for venomous snakebites in resource-limited settings: A narrative review

    Directory of Open Access Journals (Sweden)

    Godpower Chinedu Michael

    2017-01-01

    Full Text Available Venomous snakebite is a medical emergency encountered worldwide, especially in resource-limited communities. It usually leaves victims at the mercy of traditional care, whose effectiveness have come under scrutiny over time. Several of these traditional/ first aid practices have also been reported over time. Controversies over their efficacy often result in confusion among snakebite victims, their caregivers, and sometimes, among health-care providers. This narrative review describes reported prehospital interventions for venomous snakebites highlighting their usefulness, dangers, and/or limitations associated with their use and the currently widely recommended prehospital activities for venomous snakebite.

  18. Screening for genital tuberculosis in a limited resource country: case report

    OpenAIRE

    Namani, Sadie; Qehaja-Bu?aj, Emine; Namani, Diell?za

    2017-01-01

    Background Screening for benign or malignant process of pelvis in young females is a challenge for a physician in a limited resource country. Tuberculosis should be always considered in the differential diagnosis of a pelvic mass in countries with high prevalence of tuberculosis. Negative results of analysis of peritoneal fluid for acid-fast staining, late cultures, and unavailability of new diagnostics methods such as polymerase chain reaction and adenosine deaminase of the aspirated fluid f...

  19. The effects of density dependent resource limitation on size of wild reindeer.

    Science.gov (United States)

    Skogland, Terje

    1983-11-01

    A density-dependent decrement in size for wild reindeer from 12 different Norwegian herds at 16 different densities was shown using lower jawbone-length as the criterion of size. This criterion was tested and found to adequately predict body size of both bucks and does. Lactation in does did not affect jaw length but significantly affected dressed weights.A decrement in the size of does as a result of gross density was found. This size decrement was further analysed in relation to the habitat densities in winter (R 2 =0.85) and in summer (R 2 =0.75) separately, in order to estimate the relative effects of each factor. For herds with adequate food in winter (no signs of overgrazing of lichens) density in relation to summer habitat and mires yielded the highest predictive power in a multiple regression. For herds with adequate summer pastures, densities per winter habitat and lichen volumes showed likewise a highly significant correlation. The inclusion of the lichen volume data in the regression increased its predictive power. The major effect of resource limitation was to delay the time of calving because a maternal carry-over effect allowed the calf a shorter period of growth to be completed during its first summer. Neonate size at birth was highly correlated with maternal size regardless of the mean calving date although the latter was significantly delayed for small-sized does in food resource-limited herds. Likewise the postnatal growth rate of all calves were not significantly different during 50 days postpartum regardless of maternal conditions in winter feeding. The summer growth rates of bucks ≧1 year did not vary significantly between herds. The age of maturity of food resource-limited does was delayed by one year and growth ceased after the initiation of reproduction. This shows that under conditions of limited resources the does with delayed births of calves allocated less energy to body growth simply because they had less time to replenish body

  20. Cultural Health Capital on the margins: Cultural resources for navigating healthcare in communities with limited access.

    Science.gov (United States)

    Madden, Erin Fanning

    2015-05-01

    Communities struggling with access to healthcare in the U.S. are often considered to be disadvantaged and lacking in resources. Yet, these communities develop and nurture valuable strategies for healthcare access that are underrecognized by health scholars. Combining medical sociology and critical race theory perspectives on cultural capital, this paper examines the health-relevant cultural resources, or Cultural Health Capital, in South Texas Mexican American border communities. Ethnographic data collected during 2011-2013 in Cameron and Hidalgo counties on the U.S.-Mexico border provide empirical evidence for expanding existing notions of health-relevant cultural capital. These Mexican American communities use a range of cultural resources to manage healthcare exclusion and negotiate care in alternative healthcare spaces like community clinics, flea markets and Mexican pharmacies. Navigational, social, familial, and linguistic skills and knowledge are used to access doctors and prescription drugs in these spaces despite social barriers to mainstream healthcare (e.g. cost, English language skills, etc.). Cultural capital used in marginalized communities to navigate limited healthcare options may not always fully counteract healthcare exclusion. Nevertheless, recognizing the cultural resources used in Mexican American communities to facilitate healthcare challenges deficit views and yields important findings for policymakers, healthcare providers, and advocates seeking to capitalize on community resources to improve healthcare access. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Absenteeism due to Functional Limitations Caused by Seven Common Chronic Diseases in US Workers.

    Science.gov (United States)

    Vuong, Tam D; Wei, Feifei; Beverly, Claudia J

    2015-07-01

    The study examined the relationship between functional limitation due to chronic diseases and absenteeism among full-time workers. The studied chronic diseases include arthritis/rheumatism, cancer, diabetes, heart disease, hypertension, lung disease, and stroke. We analyzed data from the 2011 to 2013 National Health Interview Survey. Economic impact was determined by workdays lost and lost income. Increase in absenteeism was observed for each studied condition. Employees with multiple conditions also saw increase absenteeism. Employers lose 28.2 million workdays annually ($4.95 billion in lost income) due to functional limitation caused by chronic diseases. The results show a burden on society due to functional limitation caused by studied chronic diseases. Employers should look into implementing intervention/prevention programs, such as the Chronic Disease Self-Management Programs, to help reduce the cost associated with absenteeism.

  2. Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Scanlon ML

    2013-01-01

    Full Text Available Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART significantly reduced human immunodeficiency virus (HIV-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a

  3. Evaluation of common mode failure of safety functions for limiting fault events

    International Nuclear Information System (INIS)

    Rezendes, J.P.; Hyde, A.W.

    2004-01-01

    The draft U.S. Nuclear Regulatory Commission (NRC) policy on digital protection system software requires all Advanced Light Water Reactors (ALWRs) to be evaluated assuming a hypothetical common mode failure (CMF) which incapacitates the normal automatic initiation of safety functions. The System 80 + ALWR has been evaluated for such hypothetical conditions. The results show that the diverse automatic and manual protective systems in System 80 + provide ample safety performance margins relative to core coolability, offsite radiological releases. Reactor Coolant System (RCS) pressurization and containment integrity. This deterministic evaluation served to quantify the significant inherent safety margins in the System 80 + Standard Plant design even in the event of this extremely low probability scenario of a common mode failure. (author)

  4. Fertility Limitation and Child Schooling in Ouagadougou: Selective Fertility or Resource Dilution?

    Science.gov (United States)

    Bougma, Moussa; LeGrand, Thomas K; Kobiané, Jean-François

    2015-06-01

    Using original data collected in Ouagadougou, Burkina Faso, this study investigates evidence for the competing theories that fertility reductions increase children's education through either the quantity-quality tradeoff (intentionally choosing smaller families to make greater investments in education and other indicators of child quality) or resource dilution (having more children reduces resources available per child, regardless of intentionality of family size). The results provide evidence for both hypotheses: children having four or fewer siblings were significantly more likely to be enrolled in school if their mothers had intentionally stopped childbearing relative to those whose mothers wanted more children but whose childbearing was limited by subfecundity. The difference between intentional and unintentional family limitation was not significant for parities greater than five. In addition, the relationship between number of siblings and their schooling is negative, regardless of the intentionality of family-size limitation, but the strength of this negative relationship is approximately twice as high among children whose mothers intentionally limited fertility (reflecting both selection and dilution effects) than among children whose mothers were subfecund (reflecting the pure dilution effect). © 2015 The Population Council, Inc.

  5. Resource limits and conversion efficiency with implications for climate change and California's energy supply

    Science.gov (United States)

    Croft, Gregory Donald

    There are two commonly-used approaches to modeling the future supply of mineral resources. One is to estimate reserves and compare the result to extraction rates, and the other is to project from historical time series of extraction rates. Perceptions of abundant oil supplies in the Middle East and abundant coal supplies in the United States are based on the former approach. In both of these cases, an approach based on historical production series results in a much smaller resource estimate than aggregate reserve numbers. This difference is not systematic; natural gas production in the United States shows a strong increasing trend even though modest reserve estimates have resulted in three decades of worry about the gas supply. The implication of a future decline in Middle East oil production is that the market for transportation fuels is facing major changes, and that alternative fuels should be analyzed in this light. Because the U.S. holds very large coal reserves, synthesizing liquid hydrocarbons from coal has been suggested as an alternative fuel supply. To assess the potential of this process, one has to look at both the resource base and the net efficiency. The three states with the largest coal production declines in the 1996 to 2006 period are among the top 5 coal reserve holders, suggesting that gross coal reserves are a poor indicator of future production. Of the three categories of coal reserves reported by the U.S. Energy Information Administration, reserves at existing mines is the narrowest category and is approximately the equivalent of proved developed oil reserves. By this measure, Wyoming has the largest coal reserves in the U.S., and it accounted for all of U.S. coal production growth over the 1996 to 2006 time period. In Chapter 2, multi-cycle Hubbert curve analysis of historical data of coal production from 1850 to 2007 demonstrates that U.S. anthracite and bituminous coal are past their production peak. This result contradicts estimates based

  6. Invasive Acer negundo outperforms native species in non-limiting resource environments due to its higher phenotypic plasticity.

    Science.gov (United States)

    Porté, Annabel J; Lamarque, Laurent J; Lortie, Christopher J; Michalet, Richard; Delzon, Sylvain

    2011-11-24

    To identify the determinants of invasiveness, comparisons of traits of invasive and native species are commonly performed. Invasiveness is generally linked to higher values of reproductive, physiological and growth-related traits of the invasives relative to the natives in the introduced range. Phenotypic plasticity of these traits has also been cited to increase the success of invasive species but has been little studied in invasive tree species. In a greenhouse experiment, we compared ecophysiological traits between an invasive species to Europe, Acer negundo, and early- and late-successional co-occurring native species, under different light, nutrient availability and disturbance regimes. We also compared species of the same species groups in situ, in riparian forests. Under non-limiting resources, A. negundo seedlings showed higher growth rates than the native species. However, A. negundo displayed equivalent or lower photosynthetic capacities and nitrogen content per unit leaf area compared to the native species; these findings were observed both on the seedlings in the greenhouse experiment and on adult trees in situ. These physiological traits were mostly conservative along the different light, nutrient and disturbance environments. Overall, under non-limiting light and nutrient conditions, specific leaf area and total leaf area of A. negundo were substantially larger. The invasive species presented a higher plasticity in allocation to foliage and therefore in growth with increasing nutrient and light availability relative to the native species. The higher level of plasticity of the invasive species in foliage allocation in response to light and nutrient availability induced a better growth in non-limiting resource environments. These results give us more elements on the invasiveness of A. negundo and suggest that such behaviour could explain the ability of A. negundo to outperform native tree species, contributes to its spread in European resource

  7. A systematic review of portable electronic technology for health education in resource-limited settings.

    Science.gov (United States)

    McHenry, Megan S; Fischer, Lydia J; Chun, Yeona; Vreeman, Rachel C

    2017-08-01

    The objective of this study is to conduct a systematic review of the literature of how portable electronic technologies with offline functionality are perceived and used to provide health education in resource-limited settings. Three reviewers evaluated articles and performed a bibliography search to identify studies describing health education delivered by portable electronic device with offline functionality in low- or middle-income countries. Data extracted included: study population; study design and type of analysis; type of technology used; method of use; setting of technology use; impact on caregivers, patients, or overall health outcomes; and reported limitations. Searches yielded 5514 unique titles. Out of 75 critically reviewed full-text articles, 10 met inclusion criteria. Study locations included Botswana, Peru, Kenya, Thailand, Nigeria, India, Ghana, and Tanzania. Topics addressed included: development of healthcare worker training modules, clinical decision support tools, patient education tools, perceptions and usability of portable electronic technology, and comparisons of technologies and/or mobile applications. Studies primarily looked at the assessment of developed educational modules on trainee health knowledge, perceptions and usability of technology, and comparisons of technologies. Overall, studies reported positive results for portable electronic device-based health education, frequently reporting increased provider/patient knowledge, improved patient outcomes in both quality of care and management, increased provider comfort level with technology, and an environment characterized by increased levels of technology-based, informal learning situations. Negative assessments included high investment costs, lack of technical support, and fear of device theft. While the research is limited, portable electronic educational resources present promising avenues to increase access to effective health education in resource-limited settings, contingent

  8. Spatial distribution of limited resources and local density regulation in juvenile Atlantic salmon.

    Science.gov (United States)

    Finstad, Anders G; Einum, Sigurd; Ugedal, Ola; Forseth, Torbjørn

    2009-01-01

    1. Spatial heterogeneity of resources may influence competition among individuals and thus have a fundamental role in shaping population dynamics and carrying capacity. In the present study, we identify shelter opportunities as a limiting resource for juvenile Atlantic salmon (Salmo salar L.). Experimental and field studies are combined in order to demonstrate how the spatial distribution of shelters may influence population dynamics on both within and among population scales. 2. In closed experimental streams, fish performance scaled negatively with decreasing shelter availability and increasing densities. In contrast, the fish in open stream channels dispersed according to shelter availability and performance of fish remaining in the streams did not depend on initial density or shelters. 3. The field study confirmed that spatial variation in densities of 1-year-old juveniles was governed both by initial recruit density and shelter availability. Strength of density-dependent population regulation, measured as carrying capacity, increased with decreasing number of shelters. 4. Nine rivers were surveyed for spatial variation in shelter availability and increased shelter heterogeneity tended to decrease maximum observed population size (measured using catch statistics of adult salmon as a proxy). 5. Our studies highlight the importance of small-scale within-population spatial structure in population dynamics and demonstrate that not only the absolute amount of limiting resources but also their spatial arrangement can be an important factor influencing population carrying capacity.

  9. Farmer perceptions on factors influencing water scarcity for goats in resource-limited communal farming environments.

    Science.gov (United States)

    Mdletshe, Zwelethu Mfanafuthi; Ndlela, Sithembile Zenith; Nsahlai, Ignatius Verla; Chimonyo, Michael

    2018-05-09

    The objective of the study was to compare factors influencing water scarcity for goats in areas where there are seasonal and perennial rivers under resource-limited communal farming environments. Data were collected using a structured questionnaire (n = 285) administered randomly to smallholder goat farmers from areas with seasonal and perennial rivers. Ceremonies was ranked as the major reason for keeping goats. Water scarcity was ranked the major constraint to goat production in areas with seasonal rivers when compared to areas with perennial rivers (P goat drinking in areas with seasonal and perennial river systems during cool dry and rainy seasons. Rivers were ranked as an important water source for goat drinking where there are seasonal and perennial river systems during the cool dry season. Households located close (≤ 3 km) to the nearest water source reported drinking water for goats a scarce resource. These results show that river systems, season and distance to the nearest water source from a household were factors perceived by farmers to influence water scarcity for goats in resource-limited communal farming environments. Farmers should explore water-saving strategies such as recycling wastewater from kitchens and bathrooms as an alternative water source. The government may assist farmers through sinking boreholes to supply water for both humans and livestock.

  10. CERN Colloquium: The Effects of Limited Resources and Opportunities on Women’s Careers in Physics

    CERN Multimedia

    2012-01-01

    The Effects of Limited Resources and Opportunities on Women’s Careers in Physics: Results from the Global Survey of Physicists, by Rachel Ivie (American Institute of Physics).   Thursday, May 3, 2012 from 16:30 to 17:30 (Europe/Zurich) at CERN ( 503-1-001 - Council Chamber ) The results of the Global Survey of Physicists draw attention to the need to focus on factors other than representation when discussing the situation of women in physics. Previous studies of women in physics have mostly focused on the lack of women in the field. This study goes beyond the obvious shortage of women and shows that there are much deeper issues. For the first time, a multinational study was conducted with 15000 respondents from 130 countries, showing that problems for women in physics transcend national borders. Across all countries, women have fewer resources and opportunities and are more affected by cultural expectations concerning child care. We show that limited resources and opportunities hurt ca...

  11. Common Marsh Plants of the United States and Canada. Resource Publication 93.

    Science.gov (United States)

    Hotchkiss, Neil

    Described in this guide are the emergent and semiemergent plants most likely to be found in inland and coastal marshes. The guide is intended for field identification of marsh plants without resources to technical botanical keys. The plants are discussed in seven groups. Within each group the kinds which resemble one another most closely are next…

  12. The Influence of Ethnic Diversity on Social Network Structure in a Common-Pool Resource System: Implications for Collaborative Management

    Directory of Open Access Journals (Sweden)

    Michele Barnes-Mauthe

    2013-03-01

    Full Text Available Social networks have recently been identified as key features in facilitating or constraining collaborative arrangements that can enhance resource governance and adaptability in complex social-ecological systems. Nonetheless, the effect of ethnicity on social network structure in an ethnically diverse common-pool resource system is virtually unknown. We characterize the entire social network of Hawaii's longline fishery, an ethnically diverse competitive pelagic fishery, and investigate network homophily, network structure, and cross-scale linkages. Results show that ethnicity significantly influences social network structure and is responsible for a homophily effect, which can create challenges for stakeholder collaboration across groups. Our analysis also suggests that ethnicity influences the formation of diverse network structures, and can affect the level of linkages to outside industry leaders, government or management officials, and members of the scientific community. This study provides the first empirical examination of the impact of ethnic diversity on resource user's social networks in the common-pool resource literature, having important implications for collaborative resource management.

  13. Sustainability is possible despite greed - Exploring the nexus between profitability and sustainability in common pool resource systems.

    Science.gov (United States)

    Osten, Friedrich Burkhard von der; Kirley, Michael; Miller, Tim

    2017-05-23

    The sustainable use of common pool resources has become a significant global challenge. It is now widely accepted that specific mechanisms such as community-based management strategies, institutional responses such as resource privatization, information availability and emergent social norms can be used to constrain individual 'harvesting' to socially optimal levels. However, there is a paucity of research focused specifically on aligning profitability and sustainability goals. In this paper, an integrated mathematical model of a common pool resource game is developed to explore the nexus between the underlying costs and benefits of harvesting decisions and the sustainable level of a shared, dynamic resource. We derive optimal harvesting efforts analytically and then use numerical simulations to show that individuals in a group can learn to make harvesting decisions that lead to the globally optimal levels. Individual agents make their decision based on signals received and a trade-off between economic and ecological sustainability. When the balance is weighted towards profitability, acceptable economic and social outcomes emerge. However, if individual agents are solely driven by profit, the shared resource is depleted in the long run - sustainability is possible despite some greed, but too much will lead to over-exploitation.

  14. Integrated Yard Space Allocation and Yard Crane Deployment Problem in Resource-Limited Container Terminals

    Directory of Open Access Journals (Sweden)

    Caimao Tan

    2016-01-01

    Full Text Available Yard storage space and yard crane equipment are the core resources in the container terminal yard area. This paper studies the integrated yard space allocation (outbound container space and yard crane deployment problem in resource-limited container terminals where yard space and yard cranes are extremely scarce. Two corresponding counterstrategies are introduced, respectively, and the integrated problem is solved as mixed integer programming. The model this paper formulated considers the container volume fluctuation of the service line, and the objective is a trade-off between yard sharing space and terminal operation cost. In numerical experiments, this paper tries to reveal the management meaning in practical operation of container terminal and provides decision support for terminal managers; therefore a series of scenarios are presented to analyze the relations among the yard sharing space, the number of yard cranes, the size of yard subblock, and the cost of terminal operation.

  15. An analysis of factors affecting participation behavior of limited resource farmers in agricultural cost-share programs in Alabama

    Science.gov (United States)

    Okwudili Onianwa; Gerald Wheelock; Buddhi Gyawali; Jianbang Gan; Mark Dubois; John Schelhas

    2004-01-01

    This study examines factors that affect the participation behavior of limited resource farmers in agricultural cost-share programs in Alabama. The data were generated from a survey administered to a sample of limited resource farm operators. A binary logit model was employed to analyze the data. Results indicate that college education, age, gross sales, ratio of owned...

  16. Estimating health workforce needs for antiretroviral therapy in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Fullem Andrew

    2006-01-01

    Full Text Available Abstract Background Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART, for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. Methods We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. Results We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1–2 physicians, 2–7 nurses, Discussion These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

  17. Building local human resources to implement SLMTA with limited donor funding: The Ghana experience.

    Science.gov (United States)

    Nkrumah, Bernard; van der Puije, Beatrice; Bekoe, Veronica; Adukpo, Rowland; Kotey, Nii A; Yao, Katy; Fonjungo, Peter N; Luman, Elizabeth T; Duh, Samuel; Njukeng, Patrick A; Addo, Nii A; Khan, Fazle N; Woodfill, Celia J I

    2014-11-03

    In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM). The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors' salaries, SLMTA training and improvement project support. Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

  18. Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

    Directory of Open Access Journals (Sweden)

    Bernard Nkrumah

    2014-11-01

    Full Text Available Background: In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. Objectives: To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Method: Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental trainingon internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM. Results: The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’salaries, SLMTA training and improvement project support. Conclusion: Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such modelspromote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

  19. Resourcefulness, Desperation, Shame, Gratitude and Powerlessness: Common Themes Emerging from A Study of Food Bank Use in Northeast Scotland.

    Science.gov (United States)

    Douglas, Flora; Sapko, Jennifer; Kiezebrink, Kirsty; Kyle, Janet

    2015-01-01

    There is growing policy maker and public concern about current trends in food bank use in Scotland. Yet little is known about the experiences of those seeking help from food banks in this country. This research aimed to address this issue by studying the use and operation of a food bank situated in a rich northeast city during January and June 2014. The study aimed to establish who was seeking help from the food bank, their reasons for doing so, and what those who did thought of, and dealt with the food they received from it. Consequently, an audit of the food bank's client database, four months of participant observation based in the food bank, and seven face-to-face interviews with current and former food bank clients were conducted. The audit revealed that clients came from a range of socio-economic backgrounds, with men more likely to access it compared to women. Debt and social security benefit delays were cited as the main reasons for doing so. Qualitative data confirmed that sudden and unanticipated loss of income was a key driver of use. Resourcefulness in making donated food last as long as possible, keeping fuel costs low, and concern to minimise food waste were commonly described by participants. Desperation, gratitude, shame and powerlessness were also prevalent themes. Furthermore, clients were reluctant to ask for food they normally ate, as they were acutely aware that the food bank had little control over what it was able offer. Insights from this study suggest that recent UK policy proposals to address food poverty may have limited impact, without concomitant effort to address material disadvantage. Research is urgently required to determine the precise nature and extent of household level food insecurity in Scotland, and to consider monitoring for adverse physical and mental health outcomes for those affected by it.

  20. Resourcefulness, Desperation, Shame, Gratitude and Powerlessness: Common Themes Emerging from A Study of Food Bank Use in Northeast Scotland

    Directory of Open Access Journals (Sweden)

    Flora Douglas

    2015-07-01

    Full Text Available There is growing policy maker and public concern about current trends in food bank use in Scotland. Yet little is known about the experiences of those seeking help from food banks in this country. This research aimed to address this issue by studying the use and operation of a food bank situated in a rich northeast city during January and June 2014. The study aimed to establish who was seeking help from the food bank, their reasons for doing so, and what those who did thought of, and dealt with the food they received from it. Consequently, an audit of the food bank's client database, four months of participant observation based in the food bank, and seven face-to-face interviews with current and former food bank clients were conducted. The audit revealed that clients came from a range of socio-economic backgrounds, with men more likely to access it compared to women. Debt and social security benefit delays were cited as the main reasons for doing so. Qualitative data confirmed that sudden and unanticipated loss of income was a key driver of use. Resourcefulness in making donated food last as long as possible, keeping fuel costs low, and concern to minimise food waste were commonly described by participants. Desperation, gratitude, shame and powerlessness were also prevalent themes. Furthermore, clients were reluctant to ask for food they normally ate, as they were acutely aware that the food bank had little control over what it was able offer. Insights from this study suggest that recent UK policy proposals to address food poverty may have limited impact, without concomitant effort to address material disadvantage. Research is urgently required to determine the precise nature and extent of household level food insecurity in Scotland, and to consider monitoring for adverse physical and mental health outcomes for those affected by it.

  1. Civil society participation in the management of the common good: a case of ethics in biological resource centres

    Directory of Open Access Journals (Sweden)

    Patrici Calvo Cabezas

    2014-10-01

    Full Text Available The management of commons is now at the centre of researchers’ attention in many branches of science, particularly those related to the human or social sciences. This paper seeks to demonstrate how civil society participation in common goods or resources is not only possible but is also desirable for society because of the medium and long-term benefits it offers involved and/or affected parties. To this end, we examine the falsity of the discourse underlying the supposed incompetence of civil society to cooperate interpersonally in the pursuit of common objectives, and also analyse a specific example of the necessary and possible participation of civil society in managing common goods through biobanks.

  2. Visuo-spatialWorking Memory as a Limited Resource of Cognitive Processing

    Science.gov (United States)

    Zimmer, Hubert D.; Münzer, Stefan; Umla-Runge, Katja

    Working memory is considered a cognitive component that mainly serves two functions. It temporarily maintains information that was either perceived but is no longer present in the environment, or that was internally generated, and it supplies a work space for transforming and manipulating elements of perception and thinking. Both functions are relevant for a successful interaction with the environment and it is therefore not surprising that WM is a central topic of research in the field of general psychology. This interest is further increased by the fact that WM is seen as a limited resource that constrains cognitive performances.

  3. Hopf Bifurcation of a Delayed Epidemic Model with Information Variable and Limited Medical Resources

    Directory of Open Access Journals (Sweden)

    Caijuan Yan

    2014-01-01

    Full Text Available We consider SIR epidemic model in which population growth is subject to logistic growth in absence of disease. We get the condition for Hopf bifurcation of a delayed epidemic model with information variable and limited medical resources. By analyzing the corresponding characteristic equations, the local stability of an endemic equilibrium and a disease-free equilibrium is discussed. If the basic reproduction ratio ℛ01, we obtain sufficient conditions under which the endemic equilibrium E* of system is locally asymptotically stable. And we also have discussed the stability and direction of Hopf bifurcations. Numerical simulations are carried out to explain the mathematical conclusions.

  4. Limits of principal components analysis for producing a common trait space: implications for inferring selection, contingency, and chance in evolution.

    Directory of Open Access Journals (Sweden)

    Kevin J Parsons

    2009-11-01

    Full Text Available Comparing patterns of divergence among separate lineages or groups has posed an especially difficult challenge for biologists. Recently a new, conceptually simple methodology called the "ordered-axis plot" approach was introduced for the purpose of comparing patterns of diversity in a common morphospace. This technique involves a combination of principal components analysis (PCA and linear regression. Given the common use of these statistics the potential for the widespread use of the ordered axis approach is high. However, there are a number of drawbacks to this approach, most notably that lineages with the greatest amount of variance will largely bias interpretations from analyses involving a common morphospace. Therefore, without meeting a set of a priori requirements regarding data structure the ordered-axis plot approach will likely produce misleading results.Morphological data sets from cichlid fishes endemic to Lakes Tanganyika, Malawi, and Victoria were used to statistically demonstrate how separate groups can have differing contributions to a common morphospace produced by a PCA. Through a matrix superimposition of eigenvectors (scale-free trajectories of variation identified by PCA we show that some groups contribute more to the trajectories of variation identified in a common morphospace. Furthermore, through a set of randomization tests we show that a common morphospace model partitions variation differently than group-specific models. Finally, we demonstrate how these limitations may influence an ordered-axis plot approach by performing a comparison on data sets with known alterations in covariance structure. Using these results we provide a set of criteria that must be met before a common morphospace can be reliably used.Our results suggest that a common morphospace produced by PCA would not be useful for producing biologically meaningful results unless a restrictive set of criteria are met. We therefore suggest biologists be aware

  5. Low-cost matched sibling bone marrow transplant for standard-risk thalassemia in a limited-resource setting

    Directory of Open Access Journals (Sweden)

    Stalin Ramprakash

    2017-12-01

    Full Text Available Thalassemias are the most common inherited genetic disorder in India and a major public health burden with bone marrow transplant (BMT considered the only established curative therapy. We describe outcomes for patients (n = 71 with standard-risk thalassemia (liver size 80 at the last follow up. 5 patients (7% died, mortality related to transplant. Enough data existed for 2 centers in India (36/71 transplants to analyze overall costs from admission up to one-year post-BMT which revealed a median cost of Rs 7,30,445 ($11519 [Range Rs 4,52,821–10,32,842 ($ 7079–16147]. In conclusion, children with thalassemia in resource limited settings can achieve good outcomes with BMT at a reasonable cost.

  6. Resource Limitations on Soil Microbial Activity in an Antarctic Dry Valley

    DEFF Research Database (Denmark)

    Sparrow, Asley; Gregorich, Ed; Hopkins, David

    2011-01-01

    Although Antarctic dry valley soils function under some of the harshest environmental conditions on the planet, there is significant biological activity concentrated in small areas in the landscape. These productive areas serve as a source of C and N in organic matter redistributed...... to the surrounding biologically impoverished soils. We conducted a 3-yr replicated field experiment involving soil amendment with C and N in simple (glucose and NH4Cl) and complex (glycine and lacustrine detritus) forms to evaluate the resource limitations on soil microbial activity in an Antarctic dry valley....... The respiratory response for all substrates was slow, with a significant but weak response to NH4Cl, followed by a more widespread response to all substrates after 2 yr and in laboratory incubations conducted 3 yr after substrate addition. This response suggests that the soil microbial community is N limited and...

  7. Revegetation in China’s Loess Plateau is approaching sustainable water resource limits

    Science.gov (United States)

    Feng, Xiaoming; Fu, Bojie; Piao, Shilong; Wang, Shuai; Ciais, Philippe; Zeng, Zhenzhong; Lü, Yihe; Zeng, Yuan; Li, Yue; Jiang, Xiaohui; Wu, Bingfang

    2016-11-01

    Revegetation of degraded ecosystems provides opportunities for carbon sequestration and bioenergy production. However, vegetation expansion in water-limited areas creates potentially conflicting demands for water between the ecosystem and humans. Current understanding of these competing demands is still limited. Here, we study the semi-arid Loess Plateau in China, where the `Grain to Green’ large-scale revegetation programme has been in operation since 1999. As expected, we found that the new planting has caused both net primary productivity (NPP) and evapotranspiration (ET) to increase. Also the increase of ET has induced a significant (p develop a new conceptual framework to determine the critical carbon sequestration that is sustainable in terms of both ecological and socio-economic resource demands in a coupled anthropogenic-biological system.

  8. Regulatory challenges associated with conducting multicountry clinical trials in resource-limited settings.

    Science.gov (United States)

    Ndebele, Paul; Blanchard-Horan, Christina; Shahkolahi, Akbar; Sanne, Ian

    2014-01-01

    International public health and infectious diseases research has expanded to become a global enterprise transcending national and continental borders in organized networks addressing high-impact diseases. In conducting multicountry clinical trials, sponsors and investigators have to ensure that they meet regulatory requirements in all countries in which the clinical trials will be conducted. Some of these requirements include review and approval by national drug regulatory authorities and recognized research ethics committees. A limiting factor to the efficient conduct of multicountry clinical trials is the regulatory environment in each collaborating country, with significant differences determined by various factors including the laws and the procedures used in each country. The long regulatory processes in resource-limited countries may hinder the efficient implementation of multisite clinical trials, delaying research important to the health of populations in these countries and costing millions of dollars a year.

  9. Compact Modbus TCP/IP protocol for data acquisition systems based on limited hardware resources

    Science.gov (United States)

    Bai, Q.; Jin, B.; Wang, D.; Wang, Y.; Liu, X.

    2018-04-01

    The Modbus TCP/IP has been a standard industry communication protocol and widely utilized for establishing sensor-cloud platforms on the Internet. However, numerous existing data acquisition systems built on traditional single-chip microcontrollers without sufficient resources cannot support it, because the complete Modbus TCP/IP protocol always works dependent on a full operating system which occupies abundant hardware resources. Hence, a compact Modbus TCP/IP protocol is proposed in this work to make it run efficiently and stably even on a resource-limited hardware platform. Firstly, the Modbus TCP/IP protocol stack is analyzed and the refined protocol suite is rebuilt by streamlining the typical TCP/IP suite. Then, specific implementation of every hierarchical layer is respectively presented in detail according to the protocol structure. Besides, the compact protocol is implemented in a traditional microprocessor to validate the feasibility of the scheme. Finally, the performance of the proposed scenario is assessed. The experimental results demonstrate that message packets match the frame format of Modbus TCP/IP protocol and the average bandwidth reaches to 1.15 Mbps. The compact protocol operates stably even based on a traditional microcontroller with only 4-kB RAM and 12-MHz system clock, and no communication congestion or frequent packet loss occurs.

  10. Mathematical model of the competition life cycle under limited resources conditions: Problem statement for business community

    Science.gov (United States)

    Shelomentsev, A. G.; Medvedev, M. A.; Berg, D. B.; Lapshina, S. N.; Taubayev, A. A.; Davletbaev, R. H.; Savina, D. V.

    2017-12-01

    Present study is devoted to the development of competition life cycle mathematical model in the closed business community with limited resources. Growth of each agent is determined by the balance of input and output resource flows: input (cash) flow W is covering the variable V and constant C costs and growth dA/dt of the agent's assets A. Value of V is proportional to assets A that allows us to write down a first order non-stationary differential equation of the agent growth. Model includes the number of such equations due to the number of agents. The amount of resources that is available for agents vary in time. The balances of their input and output flows are changing correspondingly to the different stages of the competition life cycle. According to the theory of systems, the most complete description of any object or process is the model of its life cycle. Such a model describes all stages of its development: from the appearance ("birth") through development ("growth") to extinction ("death"). The model of the evolution of an individual firm, not contradicting the economic meaning of events actually observed in the market, is the desired result from modern AVMs for applied use. With a correct description of the market, rules for participants' actions, restrictions, forecasts can be obtained, which modern mathematics and the economy can not give.

  11. BK Virus-Associated Nephropathy: Current Situation in a Resource-Limited Country.

    Science.gov (United States)

    Yooprasert, P; Rotjanapan, P

    Data on BK virus-associated nephropathy (BKVAN) and treatment strategy in a resource-limited country are scarce. This study aimed to evaluate epidemiology of BKVAN and its situation in Thailand. A retrospective analysis was conducted among adult kidney transplant recipients at Ramathibodi Hospital from October 2011 to September 2016. Patients' demographic data, information on kidney transplantation, immunosuppressive therapy, cytomegalovirus and BK virus infections, and allograft outcomes were retrieved and analyzed. This study included 623 kidney transplant recipients. Only 327 patients (52.49%) received BK virus infection screening, and 176 of 327 patients had allograft dysfunction as a trigger for screening. BKVAN was identified in 39 of 327 patients (11.93%). Deceased donor transplantation and cytomegalovirus infection were associated with a higher risk of BKVAN (odds ratio = 2.2, P = .024, 95% confidence intervals [1.1, 4.43], and odds ratio = 2.6, P = .006, 95% confidence intervals [1.29, 5.26], respectively). BKVAN patients were at significantly higher risk for allograft rejection (P < .001) and allograft failure (P = .036). At the end of the study, 4 graft losses were documented (12.12%). BKVAN was associated with high rate of allograft rejection and failure. However, surveillance of its complications has been underperformed at our facility. Implementing a formal practice guideline may improve allograft outcome in resource-limited countries. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Evaluating Diagnostic Point-of-Care Tests in Resource-Limited Settings

    Science.gov (United States)

    Drain, Paul K; Hyle, Emily P; Noubary, Farzad; Freedberg, Kenneth A; Wilson, Douglas; Bishai, William; Rodriguez, William; Bassett, Ingrid V

    2014-01-01

    Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs. PMID:24332389

  13. Screening for genital tuberculosis in a limited resource country: case report.

    Science.gov (United States)

    Namani, Sadie; Qehaja-Buçaj, Emine; Namani, Diellëza

    2017-02-07

    Screening for benign or malignant process of pelvis in young females is a challenge for a physician in a limited resource country. Tuberculosis should be always considered in the differential diagnosis of a pelvic mass in countries with high prevalence of tuberculosis. Negative results of analysis of peritoneal fluid for acid-fast staining, late cultures, and unavailability of new diagnostics methods such as polymerase chain reaction and adenosine deaminase of the aspirated fluid from peritoneal cavity can often result in invasive diagnostic procedures such as laparotomy. We report a case of a 24 year old Albanian unemployed female living in urban place in Kosovo who presented with abdominal pain, loss of appetite, fever, headache, a weight loss, nonproductive cough and menstrual irregularity for three weeks. In this example case, the patient with cystic mass in tubo-ovarial complex and elevated serum cancer antigen 125 levels was diagnosed for genital tuberculosis after performing laparotomy. Caseose mass found in left tubo-ovarial complex and histopathological examination of biopsied tissue were the fastest diagnostic tools for confirming pelvis TB. The Lowenstein-Jensen cultures were positive after six weeks and her family history was positive for tuberculosis. Young females with abdominopelvic mass, ascites, a positive family history for tuberculosis and high serum cancer antigen 125, should always raise suspicion of tuberculosis especially in a limited resource country. A laparoscopy combined with peritoneal biopsy should be performed to confirm the diagnosis as this could lead to a prevention of unnecessary laparotomies.

  14. Far-from-equilibrium bidirectional transport system with constrained entrances competing for pool of limited resources

    Science.gov (United States)

    Verma, Atul Kumar; Sharma, Natasha; Gupta, Arvind Kumar

    2018-02-01

    Motivated by the wide occurrence of limited resources in many real-life systems, we investigate two-lane totally asymmetric simple exclusion process with constrained entrances under finite supply of particles. We analyze the system within the framework of mean-field theory and examine various complex phenomena, including phase separation, phase transition, and symmetry breaking. Based on the theoretical analysis, we analytically derive the phase boundaries for various symmetric as well as asymmetric phases. It has been observed that the symmetry-breaking phenomenon initiates even for very small number of particles in the system. The phases with broken symmetry originates as shock-low density phase under limited resources, which is in contrast to the scenario with infinite number of particles. As expected, the symmetry breaking continues to persist even for higher values of system particles. Seven stationary phases are observed, with three of them exhibiting symmetry-breaking phenomena. The critical values of a total number of system particles, beyond which various symmetrical and asymmetrical phases appear and disappear are identified. Theoretical outcomes are supported by extensive Monte Carlo simulations. Finally, the size-scaling effect and symmetry-breaking phenomenon on the simulation results have also been examined based on particle density histograms.

  15. Evaluation of a Music Therapy Social Skills Development Program for Youth with Limited Resources.

    Science.gov (United States)

    Pasiali, Varvara; Clark, Cherie

    2018-05-21

    Children living in low-resource communities are at risk for poorer socio-emotional development and academic performance. Emerging evidence supports use of group music therapy experiences to support social development through community afterschool programming. To examine the potential benefit of a music therapy social skills development program to improve social skills and academic performance of school-aged children with limited resources in an afterschool program. We used a single-group pre/post-test design, and recruited 20 students (11 females, 9 males), ages 5 to 11 years, from an afterschool program. The music therapy social skills program consisted of eight 50-minute sessions, and we measured social competence and antisocial behavior using the Home & Community Social Behavioral Scale (HCSBS; Merrell & Caldarella, 2008), and social skills, problem behaviors, and academic competence using the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008a, 2008b). Only students who attended a minimum of six sessions (N = 14) were included in data analysis. Results showed no significant change in individual HBSC subscale scores; however, the total number of low-performance/high-risk skills significantly decreased. SSIS teacher results indicated significant improvement in communication, significant decrease of hyperactivity, autistic behavioral tendencies and overall problem behaviors, and marginal decreases in internalization. Parent ratings mirrored, in part, those of the teacher. Results indicated that music therapy has the potential of being an effective intervention for promoting social competence of school-aged children with limited resources, particularly in the areas of communication and low-performance/high-risk behaviors. Teaching skills through song lyrics and improvisation emerged as salient interventions.

