Expert Opinions on Improving Femicide Data Collection across Europe: A Concept Mapping Study.

PubMed

Vives-Cases, Carmen; Goicolea, Isabel; Hernández, Alison; Sanz-Barbero, Belen; Gill, Aisha K; Baldry, Anna Costanza; Schröttle, Monika; Stöckl, Heidi; Stoeckl, Heidi

2016-01-01

Femicide, defined as the killings of females by males because they are females, is becoming recognized worldwide as an important ongoing manifestation of gender inequality. Despite its high prevalence or widespread prevalence, only a few countries have specific registries about this issue. This study aims to assemble expert opinion regarding the strategies which might feasibly be employed to promote, develop and implement an integrated and differentiated femicide data collection system in Europe at both the national and international levels. Concept mapping methodology was followed, involving 28 experts from 16 countries in generating strategies, sorting and rating them with respect to relevance and feasibility. The experts involved were all members of the EU-Cost-Action on femicide, which is a scientific network of experts on femicide and violence against women across Europe. As a result, a conceptual map emerged, consisting of 69 strategies organized in 10 clusters, which fit into two domains: "Political action" and "Technical steps". There was consensus among participants regarding the high relevance of strategies to institutionalize national databases and raise public awareness through different stakeholders, while strategies to promote media involvement were identified as the most feasible. Differences in perceived priorities according to the level of human development index of the experts' countries were also observed.

Expert Opinions on Improving Femicide Data Collection across Europe: A Concept Mapping Study

PubMed Central

Vives-Cases, Carmen; Goicolea, Isabel; Hernández, Alison; Sanz-Barbero, Belen; Gill, Aisha K.; Baldry, Anna Costanza; Schröttle, Monika; Stoeckl, Heidi

2016-01-01

Femicide, defined as the killings of females by males because they are females, is becoming recognized worldwide as an important ongoing manifestation of gender inequality. Despite its high prevalence or widespread prevalence, only a few countries have specific registries about this issue. This study aims to assemble expert opinion regarding the strategies which might feasibly be employed to promote, develop and implement an integrated and differentiated femicide data collection system in Europe at both the national and international levels. Concept mapping methodology was followed, involving 28 experts from 16 countries in generating strategies, sorting and rating them with respect to relevance and feasibility. The experts involved were all members of the EU-Cost-Action on femicide, which is a scientific network of experts on femicide and violence against women across Europe. As a result, a conceptual map emerged, consisting of 69 strategies organized in 10 clusters, which fit into two domains: “Political action” and “Technical steps”. There was consensus among participants regarding the high relevance of strategies to institutionalize national databases and raise public awareness through different stakeholders, while strategies to promote media involvement were identified as the most feasible. Differences in perceived priorities according to the level of human development index of the experts’ countries were also observed. PMID:26859885

Mapping tobacco industry strategies in South East Asia for action planning and surveillance

PubMed Central

Stillman, F; Hoang, M; Linton, R; Ritthiphakdee, B; Trochim, W

2008-01-01

Objective: To develop a comprehensive conceptual framework of tobacco industry tactics in four countries in South East Asia for the purpose of: (1) generating consensus on key areas of importance and feasibility for regional and cross country tobacco industry monitoring and surveillance; (2) developing measures to track and monitor the effects of the tobacco industry and to design counterstrategies; and (3) building capacity to improve tobacco control planning in the participating countries. Design: A structured conceptualisation methodology known as concept mapping was used. The process included brainstorming, sorting and rating of statements describing industry activities. Statistical analyses used multidimensional scaling and cluster analysis. Interpretation of the maps was participatory, using regional tobacco control researchers, practitioners, and policy makers during a face to face meeting. Participants: 31 participants in this study come from the four countries represented in the project along with six people from the Johns Hopkins Blomberg School of Public Health. Conclusions: The map shows eight clusters of industry activities within the four countries. These were arranged into four general sectors: economics, politics, public relations and deception. For project design purposes, the map indicates areas of importance and feasibility for monitoring tobacco industry activities and serves as a basis for an initial discussion about action planning. Furthermore, the development of the map used a consensus building process across different stakeholders or stakeholder agencies and is critical when developing regional, cross border strategies for tracking and surveillance. PMID:18218787

Biosecurity measures for backyard poultry in developing countries: a systematic review

PubMed Central

2012-01-01

Background Poultry represents an important sector in animal production, with backyard flocks representing a huge majority, especially in the developing countries. In these countries, villagers raise poultry to meet household food demands and as additional sources of incomes. Backyard production methods imply low biosecurity measures and high risk of infectious diseases, such as Newcastle disease or zoonosis such as Highly Pathogenic Avian Influenza (HPAI). We reviewed literature on biosecurity practices for prevention of infectious diseases, and published recommendations for backyard poultry and assessed evidence of their impact and feasibility, particularly in developing countries. Documents were sourced from the Food and Agriculture Organization (FAO) website, and from Pubmed and Google databases. Results A total of 62 peer-reviewed and non-referred documents were found, most of which were published recently (after 2004) and focused on HPAI/H5N1-related biosecurity measures (64%). Recommendations addressed measures for flock management, feed and water management, poultry trade and stock change, poultry health management and the risk to humans. Only one general guideline was found for backyard poultry-related biosecurity; the other documents were drawn up for specific developing settings and only engaged their authors (e.g. consultants). These national guidelines written by consultants generated recommendations regarding measures derived from the highest standards of commercial poultry production. Although biosecurity principles of isolation and containment are described in most documents, only a few documents were found on the impact of measures in family poultry settings and none gave any evidence of their feasibility and effectiveness for backyard poultry. Conclusions Given the persistent threat posed by HPAI/H5N1 to humans in developing countries, our findings highlight the importance of encouraging applied research toward identifying sustained and adapted biosecurity measures for smallholder poultry flocks in low-income countries. PMID:23216706

East-West transport corridor feasibility study : phase 1, vol. 2 : development plans : final report

DOT National Transportation Integrated Search

1998-04-01

This study, conducted by Bechtel International, was funded by the U.S. Trade and Development Agency. The member countries of the South Balkan Initiative Program (Albania, Macedonia, and Bulgaria) are seeking to improve their transportation infrastruc...

[Analysis of HIV/AIDS mortality in Mexico from 1990 to 2013: An assessment of the feasibility of millennium development goals by 2015].

PubMed

Bravo-García, Enrique; Ortiz-Pérez, Hilda

We aimed to assess the feasibility of achieving the goal of Mexican AIDS mortality in the Millennium Development Goals, nationally and by state. For the period 1990-2013, we estimated annual rates of decline/increase in AIDS mortality according to five-year interval, using published data from the Mexican Instituto Nacional de Estadística y Geografía and Consejo Nacional de Población. Subsequently, we analyzed the feasibility of achieving the Millennium Development Goals target by 2015 by estimating the year in which the country and each state could achieve them. We estimated that only 13/32 states (40%) would achieve the goal established for AIDS mortality by Millennium Development Goals. Mexico, as a country, and the remaining 19 states (60%) did not will attain it. It is important to emphasize that seven states, rather than decrease, had an upward trend in mortality in the last five years analyzed. The free and universal access to antiretroviral treatment against HIV/AIDS has failed to reduce mortality as expected in Mexico. It is urgent to improve access to HIV testing by using more aggressive strategies. Also, it is necessary to apply interventions to link and retain persons in care until they are virologically suppressed.

Canada's implementation of the Paragraph 6 Decision: is it sustainable public policy?

PubMed Central

Cohen-Kohler, Jillian C; Esmail, Laura C; Cosio, Andre Perez

2007-01-01

Background Following the Implementation of Paragraph 6 of the Doha Declaration on TRIPS and Public Health, Canada was among the first countries globally to amend its patent law, which resulted in Canada's Access to Medicines Regime (CAMR). CAMR allows the production and export of generic drugs to developing countries without the requisite manufacturing capacity to undertake a domestic compulsory license. CAMR has been the subject of much criticism lodged at its inability to ensure fast access to urgent medicines for least developing and developing countries in need. Only recently did the Canadian government grant Apotex the compulsory licenses required under CAMR to produce and export antiretroviral therapy to Rwanda's population. Methods The objective of this research is to investigate whether the CAMR can feasibly achieve its humanitarian objectives given the political interests embedded in the crafting of the legislation. We used a political economy framework to analyze the effect of varied institutions, political processes, and economic interests on public policy outcomes. In-depth, semi-structured interviews were conducted with nineteen key stakeholders from government, civil society and industry. Qualitative data analysis was performed using open-coding for themes, analyzing by stakeholder group. Results CAMR is removed from the realities of developing countries and the pharmaceutical market. The legislation needs to include commercial incentives to galvanize the generic drug industry to make use of this legislation. CAMR assumes that developing country governments have the requisite knowledge and human resource capacity to make use of the regime, which is not the case. The legislation does not offer sufficient incentives for countries to turn to Canada when needed drugs may be procured cheaply from countries such as India. In the long term, developing and least developing countries seek sustainable solutions to meet the health needs of their population, including developing their own capacity and local industries. Conclusion CAMR is symbolically meaningful but in practice, limited. The Rwanda case will be noteworthy in terms of the future of the legislation. To meet its intended international health objectives, this legislation needs to be better informed of developing country needs and global pharmaceutical market imperatives. Finally, we contend that serious public policy change cannot strike a balance between all vested interests. Above all, any feasible policy that aims to facilitate compulsory licensing must prioritize public health over trade or economic interests. PMID:18062821

Tailoring International Pressure Ulcer Prevention Guidelines for Nigeria: A Knowledge Translation Study Protocol.

PubMed

Ilesanmi, Rose Ekama; Gillespie, Brigid M; Adejumo, Prisca Olabisi; Chaboyer, Wendy

2015-07-28

The 2014 International Pressure Ulcer Prevention (PUP) Clinical Practice Guidelines (CPG) provides the most current evidence based strategies to prevent Pressure Ulcer (PU). The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in developed countries. Some of these guidelines may not be feasible in developing countries due to structural and resource issues; therefore there is a need to adapt these guidelines to the context thus making it culturally acceptable. To present a protocol detailing the tailoring of international PUPCPG into a care bundle for the Nigerian context. Guided by the Knowledge to Action (KTA) framework, a two phased study will be undertaken. In Phase 1, the Delphi technique with stakeholder leaders will be used to review the current PUPCPG, identifying core strategies that are feasible to be adopted in Nigeria. These core strategies will become components of a PUP care bundle. In Phase 2, key stakeholder interviews will be used to identify the barriers, facilitators and potential implementation strategies to promote uptake of the PUP care bundle. A PUP care bundle, with three to eight components is expected to be developed from Phase 1. Implementation strategies to promote adoption of the PUP care bundle into clinical practice in selected Nigerian hospitals, is expected to result from Phase 2. Engagement of key stakeholders and consumers in the project should promote successful implementation and translate into better patient care. Using KTA, a knowledge translation framework, to guide the implementation of PUPCPG will enhance the likelihood of successful adoption in clinical practice. In implementing a PUP care bundle, developing countries face a number of challenges such as the feasibility of its components and the required resources.

Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality.

PubMed

Wiens, Matthew O; Kumbakumba, Elias; Kissoon, Niranjan; Ansermino, J Mark; Ndamira, Andrew; Larson, Charles P

2012-01-01

Sepsis represents the progressive underlying inflammatory pathway secondary to any infectious illness, and ultimately is responsible for most infectious disease-related deaths. Addressing issues related to sepsis has been recognized as an important step towards reducing morbidity and mortality in developing countries, where the majority of the 7.5 million annual deaths in children under 5 years of age are considered to be secondary to sepsis. However, despite its prevalence, sepsis is largely neglected. Application of sepsis definitions created for use in resource-rich countries are neither practical nor feasible in most developing country settings, and alternative definitions designed for use in these settings need to be established. It has also been recognized that the inflammatory state created by sepsis increases the risk of post-discharge morbidity and mortality in developed countries, but exploration of this issue in developing countries is lacking. Research is urgently required to characterize better this potentially important issue.

Experiences From Developing and Upgrading a Web-Based Surveillance System for Malaria Elimination in Cambodia

PubMed Central

Mellor, Steve; Aryal, Siddhi; Sovannaroth, Siv; Roca-Feltrer, Arantxa

2017-01-01

Strengthening the surveillance component is key toward achieving country-wide malaria elimination in Cambodia. A Web-based upgraded malaria information system (MIS) was deemed to essentially act as the central component for surveillance strengthening. New functionality (eg, data visualization) and operational (eg, data quality) attributes of the system received particular attention. However, building from the lessons learned in previous systems’ developments, other aspects unique to Cambodia were considered to be equally important; for instance, feasibility issues, particularly at the field level (eg, user acceptability at various health levels), and sustainability needs (eg, long-term system flexibility). The Cambodian process of identifying the essential changes and critical attributes for this new information system can provide a model for other countries at various stages of the disease control and elimination continuum. Sharing these experiences not only facilitates the establishment of “best practices” but also accelerates global and regional malaria elimination efforts. In this article, Cambodia’s experience in developing and upgrading its MIS to remain responsive to country-specific needs demonstrates the necessity for considering functionality, operationalization, feasibility, and sustainability of an information system in the context of malaria elimination. PMID:28615155

The Impact of Dialogic Book-Sharing Training on Infant Language and Attention: A Randomized Controlled Trial in a Deprived South African Community

ERIC Educational Resources Information Center

Vally, Zahir; Murray, Lynne; Tomlinson, Mark; Cooper, Peter J.

2015-01-01

Background: Dialogic book-sharing is an interactive form of shared reading. It has been shown in high income countries (HICs) to be of significant benefit to child cognitive development. Evidence for such benefit in low and middle income countries (LMICs) is scarce, although a feasibility study of our own produced encouraging findings.…

Implementation of Reach Up early childhood parenting program: acceptability, appropriateness, and feasibility in Brazil and Zimbabwe.

PubMed

Smith, Joanne A; Baker-Henningham, Helen; Brentani, Alexandra; Mugweni, Rose; Walker, Susan P

2018-05-01

Young children need nurturing care, which includes responsive caregiver-child interactions and opportunities to learn. However, there are few extant large-scale programs that build parents' abilities to provide this. We have developed an early childhood parenting training package, called Reach Up, with the aim of providing an evidence-based, adaptable program that is feasible for low-resource settings. Implementation of Reach Up was evaluated in Brazil and Zimbabwe to inform modifications needed and identify challenges that implementers and delivery agents encountered. Interview guides were developed to collect information on the program's appropriateness, acceptability, and feasibility from mothers, home visitors, and supervisors. Information on adaptation was obtained from country program leads and Reach Up team logs, as well as quality of visits from observations conducted by supervisors. The program was well accepted by mothers and visitors, who perceived benefits for the children; training was viewed as appropriate, and visitors felt well-prepared to conduct visits. A need for expansion of supervisor training was identified and the program was feasible to implement, although challenges were identified, including staff turnover; implementation was less feasible for staff with other work commitments (in Brazil). However, most aspects of visit quality were high. We conclude that the Reach Up program can expand capacity for parenting programs in low- and middle-income countries. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

How to Make Diagnosis Related Groups Payment More Feasible in Developing Countries- A Case Study in Shanghai, China

PubMed Central

WANG, Zhaoxin; LIU, Rui; LI, Ping; JIANG, Chenghua; HAO, Mo

2014-01-01

Abstract Background Given limited health sources, how to make DRGs (Diagnosis Related Groups) more feasible is a big question in developing countries. This study contributes to the debate on how to bridge the pay-for-service and DRGs during the transitional period of payment reform. Methods From 2008 to 2012, 20740 patients with cirrhosis or duodenal ulcer disease were chosen as sample. Using multiple linear regression analysis, the interrelationships between the total medical expenses of the inpatients, and age, gender of the inpatients, length of stay (LOS), region and economic level of the hospitals were examined. Results The main findings were 1) length of stay (LOS) and the economic level of treatment location had a statistically significant impact on patients with cirrhosis or duodenal ulcer disease. Meanwhile gender is not a significant factor for both of them. 2) Under the premise of limited resources, developing countries should first narrow down to screen for common and frequently occurring diseases, then study the key factors which affect the treatment cost of the diseases. Conclusion Based on picking out common diseases and their key factors, Simplification of the DRGs setting process will greatly increase the efficiency of implementing DRGs in the developing world. PMID:26060758

Pilot-based assessment of the economics of recycling construction demolition waste.

PubMed

Srour, Issam M; Chehab, Ghassan R; El-Fadel, Mutasem; Tamraz, Sandy

2013-11-01

The significant amount of waste generated from construction demolition has become a chronic problem in many developing countries. Using data obtained from demolition contractors and various other sources, this paper proposes a framework for proper handling of construction demolition waste (CDW) to serve as a decision support tool in countries suffering from the lack of national CDW management guidelines. The framework is then demonstrated through a case study in the city of Beirut, Lebanon, and a sensitivity analysis is carried out to examine the economic feasibility of developing a recycling facility. The analysis showed that in order for a facility to be feasible, a gate fee should be charged in the presence of a market for recycled aggregates. The results confirm the significance of instigating and implementing legislation to control illegal dumping, constructing, and managing engineered landfills, and establishing markets for recycled CDW.

Pediatric Sepsis Guidelines: Summary for resource-limited countries

PubMed Central

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

Evaluation of an international faculty development program for developing countries in Asia: the Seoul Intensive Course for Medical Educators.

PubMed

Kim, Do-Hwan; Yoon, Hyun Bae; Sung, Minsun; Yoo, Dong-Mi; Hwang, Jinyoung; Kim, Eun Jung; Lee, Seunghee; Shin, Jwa-Seop

2015-12-18

The issue of collaboration in medical education is becoming prominent. Some faculty development programs have suggested an approach for promoting collaboration on a global level. However, non-English-speaking developing countries in Asia, especially in Southeast Asia, do not take advantage of them due to their unique context, such as language and culture. To address these issues, Seoul National University College of Medicine initiated a 6-week international faculty development program called the "Seoul Intensive Course for Medical Educators" for 16 fellows from five Asian countries (Cambodia, Laos, Mongolia, Myanmar, and Vietnam). The aim of this study is to report the evaluation results of the outcome of the program and discuss better ways of collaborating with developing countries. Three levels of collaboration-intraorganizational, intranational, and international-were central initiatives of the program. Prior to setting up the program details, we first established four design principles, following which the contents, materials, and facilitators were determined to maintain consistency with the design principles. The evaluation of the program was done with Kirkpatrick's four-level model. Most of the evaluation data for level 1 were collected by two questionnaires, the post-module survey and the post-program survey. Portfolios and progress reports were mainly used to collect outcome data for levels 2 and 3, respectively. The reaction was generally positive throughout the program and there was a significant correlation between satisfaction and relevance to one's job or needs. Despite the fellows' propensity for overestimating themselves, both the evaluators and fellows reported that there was significant improvement in learning. Opinions on the impact or urgency of the topics were slightly different from country to country; however, the answers regarding feasibility were fairly similar. Moreover, we could observe from the post-program progress reports that the transfer of learning was actively in progress, mainly for topics that were highly feasible. These results show that the program was successful in terms of its effectiveness. Consistent and timely support is essential for the sustainable development of the medical education systems in these countries. Further understanding of the underlying factors on transfer (level 3) could improve the effectiveness of faculty development programs for developing countries.

Activism needed for vaccines to reach South.

PubMed

1998-06-30

An AIDS vaccine remains the only feasible strategy for curbing the spread of HIV infection in resource-poor developing countries because of its low cost and logistic simplicity. However, the pace of vaccine development has been slowed by difficulties persuading pharmaceutical companies to invest time and money in such research. These companies do not perceive a financial advantage to vaccine development. The International AIDS Vaccine Initiative is attempting to create a market for an AIDS vaccine. It is also urging developing countries to develop their own vaccines so they have intellectual property rights. Any advances in this area will require political pressure from community activists.

Administration's Perception about the Feasibility of Elearning Practices at the University of Guyana

ERIC Educational Resources Information Center

Livingstone, Kerwin A.

2015-01-01

Since the genesis of technology, some decades ago, the use of information and communication technologies in educational practices has been steadily increasing. In educational institutions, some form of elearning has been adopted. All over the world, in both developed and developing countries, many universities have embraced this alternative and…

From malaria control to eradication: The WHO perspective.

PubMed

Mendis, Kamini; Rietveld, Aafje; Warsame, Marian; Bosman, Andrea; Greenwood, Brian; Wernsdorfer, Walther H

2009-07-01

Efforts to control malaria have been boosted in the past few years with increased international funding and greater political commitment. Consequently, the reported malaria burden is being reduced in a number of countries throughout the world, including in some countries in tropical Africa where the burden of malaria is greatest. These achievements have raised new hopes of eradicating malaria. This paper summarizes the outcomes of a World Health Organization's expert meeting on the feasibility of such a goal. Given the hindsight and experience of the Global Malaria Eradication Programme of the 1950s and 1960s, and current knowledge of the effectiveness of antimalarial tools and interventions, it would be feasible to effectively control malaria in all parts of the world and greatly reduce the enormous morbidity and mortality of malaria. It would also be entirely feasible to eliminate malaria from countries and regions where the intensity of transmission is low to moderate, and where health systems are strong. Elimination of malaria requires a re-orientation of control activity, moving away from a population-based coverage of interventions, to one based on a programme of effective surveillance and response. Sustained efforts will be required to prevent the resurgence of malaria from where it is eliminated. Eliminating malaria from countries where the intensity of transmission is high and stable such as in tropical Africa will require more potent tools and stronger health systems than are available today. When such countries have effectively reduced the burden of malaria, the achievements will need to be consolidated before a programme re-orientation towards malaria elimination is contemplated. Malaria control and elimination are under the constant threat of the parasite and vector mosquito developing resistance to medicines and insecticides, which are the cornerstones of current antimalarial interventions. The prospects of malaria eradication, therefore, rest heavily on the outcomes of research and development for new and improved tools. Malaria control and elimination are complementary objectives in the global fight against malaria.

Monitoring iCCM: a feasibility study of the indicator guide for monitoring and evaluating integrated community case management.

PubMed

Roberton, Timothy; Kasungami, Dyness; Guenther, Tanya; Hazel, Elizabeth

2016-07-01

Most countries in sub-Saharan Africa have now adopted integrated community case management (iCCM) of common childhood illnesses as a strategy to improve child health. In March 2014, the iCCM Task Force published an Indicator Guide for Monitoring and Evaluating iCCM: a 'menu' of recommended indicators with globally agreed definitions and methodology, to guide countries in developing robust iCCM monitoring systems. The Indicator Guide was conceived as an evolving document that would incorporate collective experience and learning as iCCM programmes themselves evolve. This article presents findings from two studies that examined the feasibility of collecting the Indicator Guide's 18 routine monitoring indicators with the iCCM monitoring systems that countries currently have in place. We reviewed iCCM monitoring tools, protocols and reports from a purposive sample of 10 countries in sub-Saharan Africa. We developed a scorecard system to assess which of the Indicator Guide's 18 routine monitoring indicators could be calculated with the given monitoring tools, and at which level of the health system the relevant information would be available. We found that the data needed to calculate many of the Indicator Guide's routine monitoring indicators are already being collected through existing monitoring systems, although much of these data are only available at health facility level and not aggregated to district or national levels. Our results highlight challenge of using supervision checklists as a data source, and the need for countries to maintain accurate deployment data for CHWs and CHW supervisors. We suggest that some of the recommended indicators need revising. Routine monitoring will be more feasible, effective and efficient if iCCM programmes focus on a smaller set of high-value indicators that are easy to measure, reliably interpreted and useful both for global and national stakeholders and for frontline health workers themselves. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Intelligence in Bali--A Case Study on Estimating Mean IQ for a Population Using Various Corrections Based on Theory and Empirical Findings

ERIC Educational Resources Information Center

Rindermann, Heiner; te Nijenhuis, Jan

2012-01-01

A high-quality estimate of the mean IQ of a country requires giving a well-validated test to a nationally representative sample, which usually is not feasible in developing countries. So, we used a convenience sample and four corrections based on theory and empirical findings to arrive at a good-quality estimate of the mean IQ in Bali. Our study…

Investigation of School-Based Staff Development Programs as a Means to Promote International Cooperation in Curriculum Improvement Through Teacher Training.

ERIC Educational Resources Information Center

Thurber, John C.

This study explores the feasibility of utilizing school-focused staff development programs in promoting international cooperation through transferability and/or adaptation of relevant aspects of this type of inservice education by foreign countries. The objective of this presentation is to develop interest in ways in which teachers in various…

Universal health care and equity: evidence of maternal health based on an analysis of demographic and household survey data.

PubMed

Neal, Sarah; Channon, Andrew Amos; Carter, Sarah; Falkingham, Jane

2015-06-16

The drive toward universal health coverage (UHC) is central to the post 2015 agenda, and is incorporated as a target in the new Sustainable Development Goals. However, it is recognised that an equity dimension needs to be included when progress to this goal is monitored. WHO have developed a monitoring framework which proposes a target of 80% coverage for all populations regardless of income and place of residence by 2030, and this paper examines the feasibility of this target in relation to antenatal care and skilled care at delivery. We analyse the coverage gap between the poorest and richest groups within the population for antenatal care and presence of a skilled attendant at birth for countries grouped by overall coverage of each maternal health service. Average annual rates of improvement needed for each grouping (disaggregated by wealth quintile and urban/rural residence) to reach the goal are also calculated, alongside rates of progress over the past decades for comparative purposes. Marked inequities are seen in all groups except in countries where overall coverage is high. As the monitoring framework has an absolute target countries with currently very low coverage are required to make rapid and sustained progress, in particular for the poorest and those living in rural areas. The rate of past progress will need to be accelerated markedly in most countries if the target is to be achieved, although several countries have demonstrated the rate of progress required is feasible both for the population as a whole and for the poorest. For countries with currently low coverage the target of 80% essential coverage for all populations will be challenging. Lessons should be drawn from countries who have achieved rapid and equitable progress in the past.

Wind energy: A renewable energy option

NASA Technical Reports Server (NTRS)

Zimmerman, J. S.

1977-01-01

Wind turbine generator research programs administered by the Energy Research and Development Administration are examined. The design and operation of turbine demonstration models are described. Wind assessments were made to determine the feasibility of using wind generated power for various parts of the country.

East-West transport corridor feasibility study : phase 1, vol. 1 : existing characteristics : final report

DOT National Transportation Integrated Search

1998-04-01

This study, conducted by Bechtel International, was funded by the U.S. Trade and Development Agency. The member countries of the South Balkan Initiative program (Albania, Macedonia, and Bulgaria) are seeking to improve their transportation infrastruc...

From E- to M-Learning: Feasibility for an African-Delivered Tertiary Program

ERIC Educational Resources Information Center

Benner, Allison; Pence, Alan

2013-01-01

Since 2000, the Early Childhood Development Virtual University (ECDVU) has offered graduate-level programs in sub-Saharan Africa. These programs have been highly successful in creating a cadre of early childhood development (ECD) leaders in countries throughout Africa. When ECDVU was launched, the program was considered to be at the cutting edge…

Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score.

PubMed

Stalder, J-F; Aubert, H; Anthoine, E; Futamura, M; Marcoux, D; Morren, M-A; Trzeciak, M; Szalai, Z; Veres, K; Deleuran, M; Vestergaard, C; Boralevi, F; Chu, C-Y; De Raeve, L; Svensson, Å; Fölster-Holst, R; Buchner, M; Takaoka, R; Aoki, V; Chernyshov, P; Chernyshova, L; Murrell, D F; Zhao, C; Mckinster, C D; Von Kobyletzky, L; Eichenfield, L; Totri, C; Lio, P; Seneschal, J; Moret, L; Barbarot, S

2017-11-01

Adherence to topical corticosteroids (TCS) is essential for the effective treatment of atopic dermatitis but can be limited by concerns about their use. This study examined the feasibility of applying the validated TOPICOP score for assessing TCS phobia across different countries. This was a prospective multicentre feasibility study conducted in 21 hospitals in 17 countries. Patients >3 months of age with atopic dermatitis or their parents or legal representatives completed a validated translation of the TOPICOP questionnaire in the country's native language. Respondents also completed questionnaires collecting opinions about the feasibility and acceptability of the TOPICOP questionnaire. A total of 1564 participants in 15 countries were included in the analysis. 81% of respondents considered the questions clear or very clear, and 79% reported that it took less than 5 minutes to complete. Each of the individual items in the TOPICOP questionnaire was considered to be not at all difficult to answer by 49% to 74% of participants. The mean global TOPICOP score was 44.7%±20.5. Mean TOPICOP subscores were 37.0±22.8% for knowledge and beliefs, 54.7±27.8% for fears and 50.1±29.1% for behaviours. Global scores and subscores differed between countries, although the subscores did not always vary in parallel, suggesting different levels of TCS phobia and different drivers for each country. The TOPICOP score can be feasibly applied across countries and may therefore be useful for obtaining qualitative and quantitative data from international studies and for adapting patient education and treatment. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

The Chlorination Quandary

ERIC Educational Resources Information Center

Josephson, Julian

1978-01-01

Current use of chlorination technology to disinfect water supplies can cause the production of undesirable products, among them chloroform and chlorobenzene. Alternatives to this methodology include the use of ozone, chlorine dioxide, and bromine chloride in place of chlorine. Presently, the methods are feasible in developed countries only. (MA)

Analysis of input variables for a pre-feasibility evaluation model for toll highways

DOT National Transportation Integrated Search

1998-05-01

In recent years, private industry has been more involved in highway financing and operation. Many countries have started to apply new or improved strategies to promote the development of highway projects using sources other than the State. The most w...

Breast health in developing countries.

PubMed

Yip, C H; Taib, N A

2014-12-01

Breast cancer is one of the leading cancers world-wide. While the incidence in developing countries is lower than in developed countries, the mortality is much higher. Of the estimated 1 600 000 new cases of breast cancer globally in 2012, 794 000 were in the more developed world compared to 883 000 in the less developed world; however, there were 198 000 deaths in the more developed world compared to 324 000 in the less developed world (data from Globocan 2012, IARC). Survival from breast cancer depends on two main factors--early detection and optimal treatment. In developing countries, women present with late stages of disease. The barriers to early detection are physical, such as geographical isolation, financial as well as psychosocial, including lack of education, belief in traditional medicine and lack of autonomous decision-making in the male-dominated societies that prevail in the developing world. There are virtually no population-based breast cancer screening programs in developing countries. However, before any screening program can be implemented, there must be facilities to treat the cancers that are detected. Inadequate access to optimal treatment of breast cancer remains a problem. Lack of specialist manpower, facilities and anticancer drugs contribute to the suboptimal care that a woman with breast cancer in a low-income country receives. International groups such as the Breast Health Global Initiative were set up to develop economically feasible, clinical practice guidelines for breast cancer management to improve breast health outcomes in countries with limited resources.

A strategic approach to the unfinished fortification agenda: feasibility, costs, and cost-effectiveness analysis of fortification programs in 48 countries.

PubMed

Fiedler, John L; Macdonald, Barbara

2009-12-01

Food fortification is a promising strategy for combating micronutrient deficiencies, which plague one-third of the world's population. Which foods to fortify, with which micronutrients, and in which countries remain essential questions that to date have not been addressed at the global level. To provide a tool for international agencies to identify and organize the next phase of the unfinished global fortification agenda by prioritizing roughly 250 potential interventions in 48 priority countries. By explicitly defining the structure and operations of the fortification interventions in a detailed and transparent manner, and incorporating a substantial amount of country-specific data, the study also provides a potentially useful starting point for policy discussions in each of the 48 countries, which--it is hoped--will help to catalyze the development of public-private partnerships and accelerate the introduction of fortification and reduction of micronutrient deficiencies. Forty-eight high-priority countries were identified, and the feasibility of fortifying vegetable oil and sugar with vitamin A and fortifying wheat flour and maize flour with two alternative multiple micronutrient formulations was assessed. One hundred twenty-two country-, food-, and fortification formulation-specific interventions were assessed to be feasible, and the costs of each intervention were estimated. Assuming a 30% reduction in the micronutrient deficiencies of the persons consuming the food, the number of disability-adjusted life years (DALYs) saved by each of the programs was estimated. The cost per DALY saved was calculated for each of the 122 interventions, and the interventions were rank-ordered by cost-effectiveness. It is estimated that the 60 most cost-effective interventions would carry a 10-year price tag of US$1 billion and have costs per DALY saved ranging from US$1 to US$134. The single "best bet" intervention--i.e., the most cost-effective intervention--in each of the 48 countries was identified. This study provides a detailed, transparent, evidence-based approach to defining and estimating the costs and cost-effectiveness of the unfinished global fortification agenda in the 48 priority countries. Other considerations in designing a strategic approach to the unfinished global fortification agenda are also discussed.

The technical feasibility of high-speed rail lines along interstate highways in Virginia.

DOT National Transportation Integrated Search

1984-01-01

To show the trend toward modern high-speed rail systems, an overview of recent developments in the subject is presented. Countries as Japan, France, Germany, England, and Canada, as well as the United States, are actively involved, with Japan and Fra...

Let's Talk about Sex: Development of a Sexual Health Program for Nepali Women

ERIC Educational Resources Information Center

Kaufman, Michelle R.; Harman, Jennifer J.; Shrestha, Deepti Khati

2012-01-01

The purpose of this study was to develop and test the feasibility of conducting a sexual health intervention for women in Nepal, a country with high political and economic instability and strong patriarchal systems. Of the 88 women enrolled, 100% retention was obtained over three sessions, and 85% completed a 1-month follow-up. Recruitment was so…

Experiences From Developing and Upgrading a Web-Based Surveillance System for Malaria Elimination in Cambodia.

PubMed

Fu, Clementine; Lopes, Sérgio; Mellor, Steve; Aryal, Siddhi; Sovannaroth, Siv; Roca-Feltrer, Arantxa

2017-06-14

Strengthening the surveillance component is key toward achieving country-wide malaria elimination in Cambodia. A Web-based upgraded malaria information system (MIS) was deemed to essentially act as the central component for surveillance strengthening. New functionality (eg, data visualization) and operational (eg, data quality) attributes of the system received particular attention. However, building from the lessons learned in previous systems' developments, other aspects unique to Cambodia were considered to be equally important; for instance, feasibility issues, particularly at the field level (eg, user acceptability at various health levels), and sustainability needs (eg, long-term system flexibility). The Cambodian process of identifying the essential changes and critical attributes for this new information system can provide a model for other countries at various stages of the disease control and elimination continuum. Sharing these experiences not only facilitates the establishment of "best practices" but also accelerates global and regional malaria elimination efforts. In this article, Cambodia's experience in developing and upgrading its MIS to remain responsive to country-specific needs demonstrates the necessity for considering functionality, operationalization, feasibility, and sustainability of an information system in the context of malaria elimination. ©Clementine Fu, Sérgio Lopes, Steve Mellor, Siddhi Aryal, Siv Sovannaroth, Arantxa Roca-Feltrer. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 14.06.2017.

Development and pilot of an internationally standardized measure of cardiovascular risk management in European primary care

PubMed Central

2011-01-01

Background Primary care can play an important role in providing cardiovascular risk management in patients with established Cardiovascular Diseases (CVD), patients with a known high risk of developing CVD, and potentially for individuals with a low risk of developing CVD, but who have unhealthy lifestyles. To describe and compare cardiovascular risk management, internationally valid quality indicators and standardized measures are needed. As part of a large project in 9 European countries (EPA-Cardio), we have developed and tested a set of standardized measures, linked to previously developed quality indicators. Methods A structured stepwise procedure was followed to develop measures. First, the research team allocated 106 validated quality indicators to one of the three target populations (established CVD, at high risk, at low risk) and to different data-collection methods (data abstraction from the medical records, a patient survey, an interview with lead practice GP/a practice survey). Secondly, we selected a number of other validated measures to enrich the assessment. A pilot study was performed to test the feasibility. Finally, we revised the measures based on the findings. Results The EPA-Cardio measures consisted of abstraction forms from the medical-records data of established Coronary Heart Disease (CHD)-patients - and high-risk groups, a patient questionnaire for each of the 3 groups, an interview questionnaire for the lead GP and a questionnaire for practice teams. The measures were feasible and accepted by general practices from different countries. Conclusions An internationally standardized measure of cardiovascular risk management, linked to validated quality indicators and tested for feasibility in general practice, is now available. Careful development and pilot testing of the measures are crucial in international studies of quality of healthcare. PMID:21473758

Asthma prevalence and severity in low-resource communities.

PubMed

Cruz, Álvaro A; Stelmach, Rafael; Ponte, Eduardo V

2017-06-01

The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings.

Evaluating leaf and canopy reflectance of stressed rice plants to monitor arsenic contamination

USDA-ARS?s Scientific Manuscript database

Arsenic contamination is a serious problem in rice cultivated soils of many developing countries. Hence, it is critical to monitor and control arsenic uptake in rice plants to avoid adverse effects on human health. This study evaluated the feasibility of using reflectance spectroscopy to monitor ars...

Testing Selected Behaviors to Reduce Indoor Air Pollution Exposure in Young Children

ERIC Educational Resources Information Center

Barnes, B. R.; Mathee, A.; Krieger, L.; Shafritz, L.; Favin, M.; Sherburne, L.

2004-01-01

Indoor air pollution is responsible for the deaths and illness of millions of young children in developing countries. This study investigated the acceptability (willingness to try) and feasibility (ability to perform) of four indoor air pollution reduction behaviors (improve stove maintenance practices, child location practices, ventilation…

World Trade Organization, ILO conventions, and workers' compensation.

PubMed

LaDou, Joseph

2005-01-01

The World Trade Organization, the World Bank, and the International Monetary Fund can assist in the implementation of ILO Conventions relating to occupational safety and health in developing countries. Most countries that seek to trade globally receive permission to do so from the WTO. If the WTO required member countries to accept the core ILO Conventions relating to occupational safety and health and workers' compensation, it could accomplish something that has eluded international organizations for decades. International workers' compensation standards are seldom discussed, but may at this time be feasible. Acceptance of a minimum workers' compensation insurance system could be a requirement imposed on applicant nations by WTO member states.

[Assessment of surgical teleconsultations in a developing country: two years of experience in Djibouti].

PubMed

Bertani, A; Menguy, P; Delmas, J M; Launay, F; Mathieu, L; Candoni, P; Dulou, R; Rongiéras, F

2012-01-01

Our objective was to assess the influence of teleconsultations on patient management and clinical outcomes in a developing country. All the surgical teleconsultations by a single surgeon (orthopedist) between November 2009 and November 2011 were recorded. Neurosurgery and pediatric orthopedics were the two most important specialities most often concerned, accounting for 67% of the 157 teleconsultations for 138 patients. The teleconsultations resolved the diagnostic uncertainties in 29 of 37 cases (78%). Advice from the expert modified management in 69% cases. Clinical outcomes were good or very good in 86% of the treated patients. This study establishes the feasibility and usefulness of surgical teleconsultations in Djibouti.

Opinions of researchers based in the UK on recruiting subjects from developing countries into randomized controlled trials.

PubMed

Newton, Sam K; Appiah-Poku, John

2007-12-01

Explaining technical terms in consent forms prior to seeking informed consent to recruit into trials can be challenging in developing countries, and more so when the studies are randomized controlled trials. This study was carried out to examine the opinions of researchers on ways of dealing with these challenges in developing countries. Recorded in-depth interviews with 12 lecturers and five doctoral students, who had carried out research in developing countries, at a leading school of public health in the United Kingdom. A purposive, snowballing approach was used to identify interviewees. Researchers were divided on the feasibility of explaining technical trials in illiterate populations; the majority of them held the view that local analogies could be used to explain these technical terms. Others were of the opinion that this could not be done since it was too difficult to explain technical trials, such as randomized controlled trials, even to people in developed countries. Researchers acknowledged the difficulty in explaining randomized controlled trials but it was also their perception that this was an important part of the ethics of the work of scientific research involving human subjects. These difficulties notwithstanding, efforts should be made to ensure that subjects have sufficient understanding to consent, taking into account the fact that peculiar situations in developing countries might compound this difficulty.

Vaccine safety monitoring systems in developing countries: an example of the Vietnam model.

PubMed

Ali, Mohammad; Rath, Barbara; Thiem, Vu Dinh

2015-01-01

Only few health intervention programs have been as successful as vaccination programs with respect to preventing morbidity and mortality in developing countries. However, the success of a vaccination program is threatened by rumors and misunderstanding about the risks of vaccines. It is short-sighted to plan the introduction of vaccines into developing countries unless effective vaccine safety monitoring systems are in place. Such systems that track adverse events following immunization (AEFI) is currently lacking in most developing countries. Therefore, any rumor may affect the entire vaccination program. Public health authorities should implement the safety monitoring system of vaccines, and disseminate safety issues in a proactive mode. Effective safety surveillance systems should allow for the conduct of both traditional and alternative epidemiologic studies through the use of prospective data sets. The vaccine safety data link implemented in Vietnam in mid-2002 indicates that it is feasible to establish a vaccine safety monitoring system for the communication of vaccine safety in developing countries. The data link provided the investigators an opportunity to evaluate AEFI related to measles vaccine. Implementing such vaccine safety monitoring system is useful in all developing countries. The system should be able to make objective and clear communication regarding safety issues of vaccines, and the data should be reported to the public on a regular basis for maintaining their confidence in vaccination programs.

A Mathematical Model of Gas-Turbine Pump Complex

NASA Astrophysics Data System (ADS)

Shpilevoy, V. A.; Chekardovsky, S. M.; Zakirazkov, A. G.

2016-10-01

The articles analyzes the state of an extensive network of main oil pipelines of Tyumen region on the basis of statistical data, and also suggest ways of improving the efficiency of energy-saving policy on the main transport oil. Various types of main oil pipelines pump drives were examined. It was determined that now there is no strict analytical dependence between main operating properties of the power turbine of gas turbine engine. At the same time it is necessary to determine the operating parameters using a turbine at GTPU, interconnection between power and speed frequency, as well as the feasibility of using a particular mode. Analysis of foreign experience, the state of domestic enterprises supplying the country with gas turbines, features of the further development of transport of hydrocarbon resources allows us to conclude the feasibility of supplying the oil transportation industry of our country with pumping units based on gas turbine drive.

Culturally adaptive storytelling method to improve hypertension control in Vietnam - "We talk about our hypertension": study protocol for a feasibility cluster-randomized controlled trial.

PubMed

Allison, Jeroan J; Nguyen, Hoa L; Ha, Duc A; Chiriboga, Germán; Ly, Ha N; Tran, Hanh T; Phan, Ngoc T; Vu, Nguyen C; Kim, Minjin; Goldberg, Robert J

2016-01-14

Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. At present, the major risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam; inasmuch, the burden of CVD will continue to increase in this country unless effective prevention and control measures are put in place. A national survey in 2008 found that the prevalence of hypertension (HTN) was approximately 25 % among Vietnamese adults and it increased with advancing age. Therefore, novel, large-scale, and sustainable interventions for public health education to promote engagement in the process of detecting and treating HTN in Vietnam are urgently needed. A feasibility randomized trial will be conducted in Hung Yen province, Vietnam to evaluate the feasibility and acceptability of a novel community-based intervention using the "storytelling" method to enhance the control of HTN in adults residing in four rural communities. The intervention will center on stories about living with HTN, with patients speaking in their own words. The stories will be obtained from particularly eloquent patients, or "video stars," identified during Story Development Groups. The study will involve two phases: (i) developing a HTN intervention using the storytelling method, which is designed to empower patients to facilitate changes in their lifestyle practices, and (ii) conducting a feasibility cluster-randomized trial to investigate the feasibility, acceptability, and potential efficacy of the intervention compared with usual care in HTN control among rural residents. The trial will be conducted at four communes, and within each commune, 25 individuals 50 years or older with HTN will be enrolled in the trial resulting in a total sample size of 100 patients. This feasibility trial will provide the necessary groundwork for a subsequent large-scale, fully powered, cluster-randomized controlled trial to test the efficacy of our novel community-based intervention. Results from the full-scale trial will provide health policy makers with practical evidence on how to combat a key risk factor for CVD using a feasible, sustainable, and cost-effective intervention that could be used as a national program for controlling HTN in Vietnam and other developing countries. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02483780 (registration date June 22, 2015).

A methodology for producing small scale rural land use maps in semi-arid developing countries using orbital imagery

NASA Technical Reports Server (NTRS)

Vangenderen, J. L. (Principal Investigator); Lock, B. F.

1976-01-01

The author has identified the following significant results. Results have shown that it is feasible to design a methodology that can provide suitable guidelines for operational production of small scale rural land use maps of semiarid developing regions from LANDSAT MSS imagery, using inexpensive and unsophisticated visual techniques. The suggested methodology provides immediate practical benefits to map makers attempting to produce land use maps in countries with limited budgets and equipment. Many preprocessing and interpretation techniques were considered, but rejected on the grounds that they were inappropriate mainly due to the high cost of imagery and/or equipment, or due to their inadequacy for use in operational projects in the developing countries. Suggested imagery and interpretation techniques, consisting of color composites and monocular magnification proved to be the simplest, fastest, and most versatile methods.

Incentives for organ donation in the United States: feasible alternative or forthcoming apocalypse?

PubMed

Hippen, Benjamin; Matas, Arthur

2009-04-01

Several factors have generated interest in proposals to offer incentives in exchange for kidneys from living donors, including the growing shortage of available organs, the apparent asymptote of traditional means of organ procurement, and the intimate link between the inadequacies of organ procurement policies in developed countries with the flourishing of underground organ trafficking in developing countries. Herein, we review the scope and dimensions of the growing shortage of organs in the United States, with attention to how each of the proposed solutions to same has proven insufficient. With special attention to the concerns leveled by Gabriel Danovitch in his 'Open Letter,' we conclude that each of his concerns are unfounded, and offer a prospectus on how a trial of such systems might be pursued in the United States. The failure of current approaches to organ procurement in the United States and other developed countries has led to unnecessary suffering and death, with morally unacceptable consequences for developing countries. For these reasons, a structured trial of incentives for organ procurement in the United States is a moral imperative.

Co-existence of GM, conventional and organic crops in developing countries: Main debates and concerns.

PubMed

Azadi, Hossein; Taube, Friedhelm; Taheri, Fatemeh

2017-06-05

The co-existence approach of GM crops with conventional agriculture and organic farming as a feasible agricultural farming system has recently been placed in the center of hot debates at the EU-level and become a source of anxiety in developing countries. The main promises of this approach is to ensure "food security" and "food safety" on the one hand, and to avoid the adventitious presence of GM crops in conventional and organic farming on the other, as well as to present concerns in many debates on implementing the approach in developing countries. Here, we discuss the main debates on ("what," "why," "who," "where," "which," and "how") applying this approach in developing countries and review the main considerations and tradeoffs in this regard. The paper concludes that a peaceful co-existence between GM, conventional, and organic farming is not easy but is still possible. The goal should be to implement rules that are well-established proportionately, efficiently and cost-effectively, using crop-case, farming system-based and should be biodiversity-focused ending up with "codes of good agricultural practice" for co-existence.

Qualitative adaptation of child behaviour problem instruments in a developing-country setting.

PubMed

Khan, B; Avan, B I

2014-07-08

A key barrier to epidemiological research on child behaviour problems in developing countries is the lack of culturally relevant, internationally recognized psychometric instruments. This paper proposes a model for the qualitative adaptation of psychometric instruments in developing-country settings and presents a case study of the adaptation of 3 internationally recognized instruments in Pakistan: the Child Behavior Checklist, the Youth Self-Report and the Teacher's Report Form. This model encompassed a systematic procedure with 6 distinct phases to minimize bias and ensure equivalence with the original instruments: selection, deliberation, alteration, feasibility, testing and formal approval. The process was conducted in collaboration with the instruments' developer. A multidisciplinary working group of experts identified equivalence issues and suggested modifications. Focus group discussions with informants highlighted comprehension issues. Subsequently modified instruments were thoroughly tested. Finally, the instruments' developer approval further validated the qualitative adaptation. The study proposes a rigorous and systematic model to effectively achieve cultural adaptation of psychometric instruments.

Examining gender equity in health policies in a low- (Peru), middle- (Colombia), and high- (Canada) income country in the Americas.

PubMed

Stewart, Donna E; Dorado, Linda M; Diaz-Granados, Natalia; Rondon, Marta; Saavedra, Javier; Posada-Villa, Jose; Torres, Yolanda

2009-12-01

Gender inequities in health prevail in most countries despite ongoing attempts to eliminate them. Assessment of gender-sensitive health policies can be used to identify country specific progress as well as gaps and issues that need to be addressed to meet health equity goals. This study selected and measured the existence of gender-sensitive health policies in a low- (Peru), middle- (Colombia), and high (Canada)-income country in the Americas. Investigators selected 10 of 20 gender-sensitive health policy indicators and found eight to be feasible to measure in all three countries, although the wording and scope varied. The results from this study inform policy makers and program planners who aim to develop, improve, implement, and monitor national gender-sensitive health policies. Future studies should assess the implementation of policy indicators within countries and assess their performance in increasing gender equity.

Monitoring gender equity in health using gender-sensitive indicators: a cross-national study.

PubMed

Diaz-Granados, Natalia; Pitzul, Kristen Blythe; Dorado, Linda M; Wang, Feng; McDermott, Sarah; Rondon, Marta B; Posada-Villa, Jose; Saavedra, Javier; Torres, Yolanda; Des Meules, Marie; Stewart, Donna E

2011-01-01

As gender is known to be a major determinant of health, monitoring gender equity in health systems remains a vital public health priority. Focusing on a low-income (Peru), middle-income (Colombia), and high-income (Canada) country in the Americas, this study aimed to (1) identify and select gender-sensitive health indicators and (2) assess the feasibility of measuring and comparing gender-sensitive health indicators among countries. Gender-sensitive health indicators were selected by a multidisciplinary group of experts from each country. The most recent gender-sensitive health measures corresponding to selected indicators were identified through electronic databases (CINAHL, PsycINFO, MEDLINE, Embase, LILACS, LIPECS, Latindex, and BIREME) and expert consultation. Data from population-based studies were analyzed when indicator information was unavailable from reports. Twelve of the 17 selected gender-sensitive health indicators were feasible to measure in at least two countries, and 9 of these were comparable among all countries. Indicators that were available were not stratified or adjusted by age, education, marital status, or wealth. The largest between-country difference was maternal mortality, and the largest gender inequity was mortality from homicides. This study shows that gender inequities in health exist in all countries, regardless of income level. Economic development seemed to confer advantages in the availability of such indicators; however, this finding was not consistent and needs to be further explored. Future initiatives should include identifying health system factors and risk factors associated with disparities as well as assessing the cost-effectiveness of including the routine monitoring of gender inequities in health.

Feasibility study on introduction of the bio-fuel power generation in tropical regions

NASA Astrophysics Data System (ADS)

1993-03-01

Study is made on feasibility of introducing the bio-fuel power generation in tropical regions, especially in South East Asia including Okinawa and South America. Biomass promising as bio-fuel is bagasse and palm oil mill dregs; and bagasse is found to be advantageous to the use for large-scaled power generation. Prospective uses of bagasse are a combined use of gasification process and gas turbine power generation, an effective use of gas turbine exhaust heat at sugar cane factories, and a use of the system to be developed which totalizes these two. As to how to carry out the R and D project, since the gasification power generation process itself is a high technology and has partially unknown fields, it is desirable that research and development are conducted in such technologically developed countries as Japan (Okinawa). A developmental plan, therefore, is worked out as such that a pilot plant of approximately 3000kW is to be constructed in Okinawa because the period for bagasse production is at least 3 months there, and a commercial-scale plant is to be constructed and operated in such big bagasse-producing countries as Brazil.

Developmental screening tools: feasibility of use at primary healthcare level in low- and middle-income settings.

PubMed

Fischer, Vinicius Jobim; Morris, Jodi; Martines, José

2014-06-01

An estimated 150 million children have a disability. Early identification of developmental disabilities is a high priority for the World Health Organization to allow action to reduce impairments through Gap Action Program on mental health. The study identified the feasibility of using the developmental screening and monitoring tools for children aged 0-3 year(s) by non-specialist primary healthcare providers in low-resource settings. A systematic review of the literature was conducted to identify the tools, assess their psychometric properties, and feasibility of use in low- and middle-income countries (LMICs). Key indicators to examine feasibility in LMICs were derived from a consultation with 23 international experts. We identified 426 studies from which 14 tools used in LMICs were extracted for further examination. Three tools reported adequate psychometric properties and met most of the feasibility criteria. Three tools appear promising for use in identifying and monitoring young children with disabilities at primary healthcare level in LMICs. Further research and development are needed to optimize these tools.

STUDY OF FEASIBILITY OF NEW EDUCATIONAL MEDIA FOR DEVELOPING COUNTRIES.

ERIC Educational Resources Information Center

VAIZEY, J.

COST DATA ON THE USE OF THE NEW INSTRUCTIONAL MEDIA ARE NECESSARY IN ORDER TO COMPARE DIFFERENT FORMS OF EDUCATION, TO DETERMINE THE ECONOMICALLY OPTIMUM RATE OF TECHNICAL USAGE, AND TO ASSIST ADMINISTRATORS. THE HISTORICAL INACCURACY OR STATISTICAL BIAS OF SOURCES AND THE INCOMPARABILITY OF DATA POSE DIFFICULTIES IN INTERPRETATION. THE COST OF…

Transforming Classrooms through Game-Based Learning: A Feasibility Study in a Developing Country

ERIC Educational Resources Information Center

Vate-U-Lan, Poonsri

2015-01-01

This article reports an exploratory study which investigated attitudes towards the practice of game-based learning in teaching STEM (science, technology, engineering and mathematics) within a Thai educational context. This self-administered Internet-based survey yielded 169 responses from a snowball sampling technique. Three fifths of respondents…

Feasibility of developing a pediatric telehealth network in Honduras with international consultation support.

PubMed

Brooks, Mary; Holden, Kenton R; Durón, Reyna M; McElligott, James T; Summer, Andrea

2017-01-01

Honduras is the second poorest country in Central America, and roughly 50% of the population lives in rural areas. A telehealth network linking these areas to larger health centers may improve patient access to care, and physician access to educational opportunities. This pilot study assessed the feasibility of establishing a pediatric telehealth network between underserved clinics in Honduras and the Medical University of South Carolina (MUSC). Two underserved Honduran clinics were identified and invited to participate in the telehealth network. Providers from these clinics connected remotely to educational conferences at MUSC, and received teleconsults from MUSC physicians and physicians from the other Honduran site. Honduran providers completed five-point Likert scale satisfaction surveys following participation in the conferences and teleconsults. Survey feedback was positive, with 100% of respondents stating they would utilize telemedicine in the future. Dissatisfaction was expressed subjectively in the survey comments with regards to poor Internet connectivity and unreliable electrical power. The establishment of a telehealth network between Honduras and MUSC is feasible, and rural providers were receptive to the clinical and educational opportunities this network provides. Future projects will expand telehealth capabilities to other Honduran sites and focus on intra-country collaboration to ensure sustainability.

Patient education in Parkinson's disease: Formative evaluation of a standardized programme in seven European countries.

PubMed

Macht, Michael; Gerlich, Christian; Ellgring, Heiner; Schradi, Martina; Rusiñol, Angels Bayés; Crespo, Maricruz; Prats, Ana; Viemerö, Vappu; Lankinen, Anu; Bitti, Pio Enrico Ricci; Candini, Lorena; Spliethoff-Kamminga, Noëlle; de Vreugd, Janny; Simons, Gwenda; Pasqualini, Marcia Smith; Thompson, Simon B N; Taba, Pille; Krikmann, Ulle; Kanarik, Eve

2007-02-01

To evaluate a newly developed education programme for Parkinson's disease (PD) patients. The programme consisted of eight sessions and aimed at improving knowledge and skills related to self-monitoring, health promotion, stress management, depression, anxiety, social competence, and social support, all with special reference to PD. The programme was formatively evaluated in seven European countries (Spain, Finland, Italy, The Netherlands, United Kingdom, Estonia, Germany) with 151 patients diagnosed with idiopathic PD. The evaluation included patients' ratings of the comprehensibility and feasibility of the programme as well as mood ratings before and after each session. Patients also completed questionnaires at the beginning and end of the programme to explore possible changes in disease-related psychosocial problems, quality of life, and depression. The programme was feasible to run, and patients were able to understand its elements. Patients reported mood elevations following individual sessions and reduced disease-related psychosocial problems after completing the programme. There were no substantial differences in results between cultures. Patient education appears to have potential as a useful and feasible intervention, complementing medical treatment in PD. The present programme will soon be available in seven European languages and can be tested in different health care systems.

Technical Education and Vocational Training in Central Africa. Feasibility Survey of the Regional Development of Rapid Vocational Training: Cameroon, Central African Republic, Chad, and Gabon.

ERIC Educational Resources Information Center

Organization for Rehabilitation through Training, Geneva (Switzerland).

This final report is the result of a survey requested by the United States Agency for International Development (USAID) and undertaken by the Organization for Rehabilitation through Training (ORT) of four countries (Cameroon, Chad, Central African Republic, and Gabon) and a conference on vocational training sponsored by the Economic and Customs…

Volunteered Geographic Information (vgi) and Environmental Monitoring, a New Approach in Developing Countries

NASA Astrophysics Data System (ADS)

Manouchehri, M.; Kiavarz Moghaddam, M.

2017-09-01

Increasing world population and unprecedented expansion of urbanization in the world has caused many environmental problems. The relationship between man and the environment is bidirectional one that have great short-term and long-term impacts on the cities and regions. The best way to deal with it is the participation of the people themselves. The use of new technologies has now become one of the most important methods for monitoring the environment that can increase the participation of citizens, improving environmental problems to provide the cheapest and the most accessible form. Developing countries such as Iran, which faces enormous environmental problems are suitable for the development of technological methods of monitoring. Large population and citizens' participation feasibility using VGI can have a positive effect on developing countries. Finally, by using F-VGI that ensures the validity and accuracy of data we can access an appropriate platform that leads us to suitable model for environment monitoring in the form of the application.

Postmarketing surveillance in developing countries.

PubMed

Meirik, O

1988-01-01

Authorities in developing countries need to monitor the possible adverse consequences of the increasing use of drugs in their countries. Definite differences exist in the risk-benefit ratios for developed and developing countries, particularly with fertility-regulating drugs. Some physicians believe that the increased risk of thrombosis associated with oral contraceptives (OCs) should not be considered as important in developing countries due to the fact that the background level of venous thrombosis is so low in developing countries that even a 50- or 100-fold increase in relative risk would neither be detectable nor important compared to the risk of unwanted pregnancy. In addition, evidence exists of geographically linked factors in the etiology of some adverse drug reactions (ADRs). Authorities in Brazil, India, Indonesia, Pakistan, the Philippines, Thailand, and Venezuela have established voluntary ADR reporting systems. Several developing countries also actively follow the World Health Organization's International Drug Monitoring Program and have access to its data base. A number of other methodological approaches to postmarketing surveillance are in use in addition to voluntary ADR reporting systems. These include cross-sectional surveys, studies of temporal and geographic correlations of diseases and drug use, and case-control and cohort studies. Each of these approaches offers specific advantages. Postmarketing surveillance should begin at the time new drugs, including contraceptive methods are introduced. Surveillance needs to be an integral part of plans for the introduction of new contraceptive methods in settings where the infrastructure to carry out such surveillance is in place. 3 major public sector agencies, Family Health International, the Population Council, and the World Health Organization, developed a plan to obtain funding for the postmarketing surveillance of a contraceptive implant, Norplant-R. A controlled cohort study will be conducted in 6-10 developing countries. The pilot phase of the surveillance began in 1987. The project objective is to detect possible adverse effects of Norplant-R as well as any health benefits of the method. It also will assess the feasibility of the cohort methodology for postmarketing surveillance in developing countries.

Just Deliberation: Can Communicative Rationality Support Socially Just Environmental Conservation in Rural Africa?

ERIC Educational Resources Information Center

Martin, Adrian; Rutagarama, Eugene

2012-01-01

This article evaluates the use of deliberative methods for filling the democratic deficit arising from the shift to management through partnerships in conservation in developing countries. We ask whether deliberative approaches are feasible in a rural African context and the extent to which they can form a basis for socially just environmental…

[Developing a harmonised system for the recognition of clinical trials for veterinary product registration].

PubMed

Maliandi, F S

2008-12-01

The increase of commerce between developing countries requires a harmonised system for accepting the results of clinical trials (CT) of veterinary products, similar to those that exist in developed countries. The objective of this paper is to propose a basis for the creation of a system that harmonises CTs for approving veterinary products (VP) for registration. Such a system would be a step towards unifying the CTs of different countries, while maintaining country-specific variations that are compatible with the scientific method, international standards, and the principles of objectivity, transparency and confidentiality. Basic requirements to be fulfilled by both private institutions and public offices are described, as are professional responsibilities and possible administrative procedures that could be adapted in each country. The conclusion reached is that a harmonised system is feasible, as has been demonstrated in numerous countries throughout the world. A harmonised system will result in a more efficient product approval process, a reduction in costs, greater transparency in controls, an improvement in the reliability of the health system, and a reduction in the time the process takes. It will also contribute to animal welfare by avoiding the need to repeat trials. The author acknowledges that there are cultural, technological and economic limitations and that these problems, and others, have yet to be overcome.

Differential pricing of new pharmaceuticals in lower income European countries.

PubMed

Kaló, Zoltán; Annemans, Lieven; Garrison, Louis P

2013-12-01

Pharmaceutical companies adjust the pricing strategy of innovative medicines to the imperatives of their major markets. The ability of payers to influence the ex-factory price of new drugs depends on country population size and income per capita, among other factors. Differential pricing based on Ramsey principles is a 'second-best' solution to correct the imperfections of the global market for innovative pharmaceuticals, and it is also consistent with standard norms of equity. This analysis summarizes the boundaries of differential pharmaceutical pricing for policymakers, payers and other stakeholders in lower-income countries, with special focus on Central-Eastern Europe, and describes the feasibility and implications of potential solutions to ensure lower pharmaceutical prices as compared to higher-income countries. European stakeholders, especially in Central-Eastern Europe and at the EU level, should understand the implications of increased transparency of pricing and should develop solutions to prevent the limited accessibility of new medicines in lower-income countries.

Development and pilot phase of a European MS register.

PubMed

Flachenecker, Peter; Khil, Laura; Bergmann, Sverrir; Kowalewski, Mariusz; Pascu, Ion; Pérez-Miralles, Francisco; Sastre-Garriga, Jaume; Zwingers, Thomas

2010-10-01

The MS-ID (Multiple Sclerosis Information Dividend) project was initiated by the European Multiple Sclerosis Platform (EMSP) in 2007 in order to identify and address major inequalities of MS treatment and care and thus eliminate disparities across the EU. One major approach to reach these goals in the longer term is the implementation of a European MS register for MS. The feasibility of an EU MS register was piloted among five countries (Germany, Iceland, Poland, Romania and Spain). Each country liaised with one documentation centre. Countries and test centres were both chosen in a way that a heterogeneous health care structure was provided. After reaching consensus about the data set, comprehension and acceptability of the two questionnaires-representing both the physician's and the patient's perspective-were tested with 20 MS patients in each country. In a 6-month data collection period, data from 547 patients were recorded. Most sections of the questionnaires were available for more than 90% of patients. The results obtained from the pilot phase of the European MS register indicate that it is feasible to collect standardized data across Europe. Thus, the European MS register may be a valuable instrument to compare treatment and care of MS across countries, estimate the cost of MS in Europe and monitor the implementation of and adherence to guidelines. It may help to reduce the disparities in MS care and treatment throughout Europe and eventually improve the quality of life of people with MS.

An Adjustable Gas-Mixing Device to Increase Feasibility of In Vitro Culture of Plasmodium falciparum Parasites in the Field

PubMed Central

Volkman, Sarah K.; Ahouidi, Ambroise D.; Ndiaye, Daouda; Mboup, Souleymane; Wirth, Dyann F.

2014-01-01

A challenge to conducting high-impact and reproducible studies of the mechanisms of P. falciparum drug resistance, invasion, virulence, and immunity is the lack of robust and sustainable in vitro culture in the field. While the technology exists and is routinely utilized in developed countries, various factors–from cost, to supply, to quality–make it hard to implement in malaria endemic countries. Here, we design and rigorously evaluate an adjustable gas-mixing device for the in vitro culture of P. falciparum parasites in the field to circumvent this challenge. The device accurately replicates the gas concentrations needed to culture laboratory isolates, short-term adapted field isolates, cryopreserved previously non-adapted isolates, as well as to adapt ex vivo isolates to in vitro culture in the field. We also show an advantage over existing alternatives both in cost and in supply. Furthermore, the adjustable nature of the device makes it an ideal tool for many applications in which varied gas concentrations could be critical to culture success. This adjustable gas-mixing device will dramatically improve the feasibility of in vitro culture of Plasmodium falciparum parasites in malaria endemic countries given its numerous advantages. PMID:24603696

Mexico's path towards the Sustainable Development Goal for health: an assessment of the feasibility of reducing premature mortality by 40% by 2030.

PubMed

González-Pier, Eduardo; Barraza-Lloréns, Mariana; Beyeler, Naomi; Jamison, Dean; Knaul, Felicia; Lozano, Rafael; Yamey, Gavin; Sepúlveda, Jaime

2016-10-01

The United Nations Sustainable Development Goal for health (SDG3) poses complex challenges for signatory countries that will require clear roadmaps to set priorities over the next 15 years. Building upon the work of the Commission on Investing in Health and published estimates of feasible global mortality SDG3 targets, we analysed Mexico's mortality to assess the feasibility of reducing premature (0-69 years) mortality and propose a path to meet SDG3. We developed a baseline scenario applying 2010 age-specific and cause-specific mortality rates from the Mexican National Institute of Statistics and Geography (INEGI) to the 2030 UN Population Division (UNPD) population projections. In a second scenario, INEGI age-specific and cause-specific trends in death rates from 2000 to 2014 were projected to 2030 and adjusted to match the UNPD 2030 mortality projections. A third scenario assumed a 40% reduction in premature deaths across all ages and causes. By comparing these scenarios we quantified shortfalls in mortality reductions by age group and cause, and forecasted life expectancy pathways for Mexico to converge to better performing countries. UNPD-projected death rates yield a 25·9% reduction of premature mortality for Mexico. Accelerated reductions in adult mortality are necessary to reach a 40% reduction by 2030. Mortality declines aggregated across all age groups mask uneven gains across health disorders. Injuries, particularly road traffic accidents and homicides, are the main health challenge for young adults (aged 20-49 years) whereas unabated diabetes mortality is the single most important health concern for older adults (aged 50-69 years). Urgent action is now required to control non-communicable diseases and reduce fatal injuries in Mexico, making a 40% reduction in premature mortality by 2030 feasible and putting Mexico back on a track of substantial life expectancy convergence with better performing countries. Our study provides a roadmap for setting national health priorities. Further analysis of the equity implications of following the suggested pathway remains a subject of future research. Mexico's Ministry of Health, University of California, San Francisco, and Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Costs of Addressing Heroin Addiction in Malaysia and 32 Comparable Countries Worldwide

PubMed Central

Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Luekens, Craig; Ng, Nora; Schottenfeld, Richard

2012-01-01

Objective Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide. Data Sources/Study Setting Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients (July 2003–May 2005) in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources. Study Design Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita. Principal Findings Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29–53 percent) and buprenorphine (33–72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People's Democratic Republic could be treated for $8 and $30 million, respectively. Conclusions Buprenorphine treatment can be provided at low cost in countries across the world. This study's new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions. PMID:22091732

Costs of addressing heroin addiction in Malaysia and 32 comparable countries worldwide.

PubMed

Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Luekens, Craig; Ng, Nora; Schottenfeld, Richard

2012-04-01

Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide. Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients (July 2003-May 2005) in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources. Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita. Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29-53 percent) and buprenorphine (33-72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People's Democratic Republic could be treated for $8 and $30 million, respectively. Buprenorphine treatment can be provided at low cost in countries across the world. This study's new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions. © Health Research and Educational Trust.

Avoiding 40% of the premature deaths in each country, 2010-30: review of national mortality trends to help quantify the UN sustainable development goal for health.

