Academic literature on the topic 'Service du cure'

Tuberculosis (TB) is a disease of great relevance, responsible for 1.5 million deaths worldwide. Therefore, actions to control TB are necessary, and pharmacists may play an important role, especially in primary healthcare (PHC), where the diagnosis and management of this infection occurs. In a large Brazilian city, pharmacotherapeutic follow-up in PHC has been offered by pharmacists to people with TB since 2018. The objective of this study was to evaluate the implementation and effectiveness of this service though a longitudinal type 1 effectiveness–implementation hybrid study. Data were collected from January 2018 to February 2020 in the pharmaceutical services system. The service indicators were described and effectiveness was evaluated using Poisson regression analysis to compare the incidence of cure among patients using and not using the service. The service was performed in 148 PHC units by 82 pharmacists. Of the total of 1076 treatments, 721 were followed up by pharmacists, and TB was cured more frequently in these cases (90.4% attended vs. 73.5% unattended). The adjusted hazard ratio of cure among patients enrolled in the pharmacotherapeutic follow-up service was 2.71 (2.04–3.61; p < 0.001). Pharmacotherapeutic follow-up for people with TB significantly increased the incidence of cure and should be encouraged.

The 'Wellness Sector' is an emerging sector in India. This concept is catching up the world over as this sector focuses on the maintenance of health rather than cure. The trauma involved in cure, high escalating costs and the shrinking size of families makes Wellness a better option than cure. India is known amongst westerners for its ancient wisdom and knowledge. If we plan well, this sector can become another IT sector in terms of generating goodwill and tourist interest in our country. To enable this the industry should streamline service provision and make the process of delivery international in standards. To enable this, the industry must offer comprehensive services. Service provision must be well thought our and streamlined. Process efficiency, apart from providing good standards of customer encounters, should also aim at making the customer a life long member.

IntroductionTreating tobacco dependency in patients admitted to acute care National Health Service (NHS) trusts is a key priority in the NHS 10-year plan. This paper sets out the results of a health economic analysis for ‘The CURE Project’ pilot; a new hospital-based tobacco dependency service.MethodsA health economic analysis to understand the costs of the intervention (both for the inpatient service and postdischarge costs), the return on investment (ROI) and the cost per quality-adjusted life year (QALY) of the CURE Project pilot in Greater Manchester. ROI and cost per QALY were calculated using the European Study on Quantifying Utility of Investment in Protection from Tobacco and Greater Manchester Cost Benefit Analysis Tools.ResultsThe total intervention costs for the inpatient service in the 6-month CURE pilot were £96 224 with a cost per patient who smokes of £40.21. The estimated average cost per patient who was discharged on pharmacotherapy was £97.40. The cost per quit (22% quit rate for smokers at 12 weeks post discharge) was £475. The gross financial ROI ratio was £2.12 return per £1 invested with a payback period of 4 years. The cashable financial ROI ratio was £1.06 return per £1 invested with a payback period of 10 years. The public value ROI ratio was £30.49 per £1 invested. The cost per QALY for this programme was £487.DiscussionThe CURE Project pilot has been shown to be exceptionally cost-effective with highly significant ROI in this health economic analysis. This supports the NHS priority to embed high-quality tobacco addiction treatment services in acute NHS trusts, and the CURE Project provides a blueprint and framework to achieve this.

Purpose – This paper aims to address the gaps in service recovery strategy assessment. An effective service recovery strategy that prevents customer defection after a service failure is a powerful managerial instrument. The literature to date does not present a comprehensive assessment of service recovery strategy. It also lacks a clear picture of the service recovery actions at managers’ disposal in case of failure and the effectiveness of individual strategies on customer outcomes. Design/methodology/approach – Based on service recovery theory, this paper proposes a formative index of service recovery strategy and empirically validates this measure using partial least-squares path modelling with survey data from 437 complainants in the telecommunications industry in Egypt. Findings – The CURE scale (CUstomer REcovery scale) presents evidence of reliability as well as convergent, discriminant and nomological validity. Findings also reveal that problem-solving, speed of response, effort, facilitation and apology are the actions that have an impact on the customer’s satisfaction with service recovery. Practical implications – This new formative index is of potential value in investigating links between strategy and customer evaluations of service by helping managers identify which actions contribute most to changes in the overall service recovery strategy as well as satisfaction with service recovery. Ultimately, the CURE scale facilitates the long-term planning of effective complaint management. Originality/value – This is the first study in the service marketing literature to propose a comprehensive assessment of service recovery strategy and clearly identify the service recovery actions that contribute most to changes in the overall service recovery strategy.

These facts prove that, contrary to widespread belief, no health care system offers a magic cure for rising costs. Something else is going on. The "something else" is that health care, like education and police work, is a "handicraft service." Characteristically, these activities can't be automated or sped up and made more productive. Doctors, for instance, simply cannot work much faster than they do without cutting into quality. True, technological advances can and do add some productivity to these fields, but not that much ... This important phenomenon is called "the cost disease of the handicraft services" and it undermines a basic assumption of some health reforms. If, by its craft nature, health care is condemned to low productivity growth and rapidly rising costs, then these inherent limits will simply not be correctable by price controls or other reforms of the system. In other words, cost increases are in the nature of the health care beast. Efforts to alter this nature will be fruitless or harmful.