  16. Feeding Immunity: Physiological and Behavioral Responses to Infection and Resource Limitation

    Directory of Open Access Journals (Sweden)

    Sarah A. Budischak

    2018-01-01

    Full Text Available Resources are a core currency of species interactions and ecology in general (e.g., think of food webs or competition. Within parasite-infected hosts, resources are divided among the competing demands of host immunity and growth as well as parasite reproduction and growth. Effects of resources on immune responses are increasingly understood at the cellular level (e.g., metabolic predictors of effector function, but there has been limited consideration of how these effects scale up to affect individual energetic regimes (e.g., allocation trade-offs, susceptibility to infection, and feeding behavior (e.g., responses to local resource quality and quantity. We experimentally rewilded laboratory mice (strain C57BL/6 in semi-natural enclosures to investigate the effects of dietary protein and gastrointestinal nematode (Trichuris muris infection on individual-level immunity, activity, and behavior. The scale and realism of this field experiment, as well as the multiple physiological assays developed for laboratory mice, enabled us to detect costs, trade-offs, and potential compensatory mechanisms that mice employ to battle infection under different resource conditions. We found that mice on a low-protein diet spent more time feeding, which led to higher body fat stores (i.e., concentration of a satiety hormone, leptin and altered metabolite profiles, but which did not fully compensate for the effects of poor nutrition on albumin or immune defenses. Specifically, immune defenses measured as interleukin 13 (IL13 (a primary cytokine coordinating defense against T. muris and as T. muris-specific IgG1 titers were lower in mice on the low-protein diet. However, these reduced defenses did not result in higher worm counts in mice with poorer diets. The lab mice, living outside for the first time in thousands of generations, also consumed at least 26 wild plant species occurring in the enclosures, and DNA metabarcoding revealed that the consumption of different

  17. Vaccination program in a resource-limited setting: A case study in the Philippines.

    Science.gov (United States)

    Chootipongchaivat, Sarocha; Chantarastapornchit, Varit; Kulpeng, Wantanee; Ceria, Joyce Anne; Tolentino, Niña Isabelle; Teerawattananon, Yot

    2016-09-14

    Implementing national-level vaccination programs involves long-term investment, which can be a significant financial burden, particularly in resource-limited settings. Although many studies have assessed the economic impacts of providing vaccinations, evidence on the positive and negative implications of human resources for health (HRH) is still lacking. Therefore, this study aims to estimate the HRH impact of introducing pneumococcal conjugate vaccine (PCV) using a model-based economic evaluation. This study adapted a Markov model from a prior study that was conducted in the Philippines for assessing the cost-effectiveness of 10-valent and 13-valent PCV compared to no vaccination. The Markov model was used for estimating the number of cases of pneumococcal-related diseases, categorized by policy options. HRH-related parameters were obtained from document reviews and interviews using the quantity, task, and productivity model (QTP model). The number of full-time equivalent (FTE) of general practitioners, nurses, and midwives increases significantly if the universal vaccine coverage policy is implemented. A universal coverage of PCV13 - which is considered to be the best value for money compared to other vaccination strategies - requires an additional 380 FTEs for general practitioners, 602 FTEs for nurses, and 205 FTEs for midwives; it can reduce the number of FTEs for medical social workers, paediatricians, infectious disease specialists, neurologists, anaesthesiologists, radiologists, ultrasonologists, medical technologists, radiologic technologists, and pharmacists by 7, 17.9, 9.7, 0.4, 0.1, 0.7, 0.1, 12.3, 2, and 9.7, respectively, when compared to the no vaccination policy. This is the first attempt to estimate the impact of HRH alongside a model-based economic evaluation study, which can be eventually applied to other vaccine studies, especially those which inform resource allocation in developing settings where not only financial resources but also HRH are

  18. Implications for paediatric shock management in resource-limited settings: a perspective from the FEAST trial.

    Science.gov (United States)

    Houston, Kirsty Anne; George, Elizabeth C; Maitland, Kathryn

    2018-05-04

    Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty. We re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings. We established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%). The updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group

  19. Social Cooperation and Disharmony in Communities Mediated through Common Pool Resource Exploitation

    Science.gov (United States)

    Sugiarto, H. S.; Lansing, J. S.; Chung, N. N.; Lai, C. H.; Cheong, S. A.; Chew, L. Y.

    2017-05-01

    It was theorized that when a society exploits a shared resource, the system can undergo extreme phase transition from full cooperation in abiding by a social agreement, to full defection from it. This was shown to happen in an integrated society with complex social relationships. However, real-world agents tend to segregate into communities whose interactions contain features of the associated community structure. We found that such social segregation softens the abrupt extreme transition through the emergence of multiple intermediate phases composed of communities of cooperators and defectors. Phase transitions thus now occur through these intermediate phases which avert the instantaneous collapse of social cooperation within a society. While this is beneficial to society, it nonetheless costs society in two ways. First, the return to full cooperation from full defection at the phase transition is no longer immediate. Community linkages have rendered greater societal inertia such that the switch back is now typically stepwise rather than a single change. Second, there is a drastic increase in social disharmony within the society due to the greater tension in the relationship between segregated communities of defectors and cooperators. Intriguingly, these results on multiple phases with its associated phenomenon of social disharmony are found to characterize the level of cooperation within a society of Balinese farmers who exploit water for rice production.

  20. The habitus professorial and special education: perceptions of common class teachers and resource room multifuncional

    Directory of Open Access Journals (Sweden)

    Norberto Kuhn Junior

    2016-10-01

    Full Text Available This article analyzes the Inclusive Education from the Specialized Educational Service (SES in Multifunctional Resources Classes (MRC in the Municipal Teaching web in Novo Hamburgo/RS. It counted with the participation of 99 teachers in the regular classroom who worked as teachers of students with disabilities, pervasive developmental disorders, high ability/gifted and 30 MRC teachers in 2013. The data showed that the MRC teachers shown to have minor difficulties in working with students from the Special Education than the teachers of regular class. Through the identification of the teachers’ habitus of regular class, it was understood that the difficulties indicated by them derive from the fragility in their pedagogical training to work with students of Special Education. It is about a non-inclusive habitus, which is constituted from the internalization of teaching models based on the subject homogenization (all are equal over the constitution of a new habitus, structural of a teaching model that recognizes the diversity for inclusion.

  1. Pragmatic setup for bioparticle responses by dielectrophoresis for resource limited environment application

    Science.gov (United States)

    Ali, Mohd Anuar Md; Yeop Majlis, Burhanuddin; Kayani, Aminuddin Ahmad

    2017-12-01

    Various dielectrophoretic responses of bioparticles, including cell-chain, spinning, rotation and clustering, are of high interest in the field due to their benefit into application for biomedical and clinical implementation potential. Numerous attempts using sophisticated equipment setup have been studied to perform those dielectrophoretic responses, however, for development into resource limited environment application, such as portable, sustainable and environmental friendly diagnostic tools, establishment of pragmatic setup using standard, non-sophisticated and low-cost equipment is of important task. Here we show the advantages in the judicious design optimization of tip microelectrode, also with selection of suspending medium and optimization of electric signal configuration in establishing setup that can promote the aforementioned dielectrophoretic responses within standard equipments, i.e. pragmatic setup.

  2. Modeling the 2016-2017 Yemen Cholera Outbreak with the Impact of Limited Medical Resources.

    Science.gov (United States)

    He, Daihai; Wang, Xueying; Gao, Daozhou; Wang, Jin

    2018-05-01

    We present a mathematical model to investigate the transmission dynamics of the 2016-2017 Yemen Cholera Outbreak. Our model describes the interaction between the human hosts and the pathogenic bacteria, under the impact of limited medical resources. We fit our model to Yemen epidemic data published by the World Health Organization, at both the country and regional levels. We find that the Yemen cholera outbreak is shaped by the interplay of environmental, socioeconomic, and climatic factors. Our results suggest that improvement of the public health system and strategic implementation of control measures with respect to time and location are key to future cholera prevention and intervention in Yemen. Copyright © 2018. Published by Elsevier Ltd.

  3. Helminth parasites of dogs from two resource-limited communities in South Africa : research communication

    Directory of Open Access Journals (Sweden)

    W.N. Minnaar

    1999-07-01

    Full Text Available Biological samples were collected from dogs in resource-limited communities in the North-West and Gauteng Provinces of South Africa to assess the prevalence of helminth parasitism. These samples included adhesive tape peri-anal skin swabs and fresh faecal samples for helminth examination, and thick and thin blood films (smears and whole-blood samples in anticoagulant for examination of filarial nematode microfilariae and haemoprotozoa. The eggs of Ancylostoma caninum, Toxocara canis, Toxascaris leonina, Dipylidium caninum and taeniids were identified. None of the blood samples and smears tested positive for microfilariae of Dirofilaria immitis or Dipetalonema spp. or for haemoprotozoa. The adhesive tape swabs were negative for cestode eggs and segments. Most of the helminth parasites identified in this study are zoonotic and consequently are regarded as a public health hazard.

  4. Emerging technologies in point-of-care molecular diagnostics for resource-limited settings.

    Science.gov (United States)

    Peeling, Rosanna W; McNerney, Ruth

    2014-06-01

    Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.

  5. Challenges in care of the child with special health care needs in a resource limited environment

    Directory of Open Access Journals (Sweden)

    Edwin Ehi Eseigbe

    2013-01-01

    Full Text Available To identify challenges encountered in the care of children with special health care needs in a resource limited environment a 10 year-old child with a diagnosis of Tuberous Sclerosis was studied. Challenges identified were in: making a definitive diagnosis, provision of adequate care, cost of care, meeting parental expectations and accessing community support for the child and family. Available specialist health care and related services, including community rehabilitation, were provided for the child and family. The study highlights the need for improved community awareness, development in the provision of specialist health care services and institution of governmental policies that identify, support and protect children with special health care needs.

  6. Diagnosis of primary ciliary dyskinesia: potential options for resource-limited countries

    Directory of Open Access Journals (Sweden)

    Nisreen Rumman

    2017-01-01

    Full Text Available Primary ciliary dyskinesia is a genetic disease of ciliary function leading to chronic upper and lower respiratory tract symptoms. The diagnosis is frequently overlooked because the symptoms are nonspecific and the knowledge about the disease in the primary care setting is poor. Additionally, none of the available tests is accurate enough to be used in isolation. These tests are expensive, and need sophisticated equipment and expertise to analyse and interpret results; diagnosis is therefore only available at highly specialised centres. The diagnosis is particularly challenging in countries with limited resources due to the lack of such costly equipment and expertise. In this review, we discuss the importance of early and accurate diagnosis especially for countries where the disease is clinically prevalent but diagnostic tests are lacking. We review the diagnostic tests available in specialised centres (nasal nitric oxide, high-speed video microscopy, transmission electron microscopy, immunofluorescence and genetics. We then consider modifications that might be considered in less well-resourced countries whilst maintaining acceptable accuracy.

  7. Critical Minerals and Energy–Impacts and Limitations of Moving to Unconventional Resources

    Directory of Open Access Journals (Sweden)

    Benjamin C. McLellan

    2016-05-01

    Full Text Available The nexus of minerals and energy becomes ever more important as the economic growth and development of countries in the global South accelerates and the needs of new energy technologies expand, while at the same time various important minerals are declining in grade and available reserves from conventional mining. Unconventional resources in the form of deep ocean deposits and urban ores are being widely examined, although exploitation is still limited. This paper examines some of the implications of the transition towards cleaner energy futures in parallel with the shifts through conventional ore decline and the uptake of unconventional mineral resources. Three energy scenarios, each with three levels of uptake of renewable energy, are assessed for the potential of critical minerals to restrict growth under 12 alternative mineral supply patterns. Under steady material intensities per unit of capacity, the study indicates that selenium, indium and tellurium could be barriers in the expansion of thin-film photovoltaics, while neodymium and dysprosium may delay the propagation of wind power. For fuel cells, no restrictions are observed.

  8. Diagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.

    Science.gov (United States)

    Riviello, Elisabeth D; Buregeya, Egide; Twagirumugabe, Theogene

    2017-02-01

    The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification. In the last 18 months, the need for a universally applicable ARDS definition was reinforced by advances in supportive care that can be implemented in resource poor settings. Research demonstrating the variable impact of positive end expiratory pressure on hypoxemia, the validity of using pulse oximetry rather than arterial blood gas to categorize hypoxemia, and the accuracy of lung ultrasound support the use of the Kigali modification of the Berlin definition. Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.

  9. Canadian Natural Resources Limited uses Siteview(TM) to manage its reclamation sites

    International Nuclear Information System (INIS)

    Holtby, L.

    2003-01-01

    Implementation of the Siteview(TM) computer software package designed to capture and manage reclamation data, by Canadian Natural Resources Limited is reported. Use of this software, developed by Pelodon Computer Enterprises in Calgary, enables Canadian Natural Resources to track from a single file data from each of over 3000 sites from the pre-construction stage right through to the final reclamation. Having all data in a single file permits the company to track the number of Reclamation Certificate applications submitted and received for a specific time period, helping them to capture the liability reduction and rental reduction associated with those sites and in general, manage their reclamation program more efficiently. Tracking the reclamation sites is by specific Site Status Codes, which allow the company to quickly determine current status of each site. Budgeting for reclamation can also be planned more accurately based on the current status of sites. Siteview(TM) also manages waste disposal information in the Guide 50 Drilling Waste Disposal Notification forms by digitally inputting all required data such as waste disposal location, mud system, and the volume of mud, and generating reports based on various waste disposal parameters. The software is also used by environmental consultants to track client's well site operations, and display them graphically in their reports, thus providing value-added services to their clients

  10. Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Leski Tomasz A

    2012-07-01

    Full Text Available Abstract Background Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a “cold chain” and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires “leapfrogging” to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries. Methods A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays. Results The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae. Conclusions This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting.

  11. Kangaroo mother care in resource-limited settings: implementation, health benefits, and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-06-01

    Full Text Available Samuel N Uwaezuoke Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria Abstract: Kangaroo mother care (KMC represents an intervention in low birth weight infants for resource-limited settings which aims to reduce mortality rates by thermoregulation, supporting breastfeeding, and promoting early hospital discharge. In terms of cost and impact on neonatal survival, it has comparative advantages over the conventional method of care (CMC. This paper aimed to review the evidence concerning the progress of KMC implementation, its health benefits, and its cost-effectiveness, especially in developing countries. From the synthesized evidence, KMC was shown to be a useful adjunct to CMC particularly with respect to improving neonatal survival, supporting breastfeeding, and promoting early discharge from the hospital. Substantial progress has been made in its implementation in many developing countries where facility-based KMC has been institutionalized. Despite the cost-effectiveness of KMC in neonatal care, its global implementation is bedeviled with country-specific, multifaceted challenges. In developed countries, there is an implementation gap due to easy accessibility to technology-based CMC. Nevertheless, many developing countries have initiated national policies to scale up KMC services in their domain. Given the major constraints to program implementation peculiar to these resource-limited countries, it has become imperative to boost caregiver confidence and experience using dedicated spaces in the hospital, as well as dedicated staff meant for adequate ambulatory follow-up and continuous health education. Capacity training for health professionals and provision of space infrastructure thus constitute the basic needs which could be funded by International Aid Agencies in order to scale up the program in these settings. Keywords: neonatal care, low birth weight infants, thermoregulation, breastfeeding

  12. Prediction of Severe Disease in Children with Diarrhea in a Resource-Limited Setting

    Science.gov (United States)

    Levine, Adam C.; Munyaneza, Richard M.; Glavis-Bloom, Justin; Redditt, Vanessa; Cockrell, Hannah C.; Kalimba, Bantu; Kabemba, Valentin; Musavuli, Juvenal; Gakwerere, Mathias; Umurungi, Jean Paul de Charles; Shah, Sachita P.; Drobac, Peter C.

    2013-01-01

    Objective To investigate the accuracy of three clinical scales for predicting severe disease (severe dehydration or death) in children with diarrhea in a resource-limited setting. Methods Participants included 178 children admitted to three Rwandan hospitals with diarrhea. A local physician or nurse assessed each child on arrival using the World Health Organization (WHO) severe dehydration scale and the Centers for Disease Control (CDC) scale. Children were weighed on arrival and daily until they achieved a stable weight, with a 10% increase between admission weight and stable weight considered severe dehydration. The Clinical Dehydration Scale was then constructed post-hoc using the data collected for the other two scales. Receiver Operator Characteristic (ROC) curves were constructed for each scale compared to the composite outcome of severe dehydration or death. Results The WHO severe dehydration scale, CDC scale, and Clinical Dehydration Scale had areas under the ROC curves (AUCs) of 0.72 (95% CI 0.60, 0.85), 0.73 (95% CI 0.62, 0.84), and 0.80 (95% CI 0.71, 0.89), respectively, in the full cohort. Only the Clinical Dehydration Scale was a significant predictor of severe disease when used in infants, with an AUC of 0.77 (95% CI 0.61, 0.93), and when used by nurses, with an AUC of 0.78 (95% CI 0.63, 0.93). Conclusions While all three scales were moderate predictors of severe disease in children with diarrhea, scale accuracy varied based on provider training and age of the child. Future research should focus on developing or validating clinical tools that can be used accurately by nurses and other less-skilled providers to assess all children with diarrhea in resource-limited settings. PMID:24349271

  13. Ethical considerations in HIV prevention and vaccine research in resource-limited settings.

    Science.gov (United States)

    Garner, Samual A; Anude, Chuka J; Adams, Elizabeth; Dawson, Liza

    2014-09-01

    HIV prevention research has been facing increasing ethical and operational challenges. Factors influencing the design and conduct of HIV prevention trials include a rapidly changing evidence base, new biomedical prevention methods and modalities being tested, a large diversity of countries, sites and populations affected by HIV and participating in trials, and challenges of developing and making available products that will be feasible and affordable for at-risk populations. To discuss these challenges, a meeting, Ethical considerations around novel combination prevention modalities in HIV prevention and vaccine trials in resource-limited settings, was convened by NIH/NIAID/Division of AIDS on April 22-23, 2013. Several themes emerged from the meeting: (1) because of both trial design and ethical complexities, choosing prevention packages and designing combination prevention research trials will need to be evaluated on a case by case basis in different clinical trials, countries, and health systems; (2) multilevel stakeholder engagement from the beginning is vital to a fair and transparent process and also to designing ethical and relevant trials; (3) research should generally be responsive to a host country's needs, and sponsors and stakeholders should work together to address potential barriers to future access; and finally, (4) another meeting including a broader group of stakeholders is needed to address many of the outstanding ethical issues raised by this meeting. We offer an overview of the meeting and the key discussion points and recommendations to help guide the design and conduct of future HIV prevention and vaccine research in resource-limited settings.

  14. Initial investigation into lower-cost CT for resource limited regions of the world

    Science.gov (United States)

    Dobbins, James T., III; Wells, Jered R.; Segars, W. Paul; Li, Christina M.; Kigongo, Christopher J. N.

    2010-04-01

    This paper describes an initial investigation into means for producing lower-cost CT scanners for resource limited regions of the world. In regions such as sub-Saharan Africa, intermediate level medical facilities serving millions have no CT machines, and lack the imaging resources necessary to determine whether certain patients would benefit from being transferred to a hospital in a larger city for further diagnostic workup or treatment. Low-cost CT scanners would potentially be of immense help to the healthcare system in such regions. Such scanners would not produce state-of-theart image quality, but rather would be intended primarily for triaging purposes to determine the patients who would benefit from transfer to larger hospitals. The lower-cost scanner investigated here consists of a fixed digital radiography system and a rotating patient stage. This paper describes initial experiments to determine if such a configuration is feasible. Experiments were conducted using (1) x-ray image acquisition, a physical anthropomorphic chest phantom, and a flat-panel detector system, and (2) a computer-simulated XCAT chest phantom. Both the physical phantom and simulated phantom produced excellent image quality reconstructions when the phantom was perfectly aligned during acquisition, but artifacts were noted when the phantom was displaced to simulate patient motion. An algorithm was developed to correct for motion of the phantom and demonstrated success in correcting for 5-mm motion during 360-degree acquisition of images. These experiments demonstrated feasibility for this approach, but additional work is required to determine the exact limitations produced by patient motion.

  15. The Potential for Increasing Net Incomes on Limited-Resource Farms in Eastern Kentucky. Research Report 24.

    Science.gov (United States)

    Stewart, Fred J.; And Others

    The study identified possibilities for improving farm incomes on limited-resource farms in eastern Kentucky. Objectives were to describe farm operations of full-time Appalachian farmers who had gross sales of less than $5,000 in 1972, estimate potential increases in net farm incomes from given resources, and identify nonresource constraints on…

  16. Challenges in the repair of large abdominal wall hernias in Nigeria: review of available options in resource limited environments.

    Science.gov (United States)

    Ezeome, E R; Nwajiobi, C E

    2010-06-01

    To evaluate the challenges and outcome of management of large abdominal wall hernias in a resource limited environment and highlight the options available to surgeons in similar conditions. A review of prospectively collected data on large abdominal wall hernias managed between 2003 and 2009. University of Nigeria Teaching Hospital, Enugu, Nigeria and surrounding hospitals. Patients with hernias more than 4 cm in their largest diameter, patients with closely sited multiple hernias or failed previous repairs and in whom the surgeon considers direct repair inappropriate. Demographics of patients with large hernias, methods of hernia repair, recurrences, early and late complications following the repair. There were 41 patients, comprising 28 females and 13 males with ages 14 - 73 years. Most (53.7%) were incisional hernias. Gynecological surgeries (66.7%) were the most common initiating surgeries. Fifteen of the patients (36.6%) have had failed previous repairs, 41.5% were obese, five patients presented with intestinal obstruction. Thirty nine of the hernias were repaired with prolene mesh, one with composite mesh and one by danning technique. Most of the patients had extra peritoneal mesh placement. Three patients needed ventilator support. After a mean follow up of 18.6 months, there was a single failed repair. Two post op deaths were related to respiratory distress. There were 12 wound infection and 8 superficial wound dehiscence, all of which except one resolved with dressing. One reoperation was done following mesh infection and extrusion. Large abdominal wall hernia repair in resource limited environments present several challenges with wound infection and respiratory distress being the most notable. Surgeons who embark on it in these environments must be prepared t o secure the proper tissue replacement materials and have adequate ventilation support.

  17. Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk pasteurization in resource-limited settings.

    Science.gov (United States)

    Naicker, Mageshree; Coutsoudis, Anna; Israel-Ballard, Kiersten; Chaudhri, Rohit; Perin, Noah; Mlisana, Koleka

    2015-03-01

    Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa. For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated. In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth. Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives.

  18. TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.

    Science.gov (United States)

    Pathmanathan, I; Ahmedov, S; Pevzner, E; Anyalechi, G; Modi, S; Kirking, H; Cavanaugh, J S

    2018-06-01

    Tuberculosis (TB) is the leading cause of death for persons living with the human immunodeficiency virus (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children and has been recommended as an international standard of care for over a decade, it remains highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of tuberculous infection, especially in those, such as PLHIV, who are most likely to progress to TB disease. To do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. Here we review available evidence to address several commonly stated obstacles to TPT scale-up, including the need for the tuberculin skin test, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to monitor for and prevent adverse events, a 'one size fits all' option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how best to tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.

  19. Common Practices from Two Decades of Water Resources Modelling Published in Environmental Modelling & Software: 1997 to 2016

    Science.gov (United States)

    Ames, D. P.; Peterson, M.; Larsen, J.

    2016-12-01

    A steady flow of manuscripts describing integrated water resources management (IWRM) modelling has been published in Environmental Modelling & Software since the journal's inaugural issue in 1997. These papers represent two decades of peer-reviewed scientific knowledge regarding methods, practices, and protocols for conducting IWRM. We have undertaken to explore this specific assemblage of literature with the intention of identifying commonly reported procedures in terms of data integration methods, modelling techniques, approaches to stakeholder participation, means of communication of model results, and other elements of the model development and application life cycle. Initial results from this effort will be presented including a summary of commonly used practices, and their evolution over the past two decades. We anticipate that results will show a pattern of movement toward greater use of both stakeholder/participatory modelling methods as well as increased use of automated methods for data integration and model preparation. Interestingly, such results could be interpreted to show that the availability of better, faster, and more integrated software tools and technologies free the modeler to take a less technocratic and more human approach to water resources modelling.

  20. Weight Estimation Tool for Children Aged 6 to 59 Months in Limited-Resource Settings.

    Science.gov (United States)

    Ralston, Mark E; Myatt, Mark A

    2016-01-01

    A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers. To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries. This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992-2006 using a modified Expanded Program of Immunization two-stage cluster sample design. Locations with high prevalence of acute and chronic malnutrition. A total of 453,990 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values). Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined. Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision. Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and

  1. SAGES: a suite of freely-available software tools for electronic disease surveillance in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Sheri L Lewis

    Full Text Available Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations.

  2. Breast cancer in young women in a limited-resource environment.

    Science.gov (United States)

    Basro, Sarinah; Apffelstaedt, Justus P

    2010-07-01

    Despite the higher incidence of breast cancer in young women in developing countries, there is a paucity of data on their management. We present the clinicopathological features and outcome of treatment of women 35 years or younger with breast cancer in a resource-restricted environment. A total of 141 patients who were diagnosed with primary breast cancer at 35 years or younger from January 2000 to June 2008 were retrieved from the cancer registry of a breast clinic at a tertiary hospital and a private breast health center in South Africa. Clinicopathological features, treatment, and survival were analyzed. Two patients presented with TNM stage 0 (1.4%), 14 with stage I (9.9%), 47 with stage II (33.35%), 47 with stage III (33.3%), and 31 with stage IV (21.9%). Tumor grade was 3 in 47%, grade 2 in 37%, and grade 1 in 16% of patients. One hundred and four patients with stage 0-III disease underwent treatment with curative intent, 83 had a mastectomy, and 12 had breast-conserving surgery. Ninety patients (86.5%) had chemotherapy, 68 (65.4%) had radiotherapy, and 50 (48.1%) had hormonal therapy. Of 93 patients who completed primary therapy, 4 developed contralateral cancers, 3 had locoregional recurrence, 8 developed synchronous locoregional and distant recurrence, and 19 relapsed with distant metastasis only. The 2-year disease-free and overall survival for stage 0-III disease was 48 and 56%, respectively. Young women with breast cancer in a resource-limited environment have similar adverse clinicopathological features to those in developed countries. Their disease is more advanced at presentation with poorer outcome. Increased awareness, better systemic therapy, and more comprehensive genetic studies are essential to improve the dismal outcome.

  3. New nucleic acid testing devices to diagnose infectious diseases in resource-limited settings.

    Science.gov (United States)

    Maffert, P; Reverchon, S; Nasser, W; Rozand, C; Abaibou, H

    2017-10-01

    Point-of-care diagnosis based on nucleic acid testing aims to incorporate all the analytical steps, from sample preparation to nucleic acid amplification and detection, in a single device. This device needs to provide a low-cost, robust, sensitive, specific, and easily readable analysis. Microfluidics has great potential for handling small volumes of fluids on a single platform. Microfluidic technology has recently been applied to paper, which is already used in low-cost lateral flow tests. Nucleic acid extraction from a biological specimen usually requires cell filtration and lysis on specific membranes, while affinity matrices, such as chitosan or polydiacetylene, are well suited to concentrating nucleic acids for subsequent amplification. Access to electricity is often difficult in resource-limited areas, so the amplification step needs to be equipment-free. Consequently, the reaction has to be isothermal to alleviate the need for a thermocycler. LAMP, NASBA, HDA, and RPA are examples of the technologies available. Nucleic acid detection techniques are currently based on fluorescence, colorimetry, or chemiluminescence. For point-of-care diagnostics, the results should be readable with the naked eye. Nowadays, interpretation and communication of results to health professionals could rely on a smartphone, used as a telemedicine device. The major challenge of creating an "all-in-one" diagnostic test involves the design of an optimal solution and a sequence for each analytical step, as well as combining the execution of all these steps on a single device. This review provides an overview of available materials and technologies which seem to be adapted to point-of-care nucleic acid-based diagnosis, in low-resource areas.

  4. Essential Medications for Patients With Suspected or Confirmed Ebola Virus Disease in Resource-Limited Environments.

    Science.gov (United States)

    Pierce, William F; Ready, Selena D; Chapman, John Tyson; Kulick, Corrinne; Shields, Anastasia; Wang, Jialynn; Andrews, Kimberly; Childs, Richard W; Bell, Carlos; Kosyak, Alexandr; Pham, Jade

    2017-09-01

    In 2014, the U.S. Public Health Service (USPHS) Commissioned Corps deployed to Monrovia, Liberia, to operate a 25-bed Ebola treatment unit (ETU) constructed by the U.S. Military. The ETU was named the Monrovia Medical Unit (MMU) and was constructed from an U.S. Air Force Expeditionary Medical Support (EMEDS) unit with modifications on the basis of consultation from Médecins Sans Frontières, the World Health Organization, and expert panels from the U.S. Department of Defense and Department of Health and Human Services. From November 12, 2014, to April 30, 2015, 42 patients (18 confirmed Ebola virus disease [EVD] and 24 suspected EVD) from nine countries were treated by USPHS providers at the MMU. The medications used in the MMU were primarily procured from the EMEDS 25-bed pharmacy cache. However, specific formulary additions were made for treatment of EVD. Using the MMU pharmacy dispensing data, we compared and contrasted the medications used in the MMU with recommendations in published EVD treatment guidelines for austere settings. After comparing and contrasting the MMU pharmacy dispensing data with publications with EVD medication recommendations applicable to resource-limited settings, 101 medications were included in the USPHS Essential Medications for the Management of EVD List (EML) for an austere, isolated clinical environment. Because Ebola outbreaks often occur in remote areas, proactive planning, improved preparedness, and optimal patient care for EVD are needed, especially in the context of austere environments with a scarcity of resources. We developed the EML to assist in the planning for future Ebola outbreaks in a remote clinical environment and to provide a list of medications that have been used in an ETU. The EML is a comprehensive medication list that builds on the existing publications with EVD treatment recommendations applicable to supply-constrained clinical environments. As well, it is a resource for the provision of medications when

  5. Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities.

    Science.gov (United States)

    Drummond, Jennifer L; Were, Martin C; Arrossi, Silvina; Wools-Kaloustian, Kara

    2017-07-01

    Appropriate collection and use of health information is critical to the planning, scaling up, and improvement of cervical cancer programs. The health information systems implementation landscape is unique to each country; however, systems serving cervical cancer programs in low-resource settings share characteristics that present common challenges. In response, many programs have taken innovative approaches to generating the quality information needed for decision making. Recent advances in health information technology also provide feasible solutions to challenges. This article draws from the experiences of the authors and from current literature to describe outstanding challenges and promising practices in the implementation of cervical cancer data systems, and to make recommendations for next steps. Recommendations include engaging all stakeholders-including providers, program managers, implementing partners, and donors-in promoting national, district, and community information systems; building on existing systems and processes, as well as introducing new technologies; and evolving data collection and data systems as programs advance. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  6. Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Zolfo Maria

    2010-09-01

    Full Text Available Abstract Background We present an innovative approach to healthcare worker (HCW training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones (Nokia N95 and iPhone, each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation's HIV patients in need are on treatment. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress. A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module. Methods In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction. It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning. Results With a response rate of 90% (18/20 questionnaires returned, the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone. Conclusions Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs. Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.

  7. Digitizing specimens in a small herbarium: A viable workflow for collections working with limited resources.

    Science.gov (United States)

    Harris, Kari M; Marsico, Travis D

    2017-04-01

    Small herbaria represent a significant portion of herbaria in the United States, but many are not digitizing their collections. At the Arkansas State University Herbarium (STAR), we have created a viable workflow to help small herbaria begin the digitization process, including suggestions for publishing data on the Internet. We calculated hourly rates of each phase of the digitization process. We also mapped accessions at the county level to determine geographic strengths in the collection. All 17,678 accessioned flowering plant specimens at STAR are imaged, databased in Specify, and available electronically on the herbarium's website. Students imaged the specimens at a mean rate of 145/h. We found differences in databasing rates between the graduate student leading the project (47/h) and undergraduate assistants (25/h). The majority of specimens at STAR were collected within the counties neighboring the institution. With this workflow, we estimate that one person can digitize a 20,000-specimen collection in less than 2.5 yr by working only 10 h/wk. Because STAR is a small herbarium with limited resources, the application of the workflow described should assist curators of similar-sized collections as they contemplate and undertake the digitization process.

  8. Digitizing specimens in a small herbarium: A viable workflow for collections working with limited resources1

    Science.gov (United States)

    Harris, Kari M.; Marsico, Travis D.

    2017-01-01

    Premise of the study: Small herbaria represent a significant portion of herbaria in the United States, but many are not digitizing their collections. Methods: At the Arkansas State University Herbarium (STAR), we have created a viable workflow to help small herbaria begin the digitization process, including suggestions for publishing data on the Internet. We calculated hourly rates of each phase of the digitization process. We also mapped accessions at the county level to determine geographic strengths in the collection. Results: All 17,678 accessioned flowering plant specimens at STAR are imaged, databased in Specify, and available electronically on the herbarium’s website. Students imaged the specimens at a mean rate of 145/h. We found differences in databasing rates between the graduate student leading the project (47/h) and undergraduate assistants (25/h). The majority of specimens at STAR were collected within the counties neighboring the institution. Discussion: With this workflow, we estimate that one person can digitize a 20,000-specimen collection in less than 2.5 yr by working only 10 h/wk. Because STAR is a small herbarium with limited resources, the application of the workflow described should assist curators of similar-sized collections as they contemplate and undertake the digitization process. PMID:28439474

  9. Paediatric cardiology programs in countries with limited resources: how to bridge the gap.

    Science.gov (United States)

    Sulafa, K M Ali

    2010-07-01

    Establishing paediatric cardiology service in a country with limited resources like Sudan is a challenging task. A paediatric cardiac team was formed then the services in different disciplines were gradually established. Echocardiography (echo) clinics were founded in tertiary and peripheral hospitals. Cardiac catheterization (cath) was established at the Sudan Heart Centre (SHC) in 2004 and over 400 procedures had been performed including interventional catheterization like pulmonary valve dilatation, patent ductus arteriosus and atrial septal defect device closure. Congenital heart surgery started in 2001, currently 200 cases are done each year including closed procedures as well as open heart procedures for patients weighing more than 8 kg. Cardiology-cardiac surgery as well as adult congenital heart disease meetings were held and contributed positively to the services. The cardiology-cardiac surgery scientific club meeting was founded as a forum for academic discussions. A fellowship program was established in 2004 and included seven candidates trained in paediatric cardiology and intensive care. Two training courses had been established: congenital heart disease echo and paediatric electrocardiogram interpretation. Links with regional and international cardiac centres had important roles in consolidating our program. Significant obstacles face our service due to the small number of trained personnel, high cost of procedures, the lack of regular supplies and lack of cardiac intensive care facilities for young infants. Bridging the huge gap needs extensive official as well as non-governmental efforts, training more staff, supporting families and collaboration with regional and international centres.

  10. Emergency Sonography Aids Diagnostic Accuracy of Torso Injuries: A Study in a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Charles Edward Tunuka

    2014-01-01

    Full Text Available Introduction. Clinical evaluation of patients with torso trauma is often a diagnostic challenge. Extended focused assessment with sonography for trauma (EFAST is an emergency ultrasound scan that adds to the evaluation of intrathoracic abdominal and pericardial cavities done in FAST (focused assessment with sonography for trauma. Objective. This study compares EFAST (the index test with the routine standard of care (SoC investigations (the standard reference test for torso trauma injuries. Methods. A cross-sectional descriptive study was conducted over a 3-month period. Eligible patients underwent EFAST scanning and the SoC assessment. The diagnostic accuracy of EFAST was calculated using sensitivity and specificity scores. Results. We recruited 197 patients; the M : F ratio was 5 : 1, with mean age of 27 years (SD 11. The sensitivity of EFAST was 100%, the specificity was 97%, the PPV was 87%, and the NPV was 100%. It took 5 minutes on average to complete an EFAST scan. 168 (85% patients were EFAST-scanned. Most patients (82 (48% were discharged on the same day of hospitalization, while 7 (4% were still at the hospital after two weeks. The mortality rate was 18 (9%. Conclusion. EFAST is a reliable method of diagnosing torso injuries in a resource limited context.

  11. Final environmental statement related to the Plateau Resources Limited Shootering Canyon Uranium Project (Garfield County, Utah)

    International Nuclear Information System (INIS)

    1979-07-01

    The proposed action is the issuance of a Source Material License to Plateau Resources, Ltd., for the construction and operation of the proposed Shootering Canyon Uranium Project with a product (U 3 O 8 ) production limited to 2.2 x 10 5 kg (4.9 x 10 5 lb) per year. Impacts to the area from the operation of the Shootering Canyon Uranium Project will include the following: alterations of up to 140 ha (350 acres) that will be occupied by the mill, mill facilities, borrow areas, tailings areas, and roads; an increase in the existing background radiation levels of the mill area as a result of continuous but small releases of uranium, radium, radon, and other, radioactive materials during construction and operation; socioeconomic effects on the local area, particularly the proposed community of Ticaboo, where the majority of workers will be housed during project construction and operation; and production of solid waste material (tailings) from the mill at a rate of about 680 MT (750 tons) per day and deposition as a slurry in an onsite impoundment area; construction and operation of the Shootering Canyon mill will provide employment and induced economic benefits for the region but may also result in some socioeconomic stress. On the basis of the analysis and evaluation set forth in this Environmental Statement, it is proposed that any license issued for the Shootering Canyon mill should be subject to certain conditions for the protection of the environment. A list is included. Nine appendices are also included

  12. The introduction of syphilis point of care tests in resource limited settings.

    Science.gov (United States)

    Marks, Michael; Mabey, David Cw

    2017-04-01

    Syphilis remains an important and preventable cause of stillbirth and neonatal mortality. About 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby and 33% a low birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks' gestation. Areas covered: This manuscript covers the impact of syphilis on pregnancy outcome, the diagnosis of syphilis, with a special focus on point of care (POC) tests, and challenges to the introduction of POC tests, and their potential impact on the control and prevention of syphilis in resource limited settings. Expert commentary: POC tests for syphilis are available which meet the ASSURED criteria, and could make syphilis screening accessible to all women anywhere in the world who attend an antenatal clinic. High quality dual POC tests for HIV and syphilis could ensure that well-funded programmes for the prevention of mother to child transmission of HIV can contribute towards increased coverage of antenatal syphilis screening, and prevent more than 300,000 adverse pregnancy outcomes due to syphilis annually. Alongside investment to increase availability of syphilis POC tests, operational research is needed to understand how best to improve screening of pregnant women and to translate test availability into improved pregnancy outcomes.

  13. Opportunistic mammography screening provides effective detection rates in a limited resource healthcare system.

    Science.gov (United States)

    Teh, Yew-Ching; Tan, Gie-Hooi; Taib, Nur Aishah; Rahmat, Kartini; Westerhout, Caroline Judy; Fadzli, Farhana; See, Mee-Hoong; Jamaris, Suniza; Yip, Cheng-Har

    2015-05-15

    Breast cancer is the leading cause of cancer deaths in women world-wide. In low and middle income countries, where there are no population-based mammographic screening programmes, late presentation is common, and because of inadequate access to optimal treatment, survival rates are poor. Mammographic screening is well-studied in high-income countries in western populations, and because it has been shown to reduce breast cancer mortality, it has become part of the healthcare systems in such countries. However the performance of mammographic screening in a developing country is largely unknown. This study aims to evaluate the performance of mammographic screening in Malaysia, a middle income country, and to compare the stage and surgical treatment of screen-detected and symptomatic breast cancer. A retrospective review of 2510 mammograms performed from Jan to Dec 2010 in a tertiary medical centre is carried out. The three groups identified are the routine (opportunistic) screening group, the targeted (high risk) screening group and the diagnostic group. The performance indicators of each group is calculated, and stage at presentation and treatment between the screening and diagnostic group is analyzed. The cancer detection rate in the opportunistic screening group, targeted screening group, and the symptomatic group is 0.5 %, 1.25 % and 26 % respectively. The proportion of ductal carcinoma in situ is 23.1 % in the two screening groups compared to only 2.5 % in the diagnostic group. Among the opportunistic screening group, the cancer detection rate was 0.2 % in women below 50 years old compared to 0.65 % in women 50 years and above. The performance indicators are within international standards. Early-staged breast cancer (Stage 0-2) were 84.6 % in the screening groups compared to 61.1 % in the diagnostic group. From the results, in a setting with resource constraints, targeted screening of high risk individuals will give a higher yield, and if more resources are

  14. Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo.

    Science.gov (United States)

    Kalisya, Luc Malemo; Bake, Jacques Fadhili; Bigabwa, Richard; Rothstein, David H; Cairo, Sarah B

    2018-07-01

    Surgery is an essential component of a functional health system, with surgical conditions accounting for nearly 11-15% of world disability. While communicable diseases continue to burden low- and low-middle-income countries, non-communicable diseases, such as cancer, are an important cause of morbidity and mortality worldwide. Preliminary data on malignancies in low- and middle-income countries, specifically in Africa, suggest a higher mortality compared to other regions of the world, a difference partially explained by limited availability of screening and early detection systems as well as poorer access to treatment. To evaluate the diagnosed tumor burden in the Eastern Democratic Republic of Congo (DRC) and review literature on existing and suspected barriers to accessing appropriate oncologic care. This is a retrospective study carried out at Healthcare, Education, community Action, and Leadership development Africa, a 197-bed tertiary referral hospital, in the Province of North Kivu, along the eastern border of the DRC from 2012 to 2015. Patient charts were reviewed for diagnoses of presumed malignancy with biopsy results. A total of 252 cases of suspected cancer were reviewed during the study period; 39.7% were men. The average age of patients was 43 years. Amongst adult patients, the most common presenting condition involved breast lesions with 5.8% diagnosis of fibrocystic breast changes and 2.9% invasive ductal carcinoma of the breast. 37.3% of female patients had lesions involving the cervix or uterus. The most common diagnosis amongst male adults was prostate disease (16.7% of men). For pediatric patients, the most common diagnoses involved bone and/or cartilage (27.3%) followed by skin and soft tissue lesions (20.0%). All patients underwent surgical resection of lesions; some patients were advised to travel out of country for chemotherapy and radiation for which follow-up data are unavailable. Adequate and timely treatment of malignancy in the DRC

  15. Sustainable Water and Agricultural Land Use in the Guanting Watershed under Limited Water Resources

    Science.gov (United States)

    Wechsung, F.; Möhring, J.; Otto, I. M.; Wang, X.; Guanting Project Team

    2012-04-01

    The Yongding River System is an important water source for the northeastern Chinese provinces Shanxi, Hebei, Beijing, and Tianjin. The Guanting Reservoir within this river system is one of the major water sources for Beijing, which is about 70 km away. Original planning assumed a discharge of 44 m3/s for the reservoir, but the current mean discharge rate is only about 5 m3/s; there is often hardly any discharge at all. Water scarcity is a major threat for the socio-economic development of the area. The situation is additionally aggravated by climate change impacts. Typical upstream-downstream conflicts with respect to water quantity and quality requests are mixed up with conflicts between different sectors, mainly mining, industry, and agriculture. These conflicts can be observed on different administrative levels, for example between the provinces, down to households. The German-Chinese research project "Sustainable water and agricultural land use in the Guanting Watershed under limited water resources" investigates problems and solutions related to water scarcity in the Guanting Catchment. The aim of the project is to create a vulnerability study in order to assess options for (and finally achieve) sustainable water and land use management in the Guanting region. This includes a comprehensive characterization of the current state by gap analysis and identification of pressures and impacts. The presentation gives an overview of recent project results regarding regionalization of global change scenarios and specification for water supply, evaluation of surface water quantity balances (supply-demand), evaluation of the surface water quality balances (emissions-impact thresholds), and exploration of integrative measurement planning. The first results show that climate in the area is becoming warmer and drier which leads to even more dramatically shrinking water resources. Water supply is expected to be reduced between one and two thirds. Water demand might be

  16. Intuitive ultrasonography for autonomous medical care in limited-resource environments

    Science.gov (United States)

    Dulchavsky, Scott A.; Sargsyan, Ashot E.; Garcia, Kathleen M.; Melton, Shannon L.; Ebert, Douglas; Hamilton, Douglas R.