PubMed

Norheim, Ole F; Jha, Prabhat; Admasu, Kesetebirhan; Godal, Tore; Hum, Ryan J; Kruk, Margaret E; Gómez-Dantés, Octavio; Mathers, Colin D; Pan, Hongchao; Sepúlveda, Jaime; Suraweera, Wilson; Verguet, Stéphane; Woldemariam, Addis T; Yamey, Gavin; Jamison, Dean T; Peto, Richard

2015-01-17

The UN will formulate ambitious Sustainable Development Goals for 2030, including one for health. Feasible goals with some quantifiable, measurable targets can influence governments. We propose, as a quatitative health target, "Avoid in each country 40% of premature deaths (under-70 deaths that would be seen in the 2030 population at 2010 death rates), and improve health care at all ages". Targeting overall mortality and improved health care ignores no modifiable cause of death, nor any cause of disability that is treatable (or also causes many deaths). 40% fewer premature deaths would be important in all countries, but implies very different priorities in different populations. Reinforcing this target for overall mortality in each country are four global subtargets for 2030: avoid two-thirds of child and maternal deaths; two-thirds of tuberculosis, HIV, and malaria deaths; a third of premature deaths from non-communicable diseases (NCDs); and a third of those from other causes (other communicable diseases, undernutrition, and injuries). These challenging subtargets would halve under-50 deaths, avoid a third of the (mainly NCD) deaths at ages 50-69 years, and so avoid 40% of under-70 deaths. To help assess feasibility, we review mortality rates and trends in the 25 most populous countries, in four country income groupings, and worldwide. UN sources yielded overall 1970-2010 mortality trends. WHO sources yielded cause-specific 2000-10 trends, standardised to country-specific 2030 populations; decreases per decade of 42% or 18% would yield 20-year reductions of two-thirds or a third. Throughout the world, except in countries where the effects of HIV or political disturbances predominated, mortality decreased substantially from 1970-2010, particularly in childhood. From 2000-10, under-70 age-standardised mortality rates decreased 19% (with the low-income and lower-middle-income countries having the greatest absolute gains). The proportional decreases per decade (2000-10) were: 34% at ages 0-4 years; 17% at ages 5-49 years; 15% at ages 50-69 years; 30% for communicable, perinatal, maternal, or nutritional causes; 14% for NCDs; and 13% for injuries (accident, suicide, or homicide). Moderate acceleration of the 2000-10 proportional decreases in mortality could be feasible, achieving the targeted 2030 disease-specific reductions of two-thirds or a third. If achieved, these reductions avoid about 10 million of the 20 million deaths at ages 0-49 years that would be seen in 2030 at 2010 death rates, and about 17 million of the 41 million such deaths at ages 0-69 years. Such changes could be achievable by 2030, or soon afterwards, at least in areas free of war, other major effects of political disruption, or a major new epidemic. UK Medical Research Council, Norwegian Agency for Development Cooperation, Centre for Global Health Research, and Bill & Melinda Gates Foundation. Copyright © 2015 Norheim et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by Elsevier Ltd. All rights reserved.

Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals.

PubMed

Tangcharoensathien, Viroj; Mills, Anne; Palu, Toomas

2015-04-29

The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.

Developing a Nuclear Grade of Alloy 617 for Gen IV Nuclear Energy Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ren, Weiju; Swindeman, Robert W; Santella, Michael L

2010-01-01

Alloy 617, an attractive material not particularly developed for nuclear use, is now being considered as a leading candidate alloy by several countries for applications in the Gen IV Nuclear Energy Systems. An extensive review of its existing data suggests that it would be beneficial to refine the alloy s specification to a nuclear grade for the intended Gen IV systems. In this paper, rationale for developing a nuclear grade of the alloy is first discussed through an analysis on existing data from various countries. Then initial experiments for refining the alloy specification are described. Preliminary results have suggested themore » feasibility of the refinement approach, as well as the possibility for achieving a desirable nuclear grade. Based on the results, further research activities are recommended.« less

Selective primary health care: an interim strategy for disease control in developing countries.

PubMed

Walsh, J A; Warren, K S

1979-11-01

Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year.

Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda

PubMed Central

Mendenhall, Emily; De Silva, Mary J.; Hanlon, Charlotte; Petersen, Inge; Shidhaye, Rahul; Jordans, Mark; Luitel, Nagendra; Ssebunnya, Joshua; Fekadu, Abebaw; Patel, Vikram; Tomlinson, Mark; Lund, Crick

2014-01-01

Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs. PMID:25089962

Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda.

PubMed

Mendenhall, Emily; De Silva, Mary J; Hanlon, Charlotte; Petersen, Inge; Shidhaye, Rahul; Jordans, Mark; Luitel, Nagendra; Ssebunnya, Joshua; Fekadu, Abebaw; Patel, Vikram; Tomlinson, Mark; Lund, Crick

2014-10-01

Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Setting the stage for equity-sensitive monitoring of the maternal and child health Millennium Development Goals.

PubMed Central

Wirth, Meg E.; Balk, Deborah; Delamonica, Enrique; Storeygard, Adam; Sacks, Emma; Minujin, Alberto

2006-01-01

OBJECTIVE: This analysis seeks to set the stage for equity-sensitive monitoring of the health-related Millennium Development Goals (MDGs). METHODS: We use data from international household-level surveys (Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS)) to demonstrate that establishing an equity baseline is necessary and feasible, even in low-income and data-poor countries. We assess data from six countries using 11 health indicators and six social stratifiers. Simple bivariate stratification is complemented by simultaneous stratification to expose the compound effect of multiple forms of vulnerability. FINDINGS: The data reveal that inequities are complex and interactive: inferences cannot be drawn about the nature or extent of inequities in health outcomes from a single stratifier or indicator. CONCLUSION: The MDGs and other development initiatives must become more comprehensive and explicit in their analysis and tracking of inequities. The design of policies to narrow health gaps must take into account country-specific inequities. PMID:16878225

The feasibility of measuring and monitoring social determinants of health and the relevance for policy and programme – a qualitative assessment of four countries

PubMed Central

Blas, Erik; Ataguba, John E.; Huda, Tanvir M.; Bao, Giang Kim; Rasella, Davide; Gerecke, Megan R.

2016-01-01

Background Since the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks. Objective To test proposed indicators of social determinants of health (SDH), gender, equity, and human rights with respect to their relevance in tracking progress in universal health coverage and population health (level and distribution). Design In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders. Results For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making. Conclusions This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs. PMID:26853897

Policy mapping for establishing a national emergency health policy for Nigeria

PubMed Central

Aliyu, Zakari Y

2002-01-01

Background The number of potential life years lost due to accidents and injuries though poorly studied has resulted in tremendous economic and social loss to Nigeria. Numerous socio-cultural, economic and political factors including the current epidemic of ethnic and religious conflicts act in concert in predisposing to and enabling the ongoing catastrophe of accident and injuries in Nigeria. Methods Using the "policymaker", Microsoft-Windows® based software, the information generated on accidents and injuries and emergency health care in Nigeria from literature review, content analysis of relevant documents, expert interviewing and consensus opinion, a model National Emergency Health Policy was designed and analyzed. A major point of analysis for the policy is the current political feasibility of the policy including its opportunities and obstacles in the country. Results A model National Emergency Health Policy with policy goals, objectives, programs and evaluation benchmarks was generated. Critical analyses of potential policy problems, associated multiple players, diverging interests and implementation guidelines were developed. Conclusions "Political health modeling" a term proposed here would be invaluable to policy makers and scholars in developing countries in assessing the political feasibility of policy managing. Political modeling applied to the development of a NEHP in Nigeria would empower policy makers and the policy making process and would ensure a sustainable emergency health policy in Nigeria. PMID:12181080

International telepharmacy education: another venue to improve cancer care in the developing world.

PubMed

Alfaar, Ahmad S; Kamal, Sherif; Abouelnaga, Sherif; Greene, William L; Quintana, Yuri; Ribeiro, Raul C; Qaddoumi, Ibrahim A

2012-01-01

In developed countries, pharmacists play a crucial role in designing and implementing cancer treatments as part of a multidisciplinary oncology team. However, developing countries have a shortage of pharmacists, and their role is generally limited to dispensing and selling drugs. The aim of this study was to investigate the feasibility of providing clinical pharmacy educational activities via international teleconferencing to improve cancer care in developing countries. Meticulous preparation and intense promotion of the workshop were done in Egypt before the telepharmacy conferences began. Multiple connectivity tests were performed to resolve technical problems. Nine telepharmacy conferences were delivered during 3-h sessions that were held on three consecutive days. Talks were subsequently made available via Web streaming. Attendees were requested to complete a survey to measure their satisfaction with the sessions. The teleconference was attended by a total of 345 persons, and it was subsequently reviewed online via 456 log-in sessions from 10 countries. Technical issues (e.g., poor auditory quality) were resolved on the first day of the event. The rate of attendees' responses on the survey was 30.1%, and satisfaction with the event was generally good. Telecommunication is a relatively inexpensive approach that may improve pharmacy practices, especially those used to treat patients with cancer in developing countries. Special attention to patient-based telepharmacy education, including the use of cost-effective technology, should be considered.

HOOPER BAY HOUSING ANALYSIS AND ENERGY FEASIBILITY REPORT

DOE Office of Scientific and Technical Information (OSTI.GOV)

SEA LION CORPORATION; COLD CLIMATE HOUSING RESEARCH CENTER; SOLUTIONS FOR HEALTHY BREATHING

2012-12-30

Sea Lion applied for and received a grant from the Department of Energy (DOE) towards this end titled Energy Efficiency Development and Deployment in Indian Country. The initial objectives of the Hooper Bay Energy Efficiency Feasibility Study were to demonstrate a 30% reduction in residential/commercial energy usage and identify the economic benefits of implementing energy efficiency measures to the Tribe through: (1) partnering with Whitney Construction and Solutions for Healthy Breathing in the training and hire of 2 local energy assessors to conduct energy audits of 9 representative housing models and 2 commercial units in the community. These homes aremore » representative of 52 homes constructed across different eras. (2) partnering with Cold Climate Housing Research Center to document current electrical and heating energy consumption and analyze data for a final feasibility report (3) assessing the economics of electricity & heating fuel usage; (4) projecting energy savings or fossil fuel reduction by modeling of improvement scenarios and cost feasibility The following two objectives will be completed after the publication of this report: (5) the development of materials lists for energy efficiency improvements (6) identifying financing options for the follow-up energy efficiency implementation phase.« less

Guar Near and Far: How One Crop Could Profit Lakota Country

ERIC Educational Resources Information Center

Singh, Subodh K.

2014-01-01

A Sinte Gleska University professor is exploring the feasibility of cultivating guar, one of the most expensive crops in the world, as a means to bring economic development to the Rosebud reservation and beyond. Guar is a drought-resistant industrial crop mainly grown in the Thar Desert of India and Pakistan. Since guar belongs to the legume…

The Feasibility of Flipping: An Exploratory Analysis of the Flipped Classroom in a Developing Country

ERIC Educational Resources Information Center

Griffith, Alana D. D.

2017-01-01

There has been an increased demand on educational institutions to provide students with value for money. The sociology course SOCI3035 Caribbean Social Problems with 111 students was transformed to a fully flipped course replacing several face-to-face lectures, tutorials and assessment with online versions as homework. Face to face lecture time…

A Tuning-AHELO Conceptual Framework of Expected Desired/Learning Outcomes in Engineering. OECD Education Working Papers, Number 60

ERIC Educational Resources Information Center

OECD Publishing (NJ1), 2011

2011-01-01

The OECD Secretariat, at the invitation of the AHELO Group of National Experts, contracted the Tuning Association to undertake initial development work on learning outcomes to be used for valid and reliable assessments of students from diverse institutions and countries. The two disciplines selected for the AEHLO Feasibility Study are engineering…

DRG systems in Europe: variations in cost accounting systems among 12 countries.

PubMed

Tan, Siok Swan; Geissler, Alexander; Serdén, Lisbeth; Heurgren, Mona; van Ineveld, B Martin; Redekop, W Ken; Hakkaart-van Roijen, Leona

2014-12-01

Diagnosis-related group (DRG)-based hospital payment systems have gradually become the principal means of reimbursing hospitals in many European countries. Owing to the absence or inaccuracy of costs related to DRGs, these countries have started to routinely collect cost accounting data. The aim of the present article was to compare the cost accounting systems of 12 European countries. A standardized questionnaire was developed to guide comprehensive cost accounting system descriptions for each of the 12 participating countries. The cost accounting systems of European countries vary widely by the share of hospital costs reimbursed through DRG payment, the presence of mandatory cost accounting and/or costing guidelines, the share of cost collecting hospitals, costing methods and data checks on reported cost data. Each of these aspects entails a trade-off between accuracy of the cost data and feasibility constraints. Although a 'best' cost accounting system does not exist, our cross-country comparison gives insight into international differences and may help regulatory authorities and hospital managers to identify and improve areas of weakness in their cost accounting systems. Moreover, it may help health policymakers to underpin the development of a cost accounting system. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Power-plant modernization program in Latvia. Desk Study Report No. 1. Export trade information

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-08-01

The Government of Latvia has requested the U.S. Trade and Development Program's (TDP's) assistance in financing the cost of a feasibility study to develop a modernization program for its thermal power stations aimed at improving their performance and efficiency. The consultant will work with engineers and managers of Latvenergo, Latvia's power utility, to review the performance of the country's two thermal power stations and carry out a detailed study for the rehabilitation and modernization of the TEC-2 thermal power station in Riga. The overall goal of the program will be to maximize the output capacity of the country's two powermore » stations through the implementation of economically efficient rehabilitation projects.« less

Feasibility of zero tolerance for Salmonella on raw poultry

USDA-ARS?s Scientific Manuscript database

Ideally, poultry producing countries around the globe should use internationally standardized sampling methods for Salmonella. It is difficult to compare prevalence data from country-to-country when sample plan, sample type, sample frequency and laboratory media along with methods differ. The Europe...

[The Balance of Care approach for the development of custom-fit health care services for people with dementia on the margins of care between home and nursing home: experiences with its application in Germany].

PubMed

Stephan, Astrid; Renom Guiteras, Anna; Juchems, Stefan; Meyer, Gabriele

2013-01-01

In Germany as in other countries of the European Union (EU), the majority of people with dementia are cared for by their informal caregivers at home. Across countries, however, there are considerable differences in the time to nursing home admission. The European research project RightTimePlaceCare intends to establish good practice recommendations for how to sustain the preferred living situation as long as possible. The Balance of Care approach was used to develop these recommendations, which combines empirical data, cost estimates and expert consensus, and thus implemented in a multinational context for the first time. In eight EU countries a survey was conducted among 2,014 people with dementia and their informal caregivers in nursing homes (n=1,223) or at home (n=791). Selected descriptive characteristics of the study participants were used for case type development. The case types were translated into 14 case vignettes, which were discussed by five to six expert panels (each consisting of three to four participants) per country. The experts (n=161) recommended the most suitable living place (at home or in a nursing home) and customised care packages for home care situations. Across all countries, the experts predominantly recommended care at home for four of the case types whose reference group of study participants actually lived in a nursing home. These case types represent a relevant part of the study population. In Germany, the experts judged the case vignettes as realistic but criticised that information relevant for proper decision making was missing. Expert group discussions always ended in consensus, and care at home was predominately recommended. The proposed care packages most often comprised standard care services, and hence appeared to be realistic and feasible. The development of country-specific recommendations is still ongoing. In order to assess economic feasibility, estimated costs of home care packages will be compared with costs of nursing home care. Further outcomes like the quality of life will be considered for good practice recommendation finding. Balance of Care supports the development of empirically based expert recommendations. The approach is widely applicable but seems to be particularly useful for the development of local custom-fit healthcare services. The clinical effectiveness, safety, and cost implications of the Balance of Care approach remain to be investigated in future studies. Copyright © 2013. Published by Elsevier GmbH.

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

PubMed Central

2012-01-01

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. PMID:22759725

Industry Perspective of Pediatric Drug Development in the United States: Involvement of the European Union Countries.

PubMed

Onishi, Taku; Tsukamoto, Katsura; Matsumaru, Naoki; Waki, Takashi

2018-01-01

Efforts to promote the development of pediatric pharmacotherapy include regulatory frameworks and close collaboration between the US Food and Drug Administration and the European Medicines Agency. We characterized the current status of pediatric clinical trials conducted in the United States by the pharmaceutical industry, focusing on the involvement of the European Union member countries, to clarify the industry perspective. Data on US pediatric clinical trials were obtained from ClinicalTrials.gov . Binary regression analysis was performed to identify what factors influence the likelihood of involvement of European Union countries. A total of 633 US pediatric clinical trials that met inclusion criteria were extracted and surveyed. Of these, 206 (32.5%) involved a European Union country site(s). The results of binary regression analysis indicated that attribution of industry, phase, disease area, and age of pediatric participants influenced the likelihood of the involvement of European Union countries in US pediatric clinical trials. Relatively complicated or large pediatric clinical trials, such as phase II and III trials and those that included a broad age range of participants, had a significantly greater likelihood of the involvement of European Union countries ( P < .05). Our results suggest that (1) the pharmaceutical industry utilizes regulatory frameworks in making business decisions regarding pediatric clinical trials, (2) disease area affects the involvement of European Union countries, and (3) feasibility of clinical trials is mainly concerned by pharmaceutical industry for pediatric drug development. Additional incentives for high marketability may further motivate pharmaceutical industry to develop pediatric drugs.

The role of energy systems on hydropower in Turkey

NASA Astrophysics Data System (ADS)

Yuksel, Ibrahim; Arman, Hasan; Halil Demirel, Ibrahim

2017-11-01

Over the last two decades, global electricity production has more than doubled and electricity demand is rising rapidly around the world as economic development spreads to emerging economies. Not only has electricity demand increased significantly, it is the fastest growing end-use of energy. Therefore, technical, economic and environmental benefits of hydroelectric power make it an important contributor to the future world energy mix, particularly in the developing countries. On the other hand, the hydropower industry is closely linked to both water management and renewable energy production, and so has a unique role to play in contributing to sustainable development in a world where billions of people lack access to safe drinking water and adequate energy supplies. In addition to, approximately 1.6 billion people have no access to electricity and about 1.1 billion are without adequate water supply. However, resources for hydropower development are widely spread around the world. Potential exists in about 150 countries, and about 70% of the economically feasible potential remains to be developed-mostly in developing countries where the needs are most urgent. This paper deals with renewable energy systems and the role of hydropower in Turkey.

Feasibility of 2 × 24-h dietary recalls combined with a food-recording booklet, using EPIC-Soft, among schoolchildren.

PubMed

Trolle, E; Amiano, P; Ege, M; Bower, E; Lioret, S; Brants, H; Kaic-Rak, A; de Boer, E J; Andersen, L F

2011-07-01

The aim of this study was to evaluate the feasibility of the suggested trans-European methodology for undertaking representative dietary surveys among schoolchildren: 2 × 24-h dietary recalls (24-HDRs) combined with a food-recording booklet, using EPIC-Soft (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) pc-program. A total of 75 children aged 7-8 years and 70 children aged 12-13 years old were recruited through the Civil Registration System in Denmark, and 57 children aged 7-8 years and 47 children aged 12-13 years were recruited through schools in Spain. Each child with one parent completed two face-to-face 24-HDRs, combined with optional use of a food-recording booklet (FRB) to be filled in by the child, a parent or other proxy persons for preparing the recalls. Feasibility was evaluated by questionnaires completed by parents, children and interviewers, and by selected data from the 24-HDRs. The face-to-face interviews with the child and a parent together are confirmed as feasible. The children participated actively in the interviews, the oldest children being most active. The children, parents and interviewers agreed that children needed help from the parents, and that parents were of help to the child. In both countries, other proxy persons, such as teachers or the school cafeteria staff, were involved before the interview, and the majority of the parents and children reported that the FRB had been a help for the child during the interview. Further results point at specific needed improvements of the tools. The evaluated method is shown feasible in two culturally diverse European populations. However, the feasibility study also points to specific improvements of tools and data collection protocol that are strongly recommended before implementation of the method in each country of a pan-European dietary survey.

Breast cancer in South Asia: a Bangladeshi perspective.

PubMed

Hossain, Mohammad Sorowar; Ferdous, Shameema; Karim-Kos, Henrike E

2014-10-01

South Asian countries are facing a hidden breast cancer epidemic. A significant proportion of the breast cancer cases occur in premenopausal women. Knowledge of the various aspects of breast cancer in different geographical regions is limited in South Asia. In this article, we review the Bangladeshi perspective of the epidemiology, risk factors, pathology, diagnosis and treatment of breast cancer. As in other developing countries, because of the lack of breast cancer awareness in Bangladeshi population and inadequate access to health care, most patients are diagnosed at an advanced stage of the disease. Early detection has a crucial impact on overall treatment outcomes. To battle against breast cancer in resource-limited countries like Bangladesh, it is not feasible to set up a parallel health service system solely dedicated to cancer. Therefore, a cost-effective public health strategy is needed which could reach a large number of women in the country. Considering all these issues, we propose an innovative female-based primary healthcare approach focused on awareness, screening and early detection of breast cancer in Bangladesh. This preventive strategy could be a model for other resource-limited developing countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

"In-Awareness" Approach to International Public Relations.

ERIC Educational Resources Information Center

Zaharna, R. S.

2001-01-01

Presents a three-tiered framework intended to expose hidden cultural assumptions and expectations that plague international public relations. Notes the country profile outlines what may be feasible within a particular country; the cultural profile speaks to what may be effective in that country; and the communication profile delineates…

Developing a health and human rights training program for french speaking Africa: lessons learned, from needs assessment to a pilot program

PubMed Central

2009-01-01

Background The importance of human rights education has widely been recognized as one of the strategies for their protection and promotion of health. Yet training programs have not always taken into account neither local needs, nor public health relevance, nor pedagogical efficacy. The objectives of our study were to assess, in a participative way, educational needs in the field of health and human rights among potential trainees in six French-speaking African countries and to test the feasibility of a training program through a pilot test. Ultimately the project aims to implement a health and human rights training program most appropriate to the African context. Methods Needs assessment was done according to four approaches: Revue of available data on health and human rights in the targeted countries; Country visits by one of the authors meeting key institutions; Focus group discussions with key-informants in each country; A questionnaire-based study targeting health professionals and human rights activists. Pilot training program: an interactive e-learning pilot program was developed integrating training needs expressed by partner institutions and potential trainees. Results Needs assessment showed high public health and human rights challenges that the target countries have to face. It also showed precise demands of partner institutions in regard to a health and human rights training program. It further allowed defining training objectives and core competencies useful to potential employers and future students as well as specific training contents. A pilot program allowed testing the motivation of students, the feasibility of an interactive educational approach and identifying potential difficulties. Conclusion In combining various approaches our study was able to show that training needs concentrate around tools allowing the identification of basic human rights violations in the health system, the analysis of their causes and coordinated responses through specific intervention projects. PMID:19703303

Developing a health and human rights training program for french speaking Africa: lessons learned, from needs assessment to a pilot program.

PubMed

Chastonay, Philippe; Klohn, Axel Max; Zesiger, Véronique; Freigburghaus, Franziska; Mpinga, Emmanuel Kabengele

2009-08-24

The importance of human rights education has widely been recognized as one of the strategies for their protection and promotion of health. Yet training programs have not always taken into account neither local needs, nor public health relevance, nor pedagogical efficacy.The objectives of our study were to assess, in a participative way, educational needs in the field of health and human rights among potential trainees in six French-speaking African countries and to test the feasibility of a training program through a pilot test. Ultimately the project aims to implement a health and human rights training program most appropriate to the African context. Needs assessment was done according to four approaches: Revue of available data on health and human rights in the targeted countries; Country visits by one of the authors meeting key institutions; Focus group discussions with key-informants in each country; A questionnaire-based study targeting health professionals and human rights activists.Pilot training program: an interactive e-learning pilot program was developed integrating training needs expressed by partner institutions and potential trainees. Needs assessment showed high public health and human rights challenges that the target countries have to face. It also showed precise demands of partner institutions in regard to a health and human rights training program. It further allowed defining training objectives and core competencies useful to potential employers and future students as well as specific training contents.A pilot program allowed testing the motivation of students, the feasibility of an interactive educational approach and identifying potential difficulties. In combining various approaches our study was able to show that training needs concentrate around tools allowing the identification of basic human rights violations in the health system, the analysis of their causes and coordinated responses through specific intervention projects.

Socioeconomic status and obesity in adult populations of developing countries: a review.

PubMed Central

Monteiro, Carlos A.; Moura, Erly C.; Conde, Wolney L.; Popkin, Barry M.

2004-01-01

A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. 2. The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases. 3. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US$ 2500, the mid-point value for lower-middle-income economies. The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all. A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004. PMID:15654409

Feasibility analysis of wastewater and solid waste systems for application in Indonesia.

PubMed

Kerstens, S M; Leusbrock, I; Zeeman, G

2015-10-15

Indonesia is one of many developing countries with a backlog in achieving targets for the implementation of wastewater and solid waste collection, treatment and recovery systems. Therefore a technical and financial feasibility analysis of these systems was performed using Indonesia as an example. COD, BOD, nitrogen, phosphorus and pathogen removal efficiencies, energy requirements, sludge production, land use and resource recovery potential (phosphorus, energy, duckweed, compost, water) for on-site, community based and off-site wastewater systems were determined. Solid waste systems (conventional, centralized and decentralized resource recovery) were analyzed according to land requirement, compost and energy production and recovery of plastic and paper. In the financial analysis, investments, operational costs & benefits and Total Lifecycle Costs (TLC) of all investigated options were compared. Technical performance and TLC were used to guide system selection for implementation in different residential settings. An analysis was undertaken to determine the effect of price variations of recoverable resources and land prices on TLC. A 10-fold increase in land prices for land intensive wastewater systems resulted in a 5 times higher TLC, whereas a 4-fold increase in the recovered resource selling price resulted in maximum 1.3 times higher TLC. For solid waste, these impacts were reversed - land price and resource selling price variations resulted in a maximum difference in TLC of 1.8 and 4 respectively. Technical and financial performance analysis can support decision makers in system selection and anticipate the impact of price variations on long-term operation. The technical analysis was based on published results of international research and the approach can be applied for other tropical, developing countries. All costs were converted to per capita unit costs and can be updated to assess other countries' estimated costs and benefits. Consequently, the approach can be used to guide wastewater and solid waste system planning in developing countries. Copyright © 2015 Elsevier B.V. All rights reserved.

Drug use and the role of patients and prescribers.

PubMed

Sterky, G; Tomson, G; Diwan, V K; Sachs, L

1991-01-01

In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded. Both the public and private sector have to be addressed. In the latter the pharmacists might be studied using a tracer, fictitious client. One important factor influencing prescribing, drug information, has rarely been assessed scientifically. Experimental studies using group randomization are, however feasible even in developing countries. The individual human being must be in the focus of drug studies and health care and health in the foreground. The combination of qualitative and quantitative methods will assist us to achieve rational drug use that is culturally acceptable, economically feasible and pharmacologically sound.

Closing The Gap between Two Countries: Feasibility of Dissemination Of An Evidence-Based Parenting Intervention in México.

PubMed

Parra-Cardona, José Rubén; Aguilar Parra, Elizabeth; Wieling, Elizabeth; Domenech Rodríguez, Melanie M; Fitzgerald, Hiram E

2015-10-01

In this manuscript, we describe the initial steps of an international program of prevention research in Monterrey, México. Specifically, we present a feasibility study focused on exploring the level of acceptability reported by a group of Mexican mothers who were exposed to a culturally adapted parenting intervention originally developed in the United States. The efficacious intervention adapted in this investigation is known as Parent Management Training, the Oregon Model (PMTO(®)). Following a description of our international partnership, we describe the implementation of the pilot study aimed at determining initial feasibility. Qualitative data provided by 40 Mexican mothers exposed to the culturally adapted parenting intervention illustrate the participants' high level of receptivity toward the intervention, as well as the beneficial impact on their parenting practices. © 2014 American Association for Marriage and Family Therapy.

International epidemiology of HIV and AIDS among injecting drug users.

PubMed

Des Jarlais, D C; Friedman, S R; Choopanya, K; Vanichseni, S; Ward, T P

1992-10-01

HIV/AIDS and iv drug use (IVDU) are of significant multinational scope and growing. Supporting increased IVDU in many countries are countries' geographical proximity to illicit drug trafficking distribution routes, law enforcement efforts which increase the demand for more efficient drug distribution and consumption, and countries' infrastructural and social modernization. Given the failures of intensified law enforcement efforts to thwart the use and proliferation of illegal drugs, countries with substantial IVDU should look away from preventing use to preventing HIV transmission within drug user populations. With HIV seroprevalence rates rapidly reaching 40-50% in some developing country IVDU groups, a variety of prevention programs is warranted. Such programs should be supported and implemented while prevention remains feasible. This paper examines the variation in HIV seroprevalence among IVD users, rapid HIV spread among users, HIV among IVDUs in Bangkok, emerging issues in HIV transmission among IVDUs, non-AIDS manifestations of HIV infection among IVDUs, prevention programs and effectiveness, and harm reduction.

Development of new port in Minahasa Utara: A-pre feasibility study

NASA Astrophysics Data System (ADS)

Hamzah, Suharman; Abdurahman, Asad; Saputra, Reza; Aprianti, Evi

2017-11-01

In order to support Indonesian Government priority sector to build toll maritime in conjunction to connect "nusantara" as an archipelago country, and also to develop the frontier area of Indonesia, the existence of a port should get more in attention as the gate of Indonesia. A port has significant role in changing of transport mode and at the end as catalyst of economic growth. An important thing from pre-feasibility studies is the priority factor will clearly shown wheather it is good or fair. As a supporting to service passenger moving, container, general cargo and also bulk, a port is necessary to have an excellent design and planning. A pre-feasibility study is required to obtain a scientific basis based on value of interest and the necessity of the region. A pre-feasibility study in this paper aims to identify potential support of the region and giving priority location of development of new port in Minahasa Utara regarding to spatial, government issues, transportation aspect, regional economics, environmental aspect and technical aspect consideration. Experimental Method used are qualitative and quantitative, going through to the data obtained and supported by interview on the spot as well as questionnaire surveys. Result of this paper showing that there are 5 locations suitable with the requirements. Based on the level of priority, high (Kema, Likupang), moderate (Linuhu, Kahuku) and low (Gangga 1).

International Telepharmacy Education: Another Venue to Improve Cancer Care in the Developing World

PubMed Central

AlFaar, Ahmad S.; Kamal, Sherif; AbouElnaga, Sherif; Greene, William L.; Quintana, Yuri; Ribeiro, Raul C.

2012-01-01

Abstract Objective: In developed countries, pharmacists play a crucial role in designing and implementing cancer treatments as part of a multidisciplinary oncology team. However, developing countries have a shortage of pharmacists, and their role is generally limited to dispensing and selling drugs. The aim of this study was to investigate the feasibility of providing clinical pharmacy educational activities via international teleconferencing to improve cancer care in developing countries. Materials and Methods: Meticulous preparation and intense promotion of the workshop were done in Egypt before the telepharmacy conferences began. Multiple connectivity tests were performed to resolve technical problems. Nine telepharmacy conferences were delivered during 3-h sessions that were held on three consecutive days. Talks were subsequently made available via Web streaming. Attendees were requested to complete a survey to measure their satisfaction with the sessions. Results: The teleconference was attended by a total of 345 persons, and it was subsequently reviewed online via 456 log-in sessions from 10 countries. Technical issues (e.g., poor auditory quality) were resolved on the first day of the event. The rate of attendees' responses on the survey was 30.1%, and satisfaction with the event was generally good. Conclusions: Telecommunication is a relatively inexpensive approach that may improve pharmacy practices, especially those used to treat patients with cancer in developing countries. Special attention to patient-based telepharmacy education, including the use of cost-effective technology, should be considered. PMID:22667696

Feasibility of modified surviving sepsis campaign guidelines in a resource-restricted setting based on a cohort study of severe S. aureus sepsis [corrected].

PubMed

Mahavanakul, Weera; Nickerson, Emma K; Srisomang, Pramot; Teparrukkul, Prapit; Lorvinitnun, Pichet; Wongyingsinn, Mingkwan; Chierakul, Wirongrong; Hongsuwan, Maliwan; West, T Eoin; Day, Nicholas P; Limmathurotsakul, Direk; Peacock, Sharon J

2012-01-01

The Surviving Sepsis Campaign (SSC) guidelines describe best practice for the management of severe sepsis and septic shock in developed countries, but most deaths from sepsis occur where healthcare is not sufficiently resourced to implement them. Our objective was to define the feasibility and basis for modified guidelines in a resource-restricted setting. We undertook a detailed assessment of sepsis management in a prospective cohort of patients with severe sepsis caused by a single pathogen in a 1,100-bed hospital in lower-middle income Thailand. We compared their management with the SSC guidelines to identify care bundles based on existing capabilities or additional activities that could be undertaken at zero or low cost. We identified 72 patients with severe sepsis or septic shock associated with S. aureus bacteraemia, 38 (53%) of who died within 28 days. One third of patients were treated in intensive care units (ICUs). Numerous interventions described by the SSC guidelines fell within existing capabilities, but their implementation was highly variable. Care available to patients on general wards covered the fundamental principles of sepsis management, including non-invasive patient monitoring, antimicrobial administration and intravenous fluid resuscitation. We described two additive care bundles, one for general wards and the second for ICUs, that if consistently performed would be predicted to improve outcome from severe sepsis. It is feasible to implement modified sepsis guidelines that are scaled to resource availability, and that could save lives prior to the publication of international guidelines for developing countries.

Single life time cytological screening in high risk women as an economical and feasible approach to control cervical cancer in developing countries like India.

PubMed

Misra, Jata Shankar; Srivastava, Anand Narain; Das, Vinita

2015-01-01

In view of funding crunches and inadequate manpower in cytology in developing countries like India, single lifetime screening for cervical cancer has been suggested. In this study, an attempt was made to identify high risk groups of women for this screening to make it more effective for early detection. Cytological data were derived from the ongoing routine cervical cytology screening program for women attending Gynaecology Out Patient Department of Queen Mary's Hospital of K.G.Medical University, Lucknow, India during a span of 35 years (April 1971 - December 2005). Cervical smears in a total of 38,256 women were cytologically evaluated. The frequencies of squamous intraepithelial lesions of cervix (SIL) and carcinoma cervix were found to be 7.0% and 0.6%, respectively, in the series. Predisposing factors related to cervical carcinogenesis were analyzed in detail to establish the most vulnerable groups of women for single life time screening. The incidence of SIL and carcinoma cervix was found to be maximal in women above the age of 40 years irrespective of parity and in multiparous women (with three or more children) irrespective of age. The incidence of cervical cytopathologies was significantly higher in symptomatic women, the frequency of SIL being alarmingly higher in women complaining of contact bleeding and that of carcinoma cervix in older women with postmenopausal bleeding. It is consequently felt that single life time screening must include the three groups of women delineated above. Such selective screening appears to be the most economical, cost effective and feasible approach to affordably control the menace of cervical cancer in developing countries like India.

Regulating incentives: the past and present role of the state in health care systems.

PubMed

Saltman, Richard B

2002-06-01

The desire of national policymakers to encourage entrepreneurial behavior in the health sector has generated not only a new structure of market-oriented incentives, but also a new regulatory role for the State. To ensure that entrepreneurial behavior will be directed toward achieving planned market objectives, the State must shift modalities from staid bureaucratic models of command-and-control to more sensitive and sophisticated systems of oversight and supervision. Available evidence suggests that this structural transformation is currently occurring in several Northern European countries. Successful implementation of that shift will require a new, intensive, and expensive strategy for human resources development, raising questions about the financial feasibility of this incentives-plus-regulation model for less-well-off CEE/CIS and developing countries.

Evaluating the technical feasibility of aflatoxin risk reduction strategies in Africa.

PubMed

Wu, Felicia; Khlangwiset, Pornsri

2010-05-01

Public health interventions must be readily accepted by their target populations to have any meaningful impact and must have financial and infrastructural support to be feasible in the parts of the world where they are most needed. At the same time, these interventions must be assessed for potential unintended consequences, either to the environment or to human health. In this paper, we evaluate the technical feasibility of interventions to control aflatoxin risk, to be potentially deployed in parts of Africa where aflatoxin exposure poses a significant public health concern. We have applied a conceptual framework for feasibility to four interventions, one associated with each of four different stages of aflatoxin risk: biocontrol (pre-harvest), a post-harvest intervention package (post-harvest), NovaSil clay (dietary), and hepatitis B vaccination (clinical). For each intervention, we have assessed the following four components of technical feasibility: (1) characteristics of the basic intervention, (2) characteristics of delivery, (3) requirements on government capacity, and (4) usage characteristics. We propose ways in which feasibility of each intervention is currently high or low from the perspective of adoption in Africa, how public education is crucial for each of these interventions to succeed, and how to align economic incentives to make the interventions more suitable for less developed countries.

Evaluating the technical feasibility of aflatoxin risk reduction strategies in Africa

PubMed Central

Wu, Felicia; Khlangwiset, Pornsri

2010-01-01

Public health interventions must be readily accepted by their target populations to have any meaningful impact, and must have financial and infrastructural support to be feasible in the parts of the world where they are most needed. At the same time, these interventions must be assessed for potential unintended consequences, either to the environment or to human health. In this paper, we evaluate the technical feasibility of interventions to control aflatoxin risk, to be potentially deployed in parts of Africa where aflatoxin exposure poses a significant public health concern. We have applied a conceptual framework for feasibility to four interventions, one associated with each of four different stages of aflatoxin risk: biocontrol (pre-harvest), a post-harvest intervention package (post-harvest), NovaSil clay (dietary), and hepatitis B vaccination (clinical). For each intervention, we have assessed the following four components of technical feasibility: 1) characteristics of the basic intervention, 2) characteristics of delivery, 3) requirements on government capacity, and 4) usage characteristics. We propose ways in which feasibility of each intervention is currently high or low from the perspective of adoption in Africa, how public education is crucial for each of these interventions to succeed, and how to align economic incentives to make the interventions more suitable for less developed countries. PMID:20455160

Applications of nutrient profiling: potential role in diet-related chronic disease prevention and the feasibility of a core nutrient-profiling system.

PubMed

Sacks, G; Rayner, M; Stockley, L; Scarborough, P; Snowdon, W; Swinburn, B

2011-03-01

A number of different nutrient-profiling models have been proposed and several applications of nutrient profiling have been identified. This paper outlines the potential role of nutrient-profiling applications in the prevention of diet-related chronic disease (DRCD), and considers the feasibility of a core nutrient-profiling system, which could be modified for purpose, to underpin the multiple potential applications in a particular country. The 'Four 'P's of Marketing' (Product, Promotion, Place and Price) are used as a framework for identifying and for classifying potential applications of nutrient profiling. A logic pathway is then presented that can be used to gauge the potential impact of nutrient-profiling interventions on changes in behaviour, changes in diet and, ultimately, changes in DRCD outcomes. The feasibility of a core nutrient-profiling system is assessed by examining the implications of different model design decisions and their suitability to different purposes. There is substantial scope to use nutrient profiling as part of the policies for the prevention of DRCD. A core nutrient-profiling system underpinning the various applications is likely to reduce discrepancies and minimise the confusion for regulators, manufacturers and consumers. It seems feasible that common elements, such as a standard scoring method, a core set of nutrients and food components, and defined food categories, could be incorporated as part of a core system, with additional application-specific criteria applying. However, in developing and in implementing such a system, several country-specific contextual and technical factors would need to be balanced.

Holding up a mirror: changing obstetric practice through criterion-based clinical audit in developing countries.

PubMed

Wagaarachchi, P T; Graham, W J; Penney, G C; McCaw-Binns, A; Yeboah Antwi, K; Hall, M H

2001-08-01

The objective of the study described is to assess the feasibility and effectiveness of using a criterion-based clinical audit to measure and improve the quality of obstetric care at the district hospital level in developing countries. The focus is on the management of five life-threatening obstetric complications--hemorrhage, eclampsia, genital tract infection, obstructed labor and uterine rupture was audited using a "before and after" design. The five steps of the audit cycle were followed: establish criteria of good quality care; measure current practice (Review I); feedback findings and set targets; take action to change practice; and re-evaluate practice (Review II). Systematic literature review, panel discussions and pilot work led to the development of 31 audit criteria. Review I included 555 life-threatening complications occurring over 66 hospital-months; Review II included 342 complications over 42 hospital-months. Many common areas for improvement were identified across the four hospitals. Agreed mechanisms for achieving these improvements included clinical protocols, reviews of staffing, and training workshops. Some aspects of clinical monitoring, drug use and record keeping improved significantly between Reviews I and II. Criterion-based clinical audit in four typical district hospitals in Ghana and Jamaica is a feasible and acceptable method for quality assurance and appears to have improved the management of life-threatening obstetric complications.

Observational study shows that it is feasible to provide neuroprotective treatment for neonatal encephalopathy in low-income countries.

PubMed

Biselele, T; Bambi, J; Naulaers, G; Tabu, G; Kapinga, J; Bola, V; Makaya, P; Tjabbes, H; Tady, B; Peeters-Scholte, C

2018-02-09

Perinatal asphyxia is one of the most frequent causes of neonatal morbidity and mortality worldwide, and 96% of the burden of neonatal encephalopathy occurs in low-income countries. This study investigated the feasibility of providing neuroprotective treatment for neonatal encephalopathy in low-income countries. Neonates with a gestational age of at least 36 weeks, with signs of perinatal asphyxia, were included in this 2015 observational study in three hospitals in Kinshasa, capital of the Democratic Republic of Congo. Their characteristics were described, including the time to admission and Thompson score on admission. We found that 42 of 134 patients (31.3%) reached the hospital within six hours of birth with a Thompson score of at least seven on admission. Another 15 patients (11.2%) had a five-minute Apgar score of up to five, without a Thompson score, and were eligible for treatment. Of the 57 (42.5%) eligible patients, 31 were discharged (54.4%), 25 died (43.9%) and one (1.8%) remained in hospital at the end of the study. Interventional studies are feasible and necessary, especially in countries where the burden of neonatal encephalopathy is largest. A Thompson score of 7-15 might be a useful entry criterion for neuroprotective treatment in low-income countries. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Newborn Screening for Sickle Cell Disease in Liberia: A Pilot Study.

PubMed

Tubman, Venée N; Marshall, Roseda; Jallah, Wilhemina; Guo, Dongjing; Ma, Clement; Ohene-Frempong, Kwaku; London, Wendy B; Heeney, Matthew M

2016-04-01

In malaria-endemic countries in West Africa, sickle cell disease (SCD) contributes to childhood mortality. Historically, Liberia had regions wherein hemoglobin S and beta-thalassemia trait were mutually exclusive. Data on hemoglobinopathies in the Monrovia, the capital, are outdated and do not reflect urban migration. Updating the epidemiology of SCD is necessary to plan a public health and clinical agenda. Neither newborn screening (NBS) nor screening tools were available in country. This pilot study aimed to determine the feasibility of NBS using a South-South partnership and define the incidence of sickle cell trait (SCT) and SCD in Monrovia. This descriptive epidemiologic feasibility study collected dried blood spots from 2,785 consecutive newborns delivered at a hospital in Monrovia. Samples were analyzed by isoelectric focusing at a regional reference laboratory. Infants with SCD were referred for preventive care. SCT occurred in 10.31% of infants screened. SCD occurred in 33 infants screened [1.19% (95% confidence interval [CI]: 0.79-1.59%)] (FS: 28/33, FSB: 2/33, FSA: 2/33, FSX: 1/33). There were no infants with FSC phenotype observed. Nonsickling hemoglobin phenotypes "FC" and "F" were each present in three infants screened. Seventy-six percent of infants with SCD were brought to care, demonstrating the feasibility of our approach. The incidence of SCD and other hemoglobinopathies remains high in Liberia. Additional studies are needed to clarify sickle genotypes and identify the contribution of silent beta-thalassemia alleles. By developing regional partnerships, countries similar to Liberia can acquire current data to inform NBS as an important public health initiative toward improving child health. © 2016 Wiley Periodicals, Inc.

Newborn Screening for Sickle Cell Disease in Liberia: A Pilot Study

PubMed Central

Tubman, Venée N; Marshall, Roseda; Jallah, Wilhemina; Guo, Dongjing; Ma, Clement; Ohene-Frempong, Kwaku; London, Wendy B; Heeney, Matthew M

2015-01-01

Background In malaria-endemic countries in West Africa, sickle cell disease (SCD) contributes to childhood mortality. Historically, Liberia had regions wherein hemoglobin S and beta-thalassemia trait were mutually exclusive. Data on hemoglobinopathies in the Monrovia, the capital, are outdated and do not reflect urban migration. Updating the epidemiology of SCD is necessary to plan a public health and clinical agenda. Neither newborn screening (NBS) nor screening tools were available in-country. This pilot study aimed to determine the feasibility of NBS using a South-South partnership and define the incidence of sickle cell trait (SCT) and SCD in Monrovia. Procedure This descriptive epidemiologic feasibility study collected dried blood spots from 2785 consecutive newborns delivered at a hospital in Monrovia. Samples were analyzed by isoelectric focusing at a regional reference laboratory. Infants with SCD were referred for preventive care. Results SCT occurred in 10.31% of infants screened. SCD occurred in 33 infants screened [1.19% (95% CI: 0.79%–1.59%)](FS: 28/33, FSB: 2/33, FSA: 2/33, FSX 1/33). There were no infants with FSC phenotype observed. Non-sickling hemoglobin phenotypes ‘FC’ and ‘F’ were each present in 3 infants screened. Seventy-six percent of infants with SCD were brought to care, demonstrating the feasibility of our approach. Conclusions The incidence of SCD and other hemoglobinopathies remain high in Liberia. Additional studies are needed to clarify sickle genotypes and identify the contribution of silent beta-thalassemia alleles. By developing regional partnerships, countries similar to Liberia can acquire current data to inform NBS as an important public health initiative toward improving child health. PMID:26739520

Modelling the impacts of new diagnostic tools for tuberculosis in developing countries to enhance policy decisions.

PubMed

Langley, Ivor; Doulla, Basra; Lin, Hsien-Ho; Millington, Kerry; Squire, Bertie

2012-09-01

The introduction and scale-up of new tools for the diagnosis of Tuberculosis (TB) in developing countries has the potential to make a huge difference to the lives of millions of people living in poverty. To achieve this, policy makers need the information to make the right decisions about which new tools to implement and where in the diagnostic algorithm to apply them most effectively. These decisions are difficult as the new tools are often expensive to implement and use, and the health system and patient impacts uncertain, particularly in developing countries where there is a high burden of TB. The authors demonstrate that a discrete event simulation model could play a significant part in improving and informing these decisions. The feasibility of linking the discrete event simulation to a dynamic epidemiology model is also explored in order to take account of longer term impacts on the incidence of TB. Results from two diagnostic districts in Tanzania are used to illustrate how the approach could be used to improve decisions.

Experimental program for the operational study of data collection platforms in Bolivia

NASA Technical Reports Server (NTRS)

1977-01-01

The system developed for the SMS/GOES satellite while learning the limitations possessed by this system with regard to the LANDSAT 1 and 2 satellites with respect to the transmission distance and horizon angle is investigated. The advantages possessed by this system in comparison with conventional methods are evaluated so as to permit studying the feasibility of introducing it into this country in the near future.

Solar Kilns: Feasibility of Utilizing Solar Energy for Drying Lumber in Developing Countries,

DTIC Science & Technology

1977-01-01

Design. .. ............. ... 52 Direct ( Greenhouse ) Design .. .. ............ ... 57 Literature Cited and Partial Bibliography of Solar Lumber Drying...experimental performance of a greenhouse -type solar kiln in Puerto Rico. (Chudnoff et al., 1966). 36"J. Table 9.--Comparison of experimental and calculated...at one dryer orientation (long axis north-south) from 30 percent to 10 percent moisture content. 49 Table 15.-- Greenhouse -type solar kiln capacity

Intradermal Administration of Fractional Doses of Inactivated Poliovirus Vaccine: A Dose-Sparing Option for Polio Immunization.

PubMed

Okayasu, Hiromasa; Sein, Carolyn; Chang Blanc, Diana; Gonzalez, Alejandro Ramirez; Zehrung, Darin; Jarrahian, Courtney; Macklin, Grace; Sutter, Roland W

2017-07-01

A fractional dose of inactivated poliovirus vaccine (fIPV) administered by the intradermal route delivers one fifth of the full vaccine dose administered by the intramuscular route and offers a potential dose-sparing strategy to stretch the limited global IPV supply while further improving population immunity. Multiple studies have assessed immunogenicity of intradermal fIPV compared with the full intramuscular dose and demonstrated encouraging results. Novel intradermal devices, including intradermal adapters and disposable-syringe jet injectors, have also been developed and evaluated as alternatives to traditional Bacillus Calmette-Guérin needles and syringes for the administration of fIPV. Initial experience in India, Pakistan, and Sri Lanka suggests that it is operationally feasible to implement fIPV vaccination on a large scale. Given the available scientific data and operational feasibility shown in early-adopter countries, countries are encouraged to consider introducing a fIPV strategy into their routine immunization and supplementary immunization activities. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Priority setting for the prevention and control of cardiovascular diseases: multi-criteria decision analysis in four eastern Mediterranean countries.

PubMed

Ghandour, Rula; Shoaibi, Azza; Khatib, Rana; Abu Rmeileh, Niveen; Unal, Belgin; Sözmen, Kaan; Kılıç, Bülent; Fouad, Fouad; Al Ali, Radwan; Ben Romdhane, Habiba; Aissi, Wafa; Ahmad, Balsam; Capewell, Simon; Critchley, Julia; Husseini, Abdullatif

2015-01-01

To explore the feasibility of using a simple multi-criteria decision analysis method with policy makers/key stakeholders to prioritize cardiovascular disease (CVD) policies in four Mediterranean countries: Palestine, Syria, Tunisia and Turkey. A simple multi-criteria decision analysis (MCDA) method was piloted. A mixed methods study was used to identify a preliminary list of policy options in each country. These policies were rated by different policymakers/stakeholders against pre-identified criteria to generate a priority score for each policy and then rank the policies. Twenty-five different policies were rated in the four countries to create a country-specific list of CVD prevention and control policies. The response rate was 100% in each country. The top policies were mostly population level interventions and health systems' level policies. Successful collaboration between policy makers/stakeholders and researchers was established in this small pilot study. MCDA appeared to be feasible and effective. Future applications should aim to engage a larger, representative sample of policy makers, especially from outside the health sector. Weighting the selected criteria might also be assessed.

Agricultural development in a petroleum-based economy: Qatar

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hassan, M.F

Developing countries, whose policies may have emphasized import substitution as a way to industrialize, now have incentives to stress agriculture. These new incentives are primarily the rapid increase in food prices, but also include the decline of foreign aid, particularly food aid. Qatar, a petroleum exporter, is examined to see if agricultural development is feasible, given the country's economy, which is lopsided with petroleum revenue and lacks modern accounting practices; constraints against agriculture, such as adverse climate, limited land used for cultivation, poor soil conditions, and a shortage of labor and equipment; the governmental role in agriculture; and the opportunitiesmore » for agricultural technology. Policies are needed to deal with questions of water use and resource allocation, with oil resources providing the financial means to overcome some of the constraints and with the government taking the initiative for modernizing the agricultural sector.« less

[Cardiac sonographers: a unique reality in Anglo-saxon countries? The experience of an Italian echo-lab which is employing them since 1984].

PubMed

del Mestre, Lorenzo; Compassi, Rossana; Badano, Luigi P; Monti, Maria Luisa; Ciani, Rosanna; Buiese, Simonetta; Gianfagna, Pasquale; Fioretti, Paolo M

2006-12-01

Cardiac sonographers play a key role in the management of echo-laboratories in anglo-saxon countries. In Italy, and generally in "latin" countries nearly all echocardiographic studies are performed by cardiologists. However, because of the increasing demand for echocardiography, this practice will no longer be feasible (medical schools do not graduate enough cardiologists!), and cost-effective (the cost of echocardiography performed by cardiologists only is becoming too high!). Introduction of cardiac sonographers in Italian echo-laboratories may represent a feasible and cost-effective solution to the ever increasing demand for echocardiography. In order to contribute to the debate, we report the experience of our echo-laboratory that employs cardiac sonographers since 1984.

Priority needs and wisdom strategy for blood transfusion safety in developing low-resource countries.

PubMed

Abdelrazik, Abeer Mohamed; Ezzat Ahmed, Ghada M

2016-02-01

To evaluate the implementation of alternative safety measures that reduce the risk of transfusion transmissible infections as an affordable measure in low resource countries. It is still difficult in developing countries with limited resources to mandate nucleic acid testing due to its high cost. Although NAT reduces the window period of infection, the developing countries are still in need of an efficient and effective transfusion programme before implementing the complex high cost NAT. Two thousand eight hundred eighty sero-negative first-time and repeat donations from Fayoum University Hospital blood bank were individually analysed by NAT for HIV, HBV and HCV. Only discriminatory-positive NAT were classified comparing the non-remunerated and family replacement donations. Significant discriminatory-positive differences were observed for HBV NAT results, 2 remunerated donations compared to 0 non-remunerated sero-negative donations. The discriminatory positive differences were also significant for HCV NAT results, 4 remunerated donations compared to 1 non-remunerated sero-negative donation. No sero-negative, discriminatory-positive NAT HIV case was found. Seven out of 8 discriminatory positive cases were from first time donations. In order to ensure blood safety, the recruitment and retention of voluntary, non-remunerated repeat donors should be a major commitment for low resource countries in which NAT implementation is costly and not feasible. Copyright © 2016 Elsevier Ltd. All rights reserved.

Outcome after temporal lobectomy in patients with medically-refractory mesial temporal epilepsy in Iran.

PubMed

Asadi-Pooya, Ali A; Rakei, Seyed M; Kamgarpour, Ahmad; Taghipour, Mousa; Ashjazadeh, Nahid; Razmkon, Ali; Zare, Zahra; Bagheri, Mohammad H

2017-06-01

Epilepsy surgery has been proved to be feasible and cost-effective in developing countries. In the current paper, we discussed the outcome of patients with mesial temporal lobe epilepsy (MTLE) and medically-refractory seizures who had surgery at our center in Shiraz, Iran. Patients aged 18 years and older with refractory MTLE and mesial temporal sclerosis operated at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through December 2011 were enrolled. Presurgical evaluation included clinical history, neurological examination, 2-hour video-EEG recording, and 1.5-T MRI. All patients were submitted to standard temporal lobectomy at the side determined by MRI and video-EEG. Twenty-two patients (12 women and 10 men) underwent surgery between May 2009 and December 2011. All patients were followed postoperatively for at least 12 months (mean=24.8±7.7 months; minimum=12 months; maximum=36 months). At the last follow-up visit, 18 patients (81.8%) had a good outcome (15 patients [68.2%] had Engel class 1 and three others had Engel class 2). The total cost of presurgical evaluation and epilepsy surgery at our center was less than $500. Resources are limited for the vast majority of medically-refractory patients with epilepsy who live in the developing countries. However, it is feasible to select good surgical candidates for anterior temporal lobectomy relying on the clinical history and examination, MRI and interictal EEG. Broader application of epilepsy surgery should be encouraged in countries with limited financial resources.

Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets.

PubMed

Paolucci, Francesco; Schut, Erik; Beck, Konstantin; Gress, Stefan; Van de Voorde, Carine; Zmora, Irit

2007-04-01

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

Development of harmonised food and sample lists for total diet studies in five European countries.

PubMed

Dofkova, Marcela; Nurmi, Tanja; Berg, Katharina; Reykdal, Ólafur; Gunnlaugsdóttir, Helga; Vasco, Elsa; Dias, Maria Graça; Blahova, Jitka; Rehurkova, Irena; Putkonen, Tiina; Ritvanen, Tiina; Lindtner, Oliver; Desnica, Natasa; Jörundsdóttir, Hrönn Ó; Oliveira, Luísa; Ruprich, Jiri

2016-06-01

A total diet study (TDS) is a public health tool for determination of population dietary exposure to chemicals across the entire diet. TDSs have been performed in several countries but the comparability of data produced is limited. Harmonisation of the TDS methodology is therefore desirable and the development of comparable TDS food lists is considered essential to achieve the consistency between countries. The aim of this study is to develop and test the feasibility of a method for establishing harmonised TDS food and sample lists in five European countries with different consumption patterns (Czech Republic, Finland, Germany, Iceland and Portugal). The food lists were intended to be applicable for exposure assessment of wide range of chemical substances in adults (18-64 years) and the elderly (65-74 years). Food consumption data from recent dietary surveys measured on individuals served as the basis for this work. Since the national data from these five countries were not comparable, all foods were linked to the EFSA FoodEx2 classification and description system. The selection of foods for TDS was based on the weight of food consumed and was carried out separately for each FoodEx2 level 1 food group. Individual food approach was respected as much as possible when the TDS samples were defined. TDS food lists developed with this approach represented 94.7-98.7% of the national total diet weights. The overall number of TDS samples varied from 128 in Finland to 246 in Germany. The suggested method was successfully implemented in all five countries. Mapping of data to the EFSA FoodEx2 coding system was recognised as a crucial step in harmonisation of the developed TDS food lists.

Sustainable Energy in Remote Indonesian Grids. Accelerating Project Development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hirsch, Brian; Burman, Kari; Davidson, Carolyn

2015-06-30

Sustainable Energy for Remote Indonesian Grids (SERIG) is a U.S. Department of Energy (DOE) funded initiative to support Indonesia’s efforts to develop clean energy and increase access to electricity in remote locations throughout the country. With DOE support, the SERIG implementation team consists of the National Renewable Energy Laboratory (NREL) and Winrock International’s Jakarta, Indonesia office. Through technical assistance that includes techno-economic feasibility evaluation for selected projects, government-to-government coordination, infrastructure assessment, stakeholder outreach, and policy analysis, SERIG seeks to provide opportunities for individual project development and a collective framework for national replication office.

Defining a global research agenda for breast cancer

PubMed Central

Love, Richard R.

2008-01-01

In contrast to western high income nations, the incidence and mortality from breast cancer are increasing in most low and middle income countries worldwide. Current approaches to breast cancer control developed for populations of high income societies should not be directly transferred without evaluation. A relevant research agenda includes population differences in tumor biology and metabolization of systemic therapies; cultural and psychosocial issues; and operations in health care systems. Highest priority should be given to assessments of clinical downstaging and basic systemic treatment effectiveness in low and middle income populations. Partnerships of existing organizations in high income nations with those in low and middle income countries are currently the most feasible sources of research support. PMID:18837032

Feasibility of Open Schooling in Disturbed Societies: The Case of Afghanistan

ERIC Educational Resources Information Center

Mitra, Sushmita

2014-01-01

Most countries have enshrined the right to education in their constitution but, in reality, to fulfil this commitment, countries do face a number of challenges. And this is true with the Islamic Republic of Afghanistan, which unlike other countries has a long history of war, conflicts, insurgency, and hence insecurity. Although there have been…

The Diagnosis of Autism and Autism Spectrum Disorder in Low- and Middle-Income Countries: Experience from Jamaica

ERIC Educational Resources Information Center

Samms-Vaughan, Maureen; Rahbar, Mohammad H.; Dickerson, Aisha S.; Loveland, Katherine A.; Hessabi, Manouchehr; Pearson, Deborah A.; Bressler, Jan; Shakespeare-Pellington, Sydonnie; Grove, Megan L.; Coore-Desai, Charlene; Reece, Jody; Boerwinkle, Eric

2017-01-01

The administration requirements of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, widely used in high-income countries, make them less feasible for diagnosis of autism spectrum disorder in low- and middle-income countries. The flexible administration requirements of the Childhood Autism Rating Scale have…

Standardised metrics for global surgical surveillance.

PubMed

Weiser, Thomas G; Makary, Martin A; Haynes, Alex B; Dziekan, Gerald; Berry, William R; Gawande, Atul A

2009-09-26

Public health surveillance relies on standardised metrics to evaluate disease burden and health system performance. Such metrics have not been developed for surgical services despite increasing volume, substantial cost, and high rates of death and disability associated with surgery. The Safe Surgery Saves Lives initiative of WHO's Patient Safety Programme has developed standardised public health metrics for surgical care that are applicable worldwide. We assembled an international panel of experts to develop and define metrics for measuring the magnitude and effect of surgical care in a population, while taking into account economic feasibility and practicability. This panel recommended six measures for assessing surgical services at a national level: number of operating rooms, number of operations, number of accredited surgeons, number of accredited anaesthesia professionals, day-of-surgery death ratio, and postoperative in-hospital death ratio. We assessed the feasibility of gathering such statistics at eight diverse hospitals in eight countries and incorporated them into the WHO Guidelines for Safe Surgery, in which methods for data collection, analysis, and reporting are outlined.

Determination of water environment standards based on water quality criteria in China: Limitations and feasibilities.

PubMed

Wang, Tieyu; Zhou, Yunqiao; Bi, Cencen; Lu, Yonglong; He, Guizhen; Giesy, John P

2017-07-01

There is a need to formulate water environment standards (WESs) from the current water quality criteria (WQC) in China. To this end, we briefly summarize typical mechanisms applied in several countries with longer histories of developing WESs, and three limitations to formulating WESs in China were identified. After analyzing the feasibility factors including economic development, scientific support capability and environmental policies, we realized that China is still not ready for a complete change from its current nation-wide unified WES system to a local-standard-based system. Thus, we proposed a framework for transformation from WQC to WESs in China. The framework consists of three parts, including responsibilities, processes and policies. The responsibilities include research authorization, development of guidelines, and collection of information, at both national and local levels; the processes include four steps and an impact factor system to establish water quality standards; and the policies include seven specific proposals. Copyright © 2016. Published by Elsevier B.V.

The potential role for probiotic yogurt for people living with HIV/AIDS

PubMed Central

2010-01-01

In demonstrating that it is feasible to create a community-run kitchen that produces probiotic yogurt, and that this can contribute to the health of people with HIV/AIDS, we embellished the 2001 Food and Agriculture Organization (FAO) and World Health Organization (WHO) report on probiotics that recommended efforts be made to take probiotics to developing countries. We proved that driven by humanitarian goals not profit, probiotic yogurt can be produced in the world's poor regions. This food can be safely consumed by HIV/AIDS subjects, and in many of them benefits can be accrued in gut health, nutritional and potentially immune status. Such outcomes have a scientific rationale, many social implications, and perhaps most importantly raise the question, why have developed countries not tried harder to bring nutrition-based probiotics to people in need? PMID:21468226

Senior Friendly Hospitals: Development and Application of Criteria: A Descriptive Study.

PubMed

Rashmi, M R; Kasthuri, Arvind; Rodrigues, Rashmi J

2016-01-01

The world's population is rapidly aging. Between 2000 and 2050, the proportion of the world's population over the age of 60 will double from about 11% to 22%; more so in the developing countries. The prevalence of frailty and morbidity among the elderly is high. There is a need to assess the "preparedness" of the health care system including hospitals to respond to the needs of the elderly. 1. To develop criteria for a senior friendly hospital and 2. To assess the feasibility of application of these criteria. A descriptive study was done at Bangalore, India, involving 100 subjects sampled by purposive sampling. Study population consisted of senior citizens, their caretakers, physicians, hospital support staff, nurses, geriatricians, hospital administrators, and architects. They were interviewed using a validated translated interview schedule. The study consisted of two phases; Phase 1: Developing a checklist to assess senior friendliness of a hospital by using modified Delphi technique. Phase 2: Application of the checklist thus developed to selected hospitals in order to assess the feasibility of administration. The data was then analyzed using Statistical Package for the Social Sciences (SPSS) for frequencies, proportions, central tendency and dispersion, interclass reliability, intraclass reliability, and Cronbach's alpha. A checklist containing 44 items to assess the senior friendliness of a hospital was developed. The checklist was found feasible and easy to administer. The checklist thus developed to assess senior friendliness of a hospital has wider application as it has a potential to be considered for framing senior friendly hospital guidelines/policies.

Roles for non-physicians in fertility regulation: an international overview of legal obstacles and solutions.

PubMed Central

Paxman, J M

1980-01-01

For more than a decade the roles of non-physicians in fertility regulation have been expanding. The article discusses the relationship between law and the expansion of those roles. The laws and regulations which effect these roles fall into three basic categories: those controlling the medical and other health-related professions, those regulating drugs and devices, and those affecting specific fertility regulation services. These in turn may either inhibit or facilitate the expansion of roles for non-physicians. Where legal barriers arise, and no feasible legal solution is developed, expansion of roles is difficult, if not impossible, as the law invariably reflects the prevailing views on who should provide fertility regulation services. In many countries, however, as roles have been changing, the law has been changing too in a way which affords legal protection to non-physicians. The emphasis to date has been on permitting them to assume expanded roles in the provision of contraceptives. Non-physicians are authorized to prescribe the Pill in at least 10 countries and to re-supply the Pill after prescription in seven others. Non-physicians are permitted to insert IUDs in at least 10 countries. Pilot projects are presently testing the feasibility of permitting non-physicians to perform sterilizations and early abortions. The law has an impact, for good or ill, on all of these arrangements. PMID:7350821

Health systems research in a low income country - easier said than done

PubMed Central

English, Mike; Irimu, Grace; Wamae, Annah; Were, Fred; Wasunna, Aggrey; Fegan, Greg; Peshu, Norbert

2009-01-01

Summary Small hospitals sit at the apex of the pyramid of primary care in many low-income country health systems. If the Millennium Development Goal for child survival is to be achieved hospital care for severely ill, referred children will need to be improved considerably in parallel with primary care in many countries. Yet we know little about how to achieve this. We describe the evolution and final design of an intervention study attempting to improve hospital care for children in Kenyan district hospitals. We believe our experience illustrates many of the difficulties involved in reconciling epidemiological rigour and feasibility in studies at a health system rather than an individual level and the importance of the depth and breadth of analysis when trying to provide a plausible answer to the question - does it work? While there are increasing calls for more health systems research in low-income countries the importance of strong, broadly-based local partnerships and long term commitment even to initiate projects are not always appreciated. PMID:18495913

Experiences from a pilot study on how to conduct a qualitative multi-country research project regarding use of antibiotics in Southeast Europe.

PubMed

Kaae, Susanne; Sporrong, Sofia Kälvemark; Traulsen, Janine Morgall; Wallach Kildemoes, Helle; Nørgaard, Lotte Stig; Jakupi, Arianit; Raka, Denis; Gürpinar, Emre Umut; Alkan, Ali; Hoxha, Iris; Malaj, Admir; Cantarero, Lourdes Arevalo

2016-01-01

In 2014, a qualitative multi-country research project was launched to study the reasons behind the high use of antibiotics in regions of Southeast Europe by using previously untrained national interviewers (who were engaged in other antibiotic microbial resistance-related investigations) to conduct qualitative interviews with local patients, physicians and pharmacists. Little knowledge exists about how to implement qualitative multi-country research collaborations involving previously untrained local data collectors. The aim of this paper was therefore to contribute to the knowledge regarding how to conduct these types of research projects by evaluating a pilot study of the project. Local data collectors conducted the study according to a developed protocol and evaluated the study with the responsible researcher-team from University of Copenhagen. The pilot study focused on 'local ownership', 'research quality' and 'feasibility' with regard to successful implementation and evaluation. The evaluation was achieved by interpreting 'Skype' and 'face to face' meetings and email correspondence by applying 'critical common sense'. Local data collectors achieved a sense of joint ownership. Overall, the protocol worked well. Several minor challenges pertaining to research quality and feasibility were identified, in particular obtaining narratives when conducting interviews and recruiting patients for the study. Furthermore, local data collectors found it difficult to allocate sufficient time to the project. Solutions were discussed and added to the protocol. Despite the challenges, it was possible to achieve an acceptable scientific level of research when conducting qualitative multi-country research collaboration under the given circumstances. Specific recommendations to achieve this are provided by the authors.

The global burden of cancer: priorities for prevention

PubMed Central

Thun, Michael J.; DeLancey, John Oliver; Center, Melissa M.; Jemal, Ahmedin; Ward, Elizabeth M.

2010-01-01

Despite decreases in the cancer death rates in high-resource countries, such as the USA, the number of cancer cases and deaths is projected to more than double worldwide over the next 20–40 years. Cancer is now the third leading cause of death, with >12 million new cases and 7.6 million cancer deaths estimated to have occurred globally in 2007 (1). By 2030, it is projected that there will be ∼26 million new cancer cases and 17 million cancer deaths per year. The projected increase will be driven largely by growth and aging of populations and will be largest in low- and medium-resource countries. Under current trends, increased longevity in developing countries will nearly triple the number of people who survive to age 65 by 2050. This demographic shift is compounded by the entrenchment of modifiable risk factors such as smoking and obesity in many low-and medium-resource countries and by the slower decline in cancers related to chronic infections (especially stomach, liver and uterine cervix) in economically developing than in industrialized countries. This paper identifies several preventive measures that offer the most feasible approach to mitigate the anticipated global increase in cancer in countries that can least afford it. Foremost among these are the need to strengthen efforts in international tobacco control and to increase the availability of vaccines against hepatitis B and human papilloma virus in countries where they are most needed. PMID:19934210

Chinese-American headway on some environmental issues

NASA Astrophysics Data System (ADS)

Showstack, Randy

Although Chinese Premier Zhu Rongji may have failed to gain entrance for his country into the World Trade Organization during his April visit to the United States, the two countries concluded a series of agreements as part of the Second Session of the 2-year-old U.S.-China Policy Forum on Environment and Development.A memorandum of understanding on a $100 million clean energy program accelerates the export of clean U.S. environmental technologies in the area of energy efficiency renewable energy, and pollution reduction. A statement of intent on the development of a Sulfur Dioxide (SO2) Emissions Trading Feasibility Study calls for China to develop a study to test the effectiveness of emissions trading in China as a market-based approach to reducing greenhouse gas emissions. And a Memorandum of Understanding on a natural gas pipeline project, signed by the Enron Corporation and the China National Petroleum Corporation, opens the way to jointly developing a natural gas pipeline to help offer an alternative to fossil fuels.