Due to increasing demand for energy around the world, the prevalence of global megaprojects within the oil and gas industry is increasing. Process pipes, valves and vessels may be manufactured and coated in China or Korea, where labour costs are comparatively low, before being transported to the final project location, such as Western Australia. During the transport and fabrication phase, coated steelwork may spend months or even years exposed to harsh offshore or coastal environments before going into service. This means coatings must be able to provide protection throughout an extensive construction phase, in addition to the in-service lifetime of the steel. This paper examines the demands on high temperature performance coatings both before and once in service. Test methodology and exposure data are reviewed with a focus on how modern aluminium pigmented silicone coatings provide a solution to the corrosion challenges faced in global megaprojects.

Distributed Denial of Service attack (DoS attack) is a cyber attack where the perpetrator seeks to make a machine or network resource unavailable to its intended users by temporarily or indefinitely disrupting services of a host connected to the internet. Denial of service is typically accomplished by flooding the targeted machine or resource with superfluous requests in an attempt to overload systems and prevent some or all legitimate requests from being fulfilled. It is necessary to analyze the fundamental features of DDoS attacks because these attacks can easily vary the used port/protocol, or operation method because they are designed to restricted applications on limited environments.DDoS attack detection very difficult because the non-existence of predefined rules to correctly identify the genuine network flow. A combination of unsupervised data mining techniques as IDS are introduced. The Entropy Method concept in term of windowing the incoming packets is applied with data mining technique using Clustering Using Representative (CURE) as cluster analysis to detect the DDoS attack in network flow. The data is mainly collected from datasets. The CURE DDoS attack detection technique based on entropy gives a promising way to analyze this attack and construct an efficient detection model using a clustering data mining techniques. This approach has been evaluated and compared with several existing approaches in terms of accuracy, false alarm rate, detection rate, F. measure and Phi coefficient.

Thesis (M.S. in Management) Naval Postgraduate School, June 2000.
Thesis advisor(s): Lewis, Ira A.; Liao, Shu S. "June 2000." Includes bibliographical references (p. 63-64). Also available in print.

