Profiles of men-who-have-sex-with-men seeking anonymous voluntary HIV counseling and testing at a community-based centre in Malaysia.

PubMed

Koh, K C; Kamarulzaman, A

2011-12-01

Community-based HIV voluntary counseling and testing (VCT) services is an effective alternative for mapping the local demographics of at-risk populations for HIV as well as provide an acceptable and reliable means of early detection of HIV. We describe the profiles of men-who-have-sex-with-men (MSM) who sought VCT services in a community based centre in Kuala Lumpur.

The knowledge, attitude and practice of voluntary counselling and testing (VCT) for HIV/AIDS among undergraduates in a polytechnic in southeast, Nigeria.

PubMed

Ikechebelu, I J; Udigwe, G O; Ikechebelu, N; Imoh, L C

2006-01-01

The identification of infected individuals is an important step in the control of the HIV epidemic. Voluntary counselling and testing (VCT) for HIV/AIDS is a concept developed in this direction. The objective of this study is to determine the level of knowledge, attitude and practice of Voluntary Counselling and Testing (VCT) for HIV/AIDS among undergraduates in a Nigerian tertiary institution. This is a cross sectional study using a multistage sampling method to enroll students from different levels of the national diploma programme into the study. A structured questionnaire was administered to the 260 students with response rate of 70%. Only 115 (63.2%) of the students were aware of VCT with 68 (59.1%) having heard of it at least one year prior to the study. Mass media and Churches were the highest sources of information on VCT Most of the students did not know where VCT services could be obtained and knowledge of what VCT entails was also low. However, 127 (69.8%) students approved the necessity of counselling prior to testing and 117 (64.3%) were ready to take a positive result in good fate. At least one out of every four students (54 of 182) had been sexually active within three months preceding the study Only 48 (26.4%) students had taken an HIV test at one time or the other before the study. Majority (62.5%) of those who had been tested went for the screening just to know their HIV status. Premarital testing (18.8%) was the second commonest reason for taken an HIV test. Majority of the respondents (74.2%) were willing to go for VCT Among those who were not willing to go for VCT the commonest reason given was that they were certain they were not infected. This study highlights the need to step up efforts to increase the students' awareness of VCT, deepen their knowledge and create the right attitude towards VCT through the mass media and religious bodies. Teaching on HIV/AIDS and VCT should also be incorporated into the school curriculum. A shift from the present clinic based approach to a more routine and widespread public health model will increase access to VCT Stand alone VCT centres should therefore be cited in educational institutions, community centres, marketplaces, youth friendly centres etc. for proximity to the people.

Assessing the costs of mobile voluntary counseling and testing at the work place versus facility based voluntary counseling and testing in Namibia.

PubMed

de Beer, Ingrid; Chani, Kudakwashe; Feeley, Frank G; Rinke de Wit, Tobias F; Sweeney-Bindels, Els; Mulongeni, Pancho

2015-01-01

Bophelo! is a mobile voluntary counseling and testing (VCT) and wellness screening program operated by PharmAccess at workplaces in Namibia, funded from both public and private resources. Publicly funded fixed site New Start centers provide similar services in Namibia. At this time of this study, no comparative information on the cost effectiveness of mobile versus fixed site service provision was available in Namibia to inform future programming for scale-up of VCT. The objectives of the study were to assess the costs of mobile VCT and wellness service delivery in Namibia and to compare the costs and effectiveness with fixed site VCT testing in Namibia. The full direct costs of all resources used by the mobile and fixed site testing programs and data on people tested and outcomes were obtained from PharmAccess and New Start centers in Namibia. Data were also collected on the source of funding, both public donor funding and private funding through contributions from employers. The data were analyzed using Microsoft Excel to determine the average cost per person tested for HIV. In 2009, the average cost per person tested for HIV at the Bophelo! mobile clinic was an estimated US$60.59 (US$310,451 for the 5124 people tested). Private employer contributions to the testing costs reduced the public cost per person tested to US$37.76. The incremental cost per person associated with testing for conditions other than HIV infection was US$11.35, an increase of 18.7%, consisting of the costs of additional tests (US$8.62) and staff time (US$2.73). The cost of testing one person for HIV in 2009 at the New Start centers was estimated at US$58.21 (US$4,082,936 for the 70 143 people tested). Mobile clinics can provide cost-effective wellness testing services at the workplace and have the potential to mobilize local private funding sources. Providing wellness testing in addition to VCT can help address the growing issue of non-communicable diseases.

Perception of high school students on risk for acquiring HIV and utilization of voluntary counseling and testing (VCT) service for HIV in Debre-berhan Town, Ethiopia: a quantitative cross-sectional study.

PubMed

Sisay, Solomon; Erku, Woldaregay; Medhin, Girmay; Woldeyohannes, Desalegn

2014-08-12

Human immunodeficiency virus (HIV) epidemic among youth is largely ignored and remains invisible to both young people themselves and to the society as a whole. Thus, the aim of the study was to assess the extent of perception risk of HIV and utilization of voluntary counseling and testing (VCT) service among high school students at Debre-berhan Town, Amhara Regional State, Ethiopia. A cross-sectional study was carried out from November 2010 up to January 2011 among secondary school students at Debre-berhan Town. Perception risk and VCT use were considered as dependant variables. A stratified random sampling technique was used to recruit study participants by taking schools as strata. Semi-structured self-administered questionnaire was used to collect the necessary data. Data was entered and analyzed using SPSS version 17.0. P-value < 0.05 was considered as statistically significant. A total of 339 students were consented to participate in the study and the response rate was 96.3%. The student ages' were ranged from 15 up to 24 years. Among the study participants, 30 (8.8%) had sexual contact and the mean age of first sexual encounter was 16.4 (SD =2.05) years. Of sexually active students, 12 (40%) had sex with different persons within the last 6 months, 13 (43.3%) had ever used condom and 15 (50%) had used VCT service. There was no statistically significant association between risk perception towards HIV infection and ever use of VCT service (AOR (95% CI) = 1.0(0.30, 4.02). Some students were engaged in risky sexual behavior even though they had heard about HIV/AIDS. The perception of risk for acquisition of HIV infection and utilization of VCT were low. Thus, education on topic of HIV/AIDS through integrating as part of school curriculum and encouraging the existing health institutions to provide youth-friendly sexual counseling services including VCT for HIV are strongly recommended.

The impact of voluntary counselling and testing services on sexual behaviour change and HIV incidence: observations from a cohort study in rural Tanzania.

PubMed

Cawley, Caoimhe; Wringe, Alison; Slaymaker, Emma; Todd, Jim; Michael, Denna; Kumugola, Yusufu; Urassa, Mark; Zaba, Basia

2014-03-22

It is widely assumed that voluntary counselling and testing (VCT) services contribute to HIV prevention by motivating clients to reduce sexual risk-taking. However, findings from sub-Saharan Africa have been mixed, particularly among HIV-negative persons. We explored associations between VCT use and changes in sexual risk behaviours and HIV incidence using data from a community HIV cohort study in northwest Tanzania. Data on VCT use, sexual behaviour and HIV status were available from three HIV serological surveillance rounds undertaken in 2003-4 (Sero4), 2006-7 (Sero5) and 2010 (Sero6). We used multinomial logistic regression to assess changes in sexual risk behaviours between rounds, and Poisson regression to estimate HIV incidence. The analyses included 3,613 participants attending Sero4 and Sero5 (3,474 HIV-negative and 139 HIV-positive at earlier round) and 2,998 attending Sero5 and Sero6 (2,858 HIV-negative and 140 HIV-positive at earlier round). Among HIV-negative individuals VCT use was associated with reductions in the number of sexual partners in the last year (aRR Seros 4-5: 1.42, 95% CI 1.07-1.88; aRR Seros 5-6: 1.68, 95% CI 1.25-2.26) and in the likelihood of having a non-cohabiting partner in the last year (aRR Seros 4-5: 1.57, 95% CI 1.10-2.25; aRR Seros 5-6: 1.48, 95% CI 1.07-2.04) or a high-risk partner in the last year (aRR Seros 5-6 1.57, 95% CI 1.06-2.31). However, VCT was also associated with stopping using condoms with non-cohabiting partners between Seros 4-5 (aRR 4.88, 95% CI 1.39-17.16). There were no statistically significant associations between VCT use and changes in HIV incidence, nor changes in sexual behaviour among HIV-positive individuals, possibly due to small sample sizes. We found moderate associations between VCT use and reductions in some sexual risk behaviours among HIV-negative participants, but no impacts among HIV-positive individuals in the context of low overall VCT uptake. Furthermore, there were no significant changes in HIV incidence associated with VCT use, although declining background incidence and small sample sizes may have prevented us from detecting this. The impact of VCT services will ultimately depend upon rates of uptake, with further research required to better understand processes of behaviour change following VCT use.

Reproductive health service utilization and associated factors among adolescents (15–19 years old) in Gondar town, Northwest Ethiopia

PubMed Central

2013-01-01

Background The utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. It plays a vital role in safeguarding youth in Sub-Saharan African countries including Ethiopia, which accounts for a high proportion of the region’s new HIV infections as well as maternal and infant mortality ratios. Due to this, assessing adolescent reproductive health service utilization and associated factors has its own contribution in achieving the national Millennium Development Goals (MDG), especially goals 4 to 6. Methods A community based cross-sectional study was conducted from April 5–19, 2012, in 4 randomly selected administrative areas of Gondar town. A total of 1290 adolescents aged 15–19 were interviewed using a pre-tested and structured questionnaire. Data were entered in to the EPI INFO version 3.5.3 statistical software and analyzed using an adapted SPSS version 20 software package. Logistic regression was done to identify possible factors associated with family planning (FP), and voluntary counseling and testing (VCT) service utilization. Results Out of the total participants, 79.5% and 72.2% utilized FP and VCT services, respectively. In addition, among sexually experienced adolescents, 68.1% and 88.4% utilized contraceptive methods and VCT service during their first sexual encounter, respectively. Educational status, discussion with family/relatives, peer groups, sexual partners and teachers were significantly associated with FP service utilization. Also, adolescents who had a romantic sexual relationship, and those whose last sexual relationship was long-term, were about 6.5 times (Adjusted Odds Ratio [AOR] = 6.5, 95% CI: 1.23, 34.59), and about 3 times (AOR = 3, 95% CI: 1.02, 8.24) more likely to utilize FP services than adolescents who had no romantic relationship or long-term sexual relationship, respectively. In addition, the variables significantly associated with VCT service utilization were: participants who had secondary education and above, schooling attendance, co- residence with both parents, parental communication, discussion of services with peer groups, health workers, and perception of a risk of HIV/AIDS. Conclusions The majority of the adolescents were utilizing FP and VCT service in Northwest Ethiopia. But among the sexually experienced adolescents, utilization of FP at first sexual intercourse and VCT service were found to be low. Educational status, schooling attendance, discussion of services, type of sexual relationship and perception of risk were important factors affecting the utilization of FP and VCT services. Building life skill, facilitating parent to child communication, establishing and strengthening of youth centers and school reproductive health clubs are important steps to improve adolescents’ reproductive health (RH) service utilization. PMID:23915299

A Venue-Based Approach to Reaching MSM, IDUs and the General Population with VCT: A Three Study Site in Kenya

PubMed Central

Singh, Kavita; Brodish, Paul; Mbai, Fiona; Kingola, Nzioki; Rinyuri, Agnes; Njeru, Carol; Mureithi, Patrick; Sambisa, William; Weir, Sharon

2014-01-01

A venue-based HIV prevention study which included Voluntary Counseling and Testing (VCT) was conducted in three diverse areas of Kenya— Malindi, Nanyuki and Rachounyo. Aims of the study were to: 1) assess the acceptability of VCT for the general population, men who have sex with men (MSM), and injecting drug users (IDUs) within the context of a venue-based approach; 2) determine if there were differences between those agreeing and not agreeing to testing; and 3) study factors associated with being HIV positive. Approximately 98% of IDUs and 97% of MSM agreed to VCT, providing evidence that populations with little access to services and whose behaviors are stigmatized and often considered illegal in their countries can be reached with needed HIV prevention services. Acceptability of VCT in the general population ranged from 60% in Malindi to 48% in Nanyuki. There were a few significant differences between those accepting and declining testing. Notably in Rachuonyo and Malindi those reporting multiple partners were more likely to accept testing. There was also evidence that riskier sexual behavior was associated with being HIV positive for both men in Rachounyo and women in Malindi. Overall HIV prevalence was higher among the individuals in this study compared to individuals sampled in the 2008–2009 Kenya Demographic and Health Survey, indicating the method is an appropriate means to reach the highest risk individuals including stigmatized populations. PMID:22198312

Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India.

PubMed

Beattie, Tara S H; Bhattacharjee, Parinita; Suresh, M; Isac, Shajy; Ramesh, B M; Moses, Stephen

2012-10-01

Despite high HIV prevalence rates among most-at-risk groups, utilisation of HIV testing, treatment and care services was relatively low in Karnataka prior to 2008. The authors aimed to understand the barriers to and identify potential solutions for improving HIV service utilisation. Focus group discussions were carried out among homogeneous groups of female sex workers, men who have sex with men and transgenders, and programme peer educators in six districts across Karnataka in March and April 2008. 26 focus group discussions were conducted, involving 302 participants. Participants had good knowledge about HIV and HIV voluntary counselling and testing (VCT) services, but awareness of other HIV services was low. The fear of the psychological impact of a positive HIV test result and the perceived repercussions of being seen accessing HIV services were key personal and interpersonal barriers to HIV service utilisation. Previous experiences of discrimination at government healthcare services, coupled with discriminatory attitudes and behaviours by VCT staff, were key structural barriers to VCT service uptake among those who had not been HIV tested. Among those who had used government-managed prevention of parent to child transmission and antiretroviral treatment services, poor physical facilities, long waiting times, lack of available treatment, the need to give bribes to receive care and discriminatory attitudes of healthcare staff presented additional structural barriers. Embedding some HIV care services within existing programmes for vulnerable populations, as well as improving service quality at government facilities, are suggested to help overcome the multiple barriers to service utilisation. Increasing the uptake of HIV testing, treatment and care services is key to improving the quality and longevity of the lives of HIV-infected individuals.

Client-provider interactions in provider-initiated and voluntary HIV counseling and testing services in Uganda

PubMed Central

2013-01-01

Background Provider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling. It is not known if the provider-client experiences, perceptions and client satisfaction with the information provided differs in the two approaches. Methods In 2008, we conducted structured interviews with 627 individuals in Uganda; 301 tested through PITC and 326 through voluntary counselling and testing (VCT). We compared client experiences and perceptions based on the essential elements of consent, confidentiality, counseling, and referral for follow-up care. We conducted multivariate analysis for predictors of reporting information or counselling as sufficient. Results In VCT, 96.6% (282) said they were asked for consent compared to 91.3% (198) in PITC (P = 0.01). About the information provided, 92.0% (286) in VCT found it sufficient compared to 78.7% (221) in PITC (P = <0.01). In VCT 79.9% (246) thought their results were kept confidential compared to 71.7% (200) in PITC (P = 0.02). Eighty percent (64) of HIV infected VCT clients said they were referred for follow-up care versus 87.3% (48) in PITC (p = 0.2). Predictors of perceived adequacy of information in PITC included an opportunity to ask questions (adj.RR 1.76, CI 1.41, 2.18) and expecting the test results received (adj.RR 1.18, CI 1.06, 1.33). For VCT significant factors included being given an opportunity to ask questions (adj.RR 1.62, CI 1.00, 2.60) and 3+ prior times tested, (adj.RR 1.05, CI 1.00, 1.09). Conclusions This study demonstrates good practices in the essential elements of HIV testing for both VCT and PITC. However, further quality enhancement is required in both testing approaches in relation to referral to HIV care post-test, client confidence in relation to confidentiality, and providing an opportunity to ask questions to address client-specific information needs. PMID:24139203

Do accurate HIV and antiretroviral therapy knowledge, and previous testing experiences increase the uptake of HIV voluntary counselling and testing? Results from a cohort study in rural Tanzania.

PubMed

South, Annabelle; Wringe, Alison; Kumogola, Yusufu; Isingo, Raphael; Manyalla, Rose; Cawley, Caoimhe; Zaba, Basia; Todd, Jim; Urassa, Mark

2013-09-04

Despite the introduction of free antiretroviral therapy (ART), the use of voluntary counselling and testing (VCT) services remains persistently low in many African countries. This study investigates how prior experience of HIV and VCT, and knowledge about HIV and ART influence VCT use in rural Tanzania. In 2006-7, VCT was offered to study participants during the fifth survey round of an HIV community cohort study that includes HIV testing for research purposes without results disclosure, and a questionnaire covering knowledge, attitudes and practices around HIV infection and HIV services. Categorical variables were created for HIV knowledge and ART knowledge, with "good" HIV and ART knowledge defined as correctly answering at least 4/6 and 5/7 questions about HIV and ART respectively. Experience of HIV was defined as knowing people living with HIV, or having died from AIDS. Logistic regression methods were used to assess how HIV and ART knowledge, and prior experiences of HIV and VCT were associated with VCT uptake, with adjustment for HIV status and socio-demographic confounders. 2,695/3,886 (69%) men and 2,708/5,575 women (49%) had "good" HIV knowledge, while 613/3,886 (16%) men and 585/5575 (10%) women had "good" ART knowledge. Misconceptions about HIV transmission were common, including through kissing (55% of women, 43% of men), or mosquito bites (42% of women, 34% of men).19% of men and 16% of women used VCT during the survey. After controlling for HIV status and socio-demographic factors, the odds of VCT use were lower among those with poor HIV knowledge (aOR = 0.5; p = 0.01 for men and aOR = 0.6; p < 0.01 for women) and poor ART knowledge (aOR = 0.8; p = 0.06 for men, aOR = 0.8; p < 0.01 for women), and higher among those with HIV experience (aOR = 1.3 for men and aOR = 1.6 for women, p < 0.01) and positive prior VCT experience (aOR = 2.0 for all men and aOR = 2.0 for HIV-negative women only, p < 0.001). Two years after the introduction of free ART in this setting, misconceptions regarding HIV transmission remain rife and knowledge regarding treatment is worryingly poor, especially among women and HIV-positive people. Further HIV-related information, education and communication activities are urgently needed to improve VCT uptake in rural Tanzania.