A study of medical device regulation management model in Asia.

PubMed

Wu, Yi-Hui; Li, Fong-An; Fan, Yin-Ting; Tu, Pei-Weng

2016-06-01

With the aging of the post-war baby boomer generation, the increasing demands for healthcare are driving the growth of medical industry and development of new products in order to meet the immense needs from the aging population. However, medical devices are designed to maintain the health and safety of people, therefore, medical devices are undergoing rigorous management by competent health authorities in all countries. In recent years, Asian countries have been reforming their regulations and standards for medical devices with substantial changes. The study is a summary of the framework of medical device regulations in Asian countries, including Asian Harmonization Working Party (AHWP), Japan, China, Taiwan, South Korea, India and Singapore. Expert commentary: Asian countries are constantly reforming their medical device regulations. The emergence of brand-new technology and quality management issues arose by global manufacturing have imposed difficulties in harmonizing and reaching consensus between countries. The third-party conformity assessment system for medical devices can reduce the costs for competent health authorities and shorten the review time, which could facilitate the feasibility of harmonization of medical device regulations.

Disaster risk from a macroeconomic perspective: a metric for fiscal vulnerability evaluation.

PubMed

Cardona, Omar D; Ordaz, Mario G; Marulanda, Mabel C; Carreño, Martha L; Barbat, Alex H

2010-10-01

The Disaster Deficit Index (DDI) measures macroeconomic and financial risk in a country according to possible catastrophic scenario events. Extreme disasters can generate financial deficit due to sudden and elevated need of resources to restore affected inventories. The DDI captures the relationship between the economic loss that a country could experience when a catastrophic event occurs and the availability of funds to address the situation. The proposed model utilises the procedures of the insurance industry in establishing probable losses, based on critical impacts during a given period of exposure; for economic resilience, the model allows one to calculate the country's financial ability to cope with a critical impact. There are limitations and costs associated with access to resources that one must consider as feasible values according to the country's macroeconomic and financial conditions. This paper presents the DDI model and the results of its application to 19 countries of the Americas and aims to guide governmental decision-making in disaster risk reduction. © 2010 The Author(s). Journal compilation © Overseas Development Institute, 2010.

Indicators for Universal Health Coverage: can Kenya comply with the proposed post-2015 monitoring recommendations?

PubMed

Obare, Valerie; Brolan, Claire E; Hill, Peter S

2014-12-20

Universal Health Coverage (UHC), referring to access to healthcare without financial burden, has received renewed attention in global health spheres. UHC is a potential goal in the post-2015 development agenda. Monitoring of progress towards achieving UHC is thus critical at both country and global level, and a monitoring framework for UHC was proposed by a joint WHO/World Bank discussion paper in December 2013. The aim of this study was to determine the feasibility of the framework proposed by WHO/World Bank for global UHC monitoring framework in Kenya. The study utilised three documents--the joint WHO/World Bank UHC monitoring framework and its update, and the Bellagio meeting report sponsored by WHO and the Rockefeller Foundation--to conduct the research. These documents informed the list of potential indicators that were used to determine the feasibility of the framework. A purposive literature search was undertaken to identify key government policy documents and relevant scholarly articles. A desk review of the literature was undertaken to answer the research objectives of this study. Kenya has yet to establish an official policy on UHC that provides a clear mandate on the goals, targets and monitoring and evaluation of performance. However, a significant majority of Kenyans continue to have limited access to health services as well as limited financial risk protection. The country has the capacity to reasonably report on five out of the seven proposed UHC indicators. However, there was very limited capacity to report on the two service coverage indicators for the chronic condition and injuries (CCIs) interventions. Out of the potential tracer indicators (n = 27) for aggregate CCI-related measures, four tracer indicators were available. Moreover the country experiences some wider challenges that may impact on the implementation and feasibility of the WHO/World Bank framework. The proposed global framework for monitoring UHC will only be feasible in Kenya if systemic challenges are addressed. While the infrastructure for reporting the MDG related indicators is in place, Kenya will require continued international investment to extend its capacity to meet the data requirements of the proposed UHC monitoring framework, particularly for the CCI-related indicators.

A Case Study of SSP for Indonesia

NASA Astrophysics Data System (ADS)

Mostavan, A.; Kaya, N.

2002-01-01

The market of the Solar Power Satellite must be worldwide, because it can be provide electricity anywhre in the world from the Earth's orbits. We have perform case studies of various countries to understand their benefits and disadvantages provide by the Space Solar Power, because each country has much different condition on energy from other countries. We are starting the international collaboration between Indonesia and Japan to carry out the case study for Indonesia. In Japan, METI (Ministry of Economy, Trade and Industry) has already organized a committee to investigate the feasibility of the Space Solar Power and to make a plan to launch a space demonstration of the Solar Power Satellite. While, Indonesia is quickly developing economy and increasing their energy demand. We are investigating the detailed energy conditions of Indonesia and the benefits and disadvantages of he SSP for Indonesia. Especially, we will perform the investigation on the receiving system for the Japanese pilot SPS.

Directory of financing sources for foreign energy projects

DOE Office of Scientific and Technical Information (OSTI.GOV)

La Ferla, L.

1995-09-01

The Office of National Security Policy has produced this Directory of Financing Sources for Foreign Energy Projects. The Directory reviews programs that offer financing from US government agencies, multilateral organizations, public, private, and quasi-private investment funds, and local commercial and state development banks. The main US government agencies covered are the US Agency for International Development (USAID), the Export-Import Bank of the US (EXIM Bank), Overseas Private Investment Corporation (OPIC), US Department of Energy, US Department of Defense, and the US Trade and Development Agency (TDA). Other US Government Sources includes market funds that have been in part capitalized usingmore » US government agency funds. Multilateral organizations include the World Bank, International Finance Corporation (IFC), Asian Development Bank (ADB), European Bank for Reconstruction and Development (EBRD), and various organizations of the United Nations. The Directory lists available public, private, and quasi-private sources of financing in key emerging markets in the Newly Independent States and other developing countries of strategic interest to the US Department of Energy. The sources of financing listed in this directory should be considered indicative rather than inclusive of all potential sources of financing. Initial focus is on the Russian Federation, Ukraine, india, China, and Pakistan. Separate self-contained sections have been developed for each of the countries to enable the user to readily access market-specific information and to support country-specific Departmental initiatives. For each country, the directory is organized to follow the project life cycle--from prefeasibility, feasibility, project finance, cofinancing, and trade finance, through to technical assistance and training. Programs on investment and export insurance are excluded.« less

Preparation and response in case of natural disasters: Cuban programs and experience.

PubMed

Mas Bermejo, Pedro

2006-01-01

Inadequate preparation for national disasters is frequently particularly devastating in lower income countries. The Cuba's location has a diversity of potential natural disasters, including hurricanes, non-tropical depressions, tropical storms, tropical cyclones, and severe local storms, all with intense rains and winds, earthquakes and droughts. Cuban preparation, at all levels, is geared to these predominant threats. Planning for natural disasters is integral to the political and economic life of Cuba, nationally and locally. On several occasions, United Nations (UN) officials have pointed to Cuba as a model for developing countries preparing for hurricanes and other natural disasters. A global policy for managing the risks of natural disasters could improve continuity of assistance for development and reduce the necessity of humanitarian aid. Planning in advance of disasters is a feasible way of helping people, by reducing expenses of emergencies, recuperation, and reconstruction. As climate changes accelerate, many researchers fear a period of irreversible and uncontrollable change. While the atmosphere continues to warm, it generates more intense rains, more frequent heat waves, and more ferocious storms. Thus, achieving better protection of developing countries from an increasing onslaught of natural disasters will only grow in importance. Even though Cuba's contribution to know-how has been recognized by United Nations' officials, progress toward more adequate preparation worldwide has been slow. To support other countries beyond conveying the lessons, Cuba now offers specially trained personnel to cooperate immediately with any country suffering a natural disaster.

Lay and professional stakeholder involvement in scoping palliative care issues: Methods used in seven European countries.

PubMed

Brereton, Louise; Ingleton, Christine; Gardiner, Clare; Goyder, Elizabeth; Mozygemba, Kati; Lysdahl, Kristin Bakke; Tummers, Marcia; Sacchini, Dario; Leppert, Wojciech; Blaževičienė, Aurelija; van der Wilt, Gert Jan; Refolo, Pietro; De Nicola, Martina; Chilcott, James; Oortwijn, Wija

2017-02-01

Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ⩾18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development.

Selecting indicators for patient safety at the health system level in OECD countries.

PubMed

McLoughlin, Vivienne; Millar, John; Mattke, Soeren; Franca, Margarida; Jonsson, Pia Maria; Somekh, David; Bates, David

2006-09-01

Concerns about patient safety have arisen with growing documentation of the extent and nature of harm. Yet there are no robust and meaningful data that can be used internationally to assess the extent of the problem and considerable methodological difficulties. This article describes a project undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. Patient safety indicators from OECD countries were identified and then rated against three principal criteria: importance to patient safety, scientific soundness, and potential feasibility. Although some countries are developing multi-source monitoring systems, these are not yet mature enough for international exchange. This project reviewed routine data collections as a starting point. Of an initial set of 59 candidate indicators identified, 21 were selected which cover known areas of harm to patients. This project is an important initial step towards defining a usable set of patient safety indicators that will allow comparisons to be made internationally and will support mutual learning and quality improvement in health care. Measures of harm should be complemented over time with measures of effective improvement factors.

Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries.

PubMed Central

Graham, W.; Wagaarachchi, P.; Penney, G.; McCaw-Binns, A.; Antwi, K. Y.; Hall, M. H.

2000-01-01

Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper. PMID:10859855

Harnessing the Sun for development: Actions for consideration by the international community at the UN Conference on New and Renewable Sources of Energy for promoting the use of renewable energy in developing countries

NASA Astrophysics Data System (ADS)

Jhirad, D. J.; Mubayi, V.; Weingart, J.

1981-08-01

The technical and economic evidence is reviewed for solar industrial process heat, highlighting the fact that financial parameters such as tax credits and depreciation allowance play a very large role in determining the economic competitiveness of solar investments. An analysis of the energy (and oil) consumed in providing industrial process heat in a number of selected developing countries is presented. Solar industrial process heat technology is discussed including the operating experience of several demonstration plants in the US Solar ponds are also described briefly. A financial and economic analysis of solar industrial process heat systems under different assumptions on future oil prices and various financial parameters is given. Financial analyses are summarized for a solar industrial process heat retrofit of a brewery in Zimbabwe and a high efficiency system operating in financial conditions typical of the US and a number of other industrialized nations. A set of recommended policy actions for countries wishing to enhance the commercial feasibility of renewable energy technologies in the commercial and industrial sections is presented.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

PubMed Central

2014-01-01

Background Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. Methods This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. Results Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. Conclusions Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries. PMID:24533792

Using the balanced scorecard to measure Chinese and Japanese hospital performance.

PubMed

Chen, Xiao-yun; Yamauchi, Kazunobu; Kato, Ken; Nishimura, Akio; Ito, Katuski

2006-01-01

The objective of the paper is to confirm the feasibility and value of using the balanced scorecard (BSC) to measure performance in two hospitals in different countries. One hospital from China and another from Japan were chosen and key indicators were selected according to the BSC framework. A comparative hospital performance measurement model was set up using the BSC framework to comprehensively compare hospital performance in two countries. The BSC was found to be effective for underlining existing problems and identifying opportunities for improvements. The BSC also revealed the hospitals' contribution to performance improvement of each country's total health system. Hospital performance comparisons between countries using the BSC depend on the selection of feasible and appropriate key performance indicators, which is occasionally limited by data collection problems. The first use of the BSC to compare hospital performance between China and Japan shows benefits that not only suggests performance improvements in individual hospitals but also reveals effective health factors allowing implementation of valid national health policies.

Feasibility of Rainwater Harvesting to fulfill potable water demand using quantitative water management in low-lying delta regions of Asia

NASA Astrophysics Data System (ADS)

Mahmood, A.; Hossain, F.

2016-12-01

Low-lying deltas of Asian region are usually densely populated and located in developing countries situated at the downstream end of major rivers. Extensive dam construction by the upstream countries has now caused water scarcity in large portions of low-lying deltas. Most inhabitants depend on shallow tube well for safe drinking water that tend to suffer from water quality issues (e.g. Arsenic contamination). In addition, people also get infected from water borne diseases like Cholera and Typhoid due to lack of safe drinking water. Developing a centralized piped network based water supply system is often not a feasible option in rural regions. Due to social acceptability, environment friendliness, lower capital and maintenance cost, rainwater harvesting can be the most sustainable option to supply safe drinking water in rural areas. In this study, first we estimate the monthly rainfall variability using long precipitation climatology from satellite precipitation data. The upper and lower bounds of monthly harvestable rainwater were estimated for each satellite precipitation grid. Taking this lower bound of monthly harvestable rainwater as input, we use quantitative water management concept to determine the percent of the time of the year potable water demand can be fulfilled. Analysis indicates that a 6 m³ reservoir tank can fulfill the potable water demand of a 6 person family throughout a year in almost all parts of this region.

Community triage of otology patients using a store-and-forward telemedicine device: A feasibility study.

PubMed

Gupta, Nishi; Chawla, Neeraj; Gupta, Digant; Dhawan, Nidhi; Janaki, Vidya R

2017-07-01

Chronic otitis media is a major contributor to acquired hearing loss in developing countries. Developing countries such as India, with huge populations and poor health infrastructures, have always felt the shortage of trained specialists who can provide quality care to meet the enormous demand for treatment of this disease. This pilot study assessed the feasibility of empowering trained health workers equipped with ENTraview, a store-and-forward telemedicine device that integrates a camera- enabled smart phone with an otoscope. This device allows the screening of otology patients within the community. Three months of extensive training was provided to five community health workers on primary ear and hearing care, including training on the use of the ENTraview device. Community otology screenings were conducted to triage otology patients and provide them with specialized ENT care at a tertiary hospital. In the initial 6 months of the project, 45 screening camps were organized, which screened 3,000 patients free of cost. Of these 3,000 screened patients, 54% (1,619) were referred for ENT consultation and 215 patients reported. Nearly 50% (103) of the 215 reporting patients required surgical intervention, and 29 patients underwent surgery. Reaching out to the community by remote screening of ear diseases by trained technicians with a telemedicine device seems to be an effective and cost-effective way to triage patients with otologic pathologies.

A feasibility study of a personalized, internet-based compliance system for chronic disease management.

PubMed

Wang, X H; Istepanian, R S H; Geake, T; Hayes, J; Desco, M; Kontaxakis, G; Santos, A; Prentza, A; Pavlopoulos, S

2005-10-01

This paper describes a feasibility study on an Internet-based compliance system to provide personalized care for patients suffering from chronic diseases. Relevant medical trials from three different European countries provided preliminary evidence of the feasibility of the system and its efficacy in helping patients to manage their diseases at home. The study discusses further improvements not only for the C-Monitor system, but also for other Internet-based health-care services.

Creating a new class of pharmaceutical services provider for underserved areas: the Tanzania accredited drug dispensing outlet experience.

PubMed

Rutta, Edmund; Senauer, Katie; Johnson, Keith; Adeya, Grace; Mbwasi, Romuald; Liana, Jafary; Kimatta, Suleiman; Sigonda, Margareth; Alphonce, Emmanuel

2009-01-01

In developing countries, the most accessible source of treatment for common conditions is often an informal drug shop, where drug sellers are untrained and operations are unmonitored. We sought to describe a public-private initiative in Tanzania that created a new class of provider in government-accredited drug outlets, which improved the quality of medicines and pharmaceutical services in previously underserved areas. The accredited drug-dispensing outlet program combines changing behavior and expectations of community members who use, own, regulate, and work in drug shops. Success resulted from including community stakeholders from the beginning of the process. Addressing shortages in qualified health care providers by training and accrediting private sector drug dispensers to recognize common conditions and provide quality pharmaceutical products and services is feasible in a developing country, when supported by an appropriate policy and regulatory environment. Scaling up and sustaining the program will be a challenge.

A DIY Ultrasonic Signal Generator for Sound Experiments

NASA Astrophysics Data System (ADS)

Riad, Ihab F.

2018-02-01

Many physics departments around the world have electronic and mechanical workshops attached to them that can help build experimental setups and instruments for research and the training of undergraduate students. The workshops are usually run by experienced technicians and equipped with expensive lathing, computer numerical control (CNC) machines, electric measuring instruments, and several other essential tools. However, in developing countries such as Sudan, the lack of qualified technicians and adequately equipped workshops hampers efforts by these departments to supplement their laboratories with the equipment they need. The only other option is to buy the needed equipment from specialized manufacturers. The latter option is not feasible for the departments in developing countries where funding for education and research is scarce and very limited and as equipment from these manufacturers is typically too expensive. These departments struggle significantly in equipping undergraduate teaching laboratories, and here we propose one way to address this.

Geolocation applications of the Gonets LEO messaging satellites

NASA Astrophysics Data System (ADS)

Vlasov, Vladimir N.; Ashjaee, Javad M.

Geostationary satellites carry a majority of the international telecommunications traffic not carried by transoceanic cable. However, because the radio path links to and from geostationary satellites total at least 70,000 km and because of inherent on-board spacecraft power limitations, earth stations used in conjunction with geostationary satellites are usually large and expensive. This limits their installation to areas with a well-developed industrial and economic infrastructure. This reality helps perpetuate a chicken egg dilemma for the developing countries and isolated regions. Economic integration with the developed world requires being 'networked'. But for many developing entities, even the initial price of entry exceeds their modest resources. Exclusion from the global information highways virtually assures retardation of economic growth for developing nations, remote and isolated areas. Very Small Aperture Terminal (VSAT) earth stations are often thought of as a solution for networking developing regions. But economic considerations often forecloses this option. If VSAT size and cost is to be minimized, powerful spot beams from the satellite need to be focused on relatively small regions. This is not often feasible because of the high cost of the satellite itself. To dedicate a high power spot beam to a small region is usually not economically feasible.

Geolocation applications of the Gonets LEO messaging satellites

NASA Technical Reports Server (NTRS)

Vlasov, Vladimir N.; Ashjaee, Javad M.

1993-01-01

Geostationary satellites carry a majority of the international telecommunications traffic not carried by transoceanic cable. However, because the radio path links to and from geostationary satellites total at least 70,000 km and because of inherent on-board spacecraft power limitations, earth stations used in conjunction with geostationary satellites are usually large and expensive. This limits their installation to areas with a well-developed industrial and economic infrastructure. This reality helps perpetuate a chicken egg dilemma for the developing countries and isolated regions. Economic integration with the developed world requires being 'networked'. But for many developing entities, even the initial price of entry exceeds their modest resources. Exclusion from the global information highways virtually assures retardation of economic growth for developing nations, remote and isolated areas. Very Small Aperture Terminal (VSAT) earth stations are often thought of as a solution for networking developing regions. But economic considerations often forecloses this option. If VSAT size and cost is to be minimized, powerful spot beams from the satellite need to be focused on relatively small regions. This is not often feasible because of the high cost of the satellite itself. To dedicate a high power spot beam to a small region is usually not economically feasible.

The role of economies of scale in the cost of dialysis across the world: a macroeconomic perspective.

PubMed

Karopadi, Akash Nayak; Mason, Giacomo; Rettore, Enrico; Ronco, Claudio

2014-04-01

The treatment of chronic kidney disease through dialysis is a considerable expense in most health systems. The two chief methods of providing dialysis, haemodialysis (HD) and peritoneal dialysis (PD) have significant differences in cost composition and factors of production. The aim of this article is to identify and quantify the macroeconomic variables that influence the relative cost of such modalities across different countries. From previously published literature, we extracted the estimates of HD/PD cost ratios in a total of 46 countries. We conducted a multivariate regression analysis using the estimated HD/PD cost ratio in each country, with several country level indicators as explanatory variables. We found a strong statistical effect of the following variables on the HD/PD cost ratio: country's level of development, economies of scale and percentage of private health-care expenditure. The statistical effects on HD/PD ratio by local manufacturing and relaxed import regulation of PD equipment were calculated and were found to be very significant. it is possible for a country to still reap the benefits of economies of scale in provision of PD, even in the absence of a large enough market to make local production of PD equipment feasible in that country.

Systematic documentation of new vaccine introduction in selected countries of the Latin American Region.

PubMed

de Oliveira, Lúcia H; Toscano, Cristiana M; Sanwogou, N Jennifer; Ruiz-Matus, Cuauhtémoc; Tambini, Gina; Roses-Periago, Mirta; Andrus, Jon K

2013-07-02

Countries in Latin America were among the first developing countries to introduce new vaccines, particularly rotavirus (RV) and pneumococcal conjugate vaccines (PCVs), into their national immunization schedules. Experiences and lessons learned from these countries are valuable to donors, immunization partners, and policy makers in other countries wishing to make informed decisions on vaccine introduction. In order to enhance knowledge and promote understanding of the process of new vaccine introduction in the Latin American Region, with particular focus on RV and PCV, we conducted a systematic qualitative assessment. We evaluated the decision-making process, documented the structure in place, and reviewed key factors pertaining to new vaccine introduction. These include country morbidity and mortality data available prior to vaccine introduction, funding sources and mechanisms for vaccine introduction, challenges of implementation, and assessment of vaccine impact. From March 2010 to April 2011, we evaluated a subset of countries that had introduced RV and/or PCV in the past five years through interviews with key informants at the country level and through a systematic review of published data, gray literature, official technical documents, and country-specific health indicators. Countries evaluated were Bolivia, Brazil, Nicaragua, Peru, and Venezuela. In all countries, the potential of new vaccines to reduce mortality, as established by Millennium Development Goal 4, was an important consideration leading to vaccine introduction. Several factors-the availability of funds, the existence of sufficient evidence for vaccine introduction, and the feasibility of sustainable financing-were identified as crucial components of the decision-making process in the countries evaluated. The decision making process regarding new vaccine introduction in the countries evaluated does not follow a systematic approach. Nonetheless, existing evidence on efficacy, potential impact, and cost-effectiveness of vaccine introduction, even if not local data, was important in the decision making process for vaccine introduction. Copyright © 2013 Elsevier Ltd. All rights reserved.

The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India

PubMed Central

2012-01-01

Background Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions. Methods We reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families. Results Based on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there were delivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations. Conclusions A multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India. PMID:22340662

Agricultural R&D, technology and productivity

PubMed Central

Piesse, J.; Thirtle, C.

2010-01-01

The relationships between basic and applied agricultural R&D, developed and developing country R&D and between R&D, extension, technology and productivity growth are outlined. The declining growth rates of public R&D expenditures are related to output growth and crop yields, where growth rates have also fallen, especially in the developed countries. However, growth in output value per hectare has not declined in the developing countries and labour productivity growth has increased except in the EU. Total factor productivity has generally increased, however it is measured. The public sector share of R&D expenditures has fallen and there has been rapid concentration in the private sector, where six multinationals now dominate. These companies are accumulating intellectual property to an extent that the public and international institutions are disadvantaged. This represents a threat to the global commons in agricultural technology on which the green revolution has depended. Estimates of the increased R&D expenditures needed to feed 9 billion people by 2050 and how these should be targeted, especially by the Consultative Group on International Agricultural Research (CGIAR), show that the amounts are feasible and that targeting sub-Saharan Africa (SSA) and South Asia can best increase output growth and reduce poverty. Lack of income growth in SSA is seen as the most insoluble problem. PMID:20713401

Current and future trends in the prevention, treatment and control of rabies.

PubMed

Rupprecht, Charles E; Willoughby, Rodney; Slate, Dennis

2006-12-01

Rabies remains a global zoonosis of major public health, agricultural and economic significance. Dogs are the major animal reservoirs in developing regions, wildlife maintain cycles of infection even in developed countries and new viral etiological agents continue to emerge. Nearly all human rabies cases are related directly to animal bite and thus, primary disease prevention requires minimization of suspected exposures. Once exposure occurs, modern prophylaxis entails immediate wound care, local infiltration of rabies immune globulin and parenteral administration of modern cell culture vaccines in multiple doses. Pre-exposure vaccination should occur in selected population groups at risk of occupational exposure. Historically, survival from fatal rabies by at least five human patients, vaccinated prior to the onset of clinical signs, signaled initial optimism as to the theoretical utility of medical intervention. Recently, the heroic recovery of an unvaccinated teenager from clinical rabies offers hope of future specific therapy. Canine rabies elimination is the key towards ultimate reduction of the disease burden, as first illustrated in developed countries. Implementation of oral vaccination in free-ranging carnivore hosts demonstrates the feasibility of disease abatement in particular wildlife populations, such as demonstrated in Europe and North America, with an enhanced need for application to developing countries in the Americas, Africa and Eurasia.

Agricultural R&D, technology and productivity.

PubMed

Piesse, J; Thirtle, C

2010-09-27

The relationships between basic and applied agricultural R&D, developed and developing country R&D and between R&D, extension, technology and productivity growth are outlined. The declining growth rates of public R&D expenditures are related to output growth and crop yields, where growth rates have also fallen, especially in the developed countries. However, growth in output value per hectare has not declined in the developing countries and labour productivity growth has increased except in the EU. Total factor productivity has generally increased, however it is measured. The public sector share of R&D expenditures has fallen and there has been rapid concentration in the private sector, where six multinationals now dominate. These companies are accumulating intellectual property to an extent that the public and international institutions are disadvantaged. This represents a threat to the global commons in agricultural technology on which the green revolution has depended. Estimates of the increased R&D expenditures needed to feed 9 billion people by 2050 and how these should be targeted, especially by the Consultative Group on International Agricultural Research (CGIAR), show that the amounts are feasible and that targeting sub-Saharan Africa (SSA) and South Asia can best increase output growth and reduce poverty. Lack of income growth in SSA is seen as the most insoluble problem.

Affordable remote-area power supply in the Philippines

NASA Astrophysics Data System (ADS)

Heruela, C. S.

The feasibility of photovoltaic (PV) systems for electrifying remote areas of the Philippines is discussed. In particular, a technical description is given of those PV systems that are appropriate to the needs of remote, but populated, rural areas and have been developed as part of the Philippine-German Solar Energy Project. Details are provided of a financing scheme, piloted by the Project on an unelectrified island, to make PV systems affordable to rural users. An analysis is presented of the potential of large-scale applications of PV systems in developing countries such as the Philippines, and a description is provided of current efforts to promote the use of such technology. A storage battery is identified as an essential component of a PV system. As a consequence, the wide use of PV systems will have a very significant impact on the market for storage batteries in countries embarking on PV-utilization programmes. It is clear, therefore, that battery manufacturers should take an interest in future development in PV applications.

Transradial percutaneous coronary intervention without on-site cardiac surgery for stable coronary disease and myocardial infarction: preliminary report and initial experience in 174 patients.

PubMed

Escárcega, Ricardo O; Pérez-Alva, Juan C; Jiménez-Hernández, Mario; Mendoza-Pinto, Claudia; Pérez, Ruben S; Porras, Renán S; García-Carrasco, Mario

2010-10-01

On-site cardiac surgery is not widely available in developing countries despite a high prevalence of coronary artery disease. To analyze the safety, feasibility and cost-effectiveness of transradial percutaneous coronary intervention without on-site cardiac surgery in a community hospital in a developing country. Of the 174 patients who underwent PCI for the first time in our center, we analyzed two groups: stable coronary disease and acute myocardial infarction. The primary endpoint was the rate of complications during the first 24 hours after PCI. We also analyzed the length of hospital stay and the rate of hospital readmission in the first week after PCI, and compared costs between the radial and femoral approaches. The study group comprised 131 patients with stable coronary disease and 43 with acute MI. Among the patients with stable coronary disease 8 (6.1%) had pulse loss, 12 (9.16%) had on-site hematoma, and 3 (2.29%) had bleeding at the site of the puncture. Among the patients with acute MI, 3 (6.98) had pulse loss and 5 (11.63%) had bleeding at the site of the puncture. There were no cases of atriovenous fistula or nerve damage. In the stable coronary disease group, 130 patients (99%) were discharged on the same day (2.4 +/- 2 hours). In the acute MI group, the length of stay was 6.6 +/- 2.5 days with at least 24 hours in the intensive care unit. There were no hospital readmissions in the first week after the procedure. The total cost, which includes equipment related to the specific approach and recovery room stay, was significantly lower with the radial approach compared to the femoral approach (US$ 500 saving per intervention). The transradial approach was safe and feasible in a community hospital in a developing country without on-site cardiac surgery backup. The radial artery approach is clearly more cost-effective than the femoral approach.

Constraints facing Arab banks

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khadra, F.

1980-04-01

Development projects in the Arab world have enormous investment requirements that Arab banks at present can only partially handle due to: (1) the low level of personal savings in a number of Arab countries as a result of low income levels; (2) the low capitalization of most Arab banks relative to the volume of lending activity required; (3) the reluctance of oil surplus countries to deposit any sizeable part of their funds with their own banks instead of foreign banks. Funds available in the currencies of the oil surplus countries are very limited compared to the volume of funds requiredmore » for projects. It is necessary therefore that the majority of loans be made in foreign currencies, making it necessary for Arab banks to have high international credit status. Arab banking practices and laws, which vary from country to country, are not compatible with the requirements of international lending or the establishment of well-developed financial markets. Some of the banks' organizational structures and internal practices may have become so entrenched as to make any transition not feasible. In some cases it may be more practical to establish a new financial institution with different orientations and activities than to transform the existing one. Another major constraint of the Arab banking environment is the lack of a permanent intermediary, acceptable to both the surplus countries' banks and to the borrowers. The final constraint discussed, the political environment, has prompted many Arab countries to enact legislation to guarantee a politically stable environment to safeguard risk against expropriation, nationalization, or freezing of assets. (SAC)« less

Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin

PubMed Central

Barth-Jaeggi, Tanja; Steinmann, Peter; Mieras, Liesbeth; van Brakel, Wim; Richardus, Jan Hendrik; Tiwari, Anuj; Bratschi, Martin; Cavaliero, Arielle; Vander Plaetse, Bart; Mirza, Fareed; Aerts, Ann

2016-01-01

Introduction The reported number of new leprosy patients has barely changed in recent years. Thus, additional approaches or modifications to the current standard of passive case detection are needed to interrupt leprosy transmission. Large-scale clinical trials with single dose rifampicin (SDR) given as post-exposure prophylaxis (PEP) to contacts of newly diagnosed patients with leprosy have shown a 50–60% reduction of the risk of developing leprosy over the following 2 years. To accelerate the uptake of this evidence and introduction of PEP into national leprosy programmes, data on the effectiveness, impact and feasibility of contact tracing and PEP for leprosy are required. The leprosy post-exposure prophylaxis (LPEP) programme was designed to obtain those data. Methods and analysis The LPEP programme evaluates feasibility, effectiveness and impact of PEP with SDR in pilot areas situated in several leprosy endemic countries: India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. Complementary sites are located in Brazil and Cambodia. From 2015 to 2018, contact persons of patients with leprosy are traced, screened for symptoms and assessed for eligibility to receive SDR. The intervention is implemented by the national leprosy programmes, tailored to local conditions and capacities, and relying on available human and material resources. It is coordinated on the ground with the help of the in-country partners of the International Federation of Anti-Leprosy Associations (ILEP). A robust data collection and reporting system is established in the pilot areas with regular monitoring and quality control, contributing to the strengthening of the national surveillance systems to become more action-oriented. Ethics and dissemination Ethical approval has been obtained from the relevant ethics committees in the countries. Results and lessons learnt from the LPEP programme will be published in peer-reviewed journals and should provide important evidence and guidance for national and global policymakers to strengthen current leprosy elimination strategies. PMID:27856484

Protocol of a feasibility study for cognitive assessment of an ageing cohort within the Southeast Asia Community Observatory (SEACO), Malaysia

PubMed Central

Mohan, Devi; Stephan, Blossom C M; Allotey, Pascale; Jagger, Carol; Pearce, Mark; Siervo, Mario; Reidpath, Daniel D

2017-01-01

Introduction There is a growing proportion of population aged 65 years and older in low-income and middle-income countries. In Malaysia, this proportion is predicted to increase from 5.1% in 2010 to more than 15.4% by 2050. Cognitive ageing and dementia are global health priorities. However, risk factors and disease associations in a multiethnic, middle-income country like Malaysia may not be consistent with those reported in other world regions. Knowing the burden of cognitive impairment and its risk factors in Malaysia is necessary for the development of management strategies and would provide valuable information for other transitional economies. Methods and analysis This is a community-based feasibility study focused on the assessment of cognition, embedded in the longitudinal study of health and demographic surveillance site of the South East Asia Community Observatory (SEACO), in Malaysia. In total, 200 adults aged ≥50 years are selected for an in-depth health and cognitive assessment including the Mini Mental State Examination, the Montreal Cognitive Assessment, blood pressure, anthropometry, gait speed, hand grip strength, Depression Anxiety Stress Score and dried blood spots. Discussion and conclusions The results will inform the feasibility, response rates and operational challenges for establishing an ageing study focused on cognitive function in similar middle-income country settings. Knowing the burden of cognitive impairment and dementia and risk factors for disease will inform local health priorities and management, and place these within the context of increasing life expectancy. Ethics and dissemination The study protocol is approved by the Monash University Human Research Ethics Committee. Informed consent is obtained from all the participants. The project's analysed data and findings will be made available through publications and conference presentations and a data sharing archive. Reports on key findings will be made available as community briefs on the SEACO website. PMID:28104710

Guidelines for the management of neuroendocrine tumours by the Brazilian gastrointestinal tumour group

PubMed Central

Riechelmann, Rachel P; Weschenfelder, Rui F; Costa, Frederico P; Andrade, Aline Chaves; Osvaldt, Alessandro Bersch; Quidute, Ana Rosa P; dos Santos, Allan; Hoff, Ana Amélia O; Gumz, Brenda; Buchpiguel, Carlos; Vilhena Pereira, Bruno S; Lourenço Junior, Delmar Muniz; da Rocha Filho, Duilio Reis; Fonseca, Eduardo Antunes; Riello Mello, Eduardo Linhares; Makdissi, Fabio Ferrari; Waechter, Fabio Luiz; Carnevale, Francisco Cesar; Coura-Filho, George B; de Paulo, Gustavo Andrade; Girotto, Gustavo Colagiovanni; Neto, João Evangelista Bezerra; Glasberg, João; Casali-da-Rocha, Jose Claudio; Rego, Juliana Florinda M; de Meirelles, Luciana Rodrigues; Hajjar, Ludhmila; Menezes, Marcos; Bronstein, Marcello D; Sapienza, Marcelo Tatit; Fragoso, Maria Candida Barisson Villares; Pereira, Maria Adelaide Albergaria; Barros, Milton; Forones, Nora Manoukian; do Amaral, Paulo Cezar Galvão; de Medeiros, Raphael Salles Scortegagna; Araujo, Raphael L C; Bezerra, Regis Otaviano França; Peixoto, Renata D’Alpino; Aguiar, Samuel; Ribeiro, Ulysses; Pfiffer, Tulio; Hoff, Paulo M; Coutinho, Anelisa K

2017-01-01

Neuroendocrine tumours are a heterogeneous group of diseases with a significant variety of diagnostic tests and treatment modalities. Guidelines were developed by North American and European groups to recommend their best management. However, local particularities and relativisms found worldwide led us to create Brazilian guidelines. Our consensus considered the best feasible strategies in an environment involving more limited resources. We believe that our recommendations may be extended to other countries with similar economic standards. PMID:28194228

'I Can't Concentrate': A Feasibility Study with Young Refugees in Sweden on Developing Science-Driven Interventions for Intrusive Memories Related to Trauma.

PubMed

Holmes, Emily A; Ghaderi, Ata; Eriksson, Ellinor; Lauri, Klara Olofsdotter; Kukacka, Olivia M; Mamish, Maya; James, Ella L; Visser, Renée M

2017-03-01

The number of refugees is the highest ever worldwide. Many have experienced trauma in home countries or on their escape which has mental health sequelae. Intrusive memories comprise distressing scenes of trauma which spring to mind unbidden. Development of novel scalable psychological interventions is needed urgently. We propose that brief cognitive science-driven interventions should be developed which pinpoint a focal symptom alongside a means to monitor it using behavioural techniques. The aim of the current study was to assess the feasibility and acceptability of the methodology required to develop such an intervention. In this study we recruited 22 refugees (16-25 years), predominantly from Syria and residing in Sweden. Participants were asked to monitor the frequency of intrusive memories of trauma using a daily diary; rate intrusions and concentration; and complete a 1-session behavioural intervention involving Tetris game-play via smartphone. Frequency of intrusive memories was high, and associated with high levels of distress and impaired concentration. Levels of engagement with study procedures were highly promising. The current work opens the way for developing novel cognitive behavioural approaches for traumatized refugees that are mechanistically derived, freely available and internationally scalable.

The Notion of Charter Schools and Its Feasibility in Turkey

ERIC Educational Resources Information Center

Solak, Ekrem; Özaskin, Aysegül

2015-01-01

The purpose of this study was to investigate the feasibility of Charter School system in Turkey, which was opened firstly in State of Minnesota of United States and was expanded to approximately 40 states in America today and also, in practice in some countries such as Canada, New Zealand, United Kingdom, Sweden and Norway. Charter Schools are…

Development and assessment of national performance indicators for infection prevention and control and antimicrobial stewardship in European long-term care facilities.

PubMed

Cookson, B; Mackenzie, D; Kafatos, G; Jans, B; Latour, K; Moro, M L; Ricchizzi, E; Van de Mortel, M; Suetens, C; Fabry, J

2013-09-01

Healthcare-associated infections in long-term care facilities (LTCFs) are of increasing importance. To develop consensus national performance indicators (NPIs) for infection control (ICPI) and antimicrobial stewardship (ASPI) in LTCFs, and assess the performance of 32 European countries against these NPIs. Previously established European standards were the basis for consensus and the same iterative approach with national representatives from the 32 countries. A World Health Organization scoring system recorded how close each country was to implementing each standard. The 42 agreed component indicators were grouped into six NPI categories: 'national programme', 'guidelines', 'expert advice', 'IC structure' (not present in the ASPI), 'surveillance' and 'composite'. 'Guidelines' scored the highest mean total possible score (60%, range 20-100%), followed by 'composite' (53%, range 30-100%), 'expert advice' (48%, range 20-100%), 'surveillance' (47%, range 20-83%), 'national programme' (42%, range 20-100%) and 'IC structure' (39%, range 20-100%). Although several scores were low, some countries were able to implement all NPIs, indicating that this was feasible. Most NPIs were very significantly related, indicating that they were considered to be important by the countries. 'Guidelines' and 'IC structure' were significantly related to European region (P ≤ 0.05). Accreditation/inspection was not evident in seven (22%) countries, nine (28%) countries had accreditation/inspection that included IC assessments, and seven (22%) countries had accreditation/inspection that included IC and antimicrobial stewardship assessments. Multi-variable analysis found that only the NPI and the ICPI 'expert advice' were associated with accreditation/inspection which included IC and antimicrobial stewardship. The identified gaps represent significant potential patient safety issues. The NPIs should serve as a basis for monitoring improvements over the coming years. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Exploring the feasibility of private micro flood insurance provision in Bangladesh.

PubMed

Akter, Sonia; Brouwer, Roy; van Beukering, Pieter J H; French, Laura; Silver, Efrath; Choudhury, Saria; Aziz, Syeda Salina

2011-04-01

This paper aims to contribute to the debate on the feasibility of the provision of micro flood insurance as an effective tool for spreading disaster risks in developing countries and examines the role of the institutional-organisational framework in assisting the design and implementation of such a micro flood insurance market. In Bangladesh, a private insurance market for property damage and livelihood risk due to natural disasters does not exist. Private insurance companies are reluctant to embark on an evidently unprofitable venture. Testing two different institutional-organisational models, this research reveals that the administration costs of micro-insurance play an important part in determining the long-term viability of micro flood insurance schemes. A government-facilitated process to overcome the differences observed in this study between the nonprofit micro-credit providers and profit-oriented private insurance companies is needed, building on the particular competence each party brings to the development of a viable micro flood insurance market through a public-private partnership. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries.

PubMed

McCarthy, Ona L; Wazwaz, Ola; Osorio Calderon, Veronica; Jado, Iman; Saibov, Salokhiddin; Stavridis, Amina; López Gallardo, Jhonny; Tokhirov, Ravshan; Adada, Samia; Huaynoca, Silvia; Makleff, Shelly; Vandewiele, Marieka; Standaert, Sarah; Free, Caroline

2018-05-02

Unintended pregnancies can result in poorer health outcomes for women, children and families. Young people in low and middle income countries are at particular risk of unintended pregnancies and could benefit from innovative contraceptive interventions. There is growing evidence that interventions delivered by mobile phone can be effective in improving a range of health behaviours. This paper describes the development of a contraceptive behavioural intervention delivered by mobile phone for young people in Tajikistan, Bolivia and Palestine, where unmet need for contraception is high among this group. Guided by Intervention Mapping, the following steps contributed to the development of the interventions: (1) needs assessment; (2) specifying behavioural change to result from the intervention; (3) selecting behaviour change methods to include in the intervention; (4) producing and refining the intervention content. The results of the needs assessment produced similar interventions across the countries. The interventions consist of short daily messages delivered over 4 months (delivered by text messaging in Palestine and mobile phone application instant messages in Bolivia and Tajikistan). The messages provide information about contraception, target attitudes that are barriers to contraceptive uptake and support young people in feeling that they can influence their reproductive health. The interventions each contain the same ten behaviour change methods, adapted for delivery by mobile phone. The development resulted in a well-specified, theory-based intervention, tailored to each country. It is feasible to develop an intervention delivered by mobile phone for young people in resource-limited settings.

Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models.

PubMed

Houben, Rein M G J; Menzies, Nicolas A; Sumner, Tom; Huynh, Grace H; Arinaminpathy, Nimalan; Goldhaber-Fiebert, Jeremy D; Lin, Hsien-Ho; Wu, Chieh-Yin; Mandal, Sandip; Pandey, Surabhi; Suen, Sze-Chuan; Bendavid, Eran; Azman, Andrew S; Dowdy, David W; Bacaër, Nicolas; Rhines, Allison S; Feldman, Marcus W; Handel, Andreas; Whalen, Christopher C; Chang, Stewart T; Wagner, Bradley G; Eckhoff, Philip A; Trauer, James M; Denholm, Justin T; McBryde, Emma S; Cohen, Ted; Salomon, Joshua A; Pretorius, Carel; Lalli, Marek; Eaton, Jeffrey W; Boccia, Delia; Hosseini, Mehran; Gomez, Gabriela B; Sahu, Suvanand; Daniels, Colleen; Ditiu, Lucica; Chin, Daniel P; Wang, Lixia; Chadha, Vineet K; Rade, Kiran; Dewan, Puneet; Hippner, Piotr; Charalambous, Salome; Grant, Alison D; Churchyard, Gavin; Pillay, Yogan; Mametja, L David; Kimerling, Michael E; Vassall, Anna; White, Richard G

2016-11-01

The post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements. 11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy. Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31-62%) and a 72% reduction in mortality (range 64-82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis. Major reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End TB Strategy targets at country level. Bill and Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Renewable energy and conservation measures for non-residential buildings

NASA Astrophysics Data System (ADS)

Grossman, Andrew James

The energy demand in most countries is growing at an alarming rate and identifying economically feasible building retrofit solutions to decrease the need for fossil fuels so as to mitigate their environmental and societal impacts has become imperative. Two approaches are available for identifying feasible retrofit solutions: 1) the implementation of energy conservation measures; and 2) the production of energy from renewable sources. This thesis focuses on the development of retrofit software planning tools for the implementation of solar photovoltaic systems, and lighting system retrofits for mid-Michigan institutional buildings. The solar planning tool exploits the existing blueprint of a building's rooftop, and via image processing, the layouts of the solar photovoltaic arrays are developed based on the building's geographical location and typical weather patterns. The resulting energy generation of a PV system is estimated and is utilized to determine levelized energy costs. The lighting system retrofit analysis starts by a current utilization assessment of a building to determine the amount of energy used by the lighting system. Several LED lighting options are evaluated on the basis of color correlation temperature, color rendering index, energy consumption, and financial feasibility, to determine a retrofit solution. Solar photovoltaic installations in mid-Michigan are not yet financially feasible, but with the anticipated growth and dynamic complexity of the solar photovoltaic market, this solar planning tool is able to assist building proprietors make executive decisions regarding their energy usage. Additionally, a lighting system retrofit is shown to have significant financial and health benefits.

Challenges and Opportunities of US and Arab Collaborations in Health Services Research: A Case Study from Qatar

PubMed Central

Hammoud, Maya M.; Elnashar, Maha; Abdelrahim, Huda; Khidir, Amal; Elliott, Heather A.K.; Killawi, Amal; Padela, Aasim I.; Khal, Abdul Latif Al; Bener, Abdulbari; Fetters, Michael D.

2012-01-01

Economic globalization and advances in technology have made it more feasible and even necessary to develop international research collaborations in global public health. Historically, collaborations in global research described in the literature have been mostly “North-South” collaborations in which the more developed “North” country works together with a developing “South” country to conduct research in the latter. This type of collaboration has for the most part, represented unequal partnership and rarely left behind a lasting impact. Recently, the opportunity for a new kind of international research partnership has emerged in which the host country has significant financial resources, but relatively limited expertise in research methodology or techniques and research implementation. This type of collaboration features a relative equalization of power between the international partners. The purpose of this paper is to describe the process of building a successful research collaboration between a team in the United States and a team in Qatar, a rich Arabic nation in Gulf. We present a case study that provides an overview of our own project focused on the development of a culturally and linguistically adapted health care quality instrument for Qatar, discussing many of the benefits and challenges we encountered during each phase of instrument development. We present recommendations for researchers seeking sustainable and equitable partnerships with the Arab World. PMID:23121751

Challenges and opportunities of US and Arab collaborations in health services research: a case study from Qatar.

PubMed

Hammoud, Maya M; Elnashar, Maha; Abdelrahim, Huda; Khidir, Amal; Elliott, Heather A K; Killawi, Amal; Padela, Aasim I; Al Khal, Abdul Latif; Bener, Abdulbari; Fetters, Michael D

2012-09-25

Economic globalization and advances in technology have made it more feasible and even necessary to develop international research collaborations in global public health. Historically, collaborations in global research described in the literature have been mostly "North-South" collaborations in which the more developed "North" country works together with a developing "South" country to conduct research in the latter. This type of collaboration has for the most part, represented unequal partnership and rarely left behind a lasting impact. Recently, the opportunity for a new kind of international research partnership has emerged in which the host country has significant financial resources, but relatively limited expertise in research Methodology or techniques and research implementation.  This type of collaboration features a relative equalization of power between the international partners. The purpose of this paper is to describe the process of building a successful research collaboration between a team in the United States and a team in Qatar, a rich Arabic nation in Gulf. We present a case study that provides an overview of our own project focused on the development of a culturally and linguistically adapted health care quality instrument for Qatar, discussing many of the benefits and challenges we encountered during each phase of instrument development. We present recommendations for researchers seeking sustainable and equitable partnerships with the Arab World.

Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries.

PubMed

Denny, Lynette; de Sanjose, Silvia; Mutebi, Miriam; Anderson, Benjamin O; Kim, Jane; Jeronimo, Jose; Herrero, Rolando; Yeates, Karen; Ginsburg, Ophira; Sankaranarayanan, Rengaswamy

2017-02-25

Breast and cervical cancers are the commonest cancers diagnosed in women living in low-income and middle-income countries (LMICs), where opportunities for prevention, early detection, or both, are few. Yet several cost-effective interventions could be used to reduce the burden of these two cancers in resource-limited environments. Population- wide vaccination against human papillomavirus (HPV) linked to cervical screening, at least once, for adult women has the potential to reduce the incidence of cervical cancer substantially. Strategies such as visual inspection with acetic acid and testing for oncogenic HPV types could make prevention of cervical cancer programmatically feasible. These two cancers need not be viewed as inevitably fatal, and can be cured, particularly if detected and treated at an early stage. Investing in the health of girls and women is an investment in the development of nations and their futures. Here we explore ways to lessen the divide between LMICs and high-income countries for breast and cervical cancers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Building Capacity to Use NASA Earth Observations in the Water Resource Sector

NASA Astrophysics Data System (ADS)

Childs-Gleason, L. M.; Ross, K. W.; Crepps, G.; Clayton, A.; Ruiz, M. L.; Rogers, L.; Allsbrook, K. N.

2017-12-01

The NASA DEVELOP National Program builds capacity to use and apply NASA Earth observations to address environmental concerns around the globe. The DEVELOP model builds capacity in both participants (students, recent graduates, and early and transitioning career professionals) who conduct the projects and partners (decision and policy makers) who are recipients of project methodologies and results. Projects focus on a spectrum of thematic topics, including water resource management which made up 30% of the DEVELOP FY2017 portfolio. During this period, DEVELOP conducted water-focused feasibility studies in collaboration with 22 partners across 13 U.S. states and five countries. This presentation will provide an overview of needs identified, DEVELOP's response, data sources, challenges, and lessons learned.

Components that affect the Implementation of Health Services' Strategic Purchasing: A Comprehensive Review of the Literature.

PubMed

Bastani, Peivand; Samadbeik, Mahnaz; Kazemifard, Yalda

2016-05-01

Strategic purchasing is one of the mechanisms that can increase access, equity, and efficiency as well as the correct management of health resources. The aim of this study was to extract important and influential factors as necessary infrastructures to implement this method. In this comprehensive literature review, 13 databases and search engines were searched from 2000 to 2015 by applying appropriate keywords. From a total of 1403 titles and after ensuring the validity of the study by the Clinical Appraisal Skills Program (CASP) tool, 18 articles that contained title, abstract, and associated text were used in the study, and their related information was analyzed and extracted using an extraction form and LitAssist software. The findings showed six categories of intervention have been effective in the strategic purchasing of all health interventions in different countries. These six categories were "The target group of users of the service" (demand side), "purchased interventions," "providers and suppliers of interventions" (the supply side), "Methods and incentives" (payment method), "price," and "Structure and organization." Although the necessity of performing strategic purchasing in the health sector or developing countries is an indisputable fact, it is of great importance to use the experiences of developed countries while considering the factors extracted from the study for implementing this method. In this regard, it is suggested that studies be performed that can lead to assessing the feasibility of strategic purchasing for health services in developing countries and also in Iran to help health policy makers in these countries.

'Care for Stroke', a web-based, smartphone-enabled educational intervention for management of physical disabilities following stroke: feasibility in the Indian context.

PubMed

Sureshkumar, K; Murthy, G V S; Munuswamy, Suresh; Goenka, Shifalika; Kuper, Hannah

2015-07-01

Stroke rehabilitation is a process targeted towards restoration or maintenance of the physical, mental, intellectual and social abilities of an individual affected by stroke. Unlike high-income countries, the resources for stroke rehabilitation are very limited in many low-income and middle-income countries (LMICs). Provision of cost-effective, post-stroke multidisciplinary rehabilitation services for the stroke survivors therefore becomes crucial to address the unmet needs and growing magnitude of disability experienced by the stroke survivors in LMICs. In order to meet the growing need for post-stroke rehabilitation services in India, we developed a web-based Smartphone-enabled educational intervention for management of physical disabilities following a stroke. On the basis of the findings from the rehabilitation needs assessment study, guidance from the expert group and available evidence from systematic reviews, the framework of the intervention content was designed. Web-based application designing and development by Professional application developers were subsequently undertaken. The application is called 'Care for Stroke'. It is a web-based educational intervention for management of physical disabilities following a stroke. This intervention is developed for use by the Stroke survivors who have any kind of rehabilitation needs to independently participate in his/her family and social roles. 'Care for stroke' is an innovative intervention which could be tested not just for its feasibility and acceptability but also for its clinical and cost-effectiveness through rigorously designed, randomised clinical trials. It is very important to test this intervention in LMICs where the rehabilitation and information needs of the stroke survivors seem to be substantial and largely unmet.

Ergonomics support for local initiative in improving safety and health at work: International Labour Organization experiences in industrially developing countries.

PubMed

Kawakami, T; Kogi, K

2005-04-15

Ergonomics has played essential roles in the technical cooperation activities of the International Labour Organization (ILO) in occupational safety and health in industrially developing countries. Ergonomics support focusing on practical day-to-day needs at the grass-root workplace has strengthened the local initiative in improving safety and health. Practical action-tools such as ergonomics checklists, local good example photos and group discussions have assisted workers and employers in identifying feasible solutions using locally available resources. Direct participation of workers and employers has been promoted in ergonomics training aimed at immediate solutions. ILO Guidelines on Occupational Safety and Health Management Systems have played increasingly important roles in the systematic planning of local improvement actions. Policy-level programmes to develop network support mechanisms to the grass-root workplace were essential for following up and sustaining local achievements. Practical ergonomics support tools, such as action checklists and low-cost improvement guides, should be developed and widely applied so as to reach grass-root levels and help local people create safer and healthier workplaces.

Feasibility and Acceptability of a Text Messaging Program for Smoking Cessation in Israel.

PubMed

Abroms, Lorien; Hershcovitz, Ronit; Boal, Ashley; Levine, Hagai

2015-08-01

Text messaging programs on mobile phones have been shown to promote smoking cessation. This study investigated whether a text-messaging program for smoking cessation, adapted from QuitNowTXT, is feasible in Israel and acceptable to Israeli smokers. Participants (N = 38) were given a baseline assessment, enrolled in the adapted text messaging program, and followed-up with at 2 weeks and 4 weeks after their quit date. The authors used an intent-to-treat analysis and found that 23.7% of participants reported having quit smoking at the 4-week follow-up. Participants sent an average of 12.9 text replies during the study period, and the majority reported reading most or all of the texts. However, 34.2% of participants had unsubscribed by the 4-week follow-up. Moderate levels of satisfaction were reported; more than half agreed that they would recommend the program. Suggestions for improvement included adding advice by an expert counselor, website support, and increased customization. Results indicate that a text messaging smoking cessation program developed by modifying the content of QuitNowTXT is feasible and could be acceptable to smokers in Israel. The experience adapting and pilot testing the program can serve as a model for using QuitNowTXT to develop and implement such programs in other countries.

Occupational health standards. An international comparison.

PubMed

Holmberg, B; Winell, M

1977-03-01

The background for establishing standards for toxic agents is reviewed, and the standards of 14 different countries, including Sweden, are compared with special reference to criteria and organizational aspects. The differences among countries in the numerical limit values for toxic substances are largely due to differences in definitions, biomedical criteria, technical feasibility and sociopolitical judgements.

The Prospects for the Implementation of School-Based Financial Management in Taiwan

ERIC Educational Resources Information Center

Ho, Hsuan-fu

2010-01-01

The current approach to solving educational problems in Taiwan is to adopt policies employed in Western countries. However, given the very different cultural and educational environment of Asia, not all policies effective in Western countries are necessarily applicable to schools in Taiwan. Therefore, an examination of the feasibility and…

Designing Psychological Treatments for Scalability: The PREMIUM Approach

PubMed Central

Vellakkal, Sukumar; Patel, Vikram

2015-01-01

Introduction Lack of access to empirically-supported psychological treatments (EPT) that are contextually appropriate and feasible to deliver by non-specialist health workers (referred to as ‘counsellors’) are major barrier for the treatment of mental health problems in resource poor countries. To address this barrier, the ‘Program for Effective Mental Health Interventions in Under-resourced Health Systems’ (PREMIUM) designed a method for the development of EPT for severe depression and harmful drinking. This was implemented over three years in India. This study assessed the relative usefulness and costs of the five ‘steps’ (Systematic reviews, In-depth interviews, Key informant surveys, Workshops with international experts, and Workshops with local experts) in the first phase of identifying the strategies and theoretical model of the treatment and two ‘steps’ (Case series with specialists, and Case series and pilot trial with counsellors) in the second phase of enhancing the acceptability and feasibility of its delivery by counsellors in PREMIUM with the aim of arriving at a parsimonious set of steps for future investigators to use for developing scalable EPT. Data and Methods The study used two sources of data: the usefulness ratings by the investigators and the resource utilization. The usefulness of each of the seven steps was assessed through the ratings by the investigators involved in the development of each of the two EPT, viz. Healthy Activity Program for severe depression and Counselling for Alcohol Problems for harmful drinking. Quantitative responses were elicited to rate the utility (usefulness/influence), followed by open-ended questions for explaining the rankings. The resources used by PREMIUM were computed in terms of time (months) and monetary costs. Results The theoretical core of the new treatments were consistent with those of EPT derived from global evidence, viz. Behavioural Activation and Motivational Enhancement for severe depression and harmful drinking respectively, indicating the universal applicability of these theories. All the steps of both phases in PREMIUM contributed to the development of the final EPT. However, if there were significant resource constraints, the steps can be limited to workshops with international and local experts in the first phase, and case series with specialists, and case series and pilot trial with counsellors in the second phase. Conclusions Integrating global evidence with local knowledge and practices are complementary and feasible goals to contribute to the development of contextually appropriate and feasible EPT in resource poor country settings. The emerging EPT share similar theoretical frameworks to those described in the global evidence. The PREMIUM method has relevance for any setting where populations have poor access to EPT as its explicit goal is to develop scalable treatments. PMID:26225853

An extended field test of the WHO severe malnutrition guidelines in hospitals in developing countries: preliminary observations.

PubMed

Deen, J L; Weber, M; Qazi, S; Fontaine, O

2003-01-01

The WHO has published guidelines for the inpatient management of severe malnutrition. A qualitative study in hospitals in developing countries is being conducted to document the re-organisation of the clinical ward and support services required to implement these guidelines and to gain an impression of the feasibility and sustainability of such a re-organisation. Following a postal survey of experts in the management of malnutrition in children in developing countries, hospitals were contacted and asked if they were interested to participate in the study. If so, they were requested to submit background information about admission patterns, the frequency of malnutrition, and current practice. Based on this information, hospitals are selected for a preliminary visit. Following this, and the final selection, a paediatrician conducts three visits to the study hospital over a one-year period to appraise the current practice, assist the health staff in recognising the strengths and shortcomings of their current management, help them find locally appropriate solutions, support the implementation process through a participatory approach and assess the outcome. A structured survey instrument is used to guide the assessment and identification of problems. Results of the first visit, which documents the existing situation, and changes identified by staff and implemented during the second visit are presented.

The global impact of noncommunicable diseases: estimates and projections.

PubMed

Manton, K G

1988-01-01

With the aging of populations in developing countries there is both a demographic and an epidemiological transition which affects the impact of chronic degenerative diseases on the health status of the populations. Demographic transition takes place in countries where there are effective programmes of disease control which allow for survival during the early years of childhood and adolescence. This results in an increase in life expectancy which places larger proportions of the population in the age range (60 years and older) in which chronic degenerative diseases become the major determinants of health status. Epidemiological transition in diseases may also be brought about by shifts in social and economic patterns which favour detrimental changes in risk factors for the chronic degenerative diseases. Such changes may include health-related behaviour which augments dietary consumption of fats and alcohol, increases obesity, increases smoking and decreases physical activity. Such changes in risk-factor levels increase the prevalence of chronic degenerative diseases which manifest themselves at later ages, and for which early preventive actions could be cost-effective. In order to illustrate the impact of both demographic and risk-factor effects, analyses are made of the impact of increases in life expectancy on cause-specific mortality in both developing and developed countries. It is shown that there is great similarity in the effect of major noncommunicable diseases on the life expectancy of adults in both developed and developing countries. The major differences are seen to be in the proportions of deaths expected from such diseases as cancer, diabetes, heart disease, stroke and cirrhosis; but not in the distribution of age at death which is the better measure of disease impact. Demographic analyses, computing indirect estimates of mortality, also demonstrate that there are currently more chronic disease deaths in developing than developed countries and that as expectation of life increases in developing countries the global chronic disease burden will be greatly concentrated in the developing countries. Analyses of risk-factor reduction by feasible intervention strategies, e.g. smoking cessation campaigns, treatment of high blood pressure, using relationships between risk factors and diseases established in longitudinal studies carried out in developed countries, point out that the effect of risk-factor control in long-living populations can be hidden by the dependency of risk factors and various related causes of death, e.g. smoking has an impact on lung cancer, ischaemic heart disease and emphysema, but at different ages.(ABSTRACT TRUNCATED AT 400 WORDS)

Duke Engineering explores huge African Power Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Newman, P.

1994-10-14

Duke Engineering & Services and the African Republic of Uganda have entered into a memorandum of understanding to explore the feasibility of installing one or more hydropower plants along the Nile River and building a 2,000 mile transmission line through southern Africa. The project`s participants say they envision a southern African electricity grid connecting all countries in the region. A team comprised of officials from DE&S, Edlow and SAD-ELEC will conduct a six-month, two-part study on the feasibility of linking the existing grid system in the region. The first part of the study will look at the feasibility of installingmore » one or more independent hydropower plants along the Nile and other rivers in Uganda. The second part will explore the design, construction and operation of a transmission system to interconnect Uganda, through neighboring countries to the south and east, to the Republic of South Africa. The site for the proposed hydroelectric plant will determine the route of the transmission line.« less

Diet, nutrition and the prevention of dental diseases.

PubMed

Moynihan, Paula; Petersen, Poul Erik

2004-02-01

Oral health is related to diet in many ways, for example, nutritional influences on craniofacial development, oral cancer and oral infectious diseases. Dental diseases impact considerably on self-esteem and quality of life and are expensive to treat. The objective of this paper is to review the evidence for an association between nutrition, diet and dental diseases and to present dietary recommendations for their prevention. Nutrition affects the teeth during development and malnutrition may exacerbate periodontal and oral infectious diseases. However, the most significant effect of nutrition on teeth is the local action of diet in the mouth on the development of dental caries and enamel erosion. Dental erosion is increasing and is associated with dietary acids, a major source of which is soft drinks. Despite improved trends in levels of dental caries in developed countries, dental caries remains prevalent and is increasing in some developing countries undergoing nutrition transition. There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. Although other fermentable carbohydrates may not be totally blameless, epidemiological studies show that consumption of starchy staple foods and fresh fruit are associated with low levels of dental caries. Fluoride reduces caries risk but has not eliminated dental caries and many countries do not have adequate exposure to fluoride. It is important that countries with a low intake of free sugars do not increase intake, as the available evidence shows that when free sugars consumption is <15-20 kg/yr ( approximately 6-10% energy intake), dental caries is low. For countries with high consumption levels it is recommended that national health authorities and decision-makers formulate country-specific and community-specific goals for reducing the amount of free sugars aiming towards the recommended maximum of no more than 10% of energy intake. In addition, the frequency of consumption of foods containing free sugars should be limited to a maximum of 4 times per day. It is the responsibility of national authorities to ensure implementation of feasible fluoride programmes for their country.

Combination HIV Prevention Strategy Implementation in El Salvador: Perceived Barriers and Adaptations Reported by Outreach Peer Educators and Supervisors

PubMed Central

Buck, Meredith; Dickson-Gomez, Julia; Bodnar, Gloria

2017-01-01

El Salvador was one of three countries to receive funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria to conduct a combination HIV prevention intervention among transwomen (TW), men who have sex with men (MSM), and commercial sex workers (CSW). Program evaluation revealed that prevention activities reached only 50% of the target population. The purpose of this study is to examine the barriers that Salvadoran educators faced in implementing the peer education as designed and adaptations made as a result. Between March and June 2015, 18 in-depth interviews with educators were conducted. Violence was reported as the biggest barrier to intervention implementation. Other barriers differed by subpopulation. The level of violence and discrimination calls into question the feasibility and appropriateness of peer-led interventions in the Salvadoran context and demonstrates the importance of implementation research when translating HIV prevention interventions developed in high-income countries to low- and middle-income countries. PMID:28462359

Exploring perceptions of group antenatal Care in Urban India: results of a feasibility study.

PubMed

Jolivet, R Rima; Uttekar, Bella Vasant; O'Connor, Meaghan; Lakhwani, Kanchan; Sharma, Jigyasa; Wegner, Mary Nell

2018-04-03

Making high-quality health care available to all women during pregnancy is a critical strategy for improving perinatal outcomes for mothers and babies everywhere. Research from high-income countries suggests that antenatal care delivered in a group may be an effective way to improve the provision, experiences, and outcomes of care for pregnant women and newborns. A number of researchers and programmers are adapting group antenatal care (ANC) models for use in low- and middle-income countries (LMIC), but the evidence base from these settings is limited and no studies to date have assessed the feasibility and acceptability of group ANC in India. We adapted a "generic" model of group antenatal care developed through a systematic scoping review of the existing evidence on group ANC in LMICs for use in an urban setting in India, after looking at local, national and global guidelines to tailor the model content. We demonstrated one session of the model to physicians, auxiliary nurse midwives, administrators, pregnant women, and support persons from three different types of health facilities in Vadodara, India and used qualitative methods to gather and analyze feedback from participants on the perceived feasibility and acceptability of the model. Providers and recipients of care expressed support and enthusiasm for the model and offered specific feedback on its components: physical assessment, active learning, and social support. In general, after witnessing a demonstration of the model, both groups of participants-providers and beneficiaries-saw group ANC as a vehicle for delivering more comprehensive ANC services, improving experiences of care, empowering women to become more active partners and participants in their care, and potentially addressing some current health system challenges. This study suggests that introducing group ANC would be feasible and acceptable to stakeholders from various care delivery settings, including an urban primary health clinic, a community-based mother and child health center, and a private hospital, in urban India.

Feasible groundbased atmospheric and flux measurements by developing countries in support of satellite data

NASA Astrophysics Data System (ADS)

Mitra, A. P.

To allow increasing participation of developing countries in global change studies, ground based measurement systems which can be easily comissioned and provide support to satellite observations so as to fit into global mapping need to be chosen carefully. Those relating to atmospheric parameters (greenhouse gas concentrations, emission fluxes, transport properties, etc.) are discussed here. The simplest and of most immediate interest relate to sources and sinks of CH_4 (primarily from rice paddy fields, animals, wetlands) and N_2O (soils, oceans). Measurement techniques and inter-country campaign plans are discussed. There are also important possibilities of using the same technique for measurements of emissions from biomass burning alongwith ozone measurements coupled with survey of biomass burning areas from satellites. Another major area concerns the proposed ITYO programme (International Tropospheric Ozone Year), for which, apart from balloon ozone ascents, use of UV-B radiometry at selected wavelengths is considered. The third area discussed concerns measurements of atmospheric aerosols using Multi-wavelength Radiometer (MWR). In addition, in the last few years, a number of advanced groundlevel systems have been installed at low latitudes, which, if made available widely to developing country scientists, and their participation supported financially, could provide a major opportunity for world class research. These include: the MST radar at Tirupati (India) Chung-Li (Taiwan) and Arecibo, Puerto Rico; the Lidars at Thumba and at Natal, Brazil; and the Laser Heterodyning System and mm-wave radiospectrometer at Delhi.

Global partnerships are critical to advance the control of Neglected Zoonotic Diseases: The case of the Global Alliance for Rabies Control.

PubMed

Nel, Louis H; Taylor, Louise H; Balaram, Deepashree; Doyle, Kim A S

2017-01-01

There is a need for innovation to improve control of all Neglected Zoonotic Diseases (NZDs). The Global Alliance for Rabies Control was formed to prevent human deaths from rabies and relieve the burden of rabies in other animal populations, especially dogs. It aims to identify reasons for the neglect of rabies in developing countries and to develop strategies to improve rabies control. Through initiatives such as World Rabies Day and the Partners for Rabies Prevention, progress has been made towards increased awareness of the burden of rabies transmitted by dogs at scales from local to international. An evidence base of the feasibility of canine rabies elimination has been built up and now easier access to information and tools enables countries to design and implement rabies elimination strategies in a logical way, utilizing the structures of regional networks for rabies control. The body of evidence has built consensus amongst international stakeholders in rabies control and is now being used to encourage international policy change, attract investment and increase delivery of effective rabies control programmes in canine rabies endemic countries. Copyright © 2015 Elsevier B.V. All rights reserved.

Analysis of relations between aerosol optical depth and cloud parameters over land and offshore area of Eastern China and America

NASA Astrophysics Data System (ADS)

Chen, Yi-Lun; Fu, Yun-Fei; Yang, Yuan-Jian; Zhang, Ao-Qi

2014-11-01

As we know, China is the largest developing country and the United State (US) is one of the most developed countries of the world. Due to significant differences of the developmental levels between China and the US, different pollutants emissions may be performed. It is found that aerosol optical depth (AOD) over China is much higher than that over America. Since China and the US locate in westerly wind belts, it is feasible to examine the relationship between different AOD and cloud parameters over land and offshore area of the two countries. In this paper, cloud effective radius (CER), liquid water path (LWP) and AOD derived from the Moderate Resolution Imaging Spectroradiometer (MODIS) and circulations supplied by NCEP/NCAR reanalysis data from 2000 to 2013 are employed to explore the relationships between AOD and CER under different LWP levels. Results indicate that there is a clear negative relationship between AOD and CER in different LWP levels over the offshore area contrary to the insignificant relationship over land or the open sea. It suggests that aerosol indirect effects are more obvious over the offshore area.