This thesis is about the Tukula Fenna Project (TFP) that was set up at the Home Care Department of St. Raphael of St Francis Hospital (Nsambya Hospital) in Kampala, Uganda. In 2003, Associazione Casa Accoglienza alla vita “Padre Angelo” (ACAVPA) or “HOUSE FOR LIFE, Father Angelo” and other Italian partners; in particular, PENTA Foundation and University of Padova, Department of paediatrics collectively signed a memorandum of understanding (MoU) with Nsambya Hospital. The aim of the MoU was to collaborate with the hospital in the fight against HIV particularly in children and adolescents, orphans and vulnerable children (OVC) and their families in Kampala and three surrounding districts (Mukono, Wakiso and Mpigi). Thus, the MoU officially established the children’s HIV programme at Nsambya Hospital, Home Care Department in 2003. The programme was then called the “PCP Project” because the initial intervention was among other things, providing Cotrimoxazole prophylaxis against Pneumocystis Carinii pneumonia (PCP, also known as Jiroveci Pneumonia). As more resources including provision of antiretroviral drugs (ARVs) from external sources and expertise became available over the years, the project evolved into a full-blown HIV programme for infants, children and adolescents as well as their families and caretakers. Additionally, the name “PCP”, was replaced by “Tukula Fenna”, which means “growing up together” in the local language (Luganda). The project was implemented at the Home Care Department within an existing community home-based care (CHBC) model that evolved in response to the HIV epidemic in Uganda, and other high-burden resource-limited settings. The TFP provides comprehensive HIV care, treatment and psychosocial support services (PSS) and apart from operating at the Home Care department of Nsambya Hospital, it also operates at Ggaba Parish Outreach Clinic and 3 other outreach clinics in and around Kampala. This thesis describes the research outcomes of the project that was managed by Dr. Massavon from 2008 to 2013. It reviews the published literature from the key milestones of the HIV epidemic to the post-conflict health reforms in Uganda and their relevance to current health outcomes, the national AIDS response and health systems strengthening. The literature review also examines the human resources for health (HRH) crisis and task shifting in the scaling up of ART in high-burden resource-limited settings. In addition, the review looks at the evolution of complementary HIV service delivery models like community and home-based care as a spontaneous response to the HIV epidemic in many resource-limited settings including Uganda. Finally, the literature documents that, there are relatively few paediatric HIV services in the country, leading to poor geographical access and a low antiretroviral therapy (ART) coverage for children and that, HIV-infected children and in particular, AIDS orphans are an underserved and an understudied population. At the time of this thesis, approximately 2,100 infants, children and adolescents had been enrolled into care in the TFP; about 1140 were active in care, and about 60% were on ART. Approximately, 47% of children and adolescents in the project are orphans. This thesis therefore aims at contributing to improving paediatric HIV management through operational research in the context of a CHBC model in Kampala, Uganda. The findings cover key outcomes such as retention in care, attrition and loss to follow up (LTFU), treatment failure, mortality on antiretroviral therapy (ART) and operationalization of dried blood spots (DBS) for viral load testing among HIV-infected children. The thesis also included a specific study on HIV-Epstein-Barr Virus (EBV) co infections in children and adolescents, considered relevant to the project setting. Except for study 5 (EBV study) which was a cross-sectional study, the studies were generally retrospective cohort studies conducted at the Home Care Department of Nsambya Hospital in Kampala, Uganda. The methodology of the operational research was based on an implementation schema derived from the ART guidelines of the WHO and Uganda (Figure 17). The selection of the outcomes for the operational research was based on the rationale that, they have direct bearings on implementation and potentially could improve the same. The findings and implications from the six studies that constitute the chapters of the thesis are summarized as follows: Study 1: This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC with national averages from 2007-2011. The core findings show that Nsambya CHBC activities enhance and complement national HIV and TB management, and resulted in better outcomes when compared to the national averages. This approach may hold the potential for chronic disease management in resource-limited settings. Scaling up CHBC could have wider positive impacts on the management of not only HIV and TB, but also other chronic diseases as well as the general health system. A long-standing “faith-based solidarity” among international donors and partners has been pivotal to the survival and evolution of the Nsambya CHBC. Study 2: This is a retrospective cohort analysis of attrition and LTFU and their predictors among children and adolescents aged 0-20 years. Over the study period, 5.34% (62) of patients died, 37.61% (437) were LTFU, and thus overall attrition was 42.94% (499). Generally, attrition and LTFU were relatively high among children and adolescents in the TFP. Not receiving ART was the single factor significantly associated with attrition in the cohort, while both baseline BMI z-scores and receipt of ART were protective against LTFU among HIV positive children and adolescents. Efforts should be made to initiate ART among all paediatric patients as soon as possible, and to provide aggressive follow-up for those not yet receiving ART. Orphans need more nutritional support to reduce the burden of malnutrition and improved access to early ART, which could also promote growth responses in this vulnerable and understudied group. Study 3: This retrospective cohort study reviewed records from HIV positive children age 0 to 18 years engaged in a CHBC and a Facility-based, family-centred approach (FBFCA) from 2003 to 2010 focussing on retention in care, loss to follow-up, mortality, use of ART, and clinical characteristics. Irrespective of model of care, children receiving ART had better retention in care and therefore long-term survival. Encouragingly, if children were on ART, then their survival was as good, if not slightly better, in the CHBC compared to the FBFCA. Based on our observations, substantial improvement in child survival can be achieved in either a community-based or a family-care model as long as HIV- infected children are identified early and begun on ART. To ensure this occurs, early identification of HIV infected children requires strong linkages of pregnant HIV- infected women to prevention of mother to child transmission (PMTCT) services; active tracking to ensure all HIV exposed infants receive Polymerase Chain Reaction-based early infant diagnosis. Additionally, rapid early initiation of ART among HIV infected infants and children are essential. Study 4: This is an observational study that included HIV-infected children attending the Beira Central Hospital (Mozambique) and the Nsambya Hospital, Home Care Department (Uganda), and evaluated clinical and immunological failure according to the WHO 2006 guidelines. Two hundred and eighteen of 740 children with at least 24 weeks follow-up experienced treatment failure ((29% 95%CI (26-33)), with crude incidence of 20.0 events per 100 person-years (95%CI 17.5-22.9). Having tuberculosis co-infection or WHO stage 4, or starting a non-triple cART significantly increased the risk of failure. Drug toxicity (18.3%), drug availability (17.3%) and anti-tuberculosis drug interactions (52, 25.7%) were the main reported reasons while only 9 (4%) patients switched cART for clinical or immunological failure. Considerable delay in switching to second line cART may occur despite an observed high rate of treatment failure. Our findings reinforce the need for simplification of more effective clinical and immunological criteria for prompt recognition of cART treatment failure. Children presenting with advanced disease and TB co-infection should be targeted for closer and more sensitive monitoring of treatment response. This should be matched with a constant provision of appropriate antiretroviral drugs with optimization of first line drugs and treatment sequencing. Supply of new paediatric formulations for second line regimens and drug optimization should be considered as critical milestones to allow scaling up of early cART and reduction of treatment failure in children. Study 5: In this cross-sectional study, dried blood spot (DBS) samples from 213 HIV-1 infected children were collected and EBV DNA was extracted and analysed for quantification of EBV types 1 and 2 and for quantification of 16S ribosomial DNA (16S rDNA), a marker of microbial translocation. Ninety-two of 140(66%) children on ART and 57 of 73(78%) ART-naive children had detectable EBV levels. Co-infection with both EBV types was significantly less frequent in ART-treated than in ART-naïve children (OR=0.54, 95%CI 0.30;0.98, p=0.042). HIV-1 inducing microbial translocation and a state of persistent immune activation, may lead to EBV replication and expansion of EBV-infected B-cells, thus increasing the EBV-DNA load. Super-infection by both types of EBV in HIV-1 infected subjects may represent an additional risk for the onset of EBV-related malignancies. ART, by limiting HIV-1 replication, microbial translocation and related immune activation, may prevent super-infection by both EBV types and keep EBV viremia down, thus reducing the risk of EBV-associated lymphomas. Study 6: This was a retrospective study to evaluate viral load (VL) using DBS and to explore the accuracy of clinical and immunological criteria for treatment failure (TF) in a cohort of HIV-1-infected children. In this cohort, immunological and clinical criteria as per WHO 2010 guidelines poorly predicted the presence of a viral load greater than either 1000 cp/ml or 5000 cp/ml (whole blood) from DBS. The low sensitivity and positive predictive values for immunological and/or clinical failure confirm those reported by the literature. This finding further supports the WHO recommendations that VL monitoring should be implemented and used to identify cases of treatment failure earlier. Policy implications of key findings of thesis Scaling up CHBC could have wider positive impacts on the management of not only HIV and TB, but also other chronic diseases as well as the general health system. In this thesis, and in line with the literature, Early ART initiation was associated with improved survival and retention in both community-based and facility-based approaches. ART is potentially protective against EBV-related lymphoproliferative disorders in HIV-EBV co infected children. This calls for early ART initiation and close monitoring in such children. Operationalization of the use of DBS in viral load monitoring in HIV-infected children in low and middle-income countries is feasible and should be encouraged to improve the quality of paediatric HIV management in such settings. The low ART coverage among children calls for urgent, greater and more effective decentralization of paediatric ART services within primary health care services at the district and sub-district levels in the general health system in Uganda. Children presenting with advanced HIV disease and TB co-infection should be targeted for closer and more sensitive monitoring of treatment response. Orphans need more nutritional support to reduce the burden of malnutrition and improved access to early ART, which in turn could promote growth responses in this vulnerable and understudied group
Questa tesi descrive il Progetto Fenna Tukula (TFP) in corso presso il Home Care Department dell'Ospedale St. Raphael e St. Francis (Nsambya Hospital) a Kampala (Uganda). Nel 2003, l'Associazione Casa Accoglienza alla Vita "Padre Angelo" (ACAVPA) insieme ad altri Partner (in particolare la Fondazione PENTA e l'Università di Padova), hanno firmato una lettera di intenti con il Nsambya Hospital. L'obiettivo di questo documento era di collaborare con l'ospedale nella lotta all'AIDS nei bambini ed adolescenti, orfani (OVC) e le loro famiglie a Kampala e nei distretti circostanti di Mukono, Wakiso e Mpigi. Il progetto è stato chiamato inizialmente "PCP project" in quanto l'intervento consisteva essenzialmente nella profilassi con il Cotrimoxazole per la prevenzione della polmonite da Pneumocystis Carinii (conosciuta anche come Jiroveci Pneumonia). Dopo due anni dall’inizio del progetto grazie ad una aumentata disponibilita’ di risorse e’ stato possibile fornire ai bambini che ne avevano necessita’ la terapia con farmaci antiretrovirali (ARVs) da e quindi il progetto si e’ inidirizzato verso un programma 'tout-court' di lotta all'AIDS pediatrico con un approccio globale, che includeva anche le famiglie e non solamente i bambini. Di conseguenza, il nome "PCP" è stato rimpiazzato da "Tukula Fenna", che significa "crescere insieme" nella lingua locale (luganda). Il progetto si e’ caratterizzato con l’implementazione di un modello di cure domiciliari (CHBC) adattato alla realta’ dell’ Uganda andando quindi oltre i confini dello NHC fino a comprendere delle strutture periferiche tra cui la Clinica della Parrocchia di Ggaba ed altre 3 cliniche nei dintorni di Kampala. Questa tesi descrive i risultati dell’ attivita’ di ricerca svolta nell’ ambito del progetto che è stato coordinato dal Dr. Massavon tra il 2008 e il 2013. La tesi si articola in una prima parte di revisione della letteratura con particolare riferimento alla realta’ ugandese sia da un punto di vista dell’ epidemiologia dell’ HIV che dell’ organizzazione sanitaria nel paese con particolare riferimento all'evoluzione dei modelli sanitari finalizzati alla lotta all'AIDS, come modelli di cura comunitaria o domiciliari. L’ analisi della letteratura ha documentato che, in Uganda vi sono relativamente pochi servizi specialistici sull’ HIV pediatrico. Tale aspetto ha come conseguenza una disparita’ tra le varie regioni del paese e un limitato accesso alla terapia antiretrovirale per i bambini soprattutto coloro che sono senza genitori naturali. A dicembre 2013 circa 2.100 bambini ed adolescenti sono stati arruolati nel TFP. 1.140 sono seguiti regolarmente e il 60% di loro sono in terapia con ART. Il 47% dei bambini è orfano. La finalita’ ultima della tesi e’ quello di contribuire al miglioramento delle cure nei bambini HIV positivi in Uganda attraverso la valutazione di un modello di assistenza domiciliare. In quest’ ottica l’ attivita’ di ricerca si e’ articolata nella valutazione delle caratteristiche dei pazienti persi al follow-up, dell’ outcome della terapia antiretrovirale e, in un ambito piu’ prettamente clinico, nello studio dell’ impatto della infezione da EBV sulla progressione della malattia da HIV. L’ attivita’ si e’ sviluppata attorno diverse linee di ricerca i cui risultati sono stati pubblicati (o in corso di pubblicazione) nei lavori i cui elementi fondamentali sono riassunti di seguito: Studio 1: Studio osservazionale retrospettivo che analizza i risultati del follow-up dei pazienti con HIV e TB (adulti e bambini) seguiti presso lo Nsambya Hospital confrontandoli con i dati nazionali tra il 2007 e il 2011. I risultati mostrano che il modello seguito allo Nsambya ha prodotto migliori risultati in termini di morbilita’ e mortalita’ rispetto alle medie nazionali. Il modello descritto basato sull’ assistenza domiciliare potrebbe essere utilizzato anche in altri contesti nei paesi in via di sviluppo. Studio 2: Analisi di coorte retrospettiva per la valutazione delle caratteristiche dei pazienti persi al follow up (LTFU) e dei fattori di rischio associati, nei bambini ed adolescenti tra 0 e 20 anni. Nel corso del periodo di follow up considerato, il 5,3% dei pazienti è deceduto, il 37,6% e’ stato perso al follow-up con un “attritio” globale del 42,9%. In generale, LTFU sono stati relativamente alti tra i bambini e gli adolescenti nel TFP. La terapia con ARV e la crescita regolare sono stati fattori associati con la permanenza in follow up e con la sopravvivenza. Tali osservazioni suggeriscono come gli sforzi dovrebbero essere indirizzati ad iniziare la ART nei pazienti pediatrici il prima possibile, e a fornire un follow-up regolare a coloro che non sono ancora in terapia. Particolare attenzione va data agli orfani che necessitano di un supporto alimentare particolarmente attento e di un follow up regolare per definire il momento migliore quando iniziare la ART. Studio 3: Studio di coorte retrospettivo che ha studiato i bambini HIV positivi tra 0 e 18 anni inseriti in un programma di assistenza domiciliare con un approccio centrato sulla famiglia (FBFCA) dal 2003 al 2010, focalizzandosi sulla perdita al follow-up, la mortalità, l'uso di ART e le caratteristiche cliniche. A prescindere dal modello di cura, i bambini che ricevevano l'ART sono seguiti piu’ regolarmente e di conseguenza hanno una sopravvivenza a lungo termine maggiore. Basandosi sulle nostre osservazioni, un miglioramento sostanziale nella sopravvivenza dei bambini può essere raggiunto sia con un modello basato sulla assistenza domiciliare che sul coinvolgimento attivo della comunita’. Studio 4: Studio osservazionale prospettico che ha incluso bambini HIV positivi assistiti presso il Beira Central Hospital, in Mozambico e lo Nsambya Hospital, che ha valutato il rischio di fallimento immunologico e clinico secondo le linee guida del WHO del 2006. 218 su 740 bambini con almeno 24 settimane di follow-up ha avuto un fallimento della terapia ((29% 95% CI (26-33)), con una incidenza di 20.0 eventi su 100 anni-persona (95%CI 17.5-22.9). La coinfezione con la TB, la presenza di AIDS (WHO stadio 4), o l’inizio della ART con uno o due farmaci aumenta significativamente il rischio di fallimento terapeutico. Un ritardo considerevole nel passaggio alla seconda linea di cART si e’ osservato nonostante un alto tasso di fallimento terapeutico. Tali osservazioni sottolineano ancora una volta l’importanza di garantire un efficace monitoraggio clinico e immunolgico per poter modificare la terapia prima che insorgano ceppi virali resistenti. Insieme alla necessita’ di un corretto monitoraggio va sottolineata l’importanza di garantire una fornitura di farmaco regolare senza interruzioni e le formulazioni pediatriche per i bambini piu’ piccoli Studio 5: Studio trasversale, effettuato su campioni raccolti in cartoncini assorbenti (DBS) prelevati da 243 bambini affetti da HIV-1 da cui e’ stato estratto il DNA del EBV per analisi e quantificazione dei tipi 1 e 2, e per la quantificazione di 16s DNA ribosomiale (16S rDNA), un marker di traslocazione microbica. 92 su 140 (66%) dei bambini in terapia con ART e 57 su 73 (78%) di bambini non trattati sono risultati positivi all’ EBV. La coinfezione con entrambi i tipi di EBV è stata significativamente meno frequente in coloro in terapia con ART (OR=0.54, 95%CI 0.30; 0.98, p=0.042). Tale osservazione e’ compatibile con il fatto che ' HIV-1, che induce una traslocazione microbica e uno stato di persistente attivazione immunitaria, può portare a una replicazione di EBV ed ad una espansione di cellule B infette, aumentando di conseguenza il DNA dell'EBV. La co-infezione da EBV in soggetti affetti da HIV-1 può rappresentare un rischio addizionale per lo scatenarsi di tumori (linfomi) associati al EBV. Il trattamento con ART, riducendo la replicazione dell’ HIV-1, la traslocazione microbica e la relativa attivazione immunitaria, può prevenire la super infezione da EBV e mantenere la viremia EBV bassa, riducendo il rischio di linfomi ad esso associata. Studio 6: Studio retrospettivo per valutare la carica virale dell’HIV (VL) su campioni raccolti in DBS e per esplorare l'accuratezza dei criteri clinici ed immunologici per la definizione del fallimento terapeutico. La bassa sensibilità e valore predittivo del fallimento clinico e/o immunologico, da noi osservate, confermano quanto riportato in letteratura. Questa osservazione supporta ulteriormente la raccomandazione del WHO che il monitoraggio della carica virale debba essere implementato ed utilizzato per identificare precocemente casi di fallimento del trattamento. Implicazioni dei risultati della tesi e messaggi chiave Il modello assistenziale centrato sull’ assistenza domiciliare e’ risultato molto efficace per ridurre il rischio di perdita al follow up. Tale modello potrebbe quindi essere considerato anche per l’assistenza dei malati di TB o con altre malattie croniche. Le nostre osservazioni supportano quanto gia’ riportato in letteratura che l’inizio precoce dell’ ART e’ era associato non solo aduna migliore sopravvivenza ma anche ad un minor rischio di perdita al follow up. Il trattamento ART è potenzialmente protettivo contro patologie linfoproliferative correlate al EBV nei bambini con coinfezione da HIV ed EBV. L’uso del DBS per il monitoraggio della carica virale nei bambini HIV positivi si e’ rivelato fattibile sia da un punto di vista organizzativo che della qualita’ dei campioni da testare. Tale metodica dovrebbe quindi essere incoraggiata per migliorare la qualità della gestione pediatrica dell'HIV soprattutto nei paesi in via di sviluppo La bassa copertura di ART tra i bambini richiede un urgente, maggiore e più efficace decentramento dei servizi pediatrici centrali e la loro integrazione con i servizi sanitari di base a livello distrettuale e sub-distrettuale in Uganda. I bambini che presentino uno stadio avanzato di infezione HIV e coinfezione da TB dovrebbero essere sottoposti a monitoraggio più serrato per iniziare il trattamento ART appena cio’ si renda necessario. Gli orfani necessitano un particolare attenzione sia per quanto riguarda il supporto nutrizionale che il monitoraggio clinico e immunologico necessario per iniziare correttamente la ART.