Factors Influencing the Utilization of Voluntary Counselling and Testing Services among University Students in Kenya

PubMed Central

Mwangi, Rose; Ngure, Peter; Thiga, Moses; Ngure, Jane

2014-01-01

Voluntary Counselling and Testing (VCT) is recognized as a critical component of effective HIV prevention initiative and has therefore been promoted nationally and within universities in Kenya. Upon successful counselling and testing those found to be HIV negative are informed to take the necessary measures to protect themselves while the infected are advised to start the required medication. This study examined the attitudes toward VCT services among university students in four Kenyan universities. 980 students filled self administered questionnaires. Results showed that 38.5% of the subjects had tested for HIV in the last 12 months and students (55.8%) felt less susceptible to HIV infection. Findings from a factor analysis revealed that the intention to seek the services was associated with five attitude subscales that were ranked as follows (i) people’s and personal concerns, (ii) friends concerns, (iii) value of testing, (iv) confidentiality and support, and (v) perceived susceptibility. The first three items are associated with stigma which was evidenced in the subjects’ report that admitting that one should test for HIV would imply that one has engaged in immoral behaviour. Secondly, subjects felt that their friends would look down on them if they tested for HIV. Knowing the students’ attitudes will therefore assist in the development of appropriate VCT interventions that will promote HIV testing and behaviour change. PMID:24999153

Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia.

PubMed

Siregar, Adiatma Y M; Komarudin, Dindin; Wisaksana, Rudi; van Crevel, Reinout; Baltussen, Rob

2011-02-01

To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia. We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually transmitted infection (STI) community clinic (784 clients) and prison clinic (574 clients) in Bandung, Indonesia, in the period January 2008-April 2009. The hospital clinic diagnosed the highest proportion and absolute number of HIV infections, but with the lowest average CD4 cell count and with the highest associated travelling and waiting time. The prison clinic detected fewer cases, but at an earlier stage, and all enrolled in HIV care. The community clinics detected the smallest number of cases, and only 0-8% enrolled in HIV care. The unit cost per VCT was highest in the hospital clinic (US$74), followed by the STI community clinic (US$65), the HIV community clinic (US$39) and the prison (US$23). We propose a reorientation of the delivery models for VCT and related HIV/AIDS treatment in this setting. We call for the scaling up of community clinics for VCT to improve access, promote earlier detection and to perform (early) treatment activities. This would reduce the burden of the hospital clinic to orient itself towards the treatment of AIDS patients. This is one of very few studies addressing this issue in Asia and the first of its kind in Indonesia, which has a rapidly growing HIV epidemic. The conceptual framework and overall conclusions may be relevant to other low-income settings. © 2010 Blackwell Publishing Ltd.

Evaluation of the integrated clinic model for HIV/AIDS services in Ho Chi Minh City, Viet Nam, 2013-2014.

PubMed

Hung, V; Nguyen, S T; Tieu, V T T; Nguyen, T T T; Duong, T H; Lyss, S; Oeltmann, J E

2016-12-21

Setting: Ho Chi Minh City (HCMC), Viet Nam. Objective: To evaluate a new integrated service model for human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) care. Design: In HCMC, co-located services, including voluntary HIV counseling and testing (VCT), HIV treatment at out-patient clinics (OPC), and methadone maintenance therapy (MMT) for persons who inject drugs, have operated under different administrative structures. In the context of decreasing international financial support, integration of these services into one administrative structure with reduced staff occurred in seven districts in HCMC between October 2013 and June 2014. We used a pre-post study design to compare service-related outcomes from routinely collected data at health facilities 6 months before and 6 months after integration. Results: The proportion of HIV-infected persons linked from VCT to OPCs was unchanged or increased following integration. A higher percentage of patients eligible for antiretroviral therapy (ART) were started on ART. The proportion of ART patients lost to follow-up remained unchanged. The proportions of MMT patients who tested positive for heroin or other substances decreased or were unchanged. Conclusions: VCT, OPC and MMT service delivery quality remained the same or improved during the 6 months following the integration. Expansion of the integrated model should be considered for HIV-related services.

Peer-based education and the integration of HIV and Sexual and Reproductive Health services for young people in Vietnam: evidence from a project evaluation.

PubMed

Ngo, Anh D; Ha, Toan H; Rule, John; Dang, Chinh V

2013-01-01

This paper reports changes in behavioral outcomes related to the use of HIV testing service of a project that employed peer-based education strategies and integration of HIV voluntary counseling and testing (VCT) and Sexual and Reproductive Health (SRH) services targeting young people aged 15-24 across 5 provinces in Vietnam. A pre-test/post-test, non-experimental evaluation design was used. Data were collected from cross-sectional surveys of youth and client exit interviews at project supported SRH clinics conducted at baseline and again at 24 months following implementation. The baseline samples consisted of 813 youth and 399 exit clients. The end line samples included 501 youths and 399 exit clients. Z test was used to assess changes in behavioral outcomes. Results show that there was a significant increase (p<0.05) in the percentage of youth who wanted to obtain a HIV test (from 33% to 51%), who had ever had a test (from 7.5% to 15%), and who had a repeat test in the last 12 months (from 54.5% to 67.5%). Exit client interviews found a nearly five-fold increase in the percentage of clients seeking HIV VCT in their current visit (5.0% vs. 24.5%) and almost two-fold increase in the percentage of those having their last test at a project supported clinic (9.3% vs. 17.8%). There were also positive changes in some aspects of youth HIV/AIDS knowledge, attitudes, and risk perceptions. This study provides preliminary evidence regarding the benefits of the integration of HIV VCT-SRH services in terms of increased access to HIV services and testing in Vietnam. Benefits of peer-based education regarding increased HIV knowledge were also identified. Further investigations, including experimental studies with assessment of health outcomes and the uptake of HIV testing services, are required to better elucidate the effectiveness and challenges of this intervention model in Vietnam.

Uptake of Workplace HIV Counselling and Testing: A Cluster-Randomised Trial in Zimbabwe

PubMed Central

Corbett, Elizabeth L; Dauya, Ethel; Matambo, Ronnie; Cheung, Yin Bun; Makamure, Beauty; Bassett, Mary T; Chandiwana, Steven; Munyati, Shungu; Mason, Peter R; Butterworth, Anthony E; Godfrey-Faussett, Peter; Hayes, Richard J

2006-01-01

Background HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT). Methods and Findings The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8). Conclusions High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT. PMID:16796402

Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge

PubMed Central

Wagner, Anjuli D.; Mugo, Cyrus; Bluemer-Miroite, Shay; Mutiti, Peter M.; Wamalwa, Dalton C.; Bukusi, David; Neary, Jillian; Njuguna, Irene N.; O’Malley, Gabrielle; John-Stewart, Grace C.; Slyker, Jennifer A.; Kohler, Pamela K.

2017-01-01

Objectives: To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA). Design: CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya. Methods: Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais–Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. Results: There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI −0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02–0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI −0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746). Conclusion: CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery. PMID:28665882

Global income-related inequalities in HIV testing.

PubMed

Larose, Auburn; Moore, Spencer; Harper, Sam; Lynch, John

2011-09-01

Voluntary counseling and testing (VCT) is an important prevention initiative in reducing HIV/AIDS transmission. Despite current global prevention efforts, many low- and middle-income countries continue reporting low VCT levels. Little is known about the association of within- and between-country socioeconomic inequalities and VCT. Based on the 'inverse equity hypothesis,' this study examines the degree to which low socioeconomic groups in developing countries are disadvantaged in VCT. Using recently released data from the 2002 to 2003 World Health Survey (WHS) for 106 705 individuals in 49 countries, this study used multilevel logistic regression to examine the association of individual- and national-level factors with VCT, and whether national economic development moderated the association between individual income and VCT. Individual income was based on country-specific income quintiles. National economic development was based on national gross domestic product per capita (GDP/c). Effect modification was evaluated with the likelihood ratio test (G(2)). Individuals eligible for the VCT question of the WHS were adults between the ages of 18-49 years; women who had given birth in the last 2 years were excluded from this question. VCT was more likely among higher income quintiles and in countries with higher GDP/c. GDP/c moderated the association between individual income and VCT whereby relative income differences in VCT were greater in countries with lower GDP/c (G(2)= 9.21; P= 0.002). Individual socio-demographic characteristics were also associated with the likelihood of a person having VCT. Relative socioeconomic inequalities in VCT coverage appear to decline when higher SES groups reach a certain level of coverage. These findings suggest that changes to international VCT programs may be necessary to moderate the relative VCT differences between high- and low-income individuals in lower GDP/c nations.

Developing and piloting an expert system for better routine voluntary HIV counseling and testing in China: preliminary results and lessons.

PubMed

Chai, Jing; Wang, DeBin; Zhou, Meng; Xu, WangQuan; Liang, Guojun; Shen, Yi Fang

2012-01-01

This study aims at developing and testing a pragmatic expert system for HIV voluntary counseling (VCT-ES) that leverages best practices. The VCT-ES was developed via evolutionary prototyping and piloted in 10 voluntary HIV counseling and testing (VCT) clinics from Anhui and Beijing representative of prefecture and county level VCT clinics in China. All counselors with the clinics and the clients to the clinics within selected two weeks at baseline and the end of study were invited to participate. Assessment measures included essential counseling procedures (ECPs); clients' satisfaction, knowledge, and behavior efficacy. VCT-ES was developed which tries to model and facilitate standard VCT operation procedures and best practices. One hundred and eighty-two (96 at baseline vs. 86 after intervention) cases recordings, 172 (96 vs. 76) client questionnaires, 10 counselor, and 2 expert rating instruments were collected; and 17 clients and 8 counselors participated in qualitative interviews. VCT-ES increased delivery of ECPs from 18.94% to 66.39% on average; increased clients' knowledge from 40.51% to 86.34% and self-efficacy by 22.42%. The VCT-ES applications listed were rated 9.1 on average (maximum = 10). The VCT-ES could be an easy and effective solution to better routine VCT and merits further research.

Factors that lead to changes in sexual behaviours after a negative HIV test: protocol for a prospective cohort study in Kinshasa.

PubMed

Carlos, Silvia; Nzakimuena, Francis; Reina, Gabriel; Lopez-Del Burgo, Cristina; Burgueño, Eduardo; Ndarabu, Adolphe; Osorio, Alfonso; de Irala, Jokin

2016-07-20

Considering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo). Prospective cohort study from December 2014 until March 2016. People 15-60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up. This is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.

Transitioning couple's voluntary HIV counseling and testing (CVCT) from stand-alone weekend services into routine antenatal and VCT services in government clinics in Zambia's two largest cities.

PubMed

Inambao, Mubiana; Kilembe, William; Canary, Lauren A; Czaicki, Nancy L; Kakungu-Simpungwe, Matilda; Chavuma, Roy; Wall, Kristin M; Tichacek, Amanda; Pulerwitz, Julie; Thior, Ibou; Chomba, Elwyn; Allen, Susan A

2017-01-01

Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple's voluntary HIV counseling and testing (CVCT) for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC) and individual voluntary testing and counseling (VCT) services in Zambia's two largest cities from 2009-2015 is described. Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO) subsidies were offered for overtime pay. Implementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for 'partner testing' with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities. A focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended.

Social marketing as a means of raising community awareness of an HIV voluntary counselling and testing site in Soweto, South Africa.

PubMed

Hewer, Raymond; Motaung, Enea; Mathope, Alicia; Meyer, Debra

2005-05-01

In order for HIV voluntary counselling and testing (VCT) to be successful, the approval of and attendance at the VCT centre by the community it serves is necessary. To this end, the Township AIDS Project (TAP), which has VCT sites serving the greater Soweto area, attempts to maintain a high degree of visibility in the community through campaigning and various forms of advertising. To determine whether the social marketing strategies employed by the organisation encouraged attendance, pre-test questionnaires completed by volunteers attending the TAP VCT site located in the Meadowlands district of Soweto were retrospectively analysed. During 2003, approximately 34% of volunteers were made aware of the VCT site through marketing. However, a more important factor in volunteer awareness was word of mouth, with about 46% of volunteers informed of TAP VCT by a friend, partner or relative. This attests to the success of the marketing strategies employed by the TAP organisation in raising community awareness and attendance at the VCT site investigated in this study. In total, 1 141 volunteers completed a questionnaire and 1 054 of these consented to being tested for HIV antibodies. The level of infection among the sample of individuals tested at this clinic-based VCT programme was 29.9%.

Transitioning couple’s voluntary HIV counseling and testing (CVCT) from stand-alone weekend services into routine antenatal and VCT services in government clinics in Zambia’s two largest cities

PubMed Central

Inambao, Mubiana; Kilembe, William; Canary, Lauren A.; Czaicki, Nancy L.; Kakungu-Simpungwe, Matilda; Chavuma, Roy; Wall, Kristin M.; Tichacek, Amanda; Pulerwitz, Julie; Thior, Ibou; Chomba, Elwyn; Allen, Susan A.

2017-01-01

Introduction Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple’s voluntary HIV counseling and testing (CVCT) for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC) and individual voluntary testing and counseling (VCT) services in Zambia’s two largest cities from 2009–2015 is described. Methods Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO) subsidies were offered for overtime pay. Results Implementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for ‘partner testing’ with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities. Discussion A focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended. PMID:29036208

HIV voluntary counseling and testing: an experience from India.

PubMed

Vajpayee, Madhu; Mojumdar, Kamalika; Raina, Meenakshi; Mishra, Sharad; Sreenivas, Vibhuti

2009-07-01

Despite proof of voluntary counseling and testing (VCT) effectiveness in HIV disease prevention and management, there are limited reports on experience with pre- and post-HIV-test counseling in developing countries. In view of this, we aimed to bring to the fore the voluntary counseling and testing experience at a tertiary healthcare center. The present study was conducted at the voluntary counseling and testing center of a tertiary healthcare center and the National HIV Reference Center. Participants were 1169 men and 581 females attending the VCT clinic from February 2005 to March 2006. Odds ratios were calculated for each of the variable to analyze the strength of association with HIV sero-status. Out of 1750 patients, 322 (27.5%) males and 156 females (26.9%) tested HIV-positive. HIV-sero-positivity was observed to be associated to participant age (approximately 1.5 for 25-44 yrs age group), marital status (2.3 times in married patients), primary or lower education level (1.5 times), citing spouse death/HIV-infected spouse as the reason for seeking VCT (2.2 times) and reporting a history of risk behavior as reason for getting tested. This study aims to evaluate the effectiveness of existing client initiated voluntary counseling and testing facility in the light of a recent recommendation by WHO/UNAIDS for the implementation of provider initiated voluntary counseling services. Through this study, we could also highlight socio-demographic factors, like education and age, and reasons stated by participants for seeking VCT, which were associated with HIV-positive status and put an individual at a higher risk of HIV infection.

Bisexuality, Sexual Risk Taking, and HIV Prevalence Among Men Who Have Sex With Men Accessing Voluntary Counseling and Testing Services in Mumbai, India

PubMed Central

Kumta, Sameer; Lurie, Mark; Weitzen, Sherry; Jerajani, Hemangi; Gogate, Alka; Row-kavi, Ashok; Anand, Vivek; Makadon, Harvey; Mayer, Kenneth H.

2010-01-01

Objectives To describe sociodemographics, sexual risk behavior, and estimate HIV and sexually transmitted infection (STI) prevalence among men who have sex with men (MSM) in Mumbai, India. Methods Eight hundred thirty-one MSM attending voluntary counseling and testing (VCT) services at the Humsafar Trust, answered a behavioral questionnaire and consented for Venereal Disease Research Laboratory and HIV testing from January 2003 through December 2004. Multivariate logistic regression was performed for sociodemographics, sexual risk behavior, and STIs with HIV result as an outcome. Results HIV prevalence among MSM was 12.5%. MSM who were illiterate [adjusted odds ratio (AOR) 2.28; 95% confidence interval (CI): 1.08 to 4.84], married (AOR 2.70; 95% CI: 1,56 to 4.76), preferred male partners (AOR 4.68; 95% CI: 1.90 to 11.51), had partners of both genders (AOR 2.73; 95% CI: 1.03 to 7.23), presented with an STI (AOR 3.31; 95% CI: 1.96 to 5.61); or presented with a reactive venereal disease research laboratory test (AOR 4.92; 95% CI: 2.55 to 9.53) at their VCT visit were more likely to be HIV infected. Conclusions MSM accessing VCT services in Mumbai have a high risk of STI and HIV acquisition. Culturally appropriate interventions that focus on sexual risk behavior and promote condom use among MSM, particularly the bridge population of bisexual men, are needed to slow the urban Indian AIDS epidemic. PMID:19934765

An estimate of the magnitude and trend of HIV/AIDS epidemic using data from the routine VCT services as an alternative data source to ANC sentinel surveillance in Addis Ababa, Ethiopia.