How to Improve the Validity of Sexual Behaviour Reporting: Systematic Review of Questionnaire Delivery Modes in Developing Countries

PubMed Central

Langhaug, Lisa F.; Sherr, Lorraine; Cowan, Frances M

2012-01-01

Summary Objectives To systematically review comparative research from developing countries on the effects of questionnaire delivery mode. Methods We searched Medline, EMbase and PsychINFO and ISSTDR conference proceedings. Randomized-controlled trials and quasi-experimental studies were included if they compared two or more questionnaire delivery modes, were conducted in a developing country, reported on sexual behaviours, and occurred after 1980. Results 28 articles reporting on 26 studies met the inclusion criteria. Heterogeneity of reported trial outcomes between studies made it inappropriate to combine trial outcomes. 18 studies compared audio computer-assisted survey instruments (ACASI) or its derivatives (PDA or CAPI) against another self-administered questionnaires, face-to-face interviews, or random response technique. Despite wide variation in geography and populations sampled, there was strong evidence that computer-assisted interviews lowered item-response rates and raised rates of reporting sensitive behaviours. ACASI also improved data entry quality. A wide range of sexual behaviours were reported including vaginal, oral, anal and/or forced sex, age of sexual debut, condom use at first and/or last sex. Validation of self-reports using biomarkers was rare. Conclusions These data reaffirm that questionnaire delivery modes do affect self-reported sexual ehaviours and that use of ACASI can significantly reduce reporting bias. Its acceptability and feasibility in developing country settings should encourage researchers to consider its use when conduct ing sexual health research. Triangulation of self-reported data using biomarkers is recommended. Standardising sexual behaviour measures would allow for meta-analysis. PMID:20409291

The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries.

PubMed

Renom-Guiteras, Anna; Meyer, Gabriele; Thürmann, Petra A

2015-07-01

The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people, which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice. A preliminary PIM list was developed, based on the German PRISCUS list of potentially inappropriate medications and other PIM lists from the USA, Canada and France. Thirty experts on geriatric prescribing from Estonia, Finland, France, the Netherlands, Spain and Sweden participated; eight experts performed a structured expansion of the list, suggesting further medications; twenty-seven experts participated in a two-round Delphi survey assessing the appropriateness of drugs and suggesting dose adjustments and therapeutic alternatives. Finally, twelve experts completed a brief final survey to decide upon issues requiring further consensus. Experts reached a consensus that 282 chemical substances or drug classes from 34 therapeutic groups are PIM for older people; some PIM are restricted to a certain dose or duration of use. The PIM list contains suggestions for dose adjustments and therapeutic alternatives. The European Union (EU)(7)-PIM list is a screening tool, developed with participation of experts from seven European countries, that allows identification and comparison of PIM prescribing patterns for older people across European countries. It can also be used as a guide in clinical practice, although it does not substitute the decision-making process of individualised prescribing for older people. Further research is needed to investigate the feasibility and applicability and, finally, the clinical benefits of the newly developed list.

Conducting feasibilities in clinical trials: an investment to ensure a good study.

PubMed

Rajadhyaksha, Viraj

2010-07-01

Conducting clinical trial feasibility is one of the first steps in clinical trial conduct. This process includes assessing internal and environmental capacity, alignment of the clinical trial in terms of study design, dose of investigational product, comparator, patient type, with the local environment and assessing potential of conducting clinical trial in a specific country. A robust feasibility also ensures a realistic assessment and capability to conduct the clinical trial. For local affiliates of pharmaceutical organizations, and contract research organizations, this is a precursor to study placement and influences the decision of study placement. This article provides details on different types of feasibilities, information which is to be included and relevance of each. The article also aims to provide practical hands-on suggestions to make feasibilities more realistic and informative.

The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings

PubMed Central

McClure, Elizabeth M; Goldenberg, Robert L; Brandes, Neal; Darmstadt, Gary L; Wright, Linda L

2009-01-01

Of the 4 million neonatal deaths and 500,000 maternal deaths that occur annually worldwide, almost 99% are in developing countries and one-third are associated with infections. Implementation of proven interventions and targeted research on a select number of promising high-impact preventative and curative interventions are essential to achieve Millennium Development Goals for reduction of child and maternal mortality. Feasible, simple, low-cost interventions have the potential to significantly reduce the mortality and severe morbidity associated with infection in these settings. Studies of chlorhexidine in developing countries have focused on three primary uses: 1) intrapartum vaginal and neonatal wiping, 2) neonatal wiping alone, and 3) umbilical cord cleansing. A study of vaginal wiping and neonatal skin cleansing with chlorhexidine, conducted in Malawi in the 1990s suggested that chlorhexidine has potential to reduce neonatal infectious morbidity and mortality. A recent trial of cord cleansing conducted in Nepal also demonstrated benefit. Although studies have shown promise, widespread acceptance and implementation of chlorhexidine use has not yet occurred. This paper is derived in part from data presented at a conference on the use of chlorhexidine in developing countries and reviews the available evidence related to chlorhexidine use to reduce mortality and severe morbidity due to infections in mothers and neonates in low-resource settings. It also summarizes issues related to programmatic implementation. PMID:17399714

Restoration planning to guide Aichi targets in a megadiverse country.

PubMed

Tobón, Wolke; Urquiza-Haas, Tania; Koleff, Patricia; Schröter, Matthias; Ortega-Álvarez, Rubén; Campo, Julio; Lindig-Cisneros, Roberto; Sarukhán, José; Bonn, Aletta

2017-10-01

Ecological restoration has become an important strategy to conserve biodiversity and ecosystems services. To restore 15% of degraded ecosystems as stipulated by the Convention on Biological Diversity Aichi target 15, we developed a prioritization framework to identify potential priority sites for restoration in Mexico, a megadiverse country. We used the most current biological and environmental data on Mexico to assess areas of biological importance and restoration feasibility at national scale and engaged stakeholders and experts throughout the process. We integrated 8 criteria into 2 components (i.e., biological importance and restoration feasibility) in a spatial multicriteria analysis and generated 11 scenarios to test the effect of assigning different component weights. The priority restoration sites were distributed across all terrestrial ecosystems of Mexico; 64.1% were in degraded natural vegetation and 6% were in protected areas. Our results provide a spatial guide to where restoration could enhance the persistence of species of conservation concern and vulnerable ecosystems while maximizing the likelihood of restoration success. Such spatial prioritization is a first step in informing policy makers and restoration planners where to focus local and large-scale restoration efforts, which should additionally incorporate social and monetary cost-benefit considerations. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

International validation of quality indicators for evaluating priority setting in low income countries: process and key lessons.

PubMed

Kapiriri, Lydia

2017-06-19

While there have been efforts to develop frameworks to guide healthcare priority setting; there has been limited focus on evaluation frameworks. Moreover, while the few frameworks identify quality indicators for successful priority setting, they do not provide the users with strategies to verify these indicators. Kapiriri and Martin (Health Care Anal 18:129-147, 2010) developed a framework for evaluating priority setting in low and middle income countries. This framework provides BOTH parameters for successful priority setting and proposes means of their verification. Before its use in real life contexts, this paper presents results from a validation process of the framework. The framework validation involved 53 policy makers and priority setting researchers at the global, national and sub-national levels (in Uganda). They were requested to indicate the relative importance of the proposed parameters as well as the feasibility of obtaining the related information. We also pilot tested the proposed means of verification. Almost all the respondents evaluated all the parameters, including the contextual factors, as 'very important'. However, some respondents at the global level thought 'presence of incentives to comply', 'reduced disagreements', 'increased public understanding,' 'improved institutional accountability' and 'meeting the ministry of health objectives', which could be a reflection of their levels of decision making. All the proposed means of verification were assessed as feasible with the exception of meeting observations which would require an insider. These findings results were consistent with those obtained from the pilot testing. These findings are relevant to policy makers and researchers involved in priority setting in low and middle income countries. To the best of our knowledge, this is one of the few initiatives that has involved potential users of a framework (at the global and in a Low Income Country) in its validation. The favorable validation of all the parameters at the national and sub-national levels implies that the framework has potential usefulness at those levels, as is. The parameters that were disputed at the global level necessitate further discussion when using the framework at that level. The next step is to use the validated framework in evaluating actual priority setting at the different levels.

Short Message Service (SMS) as an Educational Tool during Pregnancy: A Literature Review

ERIC Educational Resources Information Center

Lamont, Kim; Sliwa, Karen; Stewart, Simon; Carrington, Melinda; Pretorius, Sandra; Libhaber, Elena; Wiysonge, Charles S.; Adebayo, Esther F.; Klipstein-Grobusch, Kerstin

2016-01-01

Background: In many low- and middle-income countries, access to health information during pregnancy is poor. The rapid adoption of mobile phones in these countries has created new opportunities for disseminating such information. Objective: This paper reviews existing information on the use of short message services (SMSs) as a feasible tool to…

Fighting terrorism in Africa: Benchmarking policy harmonization

NASA Astrophysics Data System (ADS)

Asongu, Simplice A.; Tchamyou, Vanessa S.; Minkoua N., Jules R.; Asongu, Ndemaze; Tchamyou, Nina P.

2018-02-01

This study assesses the feasibility of policy harmonization in the fight against terrorism in 53 African countries with data for the period 1980-2012. Four terrorism variables are used, namely: domestic, transnational, unclear and total terrorism dynamics. The empirical evidence is based on absolute beta catch-up and sigma convergence estimation techniques. There is substantial absence of catch-up. The lowest rate of convergence in terrorism is in landlocked countries for regressions pertaining to unclear terrorism (3.43% per annum for 174.9 years) while the highest rate of convergence is in upper-middle-income countries in domestic terrorism regressions (15.33% per annum for 39.13 years). After comparing results from the two estimation techniques, it is apparent that in the contemporary era, countries with low levels of terrorism are not catching-up their counterparts with high levels of terrorism. As a policy implication, whereas some common policies may be feasibly adopted for the fight against terrorism, the findings based on the last periodic phase (2004-2012) are indicative that country-specific policies would better pay-off in the fight against terrorism than blanket common policies. Some suggestions of measures in fighting transnational terrorism have been discussed in the light of an anticipated surge in cross-national terrorism incidences in the coming years.

Prenatal tobacco prevention and cessation interventions for women in low- and middle-income countries.

PubMed

Oncken, Cheryl A; Dietz, Patricia M; Tong, Van T; Belizán, José M; Tolosa, Jorge E; Berghella, Vincenzo; Goldenberg, Robert L; Lando, Harry A; Samet, Jonathan M; Bloch, Michele H

2010-01-01

Although the prevalence of tobacco use is decreasing in many high-income countries, it is increasing in many low- and middle-income countries. The health and economic burden of increasing tobacco use and dependence is predictable and will have devastating effects in countries with limited resources, particularly for vulnerable populations such as pregnant women. We sought to review effective tobacco prevention and intervention strategies for decreasing tobacco use and secondhand smoke exposure before and during pregnancy in high-, middle-, and low-income countries. We reviewed several types of interventions, including population-level efforts (increasing tobacco prices, implementing tobacco control policies), community interventions, clinical interventions, and pharmacological treatments. A second purpose of this report is to present findings of an international expert working group that was convened to review the evidence and to establish research priorities in the following areas: (a) preventing the uptake and reducing tobacco use among girls and women of reproductive age; and (b) reducing tobacco use and secondhand smoke exposure among pregnant women. The working group considered the evidence on existing interventions in terms of burden of disease, intervention impact, intervention costs, feasibility of integration into existing services, uniqueness of the contribution, and overall feasibility. Finally, we present the working group's recommendations for intervention research priorities.

Identifying potential recommendation domains for conservation agriculture in Ethiopia, Kenya, and Malawi.

PubMed

Tesfaye, Kindie; Jaleta, Moti; Jena, Pradyot; Mutenje, Munyaradzi

2015-02-01

Conservation agriculture (CA) is being promoted as an option for reducing soil degradation, conserving water, enhancing crop productivity, and maintaining yield stability. However, CA is a knowledge- and technology-intensive practice, and may not be feasible or may not perform better than conventional agriculture under all conditions and farming systems. Using high resolution (≈1 km(2)) biophysical and socioeconomic geospatial data, this study identified potential recommendation domains (RDs) for CA in Ethiopia, Kenya, and Malawi. The biophysical variables used were soil texture, surface slope, and rainfall while the socioeconomic variables were market access and human and livestock population densities. Based on feasibility and comparative performance of CA over conventional agriculture, the biophysical and socioeconomic factors were first used to classify cultivated areas into three biophysical and three socioeconomic potential domains, respectively. Combinations of biophysical and socioeconomic domains were then used to develop potential RDs for CA based on adoption potential within the cultivated areas. About 39, 12, and 5% of the cultivated areas showed high biophysical and socioeconomic potential while 50, 39, and 21% of the cultivated areas showed high biophysical and medium socioeconomic potential for CA in Malawi, Kenya, and Ethiopia, respectively. The results indicate considerable acreages of land with high CA adoption potential in the mixed crop-livestock systems of the studied countries. However, there are large differences among countries depending on biophysical and socio-economic conditions. The information generated in this study could be used for targeting CA and prioritizing CA-related agricultural research and investment priorities in the three countries.

Identifying Potential Recommendation Domains for Conservation Agriculture in Ethiopia, Kenya, and Malawi

NASA Astrophysics Data System (ADS)

Tesfaye, Kindie; Jaleta, Moti; Jena, Pradyot; Mutenje, Munyaradzi

2015-02-01

Conservation agriculture (CA) is being promoted as an option for reducing soil degradation, conserving water, enhancing crop productivity, and maintaining yield stability. However, CA is a knowledge- and technology-intensive practice, and may not be feasible or may not perform better than conventional agriculture under all conditions and farming systems. Using high resolution (≈1 km2) biophysical and socioeconomic geospatial data, this study identified potential recommendation domains (RDs) for CA in Ethiopia, Kenya, and Malawi. The biophysical variables used were soil texture, surface slope, and rainfall while the socioeconomic variables were market access and human and livestock population densities. Based on feasibility and comparative performance of CA over conventional agriculture, the biophysical and socioeconomic factors were first used to classify cultivated areas into three biophysical and three socioeconomic potential domains, respectively. Combinations of biophysical and socioeconomic domains were then used to develop potential RDs for CA based on adoption potential within the cultivated areas. About 39, 12, and 5 % of the cultivated areas showed high biophysical and socioeconomic potential while 50, 39, and 21 % of the cultivated areas showed high biophysical and medium socioeconomic potential for CA in Malawi, Kenya, and Ethiopia, respectively. The results indicate considerable acreages of land with high CA adoption potential in the mixed crop-livestock systems of the studied countries. However, there are large differences among countries depending on biophysical and socio-economic conditions. The information generated in this study could be used for targeting CA and prioritizing CA-related agricultural research and investment priorities in the three countries.

Telemedicine in Western Africa: lessons learned from a pilot project in Mali, perspectives and recommendations.

PubMed

Geissbuhler, Antoine; Ly, Ousmane; Lovis, Christian; L'Haire, Jean-François

2003-01-01

to evaluate the feasibility, potential and risks of an internet-based telemedicine network in developing countries of Western Africa. a project for the development of a national telemedicine network in Mali was initiated in 2001, using internet-based technologies for distance learning and teleconsultations. the telemedicine network has been in productive use for 12 months and has enabled various collaboration channels, including North-South, South-South, and South-North distance learning and teleconsultations. It also unveiled a set of potential problems: a) limited pertinence of North-South collaborations when there are major differences in available resources or socio-cultural contexts between the collaborating parties; b) risk of induced digital divide if the periphery of the health system is not involved in the development of the network, and c) need for the development of local medical contents management skills. the identified risks must be taken into account when designing large-scale telemedicine projects in developing countries and can be mitigated by the fostering of South-South collaboration channels, the use of satellite-based internet connectivity in remote areas, and the valorization of local knowledge and its publication on-line.

Systematic review: cultural adaptation and feasibility of screening for autism in non-English speaking countries.

PubMed

Al Maskari, Turkiya S; Melville, Craig A; Willis, Diane S

2018-01-01

Screening children for autism has gained wider acceptance within clinical practice, and early intervention has improved outcomes. Increasingly, adapting an existing screening instrument is a common, fast method to create a usable screening tool, especially for countries with limited resources and/or expertise. However, concerns have been raised regarding adaptation adequacy and the feasibility of screening across cultural groups. This study systematically examined the levels of cultural adaptation and feasibility aspects considered when screening for autism in non-English speaking countries to build upon the sparse knowledge that exists on this topic in the literature. Nineteen studies, obtained from five electronic databases, were examined. PRISMA guidance was used for this review. The Ecological Validity Framework model, and Bowen Recommendations for Feasibility were adopted to extract relevant data, which was synthesised narratively. Cultural adaptation within the included studies mostly involved language translation with little information offered to enable conclusions on how the processes were guided and maintained. Few cultural adjustments involved modifying screening methods; clarifying difficult concepts and changing instrument content were employed to address the core values, competence, beliefs, and norms of the adapted culture. However, less attention was given to adapt the screening goals within the context of cultural values, and customs or to consider interactional match between the clients and assessors. The review also highlighted an acceptable level of practicality to screen for autism but did not encourage integrating autism screening within routine practice or beyond the study context for different cultures. Concurring with previous literature, we agree that knowledge on cultural adaptation for autism screening instruments is limited and not sufficiently documented to establish adaptation levels (process and/or contents), and prove adequacy. However, this review provides an infrastructure to improve future adaptation processes. Integrating autism screening as routine medical practice is not encouraged and warrants further feasibility studies to minimize wasted resources and improve screening effectiveness in various health care systems.

Using commercial advertising agencies in micronutrient promotion: lessons learned.

PubMed

Torres, M P

1998-01-01

Lack of knowledge, beliefs about food, customs, and poverty are the main factors preventing millions of people from eating enough micronutrient-rich foods. Globally, more than 2 billion people are at risk of iron, vitamin A, and iodine deficiencies. Opportunities for Micronutrient Intervention (OMNI), a 5-year project funded by the Office of Health and Nutrition, US Agency for International Development, is dedicated to preventing and controlling micronutrient deficiencies in developing countries. OMNI's general approaches to reducing micronutrient deficiencies include fortification, supplementation, and dietary diversification. For all of those approaches, the project has stressed a social marketing methodology to define and motivate feasible behavior changes which will benefit maternal and child health and nutrition. The Manoff Group, the OMNI partner most responsible for behavior change, has had many positive experiences using social marketing to address micronutrient malnutrition, breast-feeding, and child feeding in many countries. Focusing mainly upon supplementation and dietary diversification, OMNI's experience to date in El Salvador, Nicaragua, Ecuador, and Bolivia is summarized.

Two-phase anaerobic digestion of partially acidified sewage sludge: a pilot plant study for safe sludge disposal in developing countries.

PubMed

Passio, Luca; Rizzoa, Luigi; Fuchs, Stephan

2012-09-01

The unsafe disposal of wastewater and sludge in different areas of developing countries results in significant environmental pollution, particularly for groundwater, thus increasing the risk of waterborne diseases spreading. In this work, a two-phase anaerobic digestion process for post-treatment of partially acidified sewage sludge was investigated to evaluate its feasibility as a safe sludge disposal system. Pilot tests showed that an effective sludge stabilization can be achieved (total volatile solids content <65%, organic acid concentration <200 mg/L at flow rate = 50 L/d and hydraulic residence time = 18 d) as well as a relative low faecal coliform density (<1000 most probable number per g total solids), showing that land application of the sludge without restrictions is possible according to US Environmental Protection Agency criteria for safe sludge disposal. A biogas production as high as 390 L/d with a 60% methane content by volume was achieved, showing that energy production from biogas may be achieved as well.

Pilot testing of dipsticks as point-of-care assays for rapid diagnosis of poor-quality artemisinin drugs in endemic settings.

PubMed

Guo, Suqin; He, Lishan; Tisch, Daniel J; Kazura, James; Mharakurwa, Sungano; Mahanta, Jagadish; Herrera, Sócrates; Wang, Baomin; Cui, Liwang

2016-01-01

Good-quality artemisinin drugs are essential for malaria treatment, but increasing prevalence of poor-quality artemisinin drugs in many endemic countries hinders effective management of malaria cases. To develop a point-of-care assay for rapid identification of counterfeit and substandard artemisinin drugs for resource-limited areas, we used specific monoclonal antibodies against artesunate and artemether, and developed prototypes of lateral flow dipstick assays. In this pilot test, we evaluated the feasibility of these dipsticks under different endemic settings and their performance in the hands of untrained personnel. The results showed that the dipstick tests can be successfully performed by different investigators with the included instruction sheet. None of the artemether and artesunate drugs collected from public pharmacies in different endemic countries failed the test. It is possible that the simple dipstick assays, with future optimization of test conditions and sensitivity, can be used as a qualitative and semi-quantitative assay for rapid screening of counterfeit artemisinin drugs in endemic settings.

Development of the ICD-10 simplified version and field test.

PubMed

Paoin, Wansa; Yuenyongsuwan, Maliwan; Yokobori, Yukiko; Endo, Hiroyoshi; Kim, Sukil

2018-05-01

The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) has been used in various Asia-Pacific countries for more than 20 years. Although ICD-10 is a powerful tool, clinical coding processes are complex; therefore, many developing countries have not been able to implement ICD-10-based health statistics (WHO-FIC APN, 2007). This study aimed to simplify ICD-10 clinical coding processes, to modify index terms to facilitate computer searching and to provide a simplified version of ICD-10 for use in developing countries. The World Health Organization Family of International Classifications Asia-Pacific Network (APN) developed a simplified version of the ICD-10 and conducted field testing in Cambodia during February and March 2016. Ten hospitals were selected to participate. Each hospital sent a team to join a training workshop before using the ICD-10 simplified version to code 100 cases. All hospitals subsequently sent their coded records to the researchers. Overall, there were 1038 coded records with a total of 1099 ICD clinical codes assigned. The average accuracy rate was calculated as 80.71% (66.67-93.41%). Three types of clinical coding errors were found. These related to errors relating to the coder (14.56%), those resulting from the physician documentation (1.27%) and those considered system errors (3.46%). The field trial results demonstrated that the APN ICD-10 simplified version is feasible for implementation as an effective tool to implement ICD-10 clinical coding for hospitals. Developing countries may consider adopting the APN ICD-10 simplified version for ICD-10 code assignment in hospitals and health care centres. The simplified version can be viewed as an introductory tool which leads to the implementation of the full ICD-10 and may support subsequent ICD-11 adoption.

Targeting core groups for gonorrhoea control: feasibility and impact.

PubMed

Giguère, Katia; Alary, Michel

2015-06-01

We aimed to outline why core groups should be targeted in Neisseria gonorrhoeae control and suggest several important and timely interventions to target core groups while highly resistant strains are spreading. Core group definition, feasibility and impact of gonorrhoea core group interventions as well as gonorrhoea resistance development have been reviewed in the paper. Core group interventions have proven effective in gonorrhoea control in the past but are compromised by the spread of highly resistant strains. Worldwide functional Gonorrhoea Antimicrobial Surveillance Program, better screening and better treatment programmes are needed. Prevention through condom promotion aimed at core groups remains essential. More specific treatment guidance for low-income and middle-income countries without resistance data is required in the meantime to achieve a better use of antibiotics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Integrated bioleaching of copper metal from waste printed circuit board-a comprehensive review of approaches and challenges.

PubMed

Awasthi, Abhishek Kumar; Zeng, Xianlai; Li, Jinhui

2016-11-01

Waste electrical and electronic equipment (e-waste) is the most rapidly growing waste stream in the world, and the majority of the residues are openly disposed of in developing countries. Waste printed circuit boards (WPCBs) make up the major portion of e-waste, and their informal recycling can cause environmental pollution and health risks. Furthermore, the conventional disposal and recycling techniques-mechanical treatments used to recover valuable metals, including copper-are not sustainable in the long term. Chemical leaching is rapid and efficient but causes secondary pollution. Bioleaching is a promising approach, eco-friendly and economically feasible, but it is slower process. This review considers the recycling potential of microbes and suggests an integrated bioleaching approach for Cu extraction and recovery from WPCBs. The proposed recycling system should be more effective, efficient and both technically and economically feasible.

Technical, economic, and environmental impact study of converting Uzbekistan transportation fleets to natural gas operation. Export trade information

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1997-04-30

This study, conducted by Radian International, was funded by the U.S. Trade and Development Agency. The report assesses the feasibility (technical, economic and environmental) of converting the Uzbek transportation fleets to natural gas operation. The study focuses on the conversion of high fuel use vehicles and locomotives to liquefied natural gas (LNG) and the conversion of moderate fuel use veicles to compressed natural gas (CNG). The report is divided into the following sections: Executive Summary; (1.0) Introduction; (2.0) Country Background; (3.0) Characterization of Uzbek Transportation Fuels; (4.0) Uzbek Vehicle and Locomotive Fleet Characterization; (5.0) Uzbek Natural Gas Vehicle Conversion Shops;more » (6.0) Uzbek Natural Gas Infrastructure; (7.0) Liquefied Natural Gas (LNG) for Vehicular Fuel in Uzbekistan; (8.0) Economic Feasibility Study; (9.0) Environmental Impact Analysis; References; Appendices A - S.« less

In which developing countries are patents on essential medicines being filed?

PubMed

Beall, Reed F; Blanchet, Rosanne; Attaran, Amir

2017-06-26

This article is based upon data gathered during a study conducted in partnership with the World Intellectual Property Organization on the patent status of products appearing on the World Health Organization's 2013 Model List of Essential Medicines (MLEM). It is a statistical analysis aimed at answering: in which developing countries are patents on essential medicines being filed? Patent data were collected by linking those listed in the United States and Canada's medicine patent registers to corresponding patents in developing countries using two international patent databases (INPADOC and Derwent) via a commerical-grade patent search platform (Thomson Innovation). The respective supplier companies were then contacted to correct and verify our data. We next tallied the number of MLEM patents per developing country. Spearman correlations were done to assess bivariate relationships between variables, and a multivariate regression model was developed to explain the number of MLEM patents in each country using SPSS 23.0. A subset of 20 of the 375 (5%) products on the 2013 MLEM fit our inclusion criteria. The patent estate reports (i.e., the global list of patents for a given drug) varied greatly in their number with a median of 48 patents (interquartile range [IQR]: 26-76). Their geographic reach had a median of 15% of the developing countries sampled (IQR: 8-28%). The number of developing countries covered appeared to increase with the age of the patent estate (r = .433, p = 0.028). The number of MLEM patents per country was significantly positively associated with human development index (HDI), gross domestic income (GDI) per capita, total healthcare expenditure per capita, population size, the Rule of Law Index, and average education level. Population size, GDI per capita, and healthcare expenditure (in % of national expenditure) were predictors of the number of MLEM patents in countries (p = 0.001, p = 0.001, p = 0.009, respectively). Population size was the most important predictor (β = 0.59), followed by income (GDI per capita) (β = 0.32), and healthcare expenditure (β = 0.15). Holding the other factors constant, (i) 14.3 million more people, (ii) $833.33 more per capita (GDI), or (iii) 0.88% more of national spending on healthcare resulted in 1 additional essential medicine patent. Population was a powerful predictor of the number of patent filings in developing countries along with GDI and healthcare expenditure. The age and historical context of the patent estate may make a difference in the number of patents and countries covered. Broad surveillance and benchmarking of the global medicine patent landscape is valuable for detecting significant shifts that may occur over time. With improved international medicine patent transparency by companies and data available through third parties, such studies will be increasingly feasible.

Components that affect the Implementation of Health Services’ Strategic Purchasing: A Comprehensive Review of the Literature

PubMed Central

Bastani, Peivand; Samadbeik, Mahnaz; Kazemifard, Yalda

2016-01-01

Introduction Strategic purchasing is one of the mechanisms that can increase access, equity, and efficiency as well as the correct management of health resources. The aim of this study was to extract important and influential factors as necessary infrastructures to implement this method. Methods In this comprehensive literature review, 13 databases and search engines were searched from 2000 to 2015 by applying appropriate keywords. From a total of 1403 titles and after ensuring the validity of the study by the Clinical Appraisal Skills Program (CASP) tool, 18 articles that contained title, abstract, and associated text were used in the study, and their related information was analyzed and extracted using an extraction form and LitAssist software. Results The findings showed six categories of intervention have been effective in the strategic purchasing of all health interventions in different countries. These six categories were “The target group of users of the service” (demand side), “purchased interventions,” “providers and suppliers of interventions” (the supply side), “Methods and incentives” (payment method), “price,” and “Structure and organization.” Conclusion Although the necessity of performing strategic purchasing in the health sector or developing countries is an indisputable fact, it is of great importance to use the experiences of developed countries while considering the factors extracted from the study for implementing this method. In this regard, it is suggested that studies be performed that can lead to assessing the feasibility of strategic purchasing for health services in developing countries and also in Iran to help health policy makers in these countries. PMID:27382441

IMET Feasibility Study and Implementation: Maximizing the Graduate School of Business and Public Policy Experience for International Students at the Naval Postgraduate School

DTIC Science & Technology

2006-06-01

commented: Most of materials will be available for only one country. Singaporeans do not understand German, I do not read French etc. Information...informed about restaurants and supermarkets offering international cuisine or even cuisine from their country in the Monterey area. The majority of the...restaurants and supermarkets offering international cuisine , or even cuisine from their country, in the Monterey area through the welcome package

Resource availability for the management of maternal sepsis in Malawi, other low-income countries, and lower-middle-income countries.

PubMed

Abdu, Mohammed; Wilson, Amie; Mhango, Chisale; Taki, Fatima; Coomarasamy, Arri; Lissauer, David

2018-02-01

To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries. The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

The developmental implications of migration from and between small island nations.

PubMed

Mckee, D L; Tisdell, C A

1988-12-01

This article discusses the role of migration in relieving population pressures, thus making continuing development possible, using small nations in the Caribbean and the South Pacific as examples. The Caribbean islands and many Pacific islands have used out-migration to ease population pressures in this century. Surplus labor has been emerging in various Caribbean nations, independent of the international marketing problems of plantation agriculture. Rural populations alienated from plantations have had to make do on questionable and/or remote land. Population surpluses appear to originate in rural areas, but little evidence exists to suggest that those surpluses are the basis for the emigration patterns of the Caribbean islands. Emigration does not solve population problems because when ambitious, skilled workers leave their country, their actions have little to do with the existence of domestic surplus labor and their leaving may do little to facilitate domestic labor absorption. Thus, if mini-states wish to sustain their hopes of economic expansion, they must find the means to employ their surplus labor. Since mainly skilled migrants leave, their going may actually slow development and retard opportunities for labor absorption. Population movements internal to the Caribbean region may further complicate surplus labor and/or population problems. If protective entry requirements impede normal inter-island relations, they may interfere with developmental processes. In general, migration is not a feasible strategy for population control for small island nations. While temporary migration has a more positive impact than other forms of migration, problems do exist. For example, temporary migration 1) can impose significant economic costs on the source-country, and 2) may result in the source country being unable to capitalize on its initial investment in training and education of temporary migrants. In conclusion, import substitution through cooperation between small island nations, production for export where feasible, and more attention to more sophisticated international service linkages hold a better prospect for material progress than relying on the export of surplus populations.

IPNS upgrade: A feasibility study

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-04-01

Many of Argonne National Laboratory`s (ANL`s) scientific staff members were very active in R&D work related to accelerator-based spoliation sources in the 1970s and early 1980s. In 1984, the Seitz/Eastman Panel of the National Academy of Sciences reviewed U.S. materials science research facilities. One of the recommendations of this panel was that the United States build a reactor-based steady-state source, the Advanced Neutron Source (ANS), at Oak Ridge National Laboratory. Subsequently, R&D activities related to the design of an accelerator-based source assumed a lower priority. The resumption of pulsed-source studies in this country started simultaneously with design activities in Europemore » aimed at the European Spallation Source (ESS). The European Community funded a workshop in September 1991 to define the parameters of the ESS. Participants in this workshop included both accelerator builders and neutron source users. A consortium of European countries has proposed to build a 5-MW pulsed source, and a feasibility study is currently under way. Soon after the birth of the ESS, a small group at ANL set about bringing themselves up to date on pulsed-source information since 1984 and studied the feasibility of upgrading ANL`s Intense Pulsed Neutron Source (IPNS) to 1 MW by means of a rapidly cycling synchrotron that could be housed, along with its support facilities, in existing buildings. In early 1993, the Kohn panel recommended that (1) design and construction of the ANS should be completed according to the proposed project schedule and (2) development of competitive proposals for cost-effective design and construction of a 1-MW pulsed spallation source should be authorized immediately.« less

Reducing emissions from agriculture to meet the 2 °C target.

PubMed

Wollenberg, Eva; Richards, Meryl; Smith, Pete; Havlík, Petr; Obersteiner, Michael; Tubiello, Francesco N; Herold, Martin; Gerber, Pierre; Carter, Sarah; Reisinger, Andrew; van Vuuren, Detlef P; Dickie, Amy; Neufeldt, Henry; Sander, Björn O; Wassmann, Reiner; Sommer, Rolf; Amonette, James E; Falcucci, Alessandra; Herrero, Mario; Opio, Carolyn; Roman-Cuesta, Rosa Maria; Stehfest, Elke; Westhoek, Henk; Ortiz-Monasterio, Ivan; Sapkota, Tek; Rufino, Mariana C; Thornton, Philip K; Verchot, Louis; West, Paul C; Soussana, Jean-François; Baedeker, Tobias; Sadler, Marc; Vermeulen, Sonja; Campbell, Bruce M

2016-12-01

More than 100 countries pledged to reduce agricultural greenhouse gas (GHG) emissions in the 2015 Paris Agreement of the United Nations Framework Convention on Climate Change. Yet technical information about how much mitigation is needed in the sector vs. how much is feasible remains poor. We identify a preliminary global target for reducing emissions from agriculture of ~1 GtCO 2 e yr -1 by 2030 to limit warming in 2100 to 2 °C above pre-industrial levels. Yet plausible agricultural development pathways with mitigation cobenefits deliver only 21-40% of needed mitigation. The target indicates that more transformative technical and policy options will be needed, such as methane inhibitors and finance for new practices. A more comprehensive target for the 2 °C limit should be developed to include soil carbon and agriculture-related mitigation options. Excluding agricultural emissions from mitigation targets and plans will increase the cost of mitigation in other sectors or reduce the feasibility of meeting the 2 °C limit. © 2016 The Authors Global Change Biology Published by John Wiley & Sons Ltd.

Duet for menstrual protection: a feasibility study in Zimbabwe.

PubMed

Averbach, Sarah; Sahin-Hodoglugil, Nuriye; Musara, Petina; Chipato, Tsungai; van der Straten, Ariane

2009-06-01

Managing menses is a challenge for women in developing countries. Duet is a cervical barrier being developed for contraception and STI prevention. We explored the hypothetical acceptability of using Duet as a menstrual cup, among Zimbabwean women. A survey and focus group discussions (FGD) were conducted with 43 women aged 18-45 years to gain information about their menstrual practices and attitudes regarding the use of Duet for menstrual protection. All 43 women reported that if Duet were available, they would "definitely" try it, and that it was "very important" that Duet is low cost and easy to clean; 86% reported that using it would make a difference in their lives. FGD findings highlighted unhygienic practices due to the lack of affordable options for menstrual management and a genuine interest in Duet, including its potential use for multiple purposes (contraception, disease prevention and menstrual protection). Accessing affordable and hygienic menstrual protection was a problem for these Zimbabwean women. Duet appeared acceptable and it would be feasible to conduct a user-acceptability study of Duet as a menstrual cup in Zimbabwe.

Smartphone-based imaging of the corneal endothelium at sub-cellular resolution

NASA Astrophysics Data System (ADS)

Toslak, Devrim; Thapa, Damber; Erol, Muhammet Kazim; Chen, Yanjun; Yao, Xincheng

2017-07-01

This aim of this study was to test the feasibility of smartphone-based specular microscopy of the corneal endothelium at a sub-cellular resolution. Quantitative examination of endothelial cells is essential for evaluating corneal disease such as determining a diagnosis, monitoring progression and assessing treatment. Smartphone-based technology promises a new opportunity to develop affordable devices to foster quantitative examination of endothelial cells in rural and underserved areas. In our study, we incorporated an iPhone 6 and a slit lamp to demonstrate the feasibility of smartphone-based microscopy of the corneal endothelium at a sub-cellular resolution. The sub-cellular resolution images allowed quantitative calculation of the endothelial cell density. Comparative measurements revealed a normal endothelial cell density of 2978 cells/mm2 in the healthy cornea, and a significantly reduced cell density of 1466 cells/mm2 in the diseased cornea with Fuchs' dystrophy. Our ultimate goal is to develop a smartphone-based telemedicine device for low-cost examination of the corneal endothelium, which can benefit patients in rural areas and underdeveloped countries to reduce health care disparities.

[On comparison of hospital performance].

PubMed

Kjekshus, L E

2000-10-20

The motivation to identify the causes of rising health care cost and variations across providers has intensified in all industrialized countries. These countries have an ongoing debate on efficiency and effectiveness in hospital production. In this debate, national and international comparative studies are important. There are very few international comparative studies that include Norwegian hospitals. Actually we know very little about how Norwegian hospitals are performing compared to others. This paper gives an introduction to comparative studies and to the DEA model which is often used in such studies and also a multilevel model which is not so common. A short review is given of a comparative study of Norwegian and North American hospitals. I also discuss the feasibility of comparative studies of hospitals from the Nordic countries, with references to several comparative studies performed in these countries. Comparative studies are often closely linked to national health politics, policy making and reforms; thus the outcome of such studies is important for the hospitals included. This makes such studies a sensitive field of research. It is important to be aware of the strength and weaknesses of comparative studies and acknowledge their importance beyond the development of new knowledge.

The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia.

PubMed

Kapiriri, Lydia; Chanda-Kapata, Pascalina

2018-02-17

Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority. Synthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context. Based on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context. While it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select desirable attributes from the different approaches and piece together an approach that would be feasible and acceptable within their context. An approach that builds on the decision-makers' understanding of their contexts and their input to its development would foster local ownership and has a greater potential for sustainability.

Hookworm vaccines: past, present, and future.

PubMed

Loukas, Alex; Bethony, Jeffrey; Brooker, Simon; Hotez, Peter

2006-11-01

Hookworms are gastrointestinal nematodes that infect almost 1 billion people in developing countries. The main clinical symptom of human hookworm infections is iron-deficiency anaemia, a direct consequence of the intestinal blood loss resulting from the parasite's feeding behaviour. Although treatment is available and currently used for the periodic removal of adult hookworms from patients, this approach has not effectively controlled hookworm in areas of rural poverty. Furthermore, treated individuals remain susceptible to reinfection following exposure to third-stage infective hookworm larvae in the soil as early as 4-12 months after drug treatment. Therefore, a prophylactic vaccine against hookworm infection would provide an attractive additional tool for the public-health control of this disease. The feasibility of developing a vaccine is based on the previous success of an attenuated larval vaccine against canine hookworm. Several laboratory and field studies have explored the development of a human anti-hookworm vaccine, describing potential protective mechanisms and identifying candidate antigens, one of which is now in clinical trials. The current roadmap that investigators have conceived has been influenced by vaccine development for blood-feeding nematodes of livestock and companion animals; however, recombinant vaccines have yet to be developed for nematodes that parasitise animals or human beings. The roadmap also addresses the obstacles facing development of a vaccine for developing countries, where there is no commercial market.

Development of the COMmerical Experiment Transporter (COMET)

NASA Technical Reports Server (NTRS)

Pawlick, Joseph F., Jr.

1990-01-01

In order to commercialize space, this nation must develop a well defined path through which the Centers for the Commercial Development of Space (CCDS's) and their industrial partners and counterparts can exploit the advantages of space manufacturing and processing. Such a capability requires systems, a supporting infrastructure, and funding to become a viable component of this nation's economic strength. This paper follows the development of the COMmercial Experiment Program (COMET) from inception to its current position as the country's first space program dedicated to satisfying the needs of industry: an industry which must investigate the feasibility of space based processes, materials, and prototypes. With proposals now being evaluated, much of the COMET story is yet to be written, however concepts and events which led to it's current status and the plans for implementation may be presented.

Food policy in the Canadian North: Is there a role for country food markets?

PubMed

Ford, James D; Macdonald, Joanna Petrasek; Huet, Catherine; Statham, Sara; MacRury, Allison

2016-03-01

Food insecurity is widely reported to be at a crisis level in the Inuit territory of Nunavut, Canada. Various policies, programs, and initiatives have been proposed to tackle the problem, with increasing interest in developing a system of country food markets (CFMs) similar to Greenland. We examine if CFMs offer a feasible, sustainable, and effective model for strengthening food systems in Nunavut, examining the model of Greenland and drawing on semi-structured interviews with key informants (n = 45). The Greenland experience indicates that CFMs can provide access to sufficient, safe, and nutritious food on a regular basis, and can diversify locally available foods. These benefits are transferable to Nunavut, although knowledge gaps, regulatory and institutional conditions, and concerns over how CFMs might affect the cultural basis of food systems, underlies apprehension over their development in the territory. We conclude that Nunavut is not currently in the position to develop CFMs, but the role of such markets in potentially strengthening food systems should not be discounted. Future development would need to solicit community input on CFMs, resolve regulatory issues around wildlife management and harvesting, and study how future risks would affect sustainability and effectiveness. Copyright © 2016 Elsevier Ltd. All rights reserved.

A pilot study for targeted surveillance of bovine spongiform encephalopathy in Nigeria.

PubMed

Nwankiti, O O; Ikeh, E I; Asala, O; Seuberlich, T

2013-06-01

Bovine spongiform encephalopathy (BSE), popularly known as 'mad cow disease', led to an epidemic in Europe that peaked in the mid-1990s. Its impact on developing countries, such as Nigeria, has not been fully established as information on livestock and surveillance has eluded those in charge of this task. The BSE risk to Nigeria's cattle population currently remains undetermined, which has resulted in international trade restrictions on commodities from the cattle population. This is mainly because of a lack of updated BSE risk assessments and disease surveillance data. To evaluate the feasibility of BSE surveillance in Nigeria, we carried out a pilot study targeting cattle that were presented for emergency or casualty slaughter. In total, 1551 cattle of local breeds, aged 24 months and above were clinically examined. Ataxia, recumbency and other neurological signs were topmost on our list of criteria. A total of 96 cattle, which correspond to 6.2%, presented clinical signs that supported a suspect of BSE. The caudal brainstem tissues of these animals were collected post-mortem and analysed for the disease-specific form of the prion protein using a rapid test approved by the International Animal Health Organization (OIE). None of the samples were positive for BSE. Although our findings do not exclude the presence of BSE in Nigeria, they do demonstrate that targeted sampling of clinically suspected cases of BSE is feasible in developing countries. In addition, these findings point to the possibility of implementing clinical monitoring schemes for BSE and potentially other diseases with grave economic and public health consequences. © 2012 Blackwell Verlag GmbH.

Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin.

PubMed

Barth-Jaeggi, Tanja; Steinmann, Peter; Mieras, Liesbeth; van Brakel, Wim; Richardus, Jan Hendrik; Tiwari, Anuj; Bratschi, Martin; Cavaliero, Arielle; Vander Plaetse, Bart; Mirza, Fareed; Aerts, Ann

2016-11-17

The reported number of new leprosy patients has barely changed in recent years. Thus, additional approaches or modifications to the current standard of passive case detection are needed to interrupt leprosy transmission. Large-scale clinical trials with single dose rifampicin (SDR) given as post-exposure prophylaxis (PEP) to contacts of newly diagnosed patients with leprosy have shown a 50-60% reduction of the risk of developing leprosy over the following 2 years. To accelerate the uptake of this evidence and introduction of PEP into national leprosy programmes, data on the effectiveness, impact and feasibility of contact tracing and PEP for leprosy are required. The leprosy post-exposure prophylaxis (LPEP) programme was designed to obtain those data. The LPEP programme evaluates feasibility, effectiveness and impact of PEP with SDR in pilot areas situated in several leprosy endemic countries: India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. Complementary sites are located in Brazil and Cambodia. From 2015 to 2018, contact persons of patients with leprosy are traced, screened for symptoms and assessed for eligibility to receive SDR. The intervention is implemented by the national leprosy programmes, tailored to local conditions and capacities, and relying on available human and material resources. It is coordinated on the ground with the help of the in-country partners of the International Federation of Anti-Leprosy Associations (ILEP). A robust data collection and reporting system is established in the pilot areas with regular monitoring and quality control, contributing to the strengthening of the national surveillance systems to become more action-oriented. Ethical approval has been obtained from the relevant ethics committees in the countries. Results and lessons learnt from the LPEP programme will be published in peer-reviewed journals and should provide important evidence and guidance for national and global policymakers to strengthen current leprosy elimination strategies. 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/.

Protocol of a feasibility study for cognitive assessment of an ageing cohort within the Southeast Asia Community Observatory (SEACO), Malaysia.

PubMed

Mohan, Devi; Stephan, Blossom C M; Allotey, Pascale; Jagger, Carol; Pearce, Mark; Siervo, Mario; Reidpath, Daniel D

2017-01-19

There is a growing proportion of population aged 65 years and older in low-income and middle-income countries. In Malaysia, this proportion is predicted to increase from 5.1% in 2010 to more than 15.4% by 2050. Cognitive ageing and dementia are global health priorities. However, risk factors and disease associations in a multiethnic, middle-income country like Malaysia may not be consistent with those reported in other world regions. Knowing the burden of cognitive impairment and its risk factors in Malaysia is necessary for the development of management strategies and would provide valuable information for other transitional economies. This is a community-based feasibility study focused on the assessment of cognition, embedded in the longitudinal study of health and demographic surveillance site of the South East Asia Community Observatory (SEACO), in Malaysia. In total, 200 adults aged ≥50 years are selected for an in-depth health and cognitive assessment including the Mini Mental State Examination, the Montreal Cognitive Assessment, blood pressure, anthropometry, gait speed, hand grip strength, Depression Anxiety Stress Score and dried blood spots. The results will inform the feasibility, response rates and operational challenges for establishing an ageing study focused on cognitive function in similar middle-income country settings. Knowing the burden of cognitive impairment and dementia and risk factors for disease will inform local health priorities and management, and place these within the context of increasing life expectancy. The study protocol is approved by the Monash University Human Research Ethics Committee. Informed consent is obtained from all the participants. The project's analysed data and findings will be made available through publications and conference presentations and a data sharing archive. Reports on key findings will be made available as community briefs on the SEACO website. 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/.

Usability and feasibility of a tablet-based Decision-Support and Integrated Record-keeping (DESIRE) tool in the nurse management of hypertension in rural western Kenya.

PubMed

Vedanthan, Rajesh; Blank, Evan; Tuikong, Nelly; Kamano, Jemima; Misoi, Lawrence; Tulienge, Deborah; Hutchinson, Claire; Ascheim, Deborah D; Kimaiyo, Sylvester; Fuster, Valentin; Were, Martin C

2015-03-01

Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertension patients at the community level in a resource-limited setting in western Kenya. Usability testing consisted of "think aloud" exercises and "mock patient encounters" with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Usability and Feasibility of a Tablet-Based Decision-Support and Integrated Record-Keeping (DESIRE) Tool in the Nurse Management of Hypertension in Rural Western Kenya

PubMed Central

Vedanthan, Rajesh; Blank, Evan; Tuikong, Nelly; Kamano, Jemima; Misoi, Lawrence; Tulienge, Deborah; Hutchinson, Claire; Ascheim, Deborah D.; Kimaiyo, Sylvester; Fuster, Valentin; Were, Martin C.

2015-01-01

Background Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. Objective To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertension patients at the community level in a resource-limited setting in western Kenya. Methods Usability testing consisted of “think aloud” exercises and “mock patient encounters” with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. Results Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. Conclusions This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions. PMID:25612791

The feasibility of community level interventions for pre-eclampsia in South Asia and Sub-Saharan Africa: a mixed-methods design.

PubMed

Khowaja, Asif Raza; Qureshi, Rahat Najam; Sawchuck, Diane; Oladapo, Olufemi T; Adetoro, Olalekan O; Orenuga, Elizabeth A; Bellad, Mrutyunjaya; Mallapur, Ashalata; Charantimath, Umesh; Sevene, Esperança; Munguambe, Khátia; Boene, Helena Edith; Vidler, Marianne; Bhutta, Zulfiqar A; von Dadelszen, Peter

2016-06-08

Globally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials prior to implementation. Failure to fully understand the study context risks the effective implementation of the intervention and limits the likelihood of post-trial scale-up. Therefore, it was imperative to conduct community-level feasibility assessments for a trial of this magnitude. A mixed methods design guided by normalization process theory was used for this study in Nigeria, Mozambique, Pakistan, and India to explore enabling and impeding factors for the CLIP Trial implementation. Qualitative data were collected through participant observation, document review, focus group discussion and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility assessments, self-administered community health worker surveys, and household demographic and health surveillance. Refer to CLIP Trial feasibility publications in the current and/or forthcoming supplement. Feasibility assessments for community level interventions, particularly those involving task-shifting across diverse regions, require an appropriate theoretical framework and careful selection of research methods. The use of qualitative and quantitative methods increased the data richness to better understand the community contexts. NCT01911494.

Maize flour fortification in Africa: markets, feasibility, coverage, and costs.

PubMed

Fiedler, John L; Afidra, Ronald; Mugambi, Gladys; Tehinse, John; Kabaghe, Gladys; Zulu, Rodah; Lividini, Keith; Smitz, Marc-Francois; Jallier, Vincent; Guyondet, Christophe; Bermudez, Odilia

2014-04-01

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries. © 2013 New York Academy of Sciences.

Partial sick leave--review of its use, effects and feasibility in the Nordic countries.

PubMed

Kausto, Johanna; Miranda, Helena; Martimo, Kari-Pekka; Viikari-Juntura, Eira

2008-08-01

Partial sick leave and partial sickness benefits are currently available in Sweden, Norway, Denmark, and Finland. The literature was reviewed to determine their use, describe their recipients, find evidence of their effects, and explore attitudes towards and experiences with their use. Eight databases were searched. National sickness absence statistics and other relevant sources were also reviewed. Of the sickness benefits, partial benefits accounted for approximately one-fifth in Norway, less than 10% in Denmark, and over a third in Sweden. In Finland, partial sick leave was seldom used during the first year (2007) of benefit availability. Few peer-reviewed studies on its effects were identified, and scientific evidence was scarce. Its acceptance was good in all four countries. Most of the recipients were women and over 45 years of age. Studies of its feasibility seem congruent in reporting hindrances due to inflexible work arrangements and poor collaboration between actors. More research and more rigorous study designs are needed to determine whether partial sick leave is feasible and beneficial in keeping those with reduced work ability in worklife.

Interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries: a systematic review and meta-analysis

PubMed Central

Weaver, Meaghann S; Lönnroth, Knut; Howard, Scott C; Roter, Debra L

2015-01-01

Abstract Objective To assess the design, delivery and outcomes of interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries and develop a contextual framework for such interventions. Methods We searched PubMed and Cochrane databases for reports published between 1 January 2003 and 1 December 2013 on interventions to improve adherence to treatment for tuberculosis that included patients younger than 20 years who lived in a low- or middle-income country. For potentially relevant articles that lacked paediatric outcomes, we contacted the authors of the studies. We assessed heterogeneity and risk of bias. To evaluate treatment success – i.e. the combination of treatment completion and cure – we performed random-effects meta-analysis. We identified areas of need for improved intervention practices. Findings We included 15 studies in 11 countries for the qualitative analysis and of these studies, 11 qualified for the meta-analysis – representing 1279 children. Of the interventions described in the 15 studies, two focused on education, one on psychosocial support, seven on care delivery, four on health systems and one on financial provisions. The children in intervention arms had higher rates of treatment success, compared with those in control groups (odds ratio: 3.02; 95% confidence interval: 2.19–4.15). Using the results of our analyses, we developed a framework around factors that promoted or threatened treatment completion. Conclusion Various interventions to improve adherence to treatment for paediatric tuberculosis appear both feasible and effective in low- and middle-income countries. PMID:26600612

Efficiency, equity and feasibility of strategies to identify the poor: an application to premium exemptions under National Health Insurance in Ghana.

PubMed

Jehu-Appiah, Caroline; Aryeetey, Genevieve; Spaan, Ernst; Agyepong, Irene; Baltussen, Rob

2010-05-01

This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana. A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana. Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making. We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Feasibility of kangaroo mother care in Mumbai.

PubMed

Kadam, Sandeep; Binoy, S; Kanbur, Wasundhara; Mondkar, J A; Fernandez, Armida

2005-01-01

The purpose of this study was to determine the feasibility and acceptability of kangaroo care in a tertiary care hospital in India. A randomized controlled trial was performed over one year period in which 89 neonates were randomized into two groups kangaroo mother care (KMC) and conventional method of care (CMC). Forty-four babies were randomized into KMC group and 45 to CMC. There was significant reduction in KMC vs CMC group of hypothermia (10/44 vs 21/45, p-value < 0.01), higher oxygen saturations (95.7 vs 94.8%, p-value < 0.01) and decrease in respiratory rates (36.2 vs 40.7, p-value < 0.01). There were no statistically significant differences in the incidence of hyperthermia, sepsis, apnea, onset of breastfeeding and hospital stay in two groups. 79% of mothers felt comfortable during the KMC and 73% felt they would be able to give KMC at home. KMC is feasible, as mothers are already admitted in hospitals and are involved in the care of newborn. KMC is a simple and feasible intervention; acceptable to most mothers admitted in hospitals. There may be benefits in terms of reducing the incidence of hypothermia with no adverse effects of KMC demonstrated in the study. The present study has important implications in the care of LBW infants in the developing countries, where expensive facilities for conventional care may not be available at all place.

Towards a comprehensive global approach to prevention and control of NCDs.

PubMed

McKee, Martin; Haines, Andy; Ebrahim, Shah; Lamptey, Peter; Barreto, Mauricio L; Matheson, Don; Walls, Helen L; Foliaki, Sunia; Miranda, J Jaime; Chimeddamba, Oyun; Garcia-Marcos, Luis; Vineis, Paolo; Pearce, Neil

2014-10-28

The "25×25" strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors. We propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal "one-size fits all" approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors. The 25×25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.

Collecting data for global surgical indicators: a collaborative approach in the Pacific Region

PubMed Central

Guest, Glenn Douglas; McLeod, Elizabeth; Tangi, Vilami; Pedro, Joao; Ponifasio, Ponifasio; Hedson, Johnny; Tudravu, Jemesa; Pikacha, Douglas; Vreede, Eric; Leodoro, Basil; Tapaua, Noah; Kong, James; Oten, Bwabwa; Teapa, Deacon; Korin, Stephanie; Wilson, Leona; Mesol, Samson; Tuneti, Kabiri; Meara, John G; Watters, David A

2017-01-01

In 2015, the Lancet Commission on Global Surgery (LCoGS) recommended six surgical metrics to enable countries to measure their surgical and anaesthesia care delivery. These indicators have subsequently been accepted by the World Bank for inclusion in the World Development Indicators. With support from the Royal Australasian College of Surgeons and the Pacific Islands Surgical Association, 14 South Pacific countries collaborated to collect the first four of six LCoGS indicators. Thirteen countries collected all four indicators over a 6-month period from October 2015 to April 2016. Australia and New Zealand exceeded the recommended LCoGS target for all four indicators. Only 5 of 13 countries (38%) achieved 2-hour access for at least 80% of their population, with a range of 20% (Papua New Guinea and Solomon Islands) to over 65% (Fiji and Samoa). Five of 13 (38%) countries met the target surgical volume of 5000 procedures per 100 000 population, with six performing less than 1600. Four of 14 (29%) countries had at least 20 surgical, anaesthesia and obstetric providers in their workforce per 100 000 population, with a range of 0.9 (Timor Leste) to 18.5 (Tuvalu). Perioperative mortality rate was reported by 13 of 14 countries, and ranged from 0.11% to 1.0%. We believe it is feasible to collect global surgery indicators across the South Pacific, a diverse geographical region encompassing high-income and low-income countries. Such metrics will allow direct comparison between similar nations, but more importantly provide baseline data that providers and politicians can use in advocacy national health planning. PMID:29225948

Implementation of the semi-aerobic landfill system (Fukuoka method) in developing countries: a Malaysia cost analysis.

PubMed

Chong, Theng Lee; Matsufuji, Yasushi; Hassan, Mohd Nasir

2005-01-01

Most of the existing solid waste landfill sites in developing countries are practicing either open dumping or controlled dumping. Proper sanitary landfill concepts are not fully implemented due to technological and financial constraints. Implementation of a fully engineered sanitary landfill is necessary and a more economically feasible landfill design is crucial, particularly for developing countries. This study was carried out by focusing on the economics from the development of a new landfill site within a natural clay area with no cost of synthetic liner up to 10 years after its closure by using the Fukuoka method semi-aerobic landfill system. The findings of the study show that for the development of a 15-ha landfill site in Malaysia with an estimated volume of 2,000,000 m(3), the capital investment required was about US 1,312,895 dollars, or about US 0.84 dollars/tonne of waste. Assuming that the lifespan of the landfill is 20 years, the total cost of operation was about US 11,132,536 dollars or US 7.15 dollars/tonne of waste. The closure cost of the landfill was estimated to be US 1,385,526 dollars or US 0.89 dollars/tonne of waste. Therefore, the total cost required to dispose of a tonne of waste at the semi-aerobic landfill was estimated to be US 8.89 dollars. By considering an average tipping fee of about US 7.89 dollars/tonne of waste in Malaysia in the first year, and an annual increase of 3% to about US 13.84 dollars in year-20, the overall system recorded a positive revenue of US 1,734,749 dollars. This is important information for the effort of privatisation of landfill sites in Malaysia, as well as in other developing countries, in order to secure efficient and effective landfill development and management.

Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review.

PubMed

Huffman, Sandra L; Harika, Rajwinder K; Eilander, Ans; Osendarp, Saskia J M

2011-10-01

Omega-3 and omega-6 fatty acids, particularly docosahexaenoic acid (DHA), are known to play an essential role in the development of the brain and retina. Intakes in pregnancy and early life affect growth and cognitive performance later in childhood. However, total fat intake, alpha-linolenic acid (ALA) and DHA intakes are often low among pregnant and lactating women, infants and young children in developing countries. As breast milk is one of the best sources of ALA and DHA, breastfed infants are less likely to be at risk of insufficient intakes than those not breastfed. Enhancing intake of ALA through plant food products (soy beans and oil, canola oil, and foods containing these products such as lipid-based nutrient supplements) has been shown to be feasible. However, because of the low conversion rates of ALA to DHA, it may be more efficient to increase DHA status through increasing fish consumption or DHA fortification, but these approaches may be more costly. In addition, breastfeeding up to 2 years and beyond is recommended to ensure an adequate essential fat intake in early life. Data from developing countries have shown that a higher omega-3 fatty acid intake or supplementation during pregnancy may result in small improvements in birthweight, length and gestational age based on two randomized controlled trials and one cross-sectional study. More rigorous randomized controlled trials are needed to confirm this effect. Limited data from developing countries suggest that ALA or DHA supplementation during lactation and in infants may be beneficial for growth and development of young children 6-24 months of age in these settings. These benefits are more pronounced in undernourished children. However, there is no evidence for improvements in growth following omega-3 fatty acid supplementation in children >2 years of age. © 2011 Blackwell Publishing Ltd.

Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial.

PubMed

Lewis-Fernández, Roberto; Aggarwal, Neil Krishan; Lam, Peter C; Galfalvy, Hanga; Weiss, Mitchell G; Kirmayer, Laurence J; Paralikar, Vasudeo; Deshpande, Smita N; Díaz, Esperanza; Nicasio, Andel V; Boiler, Marit; Alarcón, Renato D; Rohlof, Hans; Groen, Simon; van Dijk, Rob C J; Jadhav, Sushrut; Sarmukaddam, Sanjeev; Ndetei, David; Scalco, Monica Z; Bassiri, Kavoos; Aguilar-Gaxiola, Sergio; Ton, Hendry; Westermeyer, Joseph; Vega-Dienstmaier, Johann M

2017-04-01

Background There is a need for clinical tools to identify cultural issues in diagnostic assessment. Aims To assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice. Method Mixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored. Results Mixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time. Conclusions The CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool. © The Royal College of Psychiatrists 2017.

Assessment of Internet-based tele-medicine in Africa (the RAFT project).

PubMed

Bagayoko, Cheick Oumar; Müller, Henning; Geissbuhler, Antoine

2006-01-01

The objectives of this paper on the Réseau Afrique Francophone de Télémédecine (RAFT) project are the evaluation of feasibility, potential, problems and risks of an Internet-based tele-medicine network in developing countries of Africa. The RAFT project was started in Western African countries 5 years ago and has now extended to other regions of Africa as well (i.e. Madagascar, Rwanda). A project for the development of a national tele-medicine network in Mali was initiated in 2001, extended to Mauritania in 2002 and to Morocco in 2003. By 2006, a total of nine countries are connected. The entire technical infrastructure is based on Internet technologies for medical distance learning and tele-consultations. The results are a tele-medicine network that has been in productive use for over 5 years and has enabled various collaboration channels, including North-to-South (from Europe to Africa), South-to-South (within Africa), and South-to-North (from Africa to Europe) distance learning and tele-consultations, plus many personal exchanges between the participating hospitals and Universities. It has also unveiled a set of potential problems: (a) the limited importance of North-to-South collaborations when there are major differences in the available resources or the socio-cultural contexts between the collaborating parties; (b) the risk of an induced digital divide if the periphery of the health system in developing countries is not involved in the development of the network; and (c) the need for the development of local medical content management skills. Particularly point (c) is improved through the collaboration between the various countries as professionals from the medical and the computer science field are sharing courses and resources. Personal exchanges between partners in the project are frequent, and several persons received an education at one of the partner Universities. As conclusion, we can say that the identified risks have to be taken into account when designing large-scale tele-medicine projects in developing countries. These problems can be mitigated by fostering South-South collaboration channels, by the use of satellite-based Internet connectivity in remote areas, the appreciation of local knowledge and its publication on-line. The availability of such an infrastructure also facilitates the development of other projects, courses, and local content creation.

A simple, generalizable method for measuring individual research productivity and its use in the long-term analysis of departmental performance, including between-country comparisons

PubMed Central

2013-01-01

Background A simple, generalizable method for measuring research output would be useful in attempts to build research capacity, and in other contexts. Methods A simple indicator of individual research output was developed, based on grant income, publications and numbers of PhD students supervised. The feasibility and utility of the indicator was examined by using it to calculate research output from two similarly-sized research groups in different countries. The same indicator can be used to assess the balance in the research “portfolio” of an individual researcher. Results Research output scores of 41 staff in Research Department A had a wide range, from zero to 8; the distribution of these scores was highly skewed. Only about 20% of the researchers had well-balanced research outputs, with approximately equal contributions from grants, papers and supervision. Over a five-year period, Department A's total research output rose, while the number of research staff decreased slightly, in other words research productivity (output per head) rose. Total research output from Research Department B, of approximately the same size as A, was similar, but slightly higher than Department A. Conclusions The proposed indicator is feasible. The output score is dimensionless and can be used for comparisons within and between countries. Modeling can be used to explore the effect on research output of changing the size and composition of a research department. A sensitivity analysis shows that small increases in individual productivity result in relatively greater increases in overall departmental research output. The indicator appears to be potentially useful for capacity building, once the initial step of research priority setting has been completed. PMID:23317431

A simple, generalizable method for measuring individual research productivity and its use in the long-term analysis of departmental performance, including between-country comparisons.

PubMed

Wootton, Richard

2013-01-14

A simple, generalizable method for measuring research output would be useful in attempts to build research capacity, and in other contexts. A simple indicator of individual research output was developed, based on grant income, publications and numbers of PhD students supervised. The feasibility and utility of the indicator was examined by using it to calculate research output from two similarly-sized research groups in different countries. The same indicator can be used to assess the balance in the research "portfolio" of an individual researcher. Research output scores of 41 staff in Research Department A had a wide range, from zero to 8; the distribution of these scores was highly skewed. Only about 20% of the researchers had well-balanced research outputs, with approximately equal contributions from grants, papers and supervision. Over a five-year period, Department A's total research output rose, while the number of research staff decreased slightly, in other words research productivity (output per head) rose. Total research output from Research Department B, of approximately the same size as A, was similar, but slightly higher than Department A. The proposed indicator is feasible. The output score is dimensionless and can be used for comparisons within and between countries. Modeling can be used to explore the effect on research output of changing the size and composition of a research department. A sensitivity analysis shows that small increases in individual productivity result in relatively greater increases in overall departmental research output. The indicator appears to be potentially useful for capacity building, once the initial step of research priority setting has been completed.

Responsive parenting: interventions and outcomes.

PubMed Central

Eshel, Neir; Daelmans, Bernadette; de Mello, Meena Cabral; Martines, Jose

2006-01-01

In addition to food, sanitation and access to health facilities children require adequate care at home for survival and optimal development. Responsiveness, a mother's/caregiver's prompt, contingent and appropriate interaction with the child, is a vital parenting tool with wide-ranging benefits for the child, from better cognitive and psychosocial development to protection from disease and mortality. We examined two facets of responsive parenting -- its role in child health and development and the effectiveness of interventions to enhance it -- by conducting a systematic review of literature from both developed and developing countries. Our results revealed that interventions are effective in enhancing maternal responsiveness, resulting in better child health and development, especially for the neediest populations. Since these interventions were feasible even in poor settings, they have great potential in helping us achieve the Millennium Development Goals. We suggest that responsiveness interventions be integrated into child survival strategies. PMID:17242836

Global strategies for cervical cancer prevention.

PubMed

Pimple, Sharmila; Mishra, Gauravi; Shastri, Surendra

2016-02-01

Cervical cancer still remains the fourth most common cancer, affecting women worldwide with large geographic variations in cervical cancer incidence and mortality rates. There exist vast disparities in cervix cancer control and prevention efforts globally. The present review addresses the current developments in cervical cancer prevention and control across both high-income countries and low-middle income countries and attempts to identify new strategies that might help address the gaps in cervical cancer care disparities globally. Paradigms for cervix cancer screening are changing in high-resource settings from cytology-based screening to adoption of molecular screening and cotesting to achieve program effectiveness. Low-middle income countries with larger burden of cervical cancer continue to face financial and logistic limitations to make both cervix cancer screening and human papillomavirus vaccine available to their populations. Alternative low-cost screening technologies, operationally feasible implementation strategies, reduction of cost of procurement and delivery approaches for human papillomavirus vaccine need assessment to decrease cancer care disparities. Efforts directed toward cervix cancer prevention and early detection for improvements in cervical cancer outcomes of incidence and mortality have to be proportionately matched by access to acceptable standards of cancer care.

Leveraging the private health sector to enhance HIV service delivery in lower-income countries.

PubMed

Rao, Pamela; Gabre-Kidan, Tesfai; Mubangizi, Deus Bazira; Sulzbach, Sara

2011-08-01

Evidence that the private health sector is a key player in delivering health services and impacting health outcomes, including those related to HIV/AIDS, underscores the need to optimize the role of the private health sector to scale up national HIV responses in lower-income countries. This article reviews findings on the types of HIV/AIDS services provided by the private health sector in developing countries and elaborates on the role of private providers of HIV services in Ethiopia. Drawing on data from the nation's innovative Private Health Sector Project, a pilot project that has demonstrated the feasibility of public-private partnerships in this area, the article highlights the potential for national governments to scale up HIV/AIDS services by leveraging private health sector resources, innovations, and expertise while working to regulate quality and cost of services. Although concerns about uneven quality and affordability of private sector health services must be addressed through regulation, policy, or other innovative approaches, we argue that the benefits of leveraging the private sector outweigh these challenges, particularly in light of finite donor and public domestic resources.

Novel, Family-Centered Intervention to Improve Nutrition in Patients Recovering From Critical Illness: A Feasibility Study.