Objetivou-se com o presente trabalho investigar as relações existentes entre dois espaços de \"cura\": o serviço local de saúde e a instituição religiosa, representada pelas várias Igrejas Pentecostais. A investigação, de corte qualitativo, baseou-se em depoimentos colhidos de sujeitos que frequentavam simultaneamente estes dois espaços de \"cura\". Concluiu-se que os dois espaços são usados conjuntamente e percebidos como nítidamente distintos. Através da análise dos depoimentos foi possível estabelecer uma série de categorias distintivas que permitem especificar as particularidades e diferenças entre o espaço racionalcientífico e o espaço religioso, quando se trata de \"cura\". Concluiu-se também que os sistemas oficiais tem muito a aprender dos \"sistemas religiosos\", notadamente no que diz respeito ao caráter \"acolhedor\" destes últimos.
The objective of this work is to investigate the relationships between two \"cure\" spaces: the local health service and the religious institution represented here by several Pentecostal Churches. The qualitative section investigation was based on statements taken from people who attended the two \"cure\" spaces simultarieously. We concluded that the two spaces are used concurrently and understood as clearly distinct. Through the analysis of the statements it was possible to establish a series of different categories permitting to specifY peculiarities and dissimilarities between the -rational - scientific and the religious spaces when we refer to \"cure\". We have also concluded that the official systems have much to leam from \"religious systems\" especially when considering the \"welcoming\" character of the latter ones.