    2011-05-01

    Management of health problems in limited resource environments, including spaceflight, faces challenges in both available equipment and personnel. The medical support for spaceflight outside Low Earth Orbit is still being defined; ultrasound (US) imaging is a candidate since trials on the International Space Station (ISS) prove that this highly informative modality performs very well in spaceflight. Considering existing estimates, authors find that US could be useful in most potential medical problems, as a powerful factor to mitigate risks and protect mission. Using outcome-oriented approach, an intuitive and adaptive US image catalog is being developed that can couple with just-in-time training methods already in use, to allow non-expert crew to autonomously acquire and interpret US data for research or diagnosis. The first objective of this work is to summarize the experience in providing imaging expertise from a central location in real time, enabling data collection by a minimally trained operator onsite. In previous investigations, just-in-time training was combined with real-time expert guidance to allow non-physician astronauts to perform over 80 h of complex US examinations on ISS, including abdominal, cardiovascular, ocular, musculoskeletal, dental/sinus, and thoracic exams. The analysis of these events shows that non-physician crew-members, after minimal training, can perform complex, quality US examinations. These training and guidance methods were also adapted for terrestrial use in professional sporting venues, the Olympic Games, and for austere locations including Mt. Everest. The second objective is to introduce a new imaging support system under development that is based on a digital catalog of existing sample images, complete with image recognition and acquisition logic and technique, and interactive multimedia reference tools, to guide and support autonomous acquisition, and possibly interpretation, of images without real-time link with a human

  17. Biomarkers to Stratify Risk Groups among Children with Malnutrition in Resource-Limited Settings and to Monitor Response to Intervention.

    Science.gov (United States)

    McGrath, Christine J; Arndt, Michael B; Walson, Judd L

    2017-01-01

    Despite global efforts to reduce childhood undernutrition, current interventions have had little impact on stunting and wasting, and the mechanisms underlying growth faltering are poorly understood. There is a clear need to distinguish populations of children most likely to benefit from any given intervention and to develop tools to monitor response to therapy prior to the development of morbid sequelae. In resource-limited settings, environmental enteric dysfunction (EED) is common among children, contributing to malnutrition and increasing childhood morbidity and mortality risk. In addition to EED, early alterations in the gut microbiota can adversely affect growth through nutrient malabsorption, altered metabolism, gut inflammation, and dysregulation of the growth hormone axis. We examined the evidence linking EED and the gut microbiome to growth faltering and explored novel biomarkers to identify subgroups of children at risk of malnutrition due to underlying pathology. These and other biomarkers could be used to identify specific groups of children at risk of malnutrition and monitor response to targeted interventions. © 2017 S. Karger AG, Basel.

  18. Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department.

    Science.gov (United States)

    Stolz, Lori A; Muruganandan, Krithika M; Bisanzo, Mark C; Sebikali, Mugisha J; Dreifuss, Bradley A; Hammerstedt, Heather S; Nelson, Sara W; Nayabale, Irene; Adhikari, Srikar; Shah, Sachita P

    2015-08-01

    To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound. The use of point-of-care ultrasound was taught to emergency care providers through lectures, bedsides teaching and hands-on practical sessions. Lectures were tailored to care providers' knowledge base and available therapeutic means. Every ultrasound examination performed by these providers was recorded over 4.5 years. Findings of these examinations were categorised as positive, negative, indeterminate or procedural. Other radiologic studies ordered over this same time period were also recorded. A total of 22,639 patients were evaluated in the emergency department by emergency care providers, and 2185 point-of-care ultrasound examinations were performed on 1886 patients. Most commonly used were the focused assessment with sonography in trauma examination (53.3%) and echocardiography (16.4%). Point-of-care ultrasound studies were performed more frequently than radiology department-performed studies. Positive findings were documented in 46% of all examinations. We describe a novel curriculum for point-of-care ultrasound education of non-physician emergency practitioners in a resource-limited setting. These non-physician clinicians integrated ultrasound into clinical practice and utilised this imaging modality more frequently than traditional radiology department imaging with a large proportion of positive findings. © 2015 John Wiley & Sons Ltd.

  19. Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings.

    Directory of Open Access Journals (Sweden)

    Andrea J Curtis

    Full Text Available OBJECTIVES: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART in resource limited settings (RLS. DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41. OUTCOME MEASURES: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. RESULTS: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4. The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4. During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years and children aged 5-14 years (25.76 and oral candidiasis was the most common in children <5 years (25.79. Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001. Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia. CONCLUSIONS: The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly

  20. Teasing apart plant community responses to N enrichment: the roles of resource limitation, competition and soil microbes.

    Science.gov (United States)

    Farrer, Emily C; Suding, Katharine N

    2016-10-01

    Although ecologists have documented the effects of nitrogen enrichment on productivity, diversity and species composition, we know little about the relative importance of the mechanisms driving these effects. We propose that distinct aspects of environmental change associated with N enrichment (resource limitation, asymmetric competition, and interactions with soil microbes) drive different aspects of plant response. We test this in greenhouse mesocosms, experimentally manipulating each factor across three ecosystems: tallgrass prairie, alpine tundra and desert grassland. We found that resource limitation controlled productivity responses to N enrichment in all systems. Asymmetric competition was responsible for diversity declines in two systems. Plant community composition was impacted by both asymmetric competition and altered soil microbes, with some contributions from resource limitation. Results suggest there may be generality in the mechanisms of plant community change with N enrichment. Understanding these links can help us better predict N response across a wide range of ecosystems. © 2016 John Wiley & Sons Ltd/CNRS.

  1. Gastroenterology training in a resource-limited setting: Zambia, Southern Africa.

    Science.gov (United States)

    Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul

    2013-07-07

    awareness in areas where resources are limited.

  2. Strategic establishment of an International Pharmacology Specialty Laboratory in a resource-limited setting.

    Science.gov (United States)

    Mtisi, Takudzwa J; Maponga, Charles; Monera-Penduka, Tsitsi G; Mudzviti, Tinashe; Chagwena, Dexter; Makita-Chingombe, Faithful; DiFranchesco, Robin; Morse, Gene D

    2018-01-01

    A growing number of drug development studies that include pharmacokinetic evaluations are conducted in regions lacking a specialised pharmacology laboratory. This necessitated the development of an International Pharmacology Specialty Laboratory (IPSL) in Zimbabwe. The aim of this article is to describe the development of an IPSL in Zimbabwe. The IPSL was developed collaboratively by the University of Zimbabwe and the University at Buffalo Center for Integrated Global Biomedical Sciences. Key stages included infrastructure development, establishment of quality management systems and collaborative mentorship in clinical pharmacology study design and chromatographic assay development and validation. Two high performance liquid chromatography instruments were donated by an instrument manufacturer and a contract research organisation. Laboratory space was acquired through association with the Zimbabwe national drug regulatory authority. Operational policies, standard operating procedures and a document control system were established. Scientists and technicians were trained in aspects relevant to IPSL operations. A high-performance liquid chromatography method for nevirapine was developed with the guidance of the Clinical Pharmacology Quality Assurance programme and approved by the assay method review programme. The University of Zimbabwe IPSL is engaged with the United States National Institute of Allergy and Infectious Diseases Division of AIDS research networks and is poised to begin drug assays and pharmacokinetic analyses. An IPSL has been successfully established in a resource-limited setting through the efforts of an external partnership providing technical guidance and motivated internal faculty and staff. Strategic partnerships were beneficial in navigating challenges leading to laboratory development and training new investigators. The IPSL is now engaged in clinical pharmacology research.

  3. Acute Kidney Injury Risk Assessment: Differences and Similarities Between Resource-Limited and Resource-Rich Countries

    Directory of Open Access Journals (Sweden)

    Kianoush Kashani

    2017-07-01

    Full Text Available The incidence of acute kidney injury (AKI among acutely ill patients is reportedly very high and has vexing consequences on patient outcomes and health care systems. The risks and impact of AKI differ between developed and developing countries. Among developing countries, AKI occurs in young individuals with no or limited comorbidities, and is usually due to environmental causes, including infectious diseases. Although several risk factors have been identified for AKI in different settings, there is limited information on how risk assessment can be used at population and patient levels to improve care in patients with AKI, particularly in developing countries where significant health disparities may exist. The Acute Disease Quality Initiative consensus conference work group addressed the issue of identifying risk factors for AKI and provided recommendations for developing individualized risk stratification strategies to improve care. We proposed a 5-dimension, evidence-based categorization of AKI risk that allows clinicians and investigators to study, define, and implement individualized risk assessment tools for the region or country where they practice. These dimensions include environmental, socioeconomic and cultural factors, processes of care, exposures, and the inherent risks of AKI. We provide examples of these risks and describe approaches for risk assessments in the developing world. We anticipate that these recommendations will be useful for health care providers to plan and execute interventions to limit the impact of AKI on society and each individual patient. Using a modified Delphi process, this group reached consensus regarding several aspects of AKI risk stratification.

  4. Breast Camps for Awareness and Early Diagnosis of Breast Cancer in Countries With Limited Resources: A Multidisciplinary Model From Kenya.

    Science.gov (United States)

    Sayed, Shahin; Moloo, Zahir; Ngugi, Anthony; Allidina, Amyn; Ndumia, Rose; Mutuiri, Anderson; Wasike, Ronald; Wahome, Charles; Abdihakin, Mohamed; Kasmani, Riaz; Spears, Carol D; Oigara, Raymond; Mwachiro, Elizabeth B; Busarla, Satya V P; Kibor, Kibet; Ahmed, Abdulaziz; Wawire, Jonathan; Sherman, Omar; Saleh, Mansoor; Zujewski, Jo Anne; Dawsey, Sanford M

    2016-09-01

    Breast cancer is the most common cancer of women in Kenya. There are no national breast cancer early diagnosis programs in Kenya. The objective was to conduct a pilot breast cancer awareness and diagnosis program at three different types of facilities in Kenya. This program was conducted at a not-for-profit private hospital, a faith-based public hospital, and a government public referral hospital. Women aged 15 years and older were invited. Demographic, risk factor, knowledge, attitudes, and screening practice data were collected. Breast health information was delivered, and clinical breast examinations (CBEs) were performed. When appropriate, ultrasound imaging, fine-needle aspirate (FNA) diagnoses, core biopsies, and onward referrals were provided. A total of 1,094 women were enrolled in the three breast camps. Of those, 56% knew the symptoms and signs of breast cancer, 44% knew how breast cancer was diagnosed, 37% performed regular breast self-exams, and 7% had a mammogram or breast ultrasound in the past year. Of the 1,094 women enrolled, 246 (23%) had previously noticed a lump in their breast. A total of 157 participants (14%) had abnormal CBEs, of whom 111 had ultrasound exams, 65 had FNAs, and 18 had core biopsies. A total of 14 invasive breast cancers and 1 malignant phyllodes tumor were diagnosed Conducting a multidisciplinary breast camp awareness and early diagnosis program is feasible in different types of health facilities within a low- and middle-income country setting. This can be a model for breast cancer awareness and point-of-care diagnosis in countries with limited resources like Kenya. This work describes a novel breast cancer awareness and early diagnosis demonstration program in a low- and middle-income country within a limited resource setting. The program includes breast self-awareness and breast cancer education, clinical exams, and point-of-care diagnostics for women in three different types of health facilities in Kenya. This pilot

  5. Allometric Scaling and Resource Limitations Model of Total Aboveground Biomass in Forest Stands: Site-scale Test of Model

    Science.gov (United States)

    CHOI, S.; Shi, Y.; Ni, X.; Simard, M.; Myneni, R. B.

    2013-12-01

    Sparseness in in-situ observations has precluded the spatially explicit and accurate mapping of forest biomass. The need for large-scale maps has raised various approaches implementing conjugations between forest biomass and geospatial predictors such as climate, forest type, soil property, and topography. Despite the improved modeling techniques (e.g., machine learning and spatial statistics), a common limitation is that biophysical mechanisms governing tree growth are neglected in these black-box type models. The absence of a priori knowledge may lead to false interpretation of modeled results or unexplainable shifts in outputs due to the inconsistent training samples or study sites. Here, we present a gray-box approach combining known biophysical processes and geospatial predictors through parametric optimizations (inversion of reference measures). Total aboveground biomass in forest stands is estimated by incorporating the Forest Inventory and Analysis (FIA) and Parameter-elevation Regressions on Independent Slopes Model (PRISM). Two main premises of this research are: (a) The Allometric Scaling and Resource Limitations (ASRL) theory can provide a relationship between tree geometry and local resource availability constrained by environmental conditions; and (b) The zeroth order theory (size-frequency distribution) can expand individual tree allometry into total aboveground biomass at the forest stand level. In addition to the FIA estimates, two reference maps from the National Biomass and Carbon Dataset (NBCD) and U.S. Forest Service (USFS) were produced to evaluate the model. This research focuses on a site-scale test of the biomass model to explore the robustness of predictors, and to potentially improve models using additional geospatial predictors such as climatic variables, vegetation indices, soil properties, and lidar-/radar-derived altimetry products (or existing forest canopy height maps). As results, the optimized ASRL estimates satisfactorily

  6. Framing water and forests as global or local? Transnational community-based networks transforming common-pool resources essence and scales

    OpenAIRE

    Dupuits, Emilie; Pflieger, Géraldine

    2017-01-01

    The current era of globalization and commodification has had a substantial impact on common-pool resources governance. In direct response to this, community-based organizations managing water and forests at the local level began to create their own transnational networks. Primarily, these organizations aim to achieve direct representation in international decision-making arenas in order to promote their model of collective governance. By reframing the representations of common-pool resources ...

  7. Understanding the Effects of Users' Behaviors on Effectiveness of Different Exogenous Regulatory Common Pool Resource Management Institutions

    Science.gov (United States)

    Madani, K.; Dinar, A.

    2013-12-01

    Tragedy of the commons is generally recognized as one of the possible destinies for common pool resources (CPRs). To avoid the tragedy of the commons and prolonging the life of CPRs, users may show different behavioral characteristics and use different rationales for CPR planning and management. Furthermore, regulators may adopt different strategies for sustainable management of CPRs. The effectiveness of different regulatory exogenous management institutions cannot be evaluated through conventional CPR models since they assume that either users base their behavior on individual rationality and adopt a selfish behavior (Nash behavior), or that the users seek the system's optimal solution without giving priority to their own interests. Therefore, conventional models fail to reliably predict the outcome of CPR problems in which parties may have a range of behavioral characteristics, putting them somewhere in between the two types of behaviors traditionally considered. This work examines the effectiveness of different regulatory exogenous CPR management institutions through a user-based model (as opposed to a system-based model). The new modeling framework allows for consideration of sensitivity of the results to different behavioral characteristics of interacting CPR users. The suggested modeling approach is applied to a benchmark groundwater management problem. Results indicate that some well-known exogenous management institutions (e.g. taxing) are ineffective in sustainable management of CPRs in most cases. Bankruptcy-based management can be helpful, but determination of the fair level of cutbacks remains challenging under this type of institution. Furthermore, some bankruptcy rules such as the Constrained Equal Award (CEA) method are more beneficial to wealthier users, failing to establish social justice. Quota-based and CPR status-based management perform as the most promising and robust regulatory exogenous institutions in prolonging the CPR's life and

  8. A common-garden study of resource-island effects on a native and an exotic, annual grass after fire

    Science.gov (United States)

    Hoover, Amber N.; Germino, Matthew J.

    2012-01-01

    Plant-soil variation related to perennial-plant resource islands (coppices) interspersed with relatively bare interspaces is a major source of heterogeneity in desert rangelands. Our objective was to determine how native and exotic grasses vary on coppice mounds and interspaces (microsites) in unburned and burned sites and underlying factors that contribute to the variation in sagebrush-steppe rangelands of the Idaho National Lab, where interspaces typically have abiotic crusts. We asked how the exotic cheatgrass (Bromus tectorum L.) and native bluebunch wheatgrass (Pseudoroegneria spicata [Pursh] A. Löve) were distributed among the microsites and measured their abundances in three replicate wildfires and nearby unburned areas. We conducted a common-garden study in which soil cores from each burned microsite type were planted with seed of either species to determine microsite effects on establishment and growth of native and exotic grasses. We assessed soil physical properties in the common-garden study to determine the intrinsic properties of each microsite surface and the retention of microsite soil differences following transfer of soils to the garden, to plant growth, and to wetting/drying cycles. In the field study, only bluebunch wheatgrass density was greater on coppice mounds than interspaces, in both unburned and burned areas. In the common-garden experiment, there were microsite differences in soil physical properties, particularly in crust hardness and its relationship to moisture, but soil properties were unaffected by plant growth. Also in the experiment, both species had equal densities yet greater dry mass production on coppice-mound soils compared to interspace soils, suggesting microsite differences in growth but not establishment (likely related to crust weakening resulting from watering). Coppice-interspace patterning and specifically native-herb recovery on coppices is likely important for postfire resistance of this rangeland to cheatgrass.

  9. An accurate and affordable test for the rapid diagnosis of sickle cell disease could revolutionize the outlook for affected children born in resource-limited settings.

    Science.gov (United States)

    Williams, Thomas N

    2015-09-23

    Each year, at least 280,000 children are born with sickle cell disease (SCD) in resource-limited settings. For cost, logistic and political reasons, the availability of SCD testing is limited in such settings and consequently 50-90 % of affected children die undiagnosed before their fifth birthday. The recent development of a point of care method for the diagnosis of SCD - the Sickle SCAN™ device - could afford such children the prompt access to appropriate services that has transformed the outlook for affected children in resource-rich areas. In research published in BMC Medicine, Kanter and colleagues describe a small but carefully conducted study involving 208 children and adults, in which they found that by using Sickle SCAN™ it was possible to diagnose the common forms of SCD with 99 % sensitivity and 99 % specificity, in under 5 minutes. If repeatable both in newborn babies and under real-life conditions, and if marketed at an affordable price, Sickle SCAN™ could revolutionize the survival prospects for children born with SCD in resource-limited areas.Please see related article: http://dx.doi.org/10.1186/s12916-015-0473-6.

  10. [Rationalization, rationing, prioritization: terminology and ethical approaches to the allocation of limited resources in hematology/oncology].

    Science.gov (United States)

    Winkler, Eva

    2011-01-01

    The field of oncology with its numerous high-priced innovations contributes considerably to the fact that medical progress is expensive. Additionally, due to the demographic changes and the increasing life expectancy, a growing number of cancer patients want to profit from this progress. Since resources are limited also in the health system, the fair distribution of the available resources urgently needs to be addressed. Dealing with scarcity is a typical problem in the domain of justice theory; therefore, this article first discusses different strategies to manage limited resources: rationalization, rationing, and prioritization. It then presents substantive as well as procedural criteria that assist in the just distribution of effective health benefits. There are various strategies to reduce the utilization of limited resources: Rationalization means that efficiency reserves are being exhausted; by means of rationing, effective health benefits are withheld due to cost considerations. Rationing can occur implicitly and thus covertly, e.g. through budgeting or the implementation of waiting periods, or explicitly, through transparent rules or policies about healthcare coverage. Ranking medical treatments according to their importance (prioritization) is often a prerequisite for rationing decisions. In terms of requirements of justice, both procedural and substantive criteria (e.g. equality, urgency, benefit) are relevant for the acceptance and quality of a decision to limit access to effective health benefits. Copyright © 2011 S. Karger AG, Basel.

  11. Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Campbell Timothy C

    2012-09-01

    Full Text Available Abstract Background Emerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness. Methods As components of its Suite for Automated Global bioSurveillance (SAGES program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies. Results ESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system. Conclusions OpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations.

  12. Prey choice and habitat use drive sea otter pathogen exposure in a resource-limited coastal system

    Science.gov (United States)

    Johnson, Christine K.; Tinker, M. Tim; Estes, James A.; Conrad, Patricia A.; Staedler, Michelle M.; Miller, Melissa A.; Jessup, David A.; Mazet, Jonna A.K.

    2014-01-01

    The processes promoting disease in wild animal populations are highly complex, yet identifying these processes is critically important for conservation when disease is limiting a population. By combining field studies with epidemiologic tools, we evaluated the relationship between key factors impeding southern sea otter (Enhydra lutris nereis) population growth: disease and resource limitation. This threatened population has struggled to recover despite protection, so we followed radio-tagged sea otters and evaluated infection with 2 disease-causing protozoal pathogens, Toxoplasma gondii and Sarcocystis neurona, to reveal risks that increased the likelihood of pathogen exposure. We identified patterns of pathogen infection that are linked to individual animal behavior, prey choice, and habitat use. We detected a high-risk spatial cluster of S. neurona infections in otters with home ranges in southern Monterey Bay and a coastal segment near San Simeon and Cambria where otters had high levels of infection with T. gondii. We found that otters feeding on abalone, which is the preferred prey in a resource-abundant marine ecosystem, had a very low risk of infection with either pathogen, whereas otters consuming small marine snails were more likely to be infected with T. gondii. Individual dietary specialization in sea otters is an adaptive mechanism for coping with limited food resources along central coastal California. High levels of infection with protozoal pathogens may be an adverse consequence of dietary specialization in this threatened species, with both depleted resources and disease working synergistically to limit recovery.

  13. Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting

    NARCIS (Netherlands)

    van Zyl, Gert Uves; van Mens, Thijs E.; McIlleron, Helen; Zeier, Michele; Nachega, Jean B.; Decloedt, Eric; Malavazzi, Carolina; Smith, Peter; Huang, Yong; van der Merwe, Lize; Gandhi, Monica; Maartens, Gary

    2011-01-01

    In resource-limited settings, many patients, with no prior protease inhibitor (PI) treatment on a second-line, high genetic barrier, ritonavir-boosted PI-containing regimen have virologic failure. We conducted a cross-sectional survey to investigate the aetiology of virologic failure in 2 public

  14. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit : The Importance of Active Surveillance in Resource-Limited Settings

    NARCIS (Netherlands)

    Amissah, Nana Ama; Buultjens, Andrew H.; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L.; Bulach, Dieter; Tetteh, Caitlin S.; Prah, Isaac; van der Werf, Tjip S.; Friedrich, Alexander W.; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P.; Rossen, John W.

    2017-01-01

    . Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low-and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the

  15. Implementation of a competency-based residency curriculum : experiences from a resource-limited environment in the Caribbean

    NARCIS (Netherlands)

    Busari, Jamiu O.; Verhagen, Eduard A. A.; Muskiet, Fred D.; Duits, Ashley J.

    2008-01-01

    Background: The introduction of competency-based curricula in institutions situated in resource-limited environments is likely to pose new challenges for the implementation process. The St. Elisabeth Hospital (SEHOS) in Curacao, Dutch Caribbean, is affiliated to university teaching hospitals in the

  16. Effects of introduction of new resources and fragmentation of existing resources on limiting wealth distribution in asset exchange models

    Science.gov (United States)

    Ali Saif, M.; Gade, Prashant M.

    2009-03-01

    Pareto law, which states that wealth distribution in societies has a power-law tail, has been the subject of intensive investigations in the statistical physics community. Several models have been employed to explain this behavior. However, most of the agent based models assume the conservation of number of agents and wealth. Both these assumptions are unrealistic. In this paper, we study the limiting wealth distribution when one or both of these assumptions are not valid. Given the universality of the law, we have tried to study the wealth distribution from the asset exchange models point of view. We consider models in which (a) new agents enter the market at a constant rate (b) richer agents fragment with higher probability introducing newer agents in the system (c) both fragmentation and entry of new agents is taking place. While models (a) and (c) do not conserve total wealth or number of agents, model (b) conserves total wealth. All these models lead to a power-law tail in the wealth distribution pointing to the possibility that more generalized asset exchange models could help us to explain the emergence of a power-law tail in wealth distribution.

  17. Robust Lentiviral Gene Delivery But Limited Transduction Capacity of Commonly Used Adeno-Associated Viral Serotypes in Xenotransplanted Human Skin.

    Science.gov (United States)

    Jakobsen, Maria; Askou, Anne Louise; Stenderup, Karin; Rosada, Cecilia; Dagnæs-Hansen, Frederik; Jensen, Thomas G; Corydon, Thomas J; Mikkelsen, Jacob Giehm; Aagaard, Lars

    2015-08-01

    Skin is an easily accessible organ, and therapeutic gene transfer to skin remains an attractive alternative for the treatment of skin diseases. Although we have previously documented potent lentiviral gene delivery to human skin, vectors based on adeno-associated virus (AAV) rank among the most promising gene delivery tools for in vivo purposes. Thus, we compared the potential usefulness of various serotypes of recombinant AAV vectors and lentiviral vectors for gene transfer to human skin in a xenotransplanted mouse model. Vector constructs encoding firefly luciferase were packaged in AAV capsids of serotype 1, 2, 5, 6, 8, and 9 and separately administered by intradermal injection in human skin transplants. For all serotypes, live bioimaging demonstrated low levels of transgene expression in the human skin graft, and firefly luciferase expression was observed primarily in neighboring tissue outside of the graft. In contrast, gene delivery by intradermally injected lentiviral vectors was efficient and led to extensive and persistent firefly luciferase expression within the human skin graft only. The study demonstrates the limited capacity of single-stranded AAV vectors of six commonly used serotypes for gene delivery to human skin in vivo.

  18. Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

    Science.gov (United States)

    Zakumumpa, Henry; Taiwo, Modupe Oladunni; Muganzi, Alex; Ssengooba, Freddie

    2016-10-19

    Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009. A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis. The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment. Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.

  19. The impact of resource limitation and the phenology of parasitoid attack on the duration of insect herbivore outbreaks.

    Science.gov (United States)

    Umbanhowar, James; Hastings, Alan

    2002-11-01

    Fluctuations in resource quality and quantity, and changes in mortality due to predators and parasites are thought to be of prime importance in the regular fluctuations of forest insects. We examine how food limitation and parasitoids with different phenologies of attack regulate the population cycles of insect hosts. Our analysis of the limit cycle of a model with a biologically realistic form of density dependence in the host yields two novel predictions. First, outbreaks will typically last for only 2 generations after parasitoids begin to reduce the host population below the maximum density. Second, host growth rate is important in determining cycle length only when parasitoids attack before the impacts of resource limitation affect the host. The robustness of these predictions are tested using a more general form of density dependence in the host, revealing that our predictions are valid as long as density dependence in the host is not too overcompensatory.

  20. Early neurologic complications and long-term sequelae of childhood bacterial meningitis in a limited-resource country (Kosovo).

    Science.gov (United States)

    Namani, Sadie A; Koci, Bulëza M; Milenković, Zvonko; Koci, Remzie; Qehaja-Buçaj, Emine; Ajazaj, Lindita; Mehmeti, Murat; Ismaili-Jaha, Vlora

    2013-02-01

    Since neurologic complications of childhood bacterial meningitis are encountered frequently despite antibiotic treatments, the purpose of this study was to analyze early neurologic complications and long-term sequelae of bacterial meningitis in children in a limited-resource country (Kosovo) This study uses a retrospective chart review of children treated for bacterial meningitis in two study periods: 277 treated during years 1997-2002 and 77 children treated during years 2009-2010. Of the 277 vs 77 children treated for bacterial meningitis, 60 (22%) vs 33 (43%) patients developed early neurologic complications, while there were 15 (5.4%) vs 2 (2.6%) deaths. The most frequent early neurologic complications were the following: subdural effusions (13 vs 29%), recurrent seizures (11 vs 8%), and hydrocephalus (3 vs 3%). The relative risk (95% confidence interval) for neurologic complications was the highest in infants (3.56 (2.17-5.92) vs 2.69 (1.62-4.59)) and in cases caused by Haemophilus influenzae 1.94 (1.09-3.18) vs Streptococcus pneumoniae 2.57(1.26-4.47). Long-term sequelae were observed in 10 vs 12% of children, predominantly in infants. The most frequent long-term sequelae were late seizures 9 vs 1%, neuropsychological impairment 1 vs 5%, and deafness 1 vs 3%. In both study periods, the most frequent early neurologic complications of childhood bacterial meningitis were subdural effusions. Long-term sequelae were observed in 10% of children, with late seizures, neuropsychological impairment, and deafness being the most common one. Age prior to 12 months was risk factor for both early neurologic complications and long-term sequelae of bacterial meningitis in children.

  1. Does hybridization of endophytic symbionts in a native grass increase fitness in resource-limited environments?

    DEFF Research Database (Denmark)

    Faeth, Stanley H.; Oberhofer, Martina; Saari, Susanna Talvikki

    2017-01-01

    to their grass hosts, especially in stressful environments. We tested the hybrid fitness hypothesis (HFH) that hybrid endophytes enhance fitness in stressful environments relative to non-hybrid endophytes. In a long-term field experiment, we monitored growth and reproduction of hybrid-infected (H+), non......-hybrid infected (NH+), naturally endophyte free (E-) plants and those plants from which the endophyte had been experimentally removed (H- and NH-) in resource-rich and resource-poor environments. Infection by both endophyte species enhanced growth and reproduction. H+ plants outperformed NH+ plants in terms...... of growth by the end of the experiment, supporting HFH. However, H+ plants only outperformed NH+ plants in the resource-rich treatment, contrary to HFH. Plant genotypes associated with each endophyte species had strong effects on growth and reproduction. Our results provide some support the HFH hypothesis...

  2. Response to Comment on “Dynamic Shifts of Limited Working Memory Resources in Human Vision”

    Science.gov (United States)

    Bays, Paul M; Husain, Masud

    2012-01-01

    Cowan & Rouder suggest that a modification to the four-slot model of visual working memory fits the available data better than our distributed resource model. However their comparisons of statistical fit are biased in favour of the slot model. Here we compare the predictions of the two models and present further evidence against the division of visual memory into slots. PMID:22822271

  3. Response to Comment on "Dynamic Shifts of Limited Working Memory Resources in Human Vision"

    Science.gov (United States)

    Bays, Paul M; Husain, Masud

    2009-02-13

    Cowan & Rouder suggest that a modification to the four-slot model of visual working memory fits the available data better than our distributed resource model. However their comparisons of statistical fit are biased in favour of the slot model. Here we compare the predictions of the two models and present further evidence against the division of visual memory into slots.

  4. Scheduling sampling to maximize information about time dependence in experiments with limited resources

    DEFF Research Database (Denmark)

    Græsbøll, Kaare; Christiansen, Lasse Engbo

    2013-01-01

    Looking for periodicity in sampled data requires that periods (lags) of different length are represented in the sampling plan. We here present a method to assist in planning of temporal studies with sparse resources, which optimizes the number of observed time lags for a fixed amount of samples w...

  5. Assessment of the Adoption of Agroforestry Technologies by Limited-Resource Farmers in North Carolina

    Science.gov (United States)

    Faulkner, Paula E.; Owooh, Bismark; Idassi, Joshua

    2014-01-01

    Agroforestry is a natural resource management system that integrates trees, forages, and livestock. The study reported here was conducted to determine farmers' knowledge about and willingness to adopt agroforestry technologies in North Carolina. The study reported participants were primarily older, male farmers, suggesting the need to attract more…

  6. Advances and limitations of the integrated water resources management in Panama

    International Nuclear Information System (INIS)

    Escalante Henriquez, Luis Carlos; Charpentier, Claudia; Diez Hernandez, Juan Manuel

    2011-01-01

    Panama competitiveness depends largely on quality and abundance of natural resources, which are being progressively degraded by a disordered urban and economic development. The availability of water in adequate quantity and quality poses serious problems in some areas of the country. This affects both the quality of life of the population and key sectors such as agriculture, industry, hydro and tourism; and stimulates social conflicts related to access, use and disposal of used water. To prevent the degradation of water resources has been promoted a holistic, known as integrated in water resources management (IWRM) strategy. From the Summit of Mar del Plata, Argentina (1977) until the 5th Forum world of the water in Istanbul in Turkey (2009), international meetings that have contributed to defining the principles and recommendations for the IWRM have been held. This work presents a methodological model of IWRM designed for Panama. Essentially consists of a perfected in how to manage water, requiring changes in the political, social, economic and administrative systems of water resource management approach

  7. Age Differences in Information Use While Making Decisions: Resource Limitations or Processing Differences?

    Science.gov (United States)

    Jacobs-Lawson, Joy M; Schumacher, Mitzi M; Wackerbarth, Sarah B

    2016-09-20

    Recent research on the decision-making abilities of older adults has shown that they use less information than young adults. One explanation ascribes this age difference to reductions in cognitive abilities with age. The article includes three experimental studies that focused on determining the conditions in which older and young adults would display dissimilar information processing characteristics. Findings from Studies 1 and 2 demonstrated that older adults are not necessarily at greater disadvantage than young adults in decision contexts that demand more information processing resources. Findings from Study 3 indicated that older adults when faced with decisions that require greater processing are likely to use a strategy that reduces the amount of information needed, whereas younger adults rely on strategies that utilize more resources. Combined the findings indicate that older adults change their decision-making strategies based on the context and information provided. Furthermore, support is provided for processing difference. © The Author(s) 2016.

  8. Formation of clinker and its effects on locating and limiting coal resources

    International Nuclear Information System (INIS)

    Sarnecki, J.C.

    1991-01-01

    Coal burns occur in nature primarily due to spontaneous combustion and the result is baked overburden known as clinker. Understanding occurrences of natural coal burns and formation of clinker is important for coal resource exploration and development. Clinker is an indication of potential commercial coal reserves, and can be located easily due to its difference from the unaltered coal section, especially color, geochemical properties, and aquifer properties. The high porosity and variable material strength of clinker create impacts for aspects of mine development such as foundation planning, slope stability, and water handling. This paper describes the formation of clinker, the use of clinker for coal deposit location, its effect on coal quality, its effect on coal resource development, and the use of clinker in surface mine reclamation

  9. Is the Internet a Suitable Patient Resource for Information on Common Radiological Investigations?: Radiology-Related Information on the Internet.

    Science.gov (United States)

    Bowden, Dermot J; Yap, Lee-Chien; Sheppard, Declan G

    2017-07-01

    This study aimed to assess the quality of Internet information about common radiological investigations. Four search engines (Google, Bing, Yahoo, and Duckduckgo) were searched using the terms "X-ray," "cat scan," "MRI," "ultrasound," and "pet scan." The first 10 webpage results returned for each search term were recorded, and their quality and readability were analyzed by two independent reviewers (DJB and LCY), with discrepancies resolved by consensus. Analysis of information quality was conducted using validated instruments for the assessment of health-care information (DISCERN score is a multi-domain tool for assessment of health-care information quality by health-care professionals and laypeople (max 80 points)) and readability (Flesch-Kincaid and SMOG or Simple Measure of Gobbledygook scores). The search result pages were further classified into categories as follows: commercial, academic (educational/institutional), and news/magazine. Several organizations offer website accreditation for health-care information, and accreditation is recognized by the presence of a hallmark or logo on the website. The presence of any valid accreditation marks on each website was recorded. Mean scores between groups were compared for significance using the Student t test. A total of 200 webpages returned (108 unique website addresses). The average DISCERN score was search engines. No significant difference was seen in readability between modalities or between search engines. Websites carrying validated accreditation marks were associated with higher average DISCERN scores: X-ray (39.36 vs 25.35), computed tomography (45.45 vs 31.33), and ultrasound (40.91 vs 27.62) (P information on the Internet is poor. High-quality online resources should be identified so that patients may avoid the use of poor-quality information derived from general search engine queries. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  10. Modelling Management Practices in Viticulture while Considering Resource Limitations: The Dhivine Model.

    Directory of Open Access Journals (Sweden)

    Roger Martin-Clouaire

    Full Text Available Many farming-system studies have investigated the design and evaluation of crop-management practices with respect to economic performance and reduction in environmental impacts. In contrast, little research has been devoted to analysing these practices in terms of matching the recurrent context-dependent demand for resources (labour in particular with those available on the farm. This paper presents Dhivine, a simulation model of operational management of grape production at the vineyard scale. Particular attention focuses on representing a flexible plan, which organises activities temporally, the resources available to the vineyard manager and the process of scheduling and executing the activities. The model relies on a generic production-system ontology used in several agricultural production domains. The types of investigations that the model supports are briefly illustrated. The enhanced realism of the production-management situations simulated makes it possible to examine and understand properties of resource-constrained work-organisation strategies and possibilities for improving them.

  11. 50 CFR 20.104 - Seasons, limits, and shooting hours for rails, woodcock, and common (Wilson's) snipe.

    Science.gov (United States)

    2010-10-01

    ... rails, woodcock, and common (Wilson's) snipe. 20.104 Section 20.104 Wildlife and Fisheries UNITED STATES... for rails, woodcock, and common (Wilson's) snipe. This section provides for the annual hunting of certain rails, woodcock, and snipe in the 48 contiguous United States. [44 FR 7148, Feb. 6, 1979...

  12. Shenzhen Comprehensive Transport System Planning:An Exploration of Sustainable Urban Transport Development on Condition of Limited Resources

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    With "integration" as the direction,Shenzhen Comprehensive Transport Planning integrates the plan,construction and management of all kinds of transport mode in the transport system,and integrates the transport with the social,economic and environment development.The planning specifies the strategic targets,key indicators,development strategies as well as major policies of the comprehensive transport system,which explores an alternative way for the sustainable urban transport development under the condition of limited resources in Shenzhen.

  13. Regional resources buffer the impact of functional limitations on perceived autonomy in older adults with multiple illnesses.

    Science.gov (United States)

    Schüz, Benjamin; Westland, Josh N; Wurm, Susanne; Tesch-Römer, Clemens; Wolff, Julia K; Warner, Lisa M; Schwarzer, Ralf

    2016-03-01

    Retaining perceptions of autonomy is a key component of successful aging. Perceived autonomy refers to the capacity to make and enact self-directed decisions. These perceptions are often threatened in older adults with multiple illnesses, when functional limitations resulting from these illnesses impede the enactment of self-directed decisions. Regional resources (in Germany specifically at the level of administrative districts) might counteract these impediments of autonomy. Economically stronger districts can provide more-concrete support resources for older adults, buffering the negative effect of functional limitations on self-perceived autonomy. This study assessed participants aged over 65 with 2 or more chronic conditions. In total, N = 287 provided data (Mage = 73.3, SD = 5.07), and n = 97 were women. Gross domestic product (GDP) per capita was used as a proxy measure of administrative district wealth in Germany. Hierarchical multilevel regression analyses with cross-level interactions were conducted. Results suggest that the detrimental effect of functional limitations on perceived autonomy is less pronounced for participants residing in higher GDP districts. Conversely, for participants in lower GDP districts, the effect is exacerbated. This finding suggests that districts with greater financial resources might be better able to invest in supports that promote and facilitate autonomy and, thus, provide a buffer against threats to individual perceived autonomy. (c) 2016 APA, all rights reserved).

  14. Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

    Science.gov (United States)

    Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

    2018-01-01

    Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  15. Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned

    Directory of Open Access Journals (Sweden)

    Tina M. Slusher

    2018-03-01

    Full Text Available Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  16. Low cost, low tech SNP genotyping tools for resource-limited areas: Plague in Madagascar as a model.

    Science.gov (United States)

    Mitchell, Cedar L; Andrianaivoarimanana, Voahangy; Colman, Rebecca E; Busch, Joseph; Hornstra-O'Neill, Heidie; Keim, Paul S; Wagner, David M; Rajerison, Minoarisoa; Birdsell, Dawn N

    2017-12-01

    resource constraint laboratories. This is a practical formula that reduces resource-driven limitations to genetic research and promises to advance global collective knowledge of infectious diseases emanating from resource limited regions of the world.

  17. Packaging health services when resources are limited: the example of a cervical cancer screening visit.

    Directory of Open Access Journals (Sweden)

    Jane J Kim

    2006-11-01

    Full Text Available Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services. We present an analytic framework for packaging multiple interventions during a single point of contact, explicitly taking into account a budget and scarce human resources, constraints acknowledged as significant obstacles for provision of health services in poor countries.We developed a binary integer programming (IP model capable of identifying an optimal package of health services to be provided during a single visit for a particular target population. Inputs to the IP model are derived using state-transition models, which compute lifetime costs and health benefits associated with each intervention. In a simplified example of a single lifetime cervical cancer screening visit, we identified packages of interventions among six diseases that maximized disability-adjusted life years (DALYs averted subject to budget and human resource constraints in four resource-poor regions. Data were obtained from regional reports and surveys from the World Health Organization, international databases, the published literature, and expert opinion. With only a budget constraint, interventions for depression and iron deficiency anemia were packaged with cervical cancer screening, while the more costly breast cancer and cardiovascular disease interventions were not. Including personnel constraints resulted in shifting of interventions included in the package, not only across diseases but also between low- and high-intensity intervention options within diseases.The results of our example suggest several key themes: Packaging other interventions during a one-time visit has the potential to increase health gains; the shortage of

  18. Challenges in the implementation of an electronic surveillance system in a resource-limited setting: Alerta, in Peru

    Directory of Open Access Journals (Sweden)

    Soto Giselle

    2008-11-01

    Full Text Available Abstract Background Infectious disease surveillance is a primary public health function in resource-limited settings. In 2003, an electronic disease surveillance system (Alerta was established in the Peruvian Navy with support from the U.S. Naval Medical Research Center Detachment (NMRCD. Many challenges arose during the implementation process, and a variety of solutions were applied. The purpose of this paper is to identify and discuss these issues. Methods This is a retrospective description of the Alerta implementation. After a thoughtful evaluation according to the Centers for Disease Control and Prevention (CDC guidelines, the main challenges to implementation were identified and solutions were devised in the context of a resource-limited setting, Peru. Results After four years of operation, we have identified a number of challenges in implementing and operating this electronic disease surveillance system. These can be divided into the following categories: (1 issues with personnel and stakeholders; (2 issues with resources in a developing setting; (3 issues with processes involved in the collection of data and operation of the system; and (4 issues with organization at the central hub. Some of the challenges are unique to resource-limited settings, but many are applicable for any surveillance system. For each of these challenges, we developed feasible solutions that are discussed. Conclusion There are many challenges to overcome when implementing an electronic disease surveillance system, not only related to technology issues. A comprehensive approach is required for success, including: technical support, personnel management, effective training, and cultural sensitivity in order to assure the effective deployment of an electronic disease surveillance system.