PubMed

Getachew, Yehenew; Gotu, Butte; Enquselassie, Fikre

2010-10-01

Since early 1980s when AIDS was first recognized, there has been uncertainty about the future trend and the ultimate dimensions of the pandemic. This uncertainty persists because of difficulties in measuring HIV incidence and prevalence with a substantial degree of precision in a given population. One of the many factors for the lack of precision is the problem of obtaining representative data sources that can be extrapolated to the general population. National and regional HIV estimates for Ethiopia are derived from ANC based HIV surveillance data. Alternative data sources have not been exhaustively explored as potential tools to monitor the trend of HIV/ AIDS epidemic in the country. To estimate the magnitude and trend of HIV/AIDS epidemic using data from the routine VCT services as an alternative data source to ANC sentinel surveillance data. The study used secondary data sources from all government, private and NGO VCT centers, of the period of 2003-2005 in Addis Ababa. For the purpose of making comparative analysis of the VCT based estimations and projections, records of all five sentinel sites in Addis Ababa for the period 1983-2003 were reviewed. Both ANC and VCT data sources showed similar and regular trends from the beginning of the HIV epidemic till the year 1995 where the ANC showed a relatively higher prevalence rates than VCT data, with a maximum difference in HIV prevalence of 1.06% in 1993. However, a higher HIV prevalence was noted for the VCT than the ANC data source for the period of 1996-2002, with a maximum difference of 1.4% in 1998, the year when both the ANC and VCT modeled HIV prevalence reached the highest peak in Addis Ababa. On the contrary, the ANC based prevalence was higher than the VCT data for the period 2004-2010, with a maximum difference of 2.2%. This study suggests that VCT based HIV prevalence data closely approximates the ANC based data. Therefore VCT data source can be valuable to complement the ANC data in monitoring the HIV epidemic and trend.

Implementing bathhouse-based voluntary counselling and testing has no adverse effect on bathhouse patronage among men who have sex with men.

PubMed

Huebner, D M; Binson, D; Pollack, L M; Woods, W J

2012-03-01

Implementing HIV voluntary counselling and testing (VCT) in bathhouses is a proven public health strategy for reaching high-risk men who have sex with men (MSM) and efficiently identifying new HIV cases. However, some bathhouse managers are concerned that VCT programmes could adversely affect business. This study examined whether offering VCT on the premises of a bathhouse changed patterns of patron visits. A collaborating bathhouse provided electronic anonymized patron data from their entire population of attendees. VCT was offered on premises with varying frequencies over the course of three years. Club entrances and exits were modelled as a function of intensity of VCT programming. Club entrances did not differ as a function of how many days per week testing was being offered in a given month. Additionally, club entrances did not decrease, nor did club exits increase, during specific half-hour time periods when testing was offered. Implementing bathhouse-based VCT did not have any demonstrable impact on patronage. Public health officials can leverage these results to help alleviate club managers' concerns about patron reactions to providing testing on site, and to support expanding sexual health programmes for MSM in these venues.

Knowledge, attitude and practice towards voluntary counseling and testing among university students in North West Ethiopia: a cross sectional study.

PubMed

Addis, Zelalem; Yalew, Aregawi; Shiferaw, Yitayal; Alemu, Abebe; Birhan, Wubet; Mathewose, Biniam; Tachebele, Belayenesh

2013-08-02

Voluntary counseling and testing (VCT) is one among different approaches which have been implemented as an attempt to slow the spread of HIV infection and minimize its impact at the individual, family and society level. VCT is perceived to be an effective strategy in risk reduction among sexually active young people like tertiary level students. Ethiopia as a country with high burden of HIV started responding to the epidemic by preparing and updating guidelines on VCT. The objective of this study was to assess the level of knowledge, attitude and practice of Voluntary Counseling and Testing (VCT) for HIV among university students in North West Ethiopia. A cross sectional study was conducted from February to May 2010 using a stratified sampling method to enroll students from different faculties into the study. A total of 330 university students filled in a self-administered questionnaire with response rate of 97.3%. Main outcome measures included level of knowledge, attitude and practice of VCT for HIV. A chi-square test was used to determine an association between a number of independent factors and dependant variables. About 66.1% of the study participants were males with a mean age of 20 years. Majority (75.6%) of the respondents were Orthodox with 63% reported living in urban areas before joining the university. From the study participants 86.3% were knowledgeable on VCT, 73.3% had positive attitude towards VCT for HIV and 61.8% had had VCT for HIV in the past. Previous residence before joining the university, level of education, sex and religion were among the sociodemographic variables that showed statistically significant association with the one or more of the outcome variables. Fear of positive results, stigma and discrimination following the positive results were reported as main barriers for VCT uptake. The findings reveal important barriers for VCT uptake and suggest strategies to reduce stigma and discrimination.

Knowledge, attitude and practice towards voluntary counseling and testing among university students in North West Ethiopia: a cross sectional study

PubMed Central

2013-01-01

Background Voluntary counseling and testing (VCT) is one among different approaches which have been implemented as an attempt to slow the spread of HIV infection and minimize its impact at the individual, family and society level. VCT is perceived to be an effective strategy in risk reduction among sexually active young people like tertiary level students. Ethiopia as a country with high burden of HIV started responding to the epidemic by preparing and updating guidelines on VCT. The objective of this study was to assess the level of knowledge, attitude and practice of Voluntary Counseling and Testing (VCT) for HIV among university students in North West Ethiopia. Methods A cross sectional study was conducted from February to May 2010 using a stratified sampling method to enroll students from different faculties into the study. A total of 330 university students filled in a self-administered questionnaire with response rate of 97.3%. Main outcome measures included level of knowledge, attitude and practice of VCT for HIV. A chi-square test was used to determine an association between a number of independent factors and dependant variables. Result About 66.1% of the study participants were males with a mean age of 20 years. Majority (75.6%) of the respondents were Orthodox with 63% reported living in urban areas before joining the university. From the study participants 86.3% were knowledgeable on VCT, 73.3% had positive attitude towards VCT for HIV and 61.8% had had VCT for HIV in the past. Previous residence before joining the university, level of education, sex and religion were among the sociodemographic variables that showed statistically significant association with the one or more of the outcome variables. Fear of positive results, stigma and discrimination following the positive results were reported as main barriers for VCT uptake. Conclusion The findings reveal important barriers for VCT uptake and suggest strategies to reduce stigma and discrimination. PMID:23914738

Voluntary counselling and testing for HIV in a Zambian mining community: serial interviews with people testing negative.

PubMed

Sikasote, Janet; Grant, Liz; Chinn, David J; Macwang'i, Mubiana; Murray, Scott A

2011-08-01

To understand the influence of voluntary counselling and testing (VCT) and an HIV-negative result on subsequent sexual behaviour; and to identify the specific felt needs of those testing negative. Serial interviews, 6 months apart, with people who had tested negative, and three one-off focus group discussions with counsellors. Interviews were transcribed verbatim and analysed thematically. Paired transcripts were analysed longitudinally. Purposively sampled from first attenders for VCT who had tested negative. Four health-facility affiliated VCT centres in two mining towns in the Copperbelt Province of Zambia. Participants in the 42 initial and 31 follow-up interviews understood VCT as 'testing for HIV'. Most participants reported having adopted safer sexual behaviour months before attending VCT. They had already recognised personal susceptibility to HIV infection and reported engaging both emotionally and cognitively with the issues of testing. Ultimately attendance at testing was to know their status in order to regain control of their lives. Unmet post-test support needs were common and included additional information, supportive networks, life-skills training and access to recreational activities. In this population who tested HIV negative the majority said they had made life changes months before attending VCT. Counselling served to consolidate pre-test decisions about risk behaviour. Those testing HIV negative are underserved compared with those testing positive. We recommend that counselling for HIV should be de-linked from testing to encourage earlier attendance for counselling and that clients testing negative should receive more post-test support to help them remain HIV negative.

Regional patterns and correlates of HIV voluntary counselling and testing among youths in Nigeria.

PubMed

Nwachukwu, Chukwuemeka E; Odimegwu, Clifford

2011-06-01

Prevalence of Voluntary Counselling and Testing (VCT) for HIV among young people in Nigeria is low with implications on the epidemic control. Using the 2003 Nigerian National Demographic and Health Survey, we examined the regional prevalence, pattern and correlates of VCT for HIV among youths aged 15 to 24 in Nigeria. Analysis was based on 3573 (out of 11,050) observations using logistic regression model to estimate the effects of identified predictors of volunteering for HIV testing. Results show that national prevalence of VCT is low (2.6%) with regional variations. Generally, the critical factors associated with VCT uptake are age, sex, education, wealth index and risk perception with North (sex, education, religion, occupation and risk perception) and South (age and education) variance. It is recommended that Nigerian HIV programmers should introduce evidence based youth programmes to increase the uptake of VCT with differing approaches across the regions.

Factors determining acceptance of voluntary HIV counseling and testing among pregnant women attending antenatal clinic at army hospitals in Addis Ababa.

PubMed

Worku, Getachew; Enquselassie, Fikre

2007-01-01

Mother-to-child transmission (MTCT) is by far the largest spurce of HIV infection in children below the age of 15 years. For many years little was known about preventing transmission of HIV infection from mother to child. Recently however, many interventions are available to reduce mother to child transmission, such as anti retroviral drug and avoidance of breastfeeding. For women to take advantage of measures to reduce transmission, they need to know their HIV status. The objective of the study was to identify factors determining acceptance of voluntary HIV testing among pregnant women at army hospitals in Addis Ababa. A case control study was conducted in 88 acceptors and 176 non-acceptors of VCT using structured pre tested questionnaire from December 2004 to January 2005, at army hospitals in Addis Ababa. Among socio-demographic factors the odds of VCT acceptance was higher among better educated, married, with higher income women and among women whose husbands live at the same house. Women who had better knowledge of VCT and MTCT and women with frequent ANC visit had significantly higher VCT acceptance than their counterparts. Adjusted for socio-demographic and some reproductive characteristics VCT acceptance was significantly associated with knowledge about MTCT (OR = 7.34, 95% CI = 3.44, 15.67), previous VCT experience (OR = 2.51, 95% CI = 1.03, 6.17) and husbands residence (at the same house) (OR= 4.97, 95% CI = 2.15, 11.46). Education of the mother, knowledge of MTCT and VCT and partner participation were important factors of VCT acceptance. The study gives useful information to health care providers to introduce measures that could improve the utilization of antenatal HIV testing.

HIV service delivery models towards 'Zero AIDS-related Deaths': a collaborative case study of 6 Asia and Pacific countries.

PubMed

Fujita, Masami; Poudel, Krishna C; Green, Kimberly; Wi, Teodora; Abeyewickreme, Iyanthi; Ghidinelli, Massimo; Kato, Masaya; Vun, Mean Chhi; Sopheap, Seng; San, Khin Ohnmar; Bollen, Phavady; Rai, Krishna Kumar; Dahal, Atul; Bhandari, Durga; Boas, Peniel; Yaipupu, Jessica; Sirinirund, Petchsri; Saonuam, Pairoj; Duong, Bui Duc; Nhan, Do Thi; Thu, Nguyen Thi Minh; Jimba, Masamine

2015-04-24

In the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance monitoring for maximizing HIV case detection and retention. Each country formed a review team that provided published and unpublished information from the national HIV program. Four types of continuum were examined: (i) service linkages between key population outreach and HIV diagnosis (vertical-community continuum); (ii) chronic care provision across HIV diagnosis and treatment (chronological continuum); (iii) linkages between HIV and other health services (horizontal continuum); and (iv) comprehensive care sites coordinating care provision (hub and heart of continuum). Regarding the vertical-community continuum, all districts had voluntary counselling and testing (VCT) in all countries except for Myanmar and Vietnam. In these two countries, limited VCT availability was a constraint for referring key populations reached. All countries monitored HIV testing coverage among key populations. Concerning the chronological continuum, the proportion of districts/townships having antiretroviral treatment (ART) was less than 70% except in Thailand, posing a barrier for accessing pre-ART/ART care. Mechanisms for providing chronic care and monitoring retention were less developed for VCT/pre-ART process compared to ART process in all countries. On the horizontal continuum, the availability of HIV testing for tuberculosis patients and pregnant women was limited and there were sub-optimal linkages between tuberculosis, antenatal care and HIV services except for Cambodia and Thailand. These two countries indicated higher HIV testing coverage than other countries. Regarding hub and heart of continuum, all countries had comprehensive care sites with different degrees of community involvement. The analytical framework was useful to identify similarities and considerable variations in service availability and linking approaches across the countries. The study findings would help each country critically adapt and adopt global recommendations on HIV service decentralization, linkages and integration. Especially, the findings would inform cross-fertilization among the countries and national HIV program reviews to determine county-specific measures for maximizing HIV case detection and retention.

Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study

PubMed Central

Merghati-Khoei, Effat

2018-01-01

Objectives In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. Methods A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. Results We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. Conclusions Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS. PMID:29631351

Implications for HIV testing policy derived from combining data on voluntary confidential testing with viral sequences and serological analyses.

PubMed

Brown, A E; Murphy, G; Rinck, G; Clewley, J P; Hill, C; Parry, J V; Johnson, A M; Pillay, D; Gill, O N

2009-02-01

Laboratory, clinical and sequence-based data were combined to assess the differential uptake of voluntary confidential HIV testing (VCT) according to risk and explore the occurrence of HIV transmission from individuals with recently acquired HIV infection, before the diagnostic opportunity. Between 1999 and 2002, nearly 30,000 anonymous tests for previously undiagnosed HIV infection were conducted among men who have sex with men (MSM) attending 15 sentinel sexually transmitted infection (STI) clinics in England, Wales and Northern Ireland. Using a serological testing algorithm, undiagnosed HIV-infected men were categorised into those with recent and non-recent infection. VCT uptake was compared between HIV-negative, recently HIV-infected and non-recently HIV-infected men. A phylogenetic analysis of HIV pol sequences from 127 recently HIV-infected MSM was conducted to identify instances in which transmission may have occurred before the diagnostic opportunity. HIV-negative MSM were more likely to receive VCT at clinic visits compared with undiagnosed HIV-infected MSM (56% (14,020/24,938) vs 31% (335/1072); p<0.001). Recently HIV-infected MSM were more likely to receive VCT compared with those with non-recent infections (42% (97/229) vs 28% (238/844); p<0.001). 22% (95/425) of undiagnosed HIV-infected MSM with STI received VCT. Phylogenetic analysis revealed at least seven transmissions may have been generated by recently HIV-infected MSM: a group that attended STI clinics soon after seroconversion. The integration of clinical, laboratory and sequence-based data reveals the need for specific targeting of the recently HIV exposed, and those with STI, for VCT. VCT promotion alone may be limited in its ability to prevent HIV transmission.

The forgotten half of the equation: randomized controlled trial of a male invitation to attend couple voluntary counselling and testing.

PubMed

Mohlala, Boshishi K F; Boily, Marie-Claude; Gregson, Simon

2011-07-31

Increased male participation in antenatal care and uptake of couple voluntary counselling and testing (VCT) for HIV could reduce horizontal and vertical HIV transmission in sub-Saharan Africa. Randomized controlled trial to compare pregnant women's acceptance of written invitations for VCT and pregnancy information sessions (PISs) - the control group - for their male sexual partners (MSPs) and uptake of VCT among these pregnancy partners in Khayelitsha, South Africa. All women in the study accepted the invitation letters and agreed to invite their pregnancy partners to attend for VCT or PIS as requested. Thirty-five percent (175 of 500) pregnant women given VCT invitations for their partners brought their MSPs for antenatal clinic visit compared with 26% (129 of 500) given PIS invitations [relative risk (RR) 1.36, 95% confidence interval (CI) 1.12-1.64, P = 0.002]. Thirty-two percent (161 of 500) MSPs in the VCT arm underwent HIV testing compared with 11% (57/500) in the PIS arm (RR 2.82, 95% CI 2.14-3.72, P < 0.001). The proportions of women and men reporting unprotected sex during the pregnancy were lower in the MSP VCT arm than in the MSP PIS arm - 25 versus 81% (RR 0.30, 95% CI 0.22-0.42, P < 0.001) and 26 versus 76% (RR 0.34, 95% CI 0.25-0.47, P < 0.001), respectively. No differences were seen in intimate partner violence. Providing pregnant women with a written invitation for their partners increased male participation in antenatal care and uptake of couple VCT in a township in Cape Town, South Africa where community sensitization was conducted and antiretroviral therapy was available.

Knowledge of HIV/AIDS and Attitude Toward Voluntary Counselling and Testing Among Antenatal Clinic Attendees at a Tertiary Care Hospital in India.