Objetivou-se com o presente trabalho investigar as relações existentes entre dois espaços de \"cura\": o serviço local de saúde e a instituição religiosa, representada pelas várias Igrejas Pentecostais. A investigação, de corte qualitativo, baseou-se em depoimentos colhidos de sujeitos que frequentavam simultaneamente estes dois espaços de \"cura\". Concluiu-se que os dois espaços são usados conjuntamente e percebidos como nitidamente distintos. Através da análise dos depoimentos foi possível estabelecer uma série de categorias distintivas que permitem especificar as particularidades e diferenças entre o espaço racional científico e o espaço religioso, quando se trata de \"cura\". Concluiu-se também que os sistemas oficiais tem muito a aprender dos \"sistemas religiosos\" notadamente no que diz respeito ao caráter \"acolhedor\" destes últimos.
The objective of this work is to investigate the relationships between two \"cure\" spaces: the local health service and the religious institution represented here by several Pentecostal Churches. The qualitative section investigation was bas.ed on statements taken from people who attended the two \"cure\" spaces simultarieously. We concluded that the two spaces are used concurrently and understood as clearly distinct. Through the analysis of the statements it was possible to establish a series of different categories permitting to specify peculiarities and dissimilarities bet\\veen the -rational - scientific and the religious spaces when we refer to cure\". We have also concluded that the official systems have much to leam from \"religious systems\" especially when considering the \"welcoming\" character o f the latter ones.