  19. Validation of a pediatric early warning system for hospitalized pediatric oncology patients in a resource-limited setting.

    Science.gov (United States)

    Agulnik, Asya; Méndez Aceituno, Alejandra; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

    2017-12-15

    Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital

  20. Evaluating the utility of common-pool resource theory for understanding forest governance and outcomes in Indonesia between 1965 and 2012

    Directory of Open Access Journals (Sweden)

    Forrest D Fleischman

    2014-08-01

    Full Text Available While Common Pool Resource (CPR theory has been widely applied to forestry, there are few examples of using the theory to study large-scale governance. In this paper we test the applicability of CPR theory to understanding forest governance and outcomes in Indonesia between 1965 and 2012. Indonesia contains one of the world’s largest tropical forests, and experienced rapid deforestation during this time frame, with forest cover dropping from close to 85% to less than 50%. Using a mixture of within case comparison and process tracing methods, we identify key variables that influenced the levels of deforestation during two time periods: before 1998, when governance was dominated by the dictatorship of President Suharto, and after 1998, when democratic governance and political decentralization were initiated, and deforestation rates fell and then rose again. Our results point to the value of CPR theory in identifying important variables that influence sustainability at large scales, however they also illustrate important limitations of CPR theory for the study of forests with large spatial extent and large numbers of users. The presence and absence of key variables from CPR theory did emerge as important causes of deforestation. However, some variables, such as strong leadership and local rule-making, appeared to work in the opposite direction as predicted by CPR theory. In addition, key variables that may have influenced deforestation rates are not well captured in CPR theory. These include the intention of the governance system, the presence of clientelistic politics, the influences of international politics and markets, and the influence of top-down governance. Given that CPR theory does not fully explain the case at hand, its applicability, as is, to large-scale commons should be treated with some caution.

  1. Future industrialization of the world and the necessity of nuclear power; how limited are resources?

    International Nuclear Information System (INIS)

    Jovanovic, J.

    1996-01-01

    Will the future world be forever divided into an industrial, developed and 'rich' on one side, and primitive, undeveloped, and poor on the other? Is an industrial, affluent and sustainable world of 10-15 billion people owning 5-10 billion cars physically possible to exist. Can the world have enough food, minerals and energy to support such a widespread affluence in a sustainable manner? In previous papers i have argued that even without any major breakthroughs in science and technology, an industrialized, sustainable and affluent world can be created within the next half century, but only if breeder nuclear power is widely used throughout the world. In this paper i elaborate on the question of future availability of some basic natural resources. 18 refs. 3 figs. 1 tabs

  2. CMS resource utilization and limitations on the grid after the first two years of LHC collisions

    Energy Technology Data Exchange (ETDEWEB)

    Bagliesi, Giuseppe [Pisa U.; Bloom, Kenneth [Nebraska U.; Bonacorsi, Daniele [Bologna U.; Brew, Chris [Rutherford; Fisk, Ian [Fermilab; Flix, Jose [Madrid, CIEMAT; Kreuzer, Peter [Aachen, Tech. Hochsch.; Sciaba, Andrea [CERN

    2012-01-01

    After years of development, the CMS distributed computing system is now in full operation. The LHC continues to set records for operational performance, and CMS records data at more than 300 Hz. Because of the intensity of the beams, there are multiple proton-proton interactions per beam crossing, leading to ever-larger event sizes and processing times. The CMS computing system has responded admirably to these challenges, but some reoptimization of the computing model has been required to maximize the efficient delivery of data analysis results by the collaboration in the face of increasingly constrained computing resources. We present the current status of the system, describe the recent performance, and discuss the challenges ahead and how CMS intends to meet them.

  3. Sustainable and efficient allocation of limited blue and green water resources

    OpenAIRE

    Schyns, Joseph Franciscus

    2018-01-01

    Freshwater stems from precipitation over land, which differentiates into a blue water flow (groundwater and surface water) and a green water flow (evaporation). Both flows are partially allocated to serve the economy, resulting in blue and green water footprints (WF). There are maximum sustainable levels to the blue and green WF, since rainfall is limited and part of the flows need to be reserved for aquatic and terrestrial biodiversity. Water scarcity, the degree to which the actual approach...

  4. Acceptability of donated breast milk in a resource limited South African setting

    OpenAIRE

    Coutsoudis Anna; Petrites Alissa; Coutsoudis Irene

    2011-01-01

    Abstract Background The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of th...

  5. Rebuilding common property management : a case study of community-based natural resource management in rural Guizhou, China

    NARCIS (Netherlands)

    Sun, Qiu

    2007-01-01

    Environmental degradation and rural poverty are inter-related problems of great concern to developing countries. The poor mostly live in environmentally fragile regions and rely heavily on natural resources for their livelihood subsistence. Unfortunately, environmental degradation and rural poverty

  6. A Life-cycle Approach to Improve the Sustainability of Rural Water Systems in Resource-Limited Countries

    Directory of Open Access Journals (Sweden)

    Nicholas Stacey

    2012-11-01

    Full Text Available A WHO and UNICEF joint report states that in 2008, 884 million people lacked access to potable drinking water. A life-cycle approach to develop potable water systems may improve the sustainability for such systems, however, a review of the literature shows that such an approach has primarily been used for urban systems located in resourced countries. Although urbanization is increasing globally, over 40 percent of the world’s population is currently rural with many considered poor. In this paper, we present a first step towards using life-cycle assessment to develop sustainable rural water systems in resource-limited countries while pointing out the needs. For example, while there are few differences in costs and environmental impacts for many improved rural water system options, a system that uses groundwater with community standpipes is substantially lower in cost that other alternatives with a somewhat lower environmental inventory. However, a LCA approach shows that from institutional as well as community and managerial perspectives, sustainability includes many other factors besides cost and environment that are a function of the interdependent decision process used across the life cycle of a water system by aid organizations, water user committees, and household users. These factors often present the biggest challenge to designing sustainable rural water systems for resource-limited countries.

  7. Limitations in controlling white mold on common beans with Trichoderma spp. at the fall-winter season

    Directory of Open Access Journals (Sweden)

    Trazilbo José de Paula Júnior

    2012-12-01

    Full Text Available We studied the effectiveness of application of Trichoderma spp. in controlling white mold on common beans at the fall-winter crop in the Zona da Mata region of the State of Minas Gerais, Brazil. There was no effect of the antagonist in reducing the disease severity, which could be explained by the low temperatures and the high inoculum pressure in the field. We concluded that Trichoderma applications are not recommended for control of white mold on common beans at the fall-winter season in regions with average temperature bellow 20 °C, since this condition favor more the pathogen than the antagonist.

  8. Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings.

    Science.gov (United States)

    Graham, Stephen M; English, Mike; Hazir, Tabish; Enarson, Penny; Duke, Trevor

    2008-05-01

    Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

  9. The limits of human development and the use of energy and natural resources

    International Nuclear Information System (INIS)

    Dias, Rubens A.; Mattos, Cristiano R.; Balestieri, Jose A.P.

    2006-01-01

    The development of nations is an unquestionable requirement. A lot of challenges concerning health, education and economy are present. A discussion on these development models has occupied the minds of decision makers in recent years. When energy supply and demand is considered, the situation becomes critical and the crucial question is: how to improve the quality of life of developing countries based on available models of development that are related to the life style of developed countries, for which the necessary use and waste of energy are present? How much energy is essential to humanity for not so as to endangering the survival conditions of future generations? The human development index (HDI) establishes the relationship among energy use, economic growth and social growth. Here it can be seen that 75% of the world population has a significant energy consumption potential. This is a strong reason to consider that the sustainable development concepts on energy policies are strategic to the future of the planet. This paper deals with the importance of seeking alternative development models for human development balance, natural resources conservation and environment through rational energy use concepts

  10. Biomedical laboratory science education: standardising teaching content in resource-limited countries

    Directory of Open Access Journals (Sweden)

    Wendy Arneson

    2013-06-01

    Full Text Available Background: There is a worldwide shortage of qualified laboratory personnel to provide adequate testing for the detection and monitoring of diseases. In an effort to increase laboratory capacity in developing countries, new skills have been introduced into laboratory services. Curriculum revision with a focus on good laboratory practice is an important aspect of supplying entry-level graduates with the competencies needed to meet the current needs. Objectives: Gaps in application and problem-solving competencies of newly graduated laboratory personnel were discovered in Ethiopia, Tanzania and Kenya. New medical laboratory teaching content was developed in Ethiopia, Tanzania and Kenya using national instructors, tutors, and experts and consulting medical laboratory educators from the United States of America (USA. Method: Workshops were held in Ethiopia to create standardised biomedical laboratory science (BMLS lessons based on recently-revised course objectives with an emphasis on application of skills. In Tanzania, course-module teaching guides with objectives were developed based on established competency outcomes and tasks. In Kenya, example interactive presentations and lesson plans were developed by the USA medical laboratory educators prior to the workshop to serve as resources and templates for the development of lessons within the country itself. Results: The new teaching materials were implemented and faculty, students and other stakeholders reported successful outcomes. Conclusions: These approaches to updating curricula may be helpful as biomedical laboratory schools in other countries address gaps in the competencies of entry-level graduates.

  11. Time and resource limits on working memory: cross-age consistency in counting span performance.

    Science.gov (United States)

    Ransdell, Sarah; Hecht, Steven

    2003-12-01

    This longitudinal study separated resource demand effects from those of retention interval in a counting span task among 100 children tested in grade 2 and again in grades 3 and 4. A last card large counting span condition had an equivalent memory load to a last card small, but the last card large required holding the count over a longer retention interval. In all three waves of assessment, the last card large condition was found to be less accurate than the last card small. A model predicting reading comprehension showed that age was a significant predictor when entered first accounting for 26% of the variance, but counting span accounted for a further 22% of the variance. Span at Wave 1 accounted for significant unique variance at Wave 2 and at Wave 3. Results were similar for math calculation with age accounting for 31% of the variance and counting span accounting for a further 34% of the variance. Span at Wave 1 explained unique variance in math at Wave 2 and at Wave 3.

  12. Limited and time-delayed internal resource allocation generates oscillations and chaos in the dynamics of citrus crops

    International Nuclear Information System (INIS)

    Ye, Xujun; Sakai, Kenshi

    2013-01-01

    Alternate bearing or masting is a yield variability phenomenon in perennial crops. The complex dynamics in this phenomenon have stimulated much ecological research. Motivated by data from an eight-year experiment with forty-eight individual trees, we explored the mechanism inherent to these dynamics in Satsuma mandarin (Citrus unshiu Marc.). By integrating high-resolution imaging technology, we found that the canopy structure and reproduction output of individual citrus crops are mutually dependent on each other. Furthermore, it was revealed that the mature leaves in early season contribute their energy to the fruiting of the current growing season, whereas the younger leaves show a delayed contribution to the next growing season. We thus hypothesized that the annual yield variability might be caused by the limited and time-delayed resource allocation in individual plants. A novel lattice model based on this hypothesis demonstrates that this pattern of resource allocation will generate oscillations and chaos in citrus yield

  13. Limited and time-delayed internal resource allocation generates oscillations and chaos in the dynamics of citrus crops

    Energy Technology Data Exchange (ETDEWEB)

    Ye, Xujun, E-mail: yexujun@cc.hirosaki-u.ac.jp [College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058 (China); Faculty of Agriculture and Life Sciences, Hirosaki University, Aomori 036-8561 (Japan); Sakai, Kenshi, E-mail: ken@cc.tuat.ac.jp [Environmental and Agricultural Engineering Department, Tokyo University of Agriculture and Technology, Tokyo 183-8509 (Japan)

    2013-12-15

    Alternate bearing or masting is a yield variability phenomenon in perennial crops. The complex dynamics in this phenomenon have stimulated much ecological research. Motivated by data from an eight-year experiment with forty-eight individual trees, we explored the mechanism inherent to these dynamics in Satsuma mandarin (Citrus unshiu Marc.). By integrating high-resolution imaging technology, we found that the canopy structure and reproduction output of individual citrus crops are mutually dependent on each other. Furthermore, it was revealed that the mature leaves in early season contribute their energy to the fruiting of the current growing season, whereas the younger leaves show a delayed contribution to the next growing season. We thus hypothesized that the annual yield variability might be caused by the limited and time-delayed resource allocation in individual plants. A novel lattice model based on this hypothesis demonstrates that this pattern of resource allocation will generate oscillations and chaos in citrus yield.

  14. Some fixed point theorems for weakly compatible mappings in Non-Archimedean Menger probabilistic metric spaces via common limit range property

    Directory of Open Access Journals (Sweden)

    Sunny Chauhan

    2013-11-01

    Full Text Available In this paper, we utilize the notion of common limit range property in Non-Archimedean Menger PM-spaces and prove some fixed point theorems for two pairs of weakly compatible mappings. Some illustrative examples are furnished to support our results. As an application to our main result, we present a common fixed point theorem for four finite families of self mappings. Our results improve and extend several known results existing in the literature.

  15. Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings.

    Science.gov (United States)

    Bennett, Desmond J; Carroll, Ryan W; Kacmarek, Robert M

    2018-04-01

    Respiratory compromise is a leading contributor to global neonatal death. CPAP is a method of treatment that helps maintain lung volume during expiration, promotes comfortable breathing, and improves oxygenation. Bubble CPAP is an effective alternative to standard CPAP. We sought to determine the reliability and functionality of a low-cost bubble CPAP device designed for low-resource settings. The low-cost bubble CPAP device was compared to a commercially available bubble CPAP system. The devices were connected to a lung simulator that simulated neonates of 4 different weights with compromised respiratory mechanics (∼1, ∼3, ∼5, and ∼10 kg). The devices' abilities to establish and maintain pressure and flow under normal conditions as well as under conditions of leak were compared. Multiple combinations of pressure levels (5, 8, and 10 cm H 2 O) and flow levels (3, 6, and 10 L/min) were tested. The endurance of both devices was also tested by running the systems continuously for 8 h and measuring the changes in pressure and flow. Both devices performed equivalently during the no-leak and leak trials. While our testing revealed individual differences that were statistically significant and clinically important (>10% difference) within specific CPAP and flow-level settings, no overall comparisons of CPAP or flow were both statistically significant and clinically important. Each device delivered pressures similar to the desired pressures, although the flows delivered by both machines were lower than the set flows in most trials. During the endurance trials, the low-cost device was marginally better at maintaining pressure, while the commercially available device was better at maintaining flow. The low-cost bubble CPAP device evaluated in this study is comparable to a bubble CPAP system used in developed settings. Extensive clinical trials, however, are necessary to confirm its effectiveness. Copyright © 2018 by Daedalus Enterprises.

  16. Are the kids alright? Review books and the internet as the most common study resources for the general surgery clerkship.

    Science.gov (United States)

    Taylor, Janice A; Shaw, Christiana M; Tan, Sanda A; Falcone, John L

    2018-01-01

    To define resources deemed most important to medical students on their general surgery clerkship, we evaluated their material utilization. A prospective study was conducted amongst third-year medical students using a 20-item survey. Descriptive statistics were performed on the demographics. Kruskal-Wallis and Mann-Whitney analyses were performed on the Likert responses (α = 0.05). Survey response was 69.2%. Use of review books and Internet was significantly higher compared to all other resources (p Internet source (39.1%). 56% never used textbooks. Analyses of surgery subject exam (NBME) results or intended specialty with resources used showed no statistical relationship (all p > 0.05). Resources used by students reflect access to high-yield material and increased Internet use. The Internet and review books were used more than the recommended textbook; NBME results were not affected. Understanding study habits and resource use will help guide curricular development and students' self-regulated learning. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Long time management of fossil fuel resources to limit global warming and avoid ice age onsets

    Science.gov (United States)

    Shaffer, Gary

    2009-02-01

    There are about 5000 billion tons of fossil fuel carbon in accessible reserves. Combustion of all this carbon within the next few centuries would force high atmospheric CO2 content and extreme global warming. On the other hand, low atmospheric CO2 content favors the onset of an ice age when changes in the Earth's orbit lead to low summer insolation at high northern latitudes. Here I present Earth System Model projections showing that typical reduction targets for fossil fuel use in the present century could limit ongoing global warming to less than one degree Celcius above present. Furthermore, the projections show that combustion pulses of remaining fossil fuel reserves could then be tailored to raise atmospheric CO2 content high and long enough to parry forcing of ice age onsets by summer insolation minima far into the future. Our present interglacial period could be extended by about 500,000 years in this way.

  18. Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource-limited pediatric oncology hospital.

    Science.gov (United States)

    Agulnik, Asya; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Doris Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

    2017-08-01

    Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource-limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low-resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes. A modified PEWS was implemented at UNOP with systems to track errors, transfers to a higher level of care, and high scores. A retrospective cohort study was used to evaluate clinical deterioration events in the year before and after PEWS implementation. After PEWS implementation at UNOP, there was 100% compliance with PEWS documentation and an error rate of <10%. Implementation resulted in 5 high PEWS per week, with 30% of patients transferring to a higher level of care. Among patients requiring transfer to the pediatric intensive care unit (PICU), 93% had an abnormal PEWS before transfer. The rate of clinical deterioration events decreased after PEWS implementation (9.3 vs 6.5 per 1000-hospitalpatient-days, p = .003). Despite an 18% increase in total hospital patient-days, PICU utilization for inpatient transfers decreased from 1376 to 1088 PICU patient-days per year (21% decrease; P<.001). This study describes the successful implementation of PEWS in a pediatric oncology hospital in Guatemala, resulting in decreased inpatient clinical deterioration events and PICU utilization. This work demonstrates that PEWS is a feasible and effective quality improvement measure to improve hospital care for children with cancer in hospitals with limited resources. Cancer 2017;123:2965-74. © 2017 American Cancer Society. © 2017 American Cancer Society.

  19. Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases.

    Science.gov (United States)

    Schwartz, Noah G; Rattner, Adi; Schwartz, Alan R; Mokhlesi, Babak; Gilman, Robert H; Bernabe-Ortiz, Antonio; Miranda, J Jaime; Checkley, William

    2015-09-01

    Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. There were 2,682 adults aged 35 to 92 y. Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms. Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong

  20. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Nana Ama Amissah

    2017-10-01

    Full Text Available Objectives:Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa.Methods:Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana.Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA. Notably, 25 (81% of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%, aminoglycosides (33%, oxacillin (33%, chloramphenicol (50%, tetracycline (59% and fluoroquinolones (100%.Conclusion: Population genomics uncovered multiple transmission events of S. aureus, especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  1. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings.

    Science.gov (United States)

    Amissah, Nana Ama; Buultjens, Andrew H; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L; Bulach, Dieter; Tetteh, Caitlin S; Prah, Isaac; van der Werf, Tjip S; Friedrich, Alexander W; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P; Rossen, John W

    2017-01-01

    Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa. Methods: Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana. Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical) were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA). Notably, 25 (81%) of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%), aminoglycosides (33%), oxacillin (33%), chloramphenicol (50%), tetracycline (59%) and fluoroquinolones (100%). Conclusion: Population genomics uncovered multiple transmission events of S. aureus , especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  2. Technical Aspects of Awake Craniotomy with Mapping for Brain Tumors in a Limited Resource Setting.

    Science.gov (United States)

    Leal, Rafael Teixeira Magalhaes; Barcellos, Bruno Mendonça; Landeiro, Jose Alberto

    2018-05-01

    Brain tumor surgery near or within eloquent regions is increasingly common and is associated with a high risk of neurologic injury. Awake craniotomy with mapping has been shown to be a valid method to preserve neurologic function and increase the extent of resection. However, the technique used varies greatly among centers. Most count on professionals such as neuropsychologists, speech therapists, neurophysiologists, or neurologists to help in intraoperative patient evaluation. We describe our technique with the sole participation of neurosurgeons and anesthesiologists. A retrospective review of 19 patients who underwent awake craniotomies for brain tumors between January 2013 and February 2017 at a tertiary university hospital was performed. We sought to identify and describe the most critical stages involved in this surgery as well as show the complications associated with our technique. Preoperative preparation, positioning, anesthesia, brain mapping, resection, and management of seizures and pain were stages deemed relevant to the accomplishment of an awake craniotomy. Sixteen percent of the patients developed new postoperative deficit. Seizures occurred in 24%. None led to awake craniotomy failure. We provide a thorough description of the technique used in awake craniotomies with mapping used in our institution, where the intraoperative patient evaluation is carried out solely by neurosurgeons and anesthesiologists. The absence of other specialized personnel and equipment does not necessarily preclude successful mapping during awake craniotomy. We hope to provide helpful information for those who wish to offer function-guided tumor resection in their own centers. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Assessment of water resource potential for common use of cow and goat by GIS (Case study: Boroujerd Rangeland, Sarab Sefid, Iran)

    International Nuclear Information System (INIS)

    Ariapour, A; Karami, K; Sadr, A

    2014-01-01

    One of the most important factors to sustainability utilization of natural potential by rangeland grazing suitability is water resources suitability. This study is a model for quantitative, qualitative and spatial distance assessment of water resource's propriety for goat and cow grazing based on geographic information systems (GIS) in Boroujerd Sarab Sefid rangeland, Lorestan province, Iran 2013. In this research from combining three factors such as quantity, quality and water resource's distances; the final model of degree of propriety of water resources for goat and cow grazing is characterized. Results showed that slope factor was the reason of limitation, and it is considered as a limiting factor in propriety of water resources, so in terms of access to water resources for goat grazing, 4856.4 ha (100%) located in S1 classes and for cow grazing, 4023.14 ha (68.6%) located in S1(suitability) classes, 1,187 ha (20.24%) in S2 classes and 654.8 ha (11.16%) located in S3 classes, respectively for both. So according to the results the rangelands in this region are most suitable for goat because of terrain and weather but this, in combination with, cow hasbandry will allow diversity of economic production and stability of incomes

  4. A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings.

    Science.gov (United States)

    Olusanya, B O; Iskander, I F; Slusher, T M; Wennberg, R P

    2016-05-01

    Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many low- and middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical priority-setting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

  5. Holistic care of complicated tuberculosis in healthcare settings with limited resources.

    Science.gov (United States)

    Duke, Trevor; Kasa Tom, Sharon; Poka, Harry; Welch, Henry

    2017-12-01

    In recent years, most of the focus on improving the quality of paediatric care in low-income countries has been on improving primary care using the Integrated Management of Childhood Illness, and improving triage and emergency treatment in hospitals aimed at reducing deaths in the first 24 hours. There has been little attention paid to improving the quality of care for children with chronic or complex diseases. Children with complicated forms of tuberculosis (TB), including central nervous system and chronic pulmonary TB, provide examples of acute and chronic multisystem paediatric illnesses that commonly present to district-level and second-level referral hospitals in low-income countries. The care of these children requires a holistic clinical and continuous quality improvement approach. This includes timely decisions on the commencement of treatment often when diagnoses are not certain, identification and management of acute respiratory, neurological and nutritional complications, identification and treatment of comorbidities, supportive care, systematic monitoring of treatment and progress, rehabilitation, psychological support, ensuring adherence, and safe transition to community care. New diagnostics and imaging can assist this, but meticulous attention to clinical detail at the bedside and having a clear plan for all aspects of care that is communicated well to staff and families are essential for good outcomes. The care is multidimensional: biomedical, rehabilitative, social and economic, and multidisciplinary: medical, nursing and allied health. In the era of the Sustainable Development Goals, approaches to these dimensions of healthcare are needed within the reach of the poorest people who access district hospitals in low-income countries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Assessing Face Validity of a Food Behavior Checklist for Limited-resource Filipinos.

    Science.gov (United States)

    Banna, Jinan C; Buchthal, Opal Vanessa; Tauyan, Socorro

    2015-10-01

    Diet-related chronic health conditions are prevalent in the Filipino American community; however, there is a lack of rigorously validated nutrition education evaluation tools in Tagalog for use in this population. This study aimed to develop and evaluate the face validity of a Tagalog-language food behavior checklist (FBC). A multi-step method was used, involving translation of questionnaire text from English to Tagalog by a team of professionals, creation of accompanying color photographs, cognitive testing with the target population, final review by the team of professionals, and assessment of readability. Subjects for cognitive testing were men (n=6) and women (n=14) 18 years or older in Hawai'i who received or were eligible to receive Supplemental Nutrition Assistance Program (SNAP) benefits, self-identified as Filipino, and preferred Tagalog rather than English. Participants were recruited from churches, the Filipino Center, and other community sites. Cognitive interviews revealed several issues with text and photographs, such as preferences for specific terms, and images that did not adequately illustrate the text. Image changes were made to reflect items most commonly consumed. The team of professionals agreed with participant suggestions. Assessment of readability revealed a reading level appropriate for a low-literacy population of grade 5.9. The multi-step process, which allowed members of the target audience to reveal the appropriateness of the questionnaire, yielded a Tagalog-language FBC found to have adequate face validity. After further evaluation of validity and reliability, this tool may be used to evaluate behavior change resulting from the United States Department of Agriculture's (USDA) nutrition education programs.

  7. The relation between resource limitations and optional conceptual processing by children and adults.

    Science.gov (United States)

    Ackerman, B P; Spiker, K; Bailey, K

    1989-10-01

    In some situations children fail to perform optional conceptual processing that they are able to perform. The purpose of the 4 experiments was to determine if the difficulty of word identification affects optional conceptual processing by second/third graders, fifth graders, and college students in a cued recall task. Conceptual processing was manipulated by presenting Hard (e.g., hawk eagle canary) or Easy (river lake canary) word triplets that varied in the contrastive processing necessary to identify the "odd" target word (canary). The orienting activity also varied: for the Oddity Choice activity, contrastive processing was obligatory because the subject had to identify the target; for the Read activity, contrastive processing was optional because the experimenter identified the target. A recall advantage for the Hard over the Easy triplets was the measure of contrastive processing. Finally, the difficulty of word identification varied in that the subjects read the stimuli or the experimenter read the stimuli, and all the words were degraded, only the nontarget words were degraded, or all the words were intact. The results established that contrastive processing facilitates recall, and that word identification difficulty may limit the extent of optional contrastive processing.

  8. Wind pollination and propagule formation in Rhizophora mangle L. (Rhizophoraceae: resource or pollination limitation?

    Directory of Open Access Journals (Sweden)

    TARCILA L. NADIA

    2014-03-01

    Full Text Available Rhizophora mangle is considered as a self-compatible mangrove, and is pollinated by wind and insects. However, there is no information about fruit production by autogamy and agamospermy and on the foraging behavior of its flower visitors. Hence, the present study analyzed the pollination and reproductive systems of R. mangle in a mangrove community in northern Pernambuco, Brazil. Floral morphology, sequence of anthesis, and behavior of flower visitors were described; the proportion of flowers that resulted in mature propagules was also recorded. Autogamy, agamospermy, and wind pollination tests were performed, and a new anemophily index is proposed. The flowers of R. mangle are hermaphrodite, protandric, and have high P/O rate. Flies were observed on flowers only during the male phase, probably feeding on mites that consume pollen. Rhizophora mangle is not agamospermic and its fruit production rate by spontaneous self-pollination is low (2.56% compared to wind pollination (19.44%. The anemophily index was high 0.98, and thus it was considered as a good indicator. Only 13.79% of the flowers formed mature propagules. The early stages of fruit development are the most critical and susceptible to predation. Rhizophora mangle is, therefore, exclusively anemophilous in the study area and the propagule dispersal seems to be limited by herbivory.

  9. Companion modeling for integrated renewable resource management: a new collaborative approach to create common values for sustainable development

    NARCIS (Netherlands)

    Ruankaew, N.; Page, Le C.; Dumrongrojwattana, P.; Barnaud, C.; Gajaseni, N.; Paassen, van A.; Trebuil, G.

    2010-01-01

    The sustainable management of renewable resources is often complicated by the diversity and dynamic nature of the ecological and socio-economic systems involved. As the dynamics and interactions of these systems are highly complex and frequently unpredictable, there is a need to opt for

  10. Water, stakeholders and common ground : challenges for multi-stakeholder platforms in water resource management in South Africa

    NARCIS (Netherlands)

    Simpungwe, E.

    2006-01-01

    There is a growing global concern about future water supplies. Growing demands from agriculture, industry and urban growth are streching available water supplies while pollution is undermining the quality of the resource base. Physical data available indicate that in South Africa, full utilisation

  11. The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings.

    Science.gov (United States)

    Campbell, Jeffrey I; Aturinda, Isaac; Mwesigwa, Evans; Burns, Bridget; Santorino, Data; Haberer, Jessica E; Bangsberg, David R; Holden, Richard J; Ware, Norma C; Siedner, Mark J

    2017-11-01

    Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention's acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability. Interviews guided development of a proposed conceptual framework, the technology acceptance model for resource-limited settings (TAM-RLS). This framework incorporates both classic technology acceptance model categories as well as novel factors affecting use in this setting. Participants described how SMS message language, phone characteristics, and experience with similar technologies contributed to the system's ease of use. Perceived usefulness was shaped by the perception that the system led to augmented HIV care services and improved access to social support from family and colleagues. Emergent themes specifically related to mHealth acceptance among PLWH in Uganda included (1) the importance of confidentiality, disclosure, and stigma, and (2) the barriers and facilitators downstream from the intervention that impacted achievement of the system's target outcome. The TAM-RLS is a proposed model of mHealth technology acceptance based upon end-user experiences in rural Uganda. Although the proposed model requires validation, the TAM

  12. Between the Balkans and the Baltic: Phylogeography of a Common Vole Mitochondrial DNA Lineage Limited to Central Europe.

    Science.gov (United States)

    Stojak, Joanna; McDevitt, Allan D; Herman, Jeremy S; Kryštufek, Boris; Uhlíková, Jitka; Purger, Jenő J; Lavrenchenko, Leonid A; Searle, Jeremy B; Wójcik, Jan M

    2016-01-01

    The common vole (Microtus arvalis) has been a model species of small mammal for studying end-glacial colonization history. In the present study we expanded the sampling from central and eastern Europe, analyzing contemporary genetic structure to identify the role of a potential 'northern glacial refugium', i.e. a refugium at a higher latitude than the traditional Mediterranean refugia. Altogether we analyzed 786 cytochrome b (cytb) sequences (representing mitochondrial DNA; mtDNA) from the whole of Europe, adding 177 new sequences from central and eastern Europe, and we conducted analyses on eight microsatellite loci for 499 individuals (representing nuclear DNA) from central and eastern Europe, adding data on 311 new specimens. Our new data fill gaps in the vicinity of the Carpathian Mountains, the potential northern refugium, such that there is now dense sampling from the Balkans to the Baltic Sea. Here we present evidence that the Eastern mtDNA lineage of the common vole was present in the vicinity of this Carpathian refugium during the Last Glacial Maximum and the Younger Dryas. The Eastern lineage expanded from this refugium to the Baltic and shows low cytb nucleotide diversity in those most northerly parts of the distribution. Analyses of microsatellites revealed a similar pattern but also showed little differentiation between all of the populations sampled in central and eastern Europe.

  13. Systematic review of electronic surveillance of infectious diseases with emphasis on antimicrobial resistance surveillance in resource-limited settings.

    Science.gov (United States)

    Rattanaumpawan, Pinyo; Boonyasiri, Adhiratha; Vong, Sirenda; Thamlikitkul, Visanu

    2018-02-01

    Electronic surveillance of infectious diseases involves rapidly collecting, collating, and analyzing vast amounts of data from interrelated multiple databases. Although many developed countries have invested in electronic surveillance for infectious diseases, the system still presents a challenge for resource-limited health care settings. We conducted a systematic review by performing a comprehensive literature search on MEDLINE (January 2000-December 2015) to identify studies relevant to electronic surveillance of infectious diseases. Study characteristics and results were extracted and systematically reviewed by 3 infectious disease physicians. A total of 110 studies were included. Most surveillance systems were developed and implemented in high-income countries; less than one-quarter were conducted in low-or middle-income countries. Information technologies can be used to facilitate the process of obtaining laboratory, clinical, and pharmacologic data for the surveillance of infectious diseases, including antimicrobial resistance (AMR) infections. These novel systems require greater resources; however, we found that using electronic surveillance systems could result in shorter times to detect targeted infectious diseases and improvement of data collection. This study highlights a lack of resources in areas where an effective, rapid surveillance system is most needed. The availability of information technology for the electronic surveillance of infectious diseases, including AMR infections, will facilitate the prevention and containment of such emerging infectious diseases. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Scoping the common antecedents of job stress and job satisfaction for nurses (2000-2013) using the job demands-resources model of stress.

    Science.gov (United States)

    McVicar, Andrew

    2016-03-01

    To identify core antecedents of job stress and job satisfaction, and to explore the potential of stress interventions to improve job satisfaction. Decreased job satisfaction for nurses is strongly associated with increased job stress. Stress management strategies might have the potential to improve job satisfaction. Comparative scoping review of studies (2000-2013) and location of their outcomes within the 'job demands-job resources' (JD-R) model of stress to identify commonalities and trends. Many, but not all, antecedents of both phenomena appeared consistently suggesting they are common mediators. Others were more variable but the appearance of 'emotional demands' as a common antecedent in later studies suggests an evolving influence of the changing work environment. The occurrence of 'shift work' as a common issue in later studies points to further implications for nurses' psychosocial well-being. Job satisfaction problems in nursing might be co-responsive to stress management intervention. Improving the buffering effectiveness of increased resilience and of prominent perceived job resource issues are urgently required. Participatory, psychosocial methods have the potential to raise job resources but will require high-level collaboration by stakeholders, and participative leadership and facilitation by managers to enable better decision-latitude, support for action planning and responsive changes. © 2015 John Wiley & Sons Ltd.

  15. Low cost, low tech SNP genotyping tools for resource-limited areas: Plague in Madagascar as a model.

    Directory of Open Access Journals (Sweden)

    Cedar L Mitchell

    2017-12-01

    financial cost for resource constraint laboratories. This is a practical formula that reduces resource-driven limitations to genetic research and promises to advance global collective knowledge of infectious diseases emanating from resource limited regions of the world.

  16. [Exposure to limited resources in the gastroenterology - results of a survey of hospital physicians].

    Science.gov (United States)

    Kerkemeyer, L; Reifferscheid, A; Pomorin, N; Wasem, J

    2016-11-01

    Background and research question: The hospital sector is currently characterized by a high economic pressure. As well the DRG system as the investment financing by the federal states imply financial limitations. Hospitals react to this situation by trying to reduce costs and to increase case volume. It is questionable whether and to what extent patient care and the working conditions of the physicians are affected by these circumstances. Especially, gastroenterological patients were considered to be insufficiently covered by the DRG system in the past. Therefore, this study focuses on the gastroenterology. Method: Based on prior studies and several semi-structured interviews with gastroenterologists working in hospitals a discipline-specific questionnaire was developed. Three versions of the questionnaire were differentiated to correspond to the respective experiences of the target population (chief physician, senior physician, assistant physician). All in all, 1751 members of the "Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten" (DGVS) were addressed. The questionnaire was answered by 642 participants resulting in a response rate of 36.7 %. The answers were interpreted by using descriptive and multivariate analyses. Results: A significant economic pressure is perceived by the participating gastroenterologists. This pressure manifests itself primary in perceived deficits in nursing care and human attention towards the patients. Moreover, the work satisfaction is negatively affected. Identified difficulties in the personnel recruitment can only be partially attributed to economic reasons. However, rationing of services is relatively seldom. Also, a financially-oriented overprovision is not perceived as a primary concern. In general, assistant physicians were a bit more skeptical about the situation in the gastroenterology, e. g. patient care, than the chief physicians. Conclusions: In total, the situation in the

  17. Acceptability of donated breast milk in a resource limited South African setting.

    Science.gov (United States)

    Coutsoudis, Irene; Petrites, Alissa; Coutsoudis, Anna

    2011-02-22

    The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants. The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability. This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily

  18. Acceptability of donated breast milk in a resource limited South African setting

    Directory of Open Access Journals (Sweden)

    Coutsoudis Anna

    2011-02-01

    Full Text Available Abstract Background The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants. Methods The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. Results Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability. Conclusions This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the

  19. Cancer in adolescents and young adults in countries with limited resources.

    Science.gov (United States)

    Magrath, Ian; Epelman, Sidnei

    2013-08-01

    Cancer in adolescents and young adults (AYA) represents a higher fraction of all cancer in countries that are still undergoing a demographic transition. Such countries tend to have much younger populations, and therefore unless they have a particularly low incidence of cancer in this age group, will have a higher burden of cancer (absolute number of cases with cancer) in AYA. Cancers in AYA are comprised of the tail end of the incidence curve of cancers that have their peak incidence, or occur almost exclusively in childhood, the beginning of the incidence curve of cancers that primarily affect the elderly, and a third set of cancers that have their peak incidence (or are at least common) in the AYA age group (e.g., testicular cancer, sarcomas, melanoma, thyroid cancer). Many, but not all, of these cancers require radiation or cancer surgery, but the poorest countries do not have a sufficient number of radiation therapy units and surgical oncologists, or indeed medical and pediatric oncologists, to deal with the burden of cancer they face. The AYA age group is particularly important, both with regard to their contribution to the economy now and in the future (the majority are in the "working" age-group defined as 15-64 years), as well as their important role in caring for their families. Moreover, some of these cancers are eminently curable with chemotherapy alone, and more could be cured by simply improving the efficiency of existing health services and providing education and training to both the public as well as oncologists and other specialists required for the care of AYA (although such individuals will not necessarily be exclusively concerned with this age group). Of particular importance is the detection and diagnosis of cancer patients at the earliest possible time in the course of their disease. Avoiding delays in initiating therapy, which are partly due to the poverty and lack of education of the public as well as to a failure on the part of primary

  20. Total lymphocyte count as a substitute to cd4 count in management of hiv infected individuals in resource limited society

    International Nuclear Information System (INIS)

    Daud, M.Y.; Qazi, R.A.

    2015-01-01

    Pakistan is a resource limited society and gold standard parameters to monitor HIV disease activity are very costly. The objective of the study was to evaluate total lymphocyte count (TLC) as a surrogate to CD4 count to monitor disease activity in HIV/AIDS in resource limited society. Methods: This cross sectional study was carried out at HIV/AIDS treatment centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of seven hundred and seventy four (774) HIV positive patients were enrolled in this study, and their CD4 count and total lymphocyte count were checked to find any correlation between the two by using Spearman ranked correlation coefficient. Results: The mean CD4 count was (434.30 ± 269.23), with minimum CD4 count of (9.00), and maximum of (1974.00). The mean total lymphocyte count (TLC) was (6764.0052 ± 2364.02) with minimum TLC (1200.00) and maximum TLC was (20200.00). Using the Pearson's correlation (r) there was a significant and positive correlation between TLC and CD4 count. (r2=0.127 and p=0.000) at 0.01 level. Conclusion: Our study showed a significant positive correlation between CD4 count and total lymphocyte count (TLC), so TLC can be used as a marker of disease activity in HIV infected patients. (author)

  1. Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study.

    Science.gov (United States)

    Abubakar, Amina; Van de Vijver, Fons; Van Baar, Anneloes; Mbonani, Leonard; Kalu, Raphael; Newton, Charles; Holding, Penny

    2008-09-01

    Sub-optimal physical growth has been suggested as a key pathway between the effect of environmental risk and developmental outcome. To determine if anthropometric status mediates the relation between socioeconomic status and psychomotor development of young children in resource-limited settings. A cross-sectional study design was used. A total of 204 (105 girls) children from two resource-limited communities in the Coast Province, Kenya. The mean age of these children was 29 months (SD = 3.43; range: 24-35 months). Psychomotor functioning was assessed using a locally developed and validated measure, the Kilifi Developmental Inventory. A significant association was found between anthropometric status (as measured by weight-for-age, height-for-age, mid-upper arm circumference, and head circumference) and psychomotor functioning and also between socioeconomic status and anthropometric status; no direct effects were found between socioeconomic status and developmental outcome. The models showed that weight, height and to a lesser extent mid-upper arm circumference mediate the relation between socioeconomic status and developmental outcome, while head circumference did not show the same effect. Among children under 3 years living in poverty, anthropometric status shows a clear association with psychomotor development while socioeconomic status may only have an indirect association.

  2. The Effects of Resource Limitation on a Predator-Prey Model with Control Measures as Nonlinear Pulses

    Directory of Open Access Journals (Sweden)

    Wenjie Qin

    2014-01-01

    Full Text Available The dynamical behavior of a Holling II predator-prey model with control measures as nonlinear pulses is proposed and analyzed theoretically and numerically to understand how resource limitation affects pest population outbreaks. The threshold conditions for the stability of the pest-free periodic solution are given. Latin hypercube sampling/partial rank correlation coefficients are used to perform sensitivity analysis for the threshold concerning pest extinction to determine the significance of each parameter. Comparing this threshold value with that without resource limitation, our results indicate that it is essential to increase the pesticide’s efficacy against the pest and reduce its effectiveness against the natural enemy, while enhancing the efficiency of the natural enemies. Once the threshold value exceeds a critical level, both pest and its natural enemies populations can oscillate periodically. Further-more, when the pulse period and constant stocking number as a bifurcation parameter, the predator-prey model reveals complex dynamics. In addition, numerical results are presented to illustrate the feasibility of our main results.