PubMed

Sagili, H; Kumar, S; Lakshminarayanan, S; Papa, D; Abi, C

2015-04-01

Maternal to child transmission (MTCT) is responsible for over 90 % of all childhood HIV infections. Lack of awareness regarding HIV and preventive practices against MTCT maybe one of the reasons behind high HIV transmission rates. In our study, we assessed the knowledge of HIV/AIDS in antenatal women, attending a tertiary care hospital in India as well as their attitude toward voluntary counseling and testing (VCT) for HIV. This was a cross-sectional descriptive study carried out from May-July 2012 using a pretested interview-based questionnaire given to 386 antenatal women after obtaining consent. Data were abstracted for knowledge of HIV, MTCT, and attitude toward VCT. Results were expressed as percentages using SPSS v.16 software. Amongst the respondents, 92.5 % had heard of HIV and in 41 % of them, the source of information was through mass media. 81 % were aware of sexual intercourse as a mode of transmission of HIV while 55 % knew that sharing sharp objects and infected blood products can spread HIV. 37.6 % of respondents were aware of MTCT and 44 % heard of antiretroviral therapy as a method of prevention of MTCT. While 68 % were willing to get tested for HIV, 18.9 % knew about the steps involved and 44 % knew where to get VCT. There exists a lack of adequate knowledge regarding HIV and preventive practices against MTCT. Health education and awareness campaigns on MTCT prevention and VCT promotion should target women in their antenatal period in order to increase acceptability and accessibility of these services.

Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries.

PubMed

Fonner, Virginia A; Denison, Julie; Kennedy, Caitlin E; O'Reilly, Kevin; Sweat, Michael

2012-09-12

Voluntary counseling and testing (VCT) continues to play a critical role in HIV prevention, care and treatment. In recent years, different modalities of VCT have been implemented, including clinic-, mobile- and home-based testing and counseling. This review assesses the effects of all VCT types on HIV-related risk behaviors in low- and middle-income countries. The primary objective of this review is to systematically review the literature examining the efficacy of VCT in changing HIV-related risk behaviors in developing countries across various populations. Five electronic databases - PubMed, Excerpta Medica Database (EMBASE), PsycINFO, Sociological Abstracts, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) - were searched using predetermined key words and phrases. Hand-searching was conducted in four key journals including AIDS, AIDS and Behavior, AIDS Education and Prevention, and AIDS Care; the tables of contents of these four journals during the included time period were individually screened for relevant articles. The reference lists of all articles included in the review were screened to identify any additional studies; this process was iterated until no additional articles were found. To be included in the review, eligible studies had to meet the following inclusion criteria: 1) Take place in a low- or middle-income country as defined by the World Bank, 2) Published in a peer-reviewed journal between January 1, 1990 and July 6, 2010, 3) Involve client-initiated VCT, including pre-test counseling, HIV-testing, and post-test counseling, and 4) Use a pre/post or multi-arm design that compares individuals before and after receiving VCT or individuals who received VCT to those who did not, and 5) Report results pertaining to behavioral, psychological, biological, or social HIV-related outcomes. All citations were initially screened and all relevant citations were independently screened by two reviewers to assess eligibility. For all included studies data were extracted by two team members working independently using a standardized form.  Differences were resolved through consensus or discussion with the study coordinator when necessary. Study rigor was assessed using an eight point quality score and through the Cochrane Collaboration's Risk of Bias Assessment Tool. Outcomes comparable across studies, including condom use and number of sex partners, were meta-analyzed using random effects models. With respect to both meta-analyses, data were included from multi-arm studies and from pre/post studies if adequate data were provided. Other outcomes, including HIV-incidence, STI incidence/prevalence, and positive and negative life events were synthesized qualitatively. For meta-analysis, all outcomes were converted to the standard metric of the odds ratio. If an outcome could not be converted to an odds ratio, the study was excluded from analysis.  An initial search yielded 2808 citations. After excluding studies failing to meet the inclusion criteria, 19 were deemed eligible for inclusion. Of these studies, two presented duplicate data and were removed. The remaining 17 studies were included in the qualitative synthesis and 8 studies were meta-analyzed.  Twelve studies offered  clinic-based VCT, 3 were employment-based, 1 involved mobile VCT, and 1 provided home-based VCT.  In meta-analysis, the odds of reporting increased number of sexual partners were reduced when comparing participants who received VCT to those who did not, unadjusted random effects pooled OR= 0.69 (95% CI: 0.53-0.90, p=0.007). When stratified by serostatus, these results only remained significant for those who tested HIV-positive. There was an insignificant increase in the odds of condom use/protected sex among participants who received VCT compared to those who did not, unadjusted random effects pooled OR=1.39 (95% CI: 0.97-1.99, p=0.076). When stratified by HIV status, this effect became significant among HIV-positive participants, random effects pooled OR= 3.24 (95% CI: 2.29-4.58, p<0.001). These findings add to growing evidence that VCT can change HIV-related sexual risk behaviors thereby reducing HIV-related risk, and confirming its importance as an HIV prevention strategy. To maximize the effectiveness of VCT, more studies should be conducted to understand which modalities and counseling strategies produce significant reductions in risky behaviors and lead to the greatest uptake of VCT.

Building Stakeholder Partnerships for an On-Site HIV Testing Programme

PubMed Central

Woods, William J.; Erwin, Kathleen; Lazarus, Margery; Serice, Heather; Grinstead, Olga; Binson, Diane

2009-01-01

Because of the large number of individuals at risk for HIV infection who visit gay saunas and sex clubs, these venues are useful settings in which to offer HIV outreach programmes for voluntary counselling and testing (VCT). Nevertheless, establishing a successful VCT programme in such a setting can be a daunting challenge, in large part because there are many barriers to managing the various components likely to be involved. Using qualitative data from a process evaluation of a new VCT programme at a gay sauna in California, USA, we describe how the various stakeholders overcame barriers of disparate interests and responsibilities to work together to successfully facilitate a regular and frequent on-site VCT programme that was fully utilized by patrons. PMID:18432424

Awareness and attitudes toward voluntary counseling and testing for HIV/AIDS among law undergraduates in tertiary institutions in southeast Nigeria.

PubMed

Mbamara, Sunday Uche; Obiechina, Nworah J

2013-01-01

To determine the knowledge of and attitudes toward voluntary counseling and testing (VCT) for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among undergraduates of a law faculty in tertiary institutions in Anambra State in southeast Nigeria. This was a cross-sectional, questionnaire-based survey conducted among law undergraduates in Anambra State using a multistage, random sampling method. The respondents were all full-time law students and were aged from 15-42 years with a mean of 21.06 +/- 3.0 years and a modal age of 20-24 years. In all, 210 (71.4%) of the students were aware of VCT for HIV/AIDS, while 84 (28.6%) of the respondents had no knowledge of it. The most common sources of information about VCT for HIV/AIDS were electronic media (114 [38.8%]) followed by churches (67 [22.8%]) and print media (44 [15.0%1). Although a majority of respondents had a positive attitude toward VCT for HIV/AIDS, 20% of them disapproved of VCT, and this is quite high considering their educational status. Public health education, awareness programs and VCT centers dedicated to young people should be established.

Awareness and attitude of antenatal clients towards HIV voluntary counselling and testing in Aminu Kano Teaching Hospital, Kano, Nigeria.

PubMed

Iliyasu, Z; Kabir, M; Galadanci, H S; Abubakar, I S; Aliyu, M H

2005-01-01

Mother to child transmission accounts for the majority of HIV infections in children in the developing countries. This study assessed pregnant women's knowledge of HIV/AIDS, awareness and attitudes towards Voluntary Counselling and Testing (VCT) in a teaching hospital in northern Nigeria. A pre-tested structured interview questionnaire was administered on a cross-section of 210 antenatal clients in Aminu Kano Teaching Hospital, Nigeria. All respondents were aware of HIV/AIDS. Fifty seven percent had good knowledge, 32% had fair knowledge and the remaining 11% had poor knowledge of the infection. Most respondents were aware of VCT through health workers, mass media and friends. Similarly, most respondents (81.0%) approved of VCT, 13.0% disapproved of it and the remaining (6%) was undecided. The main reasons for disapproval were; fear of stigmatisation, isolation and effect on marriage security. Those that had tertiary level of education were three times more likely to accept VCT compared to those with lower levels of education (O.R=3.2, 95% confidence interval =1.3-8.0). Although the awareness of VCT for HIV was quite high with most antenatal clients harbouring positive attitudes towards it, there is a need to intensify health education to convince the remaining minority who are still sceptical or ignorant of the benefits of VCT.

Incidence of recent HCV infection among persons seeking voluntary counselling and testing for HIV and sexually transmitted infections in Taiwan.

PubMed

Su, Yi-Ching; Liu, Wen-Chun; Chang, Lan-Hsin; Wu, Pei-Ying; Luo, Yu-Zhen; Wu, Cheng-Hsin; Sun, Hsin-Yun; Chang, Sui-Yuan; Hung, Chien-Ching

2014-01-01

The incidence of recent hepatitis C virus infection (HCV) infection has been noted to be increasing among men who have sex with men (MSM), especially those with HIV infection, in several resource-rich settings. In Taiwan, the incidence of recent HCV infection increased from 0 in 1994-2000, 2.29 in 2001-2005 to 10.13 per 1000 person-years of follow-up (PYFU) in 2006-2010. In this study, we aimed to estimate the incidence rate of recent HCV infection among those individuals who sought voluntary counselling and testing (VCT) service at a University Hospital. Between May 2006 and December 2013, 18,246 tests for HIV antibody were performed among 12,143 individuals at the VCT services. A total of 2157 clients without HIV or HCV infection at baseline were included for estimation of incidence rate of recent HCV infection. Antibodies to HCV were determined with a third-generation enzyme immunoassay. A nested case-control study with four matched controls without HCV seroconversion for one HCV seroconverter was conducted to investigate the factors associated with recent HCV infection. Phylogenetic analysis was performed among the HCV strains obtained from VCT clients and patients coinfected with HIV and HCV between 2006 and 2013. During the study period, 2157 clients received a total of 8260 tests. The HCV seroprevalence at baseline was 0.3%. Of the 2150 HCV-negative clients who contributed 5074.99 PYFU, 17 developed HCV seroconversion (incidence rate, 3.35 per 1000 PYFU; 95% CI, 1.76-4.94); the rate increased from 2.28 per 1000 PYFU (95% CI, 0.05-4.51) in 2006-2009, to 3.33 per 1000 PYFU (95% CI, 0.86-5.80) in 2010-2011, to 4.94 per 1000 PYFU (95% CI, 0.99-8.99) in 2012-2013. In case-control study, HCV seroconverters were more likely to have HIV-infected partners, recent syphilis and a Rapid Plasma Reagin (RPR) titre of 4 or greater. In multivariate analysis, having HIV-infected partners remained as the only independent associated factors with HCV seroconversion (AOR, 6.931; 95% CI, 1.064-45.163). Phylogenetic analysis revealed transmission pairs and clusters, with most clustered sequences derived from MSM. Similar to the observation among HIV-infected patients who are not IDUs, increasing trends of recent HCV infection also occur among the individuals who sought VCT services in Taiwan. Having HIV-infected partners is independently associated with recent HCV seroconversion.

Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India.

PubMed

Chandrasekaran, Varalakshmi; Krupp, Karl; George, Ruja; Madhivanan, Purnima

2007-05-01

Violence against women is a global phenomenon that cuts across all social and economic classes. This study was designed to measure the prevalence and correlates of domestic violence (DV) among women seeking services at a voluntary counseling and testing (VCT) center in Bangalore, India. A cross-sectional survey was conducted among women visiting an human immunodeficiency virus (HIV) VCT center in Bangalore, between September and November 2005. An interviewer-administered questionnaire was used to collect information about violence and other variables. Univariable associations with DV were made using Pearson Chi-squared test for categorical variables and Student t-test or the Mann-Whitney test for continuous variables. Forty-two percent of respondents reported DV, including physical abuse (29%), psychological abuse (69%) and sexual abuse (1%). Among the women who reported violence of any kind, 67% also reported that they were HIV seropositive. The most common reasons reported for DV included financial problems (38%), husband's alcohol use (29%) and woman's HIV status (18%). Older women (P < 0.001) and those with low income levels were the most likely to have experienced DV (P = 0.02). Other factors included husband's education, HIV seropositivity and alcohol or tobacco use (P < 0.001). This study found DV levels comparable to other studies from around the world. The findings highlight the need for additional training among health care providers in VCT centers in screening for DV, detection of signs of physical abuse and provisions and referrals for women suffering from domestic partner violence.

Cost-effectiveness of scaling up voluntary counselling and testing in West-Java, Indonesia.

PubMed

Tromp, Noor; Siregar, Adiatma; Leuwol, Barnabas; Komarudin, Dindin; van der Ven, Andre; van Crevel, Reinout; Baltussen, Rob

2013-01-01

to evaluate the costs-effectiveness of scaling up community-based VCT in West-Java. the Asian epidemic model (AEM) and resource needs model (RNM) were used to calculate incremental costs per HIV infection averted and per disability-adjusted life years saved (DALYs). Locally monitored demographic, epidemiological behavior and cost data were used as model input. scaling up community-based VCT in West-Java will reduce the overall population prevalence by 36% in 2030 and costs US$248 per HIV infection averted and US$9.17 per DALY saved. Cost-effectiveness estimation were most sensitive to the impact of VCT on condom use and to the population size of clients of female sex workers (FSWs), but were overall robust. The total costs for scaling up community-based VCT range between US$1.3 and 3.8 million per year and require the number of VCT integrated clinics at public community health centers to increase from 73 in 2010 to 594 in 2030. scaling up community-based VCT seems both an effective and cost-effective intervention. However, in order to prioritize VCT in HIV/AIDS control in West-Java, issues of budget availability and organizational capacity should be addressed.

A decade of an HIV workplace programme in armed conflict zones; a social responsibility response of the International Committee of the Red Cross.

PubMed

Du Mortier, Stéphane; Mukangu, Silas; Sagna, Charles; Nyffenegger, Laurent; Aebischer Perone, Sigiriya

2016-01-01

The International Committee of the Red Cross (ICRC) works in fragile States and in armed conflict zones. Some of them are affected by the HIV pandemic. Within the framework of its social responsibility programme concerning HIV affecting its staff members, the organization has implemented an HIV workplace programme since 2004. We carried out a retrospective analysis over 10 years. Data collected were initially essentially qualitative and process-oriented, but were complemented over the years by data on annual voluntary counselling and testing (VCT) uptake and on direct annual costs covering awareness, testing and antiretroviral therapy. The number of people covered by the programme grew from none in 2003 to 4,438 in 2015, with an increase in annual VCT uptake over the years increasing from 376 persons (14 %) in 2007 to 2,663 in 2015 (60 %). Over the years, the services were expanded from awareness raising to bringing VCT to the workplace, as well as offering testing and health coverage of other conditions and innovative approaches to facing challenges linked to situations of violence. Within its social responsibility framework, the ICRC has shown the importance and feasibility of a workplace HIV programme in conflict zones. A sustainable workplace programme in these conflict settings requires constant adaptation, with regular follow-up given the relatively high turnover of staff, and ensuring sustainable stocks of condoms and antiretroviral drugs.

The role of HIV testing, counselling, and treatment in coping with HIV/AIDS in Uganda: a qualitative analysis.

PubMed

Nyanzi-Wakholi, Barbara; Lara, Antonieta Medina; Watera, Christine; Munderi, Paula; Gilks, Charles; Grosskurth, Heiner

2009-07-01

HIV/AIDS has had a devastating impact at individual, household and community levels. This qualitative research investigates the role of HIV voluntary counselling and testing (VCT) and treatment in enabling HIV-positive Ugandans to cope with this disease. Twelve predetermined focus group discussions (FGDs) were conducted; six with men and six with women. Half of the men and women's groups were receiving antiretroviral therapy (ART) and half were not. An FGD was held with the health care providers administering ART. Testing for HIV was perceived as soliciting a death warrant. Participants affirmed that the incentive for testing was the possibility of accessing free ART. They described experiencing gender-variant stigma and depression on confirming their HIV status and commended the role of counselling in supporting them to adopt positive living. For those receiving ART, counselling reinforced treatment adherence. The findings also revealed gender differences in treatment adherence strategies. ART was described to reduce disease symptoms and restore physical health allowing them to resume their daily activities. Additionally, ART was preferred over traditional herbal treatment because it had clear dosages, expiry dates and was scientifically manufactured. Those that were not receiving ART bore myths and misconceptions about the effectiveness and side effects of ART, delaying the decision to seek treatment. Stigma and the attached concern of HIV/AIDS-related swift death, is a major barrier for VCT. Based on this study's findings, ensuring the provision of quality assured and gender conscious VCT and ART delivery services will enhance positive living and enforce compliance to ART programmes.

[Seroprevalence and factors associated with Voluntary Counselling and Testing (VCT) for HIV among children in Lubumbashi, Democratic Republic of the Congo].