PubMed

Marshall, Andrea P; Lemieux, Margot; Dhaliwal, Rupinder; Seyler, Hilda; MacEachern, Kristen N; Heyland, Daren K

2017-06-01

Critically ill patients are at increased risk of developing malnutrition-related complications because of physiological changes, suboptimal delivery, and reduced intake. Strategies to improve nutrition during critical illness recovery are required to prevent iatrogenic underfeeding and risk of malnutrition. The purpose of this study was to assess the feasibility and acceptability of a novel family-centered intervention to improve nutrition in critically ill patients. A 3-phase, prospective cohort feasibility study was conducted in 4 intensive care units (ICUs) across 2 countries. Intervention feasibility was determined by patient eligibility, recruitment, and retention rates. The acceptability of the intervention was assessed by participant perspectives collected through surveys. Participants included family members of the critically ill patients and ICU and ward healthcare professionals (HCPs). A total of 75 patients and family members, as well as 56 HCPs, were enrolled. The consent rate was 66.4%, and 63 of 75 (84%) of family participants completed the study. Most family members (53/55; 98.1%) would recommend the nutrition education program to others and reported improved ability to ask questions about nutrition (16/20; 80.0%). Family members viewed nutrition care more positively in the ICU. HCPs agreed that families should partner with HCPs to achieve optimal nutrition in the ICU and the wards. Health literacy was identified as a potential barrier to family participation. The intervention was feasible and acceptable to families of critically ill patients and HCPs. Further research to evaluate intervention impact on nutrition intake and patient-centered outcomes is required.

Postpartum unconscious dynamics emerging from the Lüscher color test in Ethiopian women.

PubMed

Zanardo, Vincenzo; Gabrieli, Catia; Volpe, Francesca; Savio, Francesca; Straface, Gianluca; Soldera, Gino

2017-06-01

The aim of this study was to explore the feasibility of the Lüscher color test (LCT), a psychological instrument based on theory that colors are selected in unconscious way and that the color sensory perception of color is objective and universal. The research has involved 24 Ethiopian women, which delivered at the Getche Health Center in Gurage. It seemed to be relevant for the majority of Ethiopian women identify the rejected color (58.66%), the gray, than the favorite color, the yellow 33.33%). The yellow color suggests that they better express their personality in a physical context, while the gray color indicates that they want to live this experience intensely. This exploratory work lays the foundations for further studies in disadvantaged women, both in developing low-income Countries as well as in industrialized Countries characterized by an high level of emigration, and for clinical applications by the complete LCT version.

Supporting study product use and accuracy in self-report in the iPrEx study: next step counseling and neutral assessment.

PubMed

R Amico, K; McMahan, Vanessa; Goicochea, Pedro; Vargas, Lorena; Marcus, Julia L; Grant, Robert M; Liu, Albert

2012-07-01

The recent successes of biomedical HIV prevention approaches have sparked considerable debate over the scalability, feasibility, and acceptability of pre-exposure prophylaxis (PrEP) as a widespread prevention strategy for men who have sex with men and trans-gender. Anticipated difficulties with PrEP adherence and concerns about resources required to best support it have tempered enthusiasm of PrEP demonstration projects and roll-out. While no evidence-based approach for supporting PrEP use is presently available, a number of approaches have been developed in the context of double-blind, randomized, placebo-controlled trials of PrEP that can provide guidance in moving forward with real world support of open label PrEP use. We present the development, implementation and evaluation of feasibility and acceptability of next-step counseling (NSC) and neutral assessment (NA), the adherence support and promotion of accurate reporting approaches used in the late phases of the iPrEx study. Evaluation of the approach from the perspective of implementers of over 15,000 NSC sessions in seven different countries with almost 2,000 iPrEx participants provided support for NSC, its brevity (averaging ~14 min per follow-up session) and overall acceptability and feasibility. NA also was generally well supported, with a majority of study staff believing this approach was feasible and acceptable; however, lower acceptability for certain aspects of NA was noted amongst staff reporting NA was different from their previous interview approach. Quantitative and qualitative data gathered from implementers were used to make modifications for supporting PrEP use in the open-label extension of iPrEx.

INTERMINGLED SKIN GRAFTING: A VALID TRANSPLANTATION METHOD AT LOW COST

PubMed Central

Domres, B.; Kistler, D.; Rutczynska, J.

2007-01-01

Summary The almost forgotten method of intermingled skin grafting of allogeneic material with small autogeneic islets, once developed in the People's Republic of China, proves the feasibility of permanent healing of even extensive burn wounds, at low cost, and therefore an effective treatment possibility in poorer countries, as well as under conditions of a burn disaster. Intermingled skin grafting obtains a better elasticity of the reconditioned skin as elastic fibres of the allodermis survive, and this results in fewer contractures. From the cosmetic point of view the transplantation of autologous keratinocytes results in a better aesthetic homogeneous texture. PMID:21991087

Matrix and Backstage: Cellular Substrates for Viral Vaccines

PubMed Central

Jordan, Ingo; Sandig, Volker

2014-01-01

Vaccines are complex products that are manufactured in highly dynamic processes. Cellular substrates are one critical component that can have an enormous impact on reactogenicity of the final preparation, level of attenuation of a live virus, yield of infectious units or antigens, and cost per vaccine dose. Such parameters contribute to feasibility and affordability of vaccine programs both in industrialized countries and developing regions. This review summarizes the diversity of cellular substrates for propagation of viral vaccines from primary tissue explants and embryonated chicken eggs to designed continuous cell lines of human and avian origin. PMID:24732259

GPs' views in five European countries of interventions to promote prudent antibiotic use

PubMed Central

Tonkin-Crine, Sarah; Yardley, Lucy; Coenen, Samuel; Fernandez-Vandellos, Patricia; Krawczyk, Jaroslaw; Touboul, Pia; Verheij, Theo; Little, Paul

2011-01-01

Background A variety of interventions have been developed to promote a more prudent use of antibiotics by implementing clinical guidelines. It is not yet clear which are most acceptable and feasible for implementation across a wide range of contexts. Previous research has been confined mainly to examining views of individual interventions in a national context. Aim To explore GPs' views and experiences of strategies to promote a more prudent use of antibiotics, across five countries. Design and setting Qualitative study using thematic and framework analysis in general practices in Belgium, France, Poland, Spain, and the UK. Method Fifty-two semi-structured interviews explored GPs' views and experiences of strategies aimed at promoting a more prudent use of antibiotics. Interviews were carried out in person or over the telephone, transcribed verbatim, and translated into English where necessary for analysis. Results Themes were remarkably consistent across the countries. GPs had a preference for interventions that allowed discussion and comparison with local colleagues, which helped them to identify how their practice could improve. Other popular components of interventions included the use of near-patient tests to reduce diagnostic uncertainty, and the involvement of other health professionals to increase their responsibility for prescribing. Conclusion The study findings could be used to inform future interventions to improve their acceptability to GPs. Consistency in views across countries indicates the potential for development of an intervention that could be implemented on a European scale. PMID:21619749

Weichselian permafrost depth in the Netherlands: a comprehensive uncertainty and sensitivity analysis

NASA Astrophysics Data System (ADS)

Govaerts, Joan; Beerten, Koen; ten Veen, Johan

2016-11-01

The Rupelian clay in the Netherlands is currently the subject of a feasibility study with respect to the storage of radioactive waste in the Netherlands (OPERA-project). Many features need to be considered in the assessment of the long-term evolution of the natural environment surrounding a geological waste disposal facility. One of these is permafrost development as it may have an impact on various components of the disposal system, including the natural environment (hydrogeology), the natural barrier (clay) and the engineered barrier. Determining how deep permafrost might develop in the future is desirable in order to properly address the possible impact on the various components. It is expected that periglacial conditions will reappear at some point during the next several hundred thousands of years, a typical time frame considered in geological waste disposal feasibility studies. In this study, the Weichselian glaciation is used as an analogue for future permafrost development. Permafrost depth modelling using a best estimate temperature curve of the Weichselian indicates that permafrost would reach depths between 155 and 195 m. Without imposing a climatic gradient over the country, deepest permafrost is expected in the south due to the lower geothermal heat flux and higher average sand content of the post-Rupelian overburden. Accounting for various sources of uncertainty, such as type and impact of vegetation, snow cover, surface temperature gradients across the country, possible errors in palaeoclimate reconstructions, porosity, lithology and geothermal heat flux, stochastic calculations point out that permafrost depth during the coldest stages of a glacial cycle such as the Weichselian, for any location in the Netherlands, would be 130-210 m at the 2σ level. In any case, permafrost would not reach depths greater than 270 m. The most sensitive parameters in permafrost development are the mean annual air temperatures and porosity, while the geothermal heat flux is the crucial parameter in permafrost degradation once temperatures start rising again.

International Approaches for Nuclear Waste Disposal in Geological Formations: Report on Fifth Worldwide Review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Faybishenko, Boris; Birkholzer, Jens; Persoff, Peter

2016-09-01

The goal of the Fifth Worldwide Review is to document evolution in the state-of-the-art of approaches for nuclear waste disposal in geological formations since the Fourth Worldwide Review that was released in 2006. The last ten years since the previous Worldwide Review has seen major developments in a number of nations throughout the world pursuing geological disposal programs, both in preparing and reviewing safety cases for the operational and long-term safety of proposed and operating repositories. The countries that are approaching implementation of geological disposal will increasingly focus on the feasibility of safely constructing and operating their repositories in short-more » and long terms on the basis existing regulations. The WWR-5 will also address a number of specific technical issues in safety case development along with the interplay among stakeholder concerns, technical feasibility, engineering design issues, and operational and post-closure safety. Preparation and publication of the Fifth Worldwide Review on nuclear waste disposal facilitates assessing the lessons learned and developing future cooperation between the countries. The Report provides scientific and technical experiences on preparing for and developing scientific and technical bases for nuclear waste disposal in deep geologic repositories in terms of requirements, societal expectations and the adequacy of cases for long-term repository safety. The Chapters include potential issues that may arise as repository programs mature, and identify techniques that demonstrate the safety cases and aid in promoting and gaining societal confidence. The report will also be used to exchange experience with other fields of industry and technology, in which concepts similar to the design and safety cases are applied, as well to facilitate the public perception and understanding of the safety of the disposal approaches relative to risks that may increase over long times frames in the absence of a successful implementation of final dispositioning.« less

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

PubMed

Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts. • The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.

Innovatively addressing the challenge of maintaining binocular microscopes under Tuberculosis Programme in India - Is this feasible?

PubMed

Chadha, Sarabjit; Nagaraja, Sharath Burugina; Prasad, Banaru Muralidhara; Kelamane, Santosha; Satyanarayana, Srinath; Sachdeva, Kuldeep Singh

2016-01-01

India is a high TB burden country. The preferred first line diagnostic tool under National TB Programme is sputum smear microscopy through binocular microscopes (BMs) from 13,000 designated microscopy centres across the country. The programme had devised innovative strategy for maintenance of BMs. A study was conducted to look into the operational feasibility of an external agency to provide maintenance services for BMs engaged through newer strategy. A cross-sectional study was conducted in the states of Uttar Pradesh, Bihar and Rajasthan during 2010-2013. A total of 9314 BMs were serviced during the period 2011-2013, of which 1104 (11.8%) had major repairs, 2204 (23.6%) had minor repairs, 1054 (11.3%) were provided emergency breakdown services and 223 (2.4%) were condemned. The bold initiative and newer strategy of the programme to engage agencies for BMs maintenance services is worthwhile and should be continued and could be considered for replication across the country. Copyright © 2016 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

EBM E-learning: Feasible and Effective for Occupational Physicians in Different Countries.

PubMed

Hugenholtz, Nathalie Ir; Sluiter, Judith K; van Dijk, Frank Jh; Nieuwenhuijsen, Karen

2012-09-01

Although evidence-based medicine (EBM) is a useful method for integrating evidence into the decision-making process of occupational physicians, occupational physicians lack EBM knowledge and skills, and do not have the time to learn the EBM method. In order to enable them to educate themselves at the time and place they prefer, we designed an electronic EBM course. We studied the feasibility and utility of the course as well as its effectiveness in increasing EBM knowledge, skills, and behaviour. Occupational physicians from various countries were included in a within-subjects study. Measurements were conducted on participants' EBM knowledge, skills, behaviour, and determinants of behaviour at baseline, directly after finishing the course and 2 months later (n = 36). The feasibility and utility of the course were evaluated directly after the course (n = 42). The course is applicable as an introductory course on EBM for occupational physicians in various countries. The course is effective in enhancing EBM knowledge and self-efficacy in practising EBM. No significant effect was found on EBM skills, behaviour, and determinants of behaviour. After the course, more occupational physicians use the international journals to solve a case. An electronic introductory EBM course is suitable for occupational physicians. Although it is an effective method for increasing EBM knowledge, it does not seem effective in improving skills and behaviour. We recommend integrating e-learning courses with blended learning, where it can be used side by side with other educational methods that are effective in changing behaviour.

Current status and future prospects of the development of clinical Pharmacy in China: A SWOT analysis.

PubMed

Rao, Yuefeng; Zhao, Qingwei; Zhang, Xiangyi; Yang, Hongyu; Lou, Yan; Zhang, Xingguo

2016-03-01

In many industrialized countries, clinical pharmacy has developed into a separate discipline and become a vital part of inpatient care in hospitals. However, as compared to many established branches of medicine, clinical pharmacy is still in its infancy, with much room for growth, improvement, and recognition by both the medical community and patients. In this study, a widely-recognized development strategy analysis tool, Strength, Weakness, Opportunity and Threat (SWOT), was used to systematically address several key issues to the development of clinical pharmacy in China. This analysis aims to provide feasible recommendations for the development of clinical pharmacy in China by identifying current problems and growth opportunities. Full development of clinical pharmacy as a mature clinical discipline will help promote the rational use of drugs by both clinicians and patients and lead to enhanced drug efficacy and safety.

Policy making for vaccine use as a driver of vaccine innovation and development in the developed world.

PubMed

Seib, Katherine; Pollard, Andrew J; de Wals, Philippe; Andrews, Ross M; Zhou, Fangjun; Hatchett, Richard J; Pickering, Larry K; Orenstein, Walter A

2017-03-07

In the past 200years, vaccines have had unmistakable impacts on public health including declines in morbidity and mortality, most markedly in economically-developed countries. Highly engineered vaccines including vaccines for conditions other than infectious diseases are expected to dominate future vaccine development. We examine immunization vaccine policy as a driver of vaccine innovation and development. The pathways to recommendation for use of licensed vaccines in the US, UK, Canada and Australia have been similar, including: expert review of disease epidemiology, disease burden and severity; vaccine immunogenicity, efficacy and safety; programmatic feasibility; public demand; and increasingly cost-effectiveness. Other attributes particularly important in development of future vaccines are likely to include: duration of immunity for improved vaccines such as pertussis; a greater emphasis on optimizing community protection rather than direct protection only; programmatic implementation, feasibility, improvements (as in the case of development of a universal influenza vaccine); public concerns/confidence/fears related to outbreak pathogens like Ebola and Zika virus; and major societal burden for combating hard to treat diseases like HIV and antimicrobial resistant pathogens. Driving innovation and production of future vaccines faces enormous economic hurdles as available approaches, technologies and regulatory pathways become more complex. As such, cost-mitigating strategies and focused, aligned efforts (by governments, private organizations, and private-public partnerships) will likely be needed to continue to spur major advances in vaccine technologies and development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Investing in the foundation of sustainable development: pathways to scale up for early childhood development

PubMed Central

Richter, Linda M; Daelmans, Bernadette; Lombardi, Joan; Heymann, Jody; Boo, Florencia Lopez; Behrman, Jere R; Lu, Chunling; Lucas, Jane E; Perez-Escamilla, Rafael; Dua, Tarun; Bhutta, Zulfiqar A; Stenberg, Karin; Gertler, Paul; Darmstadt, Gary L

2018-01-01

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals. PMID:27717610

Global eradication of measles: an epidemiologic and economic evaluation.

PubMed

Levin, Ann; Burgess, Colleen; Garrison, Louis P; Bauch, Chris; Babigumira, Joseph; Simons, Emily; Dabbagh, Alya

2011-07-01

Measles remains an important cause of morbidity and mortality in children in developing countries. Due to the success of the measles mortality reduction and elimination efforts thus far, the WHO has raised the question of whether global eradication of measles is economically feasible. The cost-effectiveness of various measles mortality reduction and eradication scenarios was evaluated vis-à-vis the current mortality reduction goal in six countries and globally. Data collection on costs of measles vaccination were conducted in six countries in four regions: Bangladesh, Brazil, Colombia, Ethiopia, Tajikistan, and Uganda. The number of measles cases and deaths were projected from 2010 to 2050 using a dynamic, age-structured compartmental model. The incremental cost-effectiveness ratios were then calculated for each scenario vis a vis the baseline. Measles eradication by 2020 was the found to be the most cost-effective scenario, both in the six countries and globally. Eradicating measles by 2020 is projected to cost an additional discounted $7.8 billion and avert a discounted 346 million DALYs between 2010 and 2050. In conclusion, the study found that, compared to the baseline, reaching measles eradication by 2020 would be the most cost-effective measles mortality reduction scenario, both for the six countries and on a global basis. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

The development and pilot-testing of a training curriculum in adolescent medicine and health.

PubMed

Michaud, Pierre-André; Stronski, Susanne; Fonseca, Helena; Macfarlane, Aidan

2004-07-01

To select and propose a set of knowledge, attitudes, and skills essential for the care of adolescents; to encourage the development of adolescent health multidisciplinary networks; and to set up training programs in as many European countries as possible. The curriculum was developed by 16 physicians from 11 European countries with various professional specializations. In line with modern guidelines in medical education, it is a modular, flexible instrument which covers the main teaching areas in the field, such as basic skills (i.e. setting, rights and confidentiality, gender and cultural issues) as well as specific themes (i.e. sexual and reproductive health, eating disorders, chronic conditions). It consists of 17 thematic modules, each containing detailed objectives, learning approaches, examples, and evaluation methods. Two international one-week summer schools were used to assess the feasibility and appropriateness of the curriculum. The overall evaluation was good, with most of the items surpassing three on a four-point Likert scale. However, it pointed to several aspects (process and content) which will need to be refined in the future, such as an increase in interactive sessions (role playing), and a better mix of clinical and public health issues.

Combined sewer overflow control with LID based on SWMM: an example in Shanghai, China.

PubMed

Liao, Z L; Zhang, G Q; Wu, Z H; He, Y; Chen, H

2015-01-01

Although low impact development (LID) has been commonly applied across the developed countries for mitigating the negative impacts of combined sewer overflows (CSOs) on urban hydrological environment, it has not been widely used in developing countries yet. In this paper, a typical combined sewer system in an urbanized area of Shanghai, China was used to demonstrate how to design and choose CSO control solutions with LID using stormwater management model. We constructed and simulated three types of CSO control scenarios. Our findings support the notion that LID measures possess favorable capability on CSO reduction. Nevertheless, the green scenarios which are completely comprised by LID measures fail to achieve the maximal effectiveness on CSO reduction, while the gray-green scenarios (LID measure combined with gray measures) achieve it. The unit cost-effectiveness of each type of scenario sorts as: green scenario > gray-green scenario > gray scenario. Actually, as the storage tank is built in the case catchment, a complete application of green scenario is inaccessible here. Through comprehensive evaluation and comparison, the gray-green scenario F which used the combination of storage tank, bio-retention and rain barrels is considered as the most feasible one in this case.

Designing a Sustainable Noise Mapping System Based on Citizen Scientists Smartphone Sensor Data.

PubMed

Shim, Eunyoung; Kim, Dohyeong; Woo, Hyekyung; Cho, Youngtae

2016-01-01

In this study, we attempted to assess the feasibility of collecting population health data via mobile devices. Specifically, we constructed noise maps based on sound information monitored by individuals' smartphones. We designed a sustainable way of creating noise maps that can overcome the shortcomings of existing station-based noise-monitoring systems. Three hundred and nine Seoul residents aged 20-49 years who used Android-based smartphones were recruited, and the subjects installed a special application that we developed for this study. This application collected information on sound and geographical location every 10 min for 7 days. Using GIS, we were able to construct various types of noise maps of Seoul (e.g., daytime/nighttime and weekdays/weekends) using the information on sound and geographical location obtained via the users' smartphones. Despite the public health importance of noise management, a number of countries and cities lack a sustainable system to monitor noise. This pilot study showed the possibility of using the smartphones of citizen scientists as an economical and sustainable way of monitoring noise, particularly in an urban context in developing countries.

Integrated Food Chain Surveillance System for Salmonella spp. in Mexico1

PubMed Central

Calva, Juan Jose; Estrada-Garcia, Maria Teresa; Leon, Veronica; Vazquez, Gabriela; Figueroa, Gloria; Lopez, Estela; Contreras, Jesus; Abbott, Jason; Zhao, Shaohua; McDermott, Patrick; Tollefson, Linda

2008-01-01

Few developing countries have foodborne pathogen surveillance systems, and none of these integrates data from humans, food, and animals. We describe the implementation of a 4-state, integrated food chain surveillance system (IFCS) for Salmonella spp. in Mexico. Significant findings were 1) high rates of meat contamination (21.3%–36.4%), 2) high rates of ceftriaxone-resistant S. Typhimurium in chicken, ill humans, and swine (77.3%, 66.3%, and 40.4% of S. Typhimurium T isolates, respectively), and 3) the emergence of ciprofloxacin resistance in S. Heidelberg (10.4%) and S. Typhimurium (1.7%) from swine. A strong association between Salmonella spp. contamination in beef and asymptomatic Salmonella spp. infection was only observed in the state with the lowest poverty level (Pearson r = 0.91, p<0.001). Pulsed-field gel electrophoresis analysis of 311 S. Typhimurium isolates showed 14 clusters with 102 human, retail meat, and food-animal isolates with indistinguishable patterns. An IFCS is technically and economically feasible in developing countries and can effectively identify major public health priorities. PMID:18325258

Designing a Sustainable Noise Mapping System Based on Citizen Scientists Smartphone Sensor Data

PubMed Central

Shim, Eunyoung; Kim, Dohyeong; Woo, Hyekyung; Cho, Youngtae

2016-01-01

In this study, we attempted to assess the feasibility of collecting population health data via mobile devices. Specifically, we constructed noise maps based on sound information monitored by individuals’ smartphones. We designed a sustainable way of creating noise maps that can overcome the shortcomings of existing station-based noise-monitoring systems. Three hundred and nine Seoul residents aged 20–49 years who used Android-based smartphones were recruited, and the subjects installed a special application that we developed for this study. This application collected information on sound and geographical location every 10 min for 7 days. Using GIS, we were able to construct various types of noise maps of Seoul (e.g., daytime/nighttime and weekdays/weekends) using the information on sound and geographical location obtained via the users’ smartphones. Despite the public health importance of noise management, a number of countries and cities lack a sustainable system to monitor noise. This pilot study showed the possibility of using the smartphones of citizen scientists as an economical and sustainable way of monitoring noise, particularly in an urban context in developing countries. PMID:27626273

Laparoscopic Radical Trachelectomy

PubMed Central

Rendón, Gabriel J.; Ramirez, Pedro T.; Frumovitz, Michael; Schmeler, Kathleen M.

2012-01-01

Introduction: The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. Case Description: We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Conclusion: Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries. PMID:23318085

Laparoscopic radical trachelectomy.

PubMed

Rendón, Gabriel J; Ramirez, Pedro T; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene

2012-01-01

The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

Increasing stress on disaster-risk finance due to large floods

NASA Astrophysics Data System (ADS)

Jongman, Brenden; Hochrainer-Stigler, Stefan; Feyen, Luc; Aerts, Jeroen C. J. H.; Mechler, Reinhard; Botzen, W. J. Wouter; Bouwer, Laurens M.; Pflug, Georg; Rojas, Rodrigo; Ward, Philip J.

2014-04-01

Recent major flood disasters have shown that single extreme events can affect multiple countries simultaneously, which puts high pressure on trans-national risk reduction and risk transfer mechanisms. So far, little is known about such flood hazard interdependencies across regions and the corresponding joint risks at regional to continental scales. Reliable information on correlated loss probabilities is crucial for developing robust insurance schemes and public adaptation funds, and for enhancing our understanding of climate change impacts. Here we show that extreme discharges are strongly correlated across European river basins. We present probabilistic trends in continental flood risk, and demonstrate that observed extreme flood losses could more than double in frequency by 2050 under future climate change and socio-economic development. We suggest that risk management for these increasing losses is largely feasible, and we demonstrate that risk can be shared by expanding risk transfer financing, reduced by investing in flood protection, or absorbed by enhanced solidarity between countries. We conclude that these measures have vastly different efficiency, equity and acceptability implications, which need to be taken into account in broader consultation, for which our analysis provides a basis.

A call to action for comprehensive HIV services for men who have sex with men

PubMed Central

Beyrer, Chris; Sullivan, Patrick S.; Sanchez, Jorge; Dowdy, David; Altman, Dennis; Trapence, Gift; Collins, Chris; Katabira, Elly; Kazatchkine, Michel; Sidibe, Michel; Mayer, Kenneth H.

2013-01-01

Where surveillance has been done, it has shown that men (MSM) who have sex with men bear a disproportionate burden of HIV. Yet they continue to be excluded, sometimes systematically, from HIV services because of stigma, discrimination, and criminalisation. This situation must change if global control of the HIV epidemic is to be achieved. On both public health and human rights grounds, expansion of HIV prevention, treatment, and care to MSM is an urgent imperative. Effective combination prevention and treatment approaches are feasible, and culturally competent care can be developed, even in rights-challenged environments. Condom and lubricant access for MSM globally is highly cost effective. Antiretroviral-based prevention, and antiretroviral access for MSM globally, would also be cost effective, but would probably require substantial reductions in drug costs in high-income countries to be feasible. To address HIV in MSM will take continued research, political will, structural reform, community engagement, and strategic planning and programming, but it can and must be done. PMID:22819663

Peripherally Inserted Central Venous Catheters in Pediatric Hematology/Oncology Patients in Tertiary Care Setting: A Developing Country Experience.

PubMed

Fadoo, Zehra; Nisar, Muhammad I; Iftikhar, Raza; Ali, Sajida; Mushtaq, Naureen; Sayani, Raza

2015-10-01

Peripherally inserted central venous catheters (PICC) have been successfully used to provide central access for chemotherapy and frequent transfusions. The purpose of this study was to assess the feasibility of PICCs and determine PICC-related complications in pediatric hematology/oncology patients in a resource-poor setting. All pediatric patients (age below 16 y) with hematologic and malignant disorders who underwent PICC line insertion at Aga Khan University Hospital from January 2008 to June 2010 were enrolled in the study. Demographic features, primary diagnosis, catheter days, complications, and reasons for removal of device were recorded. Total of 36 PICC lines were inserted in 32 pediatric patients. Complication rate of 5.29/1000 catheter days was recorded. Our study showed comparable complication profile such as infection rate, occlusion, breakage, and dislodgement. The median catheter life was found to be 69 days. We conclude that PICC lines are feasible in a resource-poor setting and recommend its use for chemotherapy administration and prolonged venous access.

Quantitative option analysis for implementation and management of landfills.

PubMed

Kerestecioğlu, Merih

2016-09-01

The selection of the most feasible strategy for implementation of landfills is a challenging step. Potential implementation options of landfills cover a wide range, from conventional construction contracts to the concessions. Montenegro, seeking to improve the efficiency of the public services while maintaining affordability, was considering privatisation as a way to reduce public spending on service provision. In this study, to determine the most feasible model for construction and operation of a regional landfill, a quantitative risk analysis was implemented with four steps: (i) development of a global risk matrix; (ii) assignment of qualitative probabilities of occurrences and magnitude of impacts; (iii) determination of the risks to be mitigated, monitored, controlled or ignored; (iv) reduction of the main risk elements; and (v) incorporation of quantitative estimates of probability of occurrence and expected impact for each risk element in the reduced risk matrix. The evaluated scenarios were: (i) construction and operation of the regional landfill by the public sector; (ii) construction and operation of the landfill by private sector and transfer of the ownership to the public sector after a pre-defined period; and (iii) operation of the landfill by the private sector, without ownership. The quantitative risk assessment concluded that introduction of a public private partnership is not the most feasible option, unlike the common belief in several public institutions in developing countries. A management contract for the first years of operation was advised to be implemented, after which, a long term operating contract may follow. © The Author(s) 2016.

Peak Power Markets for Satellite Solar Power

NASA Technical Reports Server (NTRS)

Landis, Geoffrey A.

2002-01-01

This paper introduces first Indonesia, comprises 15,000 islands, has land area of two millions square kilometers. Extending from 95 to 141 degrees East longitude and from 6 degrees North to 11 degrees South latitude. Further the market of the Space Solar Power/SPS must be worldwide, including Indonesia. As we know, it can provide electricity anywhere in the world from the Earth's orbit, mostly Indonesia an equator country. We have to perform case studies of various countries to understand their benefits and disadvantages provided by the SSP, because each country has much different condition on energy from other countries. We are at the moment starting the international collaboration between Indonesia and Japan to carry out the case study for Indonesia. We understand that in Indonesia itself each province has much different micro-climate between one province compared to the other. In Japan, METI (Ministry of Economy, Trade and Industry) has already organized a committee to investigate the feasibility of Space Solar Power and to make a plan to launch a space demonstration of the SPS. While, Indonesia is quickly developing economy and increasing their energy demand. We are investigating the detailed energy conditions of Indonesia, the benefits and disadvantages of the Space Solar Power for Indonesia. Especially, we will perform the investigation on the receiving system for the Japanese pilot Space Power Satellite.

The Joint Action on Health Workforce Planning and Forecasting: Results of a European programme to improve health workforce policies.

PubMed

Kroezen, Marieke; Van Hoegaerden, Michel; Batenburg, Ronald

2018-02-01

Health workforce (HWF) planning and forecasting is faced with a number of challenges, most notably a lack of consistent terminology, a lack of data, limited model-, demand-based- and future-based planning, and limited inter-country collaboration. The Joint Action on Health Workforce Planning and Forecasting (JAHWF, 2013-2016) aimed to move forward on the HWF planning process and support countries in tackling the key challenges facing the HWF and HWF planning. This paper synthesizes and discusses the results of the JAHWF. It is shown that the JAHWF has provided important steps towards improved HWF planning and forecasting across Europe, among others through the creation of a minimum data set for HWF planning and the 'Handbook on Health Workforce Planning Methodologies across EU countries'. At the same time, the context-sensitivity of HWF planning was repeatedly noticeable in the application of the tools through pilot- and feasibility studies. Further investments should be made by all actors involved to support and stimulate countries in their HWF efforts, among others by implementing the tools developed by the JAHWF in diverse national and regional contexts. Simultaneously, investments should be made in evaluation to build a more robust evidence base for HWF planning methods. Copyright © 2017 Elsevier B.V. All rights reserved.

A Physical Assessment of the Opportunities for Improved Management of the Water Resources of the Bi-National Rio Grande/Rio Bravo Basin

NASA Astrophysics Data System (ADS)

Aparicio, J.; McKinney, D.; Valdes, J.; Guitron, A.; Thomas, G.

2007-05-01

The hydro-physical opportunities for expanding the beneficial uses of the fixed water supply in the Rio Grande/Bravo Basin to better satisfy an array of water management goals are examined. These include making agriculture more resilient to periodic conditions of drought, improving the reliability of supplies to cities and towns, and restoring lost environmental functions in the river system. This is a comprehensive, outcome-neutral, model- based planning exercise performed by some 20 technical, primarily non-governmental institutions from both countries, aimed at proposing strategies that can reduce future conflicts over water throughout the entire basin. The second track consists in generating a set of future water management scenarios that respond to the needs and objectives of the basin stakeholders in each segment and each country. An array of scenarios for improved water management has been developed for the lower Rio Grande/Rio Bravo basin in Texas and the Mexican state of Tamaulipas. Another set under development will focus on the Rio Conchos and the El Paso/Juarez region. Eventually, scenarios will be generated such that will comprehend the entire basin on both sides of the border. These scenarios are the product of consultations with agricultural water districts, governmental organizations and environmental NGOs. They include strategies for reducing the physical losses of water in the system, conservation transfers, improvements in the operations of the Mexican and international reservoirs, improvements in environmental flow conditions, improvements in reliability of water supplies, and drought coping strategies.These scenarios will be evaluated for hydrologic feasibility by the basin-wide model and the gaming exercises. Modeling is necessary to understand how these options will affect the entire system and how they can be crafted to maximize the benefits and avoid unintended or uncompensated effects. The scenarios that have the potential to provide large mutual benefits to all stakeholders in the basin will then be subjected to an economic feasibility analysis, and, finally, a legal and political feasibility analysis. The scenario development, hydrologic modeling, economic and institutional analysis will culminate in the presentation of technical recommendations to policy-makers on both sides of the border on the potential for improved water management in the basin.

The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?

PubMed Central

Ooms, Gorik; Van Damme, Wim; Baker, Brook K; Zeitz, Paul; Schrecker, Ted

2008-01-01

Background The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation. In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope. Discussion This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund. Summary The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features. PMID:18364048

From modeling to morals: imagining the future of HIV PREP in Lesotho.

PubMed

Kenworthy, Nora J; Bulled, Nicola

2013-08-01

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new bio-technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries' struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. © 2013 John Wiley & Sons Ltd.

Can role models boost entrepreneurial attitudes?

PubMed Central

Fellnhofer, Katharina; Puumalainen, Kaisu

2017-01-01

This multi-country study used role models to boost perceptions of entrepreneurial feasibility and desirability. The results of a structural equation model based on a sample comprising 426 individuals who were primarily from Austria, Finland and Greece revealed a significant positive influence on perceived entrepreneurial desirability and feasibility. These findings support the argument for embedding entrepreneurial role models in entrepreneurship education courses to promote entrepreneurial activities. This direction is not only relevant for the academic community but also essential for nascent entrepreneurs, policymakers and society at large. PMID:28458611

Can role models boost entrepreneurial attitudes?

PubMed

Fellnhofer, Katharina; Puumalainen, Kaisu

2017-01-01

This multi-country study used role models to boost perceptions of entrepreneurial feasibility and desirability. The results of a structural equation model based on a sample comprising 426 individuals who were primarily from Austria, Finland and Greece revealed a significant positive influence on perceived entrepreneurial desirability and feasibility. These findings support the argument for embedding entrepreneurial role models in entrepreneurship education courses to promote entrepreneurial activities. This direction is not only relevant for the academic community but also essential for nascent entrepreneurs, policymakers and society at large.

Dissemination of an evidence-based intervention to parents of children with behavioral problems in a developing country.

PubMed

Fayyad, John A; Farah, Lynn; Cassir, Youmna; Salamoun, Mariana M; Karam, Elie G

2010-08-01

This project describes the dissemination of an evidence-based parenting skills intervention by training social and health workers with little or no mental health background so that they themselves train mothers of children with behavioral problems in impoverished communities in a developing country. The Strengths and Difficulties Questionnaire was completed by mothers to screen for children with behavioral problems and was repeated at the end of the intervention. Pre- and post-tests of knowledge and parenting attitudes were administered to mothers. Mental health workers trained social and health workers in social development centers and dispensaries. Each social and health worker trained mothers of children with behavioral problems under supervision utilizing an Arabic adaptation of the treatment manual for externalizing disorders "Helping Challenging Children" developed by the Integrated Services Taskforce of the World Psychiatric Association Child Mental Health Presidential Programme. A total of 20 workers and 87 mothers participated in the training. The proportion of children who obtained an SDQ total difficulties score in the abnormal range decreased from 54.4 to 19.7% after the training. Whereas 40.2% of mothers used severe corporal punishment with their children before the intervention, this decreased to 6.1% post-intervention. Three-fourths of mothers related that the program helped them develop new parenting skills. This pilot project demonstrated the feasibility of dissemination of a manual-based intervention and training of workers who have little background in mental health to offer effective services to families in impoverished communities who otherwise would have not received them. Successful replication in other developing countries would pave the way to incorporating such programs in national policies given their potential sustainability and cost-effectiveness.

Laparoscopic Reconstruction in Post-Tubercular Urinary Tract Strictures: Technical Challenges.

PubMed

Ghosh, Bastab; Sridhar, Kartik; Pal, Dilip Kumar

2017-11-01

Genitourinary tuberculosis still continues to plague developing countries and is a significant cause of morbidity as well as mortality in the developing world. At present, nearly 55% of the patients of genitourinary tuberculosis (GUTB) need surgical management. Owing to the presence of dense adhesions and loss of normal anatomical planes, GUTB was considered to be a contraindication to laparoscopic surgery. However, recent literature shows laparoscopy to be feasible in GUTB. Our study aimed at identifying the challenges in laparoscopic urinary tract reconstructive surgery in genitourinary tuberculosis-related urinary tract obstruction. The details of 6 patients who underwent different types of laparoscopic reconstructive surgery for genitourinary tuberculosis-related urinary tract obstruction from January 2014 to December 2015 were reviewed. Baseline characteristics, indications of surgery, type of surgery, operative duration, blood loss, and follow-up details were noted. All patients received antitubercular treatment before surgery as per the direct observed treatment short-course regimen followed in our country. We performed one bilateral laparoscopic pyeloplasty, one unilateral laparoscopic pyeloplasty, two laparoscopic ureteroneocystostomies, and two ureteroureterostomies. Difficulty was encountered during dissection owing to the presence of adhesions, but conversion to open surgery was not done in five cases. Dense adhesions adjacent to the common iliac vessels necessitated conversion to open surgery in one of the ureteroureterostomies. Stenting was done in all the patients. All patients had uneventful postoperative recovery. Functional imaging following stent removal showed unobstructed tracer flow, showing successful operative outcome. Our study showed that laparoscopic reconstructive surgery is feasible in genitourinary tuberculosis despite the presence of adhesions that may pose a challenge to dissection. This is in contrast to the previous studies which conclude that genitourinary tuberculosis is a relative contraindication to laparoscopic surgery.

Using electronic health records for clinical research: the case of the EHR4CR project.

PubMed

De Moor, Georges; Sundgren, Mats; Kalra, Dipak; Schmidt, Andreas; Dugas, Martin; Claerhout, Brecht; Karakoyun, Töresin; Ohmann, Christian; Lastic, Pierre-Yves; Ammour, Nadir; Kush, Rebecca; Dupont, Danielle; Cuggia, Marc; Daniel, Christel; Thienpont, Geert; Coorevits, Pascal

2015-02-01

To describe the IMI EHR4CR project which is designing and developing, and aims to demonstrate, a scalable, widely acceptable and efficient approach to interoperability between EHR systems and clinical research systems. The IMI EHR4CR project is combining and extending several previously isolated state-of-the-art technical components through a new approach to develop a platform for reusing EHR data to support medical research. This will be achieved through multiple but unified initiatives across different major disease areas (e.g. cardiovascular, cancer) and clinical research use cases (protocol feasibility, patient identification and recruitment, clinical trial execution and serious adverse event reporting), with various local and national stakeholders across several countries and therefore under various legal frameworks. An initial instance of the platform has been built, providing communication, security and terminology services to the eleven participating hospitals and ten pharmaceutical companies located in seven European countries. Proof-of-concept demonstrators have been built and evaluated for the protocol feasibility and patient recruitment scenarios. The specifications of the clinical trial execution and the adverse event reporting scenarios have been documented and reviewed. Through a combination of a consortium that brings collectively many years of experience from previous relevant EU projects and of the global conduct of clinical trials, of an approach to ethics that engages many important stakeholders across Europe to ensure acceptability, of a robust iterative design methodology for the platform services that is anchored on requirements of an underlying Service Oriented Architecture that has been designed to be scalable and adaptable, EHR4CR could be well placed to deliver a sound, useful and well accepted pan-European solution for the reuse of hospital EHR data to support clinical research studies. Copyright © 2014 Elsevier Inc. All rights reserved.

Changing climate, challenging choices: identifying and evaluating climate change adaptation options for protected areas management in Ontario, Canada.

PubMed

Lemieux, Christopher J; Scott, Daniel J

2011-10-01

Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders.

PubMed

Lauvergeon, Stéphanie; Burnand, Bernard; Peytremann-Bridevaux, Isabelle

2012-06-22

Chronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation. To meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients. Our results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors. Even if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders.

Changing Climate, Challenging Choices: Identifying and Evaluating Climate Change Adaptation Options for Protected Areas Management in Ontario, Canada

NASA Astrophysics Data System (ADS)

Lemieux, Christopher J.; Scott, Daniel J.

2011-10-01

Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders

PubMed Central

2012-01-01

Background Chronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation. Methods To meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients. Results Our results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors. Conclusions Even if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders. PMID:22726820

Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India

PubMed Central

CHATTERJEE, SUDIPTO; CHOWDHARY, NEERJA; PEDNEKAR, SULOCHANA; COHEN, ALEX; ANDREW, GRACY; ANDREW, GRACY; ARAYA, RICARDO; SIMON, GREGORY; KING, MICHAEL; TELLES, SHIRLEY; VERDELI, HELENA; CLOUGHERTY, KATHLEEN; KIRKWOOD, BETTY; PATEL, VIKRAM

2008-01-01

Common mental disorders, such as depression and anxiety, pose a major public health burden in developing countries. Although these disorders are thought to be best managed in primary care settings, there is a dearth of evidence about how this can be achieved in low resource settings. The MANAS project is an attempt to integrate an evidence based package of treatments into routine public and private primary care settings in Goa, India. Before initiating the trial, we carried out extensive preparatory work, over a period of 15 months, to examine the feasibility and acceptability of the planned intervention. This paper describes the systematic development and evaluation of the intervention through this preparatory phase. The preparatory stage, which was implemented in three phases, utilized quantitative and qualitative methods to inform our understanding of the potential problems and possible solutions in implementing the trial and led to critical modifications of the original intervention plan. Investing in systematic formative work prior to conducting expensive trials of the effectiveness of complex interventions is a useful exercise which potentially improves the likelihood of a positive result of such trials. PMID:18458786

Novel, Integrated Reactor/Power Conversion System (LMR-AMTEC)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dmitry V. Paramonov, Lead Collaborator

2001-07-31

The overall objective of NERI Project Number 99-0198 is to assess the technical and economic feasibility, develop engineering solutions and determine a range of potential applications for ''Novel Integrated Reactor/Energy conversion Systems''. The near term goal is the design of a power supply for developing countries in remote locations in a proliferation resistant, reliable and economical way. The heart of the concept is the use of a single loop liquid metal fast reactor (LMR) with conversion of the heat directly into electricity in a Alkali Metal Thermal to Electric Converter (AMTEC). The first year of the project focused on themore » feasibility issues with a long life, high temperature liquid metal-cooled core; selection of the working fluid, core-to-AMTEC coupling scheme and interface parameters; and, energy conversion systems design and performance. Report Number STD-ES-01-0028, Revision 0, dated July 31, 2001, summarizes the work performed by Westinghouse personnel in Year One and report number UNM-ISNPS-3-2000, dated October 2000, summarizes the work performed by the Institute for Space and Nuclear Power Studies at the University of New Mexico in Year One.« less

Artificial intelligence: contemporary applications and future compass.

PubMed

Khanna, Sunali

2010-08-01

The clinical use of information technology in the dental profession has increased substantially in the past 10 to 20 years. In most developing countries an insufficiency of medical and dental specialists has increased the mortality of patients suffering from various diseases. Employing technology, especially artificial intelligence technology, in medical and dental application could reduce cost, time, human expertise and medical error. This approach has the potential to revolutionise the dental public health scenario in developing countries. Clinical decision support systems (CDSS) are computer programs that are designed to provide expert support for health professionals. The applications in dental sciences vary from dental emergencies to differential diagnosis of orofacial pain, radiographic interpretations, analysis of facial growth in orthodontia to prosthetic dentistry. However, despite the recognised need for CDSS, the implementation of these systems has been limited and slow. This can be attributed to lack of formal evaluation of the systems, challenges in developing standard representations, cost and practitioner scepticism about the value and feasibility of CDSS. Increasing public awareness of safety and quality has accelerated the adoption of generic knowledge based CDSS. Information technology applications for dental practice continue to develop rapidly and will hopefully contribute to reduce the morbidity and mortality of oral and maxillofacial diseases and in turn impact patient care.

Self-Fitting Hearing Aids

PubMed Central

Convery, Elizabeth

2016-01-01

A self-contained, self-fitting hearing aid (SFHA) is a device that enables the user to perform both threshold measurements leading to a prescribed hearing aid setting and fine-tuning, without the need for audiological support or access to other equipment. The SFHA has been proposed as a potential solution to address unmet hearing health care in developing countries and remote locations in the developed world and is considered a means to lower cost and increase uptake of hearing aids in developed countries. This article reviews the status of the SFHA and the evidence for its feasibility and challenges and predicts where it is heading. Devices that can be considered partly or fully self-fitting without audiological support were identified in the direct-to-consumer market. None of these devices are considered self-contained as they require access to other hardware such as a proprietary interface, computer, smartphone, or tablet for manipulation. While there is evidence that self-administered fitting processes can provide valid and reliable results, their success relies on user-friendly device designs and interfaces and easy-to-interpret instructions. Until these issues have been sufficiently addressed, optional assistance with the self-fitting process and on-going use of SFHAs is recommended. Affordability and a sustainable delivery system remain additional challenges for the SFHA in developing countries. Future predictions include a growth in self-fitting products, with most future SFHAs consisting of earpieces that connect wirelessly with a smartphone and providers offering assistance through a telehealth infrastructure, and the integration of SFHAs into the traditional hearing health-care model. PMID:27072929

Responses to the Standard for Exchange of Nonclinical Data (SEND) in non-US countries

PubMed Central

Anzai, Takayuki; Kaminishi, Masamichi; Sato, Keizo; Kaufman, Laura; Iwata, Hijiri; Nakae, Dai

2015-01-01

The Standard for the Exchange of Nonclinical Data (SEND), adopted by the US FDA, is part of a set of regulations and guidances requiring the submission of standardized electronic study data for nonclinical and clinical data submissions. SEND is the nonclinical implementation of SDTM (Study Data Tabulation Model), the standard electronic format for clinical regulatory submissions to FDA. SEND, SDTM, and the associated Controlled Terminology have been developed by CDISC (Clinical Data Interchange Standards Consortium). In order to successfully implement SEND, interdisciplinary contributions between sponsors and CROs, need a model for task allocation. This is being undertaken by the Pharmaceutical Users Software Exchange (PhUSE). Because SEND is currently the preferred submission format of the US FDA only and will become required by it starting in December 2016, only American academic societies and companies are actively involved. An exception to this is the INHAND initiative, which leads the way in standardizing terminology for toxicological pathology. On the other hand, international globalization of other clinical and nonclinical practices is not feasible because there are substantial differences between the US and non-US countries in CRO involvement in drug development. Thus, non-US countries must consider and develop approaches to SEND that meet their needs. This paper summarizes the activities of the major organizations involved in SEND development and implementation, discusses the effective use of SEND, and details a compliance scheme (research material of the Showa University School of Medicine) illustrating how pharmaceutical companies can complete a large amount of work up to an FDA application with the effective utilization of CROs and solution providers. PMID:26028814

Transportability of an Evidence-Based Early Childhood Intervention in a Low-Income African Country: Results of a Cluster Randomized Controlled Study.

PubMed

Huang, Keng-Yen; Nakigudde, Janet; Rhule, Dana; Gumikiriza-Onoria, Joy Louise; Abura, Gloria; Kolawole, Bukky; Ndyanabangi, Sheila; Kim, Sharon; Seidman, Edward; Ogedegbe, Gbenga; Brotman, Laurie Miller

2017-11-01

Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions (EBIs) are not available in SSA. This study investigated the implementation quality and effectiveness of one component of an EBI from a developed country (USA) in a SSA country (Uganda). The EBI component, Professional Development, was provided by trained Ugandan mental health professionals to Ugandan primary school teachers. It included large-group experiential training and small-group coaching to introduce and support a range of evidence-based practices (EBPs) to create nurturing and predictable classroom experiences. The study was guided by the Consolidated Framework for Implementation Research, the Teacher Training Implementation Model, and the RE-AIM evaluation framework. Effectiveness outcomes were studied using a cluster randomized design, in which 10 schools were randomized to intervention and wait-list control conditions. A total of 79 early childhood teachers participated. Teacher knowledge and the use of EBPs were assessed at baseline and immediately post-intervention (4-5 months later). A sample of 154 parents was randomly selected to report on child behavior at baseline and post-intervention. Linear mixed effect modeling was applied to examine effectiveness outcomes. Findings support the feasibility of training Ugandan mental health professionals to provide Professional Development for Ugandan teachers. Professional Development was delivered with high levels of fidelity and resulted in improved teacher EBP knowledge and the use of EBPs in the classroom, and child social competence.

Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia.

PubMed

Farida, Helmia; Rondags, Angelique; Gasem, M Hussein; Leong, Katharina; Adityana, A; van den Broek, Peterhans J; Keuter, Monique; Natsch, Stephanie

2015-04-01

To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country. A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia. Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting. Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting. © 2014 John Wiley & Sons Ltd.

Baselining Fugitive and Vented Emissions Across Canadian Energy Developments

NASA Astrophysics Data System (ADS)

O'Connell, L.; Risk, D. A.; Fougère, C. R.; Lavoie, M.; Atherton, E. E.; Baillie, J.; MacKay, K.; Marshall, A. D.

2016-12-01

A recent trilateral accord between North American governments pledges to cut energy sector methane emissions 40-45 per cent below 2012 levels by 2025. Effective methane-reduction policy relies on accurate and spatially extensive emissions data. In this study, we assessed the feasibility of bottom-up data collection for Canadian energy developments, using vehicle-based emission screening and volumetric measurement, combined with forward looking infrared (FLIR) detection for pinpointing source. We analyzed trends across many Canadian developments using an 80,000 km survey campaign conducted in 2015-16 in which CO2, CH4, H2S, and δ13CH4 were measured in proximity to over ten thousand well pads. We found that emissions varied according to infrastructure age, operator size, product, and extraction style. Using these data, we conducted an analysis across several variables to evaluate the potential success of non-exhaustive campaigns for capturing trends, and super-emitters, across the Canadian industry. We found that campaigns would be fiscally feasible, and could be statistically significant depending on scale. However, success was very sensitive to the degree of variation amongst operators and developments, for which we suggest a Monte-Carlo type optimization approach that balances survey coverage with attention to specific localized threats. Similar analyses should be conducted in other accord countries because effective and harmonized oversight could help accelerate emissions reductions.

Alternatives to the use of antimicrobial agents in pig production: A multi-country expert-ranking of perceived effectiveness, feasibility and return on investment.

PubMed

Postma, Merel; Stärk, Katharina D C; Sjölund, Marie; Backhans, Annette; Beilage, Elisabeth Grosse; Lösken, Svenja; Belloc, Catherine; Collineau, Lucie; Iten, Denise; Visschers, Vivianne; Nielsen, Elisabeth O; Dewulf, Jeroen

2015-03-01

Nineteen alternatives to antimicrobial agents were ranked on perceived effectiveness, feasibility and return on investment (ROI) from 0 (not effective, not feasible, no ROI) to 10 (fully effective, completely feasible, maximum ROI) by 111 pig health experts from Belgium, Denmark, France, Germany, Sweden and Switzerland. The top 5 measures in terms of perceived effectiveness were (1) improved internal biosecurity, (2) improved external biosecurity, (3) improved climate/environmental conditions, (4) high health/Specific Pathogen Free/disease eradication and (5) increased vaccination. The top 5 measures in terms of perceived feasibility were (1) increased vaccination, (2) increased use of anti-inflammatory products, (3) improved water quality, (4) feed quality/optimization and (5) use of zinc/metals. The top 5 measures in terms of perceived ROI were (1) improved internal biosecurity, (2) zinc/metals, (3) diagnostics/action plan, (4) feed quality/optimization and (5) climate/environmental improvements. Univariate linear regression showed that veterinary practitioners rank internal biosecurity, vaccination, use of zinc/metals, feed quality optimization and climate/environmental on average highest, while researchers and professors focused more on increased use of diagnostics and action plans. Financial incentives/penalties ranked low in all countries. Belgian respondents ranked feed quality significantly lower compared to the German respondents while reduction of stocking density was ranked higher in Belgium compared to Denmark. Categorical Principal Component Analysis applied to the average ranking supported the finding that veterinary practitioners had a preference for more practical, common and already known alternatives. The results showed that improvements in biosecurity, increased use of vaccination, use of zinc/metals, feed quality improvement and regular diagnostic testing combined with a clear action plan were perceived to be the most promising alternatives to antimicrobials in industrial pig production based on combined effectiveness, feasibility and ROI. Copyright © 2015 Elsevier B.V. All rights reserved.

Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective.

PubMed

Finocchario-Kessler, Sarah; Wexler, Catherine; Maloba, May; Mabachi, Natabhona; Ndikum-Moffor, Florence; Bukusi, Elizabeth

2016-06-04

Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa. We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories. A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts. Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.

Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness.

PubMed

Bryce, Jennifer; Victora, Cesar G; Habicht, Jean-Pierre; Black, Robert E; Scherpbier, Robert W

2005-12-01

To summarize the expectations held by World Health Organization programme personnel about how the introduction of the Integrated Management of Childhood Illness (IMCI) strategy would lead to improvements in child health and nutrition, to compare these expectations with what was learned from the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE-IMCI), and to discuss the implications of these findings for child survival policies and programmes. The MCE-IMCI study designs were based on an impact model developed in 1999-2000 to define how IMCI would be implemented at country level and below, and the outcomes and impact it would have on child health and survival. MCE-IMCI studies included: feasibility assessments documenting IMCI implementation in 12 countries (1999-2001); in-depth studies using compatible designs in Bangladesh, Brazil, Peru, Tanzania and Uganda; and cross-site analyses addressing the effectiveness of specific subsets of IMCI activities. The IMCI strategy was successfully introduced in the great majority of countries with moderate to high levels of child mortality in the period from 1996 to 2001. Seven years of country-based evaluation, however, indicates that some of the basic expectations underlying the development of IMCI were not met. Four of the five countries (the exception is Tanzania) had difficulties in expanding the strategy at national level while maintaining adequate intervention quality. Technical guidelines on delivering interventions at family and community levels were slow to appear, and in their absence countries stalled in their efforts to increase population coverage with essential interventions related to care-seeking, nutrition, and correct care of the sick child at home. The full weight of health system limitations on IMCI implementation was not appreciated at the outset, and only now is it clear that solutions to larger problems in political commitment, human resources, financing, integrated or at least coordinated programme management, and effective decentralization are essential underpinnings of successful efforts to reduce child mortality. This analysis highlights the need for a shift if child survival efforts are to be successful. Delivery systems that rely solely on government health facilities must be expanded to include the full range of potential channels in a setting and strong community-based approaches. The focus on process within child health programmes must change to include greater accountability for intervention coverage at population level. Global strategies that expect countries to make massive adaptations must be complemented by country-level implementation guidelines that begin with local epidemiology and rely on tools developed for specific epidemiological profiles.

Care for Child Development: an intervention in support of responsive caregiving and early child development.

PubMed

Lucas, J E; Richter, L M; Daelmans, B

2018-01-01

An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children. In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource-constrained communities. The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services. Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale-up of CCD as part of services for families and children. © 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd.

Where midwives are not yet recognised: a feasibility study of professional midwives in Nepal.

PubMed

Bogren, Malin Upper; van Teijlingen, Edwin; Berg, Marie

2013-10-01

the professional midwife is a key person for promoting maternal and family health. Not all countries have yet reached the professional standard for midwives set by the International Confederation of Midwives (ICM) and Nepal is one of these countries. This study explores the feasibility to establish a professional midwifery cadre in Nepal that meets the global standards of competencies, and to define a strategy to reach this. a mixed-methods study comprised (1) policy-review (2) interviews and (3) observations. An assessment tool was designed for data collection and analysis using variables from three sources: ICM's Global Standards, the skilled birth attendant programme in Nepal, and JHPIEGO's site assessment tool for maternal health and new-born programmes. Data were collected in a desk review of education and policy documents, interviews with stakeholders, and site assessment of five higher education institutions and their hospital-based maternity departments. The analysis resulted in a recommended strategy. six levels of education of nurse staff providing midwifery care were identified; all regulated under the Nepal Nursing Council. No legislation was in place authorising midwifery as an autonomous profession. A post-basic midwifery programme on first cycle-bachelor level was under development. A well-organised midwifery association was established consisting of nurses providing maternal health care. Four university colleges offering higher education for nurses and clinicians had a capability to run a midwifery programme and the fifth had a genuine interest in starting a midwifery programme at bachelor level. The proposed strategy includes four strategic objectives and interventions in relation to four components identified by UNFPA: Legislation and regulation; Training and education; Deployment and utilisation; and Professional associations. the study has delivered a proposed strategy for the Government of Nepal for effective management of the midwifery workforce in order to enhance midwives' contribution in maternity care and thus promoting improved maternal and new-born health. The developed analytical framework could be used as an assessment tool also in other countries to establish professional midwifery cadres that meets the global standards of competencies. © 2013 Elsevier Ltd. All rights reserved.

Prevalence of permanent hearing threshold shift among workers of Indian iron and steel small and medium enterprises: a study.

PubMed

Singh, Lakhwinder Pal; Bhardwaj, Arvind; Kumar, Deepak Kishore

2012-01-01

Occupational noise exposure and noise-induced hearing loss (NIHL) have been recognized as a problem among workers in Indian industries. The major industries in India are based on manufacturing. There are appreciable numbers of casting and forging units spread across the country. The objective of this study is to determine the prevalence of permanent hearing threshold shift among the workers engaged in Indian iron and steel small and medium enterprises (SMEs) and compared with control group subjects. As a part of hearing protection intervention, audiometric tests were conducted at low (250-1000 Hz), medium (1500-3000 Hz), and high (4000-8000 Hz) frequencies. The occurrence of hearing loss was determined based on hearing threshold levels with a low fence of 25 dB. Comparisons were made for hearing threshold at different frequencies between the exposed and control groups using Student's t test. ANOVA was used for the comparison of hearing threshold dB at different frequencies among occupation and year of experience. A P value <0.05 was considered as statistically significant. All data were presented as mean value (SD). Over 90% of workers engaged in various processes of casting and forging industry showed hearing loss in the noise-sensitive medium and higher frequencies. Occupation was significantly associated with NIHL, and hearing loss was particularly high among the workers of forging section. The analyses revealed a higher prevalence of significant hearing loss among the forging workers compared to the workers associated with other activities. The study shows alarming signals of NIHL, especially in forging workers. The occupational exposure to noise could be minimized by efficient control measures through engineering controls, administrative controls, and the use of personal protective devices. Applications of engineering and/or administrative controls are frequently not feasible in the developing countries for technical and financial reasons. A complete hearing conservation programme, including training, audiometry, job rotation, and the use of hearing protection devices, is the most feasible method for the protection of industrial workers from prevailing noise in workplace environments in the developing countries.

Decision support in vaccination policies.

PubMed

Piso, B; Wild, C

2009-10-09

Looking across boarders reveals that the national immunization programs of various countries differ in their vaccination schedules and decisions regarding the implementation and funding of new vaccines. The aim of this review is to identify decision aids and crucial criteria for a rational decision-making process on vaccine introduction and to develop a theoretical framework for decision-making based on available literature. Systematic literature search supplemented by hand-search. We identified five published decision aids for vaccine introduction and program planning in industrialized countries. Their comparison revealed an overall similarity with some differences in the approach as well as criteria. Burden of disease and vaccine characteristics play a key role in all decision aids, but authors vary in their views on the significance of cost-effectiveness analyses. Other relevant factors that should be considered before vaccine introduction are discussed to highly differing extents. These factors include the immunization program itself as well as its conformity with other programs, its feasibility, acceptability, and equity, as well as ethical, legal and political considerations. Assuming that the most comprehensive framework possible will not provide a feasible tool for decision-makers, we suggest a stepwise procedure. Though even the best rational approach and most comprehensive evaluation is limited by remaining uncertainties, frameworks provide at least a structured approach to evaluate the various aspects of vaccine implementation decision-making. This process is essential in making consistently sound decisions and will facilitate the public's confidence in the decision and its realization.

Cardiac rehabilitation delivery model for low-resource settings

PubMed Central

Grace, Sherry L; Turk-Adawi, Karam I; Contractor, Aashish; Atrey, Alison; Campbell, Norm; Derman, Wayne; Melo Ghisi, Gabriela L; Oldridge, Neil; Sarkar, Bidyut K; Yeo, Tee Joo; Lopez-Jimenez, Francisco; Mendis, Shanthi; Oh, Paul; Hu, Dayi; Sarrafzadegan, Nizal

2016-01-01

Objective Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries. Methods A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not. Results Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings. Conclusions Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed. PMID:27181874

What European gynaecologists need to master: Consensus on medical expertise outcomes of pan-European postgraduate training in obstetrics & gynaecology.

PubMed

van der Aa, Jessica E; Tancredi, Annalisa; Goverde, Angelique J; Velebil, Petr; Feyereisl, Jaroslav; Benedetto, Chiara; Teunissen, Pim W; Scheele, Fedde

2017-09-01

European harmonisation of training standards in postgraduate medical education in Obstetrics and Gynaecology is needed because of the increasing mobility of medical specialists. Harmonisation of training will provide quality assurance of training and promote high quality care throughout Europe. Pan-European training standards should describe medical expertise outcomes that are required from the European gynaecologist. This paper reports on consensus development on the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. A Delphi procedure was performed amongst European gynaecologists and trainees in Obstetrics & Gynaecology, to develop consensus on outcomes of training. The consensus procedure consisted of two questionnaire rounds, followed by a consensus meeting. To ensure reasonability and feasibility for implementation of the training standards in Europe, implications of the outcomes were considered in a working group thereafter. We invited 142 gynaecologists and trainees in Obstetrics & Gynaecology for participation representing a wide range of European countries. They were selected through the European Board & College of Obstetrics and Gynaecology and the European Network of Trainees in Obstetrics & Gynaecology. Sixty people participated in round 1 and 2 of the consensus procedure, 38 (63.3%) of whom were gynaecologists and 22 (36.7%) were trainees in Obstetrics & Gynaecology. Twenty-eight European countries were represented in this response. Round 3 of the consensus procedure was performed in a consensus meeting with six experts. Implications of the training outcomes were discussed in a working group meeting, to ensure reasonability and feasibility of the material for implementation in Europe. The entire consensus procedure resulted in a core content of training standards of 188 outcomes, categorised in ten topics. European consensus was developed regarding the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. The outcomes will be described in core trainings standards, aimed at harmonising training in Obstetrics and Gynaecology in Europe to promote high quality care. Copyright © 2017 Elsevier B.V. All rights reserved.

Cultural and linguistic transferability of the multi-dimensional OxCAP-MH capability instrument for outcome measurement in mental health: the German language version.

PubMed

Simon, Judit; Łaszewska, Agata; Leutner, Eva; Spiel, Georg; Churchman, David; Mayer, Susanne

2018-06-05

Mental health conditions affect aspects of people's lives that are often not captured in common health-related outcome measures. The OxCAP-MH self-reported, quality of life questionnaire based on Sen's capability approach was developed in the UK to overcome these limitations. The aim of this study was to develop a linguistically and culturally valid German version of the questionnaire. Following forward and back translations, the wording underwent cultural and linguistic validation with input from a sample of 12 native German speaking mental health patients in Austria in 2015. Qualitative feedback from patients and carers was obtained via interviews and focus group meetings. Feedback from mental health researchers from Germany was incorporated to account for cross-country differences. No significant item modifications were necessary. However, changes due to ambiguous wordings, possibilities for differential interpretations, politically unacceptable expressions, cross-country language differences and differences in political and social systems, were needed. The study confirmed that all questions are relevant and understandable for people with mental health conditions in a German speaking setting and transferability of the questionnaire from English to German speaking countries is feasible. Professional translation is necessary for the linguistic accuracy of different language versions of patient-reported outcome measures but does not guarantee linguistic and cultural validity and cross-country transferability. Additional context-specific piloting is essential. The time and resources needed to achieve valid multi-lingual versions should not be underestimated. Further research is ongoing to confirm the psychometric properties of the German version.

Mashreq Arab interconnected power system potential for economic energy trading

DOE Office of Scientific and Technical Information (OSTI.GOV)

Al-Shehri, A.M.; El-Amin, I.M.; Opoku, G.

1994-12-01

The Mashreq Arab countries covered in this study are Bahrain, Egypt, Jordan, Lebanon, Oman, Qatar, Saudi Arabia, Syria, the United Arab Emirates, and Yemen. A feasibility study for the interconnection of the electrical networks of the Mashreq Arab countries, sponsored by the Arab Fund, was completed in June 1992. Each country is served by one utility except Saudi Arabia, which is served by four major utilities and some smaller utilities serving remote towns and small load centers. The major utilities are the Saudi consolidated electric Company in the Eastern Province (SCECO East), SCECO Center, SCECO West, and SCECO South. Thesemore » are the ones considered in this study. The Mashreq Arab region has a considerable mix of energy resources. Egypt and Syria have some limited amounts of hydropower resources, and the Arabian Gulf region is abundant in fossil fuel reserves. Owing to the differences in energy production costs, a potential exists for substantial energy trading between electric utilities in the region. The major objective of this project is to study the feasibility of electric energy trading between the Mashreq Arab countries. The basis, assumptions, and methodologies on which this energy trading study is based relate to the results and conclusions arising out of the previous study, power plant characteristics and costs, assumptions on economic parameters, rules for economy energy exchange, etc. This paper presents the basis, methodology, and major findings of the study.« less

The Development of Environmentally Friendly Technologies of Using Coals and Products of Their Enrichment in the Form of Coal Water Slurries

NASA Astrophysics Data System (ADS)

Murko, Vasily; Hamalainen, Veniamin

2017-11-01

The article presents the current state of the technology for production and combustion of fuel coal water slurries in Russia and foreign countries. Experimental and industrial facilities show the technological and economic efficiency of using this technology for disposal of wastes resulting after coal processing and enrichment. The feasibility studies of use of the technology at large Kuzbass thermal power stations are presented. The possibility of solving a serious environmental problem of reducing storage of the most toxic waste of coal enrichment in the location areas of coal washing plants and coal mining enterprises is demonstrated.

A methodology for small scale rural land use mapping in semi-arid developing countries using orbital imagery. Part 4: Review of land use surveys using orbital imagery outside of the USA

NASA Technical Reports Server (NTRS)

Vangenderen, J. L. (Principal Investigator); Lock, B. F.

1976-01-01

The author has identified the following significant results. Outside the U.S., various attempts were made to investigate the feasibility of utilizing orbital MSS imagery in the production of small scale land use maps. Overall, these studies are not as elaborate or extensive in their scope as the U.S. ones, and generally the non-U.S. investigators have employed nonsophisticated and less expensive techniques. A representative range of studies is presented to demonstrate the approaches and trends dealing with reprocessing, interpretation, classification, sampling, and ground truth procedures.

Technologies for Detecting Falsified and Substandard Drugs in Low and Middle-Income Countries

PubMed Central

Kovacs, Stephanie; Hawes, Stephen E.; Maley, Stephen N.; Mosites, Emily; Wong, Ling; Stergachis, Andy

2014-01-01

Falsified and substandard drugs are a global health problem, particularly in low- and middle-income countries (LMIC) that have weak pharmacovigilance and drug regulatory systems. Poor quality medicines have important health consequences, including the potential for treatment failure, development of antimicrobial resistance, and serious adverse drug reactions, increasing healthcare costs and undermining the public's confidence in healthcare systems. This article presents a review of the methods employed for the analysis of pharmaceutical formulations. Technologies for detecting substandard and falsified drugs were identified primarily through literature reviews. Key-informant interviews with experts augmented our methods when warranted. In order to aid comparisons, technologies were assigned a suitability score for use in LMIC ranging from 0–8. Scores measured the need for electricity, need for sample preparation, need for reagents, portability, level of training required, and speed of analysis. Technologies with higher scores were deemed the most feasible in LMICs. We categorized technologies that cost $10,000 USD or less as low cost, $10,000–100,000 USD as medium cost and those greater than $100,000 USD as high cost technologies (all prices are 2013 USD). This search strategy yielded information on 42 unique technologies. Five technologies were deemed both low cost and had feasibility scores between 6–8, and an additional four technologies had medium cost and high feasibility. Twelve technologies were deemed portable and therefore could be used in the field. Many technologies can aid in the detection of substandard and falsified drugs that vary from the simplest of checklists for packaging to the most complex mass spectrometry analyses. Although there is no single technology that can serve all the requirements of detecting falsified and substandard drugs, there is an opportunity to bifurcate the technologies into specific niches to address specific sections within the workflow process of detecting products. PMID:24671033

Investing in the foundation of sustainable development: pathways to scale up for early childhood development.

PubMed

Richter, Linda M; Daelmans, Bernadette; Lombardi, Joan; Heymann, Jody; Boo, Florencia Lopez; Behrman, Jere R; Lu, Chunling; Lucas, Jane E; Perez-Escamilla, Rafael; Dua, Tarun; Bhutta, Zulfiqar A; Stenberg, Karin; Gertler, Paul; Darmstadt, Gary L

2017-01-07

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Financial implications of compliance with EU waste management goals: Feasibility and consequences in a transition country.