AbstractThe United States Public Health Service Syphilis Study at Tuskegee was the longest “medical experiment” in the United States. It was an unethical study that harmed 623 black men and their families in Macon County, Alabama. There were no protocols, no (simple) informed consent, and no end date, but there was deception. These men had no idea they were in a study. They were vulnerable to those who they thought were medical doctors of good-will, assigned to their community to help cure their “bad blood.” This chapter follows the narratives of two men who were victims of the Study, Mr. Charles Pollard and Mr. Herman Shaw, and a venereal disease expert, Dr. John Cutler, who refused to admit that he and his colleagues did anything wrong. Positive results came from the Study. Informed consent and Institutional Review Boards as requirement to medical treatment and human-subjects experiments. Additionally, the Syphilis Study and men in the Study can teach us what it means to involve empathic care in our ethics and how to understand the role of trustworthiness in our values.

Bismaleimide (BMI) resins are commonly used in advanced carbon composites for their high service temperature and excellent mechanical properties. In this study, two different BMI resins were compared: 1) formula RS-8HT, a high-cure temperature resin requiring pressurized consolidation, and 2) formula BMI-2, a lower cure temperature resin compatible with vacuum bag only fabrication. The objective was to identify a suitable high-temperature resin system for hybrid aerospace gear application, however, these materials are applicable to a variety of hot-zone parts. Laminates were fabricated from each resin type and characterized by their fiber volume fraction, compression strength vs. temperature, and glass transition temperature (Tg). Optical microscopy was performed to verify laminate quality. It was found that the carbon/RS-8HT laminates were prone to thermally-induced cracking, especially during post-cure. Carbon/BMI-2 laminates were found to attain a high degree of cure and high Tg from a realtively low temperature cure, without crack development. Additionally, the fiber volume fraction of the carbon/BMI-2 laminates, which were fabricated by a vacuum bag only process, were similar to that of the autoclave-processed carbon/RS-8HT laminates.

Crucial to developing the next generation of high-performance composites are multiscale process models which have the capacity to predict in-service performance affecting residual stresses and deformations generated during manufacturing. Length scale and geometrical complexity of composites increase in tandem; thus, process models must rely upon methods for homogenization of the curing process. This work proposes a novel, high-fidelity computational approach which leverages finite element (FE) analysis at the microscale to predict effective composite properties at arbitrary cure and temperature states. The approach is applied to a high-fidelity representative volume element (RVE) and low-fidelity repeating unit cell (RUC) that models a 75% fiber volume fraction AS4-carbon fiber/epoxy composite microstructure. Elastic properties of the composite are characterized across several temperature and cure states for each FE model. Two classical closed-form composite homogenization approaches are also used to predict effective properties at each cure state. Predictions obtained by each method are compared against those of the RVE on a state-by-state and property-to-property basis.