PubMed

Ngwej, Dieudonné Tshikwej; Mukuku, Olivier; Malonga, Françoise Kaj; Luboya, Oscar Numbi; Kakoma, Jean-Baptiste Sakatolo; Wembonyama, Stanis Okitotsho

2017-01-01

Despite proposals for screening infants or preschool children for HIV infection, the proportion of children who grow or die with unknown HIV status is high in the Democratic Republic of the Congo (DRC). This study aimed to determine the seroprevalence during a voluntary screening and to identify factors associated with Voluntary Counselling and Testing (VCT) for HIV in the paediatric population of non-HIV infected or non-HIV exposed infants and children in Lubumbashi, DRC. We conducted a cross-sectional prospective analytical study in 4 community VCT centers divided into 4 health zones in the city of Lubumbashi, DRC (Lubumbashi, Ruashi, Kampemba and Kenya) over the period 1 August 2006 - 31 September 2007. The study aimed to evaluate voluntary testing for HIV among children less than 15 years. The sociodemographic characteristics and the parameters related to Voluntary Counselling and Testing (VCT) for HIV were analyzed. Usual descriptive statistical analyses and logistic regression were perfomed. Out of 463 children screened for HIV, 41 (8.9%; 95% CI: 6.5%-11.9%) were HIV positive. Voluntary Counselling and Testing (VCT) for HIV in the paediatric population of non-HIV infected or non-HIV exposed infants or children was significantly higher in children over 2 years of age (adjusted odds ratio (AOR)=3.6 [95% CI: 1,1-12,2]) when both of their parents had negative or uknown HIV status (AOR = 27.4 [95% CI: 9,4-80,0]), when either or both of their biological parents were alive (AOR = 24.9 [95% CI: 2,4-250,8]) and when screening programs were not only carried out by health professionals (AOR = 2.9 [95% CI: 1,0-7,9]). Our study shows a high HIV prevalence among children supporting the need for VCT highly accepted by parents and tutors in the city of Lubumbashi.

"It's Better Not to Know": Perceived Barriers to HIV Voluntary Counseling and Testing among Sub-Saharan African Migrants in Belgium

ERIC Educational Resources Information Center

Manirankunda, Lazare; Loos, Jasna; Alou, Therese Assebide; Colebunders, Robert; Nostlinger, Christiana

2009-01-01

This study explored perceptions, needs, and barriers of sub-Saharan African migrants in relation to HIV voluntary counseling and testing (VCT). Using an inductive qualitative methodological approach, data were obtained from focus group discussions. Results showed that participants were in principle in favor of VCT. However, they indicated that…

Increasing the acceptability of HIV counseling and testing with three C's: convenience, confidentiality and credibility.

PubMed

Angotti, Nicole; Bula, Agatha; Gaydosh, Lauren; Kimchi, Eitan Zeev; Thornton, Rebecca L; Yeatman, Sara E

2009-06-01

Agencies engaged in humanitarian efforts to prevent the further spread of HIV have emphasized the importance of voluntary counseling and testing (VCT), and most high-prevalence countries now have facilities that offer testing free of charge. The utilization of these services is disappointingly low, however, despite high numbers reporting that they would like to be tested. Explanations of this discrepancy typically rely on responses to hypothetical questions posed in terms of psychological or social barriers; often, the explanation is that people fear learning that they are infected with a disease that they understand to be fatal and stigmatizing. Yet when we offered door-to-door rapid blood testing for HIV as part of a longitudinal study in rural Malawi, the overwhelming majority agreed to be tested and to receive their results immediately. Thus, in this paper, we ask: why are more people not getting tested? Using an explanatory research design, we find that rural Malawians are responsive to door-to-door HIV testing for the following reasons: it is convenient, confidential, and the rapid blood test is credible. Our study suggests that attention to these factors in VCT strategies may mitigate the fear of HIV testing, and ultimately increase uptake in rural African settings.

Risky HIV sexual behavior and utilization of voluntary counseling and HIV testing and associated factors among undergraduate students in Addis Ababa, Ethiopia.

PubMed

Woldeyohannes, Desalegn; Asmamaw, Yehenew; Sisay, Solomon; Hailesselassie, Werissaw; Birmeta, Kidist; Tekeste, Zinaye

2017-01-25

HIV/AIDS is a major public health problem in Ethiopia. University students are often a young and sexually active group that is at risk of acquiring and transmitting HIV. We assessed risky HIV sexual behaviors and utilization of voluntary counseling and testing services among undergraduate students at Addis Ababa Science and Technology University, Ethiopia. A cross-sectional study was conducted between May and June, 2013. Standardized semi-structured self-administered questionnaire was used to collect data. Simple random sampling technique was use to select departments from each school. All students in the selected departments were the study participants. Data were entered into EPI-Info and analyzed using SPPS statistical packages. P-value < 0.05 was considered as statistically significant. Of the total 602 students selected, an overall response rate of 557 (92.6%) were registered. Among the participants 361 (60%) were males. The student ages' were ranged from 17 up to 25 years with mean age of 20.3 ± 1.6. Around 385 (64%) of them were in the age group of 17 up to 20 years. Among the study participants, 161 (26.8%) had sexual contact and the mean age of first sexual encounter was 17.4 (SD =2.3) years. About 443 (76%) of students knew that condoms can prevent Sexually Transmitted Infections (STIs). Among sexually active students, 74 (46%) had not used condom during first time sex. Among those responded, 488 (83.4%) had heard information about VCT; however, 52% had not ever used VCT service. The overall mean score of knowledge and attitude of students towards risk perception on HIV was around 66% and 57%, respectively. Students who enrolled in health science departments had almost three time more knowledge [AOR(95%CI) = 2.83 (1.67, 4.80)] and two and half times more favorable [AOR (95% CI) = 2.55 (1.60, 4.06)] attitudes towards HIV risk reduction strategies than students in non-health related departments. Some students were engaged in risky sexual behaviour even though they had heard about HIV/AIDS. The perception of risk for acquisition of HIV infection and utilization of VCT were low. HIV prevention and control strategies including education in the areas of HIV/AIDS as part of university programs curriculum, specially non-health students, and strengthening health institutions to provide youth-friendly VCT services for HIV with "know your HIV status" campaigns are strongly recommended.

Feasibility and Preliminary Efficacy of Visual Cue Training to Improve Adaptability of Walking after Stroke: Multi-Centre, Single-Blind Randomised Control Pilot Trial.

PubMed

Hollands, Kristen L; Pelton, Trudy A; Wimperis, Andrew; Whitham, Diane; Tan, Wei; Jowett, Sue; Sackley, Catherine M; Wing, Alan M; Tyson, Sarah F; Mathias, Jonathan; Hensman, Marianne; van Vliet, Paulette M

2015-01-01

Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation of walking following stroke. This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services. Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and no severe visual impairments. Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks. Participants were randomised using computer generated random permutated balanced blocks of randomly varying size. Recruitment, retention, adherence, adverse events and mobility and balance were measured before randomisation, post-intervention and at four weeks follow-up. Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment and follow-up assessments. Of the participants that completed, adherence was good with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and UC respectively. No adverse events were reported. Post-treatment improvements in walking speed, symmetry, balance and functional mobility were seen in all treatment arms. Outpatient based treadmill and over-ground walking adaptability practice using visual cues are feasible and may improve mobility and balance. Future studies should continue a carefully phased approach using identified methods to improve retention. Clinicaltrials.gov NCT01600391.

Socio-economic determinants of HIV testing and counselling: a comparative study in four African countries.

PubMed

Obermeyer, Carla Makhlouf; Neuman, Melissa; Hardon, Anita; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Cherutich, Peter; Namakhoma, Ireen

2013-09-01

Research indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested. Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses. Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested. Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent. © 2013 John Wiley & Sons Ltd.

Evaluation of rapid HIV test kits on whole blood and development of rapid testing algorithm for voluntary testing and counseling centers in Ethiopia.

PubMed

Tegbaru, Belete; Messele, Tsehaynesh; Wolday, Dawit; Meles, PhD Hailu; Tesema, Desalegn; Birhanu, Hiwot; Tesfaye, Girma; Bond, Kyle B; Martin, Robert; Rayfield, Mark A; Wuhib, Tadesse; Fekadu, Makonnen

2004-10-01

Five simple and rapid HIV antibody detection assays viz. Determine, Capillus, Oraquick, Unigold and Hemastrip were evaluated to examine their performance and to develop an alternative rapid test based testing algorithm for voluntary counseling and testing (VCT) in Ethiopia. All the kits were tested on whole blood, plasma and serum. The evaluation had three phases: Primary lab review, piloting at point of service and implementation. This report includes the results of the first two phases. A total of 2,693 specimens (both whole blood and plasma) were included in the evaluation. Results were compared to double Enzyme Linked Immuno-Sorbent Assay (ELISA) system. Discordant EIA results were resolved using Western Blot. The assays had very good sensitivities and specificities, 99-100%, at the two different phases of the evaluation. A 98-100% result agreement was obtained from those tested at VCT centers and National Referral Laboratory for AIDS (NRLA), in the quality control phase of the evaluation. A testing strategy yielding 100% [95% CI; 98.9-100.0] sensitivity was achieved by the sequential use of the three rapid test kits. Direct cost comparison showed serial testing algorithm reduces the cost of testing by over 30% compared to parallel testing in the current situation. Determine, Capillus/Oraquick (presence/absence of frefrigeration) and Unigold were recommended as screening, confirmation and tiebreaker tests, respectively.

Feasibility and Preliminary Efficacy of Visual Cue Training to Improve Adaptability of Walking after Stroke: Multi-Centre, Single-Blind Randomised Control Pilot Trial

PubMed Central

Hollands, Kristen L.; Pelton, Trudy A.; Wimperis, Andrew; Whitham, Diane; Tan, Wei; Jowett, Sue; Sackley, Catherine M.; Wing, Alan M.; Tyson, Sarah F.; Mathias, Jonathan; Hensman, Marianne; van Vliet, Paulette M.

2015-01-01

Objectives Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation of walking following stroke. Design This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services Participants Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and no severe visual impairments Intervention Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks. Main outcome measures: Participants were randomised using computer generated random permutated balanced blocks of randomly varying size. Recruitment, retention, adherence, adverse events and mobility and balance were measured before randomisation, post-intervention and at four weeks follow-up. Results Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment and follow-up assessments. Of the participants that completed, adherence was good with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and UC respectively. No adverse events were reported. Post-treatment improvements in walking speed, symmetry, balance and functional mobility were seen in all treatment arms. Conclusions Outpatient based treadmill and over-ground walking adaptability practice using visual cues are feasible and may improve mobility and balance. Future studies should continue a carefully phased approach using identified methods to improve retention. Trial Registration Clinicaltrials.gov NCT01600391 PMID:26445137

A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

PubMed Central

2011-01-01

Background Kenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle). Methods Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred. Results The scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach. Conclusion The introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors, the context and the process, is required to mitigate risks and maximise impact. PMID:22008721

Home-based HIV testing for men preferred over clinic-based testing by pregnant women and their male partners, a nested cross-sectional study.

PubMed

Osoti, Alfred Onyango; John-Stewart, Grace; Kiarie, James Njogu; Barbra, Richardson; Kinuthia, John; Krakowiak, Daisy; Farquhar, Carey

2015-07-30

Male partner HIV testing and counseling (HTC) is associated with enhanced uptake of prevention of mother-to-child HIV transmission (PMTCT), yet male HTC during pregnancy remains low. Identifying settings preferred by pregnant women and their male partners may improve male involvement in PMTCT. Participants in a randomized clinical trial (NCT01620073) to improve male partner HTC were interviewed to determine whether the preferred male partner HTC setting was the home, antenatal care (ANC) clinic or VCT center. In this nested cross sectional study, responses were evaluated at baseline and after 6 weeks. Differences between the two time points were compared using McNemar's test and correlates of preference were determined using logistic regression. Among 300 pregnant female participants, 54% preferred home over ANC clinic testing (34.0%) or VCT center (12.0%). Among 188 male partners, 68% preferred home-based HTC to antenatal clinic (19%) or VCT (13%). Men who desired more children and women who had less than secondary education or daily income < $2 USD were more likely to prefer home-based over other settings (p < 0.05 for all comparisons). At 6 weeks, the majority of male (81%) and female (65%) participants recommended home over alternative HTC venues. Adjusting for whether or not the partner was tested during follow-up did not significantly alter preferences. Pregnant women and their male partners preferred home-based compared to clinic or VCT-center based male partner HTC. Home-based HTC during pregnancy appears acceptable and may improve male testing and involvement in PMTCT.

Risk factors for HIV and STI diagnosis in a community-based HIV/STI testing and counselling site for men having sex with men (MSM) in a large German city in 2011-2012.

PubMed

Marcus, Ulrich; Ort, Jasmin; Grenz, Marc; Eckstein, Kai; Wirtz, Karin; Wille, Andreas

2015-01-13

In recent years community-based voluntary counselling and testing sites (CB-VCT) for men having sex with men (MSM) have been established in larger cities in Germany to offer more opportunities for HIV testing. Increasingly, CB-VCTs also offer testing for other bacterial sexually transmitted infections. In Hamburg, tests in CB-VCTs are offered free and anonymously. Data on demographics and sexual risk behaviours are collected with a paper questionnaire. Questionnaire data from the MSM CB-VCT in Hamburg were linked with serological test results for HIV and syphilis, and with rectal and pharyngeal swab results for gonorrhoea and chlamydia. MSM were defined as males reporting male sex partners. CB-VCT clients were characterized demographically, and associations between sexual behaviour variables and diagnosis of HIV and sexually transmitted infections (STI) were analysed by bivariate and multivariate logistic regression analysis. Among the male clients of the CB-VCT in 2011-2012 who were tested for HIV or any STI 1476 reported male sex partners. Unprotected anal intercourse (UAI) was reported as reason for testing by 61% of the clients. Forty-one of 1413 clients testing for HIV were tested positive (2.9%). Twenty-four of 1380 clients testing for syphilis required treatment (1.7%). Tests for simultaneous detection of N. gonorrhoea and Chlamydia trachomatis were conducted on 882 pharyngeal and 642 rectal swabs, revealing 58 (=6.6%) pharyngeal and 71 (=11.1%) rectal infections with one or both pathogens. In multivariate logistic regression analysis number of partners, UAI (OR=2.42) and relying on visual impression when selecting sex partners (OR = 2.92) were associated with increased risks for diagnosis of syphilis or a rectal STI. Syphilis or rectal STI diagnosis (OR=4.52) were associated with increased risk for HIV diagnosis. The MSM CB-VCT in Hamburg reaches clients at high risk for HIV and STIs. The diagnosis of syphilis or a rectal STI was associated with increased odds of testing positive for HIV. Due to the high prevalence of curable bacterial STI among clients and because syphilis and rectal bacterial STI may facilitate HIV transmission, MSM asking for HIV tests in CB-VCTs should also be offered tests for other bacterial STIs.

Healthcare Seeking Intention if Diagnosed with HIV Among Young MSM in Taiwan: A Theory-Based Comparison by Voluntary Counseling and Testing Experience.

PubMed

Li, Min-Jung; Huang, Jiun-Hau

2018-05-28

The number of HIV cases in Taiwan exceeded 30,000 in 2016. Per the UNAIDS 90-90-90 target, 81% of people living with HIV should receive medication. However, numerous previous studies focused on adherence rather than the initial healthcare seeking intention if diagnosed with HIV (HIV HSI). Based on the Theory of Planned Behavior (TPB), anonymous online survey data were collected from December 2016 through February 2017 from 2709 young MSM (YMSM) ages 15-39. Multivariate logistic regression found the significant factors and strengths of associations with HIV HSI varied by their HIV voluntary counseling and testing (VCT) experience. YMSM without VCT experience perceiving high support from salient others (AOR = 1.28) and high control under facilitating conditions (AOR = 2.73) had higher HIV HSI. YMSM with VCT experience perceiving high control under facilitating (AOR = 1.79) and constraining (AOR = 1.54) conditions had higher HIV HSI. Regardless of VCT experience, YMSM with positive attitudes toward positive healthcare seeking outcomes (AOR = 3.72-3.95) had highest HIV HSI, highlighting the importance of increasing positive outcome expectations in YMSM.

Association of sexual risk behaviour with previous HIV testing among voluntary HIV counselling and testing clients in Kigali, Rwanda.

PubMed

Stalter, Randy; Chen, Mario; Uwizeye, Glorieuse; Mutunge, Elise; Ahayo, Anita; Mugwaneza, Placidie; Shumbusho, Fabienne; Wesson, Jennifer

2016-12-01

With increased coverage of voluntary HIV counselling and testing (VCT) in Rwanda and a greater focus on repeat testing of key populations, it is important to understand whether the right clients are returning for repeat testing and if repeat testing is effective at reducing risk. We assessed the association between repeat testing and recent sexual risk behaviours among 1852 first time or repeat HIV testing clients in Kigali who had had sex, using data from a cross-sectional survey. Repeat testing was associated with being female, older and type of occupation. Multivariable analyses indicate that individuals who tested for HIV 1-2 times (aOR = 1.52, 95% CI: 1.08, 2.15) and 3+ times (aOR = 1.51, 95% CI: 1.06, 2.17) previously were more likely to report recent unprotected sex. Those with 3+ previous tests were more likely to have recently had multiple sexual partners (aOR = 2.19, 95% CI: 1.22, 3.92). However, a significant decrease in HIV prevalence is shown as individuals receive more HIV tests in their lifetime (p < 0.001). These findings show that individuals who report high-risk behaviours are returning for repeat tests. However, VCT may not be successful at addressing certain sexual risk behaviours. Therefore more intensive counselling or additional HIV prevention services may be needed. © The Author(s) 2016.

The feasibility of voluntary counselling and HIV testing for pregnant women using community volunteers in Zimbabwe.