  3. BRAIN Journal - From OER to Open Education: Perceptions of Student Teachers after Creating Digital Stories with Creative Common Resources

    OpenAIRE

    Gemma Tur; Santos Urbina; Juan Moreno

    2016-01-01

    ABSTRACT The current study explores the perceptions of three groups of student teachers in Spain after having used open licensed resources to construct their storytelling artifacts as OER. The theoretical framework briefly reviews the concept of Open Education and OER and the affordance and drawbacks previously observed in research. Data is obtained through a survey that enables the observation of students’ tendency to adapt OER, Open Educational Practices and the Open Movement. The resul...

  4. From OER to Open Education: Perceptions of Student Teachers after Creating Digital Stories with Creative Common Resources

    OpenAIRE

    Gemma Tur; Santos Urbina; Juan Moreno

    2016-01-01

    The current study explores the perceptions of three groups of student teachers in Spain after having used open licensed resources to construct their storytelling artifacts as OER. The theoretical framework briefly reviews the concept of Open Education and OER and the affordance and drawbacks previously observed in research. Data is obtained through a survey that enables the observation of students’ tendency to adapt OER, Open Educational Practices and the Open Movement. The results reveal a g...

  5. Postgraduate and research programmes in Medicine and Public Health in Rwanda: an exciting experience about training of human resources for health in a limited resources country.

    Science.gov (United States)

    Kakoma, Jean Baptiste

    2016-01-01

    The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that.

  6. Temperature-dependent innate defense against the common cold virus limits viral replication at warm temperature in mouse airway cells.

    Science.gov (United States)

    Foxman, Ellen F; Storer, James A; Fitzgerald, Megan E; Wasik, Bethany R; Hou, Lin; Zhao, Hongyu; Turner, Paul E; Pyle, Anna Marie; Iwasaki, Akiko

    2015-01-20

    Most isolates of human rhinovirus, the common cold virus, replicate more robustly at the cool temperatures found in the nasal cavity (33-35 °C) than at core body temperature (37 °C). To gain insight into the mechanism of temperature-dependent growth, we compared the transcriptional response of primary mouse airway epithelial cells infected with rhinovirus at 33 °C vs. 37 °C. Mouse airway cells infected with mouse-adapted rhinovirus 1B exhibited a striking enrichment in expression of antiviral defense response genes at 37 °C relative to 33 °C, which correlated with significantly higher expression levels of type I and type III IFN genes and IFN-stimulated genes (ISGs) at 37 °C. Temperature-dependent IFN induction in response to rhinovirus was dependent on the MAVS protein, a key signaling adaptor of the RIG-I-like receptors (RLRs). Stimulation of primary airway cells with the synthetic RLR ligand poly I:C led to greater IFN induction at 37 °C relative to 33 °C at early time points poststimulation and to a sustained increase in the induction of ISGs at 37 °C relative to 33 °C. Recombinant type I IFN also stimulated more robust induction of ISGs at 37 °C than at 33 °C. Genetic deficiency of MAVS or the type I IFN receptor in infected airway cells permitted higher levels of viral replication, particularly at 37 °C, and partially rescued the temperature-dependent growth phenotype. These findings demonstrate that in mouse airway cells, rhinovirus replicates preferentially at nasal cavity temperature due, in part, to a less efficient antiviral defense response of infected cells at cool temperature.

  7. The paddle move commonly used in magic tricks as a means for analysing the perceptual limits of combined motion trajectories.

    Science.gov (United States)

    Hergovich, Andreas; Gröbl, Kristian; Carbon, Claus-Christian

    2011-01-01

    Following Gustav Kuhn's inspiring technique of using magicians' acts as a source of insight into cognitive sciences, we used the 'paddle move' for testing the psychophysics of combined movement trajectories. The paddle move is a standard technique in magic consisting of a combined rotating and tilting movement. Careful control of the mutual speed parameters of the two movements makes it possible to inhibit the perception of the rotation, letting the 'magic' effect emerge--a sudden change of the tilted object. By using 3-D animated computer graphics we analysed the interaction of different angular speeds and the object shape/size parameters in evoking this motion disappearance effect. An angular speed of 540 degrees s(-1) (1.5 rev. s(-1)) sufficed to inhibit the perception of the rotary movement with the smallest object showing the strongest effect. 90.7% of the 172 participants were not able to perceive the rotary movement at an angular speed of 1125 degrees s(-1) (3.125 rev. s(-1)). Further analysis by multiple linear regression revealed major influences on the effectiveness of the magic trick of object height and object area, demonstrating the applicability of analysing key factors of magic tricks to reveal limits of the perceptual system.

  8. Management of Common Resources and Reciprocity: the contributions of Elinor Ostrom to the Debate Manejo dos Recursos Comuns e Reciprocidade: os Aportes de Elinor Ostrom ao Debate

    Directory of Open Access Journals (Sweden)

    Eric Sabourin

    2010-12-01

    Full Text Available This paper analyzes the importance of reciprocity in the processes and procedures recorded in the management of common resources. It examines first the role that E. Ostrom attributes to the norm of reciprocity in her approach to common property resources. A second part interprets economic and social relations in the management of common resources as seen by economic anthropology’s theory of reciprocity. Finally, the conclusion attempts to establish a dialogue between Ostrom’s proposals and the theory of reciprocity.O artigo analisa a importância da reciprocidade nos processos e dispositivos de manejo de recursos comuns. Primeiro, examina o papel que Ostrom atribui à norma de reciprocidade na sua abordagem da gestão dos recursos em propriedade comum. Uma segunda parte apresenta a leitura das relações econômicas e sociais no manejo de recursos comuns pela ótica da teoria da reciprocidade da antropologia econômica. Finalmente, a conclusão apresenta um início de diálogo entre as propostas de Ostrom e a teoria da reciprocidade.

  9. Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper.

    Science.gov (United States)

    Vandijck, Dominique; Cleemput, Irina; Hellings, Johan; Vogelaers, Dirk

    2013-11-01

    This paper aims to describe, using an evidence-based approach, the importance of and the resources necessary for implementing effective infection prevention and control (IPC) programmes. The intrinsic and explicit values of such strategies are presented from a clinical, health-economic and patient safety perspective. Policy makers and hospital managers are committed to providing comprehensive, accessible, and affordable healthcare of high quality. Changes in the healthcare system over time accompanied with variations in demographics and case-mix have considerably affected the availability, quality and ultimately the safety of healthcare. The main goal of an IPC programme is to prevent and control healthcare-associated infections (HAI). Many patient-, healthcare provider-, and organizational factors are associated with an increased risk for acquiring HAIs and may impact both the quality and outcome of patient care. Evidence has been published in support of having an effective IPC programme. It has been estimated that about one-third of HAIs could be prevented if key elements of the evidence-based recommendations for IPC are adequately introduced and followed. However, several healthcare agencies from over the world have reported deficits in the essential resources and components of current IPC programmes. To meet its main goal, staffing, training, and infrastructure requirements are needed. Nevertheless, and given the economic crisis, policy makers and hospital managers may be tempted to not increase or even to reduce the budget as it consumes resources and does not generate sufficient visible revenue. IPC is a critical issue in patient safety, as HAIs are by far the most common complication affecting admitted patients. The significant clinical and health-economic burden HAIs place on the healthcare system speak to the importance of getting introduced effective IPC programmes. Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier

  10. International Neurocognitive Normative Study: Neurocognitive Comparison Data in Diverse Resource Limited Settings: AIDS Clinical Trials Group A5271

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, SR; Marra, CM; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, TB; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S.; Kumarasamy, N; La Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L.; Amod, F; Walawander, A

    2016-01-01

    Summary ACTG A5271 collected neurocognitive normative comparison test data in 2400 at-risk HIV seronegative participants from Brazil, India, Malawi, Peru, South Africa, Thailand and Zimbabwe. The participants were enrolled in strata by site (10 levels), age (2 levels), education (2 levels), and gender (2 levels). These data provide necessary normative data infrastructure for future clinical research and care in these diverse resource limited settings. Infrastructure for conducting neurological research in resource limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment, and normative data needed for clinical interpretation impede research and clinical care. Here we report on ACTG 5271, which provided neurological training of clinical site personnel, and collected neurocognitive normative comparison data in diverse settings. At 10 sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n=240), India (n=480), Malawi (n=481), Peru (n=239), South Africa (480), Thailand (n=240) and Zimbabwe (n=240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline, and 770 at six-months. Participants were enrolled in 8 strata, gender (female and male), education (<10 years and ≥ 10 years), and age (<35 years and ≥35 years). Of 2400 enrolled, 770 completed the six-month follow up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p<.0001). There was variation between the age, gender and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the

  11. Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

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    Thin Zaw Phyu Phyu

    2012-12-01

    Full Text Available Abstract Background Inequity of accessibility to and utilization of reproductive health (RH services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. Methods A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Results Although geographical accessibility was high (79.3%, financial accessibility was low (19.1% resulting in a low overall accessibility (34.5% to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge

  12. Extravagance in the commons: Resource exploitation and the frontiers of ecosystem service depletion in the Amazon estuary.

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    de Araujo Barbosa, Caio C; Atkinson, Peter M; Dearing, John A

    2016-04-15

    Estuaries hold major economic potential due their strategic location, close to seas and inland waterways, thereby supporting intense economic activity. The increasing pace of human development in coastal deltas over the past five decades has also strained local resources and produced extensive changes across both social and ecological systems. The Amazon estuary is located in the Amazon Basin, North Brazil, the largest river basin on Earth and also one of the least understood. A considerable segment of the population living in the estuary is directly dependent on the local extraction of natural resources for their livelihood. Areas sparsely inhabited may be exploited with few negative consequences for the environment. However, recent and increasing pressure on ecosystem services is maximised by a combination of factors such as governance, currency exchange rates, exports of beef and forest products. Here we present a cross methodological approach in identifying the political frontiers of forest cover change in the estuary with consequences for ecosystem services loss. We used a combination of data from earth observation satellites, ecosystem service literature, and official government statistics to produce spatially-explicit relationships linking the Green Vegetation Cover to the availability of ecosystems provided by forests in the estuary. Our results show that the continuous changes in land use/cover and in the economic state have contributed significantly to changes in key ecosystem services, such as carbon sequestration, climate regulation, and the availability of timber over the last thirty years. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Assessing potential for community-based management of peccaries through common pool resource theory in the rural area of the Argentine Chaco.

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    Altrichter, Mariana

    2008-03-01

    Community-based management (CBM) has been recognized as an appropriate approach to conservation, assuming that local communities have higher stakes than the state in their natural resources and have better knowledge of local resources and, therefore, can manage them more efficiently. However, the implementation of CBM has not always been successful. The objective of this research was to assess the potential for the implementation of a governmental proposal for community-based management of peccaries (Tayassuidae) in the Impenetrable northern Argentine, through the examination of the reasons why arrangements to avoid overexploitation have not evolved in this region. I used the theory of common pool resources (CPRs) as a framework for this analysis. CPRs theory explains the conditions under which appropriators of a resource are likely to engage in devising and altering governing arrangements and the conditions under which such arrangements are likely to succeed. Fieldwork was conducted between June 2000 and August 2003 using a mixed methods approach. It was found that most of the condition of the resource and users identified by the CPR theory as associated with an increased likelihood of successful management of natural resources are absent or scarcely developed in the Impenetrable. Thus, the situation in the Impenetrable does not seem appropriate for the implementation of CBM of peccaries. It is first necessary to invest in training and development of local institutions' capacities and social capital. It is also important to increase the flow of relevant information, which will enable institutions to be effective, responsible, and accountable to the community. For the moment, a more appropriate approach will have to include a mixture of protectionism and comanagement of collared peccaries while the propitious conditions for a complete local management of the resource are developed.

  14. Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

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    Mahalu William

    2011-09-01

    Full Text Available Abstract Background Oesophageal perforation is a condition associated with a high mortality. Its management is still controversial with operative treatment being favoured but a shift to conservative management is occurring. Very little exists in medical literature about its management in Sub-Saharan Africa, where the paucity of thoracic surgeons is compounded by limited diagnostic and therapeutic facilities. Case Presentation We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy, nil by mouth with feeding gastrostomy, intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia. Conclusion In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations.

  15. Could self-measured office blood pressure be a hypertension screening tool for limited-resources settings?

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    Salazar, Martin R; Espeche, Walter G; Stavile, Rodolfo N; Balbín, Eduardo; Leiva Sisnieguez, Betty C; Leiva Sisnieguez, Carlos E; March, Carlos E; Cor, Susana; Eugenio Acero, Irma; Carbajal, Horacio A

    2018-05-01

    Blood pressure (BP) was assessed by patients themselves in recently published trials. Self-measured office blood pressure (SMOBP) seems particularly interesting for limited health resources regions. The aim of our study was to evaluate the relationship between SMOBP values and those estimated by ambulatory blood pressure monitoring (ABPM). Six hundred seventy-seven patients were evaluated using both, SMOBP and ABPM. The differences between SMOBP and daytime ABPM were evaluated with paired "t" test. The correlations among SMOBP and ABPM were estimated using Pearson's r. The accuracy of SMOBP to identify abnormal ABPM was determined using area under ROC curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated for different SMOBP cut-points. Using the average of three readings, systolic SMOBP was higher (3.7 (14.2) mmHg, p 95%) to identify individuals with hypertension in the ABPM; SMOBP < 130/80 mmHg reasonably discarded abnormal ABPM. In conclusion, a high proportion of individuals could be classified adequately using SMOBP, reducing the necessity of healthcare resources and supporting its utility for screening purposes.

  16. Maximizing the benefit of health workforce secondment in Botswana: an approach for strengthening health systems in resource-limited settings

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    Grignon JS

    2014-05-01

    Full Text Available Jessica S Grignon,1,2 Jenny H Ledikwe,1,2 Ditsapelo Makati,2 Robert Nyangah,2 Baraedi W Sento,2 Bazghina-werq Semo1,2 1Department of Global Health, University of Washington, Seattle, WA, USA; 2International Training and Education Center for Health, Gaborone, Botswana Abstract: To address health systems challenges in limited-resource settings, global health initiatives, particularly the President's Emergency Plan for AIDS Relief, have seconded health workers to the public sector. Implementation considerations for secondment as a health workforce development strategy are not well documented. The purpose of this article is to present outcomes, best practices, and lessons learned from a President's Emergency Plan for AIDS Relief-funded secondment program in Botswana. Outcomes are documented across four World Health Organization health systems' building blocks. Best practices include documentation of joint stakeholder expectations, collaborative recruitment, and early identification of counterparts. Lessons learned include inadequate ownership, a two-tier employment system, and ill-defined position duration. These findings can inform program and policy development to maximize the benefit of health workforce secondment. Secondment requires substantial investment, and emphasis should be placed on high-level technical positions responsible for building systems, developing health workers, and strengthening government to translate policy into programs. Keywords: human resources, health policy, health worker, HIV/AIDS, PEPFAR

  17. From OER to Open Education: Perceptions of Student Teachers after Creating Digital Stories with Creative Common Resources

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    Gemma Tur

    2016-06-01

    Full Text Available The current study explores the perceptions of three groups of student teachers in Spain after having used open licensed resources to construct their storytelling artifacts as OER. The theoretical framework briefly reviews the concept of Open Education and OER and the affordance and drawbacks previously observed in research. Data is obtained through a survey that enables the observation of students’ tendency to adapt OER, Open Educational Practices and the Open Movement. The results reveal a general positive impact on student perceptions, although nuances and challenges are observed. The part containing the discussion and conclusions suggests some implications of this current step of research for future implementation in Teacher Education and related research.

  18. e-Assessment in a Limited-Resources Dental School Using an Open-Source Learning Management System.

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    El Tantawi, Maha M A; Abdelsalam, Maha M; Mourady, Ahmed M; Elrifae, Ismail M B

    2015-05-01

    e-Assessment provides solutions to some problems encountered in dental students' evaluation. The aim of this study was to evaluate the experience of a limited-resources dental school with e-assessment provided through an open-source learning management system (LMS). Data about users' access and types of e-assessment activities at the Faculty of Dentistry, Alexandria University, Egypt, were obtained from the web-based LMS Moodle. A questionnaire developed to assess students' perceptions of the e-assessment was also sent to students registered in two courses (undergraduate and postgraduate) with the same instructor. The results showed that most e-courses at the school had one form of e-assessment (82%) and, of these, 16.7% had summative assessment activities. There were significant differences among departments in the number of e-courses with e-assessment. One-quarter of e-courses with e-assessment used Moodle quizzes. Of 285 students registered in the two courses that included the questionnaire, 170 responded (response rate=59.6%). The responding students positively perceived the impact of e-assessment on learning and its reliability and security, whereas technical issues and related stresses were negatively perceived. This study suggests that e-assessment can be used at minimal cost in dental schools with limited resources and large class sizes with the least demands on faculty members and teaching staff time. For these schools, an open-source LMS such as Moodle provides formative e-assessment not available otherwise and accommodates various question formats and varying levels of instructors' technical skills. These students seemed to have a positive impression of the e-assessment although technical problems and related stresses are issues that need to be addressed.

  19. Xpert MTB/RIF testing in a low tuberculosis incidence, high-resource setting: limitations in accuracy and clinical impact.

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    Sohn, Hojoon; Aero, Abebech D; Menzies, Dick; Behr, Marcel; Schwartzman, Kevin; Alvarez, Gonzalo G; Dan, Andrei; McIntosh, Fiona; Pai, Madhukar; Denkinger, Claudia M

    2014-04-01

    Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in low-income countries. However, little information is available on its performance in low-incidence, high-resource countries. We evaluated the accuracy of Xpert in a university hospital tuberculosis clinic in Montreal, Canada, for the detection of pulmonary tuberculosis on induced sputum samples, using mycobacterial cultures as the reference standard. We also assessed the potential reduction in time to diagnosis and treatment initiation. We enrolled 502 consecutive patients who presented for evaluation of possible active tuberculosis (most with abnormal chest radiographs, only 18% symptomatic). Twenty-five subjects were identified to have active tuberculosis by culture. Xpert had a sensitivity of 46% (95% confidence interval [CI], 26%-67%) and specificity of 100% (95% CI, 99%-100%) for detection of Mycobacterium tuberculosis. Sensitivity was 86% (95% CI, 42%-100%) in the 7 subjects with smear-positive results, and 28% (95% CI, 10%-56%) in the remaining subjects with smear-negative, culture-positive results; in this latter group, positive Xpert results were obtained a median 12 days before culture results. Subjects with positive cultures but negative Xpert results had minimal disease: 11 of 13 had no symptoms on presentation, and mean time to positive liquid culture results was 28 days (95% CI, 25-47 days) compared with 14 days (95% CI, 8-21 days) in Xpert/culture-positive cases. Our findings suggest limited potential impact of Xpert testing in high-resource, low-incidence ambulatory settings due to lower sensitivity in the context of less extensive disease, and limited potential to expedite diagnosis beyond what is achieved with the existing, well-performing diagnostic algorithm.

  20. Evaluating the Auto-MODS Assay, a Novel Tool for Tuberculosis Diagnosis for Use in Resource-Limited Settings

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    Wang, Linwei; Mohammad, Sohaib H.; Li, Qiaozhi; Rienthong, Somsak; Rienthong, Dhanida; Nedsuwan, Supalert; Mahasirimongkol, Surakameth; Yasui, Yutaka

    2014-01-01

    There is an urgent need for simple, rapid, and affordable diagnostic tests for tuberculosis (TB) to combat the great burden of the disease in developing countries. The microscopic observation drug susceptibility assay (MODS) is a promising tool to fill this need, but it is not widely used due to concerns regarding its biosafety and efficiency. This study evaluated the automated MODS (Auto-MODS), which operates on principles similar to those of MODS but with several key modifications, making it an appealing alternative to MODS in resource-limited settings. In the operational setting of Chiang Rai, Thailand, we compared the performance of Auto-MODS with the gold standard liquid culture method in Thailand, mycobacterial growth indicator tube (MGIT) 960 plus the SD Bioline TB Ag MPT64 test, in terms of accuracy and efficiency in differentiating TB and non-TB samples as well as distinguishing TB and multidrug-resistant (MDR) TB samples. Sputum samples from clinically diagnosed TB and non-TB subjects across 17 hospitals in Chiang Rai were consecutively collected from May 2011 to September 2012. A total of 360 samples were available for evaluation, of which 221 (61.4%) were positive and 139 (38.6%) were negative for mycobacterial cultures according to MGIT 960. Of the 221 true-positive samples, Auto-MODS identified 212 as positive and 9 as negative (sensitivity, 95.9%; 95% confidence interval [CI], 92.4% to 98.1%). Of the 139 true-negative samples, Auto-MODS identified 135 as negative and 4 as positive (specificity, 97.1%; 95% CI, 92.8% to 99.2%). The median time to culture positivity was 10 days, with an interquartile range of 8 to 13 days for Auto-MODS. Auto-MODS is an effective and cost-sensitive alternative diagnostic tool for TB diagnosis in resource-limited settings. PMID:25378569

  1. Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia.

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    Chidambaram, Swathi; Nair, M Nathan; Krishnan, Shyam Sundar; Cai, Ling; Gu, Weiling; Vasudevan, Madabushi Chakravarthy

    2015-12-01

    Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia. A retrospective analysis was conducted of the medical records of all 363 neurosurgical cases performed between June 1, 2012, and June 30, 2013, at a neurosurgical center in South Asia. Data from all operative neurosurgical cases during the 13-month period were included. Cerebrospinal fluid (CSF) analysis indicated that 71 of the 363 surgical cases had low CSF glucose or CSF leukocytosis. These 71 cases were categorized as PCNSIs. The PCNSIs with positive CSF cultures (9.86%) all had gram-negative bacteria with Pseudomonas aeruginosa (n = 5), Escherichia coli (n = 1), or Klebsiella pneumoniae (n = 1). The data suggest a higher rate of death (P = 0.031), a higher rate of CSF leak (P < 0.001), and a higher rate of cranial procedures (P < 0.001) among the infected patients and a higher rate of CSF leak among the patients with culture-positive infections (P = 0.038). This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Dry Blood Spots a Reliable Method for Measurement of Hepatitis B Viral Load in Resource-Limited Settings.

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    Kathrine Stene-Johansen

    Full Text Available Hepatitis B virus (HBV quantification is essential in the management of chronic hepatitis B, both to determine treatment eligibility and in the monitoring of treatment effect. This test, however, is rarely available in resource-limited settings due to high costs and stringent requirements for shipment and storage of plasma. Dried Blood Spots (DBS can be a convenient alternative to plasma, but its use for HBV monitoring has not been investigated under real-life conditions in Africa.The performance of DBS in HBV quantification was investigated using a modified commercial test (Abbott RealTime HBV assay. Paired DBS and plasma samples were collected from an HBV positive cohort in Addis Ababa, Ethiopia. DBS were stored at ambient temperature for 4-39 days before shipment to the laboratory.Twenty-six paired samples were selected covering the total range of quantification, from 2.14 log IU/ml to >7 log IU/ml. HBV was detected in 21 of 21 (100% DBS from patients with a corresponding plasma viral load above 2.70 log IU/ml. The mean difference between plasma and DBS was 0.59 log IU/ml, and the correlation was strong (R2 = 0.92. In stability studies there was no significant change in DBS viral load after storage at room temperature for up to 12 weeks.This study suggests that DBS can be a feasible and reliable alternative to plasma for quantification of HBV in resource-limited settings. DBS can expand access to antiviral treatment for patients in low- and middle-income countries.

  3. Stroke mortality and its determinants in a resource-limited setting: A prospective cohort study in Yaounde, Cameroon.

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    Nkoke, Clovis; Lekoubou, Alain; Balti, Eric; Kengne, Andre Pascal

    2015-11-15

    About three quarters of stroke deaths occur in developing countries including those in sub-Saharan African. Short and long-term stroke fatality data are needed for health service and policy formulation. We prospectively followed up from stroke onset, 254 patients recruited from the largest reference hospitals in Yaounde (Cameroon). Mortality and determinants were investigated using the accelerated failure time regression analysis. Stroke mortality rates at one-, six- and 12 months were respectively 23.2% (Ischemic strokes: 20.4%, hemorrhagic strokes: 26.1%, and undetermined strokes: 34.8, p=0.219), 31.5% (ischemic strokes: 31.5%, hemorrhagic strokes: 30.4%, and undetermined strokes: 34.8%, p=0.927), and 32.7% (ischemic strokes: 32.1%, hemorrhagic strokes: 30.4%, undetermined strokes: 43.5%, p=0.496). Fever, swallowing difficulties, and admission NIHSS independently predicted mortality at one month, six and 12 months. Elevated systolic blood pressure (BP) predicted mortality at one month. Elevated diastolic blood pressure was a predictor of mortality at one month in participants with hemorrhagic stroke. Low hemoglobin level on admission only predicted long term mortality. In this resource-limited setting, post-stroke mortality was high with 1 out of 5 deaths occurring at one month and up to 30% deaths at six and twelve months after the index event. Fever, stroke severity, elevated BP and anemia increased the risk of death. Our findings add to the body of evidence for the poor outcome after stroke in resource limited environments. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Providing Anesthesia Care in Resource-limited Settings: A 6-year Analysis of Anesthesia Services Provided at Médecins Sans Frontières Facilities.

    Science.gov (United States)

    Ariyo, Promise; Trelles, Miguel; Helmand, Rahmatullah; Amir, Yama; Hassani, Ghulam Haidar; Mftavyanka, Julien; Nzeyimana, Zenon; Akemani, Clemence; Ntawukiruwabo, Innocent Bagura; Charles, Adelin; Yana, Yanang; Moussa, Kalla; Kamal, Mustafa; Suma, Mohamed Lamin; Ahmed, Mowlid; Abdullahi, Mohamed; Wong, Evan G; Kushner, Adam; Latif, Asad

    2016-03-01

    Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed. Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively. A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.

  5. Potential for Zika virus introduction and transmission in resource limited countries in Africa and Asia-Pacific: A modeling study

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    German, Matthew; Creatore, Maria I.; Brent, Shannon; Watts, Alexander G.; Hay, Simon I.; Kulkarni, Manisha A.; Brownstein, John S.; Khan, Kamran

    2016-01-01

    Summary Background As the epidemic of Zika virus expands in the Americas, countries across Africa and the Asia-Pacific region are becoming increasingly susceptible to the importation and possible local spread of the virus. To support public health readiness, we aim to identify regions and times where the potential health, economic, and social effects from Zika virus are greatest, focusing on resource-limited countries in Africa and the Asia-Pacific region. Methods Our model combined transportation network analysis, ecological modelling of mosquito occurrences, and vector competence for flavivirus transmission, using data from the International Air Transport Association, entomological observations from Zika’s primary vector species, and climate conditions using WorldClim. We overlaid monthly flows of airline travellers arriving to Africa and the Asia-Pacific region from areas of the Americas suitable for year-round transmission of Zika virus with monthly maps of climatic suitability for mosquito-borne transmission of Zika virus within Africa and the Asia-Pacific region. Findings An estimated 2·6 billion people live in areas of Africa and the Asia-Pacific region where the presence of competent mosquito vectors and suitable climatic conditions could support local transmission of Zika virus. Countries with large volumes of travellers arriving from Zika affected areas of the Americas and large populations at risk of mosquito-borne Zika virus infection include, India (67 422 travellers arriving per year; 1·2 billion residents in potential Zika transmission areas), China (238 415 travellers; 242 million residents), Indonesia (13 865 travellers; 197 million residents), Philippines (35 635 travellers; 70 million residents), and Thailand (29 241 travellers; 59 million residents). Interpretation Many countries across Africa and the Asia-Pacific region are vulnerable to Zika virus. Strategic use of available health and human resources is essential to prevent or mitigate

  6. Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting.

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    Jermaine Khumalo

    Full Text Available Accurate etiological diagnosis of meningitis is important, but difficult in resource-limited settings due to prior administration of antibiotics and lack of viral diagnostics. We aimed to develop and validate 2 real-time multiplex PCR (RT-PCR assays for the detection of common causes of community-acquired bacterial and viral meningitis in South African children.We developed 2 multiplex RT- PCRs for detection of S. pneumoniae, N. meningitidis, H. influenzae, enteroviruses, mumps virus and herpes simplex virus. We tested residual CSF samples from children presenting to a local paediatric hospital over a one-year period, whose CSF showed an abnormal cell count. Results were compared with routine diagnostic tests and the final discharge diagnosis. We calculated accuracy of the bacterial RT-PCR assay compared to CSF culture and using World Health Organisation definitions of laboratory-confirmed bacterial meningitis.From 292 samples, bacterial DNA was detected in 12 (4.1% and viral nucleic acids in 94 (32%. Compared to CSF culture, the sensitivity and specificity of the bacterial RT-PCR was 100% and 97.2% with complete agreement in organism identification. None of the cases positive by viral RT-PCR had a bacterial cause confirmed on CSF culture. Only 9/90 (10% of patients diagnosed clinically as bacterial meningitis or partially treated bacterial meningitis tested positive with the bacterial RT-PCR.In this population the use of 2 multiplex RT-PCRs targeting 6 common pathogens gave promising results. If introduced into routine diagnostic testing, these multiplex RT-PCR assays would supplement other diagnostic tests, and have the potential to limit unnecessary antibiotic therapy and hospitalisation.

  7. A Systematic Review of Non-Traumatic Spinal Cord Injuries in Sub-Saharan Africa and a Proposed Diagnostic Algorithm for Resource-Limited Settings

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    Abdu Kisekka Musubire

    2017-12-01

    Full Text Available BackgroundNon-traumatic myelopathy is common in Africa and there are geographic differences in etiology. Clinical management is challenging due to the broad differential diagnosis and the lack of diagnostics. The objective of this systematic review is to determine the most common etiologies of non-traumatic myelopathy in sub-Saharan Africa to inform a regionally appropriate diagnostic algorithm.MethodsWe conducted a systemic review searching Medline and Embase databases using the following search terms: “Non traumatic spinal cord injury” or “myelopathy” with limitations to epidemiology or etiologies and Sub-Saharan Africa. We described the frequencies of the different etiologies and proposed a diagnostic algorithm based on the most common diagnoses.ResultsWe identified 19 studies all performed at tertiary institutions; 15 were retrospective and 13 were published in the era of the HIV epidemic. Compressive bone lesions accounted for more than 48% of the cases; a majority were Pott’s disease and metastatic disease. No diagnosis was identified in up to 30% of cases in most studies; in particular, definitive diagnoses of non-compressive lesions were rare and a majority were clinical diagnoses of transverse myelitis and HIV myelopathy. Age and HIV were major determinants of etiology.ConclusionCompressive myelopathies represent a majority of non-traumatic myelopathies in sub-Saharan Africa, and most were due to Pott’s disease. Non-compressive myelopathies have not been well defined and need further research in Africa. We recommend a standardized approach to management of non-traumatic myelopathy focused on identifying treatable conditions with tests widely available in low-resource settings.

  8. Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting.

    Science.gov (United States)

    Tibaijuka, Leevan; Odongo, Robert; Welikhe, Emma; Mukisa, Wilber; Kugonza, Lilian; Busingye, Imelda; Nabukalu, Phelomena; Ngonzi, Joseph; Asiimwe, Stephen B; Bajunirwe, Francis

    2017-04-04

    Unplanned pregnancy remains a common problem in many resource-limited settings, mostly due to limited access to modern family planning (FP) services. In particular, use of the more effective long-acting reversible contraceptive (LARC) methods (i.e., intrauterine devices and hormonal implants) remains low compared to the short-acting methods (i.e., condoms, hormonal pills, injectable hormones, and spermicides). Among reproductive-age women attending FP and antenatal care clinics in Uganda, we assessed perceptions and practices regarding the use of modern contraceptive methods. We specifically aimed to evaluate factors influencing method selection. We performed a mixed-methods cross-sectional study, in which we administered structured interviews to 180 clients, and conducted 4 focus group discussions (FGDs) with 36 clients and 8 in-depth personal qualitative interviews with health service providers. We summarized quantitative data and performed latent content analysis on transcripts from the FGDs and qualitative interviews. The prevalence of ever use for LARC methods was 23%. Method characteristics (e.g., client control) appeared to drive method selection more often than structural factors (such as method availability) or individual client characteristics (such as knowledge and perceptions). The most common reasons for choosing LARC methods were: longer protection; better child-spacing; and effectiveness. The most common reasons for not choosing LARC methods included requiring a client-controlled method and desiring to conceive in the near future. The most common reasons for choosing short-acting methods were ease of access; lower cost; privacy; perceived fewer side effects; and freedom to stop using a method without involving the health provider. The personal characteristics of clients, which appeared to be important were client knowledge and number of children. The structural factor which appeared to be important was method availability. Our results suggest that

  9. Pathogen reduction and blood transfusion safety in Africa: strengths, limitations and challenges of implementation in low-resource settings.

    Science.gov (United States)

    Ware, A D; Jacquot, C; Tobian, A A R; Gehrie, E A; Ness, P M; Bloch, E M

    2018-01-01

    Transfusion-transmitted infection risk remains an enduring challenge to blood safety in Africa. A high background incidence and prevalence of the major transfusion-transmitted infections (TTIs), dependence on high-risk donors to meet demand, suboptimal testing and quality assurance collectively contribute to the increased risk. With few exceptions, donor testing is confined to serological evaluation of human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) and syphilis. Barriers to implementation of broader molecular methods include cost, limited infrastructure and lack of technical expertise. Pathogen reduction (PR), a term used to describe a variety of methods (e.g. solvent detergent treatment or photochemical activation) that may be applied to blood following collection, offers the means to diminish the infectious potential of multiple pathogens simultaneously. This is effective against different classes of pathogen, including the major TTIs where laboratory screening is already implemented (e.g. HIV, HBV and HCV) as well pathogens that are widely endemic yet remain unaddressed (e.g. malaria, bacterial contamination). We sought to review the available and emerging PR techniques and their potential application to resource-constrained parts of Africa, focusing on the advantages and disadvantages of such technologies. PR has been slow to be adopted even in high-income countries, primarily given the high costs of use. Logistical considerations, particularly in low-resourced parts of Africa, also raise concerns about practicality. Nonetheless, PR offers a rational, innovative strategy to contend with TTIs; technologies in development may well present a viable complement or even alternative to targeted screening in the future. © 2017 International Society of Blood Transfusion.

  10. Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.

    Science.gov (United States)

    Ndayizigiye, M; Fawzi, M C Smith; Lively, C Thompson; Ware, N C

    2017-03-15

    Family planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere. We investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7). Contraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services. Where resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

  11. Coastal resource degradation in the tropics: does the tragedy of the commons apply for coral reefs, mangrove forests and seagrass beds.

    Science.gov (United States)

    Wilkinson, Clive; Salvat, Bernard

    2012-06-01

    The keynote paper by Garrett Hardin 44 years ago introduced the term 'tragedy of the commons' into our language (Hardin, 1968); this term is now used widely, but it is neither universally accepted nor fully understood. Irrespective, the 'tragedy of the commons' is an increasing reality for more than 500 million people that rely on the biodiversity resources and services of tropical coral reefs, mangrove forests, seagrass beds and associated fisheries. These natural resources continue to decline despite major advances in our scientific understanding of how ecosystems and human populations interact, and the application of considerable conservation and management efforts at scales from local user communities to oceans. Greater effort will be required to avert increasing damage from over-exploitation, pollution and global climate change; all deriving from increasing exploitation driven by poverty and progress i.e. continuing to expand development indefinitely and extraction of resources at industrial scales. However, the 'tragedy' concept has been widely criticized as a simple metaphor for a much larger set of problems and solutions. We argue that the 'tragedy' is essentially real and will continue to threaten the lives of millions of people unless there are some major moral and policy shifts to reverse increasing damage to coastal habitats and resources. We agree with the conclusion by Hardin that the solution to the tragedy will not be through the application of natural sciences, but via implementing exceedingly difficult and controversial moral decisions. An extreme example of a moral and controversial direction suggested by Hardin was in re-examining the 'freedom to breed' as an inherent human value. The need for 'moral decisions' is even greater in 2012. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Organized Communities and Potable Water Public Utilities in Colombia: Advocacy for the Third Economic Option Based on the Common-pool Resources Theory

    Directory of Open Access Journals (Sweden)

    Jhonny Moncada Mesa

    2013-11-01

    Full Text Available Based on the theory and institutional principles proposed by Elinor Ostrom, this paper explores whether Colombian organized communities are able to provide potable water public utility in a sustainable manner and manage it as a common-pool resource (CPR. For this purpose, a set of Colombian community aqueducts is selected and compared against the eight principles proposed by this theory. The results have shown that, in general it complies with institutional principles but it also highlights difficulties, particularly in regards to the "minimal recognition of organization rights" principle.

  13. The integrated workstation: A common, consistent link between nuclear plant personnel and plant information and computerized resources

    International Nuclear Information System (INIS)

    Wood, R.T.; Knee, H.E.; Mullens, J.A.; Munro, J.K. Jr.; Swail, B.K.; Tapp, P.A.

    1993-01-01

    The increasing use of computer technology in the US nuclear power industry has greatly expanded the capability to obtain, analyze, and present data about the plant to station personnel. Data concerning a power plant's design, configuration, operational and maintenance histories, and current status, and the information that can be derived from them, provide the link between the plant and plant staff. It is through this information bridge that operations, maintenance and engineering personnel understand and manage plant performance. However, it is necessary to transform the vast quantity of data available from various computer systems and across communications networks into clear, concise, and coherent information. In addition, it is important to organize this information into a consolidated, structured form within an integrated environment so that various users throughout the plant have ready access at their local station to knowledge necessary for their tasks. Thus, integrated workstations are needed to provide the inquired information and proper software tools, in a manner that can be easily understood and used, to the proper users throughout the plant. An effort is underway at the Oak Ridge National Laboratory to address this need by developing Integrated Workstation functional requirements and implementing a limited-scale prototype demonstration. The integrated Workstation requirements will define a flexible, expandable computer environment that permits a tailored implementation of workstation capabilities and facilitates future upgrades to add enhanced applications. The functionality to be supported by the integrated workstation and inherent capabilities to be provided by the workstation environment win be described. In addition, general technology areas which are to be addressed in the Integrated Workstation functional requirements will be discussed

  14. Simulation of population response to ionizing radiation in an ecosystem with a limiting resource – Model and analytical solutions

    International Nuclear Information System (INIS)

    Sazykina, Tatiana G.; Kryshev, Alexander I.

    2016-01-01

    A dynamic mathematical model is formulated, predicting the development of radiation effects in a generic animal population, inhabiting an elemental ecosystem ‘population-limiting resource’. Differential equations of the model describe the dynamic responses to radiation damage of the following population characteristics: gross biomass; intrinsic fractions of healthy and reversibly damaged tissues in biomass; intrinsic concentrations of the self-repairing pool and the growth factor; and amount of the limiting resource available in the environment. Analytical formulae are found for the steady states of model variables as non-linear functions of the dose rate of chronic radiation exposure. Analytical solutions make it possible to predict the expected severity of radiation effects in a model ecosystem, including such endpoints as morbidity, mortality, life shortening, biosynthesis, and population biomass. Model parameters are selected from species data on lifespan, physiological growth and mortality rates, and individual radiosensitivity. Thresholds for population extinction can be analytically calculated for different animal species, examples are provided for generic mice and wolf populations. The ecosystem model demonstrates a compensatory effect of the environment on the development of radiation effects in wildlife. The model can be employed to construct a preliminary scale ‘radiation exposure-population effects’ for different animal species; species can be identified, which are vulnerable at a population level to chronic radiation exposure. - Highlights: • Mathematical model is formulated predicting radiation effects in elemental ecosystem. • Analytical formulae are found for steady states of variables as functions of exposure. • Severity of radiation effects are calculated, including population extinction. • Model parameterization is made for generic mice and wolf populations.

  15. Post procedural complications of cardiac implants done in a resource limited setting under 'C' arm: A single centre experience.

    Science.gov (United States)

    Jayachandra, A; Aggarwal, Vivek; Kumar, Sandeep; Nagesh, I V

    2018-04-01

    Cardiology interventions in peripheral hospitals is a challenging task where cardiologist have to fight against time and limited resources. Most of the sudden cardiac deaths occur due to arrhythmia and heart blocks/sinus node dysfunction. Our study is a single peripheral center experience of cardiac devices implantation using a 'C' Arm. The aim of this study was to post procedural complications of cardiac implants done in aresource limited setting under 'C' arm. This study is done at a peripheral cardiology center with no cardiac catheterization laboratory (CCL) facilities. Consecutive patients reporting to cardiology center, between Jan 2015 and Oct 2016, with a definite indication for cardiac device implant were included in the study. All the procedure of implantation was done in the operation theatre under 'C' arm under local anesthesia with continuous cardiac monitoring and critical care back up. Total 58 device implantations were done from Jan 2015 to Oct 2016. The mean age of the patients was 67.15 ± 10.85 years. Males constituted almost two third (68.9%) of patients. The commonest indication for device implantation was sinus node dysfunction in 60.34% followed by complete heart block in 25.86% and ventricular tachycardia in 12.06%. No post procedure infection was observed in our study. Device implantation constitute a major group of life saving interventions in cardiology practice. Our study has emphasised that when appropriate aseptic measures are taken during device implantation at peripheral centres, the complications rate are comparable to interventions done at advance cardiac centres.