PubMed

Mihajlović, Višnja; Vujić, Goran; Stanisavljević, Nemanja; Batinić, Bojan

2016-09-01

This paper outlines the approach that can assist decision makers to have first preliminary insights regarding costs of complying with requested European Union municipal waste management goals in transition and developing countries. Serbia, as a joining member of European Union, must confront itself with the challenges resulting from European Union waste management directives. Implementation of waste separation units and the construction of sanitary landfills is already in place in Serbia. However, new waste management practice will need additional transformation and will require implementation of waste treatment technologies for additional management of generated waste. Implementation of analyzed best available technology/techniques for waste treatment can support the country's effort in reaching the policy goals. However, the question here is how much will the implementation of additional waste treatments influence the overall waste management costs? Results of the scenario's financial viability show that composting and sanitary landfill are the most viable solutions regarding the costs, even under increasing discount rates. Although different discount rates influence the overall gate fees and net present values, the level of affordability for different scenarios remains the same. © The Author(s) 2016.

"More bang for the buck": exploring optimal approaches for guideline implementation through interviews with international developers.

PubMed

Gagliardi, Anna R

2012-11-15

Population based studies show that guidelines are underused. Surveys of international guideline developers found that many do not implement their guidelines. The purpose of this research was to interview guideline developers about implementation approaches and resources. Semi-structured telephone interviews were conducted with representatives of guideline development agencies identified in the National Guideline Clearinghouse and sampled by country, type of developer, and guideline clinical indication. Participants were asked to comment on the benefits and resource implications of three approaches for guideline implementation that varied by responsibility: developers, intermediaries, or users. Thirty individuals from seven countries were interviewed, representing government (n = 12) and professional (n = 18) organizations that produced guidelines for a variety of clinical indications. Organizations with an implementation mandate featured widely inconsistent funding and staffing models, variable approaches for choosing promotional strategies, and an array of dissemination activities. When asked to choose a preferred approach, most participants selected the option of including information within guidelines that would help users to implement them. Given variable mandate and resources for implementation, it was considered the most feasible approach, and therefore most likely to have impact due to potentially broad use. While implementation approaches and strategies need not be standardized across organizations, the findings may be used by health care policy makers and managers, and guideline developers to generate strategic and operational plans that optimize implementation capacity. Further research is needed to examine how to optimize implementation capacity by guideline developers, intermediaries and users.

Increasing health worker capacity through distance learning: a comprehensive review of programmes in Tanzania.

PubMed

Nartker, Anya J; Stevens, Liz; Shumays, Alyson; Kalowela, Martin; Kisimbo, Daniel; Potter, Katy

2010-12-31

Tanzania, like many developing countries, faces a crisis in human resources for health. The government has looked for ways to increase the number and skills of health workers, including using distance learning in their training. In 2008, the authors reviewed and assessed the country's current distance learning programmes for health care workers, as well as those in countries with similar human resource challenges, to determine the feasibility of distance learning to meet the need of an increased and more skilled health workforce. Data were collected from 25 distance learning programmes at health training institutions, universities, and non-governmental organizations throughout the country from May to August 2008. Methods included internet research; desk review; telephone, email and mail-in surveys; on-site observations; interviews with programme managers, instructors, students, information technology specialists, preceptors, health care workers and Ministry of Health and Social Welfare representatives; and a focus group with national HIV/AIDS care and treatment organizations. Challenges include lack of guidelines for administrators, instructors and preceptors of distance learning programmes regarding roles and responsibilities; absence of competencies for clinical components of curricula; and technological constraints such as lack of access to computers and to the internet. Insufficient funding resulted in personnel shortages, lack of appropriate training for personnel, and lack of materials for students.Nonetheless, current and prospective students expressed overwhelming enthusiasm for scale-up of distance learning because of the unique financial and social benefits offered by these programs. Participants were retained as employees in their health care facilities, and remained in their communities and supported their families while advancing their careers. Space in health training institutions was freed up for new students entering in-residence pre-service training. A blended print-based distance learning model is most feasible at the national level due to current resource and infrastructure constraints. With an increase in staffing; improvement of infrastructure, coordination and curricula; and decentralization to the zonal or district level, distance learning can be an effective method to increase both the skills and the numbers of qualified health care workers capable of meeting the health care needs of the Tanzanian population.

Comparing end-of-life practices in different policy contexts: a scoping review.

PubMed

Boivin, Antoine; Marcoux, Isabelle; Garnon, Geneviève; Lehoux, Pascale; Mays, Nicholas; Prémont, Marie-Claude; Chao, Yi-Sheng; van Leeuwen, Evert; Pineault, Raynald

2015-04-01

End-of-life policy reforms are being debated in many countries. Research evidence is used to support different assumptions about the effects of public policies on end-of-life practices. It is however unclear whether reliable international practice comparisons can be conducted between different policy contexts. Our aim was to assess the feasibility of comparing similar end-of-life practices in different policy contexts. This is a scoping review of empirical studies on medical end-of-life practices. We developed a descriptive classification of end-of-life practices that distinguishes practices according to their legal status. We focused on the intentional use of lethal drugs by physicians because of international variations in the legal status of this practice. Bibliographic database searches were supplemented by expert consultation and hand searching of reference lists. The sensitivity of the search strategy was tested using a set of 77 articles meeting our inclusion criteria. Two researchers extracted end-of-life practice definitions, study methods and available comparisons across policy contexts. Canadian decision-makers were involved to increase the policy relevance of the review. In sum, 329 empirical studies on the intentional use of lethal drugs by doctors were identified, including studies from 19 countries. The bibliographic search captured 98.7% of studies initially identified as meeting the inclusion criteria. Studies on the intentional use of lethal drugs were conducted in jurisdictions with permissive (62%) and restrictive policies (43%). The most common study objectives related to the frequency of end-of-life practices, determinants of practices, and doctors' adherence to regulatory standards. Large variations in definitions and research methods were noted across studies. The use of a descriptive classification was useful to translate end-of-life practice definitions across countries. A few studies compared end-of-life practice in countries with different policies, using consistent research methods. We identified no comprehensive review of end-of-life practices across different policy contexts. It is feasible to compare end-of-life practices in different policy contexts. A systematic review of international evidence is needed to inform public deliberations on end-of-life policies and practice. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Increasing health worker capacity through distance learning: a comprehensive review of programmes in Tanzania

PubMed Central

2010-01-01

Background Tanzania, like many developing countries, faces a crisis in human resources for health. The government has looked for ways to increase the number and skills of health workers, including using distance learning in their training. In 2008, the authors reviewed and assessed the country's current distance learning programmes for health care workers, as well as those in countries with similar human resource challenges, to determine the feasibility of distance learning to meet the need of an increased and more skilled health workforce. Methods Data were collected from 25 distance learning programmes at health training institutions, universities, and non-governmental organizations throughout the country from May to August 2008. Methods included internet research; desk review; telephone, email and mail-in surveys; on-site observations; interviews with programme managers, instructors, students, information technology specialists, preceptors, health care workers and Ministry of Health and Social Welfare representatives; and a focus group with national HIV/AIDS care and treatment organizations. Results Challenges include lack of guidelines for administrators, instructors and preceptors of distance learning programmes regarding roles and responsibilities; absence of competencies for clinical components of curricula; and technological constraints such as lack of access to computers and to the internet. Insufficient funding resulted in personnel shortages, lack of appropriate training for personnel, and lack of materials for students. Nonetheless, current and prospective students expressed overwhelming enthusiasm for scale-up of distance learning because of the unique financial and social benefits offered by these programs. Participants were retained as employees in their health care facilities, and remained in their communities and supported their families while advancing their careers. Space in health training institutions was freed up for new students entering in-residence pre-service training. Conclusions A blended print-based distance learning model is most feasible at the national level due to current resource and infrastructure constraints. With an increase in staffing; improvement of infrastructure, coordination and curricula; and decentralization to the zonal or district level, distance learning can be an effective method to increase both the skills and the numbers of qualified health care workers capable of meeting the health care needs of the Tanzanian population. PMID:21194417

Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies.

PubMed

Kipsaina, Chebiwot; Ozanne-Smith, Joan; Bartolomeos, Kidist; Routley, Virginia

2015-08-01

Globally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low-middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs. This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. A manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each country's Principal Investigator. Questionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. The mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances and monitoring injury trends and risk factors in LMICs. However, further piloting is needed, including in rural areas and training of forensic pathologists and data-recorders to overcome some of the difficulties experienced in the pilot countries. The key to attracting ongoing funding and support from governments and donors in LMICs for fatal injury surveillance lies in further demonstrating the usefulness of collected data. Copyright © 2015 Elsevier Ltd. All rights reserved.

Capacity Building for Rare Bleeding Disorders in the Remote Commonwealth of the Northern Mariana Islands.

PubMed

Lin, Tiffany F; Carhill, Pam; Huang, James N; Baker, Judith R

2016-04-01

The US Pacific Commonwealth of the Northern Mariana Islands is home to an underserved hemophilia population. We developed a strategy in 2014 to build sustainable island-wide medical, patient and family, and community support for this rare disease. Collaboration with regional bleeding disorder leadership galvanized a weeklong conference series. More than 200 participants attended discipline-specific seminars; pre-post test evaluations documented educational benefits. This time-concentrated island-wide education intervention promoted the rapid identification of new cases and stimulated sustainable bleeding disorder care development. The education series proved feasible, efficient, and effective in increasing knowledge and reducing patient and professional isolation, serving as a model for improving capacity for orphan diseases (those that affect fewer than 200 000 people in any particular country) in underresourced areas.

Feasibility Study of Radiometry for Airborne Detection of Aviation Hazards

NASA Technical Reports Server (NTRS)

Gimmestad, Gary G.; Papanicolopoulos, Chris D.; Richards, Mark A.; Sherman, Donald L.; West, Leanne L.; Johnson, James W. (Technical Monitor)

2001-01-01

Radiometric sensors for aviation hazards have the potential for widespread and inexpensive deployment on aircraft. This report contains discussions of three aviation hazards - icing, turbulence, and volcanic ash - as well as candidate radiometric detection techniques for each hazard. Dual-polarization microwave radiometry is the only viable radiometric technique for detection of icing conditions, but more research will be required to assess its usefulness to the aviation community. Passive infrared techniques are being developed for detection of turbulence and volcanic ash by researchers in this country and also in Australia. Further investigation of the infrared airborne radiometric hazard detection approaches will also be required in order to develop reliable detection/discrimination techniques. This report includes a description of a commercial hyperspectral imager for investigating the infrared detection techniques for turbulence and volcanic ash.

Laparoscopic telesurgery between the United States and Singapore.

PubMed

Lee, B R; Png, D J; Liew, L; Fabrizio, M; Li, M K; Jarrett, J W; Kavoussi, L R

2000-09-01

Telemedicine is the use of electronic digital signals to transfer information from one site to another. With the advent of a telepresence operative system and development of remote robotic arms to hold and manoeuvre the laparoscope, telemedicine is finding its role in surgery, especially laparoscopic surgery. CLINICAL FEATURES AND TREATMENT: We report two successful cases of laparoscopic surgery--radical nephrectomy and varicocelectomy for a 3-cm renal tumour and for bilateral varicoceles causing pain, where a less experienced laparoscopic surgeon in Singapore was telementored by an experienced laparoscopic surgeon located remotely in the United States. Both patients recovered uneventfully and returned home on postoperative day 4 and on the day of surgery, respectively. This study demonstrates that telementored laparoscopic systems are feasible and safe, between countries halfway across the world. As the Internet expands in utility and the cost of higher bandwidth telecommunication lines decreases, even to remote countries, telementoring systems will become more affordable and may potentially pave the way for advanced surgical and laparoscopic applications and training for the future.

Group B Streptococcus vaccine: state of the art

PubMed Central

Nuccitelli, Annalisa; Rinaudo, C. Daniela

2015-01-01

Group B Streptococcus (GBS) is cause of neonatal invasive diseases as well as of severe infections in the elderly and immune-compromised patients. Despite significant advances in the prevention and treatment of neonatal disease, sepsis and meningitis caused by GBS still represent a significant public health care concern globally and additional prevention and therapeutic strategies against infection are highly desirable. The introduction of national recommended guidelines in several countries to screen pregnant women for GBS carriage and the use of antibiotics during delivery significantly reduced disease occurring within the first hours of life (early-onset disease), but it has had no effect on the late-onset diseases occurring after the first week and is not feasible in most countries. Availability of an effective vaccine against GBS would provide an effective means of controlling GBS disease. This review provides an overview of the burden of invasive disease caused by GBS in infants and adults, and highlights the strategies for the development of an effective vaccine against GBS infections. PMID:26288735

Developing global indicators for quality of maternal and newborn care: a feasibility assessment

PubMed Central

Smith, Helen; Mathai, Matthews; Roos, Nathalie; van den Broek, Nynke

2017-01-01

Abstract Objective To assess the feasibility of applying the World Health Organization’s proposed 15 indicators of quality of care for maternal and newborn health at health-facility level in low- and middle-income settings. Methods Six of the indicators are about maternal health, five are for newborn health and four are general cross-cutting indicators. We used data collected routinely in facility registers and obtained as part of facility assessments from 963 health-care facilities specializing in maternity services in 10 countries in Africa and Asia. We made a feasibility assessment of the availability of data and the clarity of indicator definitions and identified additional information and data collection processes needed to apply the proposed indicators in real-life settings. Findings Of the indicators evaluated, 10 were clearly defined, of which four could be applied directly in the field and six would require revisions to operationalize them. The other five indicators require further development, with one of them being ready for implementation by using information readily available in registers and four requiring further information before deployment. For indicators that measure coverage of care or availability of services or products, there is a need to further strengthen measurement. Information on emergency obstetric complications was not recorded in a standard manner, thus limiting the reliability of the information. Conclusion While some of the proposed indicators can already be applied, other indicators need to be refined or will need additional sources and methods of data collection to be applied in real-world settings. PMID:28603311

The world outlook for conventional agriculture. More emphasis is needed on farm price policy and plant research if future world food needs are to be met.

PubMed

Brown, L R

1967-11-03

1) The worldwide demand for food will continue to be strong in the coming decades. Two forces-rapidly growing population and, in much of the world, rapidly rising incomes-are expected to result in increases in the demand for food even more rapid than those that have occurred during the past. 2) Conventional agriculture has assured an adequate food supply for the economically advanced one-third of the world. The challenge now is to assure an adequate food supply for the remaining two-thirds, where population is now increasing at the rate of 1 million people per week and where malnutrition is already widespread. 3) Economically feasible prospects for significantly expanding the world's area of cultivated land in the 1960's and 1970's are limited and largely confined to sub-Saharan Africa and the Amazon Basin. Even here, agronomic problems will limit the rate of expansion. When the cost of desalting seawater is substantially reduced-probably not before the late 1970's or early 1980's at best-it may become feasible to irrigate large areas of desert. 4) Given the limited possibilities for expanding the area of land under cultivation, most of the increases in world food needs must be met, for the foreseeable future, by raising the productivity of land already under cultivation. Food output per acre, rather static throughout most of history, has begun to increase rapidly in some of the more advanced countries in recent decades. All of the increases in food production over the past quarter century in North America, western Europe, and Japan have come from increasing the productivity of land already under cultivation. The area under cultivation has actually declined. 5) Achieving dramatic gains in land productivity requires a massive investment of capital and the widespread adoption of new technology. A similar effort must now be made in the less-developed nations if these nations are to feed their people. The most important single factor influencing this rate of investment is food prices, more particularly the relationship between the price farmers receive for their food products and the cost of modern inputs such as fertilizer. 6) In some of the more-developed countries where per-acre yields have been rising for a long time, there is now evidence that the rate of yield increase may be slowing. Nonrecurring inputs may have made their maximum contribution to output in the case of some crops, pushing yield levels past the middle of the S-shaped logistic curve. Although this cannot be determined with any certainty, the possibility that the middle of the curve has been passed in some instances should be taken into account in viewing the long-term future. 7) If the rate of increase in yield per acre does in fact begin to slow in some of the agriculturally advanced countries, additional pressure will be put on the less-developed countries-which have much of the world's unrealized food-production potential-to meet the continuing future increases in world food needs. 8) Man has not yet been able to bypass the process of photosynthesis in the production of food. This dependence on photosynthesis plays a significant role in determining the upper levels of the S-shaped yield curve. Additional research is urgently needed to increase the photosynthetic efficiency of crops and to raise the upper levels of economically feasible yields.

Delivering vaccines to the people who need them most

PubMed Central

Barocchi, Michèle Anne; Rappuoli, Rino

2015-01-01

Thanks to the Global Alliance for Vaccines and Immunization (GAVI), the Vaccine Fund and the Bill & Melinda Gates Foundation, the global health community has made enormous progress in providing already existing vaccines to developing countries. However, there still exists a gap to develop vaccines for which there is no market in the Western world, owing to low economic incentives for the private sector to justify the investments necessary for vaccine development. In many cases, industry has the technologies, but lacks the impetus to direct resources to develop these vaccine products. The present emergency with the Ebola vaccine provides us an excellent example where a vaccine was feasible several years ago, but the global health community waited for a humanitarian disaster to direct efforts and resources to develop this vaccine. In the beginning of 2015, the first large-scale trials of two experimental vaccines against Ebola virus disease have begun in West Africa. During the past few years, several institutions have dedicated efforts to the development of vaccines against diseases present only in low-income countries. These include the International Vaccine Institute, the Novartis Vaccines Institute for Global Health, the Hilleman Institute, the Sabin Vaccine Institute and the Infectious Disease Research Institute. Nevertheless, solving this problem requires a more significant global effort than that currently invested. These efforts include a clear policy, global coordination of funds dedicated to the development of neglected disease and an agreement on regulatory strategies and incentives for the private sector. PMID:25964460

Is the Mediterranean diet a feasible approach to preserving cognitive function and reducing risk of dementia for older adults in Western countries? New insights and future directions.

PubMed

Knight, Alissa; Bryan, Janet; Murphy, Karen

2016-01-01

The rise in the ageing population has resulted in increased incident rates of cognitive impairment and dementia. The subsequent financial and societal burden placed on an already strained public health care system is of increasing concern. Evidence from recent studies has revealed modification of lifestyle and dietary behaviours is, at present, the best means of prevention. Some of the most important findings, in relation to the Mediterranean diet (MedDiet) and the contemporary Western diet, and potential molecular mechanisms underlying the effects of these two diets on age-related cognitive function, are discussed in this review. A major aim of this review was to discuss whether or not a MedDiet intervention would be a feasible preventative approach against cognitive decline for older adults living in Western countries. Critical appraisal of the literature does somewhat support this idea. Demonstrated evidence highlights the MedDiet as a potential strategy to reduce cognitive decline in older age, and suggests the Western diet may play a role in the aetiology of cognitive decline. However, strong intrinsic Western socio-cultural values, traditions and norms may impede on the feasibility of this notion. Copyright © 2015 Elsevier B.V. All rights reserved.

Hexavalent IPV-based combination vaccines for public-sector markets of low-resource countries

PubMed Central

Mahmood, Kutub; Pelkowski, Sonia; Atherly, Deborah; Sitrin, Robert; Donnelly, John J

2013-01-01

In anticipation of the successful eradication of wild polio virus, alternative vaccination strategies for public-sector markets of low-resource countries are extremely important, but are still under development. Following polio eradication, inactivated polio vaccine (IPV) would be the only polio vaccine available, and would be needed for early childhood immunization for several years, as maintenance of herd immunity will be important for sustaining polio eradication. Low-cost combination vaccines containing IPV could provide reliable and continuous immunization in the post-polio eradication period. Combination vaccines can potentially simplify complex pediatric routine immunization schedules, improve compliance, and reduce costs. Hexavalent vaccines containing Diphtheria (D), Tetanus (T), whole cell pertussis (wP), Hepatitis B (HBV), Haemophilus b (Hib) and the three IPV serotype antigens have been considered as the ultimate combination vaccine for routine immunization. This product review evaluates potential hexavalent vaccine candidates by composition, probable time to market, expected cost of goods, presentation, and technical feasibility and offers suggestions for development of low-cost hexavalent combination vaccines. Because there are significant technical challenges facing wP-based hexavalent vaccine development, this review also discusses other alternative approaches to hexavalent that could also ensure a timely and reliable supply of low-cost IPV based combination vaccines. PMID:23787559

International Approaches for Nuclear Waste Disposal in Geological Formations: Geological Challenges in Radioactive Waste Isolation—Fifth Worldwide Review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Faybishenko, Boris; Birkholzer, Jens; Sassani, David

The overall objective of the Fifth Worldwide Review (WWR-5) is to document the current state-of-the-art of major developments in a number of nations throughout the World pursuing geological disposal programs, and to summarize challenging problems and experience that have been obtained in siting, preparing and reviewing cases for the operational and long-term safety of proposed and operating nuclear waste repositories. The scope of the Review is to address current specific technical issues and challenges in safety case development along with the interplay of technical feasibility, siting, engineering design issues, and operational and post-closure safety. In particular, the chapters included inmore » the report present the following types of information: the current status of the deep geological repository programs for high level nuclear waste and low- and intermediate level nuclear waste in each country, concepts of siting and radioactive waste and spent nuclear fuel management in different countries (with the emphasis of nuclear waste disposal under different climatic conditions and different geological formations), progress in repository site selection and site characterization, technology development, buffer/backfill materials studies and testing, support activities, programs, and projects, international cooperation, and future plans, as well as regulatory issues and transboundary problems.« less

Hexavalent IPV-based combination vaccines for public-sector markets of low-resource countries.

PubMed

Mahmood, Kutub; Pelkowski, Sonia; Atherly, Deborah; Sitrin, Robert D; Donnelly, John J

2013-09-01

In anticipation of the successful eradication of wild polio virus, alternative vaccination strategies for public-sector markets of low-resource countries are extremely important, but are still under development. Following polio eradication, inactivated polio vaccine (IPV) would be the only polio vaccine available, and would be needed for early childhood immunization for several years, as maintenance of herd immunity will be important for sustaining polio eradication. Low-cost combination vaccines containing IPV could provide reliable and continuous immunization in the post-polio eradication period. Combination vaccines can potentially simplify complex pediatric routine immunization schedules, improve compliance, and reduce costs. Hexavalent vaccines containing Diphtheria (D), Tetanus (T), whole cell pertussis (wP), Hepatitis B (HBV), Haemophilus b (Hib) and the three IPV serotype antigens have been considered as the ultimate combination vaccine for routine immunization. This product review evaluates potential hexavalent vaccine candidates by composition, probable time to market, expected cost of goods, presentation, and technical feasibility and offers suggestions for development of low-cost hexavalent combination vaccines. Because there are significant technical challenges facing wP-based hexavalent vaccine development, this review also discusses other alternative approaches to hexavalent that could also ensure a timely and reliable supply of low-cost IPV based combination vaccines.

Evaluation System and Implementation Countermeasure of Automobile Green Maintenance

NASA Astrophysics Data System (ADS)

Zhang, Fei; Xie, Xinxin; Yan, Chaoyong

2018-01-01

Green maintenance research is in the beginning of our country, the work is being explored. Based on the existing research results at home and abroad, this paper learns and draws lessons from the experiences and lessons of foreign advanced countries and domestic advanced enterprises. In the face of the challenges brought by economic development and energy saving and emission reduction, this paper discusses the green maintenance theory and security system, And the research status of green maintenance content and system at home and abroad, through the deletion and selection of green maintenance index, through the AHP method to determine the green evaluation criteria, and the introduction of C equivalent evaluation system, the use of fuzzy synthesis Evaluation method to build a green maintenance evaluation model, and the actual validation, put forward the implementation of green maintenance feasibility programs and related security recommendations, vehicle maintenance enterprises to carry out green maintenance, improve business efficiency and reduce environmental management costs to provide theoretical basis. And to achieve effective reduction of environmental pollution, reduce maintenance costs of the target, a reasonable promotion of maintenance and environmental protection and sustainable development. Promote green maintenance from research to practice, from the laboratory to the maintenance of enterprises, from the pilot to the overall development and transformation.

Individual capacity-building approaches in a global pharmaceutical systems strengthening program: a selected review.

PubMed

Konduri, Niranjan; Rauscher, Megan; Wang, Shiou-Chu Judy; Malpica-Llanos, Tanya

2017-01-01

Medicines use related challenges such as inadequate adherence, high levels of antimicrobial resistance and preventable adverse drug reactions have underscored the need to incorporate pharmaceutical services to help achieve desired treatment outcomes, and protect patients from inappropriate use of medicines. This situation is further constrained by insufficient numbers of pharmaceutical personnel and inappropriate skill mix. Studies have addressed individual capacity building approaches of logistics, supply chain or disease specific interventions but few have documented those involving such pharmacy assistants/professionals, or health workers/professionals charged with improving access and provision of pharmaceutical services. We examined how different training modalities have been employed and adapted to meet country-specific context and needs by a global pharmaceutical systems strengthening program in collaboration with a country's Ministry of Health and local stakeholders. Structured, content analysis of training approaches from twelve selected countries and a survey among conveniently selected trainees in Bangladesh and Ethiopia. Case-based learning, practice and feedback, and repetitive interventions such as post-training action plan, supportive supervision and mentoring approaches are effective, evidence-based training techniques. In Ethiopia and Bangladesh, over 94% of respondents indicated that they have improved or developed skills or competencies as a result of the program's training activities. Supportive supervision structures and mentorship have been institutionalized with appropriate management structures. National authorities have been sensitized to secure funding from domestic resources or from the global fund grants for post-training follow-up initiatives. The Pharmaceutical Leadership Development Program is an effective, case-based training modality that motivates staff to develop quality-improvement interventions and solve specific challenges. Peer-to-peer learning mechanisms than traditional didactic methods was a preferred intervention among high level government officials both within country and between countries. Interventions must involve local institutions in the design and delivery of content for both pre-service and in-service training as well as web-based methods where feasible. Such efforts would meet the changing demand in the pharmaceutical system, and promote the ownership of the human capacity development interventions. The cost-effective partnership with universities demonstrate that competency based pre-service training will prepare the future pharmaceutical workforce with a critical foundation of knowledge and skills required to meet the growing demand for patient-centered pharmaceutical services in resource-constrained countries.

Cost-effectiveness thresholds: pros and cons.

PubMed

Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

2016-12-01

Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

Direct Saliva Real Time Polymerase Chain Reaction Assay Shows Low Birth Prevalence of Congenital CMV Infection in Urban Western India.

PubMed

Viswanathan, Rajlakshmi; Bafna, Sanjay; Mergu, Ravikanth; Deshpande, Gururajrao; Gunjikar, Rashmi; Gaikwad, Shivshankar; Mullick, Jayati

2018-05-09

Congenital cytomegalovirus infection is the leading infectious cause of mental retardation, developmental delay and sensorineural deafness. Non primary infection plays a major role in transmission of this infection in countries with high maternal seroprevalence. Non invasive sampling and testing is a useful alternative to traditional methods of laboratory detection of congenital CMV infection. The present study was conducted to understand birth prevalence of congenital cytomegalovirus (cCMV) infection using molecular techniques, in an urban setting of a developing country with evidence of high maternal seroprevalence. Universal newborn screening for cCMV was performed for 750 infants born at a tertiary care centre in Western India. Real-time PCR was directly carried out on saliva samples. Follow up laboratory testing of saliva, urine and blood was performed for neonates identified as positive. Sequential clinical follow up was offered to the affected infants. A birth prevalence of 0.4% (95% CI 0.13-1.2) was observed with 3 of 750 babies confirmed to be positive for cCMV infection. All three babies were born to seropositive mothers (anti CMV IgG positive). One of the babies detected was symptomatic with sepsis like features. All of them survived and did not develop any sequelae upto one year of age. The use of direct real-time PCR of saliva samples can be considered as a feasible option for newborn screening of congenital CMV infection in developing countries. Relatively low birth prevalence of cCMV infection was observed in our study, which needs to be corroborated through further studies.

The Development of Best Practice Recommendations to Support the Hiring, Recruitment, and Advancement of Women Physicians in Emergency Medicine.

PubMed

Choo, Esther K; Kass, Dara; Westergaard, Mary; Watts, Susan H; Berwald, Nicole; Regan, Linda; Promes, Susan B; Clem, Kathleen J; Schneider, Sandra M; Kuhn, Gloria J; Abbuhl, Stephanie; Nobay, Flavia

2016-11-01

Women in medicine continue to experience disparities in earnings, promotion, and leadership roles. There are few guidelines in place defining organization-level factors that promote a supportive workplace environment beneficial to women in emergency medicine (EM). We assembled a working group with the goal of developing specific and feasible recommendations to support women's professional development in both community and academic EM settings. We formed a working group from the leadership of two EM women's organizations, the Academy of Women in Academic Emergency Medicine (AWAEM) and the American Association of Women Emergency Physicians (AAWEP). Through a literature search and discussion, working group members identified four domains where organizational policies and practices supportive of women were needed: 1) global approaches to supporting the recruitment, retention, and advancement of women in EM; 2) recruitment, hiring, and compensation of women emergency physicians; 3) supporting development and advancement of women in EM; and 4) physician health and wellness (in the context of pregnancy, childbirth, and maternity leave). Within each of these domains, the working group created an initial set of specific recommendations. The working group then recruited a stakeholder group of EM physician leaders across the country, selecting for diversity in practice setting, geographic location, age, race, and gender. Stakeholders were asked to score and provide feedback on each of the recommendations. Specific recommendations were retained by the working group if they achieved high rates of approval from the stakeholder group for importance and perceived feasibility. Those with >80% agreement on importance and >50% agreement on feasibility were retained. Finally, recommendations were posted in an open online forum (blog) and invited public commentary. An initial set of 29 potential recommendations was created by the working group. After stakeholder voting and feedback, 16 final recommendations were retained. Recommendations were refined through qualitative comments from stakeholders and blog respondents. Using a consensus building process that included male and female stakeholders from both academic and community EM settings, we developed recommendations for organizations to implement to create a workplace environment supportive of women in EM that were perceived as acceptable and feasible. This process may serve as a model for other medical specialties to establish clear, discrete organization-level practices aimed at supporting women physicians. © 2016 by the Society for Academic Emergency Medicine.

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement.

PubMed

Ambrosino, Nicolino; Vitacca, Michele; Dreher, Michael; Isetta, Valentina; Montserrat, Josep M; Tonia, Thomy; Turchetti, Giuseppe; Winck, Joao Carlos; Burgos, Felip; Kampelmacher, Michael; Vagheggini, Guido

2016-09-01

The estimated prevalence of ventilator-dependent individuals in Europe is 6.6 per 100 000 people. The increasing number and costs of these complex patients make present health organisations largely insufficient to face their needs. As a consequence, their burden lays mostly over families. The need to reduce healthcare costs and to increase safety has prompted the development of tele-monitoring for home ventilatory assistance.A European Respiratory Society Task Force produced a literature research based statement on commonly accepted clinical criteria for indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of these patients.Many remote health monitoring systems are available, ensuring safety, feasibility, effectiveness, sustainability and flexibility to face different patients' needs. The legal problems associated with tele-monitoring are still controversial. National and European Union (EU) governments should develop guidelines and ethical, legal, regulatory, technical, administrative standards for remote medicine. The economic advantages, if any, of this new approach must be compared to a "gold standard" of home care that is very variable among different European countries and within each European country.Much more research is needed before considering tele-monitoring a real improvement in the management of these patients. Copyright ©ERS 2016.

Beyond the permissibility of embryonic and stem cell research: substantive requirements and procedural safeguards.

PubMed

Isasi, Rosario M; Knoppers, Bartha M

2006-10-01

This report provides a comparative analysis of the regulation of embryonic stem cells and cloning research in 50 countries. The development of international stem cell consortia involving the exchange of materials, data and knowledge presumes 'policy know-how' on the varying positions and governing regulations of the various partners; knowledge is essential for the feasibility of such international collaborative projects. Across the spectrum of restrictive-to-liberal policies, requirements regarding the justification for or the setting of substantive limits on (i) embryo use and/or (ii) destruction in research are often present. These goals justify the regulation, the control and even the prohibition of embryonic stem cell and cloning research. Moreover, irrespective of whether a country adopts a restrictive or a liberal approach, there is significant symmetry in both the substantive and the procedural requirements. Procedural safeguards provide another layer of protection and control over the research. In reality, such safeguards may have a greater systemic impact than the substantive requirements. They can be subdivided into three broad categories: (i) safeguards relating to the stage of embryonic development, (ii) safeguards relating to the donors of blastocysts, gametes, embryos and somatic cells and (iii) requirements for research governance.

Challenges in developing health promoting schools' project: application of global traits in local realm.

PubMed

Fathi, Behrouz; Allahverdipour, Hamid; Shaghaghi, Abdolreza; Kousha, Ahmad; Jannati, Ali

2014-01-01

Despite the importance of student health and school hygiene as an aspect of the infrastructure of community health, few feasibility studies have been conducted on school health programs in developing countries. This study examined possible barriers to and challenges of such programs from the executive perspective in East Azerbaijan Province in Iran. This qualitative study used the content analysis approach to recognize barriers to and challenges of health promoting school program from the executive perspective. Fourteen experts were selected in the areas of children and adolescents and school health, physical education and school headmasters. Data were collected using semi-structured interviews and analyzed using the content analysis method. Five themes were extracted as major barriers and challenges: 1. Intraand inter-sectorial collaboration; 2. Policy and rule formulation; 3. Infrastructure and capacity; 4. Human resources; 5. Community involvement. The localized version of the current health promoting school program had major faults. If this program is considered to be a healthcare system priority, it should be revised to set effective policies for implementation and to sustain school health programs based on the capacities and objectives of each country.

Design, implementation and scaling up of the balanced scorecard for hospitals in Lebanon: policy coherence and application lessons for low and middle income countries.

PubMed

El-Jardali, Fadi; Saleh, Shadi; Ataya, Nour; Jamal, Diana

2011-12-01

This paper describes the development and implementation of the first national hospital performance indicators in Lebanon including its institutionalization within existing policy framework and the initiation of independent governance structure for sustainability. Guided by the Ontario Acute Care Balanced Scorecard framework, a step-wise approach was used. Guiding principles were non-punitive reporting, anonymity, voluntary participation, stakeholder involvement, consensus and feasibility. Modified Delphi technique was used, readiness assessment surveys in 52 hospitals were conducted, pilot testing and evaluation were completed in 14 hospitals. Initial balanced set of 21 indicators were selected. Findings showed wide variations in indicators' measurement in hospitals including formulas and tools. Barriers to measurement included lack of quality culture, physician resistance and resources. A gradual implementation strategy was developed and selected indicators were divided into two levels. Most piloted indicators proved to be valid, feasible and reliable. The initiative was linked to the national hospital accreditation system resulting in a balanced set of 40 indicators. An independent, not-for-profit, arm's-length organization was established. This is among the first attempts made in the East Mediterranean Region to adapt the BSC approach and translate the experience of its development to addresses local needs and contextual reality. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Pathways towards chronic care-focused healthcare systems: evidence from Spain.

PubMed

García-Goñi, Manuel; Hernández-Quevedo, Cristina; Nuño-Solinís, Roberto; Paolucci, Francesco

2012-12-01

Increasing healthcare expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include ageing, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most healthcare systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. New models of chronic care provision have been developed to respond to the changing burden of disease and there is already considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies focused on testing the feasibility of moving towards chronic care models. In particular, we discuss a framework that identifies and analyses ten key prerequisites to achieving high performing chronic care-based healthcare systems and apply it to the current Spanish National Health System (NHS). We find that the design of the Spanish NHS already meets some of these pre-requisites. However, other features are still in their early stages of development or are being applied only in limited geographical and clinical contexts. We outline the policies that are being implemented and the pathway that the Spanish NHS is taking to address the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy being followed by the Spanish NHS will significantly transform its current healthcare delivery model in the next few years. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A nursing solution to primary care delivery shortfall.

PubMed

Carter, Michael; Moore, Phillip; Sublette, Nina

2018-05-21

Many countries project that they will have difficulty to meet their demand for primary care based on an inadequate supply of primary care doctors. There are many reasons for this, and they tend to vary by country. The policy options available to these countries are to increase the number of local primary care doctors, recruit doctors from other countries, ration primary care, shift more primary care to specialists, or authorize other disciplines to provide primary care. This article examines lessons learned in the United States over the past 50 years and proposes that expanding the use of nurse practitioners is the best solution when measured by feasibility, costs, ethics, and scope of the care delivered. Using nurse practitioners trained in country meets the World Health Organization global code of practice regarding the international recruitment of health personnel. © 2018 John Wiley & Sons Ltd.

Feasibility and attractiveness of indication value-based pricing in key EU countries.

PubMed

Flume, Mathias; Bardou, Marc; Capri, Stefano; Sola-Morales, Oriol; Cunningham, David; Levin, Lars-Ake; Touchot, Nicolas

2016-01-01

Indication value-based pricing (IBP) has been proposed in the United States as a tool to capture the differential value of drugs across indications or patient groups and is in the early phases of implementation. In Europe, no major country has experimented with IBP or is seriously discussing its use. We assessed how the reimbursement and pricing environment allows for IBP in seven European countries, evaluating both incentives and hurdles. In price setting countries such as France and Germany, the Health Technology Assessment and pricing process already accounts for differences of value across indications. In countries where differential value drives coverage decisions such as the United Kingdom and Sweden, IBP is likely to be used, at least partially, but not in the short-term. Italy is already achieving some form of differential value through managed entry agreements, whereas in Spain the electronic prescription system provides the infrastructure necessary for IBP but other hurdles exist.

Cost feasibility of a pre-checking medical tourism system for U.S. patients undertaking joint replacement surgery in Taiwan.

PubMed

Haung, Ching-Ying; Wang, Sheng-Pen; Chiang, Chih-Wei

2010-01-01

Medical tourism is a relatively recent global economic and political phenomenon that has assumed increasing importance for developing countries, particularly in Asia. In fact, Taiwan possesses a niche for developing medical tourism because many hospitals provide state-of-the-art medicine in all disciplines and many doctors are trained in the United States (US). Among the most common medical procedures outsourced, joint replacements such as total knee replacement (TKR) and total hip replacement (THR) are two surgeries offered to US patients at a lower cost and shorter waiting time than in the US. This paper proposed a pre-checking medical tourism system (PCMTS) and evaluated the cost feasibility of recruiting American clients traveling to Taiwan for joint replacement surgery. Cost analysis was used to estimate the prime costs for each stage in the proposed PCMTS. Sensitivity analysis was implemented to examine how different pricings for medical checking and a surgical operation (MC&SO) and recovery, can influence the surplus per patient considering the PCMTS. Finally, the break-even method was adopted to test the tradeoff between the sunk costs of investment in the PCMTS and the annual surplus for participating hospitals. A novel business plan was built showing that pre-checking stations in medical tourism can provide post-operative care and recovery follow-up. Adjustable pricing for hospital administrators engaged in the PCMTS consisted of two main costs: US$3,700 for MC&SO and US$120 for the hospital stay. Guidelines for pricing were provided to maximize the annual surplus from this plan with different number of patients participating in PCMTS. The maximal profit margin from each American patient undertaking joint surgery is about US$24,315. Using cost analysis, this article might be the first to evaluate the feasibility of PCMTS for joint replacement surgeries. The research framework in this article is applicable when hospital administrators evaluate the feasibility of outsourced medical procedures other than TKR and THR.

How can a computer be useful to you? A feasibility study to elicit perceptions of computers in rural India.

PubMed

Bhavnani, Suresh K; Chavan, Apala L; Jain, Isha; Maroo, Sudhanshoo

2011-01-01

The growing influx of information and communication technologies (ICTs) into rural India provides new opportunities for the prevention and treatment of diseases across millions of residents. However, little is known about how rural Indians with little or no exposure to computers perceive computers and their uses, and how best to elicit those perceptions. Such perceptions could lead to new insights for using ICTs to affect health behavior change in developing countries. We therefore developed a semi-structured interview approach to probe how residents of a north Indian village perceived computers and their uses. The results suggest that besides helping to overturn several assumptions of the researchers through unexpected insights, the approach could be easily implemented in rural settings, which could lead to deeper insights for developing future culturally and medically-relevant ICTs for rural residents.

How Can a Computer be Useful to You? A Feasibility Study to Elicit Perceptions of Computers in Rural India

PubMed Central

Bhavnani, Suresh K.; Chavan, Apala L.; Jain, Isha; Maroo, Sudhanshoo

2011-01-01

The growing influx of information and communication technologies (ICTs) into rural India provides new opportunities for the prevention and treatment of diseases across millions of residents. However, little is known about how rural Indians with little or no exposure to computers perceive computers and their uses, and how best to elicit those perceptions. Such perceptions could lead to new insights for using ICTs to affect health behavior change in developing countries. We therefore developed a semi-structured interview approach to probe how residents of a north Indian village perceived computers and their uses. The results suggest that besides helping to overturn several assumptions of the researchers through unexpected insights, the approach could be easily implemented in rural settings, which could lead to deeper insights for developing future culturally and medically-relevant ICTs for rural residents. PMID:22195062

The Patient Reported Outcomes, Burdens and Experiences (PROBE) Project: development and evaluation of a questionnaire assessing patient reported outcomes in people with haemophilia.

PubMed

Skinner, M W; Chai-Adisaksopha, C; Curtis, R; Frick, N; Nichol, M; Noone, D; O'Mahony, B; Page, D; Stonebraker, J S; Iorio, A

2018-01-01

The interest of health care agencies, private payers and policy makers for patient-reported outcomes (PRO) is continuously increasing. There is a substantial need to improve capacity to collect and interpret relevant PRO data to support implementation of patient-centered research and optimal care in haemophilia. The Patient Reported Outcomes, Burdens and Experiences (PROBE) Project aims to develop a patient-led research network, to develop a standardized questionnaire to gather patient-reported outcomes and to perform a feasibility study of implementing the PROBE questionnaire. A pilot questionnaire was developed using focus group methodology. Content and face validity were assessed by a pool of persons living with haemophilia (PWH) and content experts through interactive workshops. The PROBE questionnaire was translated with the forward-backward approach. PROBE recruited national haemophilia patient non-governmental organizations (NGOs) to administer the questionnaire to people with and without haemophilia. PROBE measured the time to complete the questionnaire and gathered feedback on its content and clarity; staff time and cost required to implement the questionnaire were also collected. The PROBE questionnaire is comprised of four major sections (demographic data, general health problems, haemophilia-related health problems and health-related quality of life using EQ-5D-5L and EQ-VAS). Seventeen NGOs participated in the pilot study of the PROBE Project, recruiting 656 participants. Of these, 71% completed the questionnaire within 15 min, and all participants completed within 30 min. The median total staff and volunteer time required for the NGOs to carry out the study within their country was 9 h (range 2 to 40 h). NGO costs ranged from $22.00 to $543.00 USD per country, with printing and postage being the most commonly reported expenditures. The PROBE questionnaire assesses patient-important reported outcomes in PWH and control participants, with a demonstrated short completion time. PROBE proved the feasibility to engage diverse patient communities in the structured generation of real-world outcome research at all stages. Trial registration: NCT02439710.

A strategy to implement and support pre-hospital emergency medical systems in developing, resource-constrained areas of South Africa.

PubMed

Sun, Jared H; Shing, Rachel; Twomey, Michele; Wallis, Lee A

2014-01-01

Resource-constrained countries are in extreme need of pre-hospital emergency care systems. However, current popular strategies to provide pre-hospital emergency care are inappropriate for and beyond the means of a resource-constrained country, and so new ones are needed-ones that can both function in an under-developed area's particular context and be done with the area's limited resources. In this study, we used a two-location pilot and consensus approach to develop a strategy to implement and support pre-hospital emergency care in one such developing, resource-constrained area: the Western Cape province of South Africa. Local community members are trained to be emergency first aid responders who can provide immediate, on-scene care until a Transporter can take the patient to the hospital. Management of the system is done through local Community Based Organizations, which can adapt the model to their communities as needed to ensure local appropriateness and feasibility. Within a community, the system is implemented in a graduated manner based on available resources, and is designed to not rely on the whole system being implemented first to provide partial function. The University of Cape Town's Division of Emergency Medicine and the Western Cape's provincial METRO EMS intend to follow this model, along with sharing it with other South African provinces. Copyright © 2012 Elsevier Ltd. All rights reserved.

Identification of retention strategies for neurosurgeons in Iran: Results from expert panels.

PubMed

Rafiei, Sima; Abdollahzadeh, Sina; Hashemi, Fariba; Ranjbar, Mohammad

2017-04-04

Background: The key challenge is how to encourage and retain health professionals in their work location. There is a list of policy options for this purpose but applying an appropriate and effective set of strategies requires a country level research. Our study aimed to identify retention strategies for neurosurgeons and examine both the importance and feasibility of the identified strategies using expert panels' point of view. Methods: First of all, a literature review was conducted to identify retention strategies for physicians. Then to gain consensus on the strategies and determine their importance and feasibility an expert panel was organized and a modified Delphi process was used. Results: A total of 40 strategies were identified by the panel classified in seven categories of income and economic factors, professional/job factors, clinical infrastructure, personal/family factors, living condition and welfare, educational factors and career development, governmental regulations and management policies. Conclusion: Based on the study results, three areas of economic incentives, personal and professional factors got the greatest priority in health professional planning for retention purposes.

Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy

PubMed Central

Stich, August

2015-01-01

In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea. PMID:26539001

Familias Fuertes: a feasibility study with Mexican immigrants living in low-income conditions in the southeastern United States.

PubMed

Orpinas, Pamela; Reidy, Mary Clare; Lacy, Mary Elizabeth; Kogan, Steven M; Londoño-McConnell, Angela; Powell, Gwynn

2014-11-01

Families Fuertes (FF) is a seven-session, family-centered program for supporting positive youth development of Latino children aged 10 to 14 years. The Pan American Health Organization adapted it from the Strengthening Families Program for Parents and Youth for Spanish-speaking countries. The suitability of FF for recent immigrants to the United States is, however, unknown. This feasibility study assessed the appropriateness of FF with 12 low-income Mexican immigrant families residing in Georgia. Participants, a community liaison, and program staff evaluated (a) recruitment, retention, and evaluation strategies; and (b) the acceptability and promise of the curriculum. Recruitment and retention were very high; feedback of evaluation strategies was uniformly positive. Participants perceived that the program improved family relationships and that family members changed for the better. We detail practical and cultural adaptations to enhance the potential effectiveness of the program for this population. A version adapted to address acculturation-related stressors would increase the potential public health impact. © 2014 Society for Public Health Education.

Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy.

PubMed

Unnewehr, Markus; Stich, August

2015-11-01

In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea.

Can airborne ultrasound monitor bubble size in chocolate?

NASA Astrophysics Data System (ADS)

Watson, N.; Hazlehurst, T.; Povey, M.; Vieira, J.; Sundara, R.; Sandoz, J.-P.

2014-04-01

Aerated chocolate products consist of solid chocolate with the inclusion of bubbles and are a popular consumer product in many countries. The volume fraction and size distribution of the bubbles has an effect on their sensory properties and manufacturing cost. For these reasons it is important to have an online real time process monitoring system capable of measuring their bubble size distribution. As these products are eaten by consumers it is desirable that the monitoring system is non contact to avoid food contaminations. In this work we assess the feasibility of using an airborne ultrasound system to monitor the bubble size distribution in aerated chocolate bars. The experimental results from the airborne acoustic experiments were compared with theoretical results for known bubble size distributions using COMSOL Multiphysics. This combined experimental and theoretical approach is used to develop a greater understanding of how ultrasound propagates through aerated chocolate and to assess the feasibility of using airborne ultrasound to monitor bubble size distribution in these systems. The results indicated that a smaller bubble size distribution would result in an increase in attenuation through the product.

Integrating Mental Health and HIV Services in Zimbabwean Communities: A Nurse and Community-led Approach to Reach the Most Vulnerable.

PubMed

Duffy, Malia; Sharer, Melissa; Cornman, Helen; Pearson, Jennifer; Pitorak, Heather; Fullem, Andrew

Alcohol use and depression negatively impact adherence, retention in care, and HIV progression, and people living with HIV (PLWH) have disproportionately higher depression rates. In developing countries, more than 76% of people with mental health issues receive no treatment. We hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. A three-phase mixed-method design was used with a longitudinal cohort of 325 nurses, community health workers, and traditional medicine practitioners in nine communities. During Phase 3, 312 PLWH were screened by nurses for mental health symptoms; 28% were positive. Of 59 PLWH screened for harmful alcohol and substance use, 36% were positive. Community health workers and traditional medicine practitioners screened 123 PLWH; 54% were positive for mental health symptoms and 29% were positive for alcohol and substance abuse. Findings indicated that stepped-care was acceptable and feasible for all provider types. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Assessing the acceptability, feasibility, and effectiveness of a tablet-based cervical cancer educational intervention

PubMed Central

Caster, MM; Norris, AH; Butao, C; Carr Reese, P; Chemey, E; Phuka, J; Turner, AN

2016-01-01

Cervical cancer is a common and deadly disease, especially in developing countries. We developed and implemented an interactive, tablet-based educational intervention to improve cervical cancer knowledge among women in rural Malawi. Chichewa-speaking adult women in six rural villages participated. Each woman took a pre-test, participated in the lesson, and then took a post-test. The lesson included information on cervical cancer symptoms, causes, risk factors, prevention, and treatment. Over the 6-month study period, 243 women participated. Women ranged in age from 18 to 77 years. Only 15% had education beyond primary school. Nearly half of participants (48%) had heard of cervical cancer prior to viewing the lesson. For these women, the median number of correct responses on the pre-test was 11 out of 20; after the lesson, they had a median of 18 correct responses (p<0.001). After the intervention, 93% of women indicated a desire for cervical cancer screening. Despite lack of familiarity with computers (96%), most women (94%) found the tablet easy to use. A tablet-based educational program was an effective, feasible and acceptable strategy to disseminate cervical cancer information to women with low education in rural Malawi. This method may be appropriate to distribute health information about other health topics in low-resource settings. PMID:26637473

Feasibility of Developing a Protocol for Automated Protist Analysis

DTIC Science & Technology

2010-03-01

Acquisition Directorate Research & Development Center Report No: CG-D-02-ll Feasibility of Developing a Protocol for Automated Protist Analysis...Technical Information Service, Springfield, VA 22161. March 2010 Homeland Security Feasibility of Developing a Protocol for Automated Protist ...March 21)10 Feasibility of Developing a Protocol for Automated Protist Analysis 00 00 o CM Technical Report Documentation Page 1. Report No CG-D

The feasibility and acceptability of screening for hypertension in private drug retail outlets: a pilot study in Mwanza region, Tanzania.

PubMed

Michael, Denna; Kezakubi, Dotto; Juma, Adinan; Todd, Jim; Reyburn, Hugh; Renju, Jenny

2016-09-01

Hypertension is a major contributor to ill health in sub-Saharan Africa. Developing countries need to increase access for screening. This study assesses the feasibility and acceptability of using private sector drug retail outlets to screen for hypertension in Mwanza region, Tanzania. A pilot study took place in eight drug retail outlets from August 2013 to February 2014. Customers ≥18 years were invited for screening. Socio-demographic characteristics, hypertension knowledge, hypertension screening and treatment history were collected. Subjects with systolic blood pressure over 140 mmHg were referred for follow up. Referral slips captured attendance. Mystery client visits and follow up phone calls were conducted to assess service quality. A total of 971 customers were screened, one person refused; 109 (11.2%) had blood pressure over 140/90 mmHg and were referred for ongoing assessment; 85/109 (78.0%) were newly diagnosed. Customers reported that the service was acceptable. Service providers were able to follow the protocol. Only 18/85 (21%) newly diagnosed participants visited the referral clinic within two weeks. Blood pressure screening was feasible and acceptable to customers of private drug retail outlets. However many who were referred failed to attend at a referral centre and further research is needed in this area. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Integrated package approach in delivering interventions during immunisation campaigns in a complex environment in Papua New Guinea: a case study.

PubMed

Vince, John David; Datta, Siddhartha Sankar; Toikilik, Steven; Lagani, William

2014-08-06

Papua New Guinea's difficult and varied topography, poor transport infrastructure, changing dynamics of population and economy in recent times and understaffed and poorly financed health service present major challenges for successful delivery of vaccination and other preventative health interventions to both the rural majority and urban populations, thereby posing risks for vaccine preventable disease outbreaks in the country. The country has struggled to meet the vaccination coverage targets required for the eradication of poliomyelitis and elimination of measles. Escalation of inter and intra country migration resulting from major industrial developments, particularly in extraction industries, has substantially increased the risk of infectious disease importation. This case study documents the evolution of immunisation programmes since the introduction of supplementary immunisation activities (SIAs). Single antigen SIAs have advantages and disadvantages. In situations in which the delivery of preventative health interventions is difficult, it is likely that the cost benefit is greater for multiple than for single intervention. The lessons learned from the conduct of single antigen SIAs can be effectively used for programmes delivering multiple SIA antigens, routine immunisations, and other health interventions. This paper describes a successful and cost effective multiple intervention programme in Papua New Guinea. The review of the last SIA in Papua New Guinea showed relatively high coverage of all the interventions and demonstrated the operational feasibility of delivering multiple interventions in resource constrained settings. Studies in other developing countries such as Lesotho and Ethiopia have also successfully integrated health interventions with SIA. In settings such as Papua New Guinea there is a strong case for integrating supplementary immunisation activity with routine immunisation and other health interventions through a comprehensive outreach programme. Copyright © 2014 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

A strategic approach to selecting policy mechanisms for addressing coal mine methane emissions: A case study on Kazakhstan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roshchanka, Volha; Evans, Meredydd; Ruiz, Felicia

Coal production globally is projected to grow in the foreseeable future. Countries with heavy reliance on coal could reduce methane and other emissions through the capture and utilization of coal mine methane (CMM) in the short and medium term, while they pursue structural and long-term economic changes. Several countries have successfully implemented policies to promote CMM capture and utilization; however, some countries still struggle to implement projects. This paper outlines key factors to consider in adapting policies for CMM mitigation. The authors propose an approach for selecting adequate mechanisms for stimulating CMM mitigation that involves reviewing global best practices andmore » categorizing them functionally either as mechanisms needed to improve the underlying conditions or as CMM-specific policies. It is important to understand local policy frameworks and to consider whether it is more feasible to improve underlying policy conditions or to provide targeted incentives as an interim measure. Using Kazakhstan as a case study, the authors demonstrate how policymakers could assess the overall policy framework to find the most promising options to facilitate CMM projects. Kazakhstan’s emissions from underground coal mines have been increasing both in total and per tonne of coal production, while overall production has been declining. CMM mitigation presents an opportunity for the country to reduce its greenhouse gas emissions in the near and medium term, while the government pursues sustainable development goals. Analysis shows that policymakers in Kazakhstan can leverage existing policies to stimulate utilization by extending feed-in tariffs to cover CMM and by developing working methodologies for companies to obtain emission reduction credits from CMM projects.« less

The effect of social franchising on access to and quality of health services in low- and middle-income countries.

PubMed

Koehlmoos, Tracey Perez; Gazi, Rukhsana; Hossain, S Shahed; Zaman, K

2009-01-21

Social franchising has developed as a possible means of improving provision of health services through engaging the non-state sector in low- and middle-income countries. To examine the evidence that social franchising has on access to and quality of health services in low- and middle-income countries. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (up to October 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, Ovid (1950 to September Week 3 2007), EMBASE, Ovid (1980 to 2007 Week 38), CINAHL, Ovid (1982 to September Week 3 2007), EconLit, WebSPIRS (1969 to Sept 2007), LILACS, Science Citation Index Expanded and Social Sciences Citation Index (1975 to March 2008), Sociological Abstracts, CSA Illumnia (1952 September 2007), WHOLIS (1948 November 2007). Randomized controlled trials, non-randomized controlled trials, controlled before and after studies and interrupted time series comparing social franchising models with other models of health service delivery, other social franchising models or absence of health services. Two review authors independently applied the criteria for inclusion and exclusion of studies to scan titles and abstracts. The same two review authors independently screened full reports of selected citations . At each stage, results were compared and discrepancies settled through discussion. No studies were found which were eligible for inclusion in this review. There is a need to develop rigorous studies to evaluate the effects of social franchising on access to and quality of health services in low- and middle-income countries. Such studies should be informed by the wider literature to identify models of social franchising that have a sound theoretical basis and empirical research addressing their reach, acceptability, feasibility, maintenance and measurability.

Impacts of decline harvest of country food on nutrient intake among Inuit in Arctic Canada: impact of climate change and possible adaptation plan

PubMed Central

Rosol, Renata; Powell-Hellyer, Stephanie; Chan, Hing Man

2016-01-01

Background The pervasive food insecurity and the diet transition away from local, nutrient-rich country foods present a public health challenge among Inuit living in the Canadian Arctic. While environmental factors such as climate change decreased the accessibility and availability of many country food species, new species were introduced into regions where they were previously unavailable. An adaptation such as turning to alternate country food species can be a viable solution to substitute for the nutrients provided by the declined food species. The objective of this study was to estimate the impact on nutrient intake using hypothetical scenarios that current commonly harvested country foods were reduced by 50%, and were replaced with alternate or new species. Methods Data collected during the 2007–2008 Inuit Health Survey from 36 Canadian Arctic communities spanning Nunavut, the Inuvialuit Settlement Region and Nunatsiavut were used. Results A 50% decline in consumption of fish, whale, ringed seals and birds (the food that was reported to be in decline) resulted in a significant decrease in essential nutrient intake. Possible substitute foods were identified but some nutrients such as zinc and especially vitamin D were most often found lacking in the alternative diet. Conclusions If the alternative species are not available or feasible, more expensive and less nutritionally dense store-bought foods may be sought. Given the superior quality of country foods and their association with food security, and Inuit cultural health and personal identity, developing skills and awareness for adaptation, promoting regional sharing networks, forming a co-management agency and continuing nutritional monitoring may potentially preserve the nutritional integrity of Inuit diet, and in turn their health and cultural survival. PMID:27388896

Impacts of decline harvest of country food on nutrient intake among Inuit in Arctic Canada: impact of climate change and possible adaptation plan.

PubMed

Rosol, Renata; Powell-Hellyer, Stephanie; Chan, Hing Man

2016-01-01

The pervasive food insecurity and the diet transition away from local, nutrient-rich country foods present a public health challenge among Inuit living in the Canadian Arctic. While environmental factors such as climate change decreased the accessibility and availability of many country food species, new species were introduced into regions where they were previously unavailable. An adaptation such as turning to alternate country food species can be a viable solution to substitute for the nutrients provided by the declined food species. The objective of this study was to estimate the impact on nutrient intake using hypothetical scenarios that current commonly harvested country foods were reduced by 50%, and were replaced with alternate or new species. Data collected during the 2007-2008 Inuit Health Survey from 36 Canadian Arctic communities spanning Nunavut, the Inuvialuit Settlement Region and Nunatsiavut were used. A 50% decline in consumption of fish, whale, ringed seals and birds (the food that was reported to be in decline) resulted in a significant decrease in essential nutrient intake. Possible substitute foods were identified but some nutrients such as zinc and especially vitamin D were most often found lacking in the alternative diet. If the alternative species are not available or feasible, more expensive and less nutritionally dense store-bought foods may be sought. Given the superior quality of country foods and their association with food security, and Inuit cultural health and personal identity, developing skills and awareness for adaptation, promoting regional sharing networks, forming a co-management agency and continuing nutritional monitoring may potentially preserve the nutritional integrity of Inuit diet, and in turn their health and cultural survival.

Impacts of decline harvest of country food on nutrient intake among Inuit in Arctic Canada: impact of climate change and possible adaptation plan.

PubMed

Rosol, Renata; Powell-Hellyer, Stephanie; Chan, Hing Man

2016-01-01

Background The pervasive food insecurity and the diet transition away from local, nutrient-rich country foods present a public health challenge among Inuit living in the Canadian Arctic. While environmental factors such as climate change decreased the accessibility and availability of many country food species, new species were introduced into regions where they were previously unavailable. An adaptation such as turning to alternate country food species can be a viable solution to substitute for the nutrients provided by the declined food species. The objective of this study was to estimate the impact on nutrient intake using hypothetical scenarios that current commonly harvested country foods were reduced by 50%, and were replaced with alternate or new species. Methods Data collected during the 2007-2008 Inuit Health Survey from 36 Canadian Arctic communities spanning Nunavut, the Inuvialuit Settlement Region and Nunatsiavut were used. Results A 50% decline in consumption of fish, whale, ringed seals and birds (the food that was reported to be in decline) resulted in a significant decrease in essential nutrient intake. Possible substitute foods were identified but some nutrients such as zinc and especially vitamin D were most often found lacking in the alternative diet. Conclusions If the alternative species are not available or feasible, more expensive and less nutritionally dense store-bought foods may be sought. Given the superior quality of country foods and their association with food security, and Inuit cultural health and personal identity, developing skills and awareness for adaptation, promoting regional sharing networks, forming a co-management agency and continuing nutritional monitoring may potentially preserve the nutritional integrity of Inuit diet, and in turn their health and cultural survival.

A novel mutation in KIF5A in a Malian family with spastic paraplegia and sensory loss.

PubMed

Guinto, Cheick O; Diarra, Salimata; Diallo, Salimata; Cissé, Lassana; Coulibaly, Thomas; Diallo, Seybou H; Taméga, Abdoulaye; Chen, Ke-Lian; Schindler, Alice B; Bagayoko, Koumba; Simaga, Assiatou; Blackstone, Craig; Fischbeck, Kenneth H; Landouré, Guida

2017-04-01

Hereditary spastic paraplegias (HSPs) are well-characterized disorders but rarely reported in Africa. We evaluated a Malian family in which three individuals had HSP and distal muscle atrophy and sensory loss. HSP panel testing identified a novel heterozygous missense mutation in KIF5A (c.1086G>C, p.Lys362Asn) that segregated with the disease (SPG10). Lys362 is highly conserved across species and Lys362Asn is predicted to be damaging. This study shows that HSPs are present in sub-Saharan Africa, although likely underdiagnosed. Increasing efficiency and decreasing costs of DNA sequencing will make it more feasible to diagnose HSPs in developing countries.

Candidate locations for SPS rectifying antennas

NASA Technical Reports Server (NTRS)

Eberhardt, A. W.

1977-01-01

The feasibility of placing 120 Satellite Power System (SPS) rectifying antenna (rectenna) sites across the U.S. was studied. An initial attempt is made to put two land sites in each state using several land site selection criteria. When only 69 land sites are located, it is decided to put the remaining sites in the sea and sea site selection criteria are identified. An estimated projection of electrical demand distribution for the year 2000 is then used to determine the distribution of these sites along the Pacific, Atlantic, and Gulf Coasts. A methodology for distributing rectenna sites across the country and for fine-tuning exact locations is developed, and recommendations on rectenna design and operations are made.

Solar photo-oxidative disinfection of drinking water: preliminary field observations.

PubMed

Reed, R H; Mani, S K; Meyer, V

2000-06-01

The feasibility of using solar photo-oxidation to inactivate faecal bacterial contaminants in drinking water has been evaluated under field conditions in India and South Africa. Freshly drawn samples from all six test water sources were low in dissolved oxygen, at 13-40% of the air saturation value. However, vigorous mixing followed by exposure to full-strength sunlight in transparent plastic containers (1-25 l capacity) caused a rapid decrease in the counts of faecal indicator bacteria, giving complete inactivation within 3-6 h, with no evidence of reactivation. These results demonstrate that solar photo-oxidation may provide a practical, low-cost approach to the improvement of drinking water quality in developing countries with consistently sunny climates.

Impact of shale gas development on regional water quality.

PubMed

Vidic, R D; Brantley, S L; Vandenbossche, J M; Yoxtheimer, D; Abad, J D

2013-05-17

Unconventional natural gas resources offer an opportunity to access a relatively clean fossil fuel that could potentially lead to energy independence for some countries. Horizontal drilling and hydraulic fracturing make the extraction of tightly bound natural gas from shale formations economically feasible. These technologies are not free from environmental risks, however, especially those related to regional water quality, such as gas migration, contaminant transport through induced and natural fractures, wastewater discharge, and accidental spills. We review the current understanding of environmental issues associated with unconventional gas extraction. Improved understanding of the fate and transport of contaminants of concern and increased long-term monitoring and data dissemination will help manage these water-quality risks today and in the future.

Development of inactivated poliovirus vaccine from Sabin strains: A progress report.

PubMed

Okayasu, Hiromasa; Sein, Carolyn; Hamidi, Ahd; Bakker, Wilfried A M; Sutter, Roland W

2016-11-01

The Global Polio Eradication Initiative (GPEI) has seen significant progress since it began in 1988, largely due to the worldwide use of oral poliovirus vaccine (OPV). In order to achieve polio eradication the global cessation of OPV is necessary because OPV contains live attenuated poliovirus, which in rare circumstances could re-gain wild poliovirus (WPV) characteristics with potential to establish transmission. The GPEI endgame strategy for the period 2013-2018 recommends the globally synchronised sequential cessation of the Sabin strains contained in the OPV, starting with type 2 Sabin. The withdrawal of Sabin type 2 took place in April 2016, with the introduction of at least one dose of inactivated poliovirus vaccine (IPV) as a risk mitigation strategy. The introduction of IPV into 126 countries since 2013 has required a rapid scale-up of IPV production by the two manufacturers supplying the global public sector market. This scale-up has been fraught with challenges, resulting in reductions of 40-50% of initial supply commitments. Consequently, 22 countries will not be supplied until 2018, and another 23 countries will experience serious stock-outs. In the last decade repeated calls-for-action were made to the global community to invigorate their vision and investment in developing "new poliovirus vaccines" including the development of IPV from less-virulent strains, such as Sabin-IPV (S-IPV). The conventional Salk-IPV production is limited to high-income industrialized-country manufacturers due to the containment requirements (i.e., high sanitation, low force-of-poliovirus-infection, and high population immunity). The use of Sabin strains in the production of S-IPV carries a lower biosafety risk, and was determined to be suitable for production in developing countries, expanding the manufacturing base and making IPV more affordable and accessible in the long term. Significant progress in the S-IPV has been made since 2006. S-IPV is now licensed as S-IPV in Japan and as standalone S-IPV in China, demonstrating the feasibility of this vaccine. In addition, production process improvements can further reduce the cost of production. The latter are critical to the economic success of this vaccine in the global market. We summarize the progress made to date in S-IPV technology, the scientific data and economic evidence in support of S-IPV development. Copyright © 2016 International Alliance for Biological Standardization. Published by Elsevier Ltd. All rights reserved.

Evaluation of the effectiveness of an international diploma course in tropical medicine.

PubMed

Casebeer, L L; Grimes, J; Kristofco, R E; Freeman, B; Gotuzzo, E; Freedman, D O

2001-01-01

Numerous impediments to conducting continuing education (CE) courses in remote sites, particularly those courses that take place in developing countries, can include challenges associated with planning, infrastructure, and financial risk. This study reports the effectiveness of a course planned in the United States and executed in Peru, the Gorgas Course in clinical tropical medicine. A survey was conducted of participants who had completed the Gorgas Course as recently as 6 months and as long as 3 years earlier. The questionnaire sought to determine each participant's reason for participation, whether the course was instrumental in the participant's reaching the personal goal associated with participation, and whether the participant considered the course to be worth the time and money spent to enable participation. Forty-nine participants responded to the questionnaire, all of whom indicated that the Gorgas Course enabled achievement of the personal goal associated with participation. Fully 100% of course participants stated that participation was worth the time and monetary expenditure, most often citing their having access to patients with tropical diseases and the personal enrichment of living overseas as reasons the course was worth its high cost. It is logistically and financially feasible to conduct CE courses in developing countries, provided that the organization in the planning country has strong, pre-established relationships with the host institution(s). Continued collaboration between planning partners and frequent, rigorous course evaluations are necessary to enable an international CE course to become a stable, continuous academic offering.

Milk cow feed intake and milk production and distribution estimates for Phase 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beck, D.M.; Darwin, R.F.; Erickson, A.R.

1992-04-01

This report provides initial information on milk production and distribution in the Hanford Environmental Dose Reconstruction (HEDR) Project Phase I study area. The Phase I study area consists of eight countries in central Washington and two countries in northern Oregon. The primary objective of the HEDR Project is to develop estimates of the radiation doses populations could have received from Hanford operations. The objective of Phase I of the project was to determine the feasibility of reconstructing data, models, and development of preliminary dose estimates received by people living in the ten countries surrounding Hanford from 1944 to 1947. Onemore » of the most important contributors to radiation doses from Hanford during the period of interest was radioactive iodine. Consumption of milk from cows that ate vegetation contaminated with iodine is likely the dominant pathway of human exposure. To estimate the doses people could have received from this pathway, it is necessary to estimate the amount of milk that the people living in the Phase I area consumed, the source of the milk, and the type of feed that the milk cows ate. The objective of the milk model subtask is to identify the sources of milk supplied to residents of each community in the study area as well as the sources of feeds that were fed to the milk cows. In this report, we focus on Grade A cow's milk (fresh milk used for human consumption).« less

Feasibility and limits of inguinal hernia repair under local anaesthesia in a limited resource environment: a prospective controlled study.