PubMed

Shetty, Avinash K; Mhazo, Miriam; Moyo, Sostain; von Lieven, Andrea; Mateta, Patrick; Katzenstein, David A; Maldonado, Yvonne; Hill, David; Bassett, Mary T

2005-11-01

The purpose of this pilot project was to assess the feasibility and acceptability of voluntary counselling and HIV testing (VCT) by pregnant women using community volunteers in Zimbabwe to prevent mother to child transmission (MTCT) of HIV. From July 1999 to June 2001, a short-course zidovudine (ZDV)-based perinatal HIV prevention programme was initiated in two antenatal clinics. Community volunteers, recruited from local community organizations, underwent a two-week training course in VCT, which included HIV/AIDS facts, systematic counselling approach, and practical counselling techniques using scripts and role-play. Rapid HIV testing was performed after informed consent. Lay counsellors conducted individual pre- and post-test counselling for HIV. A total of 35 women community volunteers were trained in VCT; 34 graduated and committed to work four hours per week in the clinic. Of the 6051 pregnant women presenting for antenatal clinics (ANC), 1824 (30%) underwent pre-test counselling and 1547 (26%) were tested, and 429 (28%) were HIV infected. Overall, 1283 (83%) returned for their test results including 406 (95%) of HIV-infected women. Of the 406 HIV-infected women who collected their test results, only 203 (50%) opted for ZDV prophylaxis to prevent MTCT of HIV. Over the two-year study period, two counsellors died and three sought employment at other organizations. Adherence to duty roster was 97% and no breach of confidentiality was reported. Despite many challenges, VCT delivered by community volunteers is feasible and acceptable for pregnant women aiming to reduce their risk of transmitting HIV to their infants. This programme is being implemented at several urban and rural MTCT sites in Zimbabwe and can serve as a model for other resource-poor countries.

Vasopressinergic network abnormalities potentiate conditioned anxious state of rats subjected to maternal hyperthyroidism.

PubMed

Zhang, L; Medina, M P; Hernández, V S; Estrada, F S; Vega-González, A

2010-06-30

We have previously reported that a mild maternal hyperthyroidism in rats impairs stress coping of adult offspring. To assess anxiogenesis in this rat model of stress over-reactivity, we used two behavioural tests for unconditional and conditional anxious states: elevated plus maze test (EPM) and Vogel conflict test (VCT). In the latter one, arginine vasopressin (AVP) release was enhanced due to osmotic stress. With the EPM test no differences were observed between maternal hyperthyroid rats (MH) and controls. However, with the VCT, the MH showed increased anxiety-like behaviour. This behavioural difference was abolished by diazepam. Plasma AVP concentration curve as a function of water deprivation (WD) time showed a marked increase, reaching its maximal levels within half the time of controls and another significant difference after VCT. A general increase in Fos expression in hypothalamic supraoptic and paraventricular nuclei (PVN) was observed during WD and after VCT. There was also a significant increase of AVP immunoreactivity in anterior hypothalamic area. A large number of Herring bodies were observed in the AVP containing fibres of MH hypothalamic-neurohypophysial system. Numerous reciprocal synaptic connections between AVP and corticotropin releasing factor containing neurons in MH ventromedial PVN were observed by electron microscopy. These results suggest that a mild maternal hyperthyroidism could induce an aberrant organization in offspring's hypothalamic stress related regions which could mediate the enhanced anxiety seen in this animal model. 2010 IBRO. Published by Elsevier Ltd. All rights reserved.

Sensitivity and specificity of HIV rapid tests used for research and voluntary counselling and testing.

PubMed

Anzala, O; Sanders, E J; Kamali, A; Katende, M; Mutua, G N; Ruzagira, E; Stevens, G; Simek, M; Price, M

2008-10-01

HIV rapid tests (RT) are a quick and non-technically demanding means to perform HIV voluntary counselling and testing (VCT) but understanding their limitations is vital to delivering quality VCT. To determine the sensitivity and specificity of HIV rapid tests used for research and voluntary counselling and testing at four sites in East Africa. Cross-sectional study. Masaka District, Uganda; a sugar plantation in Kakira, Uganda; Coastal Villages in the Kilifi District of Kenya; and the Urban slum of Kangemi located West of Nairobi, Kenya. Six thousands two hundred and fifty five consenting volunteers were enrolled into the study, and 675 prevalent HIV infections were identified. The RT sensitivity tended to be high for all assays at all sites (97.63-100%) with the exception of the Uni-Gold assay (90.24% in Kangemi, 96.58% in Kilifi). Twenty four RT results were recorded as 'weak positives', 22 (92%) of which were negative by ELISA. There was a high rate of RT false positives in Uganda (positive predictive values ranging from 45.70% to 86.62%). The sensitivity and specificity of the RT varied significantly across sites. The rate of RT misclassification in Uganda suggests that a multiple test algorithm may be preferable to a single test as screener for HIV VCT.

Antiretroviral Therapy Program Expansion in Zambézia Province, Mozambique: Geospatial Mapping of Community-Based and Health Facility Data for Integrated Health Planning

PubMed Central

Moon, Troy D.; Ossemane, Ezequiel B.; Green, Ann F.; Ndatimana, Elisée; José, Eurico; Buehler, Charlotte P.; Wester, C. William; Vermund, Sten H.; Olupona, Omo

2014-01-01

Objective To generate maps reflecting the intersection of community-based Voluntary Counseling and Testing (VCT) delivery points with facility-based HIV program demographic information collected at the district level in three districts (Ile, Maganja da Costa and Chinde) of Zambézia Province, Mozambique; in order to guide planning decisions about antiretroviral therapy (ART) program expansion. Methods Program information was harvested from two separate open source databases maintained for community-based VCT and facility-based HIV care and treatment monitoring from October 2011 to September 2012. Maps were created using ArcGIS 10.1. Travel distance by foot within a 10 km radius is generally considered a tolerable distance in Mozambique for purposes of adherence and retention planning. Results Community-based VCT activities in each of three districts were clustered within geographic proximity to clinics providing ART, within communities with easier transportation access, and/or near the homes of VCT volunteers. Community HIV testing results yielded HIV seropositivity rates in some regions that were incongruent with the Ministry of Health’s estimates for the entire district (2–13% vs. 2% in Ile, 2–54% vs. 11.5% in Maganja da Costa, and 23–43% vs. 14.4% in Chinde). All 3 districts revealed gaps in regional disbursement of community-based VCT activities as well as access to clinics offering ART. Conclusions Use of geospatial mapping in the context of program planning and monitoring allowed for characterizing the location and size of each district’s HIV population. In extremely resource limited and logistically challenging settings, maps are valuable tools for informing evidence-based decisions in planning program expansion, including ART. PMID:25329169

[Comparison of human papilloma virus infection status between men who have sex with men recruited from gay bathhouses and HIV voluntary counseling and testing clinics respectively in Urumqi].

PubMed

Tian, T; Cai, A J; Huang, B X; Abidan, Ainiwaer; Wang, H; Dai, J H

2017-01-10

Objective: To understand the human papilloma virus (HPV) infection status in men who have sex with men (MSM) recruited from gay bathhouses and HIV voluntary counseling and testing (VCT) clinics in Urumqi, Xinjiang Uygur autonomous region, and identify the associated risk factors. Methods: A total of 200 MSM aged ≥18 years were recruited by using the " snowballing" sampling method from gay bathhouses and VCT clinics in Urumqi during March-May, 2016. The MSM recruited completed questionnaires after filling in the informed consent form. The information about their demographic characteristics and sexual behaviors were collected, and anal swabs were collected from them for HPV genotyping. Results: The overall HPV infection rate was 54.0 % . The HPV infection rate was 66.7 % (74/111) in MSM from gay bathhouses and 38.2 % (34/89) in MSM from VCT clinics and the high risk type HPV infection rate was 39.6 % (44/111) in MSM from gay bathhouses and 14.6 % (13/89) in MSM from VCT clinics, the differences were significant ( χ (2)=16.112, P <0.05; χ (2)=15.190, P <0.05). Multiple logistic regression analysis indicated that the major risk factors for HPV infection included activity in gay bathhouse ( OR =3.732, 95 % CI : 1.950-7.141) and anal sexual behavior ( OR =2.555, 95 %CI : 1.329-4.912). Conclusion: The prevalence of HPV in MSM from gay bathhouses was higher than that in MSM from VCT clinics, indicating that close attention should be paid to the behavior intervention in MSM.

Evaluation of left ventricular function using volumetric computed tomography in the clinical setting.

PubMed

de la Peña-Almaguer, Erasmo; Trevino, Alejandro R; Sierra-Galan, Lilia; Azpiri-Lopez, José R; Assad-Morell, José L; Kirsch, Jacobo; Chang, Su Min

2016-01-01

To correlate the left ventricular parameters obtained with 64-slice Volumetric Computed Tomography (VCT) with those obtained with the reference standard, cardiovascular magnetic resonance (CMR) imaging. VCT and a 3.0T MRI scanner were used. Results from both studies were independently evaluated by two cardiologists. A linear correlation and a paired Student's t test were used to analyze the data with a P<0.05 being considered significant. Thirty consecutive patients were evaluated with VCT and CMR. The left ventricular indices for CMR and VCT were, respectively, mass 86.4±25.8 vs. 82.7±27.6g (P=0.31); ESV 45.5±27.8 vs. 48.7±40.4ml (P=.405); EDV 101.3±32.7 vs. 105.1±44.0ml (P=0.475); SV 55.9±16.1 vs. 56.8±15.6ml (P=0.713); LVEF 57.5±13.2% vs. 56.9±12.4% (P=0.630). No differences in intraobserver variability for both methods were found, CT r=0.96, r(2)=0.92 P<0.0001 and MR r=0.96 r(2)=0.93 P<0.0001. There was no significant statistical difference in the presence of artifacts. There is a close correlation between CMRI and VCT in the evaluation of LV function. VCT is as useful as 3T CMR, and could be incorporated as another resource for evaluating LV function. Copyright © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia

PubMed Central

Chipukuma, Julien M; Chiko, Matimba M; Wamulume, Chibesa S; Bolton-Moore, Carolyn; Reid, Stewart E

2011-01-01

Abstract Objective To increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. Methods Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. Data on counselling and testing were collected in registers. Outcomes of interest included HIV testing coverage, the acceptability of testing, the proportion testing HIV-positive (HIV+), the proportion enrolling in HIV care and treatment and the time between testing and enrolment. Findings After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44 420 patients were counselled under PITC and 31 197 patients, 44% of them men, accepted testing. Of those tested, 21% (6572) were HIV+; 38% of these HIV+ patients (2515) enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. Conclusion The introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research. PMID:21556300

HIV DIAGNOSIS AND SEXUAL RISK BEHAVIOR INTENTIONS AMONG COUPLE VCT CLIENTS IN ETHIOPIA

PubMed Central

Bonnenfant, Yung-Ting; Hindin, Michelle J.; Gillespie, Duff

2014-01-01

This research examines whether members of HIV affected couples are more likely to change their abstinence and condom intentions than members of HIV− couples during couple voluntary counseling and testing (VCT). 1,260 couple VCT clients in Ethiopia were asked about their sexual risk behavior intentions for the next two months after pre-test and post-test counseling. Multinomial logistic regression was used to determine whether the couple’s HIV status was associated with changed intentions to abstain or use condoms between pre-test and post-test. Individuals belonging to male HIV+ serodiscordant couples (aRRR= 7.98, p<0.001), female HIV+ serodiscordant couples (aRRR=5.85, p<0.001), and HIV+ concordant couples (aRRR=3.12, p=0.05) were more likely to have increased their intentions to abstain or use condoms in the next two months than individuals in HIV− concordant relationships. The couple’s HIV status was not associated with decreased intentions to abstain or use condoms in the next two months. Counseling for all HIV affected couples should include practical information on obtaining and using condoms. This includes HIV affected couples who intend to abstain from sex, whether for a short or long period of time, so that they are prepared to have protected sex if their intentions change. PMID:22428865

Health and cultural determinants of voluntary HIV testing and counseling among middle-aged and older Latina women.

PubMed

Craig, Shelley L; Beaulaurier, Richard L; Newman, Frederick L; De La Rosa, Mario; Brennan, David J

2012-01-01

The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.

Characteristics of volunteers and non-volunteers for voluntary counseling and HIV testing among unmarried male undergraduates.

PubMed

Adewole, D A; Lawoyin, T O

2004-06-01

The 2001 HIV sero-prevalence survey in Nigeria revealed a rate of 5.8 percent with those under the age of 25 years having the highest prevalence rate. Most University students fall within this age group. This study is part of a larger study on the sexual behavior of youths and young adults and was designed to compare the characteristics of volunteers and non-volunteers for voluntary confidential counseling and HIV testing (VCT) among males. Six hundred and nine male undergraduate students were randomly selected and enrolled for the study. Data were collected using a pre-tested questionnaire. Of the 609, 51 (8.3%) volunteered to have their blood screened for HIV. All volunteers who received pre-test counseling went for the HIV test. Volunteers were significantly older than the non-volunteers (P<0.0001), and were more likely to be sexually experienced (P=0.002). Among the sexually experienced, the volunteers were older at first sexual intercourse (FSI) (P<0.0001), and were more likely to have used a condom at FSI (P=0.001). Volunteers had significantly higher knowledge scores for HIV/AIDS (P=0.006), and the attitude to HIV/AIDS in both groups was positive. The marriage pattern of their parents with regard to polygyny was similar, and fewer volunteers had fathers in the higher socio-economic class and mothers who had completed secondary education (P<0.00001, (P=0.02). Among the 51 volunteers, 8 (15.7%) tested positive. Those who tested positive were less likely to have lived with parents, and were all sexually experienced. Those who screened positive were also more likely to be currently sexually active and to have fathers with low level of education. Three (5.9%) of volunteers did not return for results and posttest counseling. One of the three was positive for HIV. Of those who tested positive, 3 (37.5%) reported not using the condom at all, while the rest were using it only occasionally. VCT among the youths is possible however, small numbers encountered in the study is a limitation and there is a need to replicate this study using larger numbers. Tertiary institutions should provide VCT services for the students where they can be counseled appropriately and continuously throughout their stay in the institution. This hopefully will reduce the number of new HIV cases seen.

Couples' voluntary counselling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study

PubMed Central

2010-01-01

Background With the accessibility of prevention of mother to child transmission (PMTCT) services in sub-Saharan Africa, more women are being tested for HIV in antenatal care settings. Involving partners in the counselling and testing process could help prevent horizontal and vertical transmission of HIV. This study was conducted to assess the feasibility of couples' voluntary counseling and testing (CVCT) in antenatal care and to measure compliance with PMTCT. Methods A prospective cohort study was conducted over eight months at two public antenatal clinics in Kigali, Rwanda, and Lusaka, Zambia. A convenience sample of 3625 pregnant women was enrolled. Of these, 1054 women were lost to follow up. The intervention consisted of same-day individual voluntary counselling and testing (VCT) and weekend CVCT; HIV-positive participants received nevirapine tablets. In Kigali, nevirapine syrup was provided in the labour and delivery ward; in Lusaka, nevirapine syrup was supplied in pre-measured single-dose syringes. The main outcome measures were nurse midwife-recorded deliveries and reported nevirapine use. Results In eight months, 1940 women enrolled in Kigali (984 VCT, 956 CVCT) and 1685 women enrolled in Lusaka (1022 VCT, 663 CVCT). HIV prevalence was 14% in Kigali, and 27% in Lusaka. Loss to follow up was more common in Kigali than Lusaka (33% vs. 24%, p = 0.000). In Lusaka, HIV-positive and HIV-negative women had significantly different loss-to-follow-up rates (30% vs. 22%, p = 0.002). CVCT was associated with reduced loss to follow up: in Kigali, 31% of couples versus 36% of women testing alone (p = 0.011); and in Lusaka, 22% of couples versus 25% of women testing alone (p = 0.137). Among HIV-positive women with follow up, CVCT had no impact on nevirapine use (86-89% in Kigali; 78-79% in Lusaka). Conclusions Weekend CVCT, though new, was feasible in both capital cities. The beneficial impact of CVCT on loss to follow up was significant, while nevirapine compliance was similar in women tested alone or with their partners. Pre-measured nevirapine syrup syringes provided flexibility to HIV-positive mothers in Lusaka, but may have contributed to study loss to follow up. These two prevention interventions remain a challenge, with CVCT still operating without supportive government policy in Zambia. PMID:20230628

Optimization of tomotherapy treatment planning for patients with bilateral hip prostheses.