  16. Characterization of HIV-1 antiretroviral drug resistance after second-line treatment failure in Mali, a limited-resources setting

    Science.gov (United States)

    Maiga, Almoustapha Issiaka; Fofana, Djeneba Bocar; Cisse, Mamadou; Diallo, Fodié; Maiga, Moussa Youssoufa; Traore, Hamar Alassane; Maiga, Issouf Alassane; Sylla, Aliou; Fofana, Dionke; Taiwo, Babafemi; Murphy, Robert; Katlama, Christine; Tounkara, Anatole; Calvez, Vincent; Marcelin, Anne-Geneviève

    2012-01-01

    Objectives We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) or resistance testing. Methods We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm. Results Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm3. Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P < 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P < 0.0001) and darunavir (P = 0.06). Conclusion Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings. PMID:22888273

  17. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

    Science.gov (United States)

    Modi, Payal; Glavis-Bloom, Justin; Nasrin, Sabiha; Guy, Allysia; Chowa, Erika P; Dvor, Nathan; Dworkis, Daniel A; Oh, Michael; Silvestri, David M; Strasberg, Stephen; Rege, Soham; Noble, Vicki E; Alam, Nur H; Levine, Adam C

    2016-01-01

    Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy. To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children. A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity. 850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor. Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

  18. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

    Directory of Open Access Journals (Sweden)

    Payal Modi

    Full Text Available Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b. Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60, sensitivity (67%, and specificity (49%, for predicting severe dehydration were all poor.Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

  19. Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Christopher R. Stark

    2017-06-01

    Full Text Available Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda. Methods and Materials: Imaging the World Africa (ITWA is the registered non-governmental organization division of Imaging the World (ITW, a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits. Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD. Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.

  20. The 'My five moments for hand hygiene' concept for the overcrowded setting in resource-limited healthcare systems.

    Science.gov (United States)

    Salmon, S; Pittet, D; Sax, H; McLaws, M L

    2015-10-01

    Hand hygiene is a core activity of patient safety for the prevention of healthcare-associated infections (HCAIs). To standardize hand hygiene practices globally the World Health Organization (WHO) released Guidelines on Hand Hygiene in Health Care and introduced the 'My five moments for hand hygiene' concept to define indications for hand hygiene rooted in an evidence-based model for transmission of micro-organisms by healthcare workers' (HCWs) hands. Central to the concept is the division of the healthcare environment into two geographical care zones, the patient zone and the healthcare zone, that requires the HCW to comply with specific hand hygiene moments. In resource-limited, overcrowded healthcare settings inadequate or no spatial separation between beds occurs frequently. These conditions challenge the HCW's ability to visualize and delineate patient zones. The 'My five moments for hand hygiene' concept has been adapted for these conditions with the aim of assisting hand hygiene educators, auditors, and HCWs to minimize ambiguity regarding shared patient zones and achieve the ultimate goal set by the WHO Guidelines--the reduction of infectious risks. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  1. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings

    Science.gov (United States)

    Nadeem, Sayyada Ghufrana; Hakim, Shazia Tabassum; Kazmi, Shahana Urooj

    2010-01-01

    Introduction Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal–tween 80 agar and biochemical methods by using API 20 C AUX. Results The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients. PMID:21483597

  2. A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting.

    Science.gov (United States)

    Flood, David; Douglas, Kate; Goldberg, Vera; Martinez, Boris; Garcia, Pablo; Arbour, MaryCatherine; Rohloff, Peter

    2017-08-01

    Quality improvement (QI) is a key strategy for improving diabetes care in low- and middle-income countries (LMICs). This study reports on a diabetes QI project in rural Guatemala whose primary aim was to improve glycemic control of a panel of adult diabetes patients. Formative research suggested multiple areas for programmatic improvement in ambulatory diabetes care. This project utilized the Model for Improvement and Agile Global Health, our organization's complementary healthcare implementation framework. A bundle of improvement activities were implemented at the home, clinic and institutional level. Control charts of mean hemoglobin A1C (HbA1C) and proportion of patients meeting target HbA1C showed improvement as special cause variation was identified 3 months after the intervention began. Control charts for secondary process measures offered insights into the value of different components of the intervention. Intensity of home-based diabetes education emerged as an important driver of panel glycemic control. Diabetes QI work is feasible in resource-limited settings in LMICs and can improve glycemic control. Statistical process control charts are a promising methodology for use with panels or registries of diabetes patients. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  3. The use of Minilabs to improve the testing capacity of regulatory authorities in resource limited settings: Tanzanian experience.

    Science.gov (United States)

    Risha, Peter Gasper; Msuya, Zera; Clark, Malcolm; Johnson, Keith; Ndomondo-Sigonda, Margareth; Layloff, Thomas

    2008-08-01

    The Tanzania Food and Drugs Authority piloted the use of Minilab kits, a thin-layer-chromatographic based drug quality testing technique, in a two-tier quality assurance program. The program is intended to improve testing capacity with timely screening of the quality of medicines as they enter the market. After 1 week training of inspectors on Minilab screening techniques, they were stationed at key Ports-of-Entry (POE) to screen the quality of imported medicines. In addition, three non-Ports-of-Entry centres were established to screen samples collected during Post-Marketing-Surveillance. Standard operating procedures (SOPs) were developed to structure and standardize the implementation process. Over 1200 samples were tested using the Minilab outside the central quality control laboratory (QCL), almost doubling the previous testing capacity. The program contributed to increased regulatory reach and visibility of the Authority throughout the country, serving as a deterrent against entry of substandard medicines into market. The use of Minilab for quality screening was inexpensive and provided a high sample throughput. However, it suffers from the limitation that it can reliably detect only grossly substandard or wrong drug samples and therefore, it should not be used as an independent testing resource but in conjunction with a full-service quality control laboratory capable of auditing reported substandard results.

  4. Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances.

    Science.gov (United States)

    Campbell, Jeffrey I; Haberer, Jessica E

    2015-12-01

    Numerous cell phone-based and adherence monitoring technologies have been developed to address barriers to effective HIV prevention, testing, and treatment. Because most people living with HIV and AIDS reside in resource-limited settings (RLS), it is important to understand the development and use of these technologies in RLS. Recent research on cell phone-based technologies has focused on HIV education, linkage to and retention in care, disease tracking, and antiretroviral therapy adherence reminders. Advances in adherence devices have focused on real-time adherence monitors, which have been used for both antiretroviral therapy and pre-exposure prophylaxis. Real-time monitoring has recently been combined with cell phone-based technologies to create real-time adherence interventions using short message service (SMS). New developments in adherence technologies are exploring ingestion monitoring and metabolite detection to confirm adherence. This article provides an overview of recent advances in these two families of technologies and includes research on their acceptability and cost-effectiveness when available. It additionally outlines key challenges and needed research as use of these technologies continues to expand and evolve.

  5. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Sayyada Ghufrana Nadeem

    2010-02-01

    Full Text Available Introduction: Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods: A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal–tween 80 agar and biochemical methods by using API 20 C AUX. Results: The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion: The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients.

  6. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings.

    Science.gov (United States)

    Nadeem, Sayyada Ghufrana; Hakim, Shazia Tabassum; Kazmi, Shahana Urooj

    2010-02-09

    Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal-tween 80 agar and biochemical methods by using API 20 C AUX. The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients.

  7. Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review.

    Science.gov (United States)

    Lawn, Stephen D; Meintjes, Graeme; McIlleron, Helen; Harries, Anthony D; Wood, Robin

    2013-12-02

    The HIV-associated tuberculosis (TB) epidemic remains a huge challenge to public health in resource-limited settings. Reducing the nearly 0.5 million deaths that result each year has been identified as a key priority. Major progress has been made over the past 10 years in defining appropriate strategies and policy guidelines for early diagnosis and effective case management. Ascertainment of cases has been improved through a twofold strategy of provider-initiated HIV testing and counseling in TB patients and intensified TB case finding among those living with HIV. Outcomes of rifampicin-based TB treatment are greatly enhanced by concurrent co-trimoxazole prophylaxis and antiretroviral therapy (ART). ART reduces mortality across a spectrum of CD4 counts and randomized controlled trials have defined the optimum time to start ART. Good outcomes can be achieved when combining TB treatment with first-line ART, but use with second-line ART remains challenging due to pharmacokinetic drug interactions and cotoxicity. We review the frequency and spectrum of adverse drug reactions and immune reconstitution inflammatory syndrome (IRIS) resulting from combined treatment, and highlight the challenges of managing HIV-associated drug-resistant TB.

  8. Dimensions of Poverty and Health Outcomes Among People Living with HIV Infection: Limited Resources and Competing Needs.

    Science.gov (United States)

    Kalichman, Seth C; Hernandez, Dominica; Kegler, Christopher; Cherry, Chauncey; Kalichman, Moira O; Grebler, Tamar

    2015-08-01

    HIV infection is concentrated in populations living in poverty. We examined the overlapping and independent effects of multiple poverty indicators on HIV-related health status. Because substance use can create competing survival needs when resources are limited, we also sought to objectively measure expenditures on food relative to alcohol and tobacco products. To achieve these aims, 459 men and 212 women living with HIV infection in Atlanta, GA completed measures of socio-demographic and heath characteristics as well as multiple indicators of poverty including housing stability, transportation, food insecurity, and substance use. Participants were given a $30 grocery gift card for their participation and we collected receipts which were coded for alcohol (beer, wine, liquors) and tobacco purchases. Results showed that participants with unsuppressed HIV replication were significantly more likely to experience multiple indicators of poverty. In addition, one in four participants purchased alcohol or tobacco products with their gift cards, with as much as one-fourth of money spent on these products. A multivariable logistic regression model showed that food insecurity was independently associated with unsuppressed HIV, and purchasing alcohol or tobacco products did not moderate this association. Results confirm previous research to show the primacy of food insecurity in relation to HIV-related health outcomes. Competing survival needs, including addictive substances, should be addressed in programs that aim to alleviate poverty to enhance the health and well-being of people with HIV infection.

  9. Mast fruiting of large ectomycorrhizal African rain forest trees: importance of dry season intensity, and the resource-limitation hypothesis.

    Science.gov (United States)

    Newbery, David M; Chuyong, George B; Zimmermann, Lukas

    2006-01-01

    Mast fruiting is a distinctive reproductive trait in trees. This rain forest study, at a nutrient-poor site with a seasonal climate in tropical Africa, provides new insights into the causes of this mode of phenological patterning. At Korup, Cameroon, 150 trees of the large, ectomycorrhizal caesalp, Microberlinia bisulcata, were recorded almost monthly for leafing, flowering and fruiting during 1995-2000. The series was extended to 1988-2004 with less detailed data. Individual transitions in phenology were analysed. Masting occurred when the dry season before fruiting was drier, and the one before that was wetter, than average. Intervals between events were usually 2 or 3 yr. Masting was associated with early leaf exchange, followed by mass flowering, and was highly synchronous in the population. Trees at higher elevation showed more fruiting. Output declined between 1995 and 2000. Mast fruiting in M. bisulcata appears to be driven by climate variation and is regulated by internal tree processes. The resource-limitation hypothesis was supported. An 'alternative bearing' system seems to underlie masting. That ectomycorrhizal habit facilitates masting in trees is strongly implied.

  10. Mechanisms of Resilience in Common-pool Resource Management Systems: an Agent-based Model of Water Use in a River Basin

    Directory of Open Access Journals (Sweden)

    Maja Schlüter

    2007-12-01

    Full Text Available The concept of resilience is widely promoted as a promising notion to guide new approaches to ecosystem and resource management that try to enhance a system's capacity to cope with change. A variety of mechanisms of resilience specific for different systems have been proposed. In the context of resource management those include but are not limited to the diversity of response options and flexibility of the social system to adaptively respond to changes on an adequate scale. However, implementation of resilience-based management in specific real-world systems has often proven difficult because of a limited understanding of suitable interventions and their impact on the resilience of the coupled social-ecological system. We propose an agent-based modeling approach to explore system characteristics and mechanisms of resilience in a complex resource management system, based on a case study of water use in the Amudarya River, which is a semiarid river basin. Water resources in its delta are used to sustain irrigated agriculture as well as aquatic ecosystems that provide fish and other ecosystem services. The three subsystems of the social-ecological system, i.e., the social system, the irrigation system, and an aquatic ecosystem, are linked by resource flows and the allocation decision making of actors on different levels. Simulation experiments are carried out to compare the resilience of different institutional settings of water management to changes in the variability and uncertainty of water availability. The aim is to investigate the influence of (1 the organizational structure of water management, (2 information on water availability, and (3 the diversity of water uses on the resilience of the system to short and long-term water scarcity. In this paper, the model concept and first simulation results are presented. As a first illustration of the approach the performances of a centralized and a decentralized regime are compared under different

  11. Improved Cloud resource allocation: how INDIGO-DataCloud is overcoming the current limitations in Cloud schedulers

    Science.gov (United States)

    Lopez Garcia, Alvaro; Zangrando, Lisa; Sgaravatto, Massimo; Llorens, Vincent; Vallero, Sara; Zaccolo, Valentina; Bagnasco, Stefano; Taneja, Sonia; Dal Pra, Stefano; Salomoni, Davide; Donvito, Giacinto

    2017-10-01

    Performing efficient resource provisioning is a fundamental aspect for any resource provider. Local Resource Management Systems (LRMS) have been used in data centers for decades in order to obtain the best usage of the resources, providing their fair usage and partitioning for the users. In contrast, current cloud schedulers are normally based on the immediate allocation of resources on a first-come, first-served basis, meaning that a request will fail if there are no resources (e.g. OpenStack) or it will be trivially queued ordered by entry time (e.g. OpenNebula). Moreover, these scheduling strategies are based on a static partitioning of the resources, meaning that existing quotas cannot be exceeded, even if there are idle resources allocated to other projects. This is a consequence of the fact that cloud instances are not associated with a maximum execution time and leads to a situation where the resources are under-utilized. These facts have been identified by the INDIGO-DataCloud project as being too simplistic for accommodating scientific workloads in an efficient way, leading to an underutilization of the resources, a non desirable situation in scientific data centers. In this work, we will present the work done in the scheduling area during the first year of the INDIGO project and the foreseen evolutions.

  12. Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting.

    Science.gov (United States)

    Swain, JaBaris D; Sinnott, Colleen; Breakey, Suellen; Hasson Charles, Rian; Mody, Gita; Nyirimanzi, Napthal; Patton-Bolman, Ceeya; Come, Patricia; Ganza, Gapira; Rusingiza, Emmanuel; Ruhamya, Nathan; Mucumbitsi, Joseph; Borges, Jorge; Zammert, Martin; Muehlschlegel, Jochen D; Oakes, Robert; Leavitt, Bruce; Bolman, R Morton

    2018-06-01

    Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease. Humanitarian surgical outreach in this region can improve the delivery of cardiovascular care by providing sustainability through mentorship, medical expertise, training, and knowledge transfer, and ultimately the creation of a cardiac center. We describe the experience of consecutive annual visits to Rwanda since 2008 and report the outcomes of a collaborative approach to enable sustainable cardiac surgery in the region. The Ferrans and Powers Quality of Life Index tool's Cardiac Version (http://www.uic.edu/orgs/qli/) was administered to assess the postoperative quality of life. Ten visits have been completed, performing 149 open procedures, including 200 valve implantations, New York Heart Association class III or IV, with 4.7% 30-day mortality. All procedures were performed with the participation of local Rwandan personnel, expatriate physicians, nurses, residents, and support staff. Early complications included cerebrovascular accident (n = 4), hemorrhage requiring reoperation (n = 6), and death (n = 7). Quality of life was assessed to further understand challenges encountered after cardiac surgery in this resource-limited setting. Four major domains were considered: health and functioning, social and economic, psychologic/spiritual, and family. The mean total quality of life index was 20.79 ± 4.07 on a scale from 0 to 30, for which higher scores indicated higher quality of life. Women had significantly lower "social and economic" subscores (16.81 ± 4.17) than men (18.64 ± 4

  13. A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part one: considerations for success.

    Science.gov (United States)

    Ikeda, Andrea J; Grabowski, Alena M; Lindsley, Alida; Sadeghi-Demneh, Ebrahim; Reisinger, Kim D

    2014-08-01

    Literature Review We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services. Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision. We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer. We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented. Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two. © The International Society for Prosthetics and Orthotics 2013.

  14. Making the Common Good Common

    Science.gov (United States)

    Chase, Barbara

    2011-01-01

    How are independent schools to be useful to the wider world? Beyond their common commitment to educate their students for meaningful lives in service of the greater good, can they educate a broader constituency and, thus, share their resources and skills more broadly? Their answers to this question will be shaped by their independence. Any…

  15. The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border.

    Science.gov (United States)

    Chalmers, Lauren; Cross, Jessica; Chu, Cindy S; Phyo, Aung Pyae; Trip, Margreet; Ling, Clare; Carrara, Verena; Watthanaworawit, Wanitda; Keereecharoen, Lily; Hanboonkunupakarn, Borimas; Nosten, François; McGready, Rose

    2015-10-01

    Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >10(5)  CFU/ml. In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  16. Assistive technology access and service delivery in resource-limited environments: introduction to a special issue of Disability and Rehabilitation: Assistive Technology.

    Science.gov (United States)

    Harniss, Mark; Samant Raja, Deepti; Matter, Rebecca

    2015-07-01

    This special issue addresses access to and service delivery of assistive technology (AT) in resource-limited environments (RLEs). Access to AT is complicated not simply by limited funds to purchase AT, but by larger ecosystem weaknesses in RLEs related to legislation and policy, supply, distribution, human resources, consumer demand and accessible design. We present eight diverse articles that address various aspects of the AT ecosystem. These articles represent a wide range of AT, many different countries and different research methods. Our goal is to highlight a topic that has received scant research investigation and limited investment in international development efforts, and offer an insight into how different countries and programs are promoting access to AT. We encourage researchers, funders and non-profit organizations to invest additional effort and resources in this area.

  17. Self-control depletion in tufted capuchin monkeys (Sapajus spp.): does delay of gratification rely on a limited resource?

    Science.gov (United States)

    Petrillo, Francesca De; Micucci, Antonia; Gori, Emanuele; Truppa, Valentina; Ariely, Dan; Addessi, Elsa

    2015-01-01

    Self-control failure has enormous personal and societal consequences. One of the most debated models explaining why self-control breaks down is the Strength Model, according to which self-control depends on a limited resource. Either previous acts of self-control or taking part in highly demanding cognitive tasks have been shown to reduce self-control, possibly due to a reduction in blood glucose levels. However, several studies yielded negative findings, and recent meta-analyses questioned the robustness of the depletion effect in humans. We investigated, for the first time, whether the Strength Model applies to a non-human primate species, the tufted capuchin monkey. We tested five capuchins in a self-control task (the Accumulation task) in which food items were accumulated within individual's reach for as long as the subject refrained from taking them. We evaluated whether capuchins' performance decreases: (i) when tested before receiving their daily meal rather than after consuming it (Energy Depletion Experiment), and (ii) after being tested in two tasks with different levels of cognitive complexity (Cognitive Depletion Experiment). We also tested, in both experiments, how implementing self-control in each trial of the Accumulation task affected this capacity within each session and/or across consecutive sessions. Repeated acts of self-control in each trial of the Accumulation task progressively reduced this capacity within each session, as predicted by the Strength Model. However, neither experiencing a reduction in energy level nor taking part in a highly demanding cognitive task decreased performance in the subsequent Accumulation task. Thus, whereas capuchins seem to be vulnerable to within-session depletion effects, to other extents our findings are in line with the growing body of studies that failed to find a depletion effect in humans. Methodological issues potentially affecting the lack of depletion effects in capuchins are discussed.

  18. Assessing the quality of informed consent in a resource-limited setting: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kiguba Ronald

    2012-08-01

    Full Text Available Abstract Background The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University. Methods Data were collected using semi-structured interviewer-administered questionnaires on clinic days after initial or repeat informed consent procedures for the respective clinical studies had been administered to each study participant. Results Of the 600 participants interviewed, two thirds (64.2%, 385/600 were female. Overall mean age of study participants was 37.6 (SD = 7.7 years. Amongst all participants, less than a tenth (5.9%, 35/598 reported that they were not given enough information before making a decision to participate. A similar proportion (5.7%, 34/597 reported that they had not signed a consent form prior to making a decision to participate in the study. A third (33.7%, 201/596 of the participants were not aware that they could, at any time, voluntarily withdraw participation from these studies. Participants in clinical trials were 50% less likely than those in observational studies [clinical trial vs. observational; (odds ratio, OR = 0.5; 95% CI: 0.35-0.78] to perceive that refusal to participate in the parent research project would affect their regular medical care. Conclusions Most of the participants signed informed consent forms and a vast majority felt that they received enough information before deciding to participate. On the contrary, several were not aware that they could voluntarily withdraw their participation. Participants in observational studies were more likely than those in clinical trials to perceive that refusal to participate in the parent study would affect their regular medical care.

  19. Assessing the quality of informed consent in a resource-limited setting: a cross-sectional study.

    Science.gov (United States)

    Kiguba, Ronald; Kutyabami, Paul; Kiwuwa, Stephen; Katabira, Elly; Sewankambo, Nelson K

    2012-08-21

    The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University. Data were collected using semi-structured interviewer-administered questionnaires on clinic days after initial or repeat informed consent procedures for the respective clinical studies had been administered to each study participant. Of the 600 participants interviewed, two thirds (64.2%, 385/600) were female. Overall mean age of study participants was 37.6 (SD = 7.7) years. Amongst all participants, less than a tenth (5.9%, 35/598) reported that they were not given enough information before making a decision to participate. A similar proportion (5.7%, 34/597) reported that they had not signed a consent form prior to making a decision to participate in the study. A third (33.7%, 201/596) of the participants were not aware that they could, at any time, voluntarily withdraw participation from these studies. Participants in clinical trials were 50% less likely than those in observational studies [clinical trial vs. observational; (odds ratio, OR = 0.5; 95% CI: 0.35-0.78)] to perceive that refusal to participate in the parent research project would affect their regular medical care. Most of the participants signed informed consent forms and a vast majority felt that they received enough information before deciding to participate. On the contrary, several were not aware that they could voluntarily withdraw their participation. Participants in observational studies were more likely than those in clinical trials to perceive that refusal to participate in the parent study would affect their regular medical care.

  20. Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario?

    Directory of Open Access Journals (Sweden)

    Sunita Singh

    2012-01-01

    Full Text Available Aims: To analyze whether outcome of neonates having esophageal atresia with or without tracheoesophageal fistula (EA±TEF associated with anorectal malformation (ARM can be improved by doing surgery in 2 stages. Materials and Methods : A prospective study of neonates having both EA±TEF and ARM from 2004 to 2011. The patients with favorable parameters were operated in a single stage, whereas others underwent first-stage decompression surgery for ARM. Thereafter, once septicemia was under control and ventilator care available, second-stage surgery for EA±TEF was performed. Results: Total 70 neonates (single stage = 20, 2 stages = 30, expired after colostomy = 9, only EA±TEF repair needed = 11 were enrolled. The admission rate for this association was 1 per 290. Forty-one percent (24/70 neonates had VACTERL association and 8.6% (6/70 neonates had multiple gastrointestinal atresias. Sepsis screen was positive in 71.4% (50/70. The survival was 45% (9/20 in neonates operated in a single stage and 53.3% (16/30 when operated in 2 stages (P = 0.04. Data analysis of 50 patients revealed that the survived neonates had significantly better birth weight, better gestational age, negative sepsis screen, no cardiac diseases, no pneumonia, and 2-stage surgery (P value 0.002, 0.003, 0.02, 0.02, 0.04, and 0.04, respectively. The day of presentation and abdominal distension had no significant effect (P value 0.06 and 0.06, respectively. This was further supported by stepwise logistic regression analysis. Conclusions: In a limited resources scenario, the survival rate of babies with this association can be improved by treating ARM first and then for EA±TEF in second stage, once mechanical ventilator care became available and sepsis was under control.

  1. Self-control depletion in tufted capuchin monkeys (Sapajus spp.): does delay of gratification rely on a limited resource?

    Science.gov (United States)

    Petrillo, Francesca De; Gori, Emanuele; Truppa, Valentina; Ariely, Dan; Addessi, Elsa

    2015-01-01

    Self-control failure has enormous personal and societal consequences. One of the most debated models explaining why self-control breaks down is the Strength Model, according to which self-control depends on a limited resource. Either previous acts of self-control or taking part in highly demanding cognitive tasks have been shown to reduce self-control, possibly due to a reduction in blood glucose levels. However, several studies yielded negative findings, and recent meta-analyses questioned the robustness of the depletion effect in humans. We investigated, for the first time, whether the Strength Model applies to a non-human primate species, the tufted capuchin monkey. We tested five capuchins in a self-control task (the Accumulation task) in which food items were accumulated within individual’s reach for as long as the subject refrained from taking them. We evaluated whether capuchins’ performance decreases: (i) when tested before receiving their daily meal rather than after consuming it (Energy Depletion Experiment), and (ii) after being tested in two tasks with different levels of cognitive complexity (Cognitive Depletion Experiment). We also tested, in both experiments, how implementing self-control in each trial of the Accumulation task affected this capacity within each session and/or across consecutive sessions. Repeated acts of self-control in each trial of the Accumulation task progressively reduced this capacity within each session, as predicted by the Strength Model. However, neither experiencing a reduction in energy level nor taking part in a highly demanding cognitive task decreased performance in the subsequent Accumulation task. Thus, whereas capuchins seem to be vulnerable to within-session depletion effects, to other extents our findings are in line with the growing body of studies that failed to find a depletion effect in humans. Methodological issues potentially affecting the lack of depletion effects in capuchins are discussed. PMID

  2. Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings

    Science.gov (United States)

    Lam, Christopher T.; Krieger, Marlee S.; Gallagher, Jennifer E.; Asma, Betsy; Muasher, Lisa C.; Schmitt, John W.; Ramanujam, Nimmi

    2015-01-01

    Introduction Current guidelines by WHO for cervical cancer screening in low- and middle-income countries involves visual inspection with acetic acid (VIA) of the cervix, followed by treatment during the same visit or a subsequent visit with cryotherapy if a suspicious lesion is found. Implementation of these guidelines is hampered by a lack of: trained health workers, reliable technology, and access to screening facilities. A low cost ultra-portable Point of Care Tampon based digital colposcope (POCkeT Colposcope) for use at the community level setting, which has the unique form factor of a tampon, can be inserted into the vagina to capture images of the cervix, which are on par with that of a state of the art colposcope, at a fraction of the cost. A repository of images to be compiled that can be used to empower front line workers to become more effective through virtual dynamic training. By task shifting to the community setting, this technology could potentially provide significantly greater cervical screening access to where the most vulnerable women live. The POCkeT Colposcope’s concentric LED ring provides comparable white and green field illumination at a fraction of the electrical power required in commercial colposcopes. Evaluation with standard optical imaging targets to assess the POCkeT Colposcope against the state of the art digital colposcope and other VIAM technologies. Results Our POCkeT Colposcope has comparable resolving power, color reproduction accuracy, minimal lens distortion, and illumination when compared to commercially available colposcopes. In vitro and pilot in vivo imaging results are promising with our POCkeT Colposcope capturing comparable quality images to commercial systems. Conclusion The POCkeT Colposcope is capable of capturing images suitable for cervical lesion analysis. Our portable low cost system could potentially increase access to cervical cancer screening in limited resource settings through task shifting to community

  3. Increasing access to kidney transplantation in countries with limited resources: the Indian experience with kidney paired donation.

    Science.gov (United States)

    Kute, Vivek B; Vanikar, Aruna V; Shah, Pankaj R; Gumber, Manoj R; Patel, Himanshu V; Engineer, Divyesh P; Modi, Pranjal R; Shah, Veena R; Trivedi, Hargovind L

    2014-10-01

    According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen (HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy. © 2014 Asian Pacific Society of Nephrology.

  4. Qualitative study of the role of men in maternal health in resource-limited communities in western Kenya.

    Science.gov (United States)

    Brubaker, Kathryn; Nelson, Brett D; McPherson, Heather; Ahn, Roy; Oguttu, Monica; Burke, Thomas F

    2016-12-01

    To better understand the beliefs of men and women in western Kenya regarding the appropriate role of men in maternal health and to identify barriers to greater involvement. Between June 1 and July 31, 2014, a cross-sectional qualitative study enrolled lay men, lay women, and community health workers from Kisumu and Nyamira counties in western Kenya. Semi-structured focus group discussions were conducted and qualitative approaches were utilized to analyze the transcripts and identify common themes. In total, 134 individuals participated in 18 focus group discussions. Participants discussed the role of men and a general consensus was recorded that it was a man's duty to protect women during pregnancy. When discussing obstacles to male involvement, female participants highlighted gender dynamics and male participants raised financial limitations. There was considerable discrepancy between how men described their roles and how they actually behaved, although educated men appeared to describe themselves as performing more supportive behaviors compared with male participants with less education. It is suggested that interventions aimed at increasing male involvement should incorporate the existing culturally sanctioned roles men perform as a foundation upon which to build, rather than attempting to construct roles that oppose prevailing norms. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  5. A cross-sectional survey to evaluate knowledge, attitudes and practices (KAP regarding seasonal influenza vaccination among European travellers to resource-limited destinations

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    Szucs Thomas D

    2010-07-01

    Full Text Available Abstract Background Influenza is one of the most common vaccine-preventable diseases in travellers. By performing two cross-sectional questionnaire surveys during winter 2009 and winter 2010 among European travellers to resource-limited destinations, we aimed to investigate knowledge, attitudes and practices (KAP regarding seasonal influenza vaccination. Methods Questionnaires were distributed in the waiting room to the visitors of the University of Zurich Centre for Travel' Health (CTH in January and February 2009 and January 2010 prior to travel health counselling (CTH09 and CTH10. Questions included demographic data, travel-related characteristics and KAP regarding influenza vaccination. Data were analysed by using SPSS® version 14.0 for Windows. Differences in proportions were compared using the Chi-square test and the significance level was set at p ≤ 0.05. Predictors for seasonal and pandemic influenza vaccination were determined by multiple logistic regression analyses. Results With a response rate of 96.6%, 906 individuals were enrolled and 868 (92.5% provided complete data. Seasonal influenza vaccination coverage was 13.7% (n = 119. Only 43 (14.2% participants were vaccinated against pandemic influenza A/H1N1, mostly having received both vaccines simultaneously, the seasonal and pandemic one. Job-related purposes (44, 37%, age > 64 yrs (25, 21% and recommendations of the family physician (27, 22.7% were the most often reported reasons for being vaccinated. In the multiple logistic regression analyses of the pooled data increasing age (OR = 1.03, 95% CI 1.01 - 1.04, a business trip (OR = 0.39, 95% CI 0.17 - 0.92 and seasonal influenza vaccination in the previous winter seasons (OR = 12.91, 95% CI 8.09 - 20.58 were independent predictors for seasonal influenza vaccination in 2009 or 2010. Influenza vaccination recommended by the family doctor (327, 37.7%, travel to regions with known high risk of influenza (305, 35.1%, and influenza

  6. Finding Common Ground: A Critical Review of Land Use and Resource Management Policies in Ontario, Canada and their Intersection with First Nations

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    Fraser McLeod

    2015-01-01

    Full Text Available This article provides an in-depth analysis of selective land use and resource management policies in the Province of Ontario, Canada. It examines their relative capacity to recognize the rights of First Nations and Aboriginal peoples and their treaty rights, as well as their embodiment of past Crown–First Nations relationships. An analytical framework was developed to evaluate the manifest and latent content of 337 provincial texts, including 32 provincial acts, 269 regulatory documents, 16 policy statements, and 5 provincial plans. This comprehensive document analysis classified and assessed how current provincial policies address First Nation issues and identified common trends and areas of improvement. The authors conclude that there is an immediate need for guidance on how provincial authorities can improve policy to make relationship-building a priority to enhance and sustain relationships between First Nations and other jurisdictions.

  7. Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia.

    Science.gov (United States)

    Rajagopal, Revathi; Abd-Ghafar, Sayyidatul; Ganesan, Dharmendra; Bustam Mainudin, Anita Zarina; Wong, Kum Thong; Ramli, Norlisah; Jawin, Vida; Lum, Su Han; Yap, Tsiao Yi; Bouffet, Eric; Qaddoumi, Ibrahim; Krishnan, Shekhar; Ariffin, Hany; Abdullah, Wan Ariffin

    2017-04-01

    Pediatric medulloblastoma (MB) treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE) for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100%) in the average-risk group, and 5-year overall survival (± SE) in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) and 58.3% ± 18.6% (95% CI, 31.3% to 100%), respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE) of 47.6% ± 12.1% (95% CI, 28.9% to 78.4%) and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%), respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer Registry and pathology reports, inadequate long

  8. Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia

    Directory of Open Access Journals (Sweden)

    Revathi Rajagopal

    2017-04-01

    Full Text Available Purpose: Pediatric medulloblastoma (MB treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. Methods: Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. Results: Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4% in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100% in the average-risk group, and 5-year overall survival (± SE in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4% and 58.3% ± 18.6% (95% CI, 31.3% to 100%, respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE of 47.6% ± 12.1% (95% CI, 28.9% to 78.4% and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%, respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. Conclusion: The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer

  9. Hydropower vs. fisheries conservation: a test of institutional design principles for common-pool resource management in the lower Mekong basin social-ecological system

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    Sergio Villamayor-Tomas

    2016-03-01

    Full Text Available New methods have emerged for testing common-pool resource theory in large-scale environmental governance contexts. We aim to contribute to that scholarship by assessing the relevance of Elinor Ostrom's design principles in the lower Mekong basin (LMB. The recent dam-building trend in the LMB has revealed a trade-off between hydropower development and the conservation of migratory fish species. The need to internalize or avoid the negative externalities of hydropower dam construction poses a new challenge to the LMB governance system and its main management body, the Mekong River Commission. Our objective was to explain the emergence of the trade-off and the capacity of the governance system to address it. Elinor Ostrom's design principles and other variables provided by the Socio-ecological Systems Meta-analysis Database were first coded with regard to secondary data and then tested against the capacity for cooperation of the LMB governance system. The lack of sanctioning despite a strong monitoring system, and the existence of fuzzy governance boundaries in the context of a powerful outsider like China, were particularly relevant to understanding the current cooperation stalemate in the basin. Other variables such as scientific knowledge, triggering events, markets, resource spatial heterogeneity, and heterogeneity of interests were also relevant.

  10. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

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    Chalya Phillipo L

    2012-03-01

    Full Text Available Abstract Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1. Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8% perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2% patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5% patients. The majority of patients (84.6% had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (P Conclusion

  11. On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings.

    Science.gov (United States)

    Rutstein, S E; Golin, C E; Wheeler, S B; Kamwendo, D; Hosseinipour, M C; Weinberger, M; Miller, W C; Biddle, A K; Soko, A; Mkandawire, M; Mwenda, R; Sarr, A; Gupta, S; Mataya, R

    2016-01-01

    Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider

  12. Scaling up the 2010 World Health Organization HIV Treatment Guidelines in resource-limited settings: a model-based analysis.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    2010-12-01

    Full Text Available The new 2010 World Health Organization (WHO HIV treatment guidelines recommend earlier antiretroviral therapy (ART initiation (CD4<350 cells/µl instead of CD4<200 cells/µl, multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible.We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl. For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line. We rank-in survival, cost-effectiveness, and equity terms-all 12 possible combinations of the following: (1 stavudine replacement with tenofovir, (2 ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl, and (3 one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival compared with stavudine/WHO/two-lines (66% and tenofovir/WHO/one-line (66%. The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo, stavudine/<350/µl/two-lines (177.6 mo, and tenofovir/<350/µl/two-lines (193.6 mo. Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS], tenofovir/<350/µl/one-line (US$1,140/YLS, and tenofovir/<350/µl/two-lines (US$2,370/YLS.In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long

  13. Minimal intervention for controlling nosocomial transmission of methicillin-resistant staphylococcus aureus in resource limited setting with high endemicity.

    Directory of Open Access Journals (Sweden)

    Vincent Chi-Chung Cheng

    Full Text Available OBJECTIVE: To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA in resource-limited healthcare setting with high endemicity. METHODS: Three phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model. Usage density of broad-spectrum antibiotics was monitored. RESULTS: During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3% were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001, 30.4% (p<0.001, and 19.6% (p = 0.040, while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001, 24.1% (p<0.001, and 21.9% (p = 0.041 respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1 to 168.99 per 1000 patient-days (phase 3. CONCLUSIONS: Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing

  14. Pediatric Early Warning Systems aid in triage to intermediate versus intensive care for pediatric oncology patients in resource-limited hospitals.

    Science.gov (United States)

    Agulnik, Asya; Nadkarni, Anisha; Mora Robles, Lupe Nataly; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Rodriguez-Galindo, Carlos

    2018-04-10

    Pediatric oncology patients hospitalized in resource-limited settings are at high risk for clinical deterioration resulting in mortality. Intermediate care units (IMCUs) provide a cost-effective alternative to pediatric intensive care units (PICUs). Inappropriate IMCU triage, however, can lead to poor outcomes and suboptimal resource utilization. In this study, we sought to characterize patients with clinical deterioration requiring unplanned transfer to the IMCU in a resource-limited pediatric oncology hospital. Patients requiring subsequent early PICU transfer had longer PICU length of stay. PEWS results prior to IMCU transfer were higher in patients requiring early PICU transfer, suggesting PEWS can aid in triage between IMCU and PICU care. © 2018 Wiley Periodicals, Inc.

  15. Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings

    NARCIS (Netherlands)

    Revell, A. D.; Wang, D.; Wood, R.; Morrow, C.; Tempelman, H.; Hamers, R. L.; Alvarez-Uria, G.; Streinu-Cercel, A.; Ene, L.; Wensing, A. M. J.; DeWolf, F.; Nelson, M.; Montaner, J. S.; Lane, H. C.; Larder, B. A.

    2013-01-01

    Genotypic HIV drug-resistance testing is typically 6065 predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART

  16. Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti.

    Science.gov (United States)

    Rouhani, Shada A; Israel, Kerling; Leandre, Fernet; Pierre, Sosthène; Bollman, Brennan; Marsh, Regan H

    2018-04-06

    In many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists. In conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care. Fourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful. Key components to our program's success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels. Medium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings.

  17. Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Tsima BM

    2016-08-01

    Full Text Available Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better

  18. Satellite Data of Atmospheric Pollution for U.S. Air Quality Applications: Examples of Applications, Summary of Data End-user Resources, Answers to Faqs, and Common Mistakes to Avoid

    Science.gov (United States)

    Duncan, Bryan Neal; Prados, Ana; Lamsal, Lok N.; Liu, Yang; Streets, David G.; Gupta, Pawan; Hilsenrath, Ernest; Kahn, Ralph A.; Nielsen, J. Eric; Beyersdorf, Andreas J.; hide

    2014-01-01

    Satellite data of atmospheric pollutants are becoming more widely used in the decision-making and environmental management activities of public, private sector and non-profit organizations. They are employed for estimating emissions, tracking pollutant plumes, supporting air quality forecasting activities, providing evidence for "exceptional event" declarations, monitoring regional long-term trends, and evaluating air quality model output. However, many air quality managers are not taking full advantage of the data for these applications nor has the full potential of satellite data for air quality applications been realized. A key barrier is the inherent difficulties associated with accessing, processing, and properly interpreting observational data. A degree of technical skill is required on the part of the data end-user, which is often problematic for air quality agencies with limited resources. Therefore, we 1) review the primary uses of satellite data for air quality applications, 2) provide some background information on satellite capabilities for measuring pollutants, 3) discuss the many resources available to the end-user for accessing, processing, and visualizing the data, and 4) provide answers to common questions in plain language.

  19. Productive diversification in natural resource abundant countries : limitations, policies and the experience of Argentina in the 2000s

    NARCIS (Netherlands)

    L.A. Serino (Leandro)

    2009-01-01

    textabstractThe debate on the pattern of specialization in natural resource abundant countries has re-emerged as demand for raw materials and food products from the rapidly growing East Asian countries, speculation in financial markets, and changes in production techniques augmented the

  20. Use of alternative plant resources by common marmosets (Callithrix jacchus) in the semi-arid caatinga scrub forests of northeastern Brazil.

    Science.gov (United States)

    Amora, Tacyana Duarte; Beltrão-Mendes, Raone; Ferrari, Stephen F

    2013-04-01

    The common marmoset (Callithrix jacchus) is amply distributed in the Brazilian Northeast, but little is known of its ecology in the semi-arid Caatinga scrublands. The present study provides the first detailed data on the composition of the diet of C. jacchus in Caatinga ecosystems, derived from observations at four sites in the state of Sergipe. While exudate sources were gouged at all four sites in a manner typical of the species, fruit was the principal component of the diet at the main study site during most months, and a number of unusual items were eaten, including leaves, and the reproductive parts of cacti and bromeliads. These plants are rarely recorded in marmoset diets, but are common in caatinga habitats. Leaves were ingested during 5 of the 8 months monitored at the main study site, reaching 39.74% of the diet in 1 month, and appeared to be an alternative fallback food to plant exudates during periods when fruit was scarce. Three species of cactus provided both flowers and fruits, while the terrestrial bromeliad, Encholirium spectabile, provided nectar (30.81% of the diet in November). Approximately half of the plant species (and three families) identified in this study had not been recorded previously in the diet of Callithrix. Overall, the data suggest that, while the marmosets exploit the same types of plant foods in the Caatinga, the resource base is quite distinct from that of the Atlantic Forest. Other differences, such as relatively small groups and large home ranges, may contribute to divergent ecological patterns, which require more systematic investigation. Am. J. Primatol. 75:333-341, 2013. © 2012 Wiley Periodicals, Inc. © 2012 Wiley Periodicals, Inc.

  1. Lessons learned developing a diagnostic tool for HIV-associated dementia feasible to implement in resource-limited settings: pilot testing in Kenya.