PubMed

Bourgouin, S; Goudard, Y; Montcriol, A; Bordes, J; Nau, A; Balandraud, P

2017-10-01

Local anaesthesia (LA) has proven effective for inguinal hernia repair in developed countries. Hernias in low to middle income countries represent a different issue. The aim of this study was to analyse the feasibility of LA for African hernia repairs in a limited resource environment. Data from patients who underwent herniorrhaphy under LA or spinal anaesthesia (SA) by the 6th and 7th Forward Surgical Team were prospectively collected. All of the patients benefited from a transversus abdominis plane (TAP) block for postoperative analgesia. Primary endpoints concerned the pain response and conversion to general anaesthesia. Secondary endpoints concerned the complication and recurrence rates. Predictors of LA failure were then identified. In all, 189 inguinal hernias were operated during the study period, and 119 patients fulfilled the inclusion criteria: 57 LA and 62 SA. Forty-eight percent of patients presented with inguinoscrotal hernias. Local anaesthesia led to more pain during surgery and necessitated more administration of analgesics but resulted in fewer micturition difficulties and better postoperative pain control. Conversion rates were not different. Inguinoscrotal hernia and a time interval <50 min between the TAP block and skin incision were predictors of LA failure. Forty-four patients were followed-up at one month. No recurrence was noted. Local anaesthesia is a safe alternative to SA. Small or medium hernias can easily be performed under LA in rural centres, but inguinoscrotal hernias required an ultrasound-guided TAP block performed 50 min before surgery to achieve optimal analgesia, and should be managed only in centres equipped with ultrasonography.

Balint seminars: the transatlantic experience through videoconference.

PubMed

Antoun, Jumana; Romani, Maya; Johnson, Alan; Brock, Clive; Hamadeh, Ghassan

2014-12-01

The Balint seminar is used in many family medicine residencies to improve and strengthen the patient-doctor relationship: to make better doctors. Given the lack of Balint leaders in developing countries, the family medicine department at the American University of Beirut (AUB) decided to collaborate with the Medical University of South Carolina (MUSC)-with more than 30 years of experience-to start Balint seminars through videoconferencing. Evaluate the feasibility and effectiveness of Balint seminars conducted through videoconference. A qualitative research using focus group and leaders' feedback to evaluate feasibility of delivery of Balint seminars through videoconference. A Polycom videoconference was set up between residents at AUB and two credentialed Balint leaders at MUSC. The videoconference was composed of two parts: (i) MUSC faculty facilitating Balint seminars; and (ii) MUSC and AUB faculty debriefing following each Balint session. Twenty-six videoconferences were conducted from 15 February 2013 to 31 March 2014. Four themes emerged: technology and connectivity issues, administrative issues, coordination among different time zones and cultural/contextual issues. The videoconferencing with family medicine residents at AUB seemed quite natural and very familiar to the Balint leaders at MUSC. The seminars encouraged the residents to see things from the patients' perspective, inspiring new thoughts and ideas on how to deal with troubling patients. Videoconference Balint seminars offer a promising way to extend the activity to health care providers in other disciplines, states and countries. Moreover, this format has the potential to increase the number of trained Balint leaders. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Aviation obstacle auto-extraction using remote sensing information

NASA Astrophysics Data System (ADS)

Zimmer, N.; Lugsch, W.; Ravenscroft, D.; Schiefele, J.

2008-10-01

An Obstacle, in the aviation context, may be any natural, man-made, fixed or movable object, permanent or temporary. Currently, the most common way to detect relevant aviation obstacles from an aircraft or helicopter for navigation purposes and collision avoidance is the use of merged infrared and synthetic information of obstacle data. Several algorithms have been established to utilize synthetic and infrared images to generate obstacle information. There might be a situation however where the system is error-prone and may not be able to consistently determine the current environment. This situation can be avoided when the system knows the true position of the obstacle. The quality characteristics of the obstacle data strongly depends on the quality of the source data such as maps and official publications. In some countries such as newly industrializing and developing countries, quality and quantity of obstacle information is not available. The aviation world has two specifications - RTCA DO-276A and ICAO ANNEX 15 Ch. 10 - which describe the requirements for aviation obstacles. It is essential to meet these requirements to be compliant with the specifications and to support systems based on these specifications, e.g. 3D obstacle warning systems where accurate coordinates based on WGS-84 is a necessity. Existing aerial and satellite or soon to exist high quality remote sensing data makes it feasible to think about automated aviation obstacle data origination. This paper will describe the feasibility to auto-extract aviation obstacles from remote sensing data considering limitations of image and extraction technologies. Quality parameters and possible resolution of auto-extracted obstacle data will be discussed and presented.

Cumulative dietary exposure to a selected group of pesticides of the triazole group in different European countries according to the EFSA guidance on probabilistic modelling.

PubMed

Boon, Polly E; van Donkersgoed, Gerda; Christodoulou, Despo; Crépet, Amélie; D'Addezio, Laura; Desvignes, Virginie; Ericsson, Bengt-Göran; Galimberti, Francesco; Ioannou-Kakouri, Eleni; Jensen, Bodil Hamborg; Rehurkova, Irena; Rety, Josselin; Ruprich, Jiri; Sand, Salomon; Stephenson, Claire; Strömberg, Anita; Turrini, Aida; van der Voet, Hilko; Ziegler, Popi; Hamey, Paul; van Klaveren, Jacob D

2015-05-01

The practicality was examined of performing a cumulative dietary exposure assessment according to the requirements of the EFSA guidance on probabilistic modelling. For this the acute and chronic cumulative exposure to triazole pesticides was estimated using national food consumption and monitoring data of eight European countries. Both the acute and chronic cumulative dietary exposures were calculated according to two model runs (optimistic and pessimistic) as recommended in the EFSA guidance. The exposures obtained with these model runs differed substantially for all countries, with the highest exposures obtained with the pessimistic model run. In this model run, animal commodities including cattle milk and different meat types, entered in the exposure calculations at the level of the maximum residue limit (MRL), contributed most to the exposure. We conclude that application of the optimistic model run on a routine basis for cumulative assessments is feasible. The pessimistic model run is laborious and the exposure results could be too far from reality. More experience with this approach is needed to stimulate the discussion of the feasibility of all the requirements, especially the inclusion of MRLs of animal commodities which seem to result in unrealistic conclusions regarding their contribution to the dietary exposure. Copyright © 2014 Elsevier Ltd. All rights reserved.

Eradicating chancroid.

PubMed Central

Steen, R.

2001-01-01

Genital ulcers are important cofactors of HIV transmission in the countries most severely affected by HIV/AIDS. Chancroid is a common cause of genital ulcer in all 18 countries where adult HIV prevalence surpasses 8% and is rare in countries with low-level HIV epidemics. Haemophilus ducreyi, the causative organism of chancroid, is biologically vulnerable and occupies a precarious epidemiological niche. Both simple, topical hygiene and male circumcision greatly reduce risk of infection and several classes of antibiotics--some of which can be administered in single-dose treatment regimens--provide rapid cure. H. ducreyi depends on sexual networks with high rates of partner change for its survival, thriving in environments characterized by male mobility and intensive commercial sex activity. Elimination of H. ducreyi infection from vulnerable groups results in disappearance of chancroid from the larger community. Once endemic in Europe and North America, chancroid began a steady decline early in the twentieth century, well before the discovery of antibiotics. Social changes--resulting in changing patterns of commercial sex--probably disrupted the conditions needed to sustain chancroid as an endemic disease. Sporadic outbreaks are now easily controlled when effective curative and preventive services are made available to sex workers and their clients. More recently, chancroid prevalence has declined markedly in countries such as the Philippines. Senegal, and Thailand, a development that may contribute to stabilization of the HIV epidemics in these countries. Eradication of chancroid is a feasible public health objective. Protecting sex workers and their clients from exposure to sexually transmitted diseases (STDs) and improving curative services for STDs are among the proven strategies that could be employed. PMID:11584729

Eradicating chancroid.

PubMed

Steen, R

2001-01-01

Genital ulcers are important cofactors of HIV transmission in the countries most severely affected by HIV/AIDS. Chancroid is a common cause of genital ulcer in all 18 countries where adult HIV prevalence surpasses 8% and is rare in countries with low-level HIV epidemics. Haemophilus ducreyi, the causative organism of chancroid, is biologically vulnerable and occupies a precarious epidemiological niche. Both simple, topical hygiene and male circumcision greatly reduce risk of infection and several classes of antibiotics--some of which can be administered in single-dose treatment regimens--provide rapid cure. H. ducreyi depends on sexual networks with high rates of partner change for its survival, thriving in environments characterized by male mobility and intensive commercial sex activity. Elimination of H. ducreyi infection from vulnerable groups results in disappearance of chancroid from the larger community. Once endemic in Europe and North America, chancroid began a steady decline early in the twentieth century, well before the discovery of antibiotics. Social changes--resulting in changing patterns of commercial sex--probably disrupted the conditions needed to sustain chancroid as an endemic disease. Sporadic outbreaks are now easily controlled when effective curative and preventive services are made available to sex workers and their clients. More recently, chancroid prevalence has declined markedly in countries such as the Philippines. Senegal, and Thailand, a development that may contribute to stabilization of the HIV epidemics in these countries. Eradication of chancroid is a feasible public health objective. Protecting sex workers and their clients from exposure to sexually transmitted diseases (STDs) and improving curative services for STDs are among the proven strategies that could be employed.

Cost-effectiveness and resource implications of aggressive action on TB in China, India and South Africa: a combined analysis of nine models

PubMed Central

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein MGJ; Kimerling, Michael E; White, Richard G; Vassall, Anna

2017-01-01

BACKGROUND The End TB Strategy sets global goals of reducing TB incidence and mortality by 50% and 75% respectively by 2025. We assessed resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. METHODS We examined intervention scenarios developed in consultation with country stakeholders, which scaled-up existing interventions to high but feasible coverage by 2025. Nine independent TB modelling groups collaborated to estimate policy outcomes, and we costed each scenario by synthesizing service utilization estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health impact and resource implications for 2016–2035, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios to a base case representing continued current practice. FINDINGS Incremental TB service costs differed by scenario and country, and in some cases more than doubled current funding needs. In general, expanding TB services substantially reduced patient-incurred costs; and in India and China this produced net cost-savings for most interventions under a societal perspective. In all countries, expanding TB care access produced substantial health gains. Compared to current practice, most intervention approaches appeared highly cost-effective when compared to conventional cost-effectiveness thresholds. INTERPRETATION Expanding TB services appears cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, though funding needs challenge affordability. Further work is required to determine the optimal intervention mix for each country. PMID:27720689

“More bang for the buck”: exploring optimal approaches for guideline implementation through interviews with international developers

PubMed Central

2012-01-01

Background Population based studies show that guidelines are underused. Surveys of international guideline developers found that many do not implement their guidelines. The purpose of this research was to interview guideline developers about implementation approaches and resources. Methods Semi-structured telephone interviews were conducted with representatives of guideline development agencies identified in the National Guideline Clearinghouse and sampled by country, type of developer, and guideline clinical indication. Participants were asked to comment on the benefits and resource implications of three approaches for guideline implementation that varied by responsibility: developers, intermediaries, or users. Results Thirty individuals from seven countries were interviewed, representing government (n = 12) and professional (n = 18) organizations that produced guidelines for a variety of clinical indications. Organizations with an implementation mandate featured widely inconsistent funding and staffing models, variable approaches for choosing promotional strategies, and an array of dissemination activities. When asked to choose a preferred approach, most participants selected the option of including information within guidelines that would help users to implement them. Given variable mandate and resources for implementation, it was considered the most feasible approach, and therefore most likely to have impact due to potentially broad use. Conclusions While implementation approaches and strategies need not be standardized across organizations, the findings may be used by health care policy makers and managers, and guideline developers to generate strategic and operational plans that optimize implementation capacity. Further research is needed to examine how to optimize implementation capacity by guideline developers, intermediaries and users. PMID:23153052

Effect of kangaroo mother care on postpartum depression.

PubMed

de Alencar, Andréa Echeverria Martins Arraes; Arraes, Luis Cláudio; de Albuquerque, Emídio Cavalcanti; Alves, João Guilherme Bezerra

2009-02-01

Postpartum depression (PPD) is a serious public health issue. Kangaroo mother care (KMC) is widely considered to be the most feasible, readily available and preferred intervention for decreasing neonatal morbidity and mortality in developing countries. We conducted a prospective study to assess the effect of KMC on PPD. The study population included 177 low-income mothers with their preterm infants. We used the validated Portuguese version of the Postpartum Depression Screening Scale for the assessment of maternal depression. The mothers were evaluated twice, at Neonatal Intensive Care Unit admission and at KMC discharge. We found 66 mothers (37.3%) with depression and it decreased to 30 (16.9%) after KMC intervention; p < 0.0001. None developed PPD during the Kangaroo stay. We concluded that KMC may lessen maternal depression. Further studies, may be required to clarify these preliminary findings.

Capacity Building for Rare Bleeding Disorders in the Remote Commonwealth of the Northern Mariana Islands

PubMed Central

Carhill, Pam; Huang, James N.; Baker, Judith R.

2016-01-01

The US Pacific Commonwealth of the Northern Mariana Islands is home to an underserved hemophilia population. We developed a strategy in 2014 to build sustainable island-wide medical, patient and family, and community support for this rare disease. Collaboration with regional bleeding disorder leadership galvanized a weeklong conference series. More than 200 participants attended discipline-specific seminars; pre–post test evaluations documented educational benefits. This time-concentrated island-wide education intervention promoted the rapid identification of new cases and stimulated sustainable bleeding disorder care development. The education series proved feasible, efficient, and effective in increasing knowledge and reducing patient and professional isolation, serving as a model for improving capacity for orphan diseases (those that affect fewer than 200 000 people in any particular country) in underresourced areas. PMID:26890163

Evidence-based alcohol policy in the Americas: strengths, weaknesses, and future challenges.

PubMed

Babor, Thomas F; Caetano, Raul

2005-01-01

The objectives of this article are to describe the evidence base for alcohol policy in the Americas, to evaluate the extent to which national policies are likely to have an impact on public health, and to identify areas where alcohol policies could be improved. The paper begins with a brief review of epidemiological surveys of the prevalence of alcohol problems in the Americas. This is followed by an analysis of 32 prevention strategies and interventions in terms of the evidence for their effectiveness, amount of research support, cost to implement, and other feasibility issues. Overall, the strategies and interventions with the greatest amount of empirical support are low blood alcohol concentration levels for driving while intoxicated, controls on alcohol availability, age limits on alcohol purchases, and relatively high alcohol prices. The implications of the evidence are next discussed in relation to alcohol policy initiatives in the Americas, based on an analysis of the extent to which strategies and interventions currently used in 25 countries of the Americas are likely to have a public health impact on alcohol-related problems. The countries that have adopted the policies with the highest expected impact overall are Colombia, Costa Rica, Venezuela, and El Salvador. Nevertheless, the analysis indicates that almost all the countries of the Americas could improve the likelihood of preventing alcohol-related problems. Policy efforts in the developing countries of Latin America should focus on improving countermeasures against driving while intoxicated, measures that alter the drinking context, and limits on physical availability. For the developed, high-income countries of North America the goal should be to prevent deterioration of current drinking patterns and to reduce the overall volume of drinking. Given the low to moderate cost of many of the policies reviewed in this article, it now seems possible for communities and nations to substantially reduce the alcohol-related burden of illness in the Americas.

[Telescience : Feasibility studies, definition and a fair answer to the scientific brain drain].

PubMed

Craemer, E M; Bassa, B; Jacobi, C; Becher, H; Meyding-Lamadé, U

2017-02-01

What is telescience? Is it feasible to transfer academic information with the help of telematics to educate and teach young scientists over large distances? The term telescience has so far not been defined but covers a variety of possibilities, which could be successfully implemented worldwide. This article gives examples and highlights the feasibility analysis of telescience. We have carried out feasibility analyses for neurological functional diagnostics, an epidemiological cross-sectional study as well as a laboratory study for detection of thrombocyte function during dengue fever with the help of telemedicine. The basis for all these projects was a telemedical transcontinental cooperation over a distance of 12,000 km. All performed studies demonstrated the feasibility. With the help of telematics the laboratory techniques, planning, conduction and interpretation of results as well as publication skills can be transferred. Telescience is feasible. Our studies showed that telescience is a very promising option to transfer knowledge, which will help to enable professional expertise to be transferred directly to the region/country without a brain drain. All too often young motivated scientists are enticed to move to well-known institutions, which involves the danger of a brain drain. Brain drain can be avoided in favor of local implementation of scientific projects. Our results illustrate that it is feasible to educate and guide scientists with the help of telematics infrastructures.

The Massive Online Needs Assessment (MONA) to inform the development of an emergency haematology educational blog series.

PubMed

Chan, Teresa M; Jo, David; Shih, Andrew W; Bhagirath, Vinai C; Castellucci, Lana A; Yeh, Calvin; Thoma, Brent; Tseng, Eric K; de Wit, Kerstin

2018-06-01

Online educational resources are criticized as being teacher-centred, failing to address learner's needs. Needs assessments are an important precursor to inform curriculum development, but these are often overlooked or skipped by developers of online educational resources due to cumbersome measurement tools. Novel methods are required to identify perceived and unperceived learning needs to allow targeted development of learner-centred curricula. To evaluate the feasibility of performing a novel technique dubbed the Massive Online Needs Assessment (MONA) for the purpose of emergency haematology online educational curricular planning, within an online learning community (affiliated with the Free Open Access Medical education movement). An online survey was launched on CanadiEM.org using an embedded Google Forms survey. Participants were recruited using the study website and a social media campaign (utilizing Twitter, Facebook, Blogs, and a poster) targeting a specific online community. Web analytics were used to monitor participation rates in addition to survey responses. The survey was open from 20 September to 10 December 2016 and received 198 complete responses representing 6 medical specialties from 21 countries. Most survey respondents identified themselves as staff physicians (n = 109) and medical trainees (n = 75). We identified 17 high-priority perceived needs, 17 prompted needs, and 10 topics with unperceived needs through our MONA process. A MONA is a feasible, novel method for collecting data on perceived, prompted, and unperceived learning needs to inform an online emergency haematology educational blog. This methodology could be useful to the developers of other online education resources.

A techno-economic analysis of aquaculture business in Ogun State, Nigeria

NASA Astrophysics Data System (ADS)

Kareem, R. O.; Williams, S. B.

2009-05-01

Fish supplies 25% of the total protein source in developing countries. A techno-economic analysis was performed for developing a good business proposal for aquaculture loans to enhance aquaculture development in Nigeria. A case study of catfish Clarias gariepinus framing was conducted in Abeokuta North Local Government of Ogun State, Nigeria. The results show that the fixed cost is N18 338 per year, and the variable cost is N459 700 per year, accounting for the largest amount of the total; therefore, a profit of N43 289 per month can be made. Sensitivity analysis was performed to assess any risk(s) that associated with unfavorable changes in government policy with particular reference to monetary policy. Positive net present value shows that the investment in fish farm is economically feasible and the net investment ratio is 3.52. Also, the benefit-cost ratio is 2.17. The internal rate of return (IRR) is 21% showing that the enterprise is able to offset the interest being charged on the loan. It is therefore worthwhile to invest into fish farm business in the study area. The study suggests that to better sustain the local aquaculture business, the government should create a good conducive environment to foster development of the fish farming. Government intervention is urgently needed to solve problems such as in traditional land tenure, grant credit facilities and subsidies, to enhance the aquacultural development in the country.

Durably controlling bovine hypodermosis.

PubMed

Boulard, Chantal

2002-01-01

Cattle hypodermosis, due to insect larvae, is widely spread over the northern hemisphere. Very efficient insecticides are available and their use in most countries are done on an individual level but never cover the whole cattle population of a country. Untreated animals remain the reservoir of the disease and annually re-infest the cattle population. The economic effects of this disease on animal production (meat, milk and the leather industry) but also on the general cattle health status, have led many European countries to launch organised control programs. The first example of definitive hypodermosis control goes back one hundred years ago when Danish farmers eradicated hypodermosis from the Danish islands by manual elimination of the warbles. Since then, more and more European countries have considered the feasibility and economic returns of such programs. The various factors which foster these programs are related to (i) biological factors, (parasite cattle specificity, synchronous biological cycles of both species of insects involved), (ii) the development of more and more efficient insecticides used only once a year by systemic application, with high efficiency at very low dosages against the first larval stage of Hypoderma spp., (iii) the development of acute techniques of detection of the disease for the monitoring of hypodermosis free countries and (iv) the durable successful results obtained in more and more European countries. Although the programs were imposed by different partners of the livestock channel production (farmers, dairy industry, leather industry) and have been engaged within the last 50 years in many European countries (Denmark, The Netherlands, Ireland, the United Kingdom, the Czech Republic, Germany, France and Switzerland) common features have emerged among these different eradication programs. They all need a preliminary statement of the economic impact of this pest and the farmers' awareness of the economic returns of such programs. The programs' efficacy depends: (i) on a good knowledge ofthe epidemiology of the parasites, (ii) on the simultaneous implementation of the control program on the whole national cattle population whatever the structure monitoring the treatments (veterinary services, farmers association), (iii) on a national Warble fly legislation making the treatments compulsory and (iv) on an acute epidemiological survey as soon as the status of a hypodermosis free country is reached and the treatments are suspended. The sanitary and financial returns of such programs are a benefit to all the partners of livestock production, to the quality of the environment and to the consumers.

Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers

PubMed Central

2011-01-01

Background Recent global mental health research suggests that mental health interventions can be adapted for use across cultures and in low resource environments. As evidence for the feasibility and effectiveness of certain specific interventions begins to accumulate, guidelines are needed for how to train, supervise, and ideally sustain mental health treatment delivery by local providers in low- and middle-income countries (LMIC). Model and case presentations This paper presents an apprenticeship model for lay counselor training and supervision in mental health treatments in LMIC, developed and used by the authors in a range of mental health intervention studies conducted over the last decade in various low-resource settings. We describe the elements of this approach, the underlying logic, and provide examples drawn from our experiences working in 12 countries, with over 100 lay counselors. Evaluation We review the challenges experienced with this model, and propose some possible solutions. Discussion We describe and discuss how this model is consistent with, and draws on, the broader dissemination and implementation (DI) literature. Conclusion In our experience, the apprenticeship model provides a useful framework for implementation of mental health interventions in LMIC. Our goal in this paper is to provide sufficient details about the apprenticeship model to guide other training efforts in mental health interventions. PMID:22099582

Can we address cancer disparities in immigrants by improving cancer literacy through English as a second language instruction?

PubMed

Hughes, Donna L; Flight, Ingrid; Chapman, Janine; Wilson, Carlene

2018-03-27

In many Western countries, immigrants exhibit disparities in cancer incidence and mortality, and variable uptake of cancer prevention services. New immigrants may not be aware of cancer risks pertinent to their new country, or prevention resources. Traditional cancer prevention health messaging may not be accessible for cultural, language, or literacy reasons. New methods are needed. In North America, health message delivery via English classes for immigrants is showing potential as an efficacious and a feasible way to reach immigrants at the same time improving language skills. Interventions published to date are promising but limited in their ability to generalize or be adapted to a variety of populations and settings. This concept paper aims to synthesize previous findings and identify ways to improve and advance the translation potential of this approach. We propose that this could be achieved by (i) using a translation framework to guide intervention planning, development, implementation, and evaluation; (ii) encouraging and evaluating health message spread throughout language learners' social networks; and (iii) incorporating cultural sensitivity into the curriculum. A pilot project following these recommendations is planned for Australia and will be discussed. These recommendations could serve as a framework to fit the requirements of immigrant language programs in other countries and other health topics.

[How practical guidelines can be applied in poor countries? Example of the introduction of a bronchoscopy unit in Cambodia].

PubMed

Couraud, S; Chan, S; Avrillon, V; Horn, K; Try, S; Gérinière, L; Perrot, É; Guichon, C; Souquet, P-J; Ny, C

2013-10-01

According to UN, Cambodia is one of the poorest countries in the World. Respiratory diseases are current public health priorities. In this context, a new bronchoscopy unit (BSU) was created in the respiratory medicine department of Preah Kossamak hospital (PKH) thanks to a tight cooperation between a French and a Cambodian team. Aim of this study was to describe conditions of introduction of this equipment. Two guidelines for practice are available. They are respectively edited by the French and British societies of pulmonology. These guidelines were reviewed and compared to the conditions in which BS was introduced in PKH. Each item from guidelines was combined to a categorical value: "applied", "adapted" or "not applied". In 2009, 54 bronchoscopies were performed in PKH, mainly for suspicion of infectious or tumour disease. In total, 52% and 46% of the French and British guideline items respectively were followed in this Cambodian unit. Patient safety items are those highly followed. By contrast "staff safety" items were those weakly applied. Implementation of EBS in developing countries seems feasible in good conditions of quality and safety for patients. However, some recommendations cannot be applied due to local conditions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Language, culture and international exchange of virtual patients.

PubMed

Muntean, Valentin; Calinici, Tudor; Tigan, Stefan; Fors, Uno G H

2013-02-11

Language and cultural differences could be a limiting factor for the international exchange of Virtual Patients (VPs), especially for small countries and languages of limited circulation. Our research evaluated whether it would be feasible to develop a VP based educational program in our Romanian institution, with cases in English and developed in a non-Romanian setting. The participants in the research comprised 4th year Romanian medical students from the Faculty of Medicine in Cluj-Napoca, Romania, with previous training exclusively in Romanian, good English proficiency and no experience with VPs. The students worked on eight VPs in two identical versions, Romanian and English. The first group (2010) of 136 students worked with four VPs developed in Cluj and the second group (2011) of 144 students with four VPs originally developed at an US University. Every student was randomly assigned two different VPs, one in Romanian and another in English. Student activity throughout the case, the diagnosis, therapeutic plan and diagnosis justification were recorded. We also compared student performance on the two VPs versions, Romanian and English and the student performance on the two sets of cases, originally developed in Romania, respectively USA. We found no significant differences between the students' performance on the Romanian vs. English version of VPs. Regarding the students' performance on the two sets of cases, in those originally developed in Romania, respectively in the USA, we found a number of statistically significant differences in the students' activity through the cases. There were no statistically significant differences in the students' ability to reach the correct diagnosis and therapeutic plan. The development of our program with VPs in English would be feasible, cost-effective and in accordance with the globalization of medical education.

Advances in commercial application of gamma radiation in tropical fruits at Brazil

NASA Astrophysics Data System (ADS)

Sabato, S. F.; Silva, J. M.; Cruz, J. N.; Broisler, P. O.; Rela, P. R.; Salmieri, S.; Lacroix, M.

2009-07-01

All regions of Brazil are potential areas for growing tropical fruits. As this country is already a great producer and exporter of tropical fruits, ionizing radiation has been the subject of studies in many commodities. An important project has been carried out to increase the commercial use of gamma radiation in our country. Instituto de Pesquisas Energeticas e Nucleares (IPEN)-CNEN/SP together with field producers in northeast region and partners like International Atomic Energy Agency (IAEA), CIC, Empresa Brasileira Pesquisa na Agricultura (EMBRAPA) joined to demonstrate this technology, its application and commercial feasibility. The objective of this study is to show advances in feasibility demonstrate the quality of the irradiated fruits in an international consignment from Brazil to Canada. In this work, Tommy Atkins mangoes harvested in northeast region of Brazil were sent to Canada. The fruits were treated in a gamma irradiation facility at doses 0.4 and 1.0 kGy. The control group was submitted to hydrothermal treatment (46 °C for 110 min). The fruits were stored at 11 °C for 10 days until the international transportation and kept at an environmental condition (22 °C) for 12 days, where their physical-chemical and sensorial properties were evaluated. The financial part of the feasibility study covers the scope of the investment, including the net working capital and production costs.

Customising informed consent procedures for people with schizophrenia in India.

PubMed

Chatterjee, Sudipto; Kieselbach, Berit; Naik, Smita; Kumar, Shuba; John, Sujit; Balaji, Madhumitha; Koschorke, Mirja; Dabholkar, Hamid; Varghese, Mathew; Patel, Vikram; Thornicroft, Graham; Thara, Rangaswamy

2015-10-01

There is little information on how the ethical and procedural challenges involved in the informed participation of people with schizophrenia in clinical trials are addressed in low- and middle-income countries (LMICs). The informed consent procedure used in the collaborative community care for people with schizophrenia in India (COPSI) RCT was developed keeping these challenges in mind. We describe the feasibility of conducting the procedure from the trial, researcher and participants perspectives and describe the reasons for people consenting to participate in the trial or refusing to do so. Three sources of information were used to describe the feasibility of the COPSI consent procedure: key process indicators for the trial perspective, data from a specially designed post-interview form for participant's observations and focus group discussion (FGD) with the research interviewers. Categorical data were analysed by calculating frequencies and proportions, while the qualitative data from the FGD, and the reasons for participation or refusal were analysed using a thematic content analysis approach. 434 people with schizophrenia and their primary caregiver(s) were approached for participation in the trial. Consent interviews were conducted with 332, of whom 303 (91%) agreed to participate in the trial. Expectation of improvement was the most common reason for agreeing to participate in the trial, while concerns related to the potential disclosure of the illness, especially for women, were an important reason for refusing consent. The COPSI consent procedure demonstrates preliminary, observational information about the feasibility of customising informed consent procedures for people with schizophrenia LMIC contexts. This and other similar innovations need to be refined and rigorously tested to develop evidence-based guidelines for informed consent procedures in such settings.

The Global Spine Care Initiative: a consensus process to develop and validate a stratification scheme for surgical care of spinal disorders as a guide for improved resource utilization in low- and middle-income communities.

PubMed

Acaroğlu, Emre; Mmopelwa, Tiro; Yüksel, Selcen; Ayhan, Selim; Nordin, Margareta; Randhawa, Kristi; Haldeman, Scott

2017-10-16

The purpose of this study was to develop a stratification scheme for surgical spinal care to serve as a framework for referrals and distribution of patients with spinal disorders. We used a modified Delphi process. A literature search identified experts for the consensus panel and the panel was expanded by inviting spine surgeons known to be global opinion leaders. After creating a seed document of five hierarchical levels of surgical care, a four-step modified Delphi process (question validation, collection of factors, evaluation of factors, re-evaluation of factors) was performed. Of 78 invited experts, 19 participated in round 1, and of the 19, 14 participated in 2, and 12 in 3 and 4. Consensus was fairly heterogeneous for levels of care 2-4 (moderate resources). Only simple assessment methods based on the clinical skills of the medical personnel were considered feasible and safe in low-resource settings. Diagnosis, staging, and treatment were deemed feasible and safe in a specialized spine center. Accurate diagnostic workup was deemed feasible and safe for lower levels of care complexity (from level 3 upwards) compared to non-invasive procedures (level 4) and the full range of invasive procedures (level 5). This study introduces a five-level stratification scheme for the surgical care of spinal disorders. This stratification may provide input into the Global Spine Care Initiative care pathway that will be applied in medically underserved areas and low- and middle-income countries. These slides can be retrieved under Electronic Supplementary Material.

Delivering vaccines to the people who need them most.

PubMed

Barocchi, Michèle Anne; Rappuoli, Rino

2015-06-19

Thanks to the Global Alliance for Vaccines and Immunization (GAVI), the Vaccine Fund and the Bill & Melinda Gates Foundation, the global health community has made enormous progress in providing already existing vaccines to developing countries. However, there still exists a gap to develop vaccines for which there is no market in the Western world, owing to low economic incentives for the private sector to justify the investments necessary for vaccine development. In many cases, industry has the technologies, but lacks the impetus to direct resources to develop these vaccine products. The present emergency with the Ebola vaccine provides us an excellent example where a vaccine was feasible several years ago, but the global health community waited for a humanitarian disaster to direct efforts and resources to develop this vaccine. In the beginning of 2015, the first large-scale trials of two experimental vaccines against Ebola virus disease have begun in West Africa. During the past few years, several institutions have dedicated efforts to the development of vaccines against diseases present only in low-income countries. These include the International Vaccine Institute, the Novartis Vaccines Institute for Global Health, the Hilleman Institute, the Sabin Vaccine Institute and the Infectious Disease Research Institute. Nevertheless, solving this problem requires a more significant global effort than that currently invested. These efforts include a clear policy, global coordination of funds dedicated to the development of neglected disease and an agreement on regulatory strategies and incentives for the private sector. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Challenges to global measles eradication: is it all in the timing?

PubMed

Davis, Robert; Mbabazi, William Baguma

2017-01-01

The case for global eradication of measles was first made in 1982. Since then, technical aspects of measles eradication have concluded that measles satisfied all criteria required for eradication. To date, only smallpox, among human diseases, has been eradicated, with polio, the next eradication candidate. In all previous eradication programmes, the pattern of slow implementation and missed deadlines is similar. Lessons from these past eradication programs should inform development of a time-limited measles eradication program. Notably, no measles eradication resolution is likely until member states are satisfied that polio eradication is accomplished. However, there is an impetus for measles eradication from the western hemisphere, where governments continue to pay the high costs of keeping their region measles free until global measles eradication is achieved. While previous vaccine preventable diseases eradications have depended on supplemental immunizations (SIAs), measles eradication will have to build both on SIAs and routine immunization systems strengthening. This article reviews non-technical considerations that could facilitate the delivery of a time-limited measles eradication initiative. The issues discussed are categorized as a) specificities of measles disease; b) specifics of measles vaccine/vaccination; c) special considerations for endemic countries and d) organization of international partnerships. The disease and vaccine specific issues are not insurmountable. The introduction of routine measles second dose, in the context of EPI systems strengthening, is paramount to endemic developing countries. In the international partnerships, it should be noted that i) Measles eradication will be easier and cheaper; ii) the return on investment is compelling; iii) leverage is feasible on the experiences of the Measles/Rubella initiative; iv) two disease eradication targets in one initiative are feasible and v) for the first time, an eradication investment case will inform the decisions. However, if previous eradication efforts have been marathons, measles eradication will need to be a sprint.

Is control through utilization a cost effective Prosopis juliflora management strategy?

PubMed

Wakie, Tewodros T; Hoag, Dana; Evangelista, Paul H; Luizza, Matthew; Laituri, Melinda

2016-03-01

The invasive tree Prosopis juliflora is known to cause negative impacts on invaded ranges. High P. juliflora eradication costs have swayed developing countries to follow a new and less expensive approach known as control through utilization. However, the net benefits of this new approach have not been thoroughly evaluated. Our objective was to assess the economic feasibility of selected P. juliflora eradication and utilization approaches that are currently practiced in one of the severely affected developing countries, Ethiopia. The selected approaches include converting P. juliflora infested lands into irrigated farms (conversion), charcoal production, and seed flour production. We estimate the costs and revenues of the selected P. juliflora eradication and utilization approaches by interviewing 19 enterprise owners. We assess the economic feasibility of the enterprises by performing enterprise, break-even, investment, sensitivity, and risk analyses. Our results show that conversion to irrigated cotton is economically profitable, with Net Present Value (NPV) of 5234 US$/ha over 10 years and an interest rate of 10% per year. Conversion greatly reduces the spread of P. juliflora on farmlands. Managing P. juliflora infested lands for charcoal production with a four-year harvest cycle is profitable, with NPV of 805 US$/ha. However, the production process needs vigilant regulation to protect native plants from exploitation and caution should be taken to prevent charcoal production sites from becoming potential seed sources. Though flour from P. juliflora pods can reduce invasions by destroying viable seeds, flour enterprises in Ethiopia are unprofitable. Conversion and charcoal production can be undertaken with small investment costs, while flour production requires high investment costs. Introducing new changes in the production and management steps of P. juliflora flour might be considered to make the enterprise profitable. Our study shows that control through utilization may be a viable P. juliflora management strategy under the right environmental setting. Published by Elsevier Ltd.

Challenges to global measles eradication: is it all in the timing?

PubMed Central

Davis, Robert; Mbabazi, William Baguma

2017-01-01

The case for global eradication of measles was first made in 1982. Since then, technical aspects of measles eradication have concluded that measles satisfied all criteria required for eradication. To date, only smallpox, among human diseases, has been eradicated, with polio, the next eradication candidate. In all previous eradication programmes, the pattern of slow implementation and missed deadlines is similar. Lessons from these past eradication programs should inform development of a time-limited measles eradication program. Notably, no measles eradication resolution is likely until member states are satisfied that polio eradication is accomplished. However, there is an impetus for measles eradication from the western hemisphere, where governments continue to pay the high costs of keeping their region measles free until global measles eradication is achieved. While previous vaccine preventable diseases eradications have depended on supplemental immunizations (SIAs), measles eradication will have to build both on SIAs and routine immunization systems strengthening. This article reviews non-technical considerations that could facilitate the delivery of a time-limited measles eradication initiative. The issues discussed are categorized as a) specificities of measles disease; b) specifics of measles vaccine/vaccination; c) special considerations for endemic countries and d) organization of international partnerships. The disease and vaccine specific issues are not insurmountable. The introduction of routine measles second dose, in the context of EPI systems strengthening, is paramount to endemic developing countries. In the international partnerships, it should be noted that i) Measles eradication will be easier and cheaper; ii) the return on investment is compelling; iii) leverage is feasible on the experiences of the Measles/Rubella initiative; iv) two disease eradication targets in one initiative are feasible and v) for the first time, an eradication investment case will inform the decisions. However, if previous eradication efforts have been marathons, measles eradication will need to be a sprint. PMID:29296146

The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.

PubMed

Chou, Roger; Côté, Pierre; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Nordin, Margareta; Hurwitz, Eric L; Haldeman, Scott; Cedraschi, Christine

2018-02-19

The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). For patients with chronic low back and neck pain without serious pathology, primary treatment options are exercise, yoga, cognitive behavioral therapies, acupuncture, biofeedback, progressive relaxation, massage, manual therapy, interdisciplinary rehabilitation, NSAIDs, acetaminophen, and antidepressants. For patients with spinal pain with radiculopathy, clinicians may consider exercise, spinal manipulation, or NSAIDs; use of other interventions requires extrapolation from evidence regarding effectiveness for non-radicular spinal pain. Clinicians should not offer treatments that are not effective, including benzodiazepines, botulinum toxin injection, systemic corticosteroids, cervical collar, electrical muscle stimulation, short-wave diathermy, transcutaneous electrical nerve stimulation, and traction. Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences. These slides can be retrieved under Electronic Supplementary Material.

Feasibility of Recruiting a Diverse Sample of Men Who Have Sex with Men: Observation from Nanjing, China

PubMed Central

Tang, Weiming; Yang, Haitao; Mahapatra, Tanmay; Huan, Xiping; Yan, Hongjing; Li, Jianjun; Fu, Gengfeng; Zhao, Jinkou; Detels, Roger

2013-01-01

Background Respondent-driven-sampling (RDS) has well been recognized as a method for sampling from most hard-to-reach populations like commercial sex workers, drug users and men who have sex with men. However the feasibility of this sampling strategy in terms of recruiting a diverse spectrum of these hidden populations has not been understood well yet in developing countries. Methods In a cross sectional study in Nanjing city of Jiangsu province of China, 430 MSM were recruited including 9 seeds in 14 weeks of study period using RDS. Information regarding socio-demographic characteristics and sexual risk behavior were collected and testing was done for HIV and syphilis. Duration, completion, participant characteristics and the equilibrium of key factors were used for assessing feasibility of RDS. Homophily of key variables, socio-demographic distribution and social network size were used as the indicators of diversity. Results In the study sample, adjusted HIV and syphilis prevalence were 6.6% and 14.6% respectively. Majority (96.3%) of the participants were recruited by members of their own social network. Although there was a tendency for recruitment within the same self-identified group (homosexuals recruited 60.0% homosexuals), considerable cross-group recruitment (bisexuals recruited 52.3% homosexuals) was also seen. Homophily of the self-identified sexual orientations was 0.111 for homosexuals. Upon completion of the recruitment process, participant characteristics and the equilibrium of key factors indicated that RDS was feasible for sampling MSM in Nanjing. Participants recruited by RDS were found to be diverse after assessing the homophily of key variables in successive waves of recruitment, the proportion of characteristics after reaching equilibrium and the social network size. The observed design effects were nearly the same or even better than the theoretical design effect of 2. Conclusion RDS was found to be an efficient and feasible sampling method for recruiting a diverse sample of MSM in a reasonable time. PMID:24244280

Public Library Automation Report: 1984.

ERIC Educational Resources Information Center

Gotanda, Masae

Data processing was introduced to public libraries in Hawaii in 1973 with a feasibility study which outlined the candidate areas for automation. Since then, the Office of Library Services has automated the order procedures for one of the largest book processing centers for public libraries in the country; created one of the first COM…

The International Project. Progress Report.

ERIC Educational Resources Information Center

Rutimann, Hans

The International Project of the Commission on Preservation and Access was begun in June 1988 to explore the feasibility of creating an international database of preserved materials. Its main goals are to: (1) determine the extent to which preservation records exist in other countries; (2) identify the difficulties in converting records to…

Assessing the accuracy and feasibility of a refractive error screening program conducted by school teachers in pre-primary and primary schools in Thailand.

PubMed

Teerawattananon, Kanlaya; Myint, Chaw-Yin; Wongkittirux, Kwanjai; Teerawattananon, Yot; Chinkulkitnivat, Bunyong; Orprayoon, Surapong; Kusakul, Suwat; Tengtrisorn, Supaporn; Jenchitr, Watanee

2014-01-01

As part of the development of a system for the screening of refractive error in Thai children, this study describes the accuracy and feasibility of establishing a program conducted by teachers. To assess the accuracy and feasibility of screening by teachers. A cross-sectional descriptive and analytical study was conducted in 17 schools in four provinces representing four geographic regions in Thailand. A two-staged cluster sampling was employed to compare the detection rate of refractive error among eligible students between trained teachers and health professionals. Serial focus group discussions were held for teachers and parents in order to understand their attitude towards refractive error screening at schools and the potential success factors and barriers. The detection rate of refractive error screening by teachers among pre-primary school children is relatively low (21%) for mild visual impairment but higher for moderate visual impairment (44%). The detection rate for primary school children is high for both levels of visual impairment (52% for mild and 74% for moderate). The focus group discussions reveal that both teachers and parents would benefit from further education regarding refractive errors and that the vast majority of teachers are willing to conduct a school-based screening program. Refractive error screening by health professionals in pre-primary and primary school children is not currently implemented in Thailand due to resource limitations. However, evidence suggests that a refractive error screening program conducted in schools by teachers in the country is reasonable and feasible because the detection and treatment of refractive error in very young generations is important and the screening program can be implemented and conducted with relatively low costs.

Designing a global monitoring system for pilot introduction of a new contraceptive technology, subcutaneous DMPA (DMPA-SC).

PubMed

Stout, Anna; Wood, Siri; Namagembe, Allen; Kaboré, Alain; Siddo, Daouda; Ndione, Ida

2018-06-01

In collaboration with ministries of health, PATH and key partners launched the first pilot introductions of subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana ® Press) in Burkina Faso, Niger, Senegal, and Uganda from July 2014 through June 2016. While each country implemented a unique introduction strategy, all agreed to track a set of uniform indicators to chart the effect of introducing this new method across settings. Existing national health information systems (HIS) were unable to track new methods or delivery channels introduced for a pilot, thus were not a feasible source for project data. We successfully monitored the four-country pilot introductions by implementing a four-phase approach: 1) developing and defining global indicators, 2) integrating indicators into existing country data collection tools, 3) facilitating consistent reporting and data management, and 4) analyzing and interpreting data and sharing results. Project partners leveraged existing family planning registers to the extent possible, and introduced new or modified data collection and reporting tools to generate project-specific data where necessary. We routinely shared monitoring results with global and national stakeholders, informing decisions about future investments in the product and scale up of DMPA-SC nationwide. Our process and lessons learned may provide insights for countries planning to introduce DMPA-SC or other new contraceptive methods in settings where stakeholder expectations for measureable results for decision-making are high. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Screen-and-treat approach to cervical cancer prevention using visual inspection with acetic acid and cryotherapy: experiences, perceptions, and beliefs from demonstration projects in Peru, Uganda, and Vietnam.

PubMed

Paul, Proma; Winkler, Jennifer L; Bartolini, Rosario M; Penny, Mary E; Huong, Trinh Thu; Nga, Le Thi; Kumakech, Edward; Mugisha, Emmanuel; Jeronimo, Jose

2013-01-01

Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA and cryotherapy into routine services. Results showed that use of VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women's schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Although some challenges were found across all sites, others varied from country to country, suggesting that careful assessments before beginning new secondary prevention programs will optimize the probability of success.

Screen-and-Treat Approach to Cervical Cancer Prevention Using Visual Inspection With Acetic Acid and Cryotherapy: Experiences, Perceptions, and Beliefs From Demonstration Projects in Peru, Uganda, and Vietnam

PubMed Central

Paul, Proma; Winkler, Jennifer L.; Bartolini, Rosario M.; Penny, Mary E.; Huong, Trinh Thu; Nga, Le Thi; Kumakech, Edward; Mugisha, Emmanuel

2013-01-01

Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA and cryotherapy into routine services. Results showed that use of VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women's schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Although some challenges were found across all sites, others varied from country to country, suggesting that careful assessments before beginning new secondary prevention programs will optimize the probability of success. PMID:24217554

Peak-Power Markets for Satellite Solar Power

NASA Astrophysics Data System (ADS)

Landis, G.

2002-01-01

Aman MOSTAVANNobuyuki KAYA Institut Teknologi Bandung (TF)Kobe University, Rokkodai, Nada, Ganesha 10; Bandung 40132, IndonesiaKobe 657, Japan mostavan@tf.itb.ac.idkaya@kobe-u.ac.jp This paper introduces first Indonesia, comprises 15 000 islands, has land area of two millions square kilometers. Extending from 95 to 141 degrees East longitude and from 6 degrees North to 11 degrees South latitude. Further the market of the Space Solar Power/SPS must be worldwide, including Indonesia. As we know, it can provide electricity anywhere in the world from the Earth's orbit, mostly Indonesia an equator country. We have to perform case studies of various countries to understand their benefits and disadvantages provided by the SSP, because each country has much different condition on energy from other countries. We are at the moment starting the international collaboration between Indonesia and Japan to carry out the case study for Indonesia. We understand that in Indonesia itself each province has much different micro-climate between one province compared to the other. In Japan, METI (Ministry of Economy, Trade and Industry) has already organized a committee to investigate the feasibility of Space Solar Power and to make a plan to launch a space demonstration of the SPS. While, Indonesia is quickly developing economy and increasing their energy demand. We are investigating the detailed energy conditions of Indonesia, the benefits and disadvantages of the Space Solar Power for Indonesia. Especially, we will perform the investigation on the receiving system for the Japanese pilot Space Power Satellite.

Strategic management of the health workforce in developing countries: what have we learned?

PubMed

Fritzen, Scott A

2007-02-26

The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries. Lessons emerge in four areas. One concerns imbalances in workforce structure, whether from a functional specialization, geographical or facility lens. These imbalances pose a strategic challenge in that authorities must attempt to steer workforce distribution over time using a limited range of policy tools. A second group of lessons concerns the difficulties of central-level steering of the health workforce, often critically weak due to the lack of proper information systems and the complexities of public sector decentralization and service commercialization trends affecting the grassroots.A third cluster examines worker capacity and motivation, often shaped in developing countries as much by the informal norms and incentives as by formal attempts to support workers or to hold them accountable. Finally, a range of reforms centering on service contracting and improvements to human resource management are emerging. Since these have as a necessary (but not sufficient) condition some flexibility in personnel practices, recent trends towards the sharing of such functions with local authorities are promising. The paper identifies a number of current lines of productive research, focusing on the relationship between health policy reforms and the local institutional environments in which the workforce, both public and private, is deployed.

Overcoming Dietary Assessment Challenges in Low-Income Countries: Technological Solutions Proposed by the International Dietary Data Expansion (INDDEX) Project.

PubMed

Coates, Jennifer C; Colaiezzi, Brooke A; Bell, Winnie; Charrondiere, U Ruth; Leclercq, Catherine

2017-03-16

An increasing number of low-income countries (LICs) exhibit high rates of malnutrition coincident with rising rates of overweight and obesity. Individual-level dietary data are needed to inform effective responses, yet dietary data from large-scale surveys conducted in LICs remain extremely limited. This discussion paper first seeks to highlight the barriers to collection and use of individual-level dietary data in LICs. Second, it introduces readers to new technological developments and research initiatives to remedy this situation, led by the International Dietary Data Expansion (INDDEX) Project. Constraints to conducting large-scale dietary assessments include significant costs, time burden, technical complexity, and limited investment in dietary research infrastructure, including the necessary tools and databases required to collect individual-level dietary data in large surveys. To address existing bottlenecks, the INDDEX Project is developing a dietary assessment platform for LICs, called INDDEX24, consisting of a mobile application integrated with a web database application, which is expected to facilitate seamless data collection and processing. These tools will be subject to rigorous testing including feasibility, validation, and cost studies. To scale up dietary data collection and use in LICs, the INDDEX Project will also invest in food composition databases, an individual-level dietary data dissemination platform, and capacity development activities. Although the INDDEX Project activities are expected to improve the ability of researchers and policymakers in low-income countries to collect, process, and use dietary data, the global nutrition community is urged to commit further significant investments in order to adequately address the range and scope of challenges described in this paper.

Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex.

PubMed

Aliku, Twalib O; Lubega, Sulaiman; Lwabi, Peter; Oketcho, Michael; Omagino, John O; Mwambu, Tom

2014-12-01

Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country. Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed. A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2. Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.

Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management.

PubMed

Piette, John D; List, Justin; Rana, Gurpreet K; Townsend, Whitney; Striplin, Dana; Heisler, Michele

2015-11-24

We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients' unique and changing needs. © 2015 American Heart Association, Inc.

Risks, benefits, and issues in creating a behind-the-counter category of medications.

PubMed

Ried, L Douglas; Huston, Sally A; Kucukarslan, Suzan N; Sogol, Elliott M; Schafermeyer, Kenneth W; Sansgiry, Sujit S

2011-01-01

To examine the issues surrounding the development and implementation of a behind-the-counter (BTC) category of medications. Testimony from organizations submitting comments to the Food and Drug Administration (FDA) panel hearings in November 2007, the 2009 final report of the U. S. General Accounting Office regarding a BTC drug category, literature review of research that has been conducted, experiences from other countries, and publically available information from agencies in charge of regulating medications similar to BTC. Based on evidence attained from the current work, the following six recommendations regarding a BTC category of medications are provided. (1) Demonstration needs to occur that the risks and/or costs of BTC are outweighed by benefits, positive measurable outcomes, and financial savings to society. (2) Sufficient resources, including personnel, equipment, and facilities, need to be available for the appropriate provision of BTC services and to ensure ongoing monitoring and controls. (3) An appropriate compensation structure needs to be developed. (4) Encounters and outcomes should be documented in an electronic record, the information should be shared with other health care providers involved in patients' care, and interprofessional collaboration and communication should occur. (5) Criteria for designating candidates for transition, ongoing review for safety, and reverse transition must be developed. (6) Applicable lessons learned from other countries should be incorporated into BTC strategies. In addition to implementation recommendations, we also summarize additional evidence that needs to be gathered to optimize the BTC model. Based on the accumulated evidence, comments to FDA's request, and information from other countries, implementation of a BTC model probably is feasible in the United States. However, the optimal model remains uncertain and various aspects of a program need to be prioritized and rigorously tested.

Overcoming Dietary Assessment Challenges in Low-Income Countries: Technological Solutions Proposed by the International Dietary Data Expansion (INDDEX) Project

PubMed Central

Coates, Jennifer C.; Colaiezzi, Brooke A.; Bell, Winnie; Charrondiere, U. Ruth; Leclercq, Catherine

2017-01-01

An increasing number of low-income countries (LICs) exhibit high rates of malnutrition coincident with rising rates of overweight and obesity. Individual-level dietary data are needed to inform effective responses, yet dietary data from large-scale surveys conducted in LICs remain extremely limited. This discussion paper first seeks to highlight the barriers to collection and use of individual-level dietary data in LICs. Second, it introduces readers to new technological developments and research initiatives to remedy this situation, led by the International Dietary Data Expansion (INDDEX) Project. Constraints to conducting large-scale dietary assessments include significant costs, time burden, technical complexity, and limited investment in dietary research infrastructure, including the necessary tools and databases required to collect individual-level dietary data in large surveys. To address existing bottlenecks, the INDDEX Project is developing a dietary assessment platform for LICs, called INDDEX24, consisting of a mobile application integrated with a web database application, which is expected to facilitate seamless data collection and processing. These tools will be subject to rigorous testing including feasibility, validation, and cost studies. To scale up dietary data collection and use in LICs, the INDDEX Project will also invest in food composition databases, an individual-level dietary data dissemination platform, and capacity development activities. Although the INDDEX Project activities are expected to improve the ability of researchers and policymakers in low-income countries to collect, process, and use dietary data, the global nutrition community is urged to commit further significant investments in order to adequately address the range and scope of challenges described in this paper. PMID:28300759

Simulating future supply of and requirements for human resources for health in high-income OECD countries.

PubMed

Tomblin Murphy, Gail; Birch, Stephen; MacKenzie, Adrian; Rigby, Janet

2016-12-12

As part of efforts to inform the development of a global human resources for health (HRH) strategy, a comprehensive methodology for estimating HRH supply and requirements was described in a companion paper. The purpose of this paper is to demonstrate the application of that methodology, using data publicly available online, to simulate the supply of and requirements for midwives, nurses, and physicians in the 32 high-income member countries of the Organisation for Economic Co-operation and Development (OECD) up to 2030. A model combining a stock-and-flow approach to simulate the future supply of each profession in each country-adjusted according to levels of HRH participation and activity-and a needs-based approach to simulate future HRH requirements was used. Most of the data to populate the model were obtained from the OECD's online indicator database. Other data were obtained from targeted internet searches and documents gathered as part of the companion paper. Relevant recent measures for each model parameter were found for at least one of the included countries. In total, 35% of the desired current data elements were found; assumed values were used for the other current data elements. Multiple scenarios were used to demonstrate the sensitivity of the simulations to different assumed future values of model parameters. Depending on the assumed future values of each model parameter, the simulated HRH gaps across the included countries could range from shortfalls of 74 000 midwives, 3.2 million nurses, and 1.2 million physicians to surpluses of 67 000 midwives, 2.9 million nurses, and 1.0 million physicians by 2030. Despite important gaps in the data publicly available online and the short time available to implement it, this paper demonstrates the basic feasibility of a more comprehensive, population needs-based approach to estimating HRH supply and requirements than most of those currently being used. HRH planners in individual countries, working with their respective stakeholder groups, would have more direct access to data on the relevant planning parameters and would thus be in an even better position to implement such an approach.

Home administration of maintenance pemetrexed for patients with advanced non-squamous non-small cell lung cancer: rationale, practicalities and phase II feasibility study design.

PubMed

Lal, Rohit; Bourayou, Nawel; Hillerdal, Gunnar; Nicolson, Marianne; Vikstrom, Anders; Lorenzo, Maria; D'yachkova, Yulia; Barriga, Susana; Visseren-Grul, Carla

2013-10-03

Home-based care in oncology is mainly reserved for patients at the end of life. Regulations regarding home delivery of cytotoxics differ across Europe, with a notable lack of practice guidelines in most countries. This has led to a lack of data addressing the feasibility of home-based administration of cytotoxic chemotherapy. In advanced non-squamous non-small cell lung cancer, pemetrexed is approved as maintenance therapy after first-line chemotherapy. In this setting, patients have the potential to be treated long-term with maintenance therapy, which, in the absence of unacceptable toxicity, is continued until disease progression. The favourable safety profile of pemetrexed and the ease of its administration by 10-minute intravenous infusion every 3 weeks make this drug a suitable candidate for administration in a home setting. Literature and regulations relevant to the home-based delivery of cytotoxic therapy were reviewed, and a phase II feasibility study of home administration of pemetrexed maintenance therapy was designed. At least 50 patients with advanced non-squamous non-small cell lung cancer, Eastern Cooperative Oncology Group performance status 0-1 and no progressive disease after four cycles of platinum-based first-line therapy are required to allow investigation of the feasibility of home-based administration of pemetrexed maintenance therapy (500 mg/m(2) every 3 weeks until progressive disease or unacceptable toxicity). Feasibility is being assessed as adherence to the home-based administration process (primary endpoint), patient safety, impact on patients' quality of life, patient and physician satisfaction with home care, and healthcare resource use and costs. Enrolment of patients from the UK and Sweden, where home-based care is relatively well developed, commenced in December 2011. This feasibility study addresses an important aspect of maintenance therapy, that is, patient comfort during protracted home-based chemotherapy. The study design requires unusual methodology and specific logistics to address outcomes relevant to the home-delivery approach. This article presents a study design that offers a novel and reproducible model for home-based chemotherapy, and provides an up-to-date overview of the literature regarding this type of treatment. ClinicalTrials.gov: NCT01473563.

Feasibility Study: New Knowledge Demands in Turbulent Business World

NASA Astrophysics Data System (ADS)

Sprice, Renate; Kirikova, Marite

Feasibility study is one of the early activities in information systems (IS) development when important decisions regarding choice among several possible systems development alternatives are to be made. In times of relatively stable business environment and waterfall model as a systems development approach, the role and methods of feasibility study where quite clear (Kendall and Kendall 1995). However, new software development methods and the necessity to develop more rapidly new IS or their parts may. challenge the possibility to evaluate project feasibility in the early stages of IS development.

Implementation Science in Cancer Prevention and Control: A framework for research and programs in low and middle-income countries

PubMed Central

Sanchez, Michael A.; Rimer, Barbara K.; Samet, Jonathan M.; Glasgow, Russell E.

2014-01-01

Implementation Science is a set of tools, principles and methodologies that can be used to bring scientific evidence into action, improve health care quality and delivery and improve public health. As the burden of cancer increases in low- and middle-income countries, it is important to plan cancer control programs that are both evidence-based and delivered in ways that are feasible, cost-effective, contextually appropriate and sustainable. This review presents a framework for using implementation science for cancer control planning and implementation and discusses potential areas of focus for research and programs in low and middle-income countries interested in integrating research into practice and policy. PMID:25178984

EMERGENCE OF "DRIVERS" FOR THE IMPLEMENTATION OF HEALTH TECHNOLOGY ASSESSMENT.

PubMed

Castro Jaramillo, Hector Eduardo; Moreno-Mattar, Ornella; Osorio-Cuevas, Diana

2016-01-01

Health technology assessment (HTA) examines the consequences of the application of health technologies and is aimed at better informing decision-makers. Over the past 30 years, different countries have implemented HTA organizations. Colombia established by law its own HTA agency (IETS) in 2011 which started operations in November 2012. The aim of this study was to assess the feasibility of conducting and using HTA to inform decision-making in this context. Through a qualitative approach, ten "drivers" emerged with the ability to help or hinder HTA development in this context: availability and quality of data, implementation strategy, cultural aspects, local capacity, financial support, policy/political support, globalization, stakeholder pressure, health system context, and usefulness perception. Semi-structured interviews were conducted with key HTA researchers, after following rigorous transcription, and thematic content analysis, those aspects that may be barriers or facilitator for HTA development and use in Colombia were identified. Although HTA has become a tool to inform decision-making around the world, its use may vary according to setting. Determining those aspects which may enable or interfere with HTA development and use in Colombia may be useful for other countries when considering the establishment of HTA systems. The conceptual transferability of concepts like "drivers" with caveats may be of interest for similar settings trying to incorporate HTA processes and institutions into systematic decision-making.

Improving HIV outcomes in resource-limited countries: the importance of quality indicators.

PubMed

Ahonkhai, Aima A; Bassett, Ingrid V; Ferris, Timothy G; Freedberg, Kenneth A

2012-11-24

Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped. Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment. This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level. An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.

Country-wide assessment of estuary health: An approach for integrating pressures and ecosystem response in a data limited environment

NASA Astrophysics Data System (ADS)

Van Niekerk, L.; Adams, J. B.; Bate, G. C.; Forbes, A. T.; Forbes, N. T.; Huizinga, P.; Lamberth, S. J.; MacKay, C. F.; Petersen, C.; Taljaard, S.; Weerts, S. P.; Whitfield, A. K.; Wooldridge, T. H.

2013-09-01

Population and development pressures increase the need for proactive strategic management on a regional or country-wide scale - reactively protecting ecosystems on an estuary-by-estuary basis against multiple pressures is 'resource hungry' and not feasible. Proactive management requires a strategic assessment of health so that the most suitable return on investment can be made. A country-wide assessment of the nearly 300 functional South African estuaries examined both key pressures (freshwater inflow modification, water quality, artificial breaching of temporarily open/closed systems, habitat modification and exploitation of living resources) and health state. The method used to assess the type and level of the different pressures, as well as the ecological health status of a large number of estuaries in a data limited environment is described in this paper. Key pressures and the ecological condition of estuaries on a national scale are summarised. The template may also be used to provide guidance to coastal researchers attempting to inform management in other developing countries. The assessment was primarily aimed at decision makers both inside and outside the biodiversity sector. A key starting point was to delineate spatially the estuary functional zone (area) for every system. In addition, available data on pressures impacting estuaries on a national scale were collated. A desktop national health assessment, based on an Estuarine Health Index developed for South African ecological water requirement studies, was then applied systematically. National experts, all familiar with the index evaluated the estuaries in their region. Individual estuarine health assessment scores were then translated into health categories that reflect the overall status of South Africa's estuaries. The results showed that estuaries in the warm-temperate biogeographical zone are healthier than those in the cool-temperate and subtropical zones, largely reflecting the country's demographics and developmental pressures. A major finding was that, while a large number of South Africa's estuaries are still in an excellent to good condition, they tend to represent very small systems (<150 ha in size) in rural areas with few pressures. Larger systems, which are more important as nursery grounds because of their size, and also of higher economic and ecological importance, are in a fair to poor condition. This was due to pressures within the catchments influencing these downstream systems, and degradation as a result of direct development within the estuary functional zone.

The effectiveness of market-based conservation in the tropics: forest certification in Ecuador and Bolivia.

PubMed

Ebeling, Johannes; Yasué, Maï

2009-02-01

During the last decade, forest certification has gained momentum as a market-based conservation strategy in tropical forest countries. Certification has been promoted to enhance forest management in countries where governance capacities are insufficient to adequately manage natural resources and enforce pertinent regulations, given that certification relies largely on non-governmental organisations and private businesses. However, at present there are few tropical countries with large areas of certified forests. In this study, we conducted semi-structured stakeholder interviews in Ecuador and Bolivia to identify key framework conditions that influence the costs and benefits for companies to switch from conventional to certified forestry operations. Bolivia has a much greater relative area under certified forest management than Ecuador and also significantly more certified producers. The difference in the success of certification between both countries is particularly notable because Bolivia is a poorer country with more widespread corruption, and is landlocked with less access to export routes. Despite these factors, several characteristics of the Bolivian forest industry contribute to lower additional costs of certified forest management compared to Ecuador. Bolivia has stronger government enforcement of forestry regulations a fact that increases the cost of illegal logging, management units are larger, and vertical integration in the process chain from timber extraction to markets is higher. Moreover, forestry laws in Bolivia are highly compatible with certification requirements, and the government provides significant tax benefits to certified producers. Results from this study suggest that certification can be successful in countries where governments have limited governance capacity. However, the economic incentives for certification do not only arise from favourable market conditions. Certification is likely to be more successful where governments enforce forestry laws, provide financial incentives for certified forestry, and provide land tenure security, and where large-scale and vertically integrated forestry operations are commercially feasible. For this reason, at present, there are few developing countries where forest certification is likely to achieve widespread success.

An analysis framework for characterizing and explaining development of EIA legislation in developing countries-Illustrated for Georgia, Ghana and Yemen

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kolhoff, Arend J., E-mail: akolhoff@eia.nl; Driessen, Peter P.J., E-mail: p.driessen@uu.nl; Runhaar, Hens A.C., E-mail: h.a.c.runhaar@uu.nl

2013-01-15

Actors in the field of international development co-operation supporting the development of EIA legislation in developing countries often do not achieve the results envisaged. The performance of EIA in these countries often remains weak. One reason, we assume, is that often those actors support the establishment of overly ambitious EIA legislation that cannot achieve its objectives in the light of constraining contexts. To provide more effective support we need to better understand the enabling and constraining contextual factors that influence the development of EIA legislation and to which support actors should align itself. In this article a new analysis frameworkmore » for classifying, characterizing and explaining the development of EIA legislation is described, measured in terms of ambition levels. Ambitions are defined as intentions the EIA authorities aim to fulfill, expressed in formal EIA legislation. Three country cases, Yemen, Georgia and Ghana are used to illustrate the usefulness of our framework and as a first test to refine the framework. We have formulated the following five hypotheses that complement and refine our analysis framework. One, EIA legislation may develop multilinearly in terms of ambition levels. Two, ambitions in EIA legislation seem to be influenced to a great extent by the power and capacity of, on the one hand, the environmental authorities supporting EIA and, on the other hand, the sector authorities hindering the development of EIA. Three, the political system is the most important context factor influencing the rules of policy-making and the power of the different actors involved. Four, the importance of context factors on the development of ambitions is dependent on the phase of EIA system development. Five, some ambitions seem to be influenced by particular factors; for instance the ambitions for the object of study seem to be influenced by the level of environmental awareness of the sector ministries and parliament. The analysis framework may also assist actors involved in the development of EIA legislation in setting ambitions for EIA legislation that are feasible within the context in which it will be developed and implemented. Application of a country-specific EIA model would seem to be the preferred model to develop EIA legislation because by taking capacities of actors and context factors as a starting point, it offers more potential to well-performing EIA systems. - Highlights: Black-Right-Pointing-Pointer EIA systems develop from less to high ambitious and sometimes vice versa. Black-Right-Pointing-Pointer Ambitions in EIA legislation are determined by the capacity of environment- and sector authority. Black-Right-Pointing-Pointer The political system is the most important context factor explaining the ambitions of an EIA system. Black-Right-Pointing-Pointer An analysis framework developed to measure EIA system ambitions might help to setambitions.« less

The safety of H1N1 vaccine in children in Saudi Arabia: a cohort study using modern technology in a developing country.

PubMed

Aljadhey, Hisham; Alyabsi, Mesnad; Alrwisan, Adel; Alqahtani, Nasser; Almutairi, Reem; Al Tawil, Esraa; Adam, Mansour; Shakir, Saad; Aljeraisy, Majed; Al-Blowi, Ali; Alkhashan, Hesham; Albogami, Yasser; Murray, Michael D

2012-07-01

With its rapid introduction in 2009, concerns about the safety of the H1N1 vaccines have been raised. Data were especially limited on the pediatric safety of H1N1 vaccine in Saudi Arabia. The objectives of this study were to investigate the safety of the H1N1 vaccine (Pandemrix(®)) in children and examine the feasibility of obtaining information on possibly associated adverse reactions using mobile telephone contact with child caregivers. A cohort study was conducted in Riyadh, Saudi Arabia. Patients were included if they were aged between 6 and 18 years and had received one dose of the H1N1 vaccine. A control group involved children from the same school system who had not received the vaccine. Six months following vaccination, a clinical pharmacist called the caregiver of the child to ask about hospitalization, emergency room visits and events related to H1N1 vaccine administration using a standardized questionnaire. Caregivers of 372 school-age children were contacted. The response rate was 97% (n = 359). A total of 169 children who received at least one dose of the H1N1 vaccine were compared with 190 children in the control group who had not received the vaccine. Controlling for age, sex, education and use of medications, the odds ratio (OR) of hospitalization or emergency room visits for children within the 6 months after vaccination relative to the unvaccinated children was 1.25 (95% CI 0.47, 3.35). The risk of influenza-like symptoms was significantly reduced in vaccinated children compared with unvaccinated children (OR 0.63; 95% CI 0.41, 0.99). School-age children in Saudi Arabia who received the H1N1 vaccine did not have an increased risk of hospitalization or emergency room visits. Larger studies are needed to confirm these results. Proactive pharmacovigilance is important in assessing the safety of vaccines and other medications. It is feasible to collect information on adverse drug reactions using mobile telephones, a method that can be of benefit in both developed and developing countries.

Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.

PubMed

Campbell, Stephen M; Kontopantelis, Evangelos; Hannon, Kerin; Burke, Martyn; Barber, Annette; Lester, Helen E

2011-08-10

Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes.

The feasibility of multisectoral policy options aimed at reducing trans fats and encouraging its replacement with healthier oils in India.