Feline sporotrichosis is a zoonosis transmitted by Sporothrix brasiliensis that causes cutaneous and disseminated lesions. The study aimed to evaluate the efficiency of the clinical routine, diagnosis and treatment of feline sporotrichosis. 96 cases suggestive of sporotrichosis were analyzed, through clinical and laboratory examinations. A protocol defined by the Sporotrichosis Service of the Zoonosis Control area of ​​the City of Vitória – ES was recommended. The material was collected by Swabs or by the imprint method , from an exudative lesion, identified, packaged and examined in the laboratory. Of the 95 (100%) animals were diagnosed with sporotrichosis, 69 (73%) submitted to the proposed treatment (itraconazole or itraconazole + potassium iodide) were cured and 26 (27%) were unsuccessful in the treatment. Therefore, it is concluded that felines between 23 months and 35 weeks, classified in stages I and II of treatment, achieved satisfactory cure rates and demonstrated that the therapeutic protocol used was effective.

<p>Presently, no systematic policy for the preventive conservation of the built cultural heritage exists in South-West Europe. Current approaches for inspection, diagnosis, monitoring and reactive conservation are normally intermittent, unplanned, expensive and lack methodical strategy. The available financial resources are scarce and are mostly addressed to listed buildings. Besides, owners and stakeholders often reveal reluctance to invest in preventive conservation and maintenance programs. In view of these considerations, and driven by the principle “prevention is better than cure”, the HeritageCare project has developed a system for the preventive conservation and maintenance of the built heritage. The main aim of this paper is to briefly describe the methodology, including its three levels of service, and present the main results of the implementation and validation of the service level 1 on a case study belonging to the Portuguese architectural heritage.</p>

Today all over the world costs of medical services are growing and alternative ways of effective financing of health care are being researched. During the reforms the Kyrgyz Republic introduced a system of compulsory medical insurance, the institution of family medicine and a "single payer" system. Methods of payment for hospital services flush to an artificial increase in the number of hospitalizations and unnecessary assignment of diagnostic and therapeutic procedures. The main brake of health care reform is underfunding of sector. Improving health care is possible by limiting the free medical care. The replacement of free care by paid services occurs spontaneously, there are abuses and the shadow economy in health care. The Compulsory medical insurance doesn’t have such terms as an accident, insurance risk, and the current model in Kyrgyzstan is not a real model of insurance and serves as a kind of state-funding health care. The most part of the population in rural areas is not involved in the payment of health insurance due to unemployment. Patients pay a fee in addition to medication, and also carry out informal payments to doctors, that is, patient with co-payments have to repeatedly pay for the same medical service without a guarantee of a cure. Taking into account the experience of other countries, the imposition of patient payment for their own care is more just to bringing the patient for his treatment.

Combining one or more functional capabilities of subsystems within a structure can provide system-level savings, particularly for weight-critical applications such as air and space vehicles. Nanoengineering presents a significant opportunity for additional functionalities on the nanoscale without the necessity to modify shape, design, or load carrying capacity of the structure. Here, an integrated-multifunctional nano-engineered system was preliminarily studied in composite laminate structures. The study would support the exploration of a system designed to serve independent yet synergistic functionalities in life-cycle enhancements, energy savings during manufacturing, in-situ cure (manufacturing) monitoring, and in-service damage sensing. For the preliminary study, an integrated multifunctional composite (IMC) laminate was created via aligned nanofiber introduction into the composite interlaminar region and the laminate surfaces of Hexcel E-glass/913 unidirectional glass fiber prepreg. Various heights ranging from 10 - 40 μm-tall vertically aligned carbon nanotube (VA-CNT) arrays, as well as patterned and buckled VA-CNT architectures, were used to reinforce the weak interlaminar regions within the laminates showing a ~ 4 - 5% increase in short beam strength of VA-CNT reinforced specimens hence demonstrating interlaminar enhancement for life-cycle advancements. The same layers, being electrically conductive, can provide several additional multifunctionalities.

Confirmed coronavirus cases in Africa in early November 2020 exceeded 1.8 million, with 45% occurring in Southern Africa (SAF). Most SAF countries lack the capacity to adequately protect lives and livelihoods. High indebtedness means underfunded essential services, and most countries had just emerged from a severe food crisis and the effects of Cyclone Idai. Donors must go beyond temporary debt service suspension and provide new aid grants. SAF governments must not use the pandemic to restrict civil society advocacy on behalf of the most vulnerable people.