PubMed

Chapman, David; Smith, Shaun; Barnett, Rob; Bauman, Glenn; Yartsev, Slav

2014-02-04

To determine the effect of different imaging options and the most efficient imaging strategy for treatment planning of patients with hip prostheses. The planning kilovoltage CT (kVCT) and daily megavoltage CT (MVCT) studies for three prostate cancer patients with bilateral hip prostheses were used for creating hybrid kVCT/MVCT image sets. Treatment plans were created for kVCT images alone, hybrid kVCT/MVCT images, and MVCT images alone using the same dose prescription and planning parameters. The resulting dose volume histograms were compared. The orthopedic metal artifact reduction (O-MAR) reconstruction tool for kVCT images and different MVCT options were investigated with a water tank fit with double hip prostheses. Treatment plans were created for all imaging options and calculated dose was compared with the one measured by a pin-point ion chamber. On average for three patients, the D35% for the bladder was 8% higher in plans based on MVCT images and 7% higher in plans based on hybrid images, compared to the plans based on kVCT images alone. Likewise, the D35% for the rectum was 3% higher than the kVCT based plan for both hybrid and MVCT plans. The average difference in planned D99% in the PTV compared to kVCT plans was 0.9% and 0.1% for MVCT and hybrid plans, respectively. For the water tank with hip prostheses phantom, the kVCT plan with O-MAR correction applied showed better agreement between the measured and calculated dose than the original image set, with a difference of -1.9% compared to 3.3%. The measured doses for the MVCT plans were lower than the calculated dose due to image size limitations. The best agreement was for the kVCT/MVCT hybrid plans with the difference between calculated and measured dose around 1%. MVCT image provides better visualization of patient anatomy and hybrid kVCT/MVCT study enables more accurate calculations using updated MVCT relative electron density calibration.

Modeling the height of young forests regenerating from recent disturbances in Mississippi using Landsat and ICESat data

USGS Publications Warehouse

Li, Ainong; Huang, Chengquan; Sun, Guoqing; Shi, Hua; Toney, Chris; Zhu, Zhiliang; Rollins, Matthew G.; Goward, Samuel N.; Masek, Jeffery G.

2011-01-01

Many forestry and earth science applications require spatially detailed forest height data sets. Among the various remote sensing technologies, lidar offers the most potential for obtaining reliable height measurement. However, existing and planned spaceborne lidar systems do not have the capability to produce spatially contiguous, fine resolution forest height maps over large areas. This paper describes a Landsat–lidar fusion approach for modeling the height of young forests by integrating historical Landsat observations with lidar data acquired by the Geoscience Laser Altimeter System (GLAS) instrument onboard the Ice, Cloud, and land Elevation (ICESat) satellite. In this approach, “young” forests refer to forests reestablished following recent disturbances mapped using Landsat time-series stacks (LTSS) and a vegetation change tracker (VCT) algorithm. The GLAS lidar data is used to retrieve forest height at sample locations represented by the footprints of the lidar data. These samples are used to establish relationships between lidar-based forest height measurements and LTSS–VCT disturbance products. The height of “young” forest is then mapped based on the derived relationships and the LTSS–VCT disturbance products. This approach was developed and tested over the state of Mississippi. Of the various models evaluated, a regression tree model predicting forest height from age since disturbance and three cumulative indices produced by the LTSS–VCT method yielded the lowest cross validation error. The R2 and root mean square difference (RMSD) between predicted and GLAS-based height measurements were 0.91 and 1.97 m, respectively. Predictions of this model had much higher errors than indicated by cross validation analysis when evaluated using field plot data collected through the Forest Inventory and Analysis Program of USDA Forest Service. Much of these errors were due to a lack of separation between stand clearing and non-stand clearing disturbances in current LTSS–VCT products and difficulty in deriving reliable forest height measurements using GLAS samples when terrain relief was present within their footprints. In addition, a systematic underestimation of about 5 m by the developed model was also observed, half of which could be explained by forest growth that occurred between field measurement year and model target year. The remaining difference suggests that tree height measurements derived using waveform lidar data could be significantly underestimated, especially for young pine forests. Options for improving the height modeling approach developed in this study were discussed.

Modeling the Height of Young Forests Regenerating from Recent Disturbances in Mississippi using Landsat and ICESat data

NASA Technical Reports Server (NTRS)

Li, Ainong; Huang, Chengquan; Sun, Guoqing; Shi, Hua; Toney, Chris; Zhu, Zhiliang; Rollins, Matthew G.; Goward, Samuel N.; Masek, Jeffrey G.

2011-01-01

Many forestry and earth science applications require spatially detailed forest height data sets. Among the various remote sensing technologies, lidar offers the most potential for obtaining reliable height measurement. However, existing and planned spaceborne lidar systems do not have the capability to produce spatially contiguous, fine resolution forest height maps over large areas. This paper describes a Landsat-lidar fusion approach for modeling the height of young forests by integrating historical Landsat observations with lidar data acquired by the Geoscience Laser Altimeter System (GLAS) instrument onboard the Ice, Cloud, and land Elevation (ICESat) satellite. In this approach, "young" forests refer to forests reestablished following recent disturbances mapped using Landsat time-series stacks (LTSS) and a vegetation change tracker (VCT) algorithm. The GLAS lidar data is used to retrieve forest height at sample locations represented by the footprints of the lidar data. These samples are used to establish relationships between lidar-based forest height measurements and LTSS-VCT disturbance products. The height of "young" forest is then mapped based on the derived relationships and the LTSS-VCT disturbance products. This approach was developed and tested over the state of Mississippi. Of the various models evaluated, a regression tree model predicting forest height from age since disturbance and three cumulative indices produced by the LTSS-VCT method yielded the lowest cross validation error. The R(exp 2) and root mean square difference (RMSD) between predicted and GLAS-based height measurements were 0.91 and 1.97 m, respectively. Predictions of this model had much higher errors than indicated by cross validation analysis when evaluated using field plot data collected through the Forest Inventory and Analysis Program of USDA Forest Service. Much of these errors were due to a lack of separation between stand clearing and non-stand clearing disturbances in current LTSS-VCT products and difficulty in deriving reliable forest height measurements using GLAS samples when terrain relief was present within their footprints. In addition, a systematic underestimation of about 5 m by the developed model was also observed, half of which could be explained by forest growth that occurred between field measurement year and model target year. The remaining difference suggests that tree height measurements derived using waveform lidar data could be significantly underestimated, especially for young pine forests. Options for improving the height modeling approach developed in this study were discussed.

Pregnant Women's Knowledge of and Attitudes to HIV Testing at Komfo Anokye Teaching Hospital, Kumasi.

PubMed

Addo, Vn

2005-06-01

SummaryA questionnaire survey on the knowledge about human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and attitudes to voluntary counselling and testing (VCT) in pregnancy of 334 antenatal attendants at Komfo Anokye Teaching Hospital (KATH) was conducted. The survey showed that HIV/AIDS is recognized as a life-threatening condition and is mainly acquired through unprotected sexual intercourse with an infected partner, use of unsterile sharp instruments and blood transfusion. Knowledge about mother to child transmission (MTCT) was lacking.The majority of women who had done the test did so as a pre-requisite for church blessing of their marriage.VCT would be acceptable especially when anonymity is ensured and drug treatment is available for mother and child should the pregnant woman test positive for HIV.

HIV/AIDS knowledge and uptake of HIV counselling and testing among undergraduate private university students in Accra, Ghana.

PubMed

Oppong Asante, Kwaku

2013-03-28

HIV Counselling and Testing (VCT) and knowledge about HIV are some key strategies in the prevention and control of HIV/AIDS in Ghana. However, HIV knowledge and utilization of VCT services among university students is low. The main objective was to determine the level of HIV/AIDS knowledge and to explore factors associated with the use HIV counselling and testing among private university students in Accra, Ghana. A cross-sectional study was conducted using structured questionnaires among 324 conveniently selected students enrolled at a privately owned tertiary institution in Accra, Ghana. The respondents consisted of 56.2% males and 43.8% females aged 17 - 37 years. The mean HIV/AIDS knowledge score of was 7.70. There was a significant difference in knowledge of HIV/AIDS by gender where female students had more knowledge about HIV/AIDS than males [t (322) = 2.40, p = 0.017]. The ANOVA results showed that there was a significant difference in HIV/AIDS knowledge according to the age groups [F (3, 321) = 6.26, p = 0. 0001] and marital status [F (3, 321) = 4.86, p = 0. 008] of the sample. Over half of the participants had not tested for HIV, although over 95% of them knew where to access counseling and testing services. The study also revealed a significant association between demographic variables, testing for HIV and intention to test in the future. Participants who were never married (single), aged 17 - 20 years and had knowledge of two routes of HIV transmission were more likely to have taken an HIV test. Males were more likely to take an HIV test in the future than females. Majority of the students receive HIV/AIDS information from both print and electronic media, but few of them received such information from parents. The students HIV knowledge was very good, yet HIV testing were low. Health education and HIV intervention programmes must not only provide accurate information, but must be made to help to equip private university students, especially females to test for HIV consistently.

Prevention of mother-to-child transmission of HIV: the Georgian experience.

PubMed

Tsertsvadze, Tengiz; Kakabadze, Tea; Shermadini, Ketevan; Abutidze, Akaki; Karchava, Marika; Chkhartishvili, Nikoloz; Badridze, Nino; Bokhua, Zaza; Asatiani, Tengiz

2008-09-01

The objective of this paper is to review experience in prevention of mother-to-child transmission (PMTCT) of HIV in Georgia. PMTCT is one of the strategic priorities in Georgia. The first case of HIV infection in pregnant women was reported in 1999. Starting 2005 the National Programme on PMTCT became operational. One hundred sixteen HIV voluntary counselling and testing (VCT) centers operate throughout the country at antenatal clinics. According to the National PMTCT protocol, all first time attending pregnant women are offered Voluntary Counselling and Testing (VCT). Testing on HIV/AIDS is based on identification of HIV antibodies by screening method and all positive results are referred to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) for the further investigation (confirmation by Western Blot assay) and further management. Data collection was made retrospectively, using information from IDACIRC National HIV/AIDS Data Base, VRF for the period 1999-2007. Prevalence of HIV among pregnant women availing VCT services in 2006 was 0.03%. As of December, 2007 total 69 pregnancies of 64 women were registered at the IDACIRC. Fifty eight women (90.6%) acquired infection through heterosexual contact. None of the HIV positive women reported intravenous injection of illicit drugs. The majority of the HIV infected pregnant women had one sexual partner (90.6%). Of children delivered by 51 positive partners 41(80%) were infected through injecting drugs intravenously and 10 (20%) persons through heterosexual contacts. Throughout the period 1999-2007 14 pregnant women received PMTCT services only partially. In 2 cases children were HIV-infected. In 12 pregnancies women received AZT in about the 28th week of pregnancy. No case of HIV transmission to child was recorded in this group. In 32 cases pregnant women received full prophylaxis therapy and all children were negative for HIV infection. Among 6 pregnant women admitted at IDACIRC later than the 28th week of pregnancy only 1 child was infected. As of December 2007, 5 women are still pregnant. Three of them receive antiretroviral drugs (ARV) prophylaxis with AZT+3TC+SQV/r. Two women are under 28 weeks of gestational age. Over the last several years the national response to AIDS in Georgia achieved significant progress. The provision of comprehensive packages of PMTCT services in Georgia has been shown to minimize the risk of vertical transmission. As described above none of the women completing full course of ARV prophylaxis, combined with appropriate infant feeding, transmitted HIV to their children. PMTCT programmes are indisputably the main entry point not only for HIV related care and treatment for women, but also for other comprehensive care and prevention.

Metal artifact reduction through MVCBCT and kVCT in radiotherapy

NASA Astrophysics Data System (ADS)

Liugang, Gao; Hongfei, Sun; Xinye, Ni; Mingming, Fang; Zheng, Cao; Tao, Lin

2016-11-01

This study proposes a new method for removal of metal artifacts from megavoltage cone beam computed tomography (MVCBCT) and kilovoltage CT (kVCT) images. Both images were combined to obtain prior image, which was forward projected to obtain surrogate data and replace metal trace in the uncorrected kVCT image. The corrected image was then reconstructed through filtered back projection. A similar radiotherapy plan was designed using the theoretical CT image, the uncorrected kVCT image, and the corrected image. The corrected images removed most metal artifacts, and the CT values were accurate. The corrected image also distinguished the hollow circular hole at the center of the metal. The uncorrected kVCT image did not display the internal structure of the metal, and the hole was misclassified as metal portion. Dose distribution calculated based on the corrected image was similar to that based on the theoretical CT image. The calculated dose distribution also evidently differed between the uncorrected kVCT image and the theoretical CT image. The use of the combined kVCT and MVCBCT to obtain the prior image can distinctly improve the quality of CT images containing large metal implants.

[Prevalence of intimate partner violence in heterosexual men attending HIV voluntary counsel and test clinics and related factors in Shanghai].

PubMed

Liu, Y; Yang, Y M; Ning, Z; Zheng, H; Liu, H; Tang, H F; Zhang, Y Y; He, N

2016-07-01

To understand prevalence of intimate partner violence(IPV)in heterosexual men(HM)attending HIV voluntary counseling and testing(VCT)clinics and related factors in Shanghai. All the HM attending two VCT clinics in Shanghai during March-August, 2015 were recruited to participate in a cross-sectional survey with questionnaire interview and blood test for HIV. IPV was evaluated by using the questionnaire developed by WHO Multi-Country Study on Women' s Health and Domestic Violence against Women. A total of 327 participants were recruited, their average age was 29.4 years(s∶6.1). Among them 60.2%(197/327)were aged 26-35, 57.8%(189/327)never married, 78.8%(260/327)had educational level of ≥college degree, 49.5%(162/327)were not local residents; 72.2%(236/327)had steady female partners, 72.2%(236/327)had 2 or more female partners in the past year, 6.1%(20/327)reported being diagnosed with sexually transmitted disease(STD). 1.8%(6/327)were tested to be HIV-positive. 28.4%(93/327)had IPV behaviors against heterosexual partners. Multivariate logistic regression analysis indicated that IPV behavior against heterosexual partners was significantly associated with experience of commercial sex(aOR=2.19, 95%CI: 1.16-4.15)and witness of domestic violence in early life(aOR=3.19; 95%CI: 1.58-6.45). IPV prevalence was relatively high in HM attendants in VCT clinics in Shanghai and IPV intervention is needed to conduct in VCT clinics. Multivariate regression analysis showed that the factors associated with IPV behaviors included having sex with female sex workers and the witness of domestic violence between parents. Future research is needed to further explore the association between IPV and HIV infection.

Surveillance of transmitted HIV drug resistance using matched plasma and dried blood spot specimens from voluntary counseling and testing sites in Ho Chi Minh City, Vietnam, 2007-2008.

PubMed

Duc, Nguyen Bui; Hien, Bui Thu; Wagar, Nick; Tram, Tran Hong; Giang, Le Truong; Yang, Chunfu; Wolfe, Mitchell I; Hien, Nguyen Tran; Tuan, Nguyen Anh

2012-05-01

During 2007-2008, surveillance of transmitted human immunodeficiency virus (HIV) drug resistance (TDR) was performed following World Health Organization guidance among clients with newly diagnosed HIV infection attending voluntary counseling and testing (VCT) sites in Ho Chi Minh City (HCMC), Vietnam. Moderate (5%-15%) TDR to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was observed among VCT clients aged 18-21 years. Follow-up surveillance of TDR in HCMC and other geographic regions of Vietnam is warranted. Data generated will guide the national HIV drug resistance surveillance strategy and support selection of current and future first-line antiretroviral therapy and HIV prevention programs.

Measuring intra-operative decision-making during laparoscopic cholecystectomy: validity evidence for a novel interactive Web-based assessment tool.

PubMed

Madani, Amin; Watanabe, Yusuke; Bilgic, Elif; Pucher, Philip H; Vassiliou, Melina C; Aggarwal, Rajesh; Fried, Gerald M; Mitmaker, Elliot J; Feldman, Liane S

2017-03-01

Errors in judgment during laparoscopic cholecystectomy can lead to bile duct injuries and other complications. Despite correlations between outcomes, expertise and advanced cognitive skills, current methods to evaluate these skills remain subjective, rater- and situation-dependent and non-systematic. The purpose of this study was to develop objective metrics using a Web-based platform and to obtain validity evidence for their assessment of decision-making during laparoscopic cholecystectomy. An interactive online learning platform was developed ( www.thinklikeasurgeon.com ). Trainees and surgeons from six institutions completed a 12-item assessment, developed based on a cognitive task analysis. Five items required subjects to draw their answer on the surgical field, and accuracy scores were calculated based on an algorithm derived from experts' responses ("visual concordance test", VCT). Test-retest reliability, internal consistency, and correlation with self-reported experience, Global Operative Assessment of Laparoscopic Skills (GOALS) score and Objective Performance Rating Scale (OPRS) score were calculated. Questionnaires were administered to evaluate the platform's usability, feasibility and educational value. Thirty-nine subjects (17 surgeons, 22 trainees) participated. There was high test-retest reliability (intraclass correlation coefficient = 0.95; n = 10) and internal consistency (Cronbach's α = 0.87). The assessment demonstrated significant differences between novices, intermediates and experts in total score (p < 0.01) and VCT score (p < 0.01). There was high correlation between total case number and total score (ρ = 0.83, p < 0.01) and between total case number and VCT (ρ = 0.82, p < 0.01), and moderate to high correlations between total score and GOALS (ρ = 0.66, p = 0.05), VCT and GOALS (ρ = 0.83, p < 0.01), total score and OPRS (ρ = 0.67, p = 0.04), and VCT and OPRS (ρ = 0.78, p = 0.01). Most subjects agreed or strongly agreed that the platform and assessment was easy to use [n = 29 (78 %)], facilitates learning intra-operative decision-making [n = 28 (81 %)], and should be integrated into surgical training [n = 28 (76 %)]. This study provides preliminary validity evidence for a novel interactive platform to objectively assess decision-making during laparoscopic cholecystectomy.