PubMed

Downs, Shauna M; Thow, Anne-Marie; Ghosh-Jerath, Suparna; Leeder, Stephen R

2015-05-01

The World Health Organization recommends replacement of trans fat with polyunsaturated fat to reduce cardiovascular disease risk. Although several high-income countries have been successful in reducing trans fat in the food supply, low- and middle-income countries such as India may face additional contextual challenges such as the large informal sector, lack of consumer awareness, less enforcement capacity and low availability and affordability of healthier unsaturated fats. The objective of this study was to examine the feasibility and acceptability of multisectoral policy options aimed at supporting trans fat reduction and its replacement with polyunsaturated fats in India. Multisectoral policy options examined in this study were identified using food supply chain analysis. Semi-structured interviews (n = 17) were conducted with key informants from agriculture, trade, finance, retail, industry, food standards, non-governmental organizations and the health professions to gain their views on the feasibility and acceptability of the policy options. Purposive sampling was used to identify key informants. Data were coded and organized based on key themes. There was support for policies aimed at improving the quality of seeds, supporting farmer co-operatives and developing affordable farming equipment suited to smallholders to improve the production of healthier oils. Increasing the role of the private sector to improve links among producers, processors and retailers may help to streamline the fats supply chain in India. Blending healthier oils with oils high in saturated fat, which are currently readily available, could help to improve the quality of fat in the short term. Improving consumer awareness through mass media campaigns and improved labelling may help increase consumer demand for healthier products. Reorienting agricultural policies to support production of healthier oils will help increase their uptake by industry. Policy coherence across sectors will be critical to reduce trans fat intakes and could be improved by increasing engagement among researchers, the private sector and government. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Universal Health Coverage for Schizophrenia: A Global Mental Health Priority

PubMed Central

Patel, Vikram

2016-01-01

The growing momentum towards a global consensus on universal health coverage, alongside an acknowledgment of the urgency and importance of a comprehensive mental health action plan, offers a unique opportunity for a substantial scale-up of evidence-based interventions and packages of care for a range of mental disorders in all countries. There is a robust evidence base testifying to the effectiveness of drug and psychosocial interventions for people with schizophrenia and to the feasibility, acceptability and cost-effectiveness of the delivery of these interventions through a collaborative care model in low resource settings. While there are a number of barriers to scaling up this evidence, for eg, the finances needed to train and deploy community based workers and the lack of agency for people with schizophrenia, the experiences of some upper middle income countries show that sustained political commitment, allocation of transitional financial resources to develop community services, a commitment to an integrated approach with a strong role for community based institutions and providers, and a progressive realization of coverage are the key ingredients for scale up of services for schizophrenia. PMID:26245942

Feasibility and effectiveness of a brief, intensive phylogenetics workshop in a middle-income country.

PubMed

Pollett, S; Leguia, M; Nelson, M I; Maljkovic Berry, I; Rutherford, G; Bausch, D G; Kasper, M; Jarman, R; Melendrez, M

2016-01-01

There is an increasing role for bioinformatic and phylogenetic analysis in tropical medicine research. However, scientists working in low- and middle-income regions may lack access to training opportunities in these methods. To help address this gap, a 5-day intensive bioinformatics workshop was offered in Lima, Peru. The syllabus is presented here for others who want to develop similar programs. To assess knowledge gained, a 20-point knowledge questionnaire was administered to participants (21 participants) before and after the workshop, covering topics on sequence quality control, alignment/formatting, database retrieval, models of evolution, sequence statistics, tree building, and results interpretation. Evolution/tree-building methods represented the lowest scoring domain at baseline and after the workshop. There was a considerable median gain in total knowledge scores (increase of 30%, p<0.001) with gains as high as 55%. A 5-day workshop model was effective in improving the pathogen-applied bioinformatics knowledge of scientists working in a middle-income country setting. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Comparative advantage strategy for rapid pollution mitigation in China.

PubMed

Xu, Yuan

2013-09-03

Due to its sheer size and growth trend, no other country is facing more daunting challenges than China in reducing its pollutant emissions. A critical but inadequately addressed question is how rapidly China could feasibly achieve such mitigation. The stake is high not only about how much worse China's environmental quality could become but also about how the world can prevent catastrophic climate change. Through examining sulfur dioxide (SO2) mitigation in coal-fired power plants and wind energy development for carbon dioxide (CO2) mitigation, this article proposes a comparative advantage strategy for overcoming high barriers to fast pollution mitigation. On the demand side, China could first make progress in the deployment of more pollution control facilities and then improve their operational performance. The resulting low technological market entry barriers could help to build enough industrial capacity to meet the huge demand with prices under control. The strategy in the current practice could be improved to establish not only a large supply industry but also a strong one to enable other countries to move more rapidly in pollution mitigation.

Authorship in Global Mental Health Research: Recommendations for Collaborative Approaches to Writing and Publishing

PubMed Central

Kohrt, Brandon A.; Upadhaya, Nawaraj; Luitel, Nagendra P.; Maharjan, Sujen M.; Kaiser, Bonnie N.; MacFarlane, Elizabeth K.; Khan, Noreen

2014-01-01

Background Collaborations among researchers, clinicians, and individuals with mental illness from high-income countries (HICs) and low- and middle-income countries (LMICs) are crucial to produce research, interventions, and policies that are relevant, feasible, and ethical. However, global mental health and cultural psychiatry research publications have been dominated by HIC investigators. Objective The aim of this review was to present recommendations for collaborative writing with a focus on early career researchers in HICs and LMICs. Methods A workshop was conducted with HIC and LMIC investigators in Nepal to discuss lessons learned for collaborative writing. The researchers had experience in cross-cultural psychiatric epidemiology, health services research, randomized controlled trials, and projects with war and disaster-affected populations in complex humanitarian emergencies including child soldiers and refugees. Additional lessons learned were contributed from researchers engaged in similar collaborations in Haiti. Findings A step-by-step process for collaborative writing was developed. Conclusions HIC and LMIC writing collaborations will encourage accurate, ethical, and contextually grounded publications to foster understanding and facilitate reduction of the global burden of mental illness. PMID:24976552

The Usability and Effectiveness of Mobile Health Technology–Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review

PubMed Central

Rosman, Ageeth N; van Beukering, Monique DM; Kok, Marjolein

2018-01-01

Background A growing number of mobile health (mHealth) technology–based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. Objective This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. Methods We performed a systematic review searching the following electronic databases for studies on mHealth technology–based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. Results Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects. Conclusions Most studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care. PMID:29691216

The Best-of-2-Worlds philosophy: developing local dismantling and global infrastructure network for sustainable e-waste treatment in emerging economies.

PubMed

Wang, Feng; Huisman, Jaco; Meskers, Christina E M; Schluep, Mathias; Stevels, Ab; Hagelüken, Christian

2012-11-01

E-waste is a complex waste category containing both hazardous and valuable substances. It demands for a cost-efficient treatment system which simultaneously liberates and refines target fractions in an environmentally sound way. In most developing countries there is a lack of systems covering all steps from disposal until final processing due to limited infrastructure and access to technologies and investment. This paper introduces the 'Best-of-2-Worlds' philosophy (Bo2W), which provides a network and pragmatic solution for e-waste treatment in emerging economies. It seeks technical and logistic integration of 'best' pre-processing in developing countries to manually dismantle e-waste and 'best' end-processing to treat hazardous and complex fractions in international state-of-the-art end-processing facilities. A series of dismantling trials was conducted on waste desktop computers, IT equipment, large and small household appliances, in order to compare the environmental and economic performances of the Bo2W philosophy with other conventional recycling scenarios. The assessment showed that the performance of the Bo2W scenario is more eco-efficient than mechanical separation scenarios and other local treatment solutions. For equipment containing substantial hazardous substances, it demands the assistance from domestic legislation for mandatory removal and safe handling of such fractions together with proper financing to cover the costs. Experience from Bo2W pilot projects in China and India highlighted key societal factors influencing successful implementation. These include market size, informal competitors, availability of national e-waste legislation, formal take-back systems, financing and trust between industrial players. The Bo2W philosophy can serve as a pragmatic and environmentally responsible transition before establishment of end-processing facilities in developing countries is made feasible. The executive models of Bo2W should be flexibly differentiated for various countries by adjusting to local conditions related to operational scale, level of centralized operations, dismantling depth, combination with mechanical processing and optimized logistics to international end-processors. Copyright © 2012 Elsevier Ltd. All rights reserved.

Standardized reporting for rapid relative effectiveness assessments of pharmaceuticals.

PubMed

Kleijnen, Sarah; Pasternack, Iris; Van de Casteele, Marc; Rossi, Bernardette; Cangini, Agnese; Di Bidino, Rossella; Jelenc, Marjetka; Abrishami, Payam; Autti-Rämö, Ilona; Seyfried, Hans; Wildbacher, Ingrid; Goettsch, Wim G

2014-11-01

Many European countries perform rapid assessments of the relative effectiveness (RE) of pharmaceuticals as part of the reimbursement decision making process. Increased sharing of information on RE across countries may save costs and reduce duplication of work. The objective of this article is to describe the development of a tool for rapid assessment of RE of new pharmaceuticals that enter the market, the HTA Core Model® for Rapid Relative Effectiveness Assessment (REA) of Pharmaceuticals. Eighteen member organisations of the European Network of Health Technology Assessment (EUnetHTA) participated in the development of the model. Different versions of the model were developed and piloted in this collaboration and adjusted accordingly based on feedback on the content and feasibility of the model. The final model deviates from the traditional HTA Core Model® used for assessing other types of technologies. This is due to the limited scope (strong focus on RE), the timing of the assessment (just after market authorisation), and strict timelines (e.g. 90 days) required for performing the assessment. The number of domains and assessment elements was limited and it was decided that the primary information sources should preferably be a submission file provided by the marketing authorisation holder and the European Public Assessment Report. The HTA Core Model® for Rapid REA (version 3.0) was developed to produce standardised transparent RE information of pharmaceuticals. Further piloting can provide input for possible improvements, such as further refining the assessment elements and new methodological guidance on relevant areas.

Towards the systematic development of medical networking technology.

PubMed

Faust, Oliver; Shetty, Ravindra; Sree, S Vinitha; Acharya, Sripathi; Acharya U, Rajendra; Ng, E Y K; Poo, Chua Kok; Suri, Jasjit

2011-12-01

Currently, there is a disparity in the availability of doctors between urban and rural areas of developing countries. Most experienced doctors and specialists, as well as advanced diagnostic technologies, are available in urban areas. People living in rural areas have less or sometimes even no access to affordable healthcare facilities. Increasing the number of doctors and charitable medical hospitals or deploying advanced medical technologies in these areas might not be economically feasible, especially in developing countries. We need to mobilize science and technology to master this complex, large scale problem in an objective, logical, and professional way. This can only be achieved with a collaborative effort where a team of experts works on both technical and non-technical aspects of this health care divide. In this paper we use a systems engineering framework to discuss hospital networks which might be solution for the problem. We argue that with the advancement in communication and networking technologies, economically middle class people and even some rural poor have access to internet and mobile communication systems. Thus, Hospital Digital Networking Technologies (HDNT), such as telemedicine, can be developed to utilize internet, mobile and satellite communication systems to connect primitive rural healthcare centers to well advanced modern urban setups and thereby provide better consultation and diagnostic care to the needy people. This paper describes requirements and limitations of the HDNTs. It also presents the features of telemedicine, the implementation issues and the application of wireless technologies in the field of medical networking.

Public Housing: A Tailored Approach to Energy Retrofits

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dentz, J.; Conlin, F.; Podorson, D.

2014-06-01

Over one million HUD-supported public housing units provide rental housing for eligible low-income families across the country. A survey of over 100 PHAs across the country indicated that there is a high level of interest in developing low cost solutions that improve energy efficiency and can be seamlessly included in the refurbishment process. Further, PHAs, have incentives (both internal and external) to reduce utility bills. ARIES worked with two public housing authorities (PHAs) to develop packages of energy efficiency retrofit measures the PHAs can cost effectively implement with their own staffs in the normal course of housing operations at themore » time when units are refurbished between occupancies. The energy efficiency turnover protocols emphasized air infiltration reduction, duct sealing and measures that improve equipment efficiency. ARIES documented implementation in ten housing units. Reductions in average air leakage were 16-20% and duct leakage reductions averaged 38%. Total source energy consumption savings was estimated at 6-10% based on BEopt modeling with a simple payback of 1.7 to 2.2 years. Implementation challenges were encountered mainly related to required operational changes and budgetary constraints. Nevertheless, simple measures can feasibly be accomplished by PHA staff at low or no cost. At typical housing unit turnover rates, these measures could impact hundreds of thousands of unit per year nationally.« less

Teleconsultation in diagnostic pathology: experience from Iran and Germany with the use of two European telepathology servers.

PubMed

Mireskandari, Masoud; Kayser, Gian; Hufnagl, Peter; Schrader, Thomas; Kayser, Klaus

2004-01-01

Eighty pathology cases were sent independently to each of two telepathology servers. Cases were submitted from the Department of Pathology at the University of Kerman in Iran (40 cases) and from the Institute of Pathology in Berlin, Germany (40 cases). The telepathology servers were located in Berlin (the UICC server) and Basel in Switzerland (the iPATH server). A scoring system was developed to quantify the differences between the diagnoses of the referring pathologist and the remote expert. Preparation of the cases, as well as the submission of images, took considerably longer from Kerman than from Berlin; this was independent of the server system. The Kerman delay was mainly associated with a slower transmission rate and longer image preparation. The diagnostic gap between referrers' and experts' diagnoses was greater with the iPATH system, but not significantly so. The experts' response time was considerably shorter for the iPATH system. The results showed that telepathology is feasible for requesting pathologists working in a developing country or in an industrialized country. The key factor in the quality of the service is the work of the experts: they should be selected according to their diagnostic expertise, and their commitment to the provision of telepathology services is critical.

Engaging One Health for Non-Communicable Diseases in Africa: Perspective for Mycotoxins

PubMed Central

Ladeira, Carina; Frazzoli, Chiara; Orisakwe, Orish Ebere

2017-01-01

The role of mycotoxins—e.g., aflatoxins, ochratoxins, trichothecenes, zearalenone, fumonisins, tremorgenic toxins, and ergot alkaloids—has been recognized in the etiology of a number of diseases. In many African countries, the public health impact of chronic (indoor) and/or repeated (dietary) mycotoxin exposure is largely ignored hitherto, with impact on human health, food security, and export of African agricultural food products. Notwithstanding, African scientific research reached milestones that, when linked to findings gained by the international scientific community, make the design and implementation of science-driven governance schemes feasible. Starting from Nigeria as leading African Country, this article (i) overviews available data on mycotoxins exposure in Africa; (ii) discusses new food safety issues, such as the environment–feed–food chain and toxic exposures of food producing animals in risk assessment and management; (iii) identifies milestones for mycotoxins risk management already reached in West Africa; and (iv) points out preliminary operationalization aspects for shielding communities from direct (on health) and indirect (on trade, economies, and livelihoods) effects of mycotoxins. An African science-driven engaging of scientific knowledge by development actors is expected therefore. In particular, One health/One prevention is suggested, as it proved to be a strategic and sustainable development framework. PMID:29085817

Mass spectrometry applied to the identification of Mycobacterium tuberculosis and biomarker discovery.

PubMed

López-Hernández, Y; Patiño-Rodríguez, O; García-Orta, S T; Pinos-Rodríguez, J M

2016-12-01

An adequate and effective tuberculosis (TB) diagnosis system has been identified by the World Health Organization as a priority in the fight against this disease. Over the years, several methods have been developed to identify the bacillus, but bacterial culture remains one of the most affordable methods for most countries. For rapid and accurate identification, however, it is more feasible to implement molecular techniques, taking advantage of the availability of public databases containing protein sequences. Mass spectrometry (MS) has become an interesting technique for the identification of TB. Here, we review some of the most widely employed methods for identifying Mycobacterium tuberculosis and present an update on MS applied for the identification of mycobacterial species. © 2016 The Society for Applied Microbiology.

Exploring the Opportunities of a Balloon-Satellite in Bangladesh for Weather Data Collection and Vegetative Analysis

NASA Astrophysics Data System (ADS)

Shafique, Md. Ishraque Bin; Razzaq Halim, M. A.; Rabbi, Fazle; Khalilur Rhaman, Md.

2016-07-01

For a third world country like Bangladesh, satellite and space research is not feasible due to lack of funding. Therefore, in order to imitate the principles of such a satellite Balloon Satellite can easily and inexpensively be setup. Balloon satellites are miniature satellites, which are cheap and easy to construct. This paper discusses a BalloonSat developed using a Raspberry Pi, IMU module, UV sensor, GPS module, Camera and XBee Module. An interactive GUI was designed to display all the data collected after processing. To understand nitrogen concentration of a plant, a leaf color chart is used. This paper attempts to digitalize this process, which is applied on photos taken by the BallonSat.

Adapting Evidence-Based Interventions to Meet the Needs of Adolescents Growing Up with HIV in South Africa: The VUKA Case Example

PubMed Central

Nestadt, Danielle; Bhana, Arvin; Petersen, Inge; Abrams, Elaine J.; Alicea, Stacey; Holst, Helga; Myeza, Nonhlahla; John, Sally; Small, Latoya; McKay, Mary

2015-01-01

The VUKA family program is one of the only evidence-based interventions to promote positive psychosocial outcomes in South African HIV-infected pre- and early adolescents and their families. In this paper, we discuss the collaborative process by which a multidisciplinary team of clinicians, researchers, counselors, and artists/educators and families adapted and developed VUKA for this population using community-based participatory research methods. We describe the intervention and explore lessons learned that may be applicable across contexts related to international collaboration and adapting evidence-based interventions so that they are likely to be acceptable, feasible, and effective in a given setting and country context. PMID:25984440

The role of geomatics in supporting sustainable development policy-making

NASA Astrophysics Data System (ADS)

Zhang, Aining

Sustainable development has been on national policy agendas since 1992 when Agenda 21, an international agreement on sustainable development, was signed by over 150 countries. A key to sustainable development policy-making is information. Spatial information is an integral part of this information pool given the spatial nature of sustainable development. Geomatics, a technology dealing specifically with spatial information, can play a major role in support of the policy-making process. This thesis is aimed at advancing this role. The thesis starts with a discussion of theories and methodologies for sustainable development. The policy process for sustainable development is characterized, followed by an analysis of the requirements of sustainable development policy-making for geomatics support. The current status of geomatics in meeting these requirements is then examined, and the challenges and potential for geomatics to further address the needs are identified. To deal with these challenges, an integrated solution, namely the development of an on-line national policy atlas for sustainable development, is proposed, with a focus to support policy action formulation. The thesis further addresses one of the major research topics required for the implementation of the proposed solution, namely the exploration of the feasibility of a spatial statistics approach to predictive modelling in support of policy scenario assessments. The study is based on the case of national climate change policy formulation, with a focus on the development of new light duty vehicle sales mix models in support of transportation fuel efficiency policy-making aimed at greenhouse gas reductions. The conceptual framework and methodology for the case study are followed by the presentation of outcomes including models and policy scenario forecasts. The case study has illustrated that a spatial statistics approach is not only feasible for the development of predictive models in support of policy-making, but also provides several unique advantages that could potentially improve sustainable development policymaking.

Telemedicine Enables Broader Access to Movement Disorders Curricula for Medical Students.

PubMed

Cubo, Esther; Doumbe, Jacques; López, Emiliano; Lopez, Guadalupe A; Gatto, Emilia; Persi, Gabriel; Guttman, Mark

2017-01-01

The impact of tele-education for movement disorders on medical students is unknown. The present study had three objectives. First, to create a tele-education program for medical students in regions with limited access to movement disorders curricula. Second, to analyze the feasibility, satisfaction, and improvement of medical knowledge. Third, to assess the main reasons of medical students for attending this course. In 2016, a program was piloted in a low-middle income (Cameroon) and a middle-high income (Argentina) country. Medical students were offered a free movement disorder tele-education program (four medical schools in Argentina, and 1 medical school in Cameroon). Six real-time videoconferences covering hyperkinetic and hypokinetic movement disorders were included. Evaluations included attendance, pre- and post-medical knowledge, and satisfaction questionnaires. The study included 151 undergraduate medical students (79.4% from Argentina, 20.6% from Cameroon). Feasibility was acceptable with 100% and 85.7% of the videoconferences completed in Argentina and Cameroon, respectively. Attendance was higher in Argentina compared to Cameroon (75% vs. 33.1%). According to student reports, the topics and innovative educational environment were the main reasons for attendance. Both groups ranked satisfaction as moderate to high, and medical knowledge improved similarly in both countries. Tele-education can improve movement disorders knowledge in medical schools in high-middle and low-middle income countries lacking access to other educational opportunities.

Environmental Profile of a Community's Health (EPOCH): An Instrument to Measure Environmental Determinants of Cardiovascular Health in Five Countries

PubMed Central

Chow, Clara K.; Lock, Karen; Madhavan, Manisha; Corsi, Daniel J.; Gilmore, Anna B.; Subramanian, S. V.; Li, Wei; Swaminathan, Sumathi; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Lear, Scott A.; Dagenais, Gilles; Teo, Koon; McKee, Martin; Yusuf, Salim

2010-01-01

Background The environment in which people live is known to be important in influencing diet, physical activity, smoking, psychosocial and other risk factors for cardiovascular (CV) disease. However no instrument exists that evaluates communities for these multiple environmental factors and is suitable for use across different communities, regions and countries. This report describes the design and reliability of an instrument to measure environmental determinants of CV risk factors. Method/Principal Findings The Environmental Profile of Community Health (EPOCH) instrument comprises two parts: (I) an assessment of the physical environment, and (II) an interviewer-administered questionnaire to collect residents' perceptions of their community. We examined the inter-rater reliability amongst 3 observers from each region of the direct observation component of the instrument (EPOCH I) in 93 rural and urban communities in 5 countries (Canada, Colombia, Brazil, China and India). Data collection using the EPOCH instrument was feasible in all communities. Reliability of the instrument was excellent (Intraclass Correlation Coefficient - ICC>0.75) for 24 of 38 items and fair to good (ICC 0.4–0.75) for 14 of 38 items. Conclusion This report shows data collection with the EPOCH instrument is feasible and direct observation of community measures reliable. The EPOCH instrument will enable further research on environmental determinants of health for population studies from a broad range of settings. PMID:21170320

Improving coverage measurement for reproductive, maternal, neonatal and child health: gaps and opportunities.

PubMed

Munos, Melinda K; Stanton, Cynthia K; Bryce, Jennifer

2017-06-01

Regular monitoring of coverage for reproductive, maternal, neonatal, and child health (RMNCH) is central to assessing progress toward health goals. The objectives of this review were to describe the current state of coverage measurement for RMNCH, assess the extent to which current approaches to coverage measurement cover the spectrum of RMNCH interventions, and prioritize interventions for a novel approach to coverage measurement linking household surveys with provider assessments. We included 58 interventions along the RMNCH continuum of care for which there is evidence of effectiveness against cause-specific mortality and stillbirth. We reviewed household surveys and provider assessments used in low- and middle-income countries (LMICs) to determine whether these tools generate measures of intervention coverage, readiness, or quality. For facility-based interventions, we assessed the feasibility of linking provider assessments to household surveys to provide estimates of intervention coverage. Fewer than half (24 of 58) of included RMNCH interventions are measured in standard household surveys. The periconceptional, antenatal, and intrapartum periods were poorly represented. All but one of the interventions not measured in household surveys are facility-based, and 13 of these would be highly feasible to measure by linking provider assessments to household surveys. We found important gaps in coverage measurement for proven RMNCH interventions, particularly around the time of birth. Based on our findings, we propose three sets of actions to improve coverage measurement for RMNCH, focused on validation of coverage measures and development of new measurement approaches feasible for use at scale in LMICs.

Impact of novel energy sources: OTEC, wind, goethermal, biomass

NASA Technical Reports Server (NTRS)

Roberts, A. S., Jr.

1978-01-01

Alternate energy conversion methods such as ocean thermal energy conversion (OTEC), wind power, geothermal wells and biomass conversion are being explored, and re-examined in some cases, for commercial viability. At a time when United States fossil fuel and uranium resources are found to be insufficient to supply national needs into the twenty-first century, it is essential to broaden the base of feasible energy conversion technologies. The motivations for development of these four alternative energy forms are established. Primary technical aspects of OTEC, wind, geothermal and biomass energy conversion systems are described along with a discussion of relative advantages and disadvantages of the concepts. Finally, the sentiment is voiced that each of the four systems should be developed to the prototype stage and employed in the region of the country and in the sector of economy which is complimentary to the form of system output.

Development and pilot testing of a mental healthcare plan in Nepal

PubMed Central

Jordans, M. J. D.; Luitel, N. P.; Pokhrel, P.; Patel, V.

2016-01-01

Background Mental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries. Aims To present the development, and content, of a mental healthcare plan (MHCP) in Nepal and assess initial feasibility. Method A mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from patients (n = 135) during the pilot-testing phase in two health facilities. Results The resulting MHCP consists of 12 packages, divided over community, health facility and organisation platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates. Conclusions The MHCP follows a collaborative care model encompassing community and primary healthcare interventions. PMID:26447173

Mobile Phone–based Infectious Disease Surveillance System, Sri Lanka

PubMed Central

Sawford, Kate; Daniel, Samson L.A.; Nelson, Trisalyn A.; Stephen, Craig

2010-01-01

Because many infectious diseases are emerging in animals in low-income and middle-income countries, surveillance of animal health in these areas may be needed for forecasting disease risks to humans. We present an overview of a mobile phone–based frontline surveillance system developed and implemented in Sri Lanka. Field veterinarians reported animal health information by using mobile phones. Submissions increased steadily over 9 months, with ≈4,000 interactions between field veterinarians and reports on the animal population received by the system. Development of human resources and increased communication between local stakeholders (groups and persons whose actions are affected by emerging infectious diseases and animal health) were instrumental for successful implementation. The primary lesson learned was that mobile phone–based surveillance of animal populations is acceptable and feasible in lower-resource settings. However, any system implementation plan must consider the time needed to garner support for novel surveillance methods among users and stakeholders. PMID:20875276

Development and pilot testing of a mental healthcare plan in Nepal.

PubMed

Jordans, M J D; Luitel, N P; Pokhrel, P; Patel, V

2016-01-01

Mental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries. To present the development, and content, of a mental healthcare plan (MHCP) in Nepal and assess initial feasibility. A mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from patients (n = 135) during the pilot-testing phase in two health facilities. The resulting MHCP consists of 12 packages, divided over community, health facility and organisation platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates. The MHCP follows a collaborative care model encompassing community and primary healthcare interventions. © The Royal College of Psychiatrists 2016.

The Feasibility of Utilizing Wind Energy in Commercial Buildings With Special Reference to the Kingdom of Bahrain

NASA Astrophysics Data System (ADS)

Abdulrahim Saeed, Saeed

2017-11-01

This article shall investigate the feasibility of utilizing wind energy for commercial buildings with special reference to the Kingdom of Bahrain. Bahrain World Trade Center which was built in 2008, is located in the city of Manama. The fifty-story complex contains identical twin towers that rise over 240 meters in height. The towers are connected by three bridges which hold three turbines each 29 meters long. The three turbines were originally design to provide electric energy required for lighting. The Bahrain World Trade Center was selected as a case study to investigate the feasibility of utilizing wind energy technologies in skyscrapers with special reference to the Kingdom of Bahrain. It is hoped that the findings and conclusion of the study shall be of some value for future utilization of wind energy in the GCC countries and the world at large.

Considering Trilingual Education. Routledge Research in Education

ERIC Educational Resources Information Center

Henn-Reinke, Kathryn

2012-01-01

Based in case studies conducted in the US, Europe, and Latin America, this book explores the feasibility and benefits of trilingual/multilingual education in the United States. Currently, there are few programs in the country of this nature, as educators tend to conclude that English-language learners would be overwhelmed by study in additional…

Solar Heating and Cooling of Buildings: Phase 0. Executive Summary. Final Report.

ERIC Educational Resources Information Center

Westinghouse Electric Corp., Baltimore, MD.

After the Westinghouse Electric Corporation made a comprehensive analysis of the technical, economic, social, environmental, and institutional factors affecting the feasibility of utilizing solar energy for heating and cooling buildings, it determined that solar heating and cooling systems can become competitive in most regions of the country in…

Clinical Assessment of Risk Management: an INtegrated Approach (CARMINA).

PubMed

Tricarico, Pierfrancesco; Tardivo, Stefano; Sotgiu, Giovanni; Moretti, Francesca; Poletti, Piera; Fiore, Alberto; Monturano, Massimo; Mura, Ida; Privitera, Gaetano; Brusaferro, Silvio

2016-08-08

Purpose - The European Union recommendations for patient safety calls for shared clinical risk management (CRM) safety standards able to guide organizations in CRM implementation. The purpose of this paper is to develop a self-evaluation tool to measure healthcare organization performance on CRM and guide improvements over time. Design/methodology/approach - A multi-step approach was implemented including: a systematic literature review; consensus meetings with an expert panel from eight Italian leader organizations to get to an agreement on the first version; field testing to test instrument feasibility and flexibility; Delphi strategy with a second expert panel for content validation and balanced scoring system development. Findings - The self-assessment tool - Clinical Assessment of Risk Management: an INtegrated Approach includes seven areas (governance, communication, knowledge and skills, safe environment, care processes, adverse event management, learning from experience) and 52 standards. Each standard is evaluated according to four performance levels: minimum; monitoring; outcomes; and improvement actions, which resulted in a feasible, flexible and valid instrument to be used throughout different organizations. Practical implications - This tool allows practitioners to assess their CRM activities compared to minimum levels, monitor performance, benchmarking with other institutions and spreading results to different stakeholders. Originality/value - The multi-step approach allowed us to identify core minimum CRM levels in a field where no consensus has been reached. Most standards may be easily adopted in other countries.

The hospital incident command system: modified model for hospitals in iran.

PubMed

Djalali, Ahmadreza; Hosseinijenab, Vahid; Peyravi, Mahmoudreza; Nekoei-Moghadam, Mahmood; Hosseini, Bashir; Schoenthal, Lisa; Koenig, Kristi L

2015-03-27

Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran. In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS. The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section. An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.

Assessing the Acceptability, Feasibility, and Effectiveness of a Tablet-Based Cervical Cancer Educational Intervention.

PubMed

Caster, M M; Norris, A H; Butao, C; Carr Reese, P; Chemey, E; Phuka, J; Turner, A N

2017-03-01

Cervical cancer is a common and deadly disease, especially in developing countries. We developed and implemented an interactive, tablet-based educational intervention to improve cervical cancer knowledge among women in rural Malawi. Chichewa-speaking adult women in six rural villages participated. Each woman took a pretest, participated in the lesson, and then took a posttest. The lesson included information on cervical cancer symptoms, causes, risk factors, prevention, and treatment. Over the 6-month study period, 243 women participated. Women ranged in age from 18 to 77 years. Only 15 % had education beyond primary school. Nearly half of participants (48 %) had heard of cervical cancer prior to viewing the lesson. For these women, the median number of correct responses on the pretest was 11 out of 20; after the lesson, they had a median of 18 correct responses (p < 0.001). After the intervention, 93 % of women indicated a desire for cervical cancer screening. Despite lack of familiarity with computers (96 %), most women (94 %) found the tablet easy to use. A tablet-based educational program was an effective, feasible, and acceptable strategy to disseminate cervical cancer information to women with low education in rural Malawi. This method may be appropriate to distribute health information about other health topics in low-resource settings.

Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.

PubMed

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-Chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M G J; Kimerling, Michael E; White, Richard G; Vassall, Anna

2016-11-01

The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

European framework for tuberculosis control and elimination in countries with a low incidence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group.

PubMed

Broekmans, J F; Migliori, G B; Rieder, H L; Lees, J; Ruutu, P; Loddenkemper, R; Raviglione, M C

2002-04-01

As countries approach the elimination phase of tuberculosis, specific problems and challenges emerge, due to the steadily declining incidence in the native population, the gradually increasing importance of the importation of latent tuberculosis infection and tuberculosis from other countries and the emergence of groups at particularly high risk of tuberculosis. Therefore, a Working Group of the World Health Organization (WHO), the International Union Against Tuberculosis and Lung Disease (IUATLD) and the Royal Netherlands Tuberculosis Association (KNCV) have developed a new framework for low incidence countries based on concepts and definitions consistent with those of previous recommendations from WHO/IUATLD Working Groups. In low-incidence countries, a broader spectrum of interventions is available and feasible, including: 1) a general approach to tuberculosis which ensures rapid detection and treatment of all the cases and prevention of unnecessary deaths; 2) an overall control strategy aimed at reducing the incidence of tuberculosis infection (risk-group management and prevention of transmission of infection in institutional settings) and 3) a tuberculosis elimination strategy aimed at reducing the prevalence of tuberculosis infection (outbreak management and provision of preventive therapy for specified groups and individuals). Government and private sector commitment towards elimination, effective case detection among symptomatic individuals together with active case finding in special groups, standard treatment of disease and infection, access to tuberculosis diagnostic and treatment services, prevention (e.g. through screening and bacille Calmette-Guéria immunization in specified groups), surveillance and treatment outcome monitoring are prerequisites to implementing the policy package recommended in this new framework document.

Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators.

PubMed

Carinci, F; Van Gool, K; Mainz, J; Veillard, J; Pichora, E C; Januel, J M; Arispe, I; Kim, S M; Klazinga, N S

2015-04-01

To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. International group of countries participating to OECD projects. Members of the OECD HCQI expert group. A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Evidences on weaknesses and strengths from health financing after decentralization: lessons from Latin American countries.

PubMed

Arredondo, Armando; Orozco, Emanuel; De Icaza, Esteban

2005-01-01

The main objective was to identify trends and evidence on health financing after health care decentralization. Evaluative research with a before-after design integrating qualitative and quantitative analysis. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru. The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. The trends and evidence reported in all five financing indicators may identify major weaknesses and strengths in health financing. Weaknesses: a lack of human resources trained in health economics who can implement changes, a lack of financial resource independence between the local and central levels, the negative behavior of the main macro-economic variables, and the difficulty in developing new financing alternatives. Strengths: the sharing between the central level and local levels of responsibility for financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking as a basis the efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.

Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience

PubMed Central

Magesa, Stephen M; Lengeler, Christian; deSavigny, Don; Miller, Jane E; Njau, Ritha JA; Kramer, Karen; Kitua, Andrew; Mwita, Alex

2005-01-01

Introduction Malaria is the largest cause of health services attendance, hospital admissions and child deaths in Tanzania. At the Abuja Summit in April 2000 Tanzania committed itself to protect 60% of its population at high risk of malaria by 2005. The country is, therefore, determined to ensure that sustainable malaria control using insecticide-treated nets is carried out on a national scale. Case description Tanzania has been involved for two decades in the research process for developing insecticide-treated nets as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. Since 2000, the emphasis has changed from a project approach to that of a concerted multi-stakeholder action for taking insecticide-treated nets to national scale (NATNETS). This means creating conditions that make insecticide-treated nets accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania's experience in (1) creating an enabling environment for insecticide-treated nets scale-up, (2) promoting the development of a commercial sector for insecticide-treated nets, and (3) targeting pregnant women with highly subsidized insecticide-treated nets through a national voucher scheme. As a result, nearly 2 million insecticide-treated nets and 2.2 million re-treatment kits were distributed in 2004. Conclusion National upscaling of insecticide-treated nets is possible when the programme is well designed, coordinated and supported by committed stakeholders; the Abuja target of protecting 60% of those at high risk is feasible, even for large endemic countries. PMID:16042780

One hundred injured patients a day: multicenter emergency room surveillance of trauma in Pakistan.

PubMed

Hyder, A A; He, S; Zafar, W; Mir, M U; Razzak, J A

2017-07-01

Injuries increasingly contribute to the global burden of disease in low- and middle-income countries. This study presents results from a large-scale surveillance study on injury from several urban emergency departments (EDs) in Pakistan. The objective is to document the burden of injuries that present to the healthcare system in Pakistan and to test the feasibility of an ED-based injury and trauma surveillance system. Cross-sectional study conducted using active surveillance approach. This study included EDs of seven tertiary care hospitals in Pakistan. The data were collected between November 2010 and March 2011. All patients presenting with injuries to the participating EDs were enrolled. The study was approved by the Institutional Review Boards of the Johns Hopkins School of Public Health, Aga Khan University, and all participating sites. The study recorded 68,390 patients; 93.8% were from the public hospitals. There were seven male for every three female patients, and 50% were 20-39 years of age. About 69.3% were unintentional injuries. Among injuries with a known mechanism (19,102), 51.1% were road traffic injuries (RTIs) and 17.5% were falls. Female, patients aged 60 years or older, patients transferred by ambulance, patients who had RTIs, and patients with intentional injuries were more likely to be hospitalized. The study is the first to use standardized methods for regular collection of multiple ED data in Pakistan. It explored the pattern of injuries and the feasibility to develop and implement facility-based systems for injury and acute illness in countries like Pakistan. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Spanish-Speaking Patients’ Engagement in Interactive Voice Response (IVR) Chronic Disease Self-Management Support Calls: Analyses of Data from Three Countries

PubMed Central

Piette, John D.; Marinec, Nicolle; Gallegos-Cabriales, Esther C.; Gutierrez-Valverde, Juana Mercedes; Rodriguez-Saldaña, Joel; Mendoz-Alevares, Milton; Silveira, Maria J.

2013-01-01

We used data from Interactive Voice Response (IVR) self-management support studies in Honduras, Mexico, and the United States (US) to determine whether IVR calls to Spanish-speaking patients with chronic illnesses is a feasible strategy for improving monitoring and education between face-to-face visits. 268 patients with diabetes or hypertension participated in 6–12 weeks of weekly IVR follow-up. IVR calls emanated from US servers with connections via Voice over IP. More than half (54%) of patients enrolled with an informal caregiver who received automated feedback based on the patient’s assessments, and clinical staff received urgent alerts. Participants had on average 6.1 years of education, and 73% were women. After 2,443 person weeks of follow-up, patients completed 1,494 IVR assessments. Call completion rates were higher in the US (75%) than in Honduras (59%) or Mexico (61%; p<0.001). Patients participating with an informal caregiver were more likely to complete calls (adjusted odds ratio [AOR]: 1.53; 95% confidence interval [CI]: 1.04, 2.25) while patients reporting fair or poor health at enrollment were less likely (AOR:0.59; 95% CI: 0.38, 0.92). Satisfaction rates were high, with 98% of patients reporting that the system was easy to use, and 86% reporting that the calls helped them a great deal in managing their health problems. In summary, IVR self-management support is feasible among Spanish-speaking patients with chronic disease, including those living in less-developed countries. Voice over IP can be used to deliver IVR disease management services internationally; involving informal caregivers may increase patient engagement. PMID:23532005

Derivation, Validation and Application of a Pragmatic Risk Prediction Index for Benchmarking of Surgical Outcomes.

PubMed

Spence, Richard T; Chang, David C; Kaafarani, Haytham M A; Panieri, Eugenio; Anderson, Geoffrey A; Hutter, Matthew M

2018-02-01

Despite the existence of multiple validated risk assessment and quality benchmarking tools in surgery, their utility outside of high-income countries is limited. We sought to derive, validate and apply a scoring system that is both (1) feasible, and (2) reliably predicts mortality in a middle-income country (MIC) context. A 5-step methodology was used: (1) development of a de novo surgical outcomes database modeled around the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) in South Africa (SA dataset), (2) use of the resultant data to identify all predictors of in-hospital death with more than 90% capture indicating feasibility of collection, (3) use these predictors to derive and validate an integer-based score that reliably predicts in-hospital death in the 2012 ACS-NSQIP, (4) apply the score in the original SA dataset and demonstrate its performance, (5) identify threshold cutoffs of the score to prompt action and drive quality improvement. Following step one-three above, the 13 point Codman's score was derived and validated on 211,737 and 109,079 patients, respectively, and includes: age 65 (1), partially or completely dependent functional status (1), preoperative transfusions ≥4 units (1), emergency operation (2), sepsis or septic shock (2) American Society of Anesthesia score ≥3 (3) and operative procedure (1-3). Application of the score to 373 patients in the SA dataset showed good discrimination and calibration to predict an in-hospital death. A Codman Score of 8 is an optimal cutoff point for defining expected and unexpected deaths. We have designed a novel risk prediction score specific for a MIC context. The Codman Score can prove useful for both (1) preoperative decision-making and (2) benchmarking the quality of surgical care in MIC's.

Cardiac rehabilitation delivery model for low-resource settings.

PubMed

Grace, Sherry L; Turk-Adawi, Karam I; Contractor, Aashish; Atrey, Alison; Campbell, Norm; Derman, Wayne; Melo Ghisi, Gabriela L; Oldridge, Neil; Sarkar, Bidyut K; Yeo, Tee Joo; Lopez-Jimenez, Francisco; Mendis, Shanthi; Oh, Paul; Hu, Dayi; Sarrafzadegan, Nizal

2016-09-15

Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries. A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not. Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings. Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed. 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/

Regular monitoring of breast-feeding rates: feasible and sustainable. The Emilia-Romagna experience.

PubMed

Di Mario, Simona; Borsari, Silvana; Verdini, Eleonora; Battaglia, Sergio; Cisbani, Luca; Sforza, Stefano; Cuoghi, Chiara; Basevi, Vittorio

2017-08-01

An efficient breast-feeding monitoring system should be in place in every country to assist policy makers and health professionals plan activities to reach optimal breast-feeding rates. Design/Setting/Subjects From March to June 2015, breast-feeding rates at 3 and 5 months of age were monitored in Emilia-Romagna, an Italian region, using four questions added to a newly developed paediatric immunization database with single records for each individual. Data were collected at primary-care centres. Breast-feeding definitions and 24 h recall as recommended by the WHO were used. Direct age standardization was applied to breast-feeding rates. Record linkage with the medical birth database was attempted to identify maternal, pregnancy and delivery factors associated with full breast-feeding rates at 3 and 5 months of age. Data on breast-feeding were collected for 14044 infants. The mean regional full breast-feeding rate at 3 months was 52 %; differences between local health authorities ranged from 42 to 62 %. At 5 months of age, the mean regional full breast-feeding rate dropped to 33 % (range between local health authorities: 26 to 46 %). Record linkage with the birth certificate database was successful for 93 % of records. Total observations more than doubled with respect to the previous regional survey. The new monitoring system implemented in 2015 in Emilia-Romagna region, totally integrated with the immunization database, has proved to be feasible, sustainable and more efficient than the previous one. This system can be a model for other regions and countries where the vast majority of mothers obtain vaccinations from public health facilities and that already have an immunization database in place.

A preliminary study of a cloud-computing model for chronic illness self-care support in an underdeveloped country

PubMed Central

Piette, John D.; Mendoza-Avelares, Milton O.; Ganser, Martha; Mohamed, Muhima; Marinec, Nicolle; Krishnan, Sheila

2013-01-01

Background Although interactive voice response (IVR) calls can be an effective tool for chronic disease management, many regions of the world lack the infrastructure to provide these services. Objective This study evaluated the feasibility and potential impact of an IVR program using a cloud-computing model to improve diabetes management in Honduras. Methods A single group, pre-post study was conducted between June and August 2010. The telecommunications infrastructure was maintained on a U.S. server, and calls were directed to patients’ cell phones using VoIP. Eighty-five diabetes patients in Honduras received weekly IVR disease management calls for six weeks, with automated follow-up emails to clinicians, and voicemail reports to family caregivers. Patients completed interviews at enrollment and a six week follow-up. Other measures included patients’ glycemic control (A1c) and data from the IVR calling system. Results 55% of participants completed the majority of their IVR calls and 33% completed 80% or more. Higher baseline blood pressures, greater diabetes burden, greater distance from the clinic, and better adherence were related to higher call completion rates. Nearly all participants (98%) reported that because of the program, they improved in aspects of diabetes management such as glycemic control (56%) or foot care (89%). Mean A1c’s decreased from 10.0% at baseline to 8.9% at follow-up (p<.01). Most participants (92%) said that if the service were available in their clinic they would use it again. Conclusions Cloud computing is a feasible strategy for providing IVR services globally. IVR self-care support may improve self-care and glycemic control for patients in under-developed countries. PMID:21565655

Merging pedigree databases to describe and compare mating practices and gene flow between pedigree dogs in France, Sweden and the UK.

PubMed

Wang, S; Leroy, G; Malm, S; Lewis, T; Strandberg, E; Fikse, W F

2017-04-01

Merging pedigree databases across countries may improve the ability of kennel organizations to monitor genetic variability and health-related issues of pedigree dogs. We used data provided by the Société Centrale Canine (France), Svenska Kennelklubben (Sweden) and the Kennel Club (UK) to study the feasibility of merging pedigree databases across countries and describe breeding practices and international gene flow within the following four breeds: Bullmastiff (BMA), English setter (ESE), Bernese mountain dog (BMD) and Labrador retriever (LBR). After merging the databases, genealogical parameters and founder contributions were calculated according to the birth period, breed and registration country of the dogs. Throughout the investigated period, mating between close relatives, measured as the proportion of inbred individuals (considering only two generations of pedigree), decreased or remained stable, with the exception of LBR in France. Gene flow between countries became more frequent, and the origins of populations within countries became more diverse over time. In conclusion, the potential to reduce inbreeding within purebred dog populations through exchanging breeding animals across countries was confirmed by an improved effective population size when merging populations from different countries. © 2016 Blackwell Verlag GmbH.

[An assessment of fiscal space for public health in Peru].

PubMed

Matus-López, Mauricio; Toledo, Lorena Prieto; Pedraza, Camilo Cid

2016-08-01

Objective To assess the fiscal space for public health in Peru so as to attain the goal of raising health spending to 6% of gross domestic product, as agreed upon by member countries of the Pan American Health Organization in 2014. Methods The main sources of fiscal space were identified by means of a thorough literature review. Technical feasibility was determined from statistics and national and international surveys and by reviewing various documents and official reports. Political feasibility was ascertained by studying policy guidelines. Results The sources showing the greatest technical and political feasibility are economic growth, a broadening of the personal income tax base, and an increase in tobacco-specific taxes. Decreasing informality in the job market and increasing contributory coverage are considered to be less politically feasible, but there is ample technical space for these measures. Conclusions There is enough fiscal space to allow for an increase in public health spending. Nevertheless, the 6% target will be reached only if the timeline is extended, tax revenues are increased, and informality in the job market is reduced.

Development of a Multilevel Optimization Approach to the Design of Modern Engineering Systems. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Barthelemy, J. F. M.

1983-01-01

A general algorithm is proposed which carries out the design process iteratively, starting at the top of the hierarchy and proceeding downward. Each subproblem is optimized separately for fixed controls from higher level subproblems. An optimum sensitivity analysis is then performed which determines the sensitivity of the subproblem design to changes in higher level subproblem controls. The resulting sensitivity derivatives are used to construct constraints which force the controlling subproblems into chosing their own designs so as to improve the lower levels subproblem designs while satisfying their own constraints. The applicability of the proposed algorithm is demonstrated by devising a four-level hierarchy to perform the simultaneous aerodynamic and structural design of a high-performance sailplane wing for maximum cross-country speed. Finally, the concepts discussed are applied to the two-level minimum weight structural design of the sailplane wing. The numerical experiments show that discontinuities in the sensitivity derivatives may delay convergence, but that the algorithm is robust enough to overcome these discontinuities and produce low-weight feasible designs, regardless of whether the optimization is started from the feasible space or the infeasible one.

Measuring health and disability: supporting policy development. The European MHADIE project.

PubMed

Leonardi, Matilde

2010-01-01

Disability is a multi-dimensional phenomenon arising out of an interaction between the individual's health status and his environment: disability data must reflect this bio-psychosocial model. WHO's International Classification of Functioning, Disability and Health (ICF) provides the framework for documenting the interaction between health status and environmental features. MHADIE, a 3-year project supported by a EC 6th Framework Programme Grant, aimed at demonstrating the feasibility and utility of the ICF model in the measurement and description of disability. The ICF model was used as the structure for analysing existing population health surveys and education statistics data. ICF-based tools were used to describe disability in selected health conditions. MHADIE researchers showed that the ICF model is adequate for describing and measuring patterns of disability in clinical samples from different countries cross-sectionally and over time as well as feasible and useful in educational sectors. Valid and reliable information are essential to design, implement or evaluate policies to combat discrimination, promote integration and enhance opportunities. Results made it possible to produce a definition of disability as well as policy recommendations concerning how, in Europe and internationally, the existing sources of data can be harmonized with the ICF model.

Conducting Site and Economic Renewable Energy Project Feasibility Assessments

EPA Pesticide Factsheets

The Toolbox for Renewable Energy Project Development's Conducting Site and Economic Renewable Energy Project Feasibility Assessments page provides tools and resources to evaluate solar project feasibility and economics that influence project development.

An economic order quantity model with shortage and inflation

NASA Astrophysics Data System (ADS)

Wulan, Elis Ratna; Nurjaman, Wildan

2015-09-01

The effect of inflation has become a persistent characteristic and more significant problem of many developing economies especially in the third world countries. While making effort to achieve optimal quantity of product to be produced or purchased using the simplest and on the shelf classical EOQ model, the non-inclusion of conflicting economic realities as shortage and inflation has rendered its result quite uneconomical and hence the purpose for this study. Mathematical expression was developed for each of the cost components the sum of which become the total inventory model over the period (0,L) ((TIC(0,L)). L is planning horizon and TIC(0,L) is total inventory cost over a period of (0,L). Significant savings with increase in quantity was achieved based on deference in the varying price regime. With the assumptions considered and subject to the availability of reliable inventory cost element, the developed model is found to produce a feasible, and economic inventory stock-level with the numerical example of a material supply of a manufacturing company.

The role of policy in improving diets: experiences from the Pacific Obesity Prevention in Communities food policy project.

PubMed

Thow, A M; Snowdon, W; Schultz, J T; Leeder, S; Vivili, P; Swinburn, B A

2011-11-01

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

Carbon Capture and Sequestration- A Review

NASA Astrophysics Data System (ADS)

Sood, Akash; Vyas, Savita

2017-08-01

The Drastic increase of CO2 emission in the last 30 years is due to the combustion of fossil fuels and it causes a major change in the environment such as global warming. In India, the emission of fossil fuels is developed in the recent years. The alternate energy sources are not sufficient to meet the values of this emission reduction and the framework of climate change demands the emission reduction, the CCS technology can be used as a mitigation tool which evaluates the feasibility for implementation of this technology in India. CCS is a process to capture the carbon dioxide from large sources like fossil fuel station to avoid the entrance of CO2 in the atmosphere. IPCC accredited this technology and its path for mitigation for the developing countries. In this paper, we present the technologies of CCS with its development and external factors. The main goal of this process is to avoid the release the CO2 into the atmosphere and also investigates the sequestration and mitigation technologies of carbon.

Travel patterns in China.

PubMed

Garske, Tini; Yu, Hongjie; Peng, Zhibin; Ye, Min; Zhou, Hang; Cheng, Xiaowen; Wu, Jiabing; Ferguson, Neil

2011-02-02

The spread of infectious disease epidemics is mediated by human travel. Yet human mobility patterns vary substantially between countries and regions. Quantifying the frequency of travel and length of journeys in well-defined population is therefore critical for predicting the likely speed and pattern of spread of emerging infectious diseases, such as a new influenza pandemic. Here we present the results of a large population survey undertaken in 2007 in two areas of China: Shenzhen city in Guangdong province, and Huangshan city in Anhui province. In each area, 10,000 randomly selected individuals were interviewed, and data on regular and occasional journeys collected. Travel behaviour was examined as a function of age, sex, economic status and home location. Women and children were generally found to travel shorter distances than men. Travel patterns in the economically developed Shenzhen region are shown to resemble those in developed and economically advanced middle income countries with a significant fraction of the population commuting over distances in excess of 50 km. Conversely, in the less developed rural region of Anhui, travel was much more local, with very few journeys over 30 km. Travel patterns in both populations were well-fitted by a gravity model with a lognormal kernel function. The results provide the first quantitative information on human travel patterns in modern China, and suggest that a pandemic emerging in a less developed area of rural China might spread geographically sufficiently slowly for containment to be feasible, while spatial spread in the more economically developed areas might be expected to be much more rapid, making containment more difficult.

Travel Patterns in China

PubMed Central

Garske, Tini; Yu, Hongjie; Peng, Zhibin; Ye, Min; Zhou, Hang; Cheng, Xiaowen; Wu, Jiabing; Ferguson, Neil

2011-01-01

The spread of infectious disease epidemics is mediated by human travel. Yet human mobility patterns vary substantially between countries and regions. Quantifying the frequency of travel and length of journeys in well-defined population is therefore critical for predicting the likely speed and pattern of spread of emerging infectious diseases, such as a new influenza pandemic. Here we present the results of a large population survey undertaken in 2007 in two areas of China: Shenzhen city in Guangdong province, and Huangshan city in Anhui province. In each area, 10,000 randomly selected individuals were interviewed, and data on regular and occasional journeys collected. Travel behaviour was examined as a function of age, sex, economic status and home location. Women and children were generally found to travel shorter distances than men. Travel patterns in the economically developed Shenzhen region are shown to resemble those in developed and economically advanced middle income countries with a significant fraction of the population commuting over distances in excess of 50 km. Conversely, in the less developed rural region of Anhui, travel was much more local, with very few journeys over 30 km. Travel patterns in both populations were well-fitted by a gravity model with a lognormal kernel function. The results provide the first quantitative information on human travel patterns in modern China, and suggest that a pandemic emerging in a less developed area of rural China might spread geographically sufficiently slowly for containment to be feasible, while spatial spread in the more economically developed areas might be expected to be much more rapid, making containment more difficult. PMID:21311745

Developing hospital accreditation standards in Uganda.

PubMed

Galukande, Moses; Katamba, Achilles; Nakasujja, Noeline; Baingana, Rhona; Bateganya, Moses; Hagopian, Amy; Tavrow, Paula; Barnhart, Scott; Luboga, Sam

2016-07-01

Whereas accreditation is widely used as a tool to improve quality of healthcare in the developed world, it is a concept not well adapted in most developing countries for a host of reasons, including insufficient incentives, insufficient training and a shortage of human and material resources. The purpose of this paper is to describe refining use and outcomes of a self-assessment hospital accreditation tool developed for a resource-limited context. We invited 60 stakeholders to review a set of standards (from which a self-assessment tool was developed), and subsequently refined them to include 485 standards in 7 domains. We then invited 60 hospitals to test them. A study team traveled to each of the 40 hospitals that agreed to participate providing training and debrief the self-assessment. The study was completed in 8 weeks. Hospital self-assessments revealed hospitals were remarkably open to frank rating of their performance and willing to rank all 485 measures. Good performance was measured in outreach programs, availability of some types of equipment and running water, 24-h staff calls systems, clinical guidelines and waste segregation. Poor performance was measured in care for the vulnerable, staff living quarters, physician performance reviews, patient satisfaction surveys and sterilizing equipment. We have demonstrated the feasibility of a self-assessment approach to hospital standards in low-income country setting. This low-cost approach may be used as a good precursor to establishing a national accreditation body, as indicated by the Ministry's efforts to take the next steps. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Feasibility of a combined camp approach for vector control together with active case detection of visceral leishmaniasis, post kala-azar dermal leishmaniasis, tuberculosis, leprosy and malaria in Bangladesh, India and Nepal: an exploratory study.

PubMed

Banjara, Megha R; Kroeger, Axel; Huda, Mamun M; Kumar, Vijay; Gurung, Chitra K; Das, Murari L; Rijal, Suman; Das, Pradeep; Mondal, Dinesh

2015-06-01

We assessed the feasibility and results of active case detection (ACD) of visceral leishmaniasis (VL), post kala-azar dermal leishmaniasis (PKDL) and other febrile diseases as well as of bednet impregnation for vector control. Fever camps were organized and analyzed in twelve VL endemic villages in Bangladesh, India, and Nepal. VL, PKDL, tuberculosis, malaria and leprosy were screened among the febrile patients attending the camps, and existing bednets were impregnated with a slow release insecticide. Among the camp attendees one new VL case and two PKDL cases were detected in Bangladesh and one VL case in Nepal. Among suspected tuberculosis cases two were positive in India but none in the other countries. In India, two leprosy cases were found. No malaria cases were detected. Bednet impregnation coverage during fever camps was more than 80% in the three countries. Bednet impregnation led to a reduction of sandfly densities after 2 weeks by 86% and 32%, and after 4 weeks by 95% and 12% in India and Nepal respectively. The additional costs for the control programmes seem to be reasonable. It is feasible to combine ACD camps for VL and PKDL along with other febrile diseases, and vector control with bednet impregnation. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Modeling Drought Impact Occurrence Based on Climatological Drought Indices for Europe

NASA Astrophysics Data System (ADS)

Stagge, J. H.; Kohn, I.; Tallaksen, L. M.; Stahl, K.

2014-12-01

Meteorological drought indices are often assumed to accurately characterize the severity of a drought event; however, these indices do not necessarily reflect the likelihood or severity of a particular type of drought impact experienced on the ground. In previous research, this link between index and impact was often estimated based on thresholds found by experience, measured using composite indices with assumed weighting schemes, or defined based on very narrow impact measures, using either a narrow spatial extent or very specific impacts. This study expands on earlier work by demonstrating the feasibility of relating user-provided impact reports to the climatological drought indices SPI and SPEI by logistic regression. The user-provided drought impact reports are based on the European Drought Impact Inventory (EDII, www.geo.uio.no/edc/droughtdb/), a newly developed online database that allows both public report submission and querying the more than 4,000 reported impacts spanning 33 European countries. This new tool is used to quantify the link between meteorological drought indices and impacts focusing on four primary impact types, spanning agriculture, energy and industry, public water supply, and freshwater ecosystem across five European countries. Statistically significant climate indices are retained as predictors using step-wise regression and used to compare the most relevant drought indices and accumulation periods for different impact types and regions. Agricultural impacts are explained best by 2-12 month anomalies, with 2-3 month anomalies found in predominantly rain-fed agricultural regions, and anomalies greater than 3 months related to agricultural management practices. Energy and industry impacts, related to hydropower and energy cooling water in these countries, respond to longer accumulated precipitation anomalies (6-12 months). Public water supply and freshwater ecosystem impacts are explained by a more complex combination of short (1-3 month) and seasonal (6-12 month) anomalies. A mean of 47.0% (22.4-71.6%) impact deviance is explained by the resulting models, highlighting the feasibility of using such statistical techniques and drought impact databases to model drought impact likelihood based on relatively easily calculated meteorological drought indices.

Adapting to social and political transitions - the influence of history on health policy formation in the Republic of the Union of Myanmar (Burma).

PubMed

Grundy, John; Annear, Peter; Ahmed, Shakil; Biggs, Beverley-Ann

2014-04-01

The Republic of the Union of Myanmar (Burma) has a long and complex history characterized by internal conflict and tense international relations. Post-independence, the health sector has gradually evolved, but with health service development and indicators lagging well behind regional expectations. In recent years, the country has initiated political reforms and a reorientation of development policy towards social sector investment. In this study, from a systems and historical perspective, we used publicly available data sources and grey literature to describe and analyze links between health policy and history from the post-independence period up until 2012. Three major periods are discernable in post war health system development and political history in Myanmar. The first post-independence period was associated with the development of the primary health care system extending up to the 1988 political events. The second period is from 1988 to 2005, when the country launched a free market economic model and was arguably experiencing its highest levels of international isolation as well as very low levels of national health investment. The third period (2005-2012) represents the first attempts at health reform and recovery, linked to emerging trends in national political reform and international politics. Based on the most recent period of macro-political reform, the central state is set to transition from a direct implementer of a command and control management system, towards stewardship of a significantly more complex and decentralized administrative order. Historical analysis demonstrates the extent to which these periodic shifts in the macro-political and economic order acts to reset the parameters for health policy making. This case demonstrates important lessons for other countries in transition by highlighting the extent to which analysis of political history can be instructive for determination of more feasible boundaries for future health policy action. Copyright © 2014 Elsevier Ltd. All rights reserved.

CARRS Surveillance study: design and methods to assess burdens from multiple perspectives

PubMed Central

2012-01-01

Background Cardio-metabolic diseases (CMDs) are a growing public health problem, but data on incidence, trends, and costs in developing countries is scarce. Comprehensive and standardised surveillance for non-communicable diseases was recommended at the United Nations High-level meeting in 2011. Aims: To develop a model surveillance system for CMDs and risk factors that could be adopted for continued assessment of burdens from multiple perspectives in South-Asian countries. Methods Design: Hybrid model with two cross-sectional serial surveys three years apart to monitor trend, with a three-year prospective follow-up of the first cohort. Sites: Three urban settings (Chennai and New Delhi in India; Karachi in Pakistan), 4000 participants in each site stratified by gender and age. Sampling methodology: Multi-stage cluster random sampling; followed by within-household participant selection through a combination of Health Information National Trends Study (HINTS) and Kish methods. Culturally-appropriate and methodologically-relevant data collection instruments were developed to gather information on CMDs and their risk factors; quality of life, health-care utilisation and costs, along with objective measures of anthropometric, clinical and biochemical parameters. The cohort follow-up is designed as a pilot study to understand the feasibility of estimating incidence of risk factors, disease events, morbidity, and mortality. Results The overall participant response rate in the first cross-sectional survey was 94.1% (Chennai 92.4%, n = 4943; Delhi 95.7%, n = 4425; Karachi 94.3%, n = 4016). 51.8% of the participants were females, 61.6% < 45years, 27.5% 45–60years and 10.9% >60 years. Discussion This surveillance model will generate data on prevalence and trends; help study the complex life-course patterns of CMDs, and provide a platform for developing and testing interventions and tools for prevention and control of CMDs in South-Asia. It will also help understanding the challenges and opportunities in establishing a surveillance system across countries. PMID:22928740

Teenagers and Texting: Use of a Youth Ecological Momentary Assessment System in Trajectory Health Research With Latina Adolescents

PubMed Central

Hardeman, Rachel R; Kwon, Gyu; Lando-King, Elizabeth; Zhang, Lei; Genis, Therese; Brady, Sonya S; Kinder, Elizabeth

2014-01-01

Background Adolescent females send and receive more text messages than any others, with an average of 4050 texts a month. Despite this technological inroad among adolescents, few researchers are utilizing text messaging technology to collect real time, contextualized data. Temporal variables (ie, mood) collected regularly over a period of time could yield useful insights, particularly for evaluating health intervention outcomes. Use of text messaging technology has multiple benefits, including capacity of researchers to immediately act in response to texted information. Objective The objective of our study was to custom build a short messaging service (SMS) or text messaging assessment delivery system for use with adolescents. The Youth Ecological Momentary Assessment System (YEMAS) was developed to collect automated texted reports of daily activities, behaviors, and attitudes among adolescents, and to examine the feasibility of YEMAS. This system was created to collect and transfer real time data about individual- and social-level factors that influence physical, mental, emotional, and social well-being. Methods YEMAS is a custom designed system that interfaces with a cloud-based communication system to automate scheduled delivery of survey questions via text messaging; we designed this university-based system to meet data security and management standards. This was a two-phase study that included development of YEMAS and a feasibility pilot with Latino adolescent females. Relative homogeneity of participants was desired for the feasibility pilot study; adolescent Latina youth were sought because they represent the largest and fastest growing ethnic minority group in the United States. Females were targeted because they demonstrate the highest rate of text messaging and were expected to be interested in participating. Phase I involved development of YEMAS and Phase II involved piloting of the system with Latina adolescents. Girls were eligible to participate if they were attending one of the participating high schools and self-identified as Latina. We contacted 96 adolescents; of these, 24 returned written parental consent forms, completed assent processes, and enrolled in the study. Results YEMAS was collaboratively developed and implemented. Feasibility was established with Latina adolescents (N=24), who responded to four surveys daily for two two-week periods (four weeks total). Each survey had between 12 and 17 questions, with responses including yes/no, Likert scale, and open-ended options. Retention and compliance rates were high, with nearly 18,000 texts provided by the girls over the course of the pilot period. Conclusions Pilot results support the feasibility and value of YEMAS, an automated SMS-based text messaging data collection system positioned within a secure university environment. This approach capitalizes on immediate data transfer protocols and enables the documentation of participants’ thoughts, feelings, and behaviors in real time. Data are collected using mobile devices that are familiar to participants and nearly ubiquitous in developed countries. PMID:25098355

A paradigm shift for socioeconomic justice and health: from focusing on inequalities to aiming at sustainable equity.

PubMed

Garay, Juan E; Chiriboga, David E

2017-08-01

To measure the 'best possible health for all', incorporating sustainability, and to establish the magnitude of global health inequity. Observational, retrospective. We identified countries with three criteria: (1) a healthy population-life expectancy above world average; (2) living conditions feasible to replicate worldwide-per-capita gross domestic product (GDP-pc) below the world average; and (3) sustainability-per-capita carbon dioxide emissions lower than the planetary pollution boundary. Using these healthy, feasible, and sustainable (HFS) countries as the gold standard, we estimated the burden of global health inequity (BGHiE) in terms of excess deaths, analyzing time-trends (1950-2012) by age, sex, and geographic location. Finally, we defined a global income 'equity zone' and quantified the economic gap needed to achieve global sustainable health equity. A total of 14 countries worldwide met the HFS criteria. Since 1970, there has been a BGHiE of ∼17 million avoidable deaths per year (∼40% of all deaths), with 36 life-years-lost per excess death. Young children and women bore a higher BGHiE, and, in recent years, the highest proportion of avoidable deaths occurred in Africa, India, and the Russian Federation. By 2012, the most efficient HFS countries had a GDP-pc/year of USD$2,165, which we proposed as the lower equity zone threshold. The estimated USD$2.58 trillion economic gap represents 3.6% of the world's GDP-twenty times larger than current total global foreign aid. Sustainable health equity metrics provide a benchmark tool to guide efforts toward transforming overall living conditions, as a means to achieve the 'best possible health for all.' Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Feasibility of using self-reported ethnicity in pregnancy according to the gestation-related optimal weight classification: a cross-sectional study.

PubMed

Lockie, E; McCarthy, E A; Hui, L; Churilov, L; Walker, S P

2018-05-01

To evaluate the feasibility of self-reported ethnicity using the gestation-related optimal growth (GROW) classification in a contemporary multicultural antenatal population. Cross-sectional study. Tertiary obstetric hospital in Melbourne, Australia. Pregnant women attending the antenatal clinic. We surveyed pregnant women during April-June 2016 regarding their understanding of the term 'ethnicity', and how they would classify the ethnicity of themselves, their partner, and family members according to the Australian GROW classification. Two hundred and thirty-five women completed the survey. When describing 'ethnicity', most women (103, 44%) chose multiple descriptors, most frequently country of birth (54%) and region of ancestry (47%). Interpretation of 'ethnicity' varied significantly between ethnic groups: those choosing 'country of birth' were more likely to identify as Indian (odds ratio, OR 3.5, P = 0.03), whereas those choosing 'physical appearance' were more likely to identify as Chinese (OR 3.0, P = 0.047). Thirty participants (13%) were unable to describe their ethnicity from the available GROW options. Sixty-one (26%) respondents' ethnicity was inconsistent with that of their parents' heritage. A further 35% had a partner of different ethnicity. The agreement between country of birth and self-reported ethnicity was only fair (kappa 0.73, 95% confidence interval, 95% CI 0.64-0.82). This study confirms the complexity of defining ethnicity in contemporary multicultural settings. Self-reported ethnicity is often inaccurate, concepts of ethnicity vary by ethnic group, and country of birth is a poor descriptive surrogate. Adjustment for maternal ethnicity should be undertaken with caution in the customised assessment of fetal growth. Is self-reported maternal ethnicity reliable? We think not. © 2017 Royal College of Obstetricians and Gynaecologists.

Monitoring progress towards universal health coverage at country and global levels.

PubMed

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-09-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries.

Monitoring Progress towards Universal Health Coverage at Country and Global Levels

PubMed Central

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-01-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries. PMID:25243899

Cross-cultural variation in disease-related concerns among patients with inflammatory bowel disease.

PubMed

Levenstein, S; Li, Z; Almer, S; Barbosa, A; Marquis, P; Moser, G; Sperber, A; Toner, B; Drossman, D A

2001-06-01

The aim of this work was to study cross-cultural variations in the impact of inflammatory bowel disease (IBD) on health-related quality of life by an international comparison of disease-related concerns. Item and factor scores on the Rating Form of Inflammatory Bowel Disease Patient Concerns and overall mean concern levels were compared by analysis of variance among 2002 IBD patients in eight countries. The overall level of concern varied from 51 out of 100 in Portugal to 19 in Sweden, with intermediate scores for Italy (43), Canada (40), United States (39), France (39), Austria (33), and Israel (25). Having surgery, an ostomy, the uncertain nature of the disease, and medication side effects were each rated among the first five in importance in six countries. Other items varied considerably. For example, concern regarding pain and suffering was high in Israel and low in Portugal, whereas concern over developing cancer was low in Italy. Concern over financial issues and access to high-quality health care were inversely associated with measures of national economic prosperity. 1) Cross-cultural comparisons of patient concerns related to IBD are feasible using translated scales. 2) Reporting tendencies vary greatly; within Europe, patients from southern countries report greater overall concern. 3) The complications and the variable evolution of disease elicit general concern, but the importance of specific issues varies among countries. 4) The reasons for national differences may have social, cultural, and/or economic determinants with relevance to the patient-physician relationship, patient education, and therapeutic decision making.