    Directory of Open Access Journals (Sweden)

    Judith Kwasa

    Full Text Available To conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD for use by primary health care workers (HCW which would be feasible to implement in resource-limited settings.In resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests. Thus, a simple diagnostic tool which is practical to implement in resource-limited settings is an urgent need.A convenience sample of 30 HIV-infected outpatients was enrolled in Western Kenya. We assessed the sensitivity and specificity of a diagnostic tool for HAD as administered by a primary HCW. This was compared to an expert clinical assessment which included examination by a physician, neuropsychological testing, and in selected cases, brain imaging. Agreement between HCW and an expert examiner on certain tool components was measured using Kappa statistic.The sample was 57% male, mean age was 38.6 years, mean CD4 T-cell count was 323 cells/µL, and 54% had less than a secondary school education. Six (20% of the subjects were diagnosed with HAD by expert clinical assessment. The diagnostic tool was 63% sensitive and 67% specific for HAD. Agreement between HCW and expert examiners was poor for many individual items of the diagnostic tool (K = .03-.65. This diagnostic tool had moderate sensitivity and specificity for HAD. However, reliability was poor, suggesting that substantial training and formal evaluations of training adequacy will be critical to enable HCW to reliably administer a brief diagnostic tool for HAD.

  2. Morphological, Phenological And Agronomical Characterisation Of Variability Among Common Bean (Phaseolus Vulgaris L. Local Populations From The National Centre For Plant Genetic Resources: Polish Genebank

    Directory of Open Access Journals (Sweden)

    Boros Lech

    2014-12-01

    Full Text Available The main purpose of this work was to analyse the morphological, phenological and agronomical variability among common bean local populations from The National Centre for Plant Genetic Resources, Polish Genebank, in order to know the relation among them, and to identify potentially useful accessions for future production and breeding. A considerable genotypic variation for number of seeds per plant, number of pods per plant and weight of seeds per plant were found. Studied bean accessions differed significantly in terms of thousand seeds weight (TSW as well as severity of bacterial halo blight and anthracnose, the major bean diseases. The lowest genotypic diversity was found for the percentage of protein in the seeds, the length of the vegetation period and lodging. The cluster analysis allowed identification of five groups of bean accessions. Genotypes from the first cluster (POLPOD 98-77, KOS 002 and Raba cv. and from the second cluster (WUKR 06-573a, KRA 4, WUKR 06-0534 together with Prosna cv. are of the highest usefulness for breeding purposes. There was no grouping of local populations depending on region of origin.

  3. “The Effects of Limited Resources and Opportunities on Women’s Careers in Physics: Results from the Global Survey of Physicists

    CERN Multimedia

    CERN. Geneva

    2012-01-01

    The results of the Global Survey of Physicists draw attention to the need to focus on factors other than representation when discussing the situation of women in physics. Previous studies of women in physics have mostly focused on the lack of women in the field. This study goes beyond the obvious shortage of women and shows that there are much deeper issues. For the first time, a multinational study was conducted with 15000 respondents from 130 countries, showing that problems for women in physics transcend national borders. Across all countries, women have fewer resources and opportunities and are more affected by cultural expectations concerning child care. We show that limited resources and opportunities hurt career progress, and because women have fewer opportunities and resources, their careers progress more slowly. We also show the disproportionate effects of children on women physicists' careers. Cultural expectations about home and family are difficult to change. However, for women to have successful ...

  4. Assessing anthropogenic impacts on limited water resources under semi-arid conditions: three-dimensional transient regional modelling in Jordan

    Science.gov (United States)

    Rödiger, Tino; Magri, Fabien; Geyer, Stefan; Morandage, Shehan Tharaka; Ali Subah, H. E.; Alraggad, Marwan; Siebert, Christian

    2017-11-01

    Both increasing aridity and population growth strongly stress freshwater resources in semi-arid areas such as Jordan. The country's second largest governorate, Irbid, with over 1 million inhabitants, is already suffering from an annual water deficit of 25 million cubic meters (MCM). The population is expected to double within the next 20 years. Even without the large number of refugees from Syria, the deficit will likely increase to more then 50 MCM per year by 2035 The Governorate's exclusive resource is groundwater, abstracted by the extensive Al Arab and Kufr Asad well fields. This study presents the first three-dimensional transient regional groundwater flow model of the entire Wadi al Arab to answer important questions regarding the dynamic quality and availability of water within the catchment. Emphasis is given to the calculation and validation of the dynamic groundwater recharge, derived from a multi-proxy approach, including (1) a hydrological model covering a 30-years dataset, (2) groundwater level measurements and (3) information about springs. The model enables evaluation of the impact of abstraction on the flow regime and the groundwater budget of the resource. Sensitivity analyses of controlling parameters indicate that intense abstraction in the southern part of the Wadi al Arab system can result in critical water-level drops of 10 m at a distance of 16 km from the production wells. Moreover, modelling results suggest that observed head fluctuations are strongly controlled by anthropogenic abstraction rather than variable recharge rates due to climate changes.

  5. Clean Water Act Section 303(d) Water Quality Limited Segments, California, 2006, State Water Resources Control Board

    Data.gov (United States)

    U.S. Environmental Protection Agency — 2006 303d List of Water Quality Limited Segments that: 1) Require Total Maximum Daily Loads (TMDLS), 2) Are being addressed by USEPA approved TMDLs 3) Are being...

  6. What are the minimum requirements for ketogenic diet services in resource-limited regions? Recommendations from the International League Against Epilepsy Task Force for Dietary Therapy.

    Science.gov (United States)

    Kossoff, Eric H; Al-Macki, Nabil; Cervenka, Mackenzie C; Kim, Heung D; Liao, Jianxiang; Megaw, Katherine; Nathan, Janak K; Raimann, Ximena; Rivera, Rocio; Wiemer-Kruel, Adelheid; Williams, Emma; Zupec-Kania, Beth A

    2015-09-01

    Despite the increasing use of dietary therapies for children and adults with refractory epilepsy, the availability of these treatments in developing countries with limited resources remains suboptimal. One possible contributory factor may be the costs. There is often reported a significant perceived need for a large ketogenic diet team, supplements, laboratory studies, and follow-up visits to provide this treatment. The 2009 Epilepsia Consensus Statement described ideal requirements for a ketogenic diet center, but in some situations this is not feasible. As a result, the International League Against Epilepsy (ILAE) Task Force on Dietary Therapy was asked to convene and provide practical, cost-effective recommendations for new ketogenic diet centers in resource-limited regions of the world. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  7. Treatment of elephantiasis of the leg by fasciotomy and lymphangiectomy with skin preservation in a resource-limited setting: a case report and review.

    Science.gov (United States)

    Kibadi, K

    2018-02-01

    The author reports the surgical management of a patient with elephantiasis of the leg in the Democratic Republic of Congo. A fasciotomy and lymphangiectomy with skin preservation, combined with compression therapy, resulted in significant cosmetic, functional, and social improvement. Although challenging in a resource-limited setting, development of surgical management may make it possible to reduce beliefs that elephantiasis is incurable or due to witchcraft and may reduce time to consultation.

  8. The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya.

    Science.gov (United States)

    Foley, Alan R; Masingila, Joanna O

    2015-07-01

    In this paper, the authors explore the use of mobile devices as assistive technology for students with visual impairments in resource-limited environments. This paper provides initial data and analysis from an ongoing project in Kenya using tablet devices to provide access to education and independence for university students with visual impairments in Kenya. The project is a design-based research project in which we have developed and are refining a theoretically grounded intervention--a model for developing communities of practice to support the use of mobile technology as an assistive technology. We are collecting data to assess the efficacy and improve the model as well as inform the literature that has guided the design of the intervention. In examining the impact of the use of mobile devices for the students with visual impairments, we found that the devices provide the students with (a) access to education, (b) the means to participate in everyday life and (c) the opportunity to create a community of practice. Findings from this project suggest that communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments. Implications for Rehabilitation The use of mobile devices as assistive technology in resource-limited environments provides students with visual impairments access to education and enhanced means to participate in everyday life. Communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments. Providing access to assistive technology early and consistently throughout students' schooling builds both their skill and confidence and also demonstrates the capabilities of people with visual impairments to the larger society.

  9. Allocating limited resources in a time of fiscal constraints: a priority setting case study from Dalhousie University Faculty of Medicine.

    Science.gov (United States)

    Mitton, Craig; Levy, Adrian; Gorsky, Diane; MacNeil, Christina; Dionne, Francois; Marrie, Tom

    2013-07-01

    Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.

  10. Push it to the limit: Characterizing the convergence of common sequences of basis sets for intermolecular interactions as described by density functional theory

    Energy Technology Data Exchange (ETDEWEB)

    Witte, Jonathon [Department of Chemistry, University of California, Berkeley, California 94720 (United States); Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Neaton, Jeffrey B. [Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Department of Physics, University of California, Berkeley, California 94720 (United States); Kavli Energy Nanosciences Institute at Berkeley, Berkeley, California 94720 (United States); Head-Gordon, Martin, E-mail: mhg@cchem.berkeley.edu [Department of Chemistry, University of California, Berkeley, California 94720 (United States); Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States)

    2016-05-21

    With the aim of systematically characterizing the convergence of common families of basis sets such that general recommendations for basis sets can be made, we have tested a wide variety of basis sets against complete-basis binding energies across the S22 set of intermolecular interactions—noncovalent interactions of small and medium-sized molecules consisting of first- and second-row atoms—with three distinct density functional approximations: SPW92, a form of local-density approximation; B3LYP, a global hybrid generalized gradient approximation; and B97M-V, a meta-generalized gradient approximation with nonlocal correlation. We have found that it is remarkably difficult to reach the basis set limit; for the methods and systems examined, the most complete basis is Jensen’s pc-4. The Dunning correlation-consistent sequence of basis sets converges slowly relative to the Jensen sequence. The Karlsruhe basis sets are quite cost effective, particularly when a correction for basis set superposition error is applied: counterpoise-corrected def2-SVPD binding energies are better than corresponding energies computed in comparably sized Dunning and Jensen bases, and on par with uncorrected results in basis sets 3-4 times larger. These trends are exhibited regardless of the level of density functional approximation employed. A sense of the magnitude of the intrinsic incompleteness error of each basis set not only provides a foundation for guiding basis set choice in future studies but also facilitates quantitative comparison of existing studies on similar types of systems.

  11. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

    LENUS (Irish Health Repository)

    Elmusharaf, Khalifa

    2015-09-01

    Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

  12. Integrative Review of the Literature on Adults with Limited Education and Skills and the Implications for Human Resource Development

    Science.gov (United States)

    Hamilton, David W.; Torraco, Richard J.

    2013-01-01

    Adults with limited education and skills--those who lack the education and skills needed for full participation in U.S. culture and economy--are increasing in numbers. However, the knowledge base addressing this population and their educational needs is fragmented across the literature of several disciplines. A comprehensive review and critique of…

  13. Integrating Students of Limited English Proficiency into Standards-Based Reform in the Abbott Districts. Abbott Implementation Resource Guide

    Science.gov (United States)

    Lucas, Tamara; Villegas, Ana Maria

    2004-01-01

    In 1999-2000, over one-third of all students in the 30 Abbott districts spoke a native language other than English, and more than one-tenth were considered limited English proficient (LEP). The proportions of LEP students varied considerably across the districts, but they comprised between 5% and 29% of total enrollments in 18 of the districts.…

  14. Evaluation of a Broad-Spectrum Partially Automated Adverse Event Surveillance System: A Potential Tool for Patient Safety Improvement in Hospitals With Limited Resources.

    Science.gov (United States)

    Saikali, Melody; Tanios, Alain; Saab, Antoine

    2017-11-21

    The aim of the study was to evaluate the sensitivity and resource efficiency of a partially automated adverse event (AE) surveillance system for routine patient safety efforts in hospitals with limited resources. Twenty-eight automated triggers from the hospital information system's clinical and administrative databases identified cases that were then filtered by exclusion criteria per trigger and then reviewed by an interdisciplinary team. The system, developed and implemented using in-house resources, was applied for 45 days of surveillance, for all hospital inpatient admissions (N = 1107). Each trigger was evaluated for its positive predictive value (PPV). Furthermore, the sensitivity of the surveillance system (overall and by AE category) was estimated relative to incidence ranges in the literature. The surveillance system identified a total of 123 AEs among 283 reviewed medical records, yielding an overall PPV of 52%. The tool showed variable levels of sensitivity across and within AE categories when compared with the literature, with a relatively low overall sensitivity estimated between 21% and 44%. Adverse events were detected in 23 of the 36 AE categories defined by an established harm classification system. Furthermore, none of the detected AEs were voluntarily reported. The surveillance system showed variable sensitivity levels across a broad range of AE categories with an acceptable PPV, overcoming certain limitations associated with other harm detection methods. The number of cases captured was substantial, and none had been previously detected or voluntarily reported. For hospitals with limited resources, this methodology provides valuable safety information from which interventions for quality improvement can be formulated.

  15. A Standardized Needs Assessment Tool to Inform the Curriculum Development Process for Pediatric Resuscitation Simulation-Based Education in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Nicole Shilkofski

    2018-02-01

    Full Text Available IntroductionUnder five mortality rates (UFMR remain high for children in low- and middle-income countries (LMICs in the developing world. Education for practitioners in these environments is a key factor to improve outcomes that will address United Nations Sustainable Development Goals 3 and 10 (good health and well being and reduced inequalities. In order to appropriately contextualize a curriculum using simulation, it is necessary to first conduct a needs assessment of the target learner population. The World Health Organization (WHO has published a tool to assess capacity for emergency and surgical care in LMICs that is adaptable to this goal.Materials and methodsThe WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was modified to assess pediatric resuscitation capacity in clinical settings in two LMICs: Uganda and Myanmar. Modifications included assessment of self-identified learning needs, current practices, and perceived epidemiology of disease burden in each clinical setting, in addition to assessment of pediatric resuscitation capacity in regard to infrastructure, procedures, equipment, and supplies. The modified tool was administered to 94 respondents from the two settings who were target learners of a proposed simulation-based curriculum in pediatric and neonatal resuscitation.ResultsInfectious diseases (respiratory illnesses and diarrheal disease were cited as the most common causes of pediatric deaths in both countries. Self-identified learning needs included knowledge and skill development in pediatric airway/breathing topics, as well as general resuscitation topics such as CPR and fluid resuscitation in shock. Equipment and supply availability varied substantially between settings, and critical shortages were identified in each setting. Current practices and procedures were often limited by equipment availability or infrastructural considerations.Discussion and conclusionEpidemiology of disease

  16. Future Industrialization of the World and the Necessity of Nuclear Power, Part II: How Limited are Resources?

    International Nuclear Information System (INIS)

    Jovanovich, Jovan V.

    1997-01-01

    Will the future world be forever divided into an industrial, developed and 'rich' on one side, and the primitive, undeveloped, and poor on the other? Is an industrial, affluent and sustainable world of 10-15 billion people owning 5-10 billion cars physically possible to exist? Can the world have enough food, minerals and energy to support such a widespread affluence in a sustainable manner? In previous papers I have argued that even without any major breakthroughs in science and technology, an industrialized, sustainable and affluent world can be created within the next half a century to a century, but only if breeder nuclear power is widely used throughout the world. In this paper I elaborate on the question of future availability of some basic natural resources. (author)

  17. Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources

    Directory of Open Access Journals (Sweden)

    Bagshaw Sean M

    2009-02-01

    Full Text Available Abstract Critical care is in an emerging crisis of conflict between what individuals expect and the economic burden society and government are prepared to provide. The goal of critical care support is to prevent suffering and premature death by intensive therapy of reversible illnesses within a reasonable timeframe. Recently, it has become apparent that early support in an intensive care environment can improve patient outcomes. However, life support technology has advanced, allowing physicians to prolong life (and postpone death in circumstances that were not possible in the recent past. This has been recognized by not only the medical community, but also by society at large. One corollary may be that expectations for recovery from critical illness have also become extremely high. In addition, greater numbers of patients are dying in intensive care units after having receiving prolonged durations of life-sustaining therapy. Herein lies the emerging crisis – critical care therapy must be available in a timely fashion for those who require it urgently, yet its provision is largely dependent on a finite availability of both capital and human resources. Physicians are often placed in a troubling conflict of interest by pressures to use health resources prudently while also promoting the equitable and timely access to critical care therapy. In this commentary, these issues are broadly discussed from the perspective of the individual clinician as well as that of society as a whole. The intent is to generate dialogue on the dynamic between individual clinicians navigating the complexities of how and when to use critical care support in the context of end-of-life issues, the increasing demands placed on finite critical care capacity, and the reasonable expectations of society.

  18. Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization.

    Science.gov (United States)

    Baumann, L M; Romero, K M; Robinson, C L; Hansel, N N; Gilman, R H; Hamilton, R G; Lima, J J; Wise, R A; Checkley, W

    2015-01-01

    Allergic rhinitis is a disease with a high global disease burden, but risk factors that contribute to this condition are not well understood. To assess the prevalence and risk factors of allergic rhinitis in two Peruvian populations with disparate degrees of urbanization. We conducted a population-based, cross-sectional study on 1441 children aged 13-15 years at enrollment (mean age 14.9 years, 51% boys) to investigate the prevalence of allergic disease. We used a standardized, Spanish validated questionnaire to determine the prevalence of allergic rhinitis and asked about sociodemographics and family history of allergies. Children also underwent spirometry, exhaled nitric oxide, allergy skin testing to 10 common household allergens and provided a blood sample for measurement of 25OH vitamin D and total serum IgE. Overall prevalence of allergic rhinitis was 18% (95% CI 16% to 20%). When stratified by site, the prevalence of allergic rhinitis was 23% Lima vs. 13% in Tumbes (P overweight (1.5, 1.0-2.3); exhaled nitric oxide ≥ 20 ppb (1.9, 1.3-2.7); and total serum IgE ≥ 95th percentile (2.4, 1.2-4.8). Population attributable risk of important factors for allergic rhinitis were 25% for high exhaled nitric oxide, 22% for allergic sensitization to common household aeroallergens, 22% for paternal rhinitis, 10% for being overweight and 7% for an elevated total serum IgE. Allergic rhinitis was prevalent in both settings, and important risk factors include elevated exhaled nitric oxide, allergic sensitization to common household aeroallergens, parental rhinitis, being overweight and high total serum IgE. When considering subject-specific factors, the difference in prevalence between the urban and rural settings became non-important. © 2014 John Wiley & Sons Ltd.

  19. Treatment of Children with Protein – Losing Enteropathy After Fontan and Other Complex Congenital Heart Disease Procedures in Condition with Limited Human and Technical Resources

    Science.gov (United States)

    Bejiqi, Ramush; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Vuqiterna, Armend; Maloku, Arlinda

    2014-01-01

    Background Protein-losing enteropathy (PLE) is a disorder characterized by abnormal and often profound enteric protein loss. It’s relatively uncommon complication of Fontan and other complex congenital heart disease (CCHD) procedures. Because of the complexity and rarity of this disease process, the pathogenesis and pathophysiology of protein-losing enteropathy remain poorly understood, and attempts at treatment seldom yield long-term success. Aim of presentation is to describe single centre experience in diagnosis, evaluation, management and treatment of children with protein-losing enteropathy after Fontan and other CCHD procedures in the current era and in centre with limited human and technical resources, follows with a comprehensive review of protein-losing enteropathy publications, and concludes with suggestions for prevention and treatment. Material and methodology Retrospectively we analyzed patients with CCHD and protein-losing enteropathy in our institution, starting from January 2000 to December 2012. The including criteria were age between two and 17 years, to have a complex congenital heart disease and available complete documentation of cardiac surgery under cardiopulmonary bypass. Results Of all patients we evaluated 18 cases with protein-losing enteropathy, aged 6 to 19 years (mean 14±9); there were three children who had undergone screening procedure for D-transposition, one Tetralogy of Fallot, and remaining 14 patients had undergone Fontan procedures; (anatomic diagnosis are: six with tricuspid atresia, seven with d-transposition, double outlet right ventricle and pulmonary atresia and two with hypoplastic left heart syndrome). The diagnosis of protein-losing enteropathy was made at median age of 5.6 years, ranging from 13 months to 15 years. Diagnosis was made using alpha 1-antitrypsin as a gold marker in stool. By physical examination in 14 patients edema was found, in three ascites, and six patients had pleural effusion. Laboratory findings

  20. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

    Science.gov (United States)

    Elmusharaf, Khalifa; Byrne, Elaine; O'Donovan, Diarmuid

    2015-09-08

    Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

  1. Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

    Science.gov (United States)

    Abdelaziz, Adel; Hany, Mohamed; Atwa, Hani; Talaat, Wagdy; Hosny, Somaya

    2016-01-01

    In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

  2. Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia.

    Science.gov (United States)

    Devi, B C R; Tang, T S; Corbex, M

    2008-12-01

    The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from 1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

  3. Optical pre-screening in breast screening programs: Can we identify women who benefit most from limited mammography resources?

    Science.gov (United States)

    Walter, Jane; Loshchenov, Maxim; Zhilkin, Vladimir; Peake, Rachel; Stone, Jennifer; Lilge, Lothar

    2017-04-01

    Background: In excess of 60% of all cancers are detected in low and middle-income countries, with breast cancer (BC) the dominant malignancy for women. Incidence rates continue to climb, most noticeably in the less than 50-year-old population. Expansion of mammography infrastructure and resources is lacking, resulting in over 60% of women diagnosed with stage III/IV BC in the majority of these countries. Optical Breast Spectroscopy (OBS) was shown to correlate well with mammographic breast density (MBD). OBS could aid breast screening programs in low- and middle-income countries by lowering the number of mammographs required for complete population coverage. However, its performance needs to be tested in large population trails to ensure high sensitivity and acceptable specificity. Methods: For the planned studies in low- and middle-income countries in different continents, online methods need to be implemented to monitor the performance and data collection by these devices, operated by trained nurses. Based on existing datasets, procedures were developed to validate an individual woman's data integrity and to identify operator errors versus system malfunctions. Results: Using a dataset comprising spectra from 360 women collected by 2 instruments in different locations and with 3 different trained operators, automated methods were developed to identify 100% of the source or photodetector malfunctions as well as incorrect calibrations and 96% of instances of insufficient tissue contact. Conclusions: Implementing the dataset validation locally in each instrument and tethered to a cloud database will allow the planned clinical trials to proceed.

  4. Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study

    Science.gov (United States)

    van der Eem, Lisette; Nyanza, Elias C.; van Pelt, Sandra; Ndaki, Pendo; Basinda, Namanya; Sundby, Johanne

    2017-01-01

    Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client’s wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria. PMID:29236699

  5. Simplification of antiretroviral therapy: a necessary step in the public health response to HIV/AIDS in resource-limited settings.

    Science.gov (United States)

    Vitoria, Marco; Ford, Nathan; Doherty, Meg; Flexner, Charles

    2014-01-01

    The global scale-up of antiretroviral therapy (ART) over the past decade represents one of the great public health and human rights achievements of recent times. Moving from an individualized treatment approach to a simplified and standardized public health approach has been critical to ART scale-up, simplifying both prescribing practices and supply chain management. In terms of the latter, the risk of stock-outs can be reduced and simplified prescribing practices support task shifting of care to nursing and other non-physician clinicians; this strategy is critical to increase access to ART care in settings where physicians are limited in number. In order to support such simplification, successive World Health Organization guidelines for ART in resource-limited settings have aimed to reduce the number of recommended options for first-line ART in such settings. Future drug and regimen choices for resource-limited settings will likely be guided by the same principles that have led to the recommendation of a single preferred regimen and will favour drugs that have the following characteristics: minimal risk of failure, efficacy and tolerability, robustness and forgiveness, no overlapping resistance in treatment sequencing, convenience, affordability, and compatibility with anti-TB and anti-hepatitis treatments.

  6. Inter-Firm Information Sharing in Enterprise Resource Planning Systems: a call for timely but limited access to customer information

    Directory of Open Access Journals (Sweden)

    Michael Busing

    2001-11-01

    Full Text Available Current trends in Enterprise Resource Planning (ERP suggest that supply chain management and tight control over scheduling jobs within the supply chain are key tactical planning issues. Modern ERP software packages, in conjunction with the World Wide Web, allow for automated exchange of information within a company and also between two or more companies (i.e., conveyance of customer information to suppliers of parts and components for the purposes of effective planning and control. While ease of information exchange between a customer and supplier is increasingly critical to the success of modern-day planning and control efforts, the issue of information security is also a very real concern. Suppliers can benefit from gaining access to a customer's dispatch list and material requirements plan (MRP in order to determine real-time priority of jobs in queue at various work centers within their own organization. Other customer information, however, should remain secure and unavailable to supplier firms for competitive reasons such as threat of forward integration. This paper presents a previously tested priority-sequencing rule that explicitly considers downstream shop conditions in determining which job to run next The rule proves to perform well on mean flow time and lateness as well as on variability of these measures. The rule is extended here to incorporate the case where a downstream work center is outside official corporate boundaries. With the call for free exchange of information comes the threat of other, perhaps proprietary, information being accessed by vendors or others outside the official corporate boundaries. The paper will propose information that should be freely exchanged between customers and suppliers and information that should remain secure. Finally, practical measures to manage access to web-enabled ERP information will be proposed.

  7. Host Genetics and Environment Drive Divergent Responses of Two Resource Sharing Gall-Formers on Norway Spruce: A Common Garden Analysis.

    Science.gov (United States)

    Axelsson, E Petter; Iason, Glenn R; Julkunen-Tiitto, Riitta; Whitham, Thomas G

    2015-01-01

    A central issue in the field of community genetics is the expectation that trait variation among genotypes play a defining role in structuring associated species and in forming community phenotypes. Quantifying the existence of such community phenotypes in two common garden environments also has important consequences for our understanding of gene-by-environment interactions at the community level. The existence of community phenotypes has not been evaluated in the crowns of boreal forest trees. In this study we address the influence of tree genetics on needle chemistry and genetic x environment interactions on two gall-inducing adelgid aphids (Adelges spp. and Sacchiphantes spp.) that share the same elongating bud/shoot niche. We examine the hypothesis that the canopies of different genotypes of Norway spruce (Picea abies L.) support different community phenotypes. Three patterns emerged. First, the two gallers show clear differences in their response to host genetics and environment. Whereas genetics significantly affected the abundance of Adelges spp. galls, Sacchiphantes spp. was predominately affected by the environment suggesting that the genetic influence is stronger in Adelges spp. Second, the among family variation in genetically controlled resistance was large, i.e. fullsib families differed as much as 10 fold in susceptibility towards Adelges spp. (0.57 to 6.2 galls/branch). Also, the distribution of chemical profiles was continuous, showing both overlap as well as examples of significant differences among fullsib families. Third, despite the predicted effects of host chemistry on galls, principal component analyses using 31 different phenolic substances showed only limited association with galls and a similarity test showed that trees with similar phenolic chemical characteristics, did not host more similar communities of gallers. Nonetheless, the large genetic variation in trait expression and clear differences in how community members respond to host

  8. Host Genetics and Environment Drive Divergent Responses of Two Resource Sharing Gall-Formers on Norway Spruce: A Common Garden Analysis.

    Directory of Open Access Journals (Sweden)

    E Petter Axelsson

    Full Text Available A central issue in the field of community genetics is the expectation that trait variation among genotypes play a defining role in structuring associated species and in forming community phenotypes. Quantifying the existence of such community phenotypes in two common garden environments also has important consequences for our understanding of gene-by-environment interactions at the community level. The existence of community phenotypes has not been evaluated in the crowns of boreal forest trees. In this study we address the influence of tree genetics on needle chemistry and genetic x environment interactions on two gall-inducing adelgid aphids (Adelges spp. and Sacchiphantes spp. that share the same elongating bud/shoot niche. We examine the hypothesis that the canopies of different genotypes of Norway spruce (Picea abies L. support different community phenotypes. Three patterns emerged. First, the two gallers show clear differences in their response to host genetics and environment. Whereas genetics significantly affected the abundance of Adelges spp. galls, Sacchiphantes spp. was predominately affected by the environment suggesting that the genetic influence is stronger in Adelges spp. Second, the among family variation in genetically controlled resistance was large, i.e. fullsib families differed as much as 10 fold in susceptibility towards Adelges spp. (0.57 to 6.2 galls/branch. Also, the distribution of chemical profiles was continuous, showing both overlap as well as examples of significant differences among fullsib families. Third, despite the predicted effects of host chemistry on galls, principal component analyses using 31 different phenolic substances showed only limited association with galls and a similarity test showed that trees with similar phenolic chemical characteristics, did not host more similar communities of gallers. Nonetheless, the large genetic variation in trait expression and clear differences in how community members

  9. The history of antiretroviral therapy and of its implementation in resource-limited areas of the world.

    Science.gov (United States)

    Vella, Stefano; Schwartländer, Bernard; Sow, Salif Papa; Eholie, Serge Paul; Murphy, Robert L

    2012-06-19

    HIV/AIDS not only represents the most severe epidemic in modern times, but also the greatest public health challenge in history. The response of the scientific community has been impressive and in just a few years, turned an inevitably fatal disease into a chronic manageable although not yet curable condition. The development of antiretroviral therapy is not only the history of scientific advancements: it is the result of the passionate 'alliance' towards a common goal between researchers, doctors and nurses, pharmaceutical industries, regulators, public health officials and the community of HIV-infected patients, which is rather unique in the history of medicine. In addition, the rapid and progressive development of antiretroviral therapy has not only proven to be life-saving for many millions but has been instrumental in unveiling the inequities in access to health between rich and poor countries of the world. Optimal benefits indeed, are not accessible to all people living with HIV, with challenges to coverage and sustainability in low and middle income countries. This paper will review the progress made, starting from the initial despairing times, till the current battle towards universal access to treatment and care for all people living with HIV.

  10. Protocol for the systematic review of the prevention, treatment and public health management of impetigo, scabies and fungal skin infections in resource-limited settings.

    Science.gov (United States)

    May, Philippa; Bowen, Asha; Tong, Steven; Steer, Andrew; Prince, Sam; Andrews, Ross; Currie, Bart; Carapetis, Jonathan

    2016-09-23

    Impetigo, scabies, and fungal skin infections disproportionately affect populations in resource-limited settings. Evidence for standard treatment of skin infections predominantly stem from hospital-based studies in high-income countries. The evidence for treatment in resource-limited settings is less clear, as studies in these populations may lack randomisation and control groups for cultural, ethical or economic reasons. Likewise, a synthesis of the evidence for public health control within endemic populations is also lacking. We propose a systematic review of the evidence for the prevention, treatment and public health management of skin infections in resource-limited settings, to inform the development of guidelines for the standardised and streamlined clinical and public health management of skin infections in endemic populations. The protocol has been designed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. All trial designs and analytical observational study designs will be eligible for inclusion. A systematic search of the peer-reviewed literature will include PubMed, Excertpa Medica and Global Health. Grey literature databases will also be systematically searched, and clinical trials registries scanned for future relevant studies. The primary outcome of interest will be the clinical cure or decrease in prevalence of impetigo, scabies, crusted scabies, tinea capitis, tinea corporis or tinea unguium. Two independent reviewers will perform eligibility assessment and data extraction using standardised electronic forms. Risk of bias assessment will be undertaken by two independent reviewers according to the Cochrane Risk of Bias tool. Data will be tabulated and narratively synthesised. We expect there will be insufficient data to conduct meta-analysis. The final body of evidence will be reported against the Grades of Recommendation, Assessment, Development and Evaluation grading system. The evidence

  11. Detection of Acute and Early HIV-1 Infections in an HIV Hyper-Endemic Area with Limited Resources.

    Directory of Open Access Journals (Sweden)

    Simnikiwe H Mayaphi

    Full Text Available Two thirds of the world's new HIV infections are in sub-Saharan Africa. Acute HIV infection (AHI is the time of virus acquisition until the appearance of HIV antibodies. Early HIV infection, which includes AHI, is the interval between virus acquisition and establishment of viral load set-point. This study aimed to detect acute and early HIV infections in a hyper-endemic setting.This was a cross-sectional diagnostic study that enrolled individuals who had negative rapid HIV results in five clinics in South Africa. Pooled nucleic acid amplification testing (NAAT was performed, followed by individual sample testing in positive pools. NAAT-positive participants were recalled to the clinics for confirmatory testing and appropriate management. HIV antibody, p24 antigen, Western Blot and avidity tests were performed for characterization of NAAT-positive samples.The study enrolled 6910 individuals with negative rapid HIV results. Median age was 27 years (interquartile range {IQR}: 23-31. NAAT was positive in 55 samples, resulting in 0.8% newly diagnosed HIV-infected individuals (95% confidence interval {CI}: 0.6-1.0. The negative predictive value for rapid HIV testing was 99.2% (95% CI: 99.0-99.4. Characterization of NAAT-positive samples revealed that 0.04% (95% CI: 0.000-0.001 had AHI, 0.3% (95% CI: 0.1-0.4 had early HIV infection, and 0.5% (95% CI: 0.5-0.7 had chronic HIV infection. Forty-seven (86% of NAAT-positive participants returned for follow-up at a median of 4 weeks (IQR: 2-8. Follow-up rapid tests were positive in 96% of these participants.NAAT demonstrated that a substantial number of HIV-infected individuals are misdiagnosed at South African points-of-care. Follow-up rapid tests done within a 4 week interval detected early and chronic HIV infections initially missed by rapid HIV testing. This may be a practical and affordable strategy for earlier detection of these infections in resource-constrained settings. Newer molecular tests that can

  12. Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.

    Science.gov (United States)

    Garg, Sachin K; Lyles, Courtney R; Ackerman, Sara; Handley, Margaret A; Schillinger, Dean; Gourley, Gato; Aulakh, Veenu; Sarkar, Urmimala

    2016-02-06

    Text messaging is an affordable, ubiquitous, and expanding mobile communication technology. However, safety net health systems in the United States that provide more care to uninsured and low-income patients may face additional financial and infrastructural challenges in utilizing this technology. Formative evaluations of texting implementation experiences are limited. We interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation. We conducted telephone interviews with various stakeholders who volunteered from each of the eight California-based safety net systems that received external funding to pilot a texting-based program of their choosing to serve a primary care need. We developed a semi-structured interview guide based partly on the Consolidated Framework for Implementation Research (CFIR), which encompasses several domains: the intervention, individuals involved, contextual factors, and implementation process. We inductively and deductively (using CFIR) coded transcripts, and categorized themes into facilitators and barriers. We performed eight interviews (one interview per pilot site). Five sites had no prior texting experience. Sites applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. No site texted patient-identifying health information, and most sites manually obtained informed consent from each participating patient. Facilitators of implementation included perceived enthusiasm from patients, staff and management belief that texting is patient-centered, and the early identification of potential barriers through peer collaboration among grantees. Navigating government regulations that protect patient privacy and guide the handling of protected health information emerged as a crucial barrier. A related technical challenge in five sites was the labor-intensive tracking and documenting

  13. The REVAMP trial to evaluate HIV resistance testing in sub-Saharan Africa: a case study in clinical trial design in resource limited settings to optimize effectiveness and cost effectiveness estimates.

    Science.gov (United States)

    Siedner, Mark J; Bwana, Mwebesa B; Moosa, Mahomed-Yunus S; Paul, Michelle; Pillay, Selvan; McCluskey, Suzanne; Aturinda, Isaac; Ard, Kevin; Muyindike, Winnie; Moodley, Pravikrishnen; Brijkumar, Jaysingh; Rautenberg, Tamlyn; George, Gavin; Johnson, Brent; Gandhi, Rajesh T; Sunpath, Henry; Marconi, Vincent C

    2017-07-01

    In sub-Saharan Africa, rates of sustained HIV virologic suppression remain below international goals. HIV resistance testing, while common in resource-rich settings, has not gained traction due to concerns about cost and sustainability. We designed a randomized clinical trial to determine the feasibility, effectiveness, and cost-effectiveness of routine HIV resistance testing in sub-Saharan Africa. We describe challenges common to intervention studies in resource-limited settings, and strategies used to address them, including: (1) optimizing generalizability and cost-effectiveness estimates to promote transition from study results to policy; (2) minimizing bias due to patient attrition; and (3) addressing ethical issues related to enrollment of pregnant women. The study randomizes people in Uganda and South Africa with virologic failure on first-line therapy to standard of care virologic monitoring or immediate resistance testing. To strengthen external validity, study procedures are conducted within publicly supported laboratory and clinical facilities using local staff. To optimize cost estimates, we collect primary data on quality of life and medical resource utilization. To minimize losses from observation, we collect locally relevant contact information, including Whatsapp account details, for field-based tracking of missing participants. Finally, pregnant women are followed with an adapted protocol which includes an increased visit frequency to minimize risk to them and their fetuses. REVAMP is a pragammatic randomized clinical trial designed to test the effectiveness and cost-effectiveness of HIV resistance testing versus standard of care in sub-Saharan Africa. We anticipate the results will directly inform HIV policy in sub-Saharan Africa to optimize care for HIV-infected patients.

  14. Efficient common rail injection systems and intelligent control strategies for the fulfillment of future on/off highway emission limits; Effiziente Common Rail Einspritzsysteme und intelligente Regelstrategien fuer die Erfuellung zukuenftiger On-/Off-Highway Emissionsgrenzwerte

    Energy Technology Data Exchange (ETDEWEB)

    Schugger, Christian; Krauss, Jost; Projahn, Ulrich; Gerhardt, Juergen [Robert Bosch GmbH, Stuttgart-Feuerbach (Germany)

    2011-07-01

    The diesel engine is the most common powertrain in commercial applications, and will retain that position for the foreseeable future. In order to meet future emission standards, a wide variety of solutions within combustion process control, exhaust gas aftertreatment, air and injection systems have been developed. The development of common rail injection systems for trucks with 2000 and 2200 bar injection pressure increases the opportunities for internal engine emissions reductions. The systems are designed for medium-duty and heavy-duty applications, on-highway (on-HW) and Off-highway (off-HW). Besides increasing the injection pressure this system features high efficiency in hydraulic pressure generation and injection, making a direct contribution to reducing fuel consumption. To meet even greater requirements, a system with an injection pressure of 2500 bar is under development. As an indicator for the hydraulic efficiency of an injector, the ''effective injection pressure'' is derived. This indicator allows for a uniform rating of different injector concepts. Software functions contribute to the fulfillment of the system requirements over lifetime. An engine speed based function calibrates the pilot injection quantity during low idle operation for on- and off-highway applications. The increase in system pressure results in increased loads for the components. A calibration function for the pump delivery characteristics minimizes pressure overshoots and ensures the pressure control dynamics over lifetime. (orig.)

  15. Contribution of modifiable risk factors for hypertension and type-2 diabetes in Peruvian resource-limited settings.

    Science.gov (United States)

    Bernabé-Ortiz, Antonio; Carrillo-Larco, Rodrigo M; Gilman, Robert H; Checkley, William; Smeeth, Liam; Miranda, J Jaime

    2016-01-01

    It is important to understand the local burden of non-communicable diseases including within-country heterogeneity. The aim of this study was to characterise hypertension and type-2 diabetes profiles across different Peruvian geographical settings emphasising the assessment of modifiable risk factors. Analysis of the CRONICAS Cohort Study baseline assessment was conducted. Cardiometabolic outcomes were blood pressure categories (hypertension, prehypertension, normal) and glucose metabolism disorder status (diabetes, prediabetes, normal). Exposures were study setting and six modifiable factors (smoking, alcohol drinking, leisure time and transport-related physical activity levels, TV watching, fruit/vegetables intake and obesity). Poisson regression models were used to report prevalence ratios (PR). Population attributable risks (PAR) were also estimated. Data from 3238 participants, 48.3% male, mean age 45.3 years, were analysed. Age-standardised (WHO population) prevalence of prehypertension and hypertension was 24% and 16%, whereas for prediabetes and type-2 diabetes it was 18% and 6%, respectively. Outcomes varied according to study setting (pdiabetes. PAR showed that obesity was an important determinant for hypertension (15.7%) and type-2 diabetes (23.9%). There is an evident heterogeneity in the prevalence of and risk factors for hypertension and diabetes within Peru. Prehypertension and prediabetes are highly prevalent across settings. Our results emphasise the need of understanding the epidemiology of cardiometabolic conditions to appropriately implement interventions to tackle the burden of non-communicable diseases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Mentorship needs at academic institutions in resource-limited settings: a survey at makerere university college of health sciences

    Directory of Open Access Journals (Sweden)

    Nakwagala Fred

    2011-07-01

    Full Text Available Abstract Background Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS. Methods Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees registered with the Uganda Society for Health Scientists (USHS. Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes. Results Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses. Up to 77% (17/22 of mentors had Master's-level training and only 18% (4/22 had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions. Conclusions

  17. Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

    Directory of Open Access Journals (Sweden)

    Jane W. Muchiri

    2012-10-01

    Full Text Available Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary

  18. Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

    Directory of Open Access Journals (Sweden)

    Jane W. Muchiri

    2012-10-01

    Full Text Available Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary

  19. vSDC: a method to improve early recognition in virtual screening when limited experimental resources are available.