Water-quality monitoring in National Park Service units of the Northern Colorado Plateau Network (NCPN) is made possible through partnerships between the National Park Service Inventory & Monitoring Division, individual park units, the U.S. Geological Survey, and the Utah Division of Water Quality. This report evaluates data from site visits at 62 different locations on streams, rivers, and reservoirs in or near ten NCPN park units between October 1, 2015 and September 30, 2018. Data are compared to state water-quality standards for the purpose of providing information to park managers about potential water-quality problems. The National Park Service does not determine the regulatory status of surface waters; state water quality agencies determine whether waters comply with the Clean Water Act. Evaluation of water-quality parameters relative to state water-quality standards indicated that 17,997 (96.8%) of the 18,583 total designated beneficial-use evaluations completed for the period covered in this report met state water-quality standards. The most common exceedances or indications of impairment, in order of abundance, were due to elevated nutrients, elevated bacteria (E. coli), elevated water temperature, elevated trace metals, elevated total dissolved solids (and sulfate), elevated pH, and low dissolved oxygen. While some exceedances were recurring and may have been caused by human activities in the watersheds, many were due to naturally occurring conditions characteristic of the geographic setting. This is most apparent with phosphorus, which can be introduced into surface water bodies at elevated levels by natural weathering of the geologic strata found throughout the Colorado Plateau. Higher phosphorus concentrations could also be attributed to anthropogenic activities that can accelerate erosion and transport of phosphorus. Some activities that can increase erosional processes include grazing, logging, mining, pasture irrigation, and off-highway vehicle (OHV) use. Exceedances for total phosphorus were common occurrences at nine out of ten NCPN park units, where at least one site in each of these parks had elevated phosphorus concentrations. At these sites, high levels of nutrients have not led to algal blooms or other signs of eutrophication. Sites monitored in Arches National Park (NP), Black Canyon of the Gunnison NP (BLCA), Bryce Canyon NP (BRCA), Capitol Reef NP (CARE), Curecanti National Recreation Area (CURE), Dinosaur National Monument (DINO), and Zion NP (ZION) all had E. coli ex-ceedances that could be addressed by management actions. While many of these sites already have management actions underway, some of the actions necessary to bring these waters into compliance are beyond the control of the National Park Service. Changes to agricultural practices to improve water quality involves voluntary participation by landowners and/or grazing permittees and their respective states. This could be the case with lands upstream of several parks with E. coli contamination issues, including Red Rock Canyon (BLCA); Sul-phur, Oak, and Pleasant creeks (CARE); Blue Creek and Cimarron River (CURE); Brush and Pot creeks (DINO); and North Fork Virgin River (ZION). Issues with E. coli contamination at Yellow Creek (BRCA) seemed to be resolved after the park boundary fence downstream of the site was repaired, keeping cattle out of the park. At North Fork Virgin River, E. coli exceedances have been less frequent since the State of Utah worked with landowners and grazing permittees to modify agricultural practices. Continued coordination between the National Park Service, state agencies, and local landowners will be necessary to further re-duce E. coli exceedances and, in turn, improve public health and safety in these streams. Selenium concentrations in Red Rock Canyon (BLCA) continued to exceed the state aquat-ic-life standard at both the upstream and downstream sites. Although selenium weathers naturally from bedrock and...

Decentralization of provision of public services has been an important item in the agenda of developing countries. While some scholars and practitioners argue that decentralization is associated with improvements in provision due to higher accountability, others note its potential pitfalls. In particular, decentralization to local communities characterized by poverty, low levels of education, and inequality may lead to low accountability and higher susceptibility to political capture. This paper explores these dynamics empirically, taking advantage of the fact that in Brazilian municipalities primary education is provided by schools under municipal as well as under state management. The performance of these two types of school in the same municipalities is compared in terms of their levels of inputs and the efficiency of service delivery using non-parametric data envelopment analysis (DEA). The results suggest that there are indeed drawbacks to decentralization in municipalities where inequality is higher and education and political participation are lower.

The curve number method first developed by the US Department of Agriculture Soil Conservation Service (now the Natural Resources Conservation Service) is often used for post-wildfire runoff assessments. These assessments are critical for land and emergency managers making decisions on life and property risks following a wildfire event. Three approaches (i.e., historical event observations, linear regression model, and regression tree model) were used to help estimate a post-wildfire curve number from watershed and wildfire parameters. For the first method, we used runoff events from 102 burned watersheds in Colorado, southern Wyoming, northern New Mexico, and eastern Utah to quantify changes in curve number values from pre- to post-wildfire conditions. The curve number changes from the measured runoff events vary substantially between positive and negative values. The measured curve number changes were then associated with watershed characteristics (e.g., slope, elevation, northness, and eastness) and land cover type to develop prediction models that provide estimates of post-wildfire curve number changes. Finally, we used a regression tree method to demonstrate that accurate predications can be developed using the measured curve number changes from our study domain. These models can be used for future post-wildfire assessments within the region.

Author’s methodology of forming modeling skills involves 4 steps: Step 1 – the teacher step by step constructs the curve by means of cloud based service GeoGebra; Step 2 – the teacher offers a description- definition of the curve and provides a ready-made algorithm by which students model the curve inde- pendently in GeoGebra; Step 3 – the teacher offers an algorithm for constructing a curve model, and students need to characterize the properties of the curve or give its definition based on the results, Step 4 – students are offered definitions of curves that they have to model in GeoGebra). An example of realization of the author’s methodology is given, the pedagogical experiment on proof of its effectiveness is described.

This paper assesses whether the expansion of online job vacancies leads to a more efficient labor market. We provide compelling evidence that the increase in online job vacancy penetration in Colombia has had an enhancing effect on the labor market's efficiency by making it easier for firms to find workers to fill their job openings. An estimation of the Beveridge Curve (unemployment to vacancies relationship), a well-established theoretical development from search models, concludes that policies that increase online vacancy posting enhance efficiency. We implement a differences in differences design to take advantage of a regulation, which mandates that all authorized online vacancy providers report any online vacancy to the Public Employment Service in Colombia. We find that sub-segments of the labor market with a relevant fraction of their vacancies posted online, presented on average nearly 15% lower vacancy rate for a given unemployment rate. Therefore, for these sub-segments, the Beveridge curve shifted inwards due to efficiency enhancements. These findings support active search policies to reduce information barriers, which reduce the odds of firms and workers finding one other in the labor market. Policies as those implemented by the Public Employment Service in Colombia seem to be beneficial.