    Science.gov (United States)

    Chaput, Ludovic; Martinez-Sanz, Juan; Quiniou, Eric; Rigolet, Pascal; Saettel, Nicolas; Mouawad, Liliane

    2016-01-01

    In drug design, one may be confronted to the problem of finding hits for targets for which no small inhibiting molecules are known and only low-throughput experiments are available (like ITC or NMR studies), two common difficulties encountered in a typical academic setting. Using a virtual screening strategy like docking can alleviate some of the problems and save a considerable amount of time by selecting only top-ranking molecules, but only if the method is very efficient, i.e. when a good proportion of actives are found in the 1-10 % best ranked molecules. The use of several programs (in our study, Gold, Surflex, FlexX and Glide were considered) shows a divergence of the results, which presents a difficulty in guiding the experiments. To overcome this divergence and increase the yield of the virtual screening, we created the standard deviation consensus (SDC) and variable SDC (vSDC) methods, consisting of the intersection of molecule sets from several virtual screening programs, based on the standard deviations of their ranking distributions. SDC allowed us to find hits for two new protein targets by testing only 9 and 11 small molecules from a chemical library of circa 15,000 compounds. Furthermore, vSDC, when applied to the 102 proteins of the DUD-E benchmarking database, succeeded in finding more hits than any of the four isolated programs for 13-60 % of the targets. In addition, when only 10 molecules of each of the 102 chemical libraries were considered, vSDC performed better in the number of hits found, with an improvement of 6-24 % over the 10 best-ranked molecules given by the individual docking programs.Graphical abstractIn drug design, for a given target and a given chemical library, the results obtained with different virtual screening programs are divergent. So how to rationally guide the experimental tests, especially when only a few number of experiments can be made? The variable Standard Deviation Consensus (vSDC) method was developed to

  20. Potential Impact of a Free Online HIV Treatment Response Prediction System for Reducing Virological Failures and Drug Costs after Antiretroviral Therapy Failure in a Resource-Limited Setting

    Directory of Open Access Journals (Sweden)

    Andrew D. Revell

    2013-01-01

    Full Text Available Objective. Antiretroviral drug selection in resource-limited settings is often dictated by strict protocols as part of a public health strategy. The objective of this retrospective study was to examine if the HIV-TRePS online treatment prediction tool could help reduce treatment failure and drug costs in such settings. Methods. The HIV-TRePS computational models were used to predict the probability of response to therapy for 206 cases of treatment change following failure in India. The models were used to identify alternative locally available 3-drug regimens, which were predicted to be effective. The costs of these regimens were compared to those actually used in the clinic. Results. The models predicted the responses to treatment of the cases with an accuracy of 0.64. The models identified alternative drug regimens that were predicted to result in improved virological response and lower costs than those used in the clinic in 85% of the cases. The average annual cost saving was $364 USD per year (41%. Conclusions. Computational models that do not require a genotype can predict and potentially avoid treatment failure and may reduce therapy costs. The use of such a system to guide therapeutic decision-making could confer health economic benefits in resource-limited settings.

  1. Understanding the impact of interprofessional collaboration on the quality of care: a case report from a small-scale resource limited health care environment.

    Science.gov (United States)

    Busari, Jamiu O; Moll, Franka M; Duits, Ashley J

    2017-01-01

    A critical assessment of current health care practices, as well as the training needs of various health care providers, is crucial for improving patient care. Several approaches have been proposed for defining these needs with attention on communication as a key competency for effective collaboration. Taking our cultural context, resource limitations, and small-scale setting into account, we researched the applicability of a mixed focus group approach for analysis of the communication between doctors and nurses, as well as the measures for improvement. Assessment of nurse-physician communication perception in patient care in a Caribbean setting. Focus group sessions consisting of nurses, interns, and medical specialists were conducted using an ethnographic approach, paying attention to existing communication, risk evaluation, and recommendations for improvement. Data derived from the focus group sessions were analyzed by thematic synthesis method with descriptive themes and development of analytic themes. The initial focus group sessions produced an extensive list of key recommendations which could be clustered into three domains (standardization, sustainment, and collaboration). Further discussion of these domains in focus groups showed nurses' and physicians' domain perspectives and effects on patient care to be broadly similar. Risks related to lack of information, knowledge sharing, and professional respect were clearly described by the participants. The described mixed focus group session approach for effectively determining current interprofessional communication and key improvement areas seems suitable for our small-scale, limited resource setting. The impact of the cultural context should be further evaluated by a similar study in a different cultural context.

  2. An Empirical Determination of Tasks Essential to Successful Performance as an Animal Health Assistant. Determination of a Common Core of Basic Skills in Agribusiness and Natural Resources.

    Science.gov (United States)

    Cooke, Fred C.; And Others

    To improve vocational educational programs in agriculture, occupational information on a common core of basic skills within the occupational area of the animal health assistant is presented in the revised task inventory survey. The purpose of the occupational survey was to identify a common core of basic skills which are performed and are…

  3. Translating vaccine policy into action: a report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings.

    Science.gov (United States)

    Ortiz, Justin R; Neuzil, Kathleen M; Ahonkhai, Vincent I; Gellin, Bruce G; Salisbury, David M; Read, Jennifer S; Adegbola, Richard A; Abramson, Jon S

    2012-11-26

    Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life. In April 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended revisions to the WHO position paper on influenza vaccines. For the first time, SAGE recommended pregnant women should be made the highest priority for inactivated seasonal influenza vaccination. However, the variable maternal influenza vaccination coverage in countries with pre-existing maternal influenza vaccine recommendations underscores the need to understand and to address the discrepancy between recommendations and implementation success. We present the outcome of a multi-stakeholder expert consultation on inactivated influenza vaccination in pregnancy. The creation and implementation of vaccine policies and regulations require substantial resources and capacity. As with all public health interventions, the existence of perceived and real risks of vaccination will necessitate effective and transparent risk communication. Potential risk allocation and sharing mechanisms should be addressed by governments, vaccine manufacturers, and other stakeholders. In resource-limited settings, vaccine-related issues concerning supply, formulation, regulation, evidence evaluation, distribution, cost-utility, and post-marketing safety surveillance need to be addressed. Lessons can be learned from the Maternal and Neonatal Tetanus Elimination Initiative as well as efforts to increase vaccine coverage among pregnant

  4. Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings.

    Science.gov (United States)

    Revell, A D; Wang, D; Wood, R; Morrow, C; Tempelman, H; Hamers, R L; Alvarez-Uria, G; Streinu-Cercel, A; Ene, L; Wensing, A M J; DeWolf, F; Nelson, M; Montaner, J S; Lane, H C; Larder, B A

    2013-06-01

    Genotypic HIV drug-resistance testing is typically 60%-65% predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART without a genotype and evaluated their potential as a treatment support tool in RLSs. Random forest models were trained to predict the probability of response to ART (≤400 copies HIV RNA/mL) using the following data from 14 891 treatment change episodes (TCEs) after virological failure, from well-resourced countries: viral load and CD4 count prior to treatment change, treatment history, drugs in the new regimen, time to follow-up and follow-up viral load. Models were assessed by cross-validation during development, with an independent set of 800 cases from well-resourced countries, plus 231 cases from Southern Africa, 206 from India and 375 from Romania. The area under the receiver operating characteristic curve (AUC) was the main outcome measure. The models achieved an AUC of 0.74-0.81 during cross-validation and 0.76-0.77 with the 800 test TCEs. They achieved AUCs of 0.58-0.65 (Southern Africa), 0.63 (India) and 0.70 (Romania). Models were more accurate for data from the well-resourced countries than for cases from Southern Africa and India (P < 0.001), but not Romania. The models identified alternative, available drug regimens predicted to result in virological response for 94% of virological failures in Southern Africa, 99% of those in India and 93% of those in Romania. We developed computational models that predict virological response to ART without a genotype with comparable accuracy to genotyping with rule-based interpretation. These models have the potential to help optimize antiretroviral therapy for patients in RLSs where genotyping is not generally available.

  5. Citizens, Leaders and the Common Good in a world of Necessity and Scarcity: Machiavelli’s Lessons for Community-Based Natural Resource Management.

    NARCIS (Netherlands)

    Assche, van K.A.M.; Beunen, R.; Duineveld, M.

    2016-01-01

    In this article we investigate the value and utility of Machiavelli’s work for Community-Based Natural Resource Management (CBNRM). We made a selection of five topics derived from literature on NRM and CBNRM: (1) Law and Policy, (2) Justice, (3) Participation, (4) Transparency, and (5) Leadership

  6. Citizens, Leaders and the Common Good in a world of Necessity and Scarcity: Machiavelli’s Lessons for Community-Based Natural Resource Management

    NARCIS (Netherlands)

    Van Assche, Kristof; Beunen, R.; Duineveld, Martijn

    2016-01-01

    n this article we investigate the value and utility of Machiavelli’s work for Community-Based Natural Resource Management (CBNRM). We made a selection of five topics derived from literature on NRM and CBNRM: (1) Law and Policy, (2) Justice, (3) Participation, (4) Transparency, and (5) Leadership and

  7. Reaching the end of the line: Operational issues with implementing phone-based unannounced pill counts in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Yael Hirsch-Moverman

    Full Text Available Accurate measurement of adherence is necessary to ensure that therapeutic outcomes can be attributed to the recommended treatment. Phone-based unannounced pill counts were shown to be feasible and reliable measures of adherence in developed settings; and have been further used as part of medication adherence interventions. However, it is not clear whether this method can be implemented successfully in resource-limited settings, where cellular network and mobile phone coverage may be low. Our objective is to describe operational issues surrounding the use of phone-based unannounced pill counts in Lesotho and Ethiopia.Phone-based monthly unannounced pill counts, using an adaptation of a standardized protocol from previous US-based studies, were utilized to measure anti-TB and antiretroviral medication adherence in two implementation science studies in resource-limited settings, START (Lesotho and ENRICH (Ethiopia.In START, 19.6% of calls were completed, with 71.9% of participants reached at least once; majority of failed call attempts were due to phones not being available (54.8% or because participants were away from the pills (32.7%. In ENRICH, 33.5% of calls were completed, with 86.7% of participants reached at least once; the main reasons for failed call attempts were phones being switched off (31.5%, participants not answering (27.3%, participants' discomfort speaking on the phone (15.4%, and network problems (13.2%. Structural, facility-level, participant-level, and data collection challenges were encountered in these settings.Phone-based unannounced pill counts were found to be challenging, and response rates suboptimal. While some of these challenges were specific to local contexts, most of them are generalizable to resource-limited settings. In a research study context, a possible solution to ease operational challenges may be to focus phone-based unannounced pill count efforts on a randomly selected sample from participants who are

  8. Identifications and limited spectroscopy for Luyten common proper motion stars with probable white dwarf components. I - Pair brighter than 17th magnitude

    Science.gov (United States)

    Oswalt, Terry D.; Hintzen, Paul M.; Luyten, Willem J.

    1988-01-01

    Identifications are provided for 103 bright Luyten common proper motion (CPM) stellar systems with m(pg) less than 17.0 mag containing likely white dwarf (WD) components. New spectral types are presented for 55 components, and spectral types for 51 more are available in the literature. With the CPM systems previously published by Giclas et al. (1978), the Luyten stars provide a uniform sample of nearly 200 pairs or multiples brighter than 17h magnitude. Selection effects biasing the combined samples are discussed; in particular, evidence is presented that fewer than 1 percent of wide WD binaries have been detected.

  9. Winter precipitation effect in a mid-latitude temperature-limited environment: the case of common juniper at high elevation in the Alps

    International Nuclear Information System (INIS)

    Pellizzari, Elena; Pividori, Mario; Carrer, Marco

    2014-01-01

    Common juniper (Juniperus communis L.) is by far the most widespread conifer in the world. However, tree-ring research dealing with this species is still scarce, mainly due to the difficulty in crossdating associated with the irregular stem shape with strip-bark growth form in older individuals and the high number of missing and wedging rings. Given that many different species of the same genus have been successfully used in tree-ring investigations and proved to be reliable climate proxies, this study aims to (i) test the possibility to successfully apply dendrochronological techniques on common juniper growing above the treeline and (ii) verify the climate sensitivity of the species with special regard to winter precipitation, a climatic factor that generally does not affect tree-ring growth in all Alpine high-elevation tree species. Almost 90 samples have been collected in three sites in the central and eastern Alps, all between 2100 and 2400 m in elevation. Despite cross-dating difficulties, we were able to build a reliable chronology for each site, each spanning over 200 years. Climate-growth relationships computed over the last century highlight that juniper growth is mainly controlled by the amount of winter precipitation. The high variability of the climate-growth associations among sites, corresponds well to the low spatial dependence of this meteorological factor. Fairly long chronologies and the presence of a significant precipitation signal open up the possibility to reconstruct past winter precipitation. (letter)

  10. Linear Quadratic Mean Field Type Control and Mean Field Games with Common Noise, with Application to Production of an Exhaustible Resource

    Energy Technology Data Exchange (ETDEWEB)

    Graber, P. Jameson, E-mail: jameson-graber@baylor.edu [Baylor University, Department of Mathematics (United States)

    2016-12-15

    We study a general linear quadratic mean field type control problem and connect it to mean field games of a similar type. The solution is given both in terms of a forward/backward system of stochastic differential equations and by a pair of Riccati equations. In certain cases, the solution to the mean field type control is also the equilibrium strategy for a class of mean field games. We use this fact to study an economic model of production of exhaustible resources.

  11. Melt-and-mold fabrication (MnM-Fab) of reconfigurable low-cost devices for use in resource-limited settings.

    Science.gov (United States)

    Li, Zhi; Tevis, Ian D; Oyola-Reynoso, Stephanie; Newcomb, Lucas B; Halbertsma-Black, Julian; Bloch, Jean-Francis; Thuo, Martin

    2015-12-01

    Interest in low-cost analytical devices (especially for diagnostics) has recently increased; however, concomitant translation to the field has been slow, in part due to personnel and supply-chain challenges in resource-limited settings. Overcoming some of these challenges require the development of a method that takes advantage of locally available resources and/or skills. We report a Melt-and-mold fabrication (MnM Fab) approach to low-cost and simple devices that has the potential to be adapted locally since it requires a single material that is recyclable and simple skills to access multiple devices. We demonstrated this potential by fabricating entry level bio-analytical devices using an affordable low-melting metal alloy, Field's metal, with molds produced from known materials such as plastic (acrylonitrile-butadiene-styrene (ABS)), glass, and paper. We fabricated optical gratings then 4×4 well plates using the same recycled piece of metal. We then reconfigured the well plates into rapid prototype microfluidic devices with which we demonstrated laminar flow, droplet generation, and bubble formation from T-shaped channels. We conclude that this MnM-Fab method is capable of addressing some challenges typically encountered with device translation, such as technical know-how or material supply, and that it can be applied to other devices, as needed in the field, using a single moldable material. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Trading off natural resources and rural livelihoods. A framework for sustainability assessment of small-scale food production in water-limited regions

    Science.gov (United States)

    Recanati, Francesca; Castelletti, Andrea; Dotelli, Giovanni; Melià, Paco

    2017-12-01

    Enhancing local production is key to promoting food security, especially in rural households of low-income countries, but may conflict with limited natural resources and ecosystems preservation. We propose a framework integrating the water-food nexus and a sustainable livelihoods perspective to assess small-scale food production in water-poor regions. We demonstrate it by assessing alternative production scenarios in the Gaza Strip at different spatial scales. At the scale of a single farm, there is a clear conflict among objectives: while cash crops ensure good incomes but contribute scarcely to domestic protein supply, crops performing well from the nutritional and environmental viewpoint are among the worst from the economic one. At the regional scale, domestic production might cover an important fraction of nutritional needs while contributing to household income, but water scarcity impairs the satisfaction of food demand by domestic production alone. Pursuing food security under multiple constraints thus requires a holistic perspective: we discuss how a multidimensional approach can promote the engagement of different stakeholders and allow the exploration of trade-offs between food security, sustainable exploitation of natural resources and economic viability.

  13. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yalda Jafari

    Full Text Available Rapid and point-of-care (POC tests for syphilis are an invaluable screening tool, yet inadequate evaluation of their diagnostic accuracy against best reference standards limits their widespread global uptake. To fill this gap, a systematic review and meta-analysis was conducted to evaluate the sensitivity and specificity of rapid and POC tests in blood and serum samples against Treponema pallidum (TP specific reference standards.Five electronic databases (1980-2012 were searched, data was extracted from 33 articles, and Bayesian hierarchical models were fit.In serum samples, against a TP specific reference standard point estimates with 95% credible intervals (CrI for the sensitivities of popular tests were: i Determine, 90.04% (80.45, 95.21, ii SD Bioline, 87.06% (75.67, 94.50, iii VisiTect, 85.13% (72.83, 92.57, and iv Syphicheck, 74.48% (56.85, 88.44, while specificities were: i Syphicheck, 99.14% (96.37, 100, ii Visitect, 96.45% (91.92, 99.29, iii SD Bioline, 95.85% (89.89, 99.53, and iv Determine, 94.15% (89.26, 97.66. In whole blood samples, sensitivities were: i Determine, 86.32% (77.26, 91.70, ii SD Bioline, 84.50% (78.81, 92.61, iii Syphicheck, 74.47% (63.94, 82.13, and iv VisiTect, 74.26% (53.62, 83.68, while specificities were: i Syphicheck, 99.58% (98.91, 99.96, ii VisiTect, 99.43% (98.22, 99.98, iii SD Bioline, 97.95%(92.54, 99.33, and iv Determine, 95.85% (92.42, 97.74.Rapid and POC treponemal tests reported sensitivity and specificity estimates comparable to laboratory-based treponemal tests. In resource limited settings, where access to screening is limited and where risk of patients lost to follow up is high, the introduction of these tests has already been shown to improve access to screening and treatment to prevent stillbirths and neonatal mortality due to congenital syphilis. Based on the evidence, it is concluded that rapid and POC tests are useful in resource limited settings with poor access to laboratories or screening

  14. A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting.

    Science.gov (United States)

    Mazmanyan, P; Mellor, K; Doré, C J; Modi, N

    2016-01-01

    The variable-flow flow driver (FD; EME) and continuous-flow bubble (Fisher-Paykel) continuous positive airway pressure (CPAP) systems are widely used. As these differ in cost and technical requirements, determining comparative efficacy is important particularly where resources are limited. We performed a randomised, controlled, equivalence trial of CPAP systems. We specified the margin of equivalence as 2 days. We analysed binary variables by logistical regression adjusted for gestation, and log transformed continuous variables by multiple linear regression adjusted for gestation, sex and antenatal steroids. A neonatal unit with no blood gas analyser or surfactant availability and limited X-ray and laboratory facilities Neonates CPAP at delivery followed by randomisation to FD or bubble (B). Primary outcome included total days receiving CPAP; secondary outcomes included days receiving CPAP, supplemental oxygen, ventilation, death, pneumothorax and nasal excoriation. We randomised 125 infants (B 66, FD 59). Differences in infant outcomes on B and FD were not statistically significant. The median (range) for CPAP days for survivors was B 0.8 (0.04 to 17.5), FD 0.5 (0.04 to 5.3). B:FD (95% CI) ratios were CPAP days 1.3 (0.9 to 2.1), CPAP plus supplementary oxygen days 1.2 (0.7 to 1.9). B:FD (95% CI) ORs were death 2.3 (0.2 to 28), ventilation 2.1 (0.5 to 9), nasal excoriation 1.2 (0.2 to 8) and pneumothorax 2.4 (0.2 to 26). In a resource-limited setting we found B CPAP equivalent to FD CPAP in the total number of days receiving CPAP within a margin of 2 days. ISRCTN22578364. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings.

    Science.gov (United States)

    Shrivastava, Rakesh; Sen, Sourav; Banerji, Debabrata; Praharaj, Ashok K; Chopra, Gurvinder Singh; Gill, Satyajit Singh

    2013-01-01

    A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. The aim of this study is to assess the utility of non-invasive mathematical models of liver fibrosis in chronic hepatitis B (CHB). Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. A cross-sectional study carried out at a tertiary care center. A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gama glutamyl transpeptidase (GGT), total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI), Fibrosis 4 (FIB-4) and Forn's index were calculated. Outcomes were compared for the assessment of best predictor of fibrosis by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each index. Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for significance. P value value of all 3 indices were significantly higher in patients group as compare with the controls (P model for excluding significant liver fibrosis while FIB-4 with a PPV of 61% showed fair correlation with significant fibrosis. Thus, these two non-invasive models for predicting of liver fibrosis, namely APRI and FIB-4, can be utilized in combination as screening tools in monitoring of CHB patients, especially in resource limiting settings.

  16. Improved Neuropsychological and Neurological Functioning Across Three Antiretroviral Regimens in Diverse Resource-Limited Settings: AIDS Clinical Trials Group Study A5199, the International Neurological Study

    Science.gov (United States)

    Robertson, K.; Jiang, H.; Kumwenda, J.; Supparatpinyo, K.; Evans, S.; Campbell, T. B.; Price, R.; Tripathy, S.; Kumarasamy, N.; La Rosa, A.; Santos, B.; Silva, M. T.; Montano, S.; Kanyama, C.; Faesen, S.; Murphy, R.; Hall, C.; Marra, C. M.; Marcus, C.; Berzins, B.; Allen, R.; Housseinipour, M.; Amod, F.; Sanne, I.; Hakim, J.; Walawander, A.; Nair, A.

    2012-01-01

    Background. AIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings. Methods. Participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations. Results. The median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P  .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01). Conclusions. The study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization –recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction. Clinical trials registration.  NCT00096824. PMID:22661489

  17. Potential for Zika virus introduction and transmission in resource-limited countries in Africa and the Asia-Pacific region: a modelling study.

    Science.gov (United States)

    Bogoch, Isaac I; Brady, Oliver J; Kraemer, Moritz U G; German, Matthew; Creatore, Maria I; Brent, Shannon; Watts, Alexander G; Hay, Simon I; Kulkarni, Manisha A; Brownstein, John S; Khan, Kamran

    2016-11-01

    As the epidemic of Zika virus expands in the Americas, countries across Africa and the Asia-Pacific region are becoming increasingly susceptible to the importation and possible local spread of the virus. To support public health readiness, we aim to identify regions and times where the potential health, economic, and social effects from Zika virus are greatest, focusing on resource-limited countries in Africa and the Asia-Pacific region. Our model combined transportation network analysis, ecological modelling of mosquito occurrences, and vector competence for flavivirus transmission, using data from the International Air Transport Association, entomological observations from Zika's primary vector species, and climate conditions using WorldClim. We overlaid monthly flows of airline travellers arriving to Africa and the Asia-Pacific region from areas of the Americas suitable for year-round transmission of Zika virus with monthly maps of climatic suitability for mosquito-borne transmission of Zika virus within Africa and the Asia-Pacific region. An estimated 2·6 billion people live in areas of Africa and the Asia-Pacific region where the presence of competent mosquito vectors and suitable climatic conditions could support local transmission of Zika virus. Countries with large volumes of travellers arriving from Zika virus-affected areas of the Americas and large populations at risk of mosquito-borne Zika virus infection include India (67 422 travellers arriving per year; 1·2 billion residents in potential Zika transmission areas), China (238 415 travellers; 242 million residents), Indonesia (13 865 travellers; 197 million residents), Philippines (35 635 travellers; 70 million residents), and Thailand (29 241 travellers; 59 million residents). Many countries across Africa and the Asia-Pacific region are vulnerable to Zika virus. Strategic use of available health and human resources is essential to prevent or mitigate the health, economic, and social

  18. Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study.

    Directory of Open Access Journals (Sweden)

    Sophie Janet

    Full Text Available Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable.Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU on the Thailand-Myanmar border.From 21,225 newbonrs delivered, 15,073 (71% met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU. Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06. Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442, and 6.32 (95%CI 3.01-13.26; p<0.001 respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001. Neurodevelopmental follow-up to one year was performed in 1,608 (10.5% of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565 versus 63 (n = 41; p = 0.732, while advanced resuscitation scores were significantly lower (56 (n = 5; p = 0.017.Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.

  19. Outcomes of Hematopoietic Stem Cell Transplantation at a Limited-Resource Center in Mexico Are Comparable to Those in Developed Countries.

    Science.gov (United States)

    Leon Rodriguez, Eucario; Rivera Franco, Monica M

    2017-11-01

    The first hematopoietic stem cell transplantation (HSCT) in Mexico was performed at our institution in 1980. Eighteen years later, our HSCT program was restructured to reduce transplantation-related mortality (TRM) and improve overall survival (OS). The aim of this study was to describe outcomes of HSCT at our institution despite limited resources. Consecutive patients undergoing HSCT, from November 1998 to February 2017, were retrospectively analyzed at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City. Three hundred nine HSCT (59% autologous) were performed in 275 patients. From 114 patients (41%) undergoing an allogeneic HSCT, acute and chronic graft-versus-host disease developed in 21% and 33%, respectively. From the entire cohort, 98 patients relapsed after HSCT and at the last follow-up, 183 (67%) patients were alive. The 100-day TRM rates were 1.9% and 6.1% for autologous and allogeneic HSCT, respectively. Ten-year relapse/progression-free survival were 54% and 65%, for autologous and allogeneic HSCT, respectively. Ten-year OS rates in autologous and allogeneic HSCT were 61% and 57%, respectively. We highlight that HSCT is feasible in developing countries, despite financial and infrastructure limitations, and conclude that our results are comparable to international literature and probably better in terms of TRM and cost-effectiveness. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  20. From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria.

    Science.gov (United States)

    Oleribe, Obinna Ositadimma; Oladipo, Olabisi Abiodun; Ezieme, Iheaka Paul; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

    2016-01-01

    Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.

  1. Sensitive products and services in the light of the law of the European Union. Chances and limits of common EU export controls

    International Nuclear Information System (INIS)

    Janik, M.

    1995-01-01

    The invasion of Kuwait by the Iraq has made it very clear to the world at large that international exports of sensitive products and services is an urgent international problem. This war demonstrated the absurdity of the fact that the troups of the allied coalition under the roof of the UN had to fight against a military potential of Iraq that these nations themselves had been building up by trade with the Iraq in the years before, having sold not only weaponry but also other technical systems and equipment and technologies to which the term ''sensitive products and services'' applies. Having become aware of the international dimension of this problem, the approach to solutions starts from the following questions: How can the international community prevent unwanted support of political regimes or groups judged to be potentially aggressive in their efforts towards building up a dangerous military potential? What are the instruments to be implemented at an international level, and to which foreign relations, as for example trade relations, and to which objects of trade, shall these instruments and controls apply? These questions show the essential importance of the definition of ''dual-use products''. The book analyses and explains the current legal framework within the EU and the approaches elaborated by working groups and bodies of the EU for the purpose of establishing a Single European exports control system, presenting the survey in five main chapters entitled as follows: Rationale, outline conditions and characteristic features of export controls; Legal basis of export controls for sensitive products and services; Admissibility of national controls of the export of sensitive products and services within the EU; Common EU controls of exports to third countries; EU action and means for harmonization of controls of exports of dual-use products to countries not members of the EU. (orig./CB) [de

  2. Chemical characterization of 21 species of marine macroalgae common in Norwegian waters: benefits of and limitations to their potential use in food and feed

    Science.gov (United States)

    Biancarosa, Irene; Belghit, Ikram; Bruckner, Christian G; Liland, Nina S; Waagbø, Rune; Amlund, Heidi; Heesch, Svenja

    2018-01-01

    Abstract BACKGROUND In the past few years, much effort has been invested into developing a new blue economy based on harvesting, cultivating and processing marine macroalgae in Norway. Macroalgae have high potential for a wide range of applications, e.g. as source of pharmaceuticals, production of biofuels or as food and feed. However, data on the chemical composition of macroalgae from Norwegian waters are scant. This study was designed to characterize the chemical composition of 21 algal species. Both macro‐ and micronutrients were analysed. Concentrations of heavy metals and the metalloid arsenic in the algae were also quantified. RESULTS The results confirm that marine macroalgae contain nutrients which are relevant for both human and animal nutrition, the concentrations whereof are highly dependent on species. Although heavy metals and arsenic were detected in the algae studied, concentrations were mostly below maximum allowed levels set by food and feed legislation in the EU. CONCLUSION This study provides chemical data on a wide range of algal species covering the three taxonomic groups (brown, red and green algae) and discusses both benefits of and potential limitations to their use for food and feed purposes. © 2017 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. PMID:29193189

  3. Chemical characterization of 21 species of marine macroalgae common in Norwegian waters: benefits of and limitations to their potential use in food and feed.

    Science.gov (United States)

    Biancarosa, Irene; Belghit, Ikram; Bruckner, Christian G; Liland, Nina S; Waagbø, Rune; Amlund, Heidi; Heesch, Svenja; Lock, Erik-Jan

    2018-03-01

    In the past few years, much effort has been invested into developing a new blue economy based on harvesting, cultivating and processing marine macroalgae in Norway. Macroalgae have high potential for a wide range of applications, e.g. as source of pharmaceuticals, production of biofuels or as food and feed. However, data on the chemical composition of macroalgae from Norwegian waters are scant. This study was designed to characterize the chemical composition of 21 algal species. Both macro- and micronutrients were analysed. Concentrations of heavy metals and the metalloid arsenic in the algae were also quantified. The results confirm that marine macroalgae contain nutrients which are relevant for both human and animal nutrition, the concentrations whereof are highly dependent on species. Although heavy metals and arsenic were detected in the algae studied, concentrations were mostly below maximum allowed levels set by food and feed legislation in the EU. This study provides chemical data on a wide range of algal species covering the three taxonomic groups (brown, red and green algae) and discusses both benefits of and potential limitations to their use for food and feed purposes. © 2017 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. © 2017 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

  4. The clinical and economic impact of point-of-care CD4 testing in mozambique and other resource-limited settings: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Emily P Hyle

    2014-09-01

    Full Text Available Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique.We use a validated model of HIV testing, linkage, and treatment (CEPAC-International to examine two strategies of immunological staging in Mozambique: (1 laboratory-based CD4 testing (LAB-CD4 and (2 point-of-care CD4 testing (POC-CD4. Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs. Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%, probability of correctly detecting antiretroviral therapy (ART eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90% or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%, and test cost (LAB-CD4, US$10; POC-CD4, US$24. In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570 to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%, increasing to 65.0% (95% CI, 64.9%-65.1% with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y and US$2,440 (95% CI, US$2,440-US$2,450 and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y and US$2,800 (95% CI, US$2,790-US$2,800; the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS (95% CI, US$480-US$520/YLS. POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published

  5. From invasion to latency: intracellular noise and cell motility as key controls of the competition between resource-limited cellular populations

    KAUST Repository

    Guerrero, Pilar

    2015-04-02

    © 2015, Springer-Verlag Berlin Heidelberg. In this paper we analyse stochastic models of the competition between two resource-limited cell populations which differ in their response to nutrient availability: the resident population exhibits a switch-like response behaviour while the invading population exhibits a bistable response. We investigate how noise in the intracellular regulatory pathways and cell motility influence the fate of the incumbent and invading populations. We focus initially on a spatially homogeneous system and study in detail the role of intracellular noise. We show that in such well-mixed systems, two distinct regimes exist: In the low (intracellular) noise limit, the invader has the ability to invade the resident population, whereas in the high noise regime competition between the two populations is found to be neutral and, in accordance with neutral evolution theory, invasion is a random event. Careful examination of the system dynamics leads us to conclude that (i) even if the invader is unable to invade, the distribution of survival times, PS(t), has a fat-tail behaviour (PS(t)∼t-1) which implies that small colonies of mutants can coexist with the resident population for arbitrarily long times, and (ii) the bistable structure of the invading population increases the stability of the latent population, thus increasing their long-term likelihood of survival, by decreasing the intensity of the noise at the population level. We also examine the effects of spatial inhomogeneity. In the low noise limit we find that cell motility is positively correlated with the aggressiveness of the invader as defined by the time the invader takes to invade the resident population: the faster the invasion, the more aggressive the invader.

  6. From invasion to latency: intracellular noise and cell motility as key controls of the competition between resource-limited cellular populations

    KAUST Repository

    Guerrero, Pilar; Byrne, Helen M.; Maini, Philip K.; Alarcó n, Tomá s

    2015-01-01

    © 2015, Springer-Verlag Berlin Heidelberg. In this paper we analyse stochastic models of the competition between two resource-limited cell populations which differ in their response to nutrient availability: the resident population exhibits a switch-like response behaviour while the invading population exhibits a bistable response. We investigate how noise in the intracellular regulatory pathways and cell motility influence the fate of the incumbent and invading populations. We focus initially on a spatially homogeneous system and study in detail the role of intracellular noise. We show that in such well-mixed systems, two distinct regimes exist: In the low (intracellular) noise limit, the invader has the ability to invade the resident population, whereas in the high noise regime competition between the two populations is found to be neutral and, in accordance with neutral evolution theory, invasion is a random event. Careful examination of the system dynamics leads us to conclude that (i) even if the invader is unable to invade, the distribution of survival times, PS(t), has a fat-tail behaviour (PS(t)∼t-1) which implies that small colonies of mutants can coexist with the resident population for arbitrarily long times, and (ii) the bistable structure of the invading population increases the stability of the latent population, thus increasing their long-term likelihood of survival, by decreasing the intensity of the noise at the population level. We also examine the effects of spatial inhomogeneity. In the low noise limit we find that cell motility is positively correlated with the aggressiveness of the invader as defined by the time the invader takes to invade the resident population: the faster the invasion, the more aggressive the invader.

  7. A Retrospective Analysis on the Occurrence of Arsenic in Ground-Water Resources of the United States and Limitations in Drinking-Water-Supply Characterizations

    Science.gov (United States)

    Focazio, Michael J.; Welch, Alan H.; Watkins, Sharon A.; Helsel, Dennis R.; Horn, Marilee A.

    2000-01-01

    ,000 and less than 10,000 people) in the United States. The arsenic data were summarized for the selected counties by associating the arsenic concentrations measured in the ground-water resource with the numbers and sizes of public water-supply systems using ground water in those counties. Targeted arsenic concentrations of 1, 2, 5, 10, 20, and 50 ug/L were exceeded in the ground-water resource associated with 36, 25, 14, 8, 3, and 1 percent respectively of all public water-supply systems accounted for in the analysis.Contributions to uncertainty such as changes in sampling methods and changes in laboratory reporting appear to be less important to the national occurrence estimates than other factors such as temporal variability in arsenic concentrations at a given well, the types of wells sampled, and density and types of sampling locations. In addition, no attempt was made to quantify arsenic concentrations in relation to depth within aquifers. With these qualifications, the USGS data represent the ground-water resource in general and are not restricted to wells currently used for public drinking-water sources. In this way, the broad spatial extent, large number of water samples, and low detection limits used for the USGS data provide a unique source of information to determine where targeted concentrations of arsenic are likely to occur in the ground-water resources within much of the United States.These results indicate USGS data can be effectively used to augment national estimates of arsenic occurrence in the nation's ground-water resources if limitations are recognized. Existing estimates of the occurrence of arsenic in ground water that are used as a source of drinking water can be supplemented with the USGS arsenic concentration data when associated with the public water-supply data base. One such supplementary application is the additional insight gained by establishing relations between arsenic concentration data in the ground-water resource and small public wat

  8. Feasibility of establishing a biosafety level 3 tuberculosis culture laboratory of acceptable quality standards in a resource-limited setting: an experience from Uganda.

    Science.gov (United States)

    Ssengooba, Willy; Gelderbloem, Sebastian J; Mboowa, Gerald; Wajja, Anne; Namaganda, Carolyn; Musoke, Philippa; Mayanja-Kizza, Harriet; Joloba, Moses Lutaakome

    2015-01-15

    Despite the recent innovations in tuberculosis (TB) and multi-drug resistant TB (MDR-TB) diagnosis, culture remains vital for difficult-to-diagnose patients, baseline and end-point determination for novel vaccines and drug trials. Herein, we share our experience of establishing a BSL-3 culture facility in Uganda as well as 3-years performance indicators and post-TB vaccine trials (pioneer) and funding experience of sustaining such a facility. Between September 2008 and April 2009, the laboratory was set-up with financial support from external partners. After an initial procedure validation phase in parallel with the National TB Reference Laboratory (NTRL) and legal approvals, the laboratory registered for external quality assessment (EQA) from the NTRL, WHO, National Health Laboratories Services (NHLS), and the College of American Pathologists (CAP). The laboratory also instituted a functional quality management system (QMS). Pioneer funding ended in 2012 and the laboratory remained in self-sustainability mode. The laboratory achieved internationally acceptable standards in both structural and biosafety requirements. Of the 14 patient samples analyzed in the procedural validation phase, agreement for all tests with NTRL was 90% (P 80% in all years from NTRL, CAP, and NHLS, and culture was 100% for CAP panels and above regional average scores for all years with NHLS. Quarterly DST scores from WHO-EQA ranged from 78% to 100% in 2010, 80% to 100% in 2011, and 90 to 100% in 2012. From our experience, it is feasible to set-up a BSL-3 TB culture laboratory with acceptable quality performance standards in resource-limited countries. With the demonstrated quality of work, the laboratory attracted more research groups and post-pioneer funding, which helped to ensure sustainability. The high skilled experts in this research laboratory also continue to provide an excellent resource for the needed national discussion of the laboratory and quality management systems.

  9. Outreach to the Public on Earthquake and Tsunami Safety with Limited Human Resources: Train the Trainers Pilot Program in Puerto Rico

    Science.gov (United States)

    Gonzalez Ruiz, W.; Vanacore, E. A.; Gomez, G.; Martinez Colon, J. F.; Perez, F.; Baez-Sanchez, G.; Flores Hots, V. E.; Lopez, A. M.; Huerfano, V.; Figueroa, J. M.

    2017-12-01

    Given the limited human resources available to interact directly with the public and disseminate information on earthquake and tsunami safety, the Puerto Rico Seismic Network has developed the Train the Trainers course, designed exclusively for emergency management officers (EMOs). This three-day training course provides a complete package of educational tools that will allow EMOs to present standard conferences, and lectures, with the appropriate and accurate information for different audiences on earthquake and tsunami hazard and safety. Here we present preliminary observations and lessons learned from the pilot program that was offered in July 2017 to 20 EMOs from the twelve Puerto Rico Emergency Management Agency (PREMA) zones and two students from the University of Puerto Rico Mayaguez. To ensure sufficient preparation, the training course provided evaluation tools including written and practical exams that participants were required to score 80% or more to complete the training successfully. Of the 20 EMO participants, 18 EMOs passed the final exam. Preliminary analysis of the pre-test scores and the post-test scores, show a score improvement between 8% to 46% amongst the participants. These 18 participants will receive a certificate as well as tools and resources to offer earthquakes and tsunamis conferences for up to two years across Puerto Rico and its outlying islands. To ensure that the pilot participants will provide conferences to the public PRSN required a signed commitment to give at least 5 conferences in one year from each participant and PRSN will monitor the participants for the next two years to evaluate the efficacy of the program. However, based on the preliminary data this program appears to be an effective method to increase the amount of outreach professionals on the Island.

  10. The value of point-of-care CD4+ and laboratory viral load in tailoring antiretroviral therapy monitoring strategies to resource limitations.

    Science.gov (United States)

    Hyle, Emily P; Jani, Ilesh V; Rosettie, Katherine L; Wood, Robin; Osher, Benjamin; Resch, Stephen; Pei, Pamela P; Maggiore, Paolo; Freedberg, Kenneth A; Peter, Trevor; Parker, Robert A; Walensky, Rochelle P

    2017-09-24

    To examine the clinical and economic value of point-of-care CD4 (POC-CD4) or viral load monitoring compared with current practices in Mozambique, a country representative of the diverse resource limitations encountered by HIV treatment programs in sub-Saharan Africa. We use the Cost-Effectiveness of Preventing AIDS Complications-International model to examine the clinical impact, cost (2014 US$), and incremental cost-effectiveness ratio [$/year of life saved (YLS)] of ART monitoring strategies in Mozambique. We compare: monitoring for clinical disease progression [clinical ART monitoring strategy (CLIN)] vs. annual POC-CD4 in rural settings without laboratory services and biannual laboratory CD4 (LAB-CD4), biannual POC-CD4, and annual viral load in urban settings with laboratory services. We examine the impact of a range of values in sensitivity analyses, using Mozambique's 2014 per capita gross domestic product ($620) as a benchmark cost-effectiveness threshold. In rural settings, annual POC-CD4 compared to CLIN improves life expectancy by 2.8 years, reduces time on failed ART by 0.6 years, and yields an incremental cost-effectiveness ratio of $480/YLS. In urban settings, biannual POC-CD4 is more expensive and less effective than viral load. Compared to biannual LAB-CD4, viral load improves life expectancy by 0.6 years, reduces time on failed ART by 1.0 year, and is cost-effective ($440/YLS). In rural settings, annual POC-CD4 improves clinical outcomes and is cost-effective compared to CLIN. In urban settings, viral load has the greatest clinical benefit and is cost-effective compared to biannual POC-CD4 or LAB-CD4. Tailoring ART monitoring strategies to specific settings with different available resources can improve clinical outcomes while remaining economically efficient.

  11. A common agenda of global challenges. Japan and U.S. pool resources to tackle global issues including population and HIV / AIDS.

    Science.gov (United States)

    1998-05-01

    The Common Agenda for Cooperation in Global Perspective is a bilateral partnership established in 1993 between the US and Japan to address important global challenges of the 21st century such as global health and human development, including population and HIV/AIDS, global stability, protection of the global environment, and the advancement of science and technology. On the fifth anniversary of the agenda, representatives of the Japan and the US governments, international organizations, and private sectors discussed ways to further promote US-Japan cooperation under the agenda at a meeting held in Tokyo during March 12-13. Participants of the Common Agenda Open Forum also reviewed efforts made by Japan and the US under the agenda to address population and the environment. Forum participants focused upon developing new ideas for future cooperation between the governments, the private sector, and other nations, especially in the areas of health and the environment. The meeting was jointly organized by Japan's Ministry of Foreign Affairs and the US Department of State. Attention was also given during talks to diminishing international assistance budgets worldwide.

  12. Interference and memory capacity limitations.

    Science.gov (United States)

    Endress, Ansgar D; Szabó, Szilárd

    2017-10-01

    Working memory (WM) is thought to have a fixed and limited capacity. However, the origins of these capacity limitations are debated, and generally attributed to active, attentional processes. Here, we show that the existence of interference among items in memory mathematically guarantees fixed and limited capacity limits under very general conditions, irrespective of any processing assumptions. Assuming that interference (a) increases with the number of interfering items and (b) brings memory performance to chance levels for large numbers of interfering items, capacity limits are a simple function of the relative influence of memorization and interference. In contrast, we show that time-based memory limitations do not lead to fixed memory capacity limitations that are independent of the timing properties of an experiment. We show that interference can mimic both slot-like and continuous resource-like memory limitations, suggesting that these types of memory performance might not be as differe