First Clinical Investigation of Cone Beam Computed Tomography and Deformable Registration for Adaptive Proton Therapy for Lung Cancer

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

Veiga, Catarina; Janssens, Guillaume; Teng, Ching-Ling

2016-05-01

Purpose: An adaptive proton therapy workflow using cone beam computed tomography (CBCT) is proposed. It consists of an online evaluation of a fast range-corrected dose distribution based on a virtual CT (vCT) scan. This can be followed by more accurate offline dose recalculation on the vCT scan, which can trigger a rescan CT (rCT) for replanning. Methods and Materials: The workflow was tested retrospectively for 20 consecutive lung cancer patients. A diffeomorphic Morphon algorithm was used to generate the lung vCT by deforming the average planning CT onto the CBCT scan. An additional correction step was applied to account formore » anatomic modifications that cannot be modeled by deformation alone. A set of clinical indicators for replanning were generated according to the water equivalent thickness (WET) and dose statistics and compared with those obtained on the rCT scan. The fast dose approximation consisted of warping the initial planned dose onto the vCT scan according to the changes in WET. The potential under- and over-ranges were assessed as a variation in WET at the target's distal surface. Results: The range-corrected dose from the vCT scan reproduced clinical indicators similar to those of the rCT scan. The workflow performed well under different clinical scenarios, including atelectasis, lung reinflation, and different types of tumor response. Between the vCT and rCT scans, we found a difference in the measured 95% percentile of the over-range distribution of 3.4 ± 2.7 mm. The limitations of the technique consisted of inherent uncertainties in deformable registration and the drawbacks of CBCT imaging. The correction step was adequate when gross errors occurred but could not recover subtle anatomic or density changes in tumors with complex topology. Conclusions: A proton therapy workflow based on CBCT provided clinical indicators similar to those using rCT for patients with lung cancer with considerable anatomic changes.« less

Monitoring of experimental rat lung transplants by high-resolution flat-panel volumetric computer tomography (fpVCT).

PubMed

Greschus, Susanne; Kuchenbuch, Tim; Plötz, Christian; Obert, Martin; Traupe, Horst; Padberg, Winfried; Grau, Veronika; Hirschburger, Markus

2009-01-01

Noninvasive assessment of experimental lung transplants with high resolution would be favorable to exclude technical failure and to follow up graft outcome in the living animal. Here we describe a flat-panel Volumetric Computed Tomography (fpVCT) technique using a prototype scanner. Lung transplantation was performed in allogeneic as well as in corresponding syngeneic rat strain combinations. At different time points post-transplantation, fpVCT was performed. Lung transplants can be visualized in the living rat with high-spatial resolution. FpVCT allows a detailed analysis of the lung and the bronchi. Infiltrates developing during rejection episodes can be diagnosed and follow-up studies can easily be performed. With fpVCT it is possible to control the technical success of the surgical procedure. Graft rejection can be visualized individually in the living animal noninvasively, which is highly advantageous for studying the pathogenesis of chronic rejection or to monitor new therapies.

Impact of systematic HIV testing on case finding and retention in care at a primary care clinic in South Africa.

PubMed

Clouse, Kate; Hanrahan, Colleen F; Bassett, Jean; Fox, Matthew P; Sanne, Ian; Van Rie, Annelies

2014-12-01

Systematic, opt-out HIV counselling and testing (HCT) may diagnose individuals at lower levels of immunodeficiency but may impact loss to follow-up (LTFU) if healthier people are less motivated to engage and remain in HIV care. We explored LTFU and patient clinical outcomes under two different HIV testing strategies. We compared patient characteristics and retention in care between adults newly diagnosed with HIV by either voluntary counselling and testing (VCT) plus targeted provider-initiated counselling and testing (PITC) or systematic HCT at a primary care clinic in Johannesburg, South Africa. One thousand one hundred and forty-four adults were newly diagnosed by VCT/PITC and 1124 by systematic HCT. Two-thirds of diagnoses were in women. Median CD4 count at HIV diagnosis (251 vs. 264 cells/μl, P = 0.19) and proportion of individuals eligible for antiretroviral therapy (ART) (67.2% vs. 66.7%, P = 0.80) did not differ by HCT strategy. Within 1 year of HIV diagnosis, half were LTFU: 50.5% under VCT/PITC and 49.6% under systematic HCT (P = 0.64). The overall hazard of LTFU was not affected by testing policy (aHR 0.98, 95%CI: 0.87-1.10). Independent of HCT strategy, males, younger adults and those ineligible for ART were at higher risk of LTFU. Implementation of systematic HCT did not increase baseline CD4 count. Overall retention in the first year after HIV diagnosis was low (37.9%), especially among those ineligible for ART, but did not differ by testing strategy. Expansion of HIV testing should coincide with effective strategies to increase retention in care, especially among those not yet eligible for ART at initial diagnosis. © 2014 John Wiley & Sons Ltd.

Role of pretest counseling sessions on increasing subjective knowledge about HIV and hepatitis transmission among the beneficiaries of a free of charge, voluntary counseling and testing program in Constanta, Romania.

PubMed

Schweitzer, A-M; Bogdan, M; Corduneanu, A; Ciocea, I

2018-02-01

To describe the characteristics of clients who enrolled into of an opt-in, HIV, HBV & HCV Voluntary Counseling and Testing Program in Dobrogea Region, Romania (VCT) and to identify the utility of the pre-test counseling sessions in increasing subjective perception regarding transmission knowledge for the clients attending the VCT program. Cross sectional data collection, between August 2015 and September 2016. Sociodemographic and behavioral information were collected for the clients who enrolled at two Baylor centers. Counselors were trained regarding the delivery of standardized information during the session, to reduce variation. After the pre-test session clients evaluated the subjective level of knowledge (SK) increase regarding viral transmission. 3065 clients were screened at the two centers and completed the SK increase assessment after the pre-test session. About 9% of all persons tested had reactive results to any of the infections in the context of high exposure risks for 62% and low hepatitis B vaccination rates (8%). 78% of attendees perceived that their knowledge regarding HIV and viral hepatitis transmission increasing with more than 60% as the result of the pretest counselling; more information was gained about hepatitis transmission compared with HIV. Cumulative prevalence in Dobrogea community is high. The NGO-run VCT program is helping the healthcare system to efficiently screen for undiagnosed HIV and hepatitis cases. Pre-test counselling is directly contributing to increasing SK among attendees. Routine HIV and hepatitis integrated pre-test counseling should be considered as a good-practice even in settings where it is not compulsory by law. © 2018 British HIV Association.

HIV/AIDS stigma and utilization of voluntary counselling and testing in Nigeria.

PubMed

Odimegwu, Clifford; Adedini, Sunday A; Ononokpono, Dorothy N

2013-05-13

Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it.

HIV/AIDS stigma and utilization of voluntary counselling and testing in Nigeria

PubMed Central

2013-01-01

Background Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community’s perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. Methods A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. Results It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. Conclusions Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it. PMID:23668880

HIV/AIDS knowledge and uptake of HIV counselling and testing among undergraduate private university students in Accra, Ghana

PubMed Central

2013-01-01

Background HIV Counselling and Testing (VCT) and knowledge about HIV are some key strategies in the prevention and control of HIV/AIDS in Ghana. However, HIV knowledge and utilization of VCT services among university students is low. The main objective was to determine the level of HIV/AIDS knowledge and to explore factors associated with the use HIV counselling and testing among private university students in Accra, Ghana. Materials and methods A cross-sectional study was conducted using structured questionnaires among 324 conveniently selected students enrolled at a privately owned tertiary institution in Accra, Ghana. Results The respondents consisted of 56.2% males and 43.8% females aged 17 – 37 years. The mean HIV/AIDS knowledge score of was 7.70. There was a significant difference in knowledge of HIV/AIDS by gender where female students had more knowledge about HIV/AIDS than males [t (322) = 2.40, p = 0.017]. The ANOVA results showed that there was a significant difference in HIV/AIDS knowledge according to the age groups [F (3, 321) = 6.26, p = 0. 0001] and marital status [F (3, 321) = 4.86, p = 0. 008] of the sample. Over half of the participants had not tested for HIV, although over 95% of them knew where to access counseling and testing services. The study also revealed a significant association between demographic variables, testing for HIV and intention to test in the future. Participants who were never married (single), aged 17 – 20 years and had knowledge of two routes of HIV transmission were more likely to have taken an HIV test. Males were more likely to take an HIV test in the future than females. Majority of the students receive HIV/AIDS information from both print and electronic media, but few of them received such information from parents. Conclusion The students HIV knowledge was very good, yet HIV testing were low. Health education and HIV intervention programmes must not only provide accurate information, but must be made to help to equip private university students, especially females to test for HIV consistently. PMID:23537116

Investigating CT to CBCT image registration for head and neck proton therapy as a tool for daily dose recalculation

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

Landry, Guillaume, E-mail: g.landry@lmu.de; Nijhuis, Reinoud; Thieke, Christian

2015-03-15

Purpose: Intensity modulated proton therapy (IMPT) of head and neck (H and N) cancer patients may be improved by plan adaptation. The decision to adapt the treatment plan based on a dose recalculation on the current anatomy requires a diagnostic quality computed tomography (CT) scan of the patient. As gantry-mounted cone beam CT (CBCT) scanners are currently being offered by vendors, they may offer daily or weekly updates of patient anatomy. CBCT image quality may not be sufficient for accurate proton dose calculation and it is likely necessary to perform CBCT CT number correction. In this work, the authors investigatedmore » deformable image registration (DIR) of the planning CT (pCT) to the CBCT to generate a virtual CT (vCT) to be used for proton dose recalculation. Methods: Datasets of six H and N cancer patients undergoing photon intensity modulated radiation therapy were used in this study to validate the vCT approach. Each dataset contained a CBCT acquired within 3 days of a replanning CT (rpCT), in addition to a pCT. The pCT and rpCT were delineated by a physician. A Morphons algorithm was employed in this work to perform DIR of the pCT to CBCT following a rigid registration of the two images. The contours from the pCT were deformed using the vector field resulting from DIR to yield a contoured vCT. The DIR accuracy was evaluated with a scale invariant feature transform (SIFT) algorithm comparing automatically identified matching features between vCT and CBCT. The rpCT was used as reference for evaluation of the vCT. The vCT and rpCT CT numbers were converted to stopping power ratio and the water equivalent thickness (WET) was calculated. IMPT dose distributions from treatment plans optimized on the pCT were recalculated with a Monte Carlo algorithm on the rpCT and vCT for comparison in terms of gamma index, dose volume histogram (DVH) statistics as well as proton range. The DIR generated contours on the vCT were compared to physician-drawn contours on the rpCT. Results: The DIR accuracy was better than 1.4 mm according to the SIFT evaluation. The mean WET differences between vCT (pCT) and rpCT were below 1 mm (2.6 mm). The amount of voxels passing 3%/3 mm gamma criteria were above 95% for the vCT vs rpCT. When using the rpCT contour set to derive DVH statistics from dose distributions calculated on the rpCT and vCT the differences, expressed in terms of 30 fractions of 2 Gy, were within [−4, 2 Gy] for parotid glands (D{sub mean}), spinal cord (D{sub 2%}), brainstem (D{sub 2%}), and CTV (D{sub 95%}). When using DIR generated contours for the vCT, those differences ranged within [−8, 11 Gy]. Conclusions: In this work, the authors generated CBCT based stopping power distributions using DIR of the pCT to a CBCT scan. DIR accuracy was below 1.4 mm as evaluated by the SIFT algorithm. Dose distributions calculated on the vCT agreed well to those calculated on the rpCT when using gamma index evaluation as well as DVH statistics based on the same contours. The use of DIR generated contours introduced variability in DVH statistics.« less

Empowering HIV testing as a prevention tool: targeting interventions for high-risk men who have sex with men.

PubMed

Lorente, Nicolas; Suzan-Monti, Marie; Vernay-Vaisse, Chantal; Mora, Marion; Blanche, Jérôme; Fugon, Lionel; Dhotte, Philippe; Le Gall, Jean-Marie; Rovera, Patrick; Carrieri, Maria Patrizia; Préau, Marie; Spire, Bruno

2012-01-01

In France, HIV testing can be easily performed in free and anonymous voluntary counselling testing (VCT) centres. The recent national study among French men who have sex with men (MSM) showed that 73% of those already tested for HIV had been tested in the previous two years. Nothing is known about the risk behaviours of MSM attending VCT centres. This study aimed to characterize sexual risk behaviours of MSM tested for HIV in such centres and identify factors associated with inconsistent condom use (ICU). A cross-sectional study was conducted from March to December 2009 in four VCT centres where a self-administered questionnaire was proposed to all MSM about to have a HIV test. ICU was defined as reporting non-systematic condom use during anal intercourse with casual male partners. Among the 287 MSM who fully completed their questionnaire, 44% reported ICU in the previous six months. Among those who had been already tested, 63% had had their test in the previous two years. Factors independently associated with ICU included: never avoiding one-night stands, not having been recently HIV tested, experiencing difficulty in using condoms when with a HIV negative partner or when under the influence of drugs or alcohol and finally, reporting to have had a large number of casual male partners in the previous six months. The rate of recently tested MSM was high in our study. Nevertheless, this rate was lower than that found in the last national study. Furthermore those not recently tested were significantly more likely to report high risk behaviours. We therefore recommend that further efforts be made to adapt the offer of both HIV testing and counselling to meet the specific needs of hard-to-reach MSM. Accordingly, an additional community-based offer of HIV testing to reach most-at-risk MSM is forthcoming in France.

Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury.

PubMed

Besnard, Jeremy; Richard, Paul; Banville, Frederic; Nolin, Pierre; Aubin, Ghislaine; Le Gall, Didier; Richard, Isabelle; Allain, Phillippe

2016-01-01

Traumatic brain injury (TBI) causes impairments affecting instrumental activities of daily living (IADL). However, few studies have considered virtual reality as an ecologically valid tool for the assessment of IADL in patients who have sustained a TBI. The main objective of the present study was to examine the use of the Nonimmersive Virtual Coffee Task (NI-VCT) for IADL assessment in patients with TBI. We analyzed the performance of 19 adults suffering from TBI and 19 healthy controls (HCs) in the real and virtual tasks of making coffee with a coffee machine, as well as in global IQ and executive functions. Patients performed worse than HCs on both real and virtual tasks and on all tests of executive functions. Correlation analyses revealed that NI-VCT scores were related to scores on the real task. Moreover, regression analyses demonstrated that performance on NI-VCT matched real-task performance. Our results support the idea that the virtual kitchen is a valid tool for IADL assessment in patients who have sustained a TBI.

Comparison of survivability of Staphylococcus aureus and spores of Aspergillus niger on commonly used floor materials.

PubMed

Gupta, Mridula; Bisesi, Michael; Lee, Jiyoung

2017-07-01

The survivability of Staphylococcus aureus and spores of Aspergillus niger was compared on 5 common floor materials. Floor materials were inoculated with a known concentration of S aureus and spores of A niger on day 0. Their survivability was measured on days, 2, 7, 14, and 28 by bulk rinsate method and enumerated using culture-based method. The difference in change of S aureus levels was statistically significant for all tested days (P < .001) for all floor materials. Vinyl composition tile (VCT) and porcelain tile (PT) had statistically similar survivability and differed statistically from carpets. On both VCT and PT, positive growth for S aureus occurred by day 2 (1-1.7 log 10 ), declined slightly (0.1 to -0.2 log 10 ) by day 7, and remained positive until day 28. However, S aureus was undetected by day 7 on both carpets. A niger spores were undetected on residential broadloom carpet and rubber-backed commercial carpet after day 2 but survived on VCT, PT, and wood until day 28. Floor materials with hard and smooth surfaces, such as VCT and PT, can allow survival of S aureus and A niger for up to 4 weeks. It may imply that floor materials can play a major role in preserving microbial contaminants in the built environment. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Snow-covered Landsat time series stacks improve automated disturbance mapping accuracy in forested landscapes

Treesearch

Kirk M. Stueve; Ian W. Housman; Patrick L. Zimmerman; Mark D. Nelson; Jeremy B. Webb; Charles H. Perry; Robert A. Chastain; Dale D. Gormanson; Chengquan Huang; Sean P. Healey; Warren B. Cohen

2011-01-01

Accurate landscape-scale maps of forests and associated disturbances are critical to augment studies on biodiversity, ecosystem services, and the carbon cycle, especially in terms of understanding how the spatial and temporal complexities of damage sustained from disturbances influence forest structure and function. Vegetation change tracker (VCT) is a highly automated...

[Non-destructive, preclinical evaluation of root canal anatomy of human teeth with flat-panel detector volume CT (FD-VCT)].

PubMed

Heidrich, G; Hassepass, F; Dullin, C; Attin, T; Grabbe, E; Hannig, C

2005-12-01

Successful endodontic diagnostics and therapy call for adequate depiction of the root canal anatomy with multimodal diagnostic imaging. The aim of the present study is to evaluate visualization of the endodont with flat-panel detector volume CT (FD-VCT). 13 human teeth were examined with the prototype of a FD-VCT. After data acquisition and generation of volume data sets in volume rendering technology (VRT), the findings obtained were compared to conventional X-rays and cross-section preparations of the teeth. The anatomical structures of the endodont such as root canals, side canals and communications between different root canals as well as denticles could be detected precisely with FD-VCT. The length of curved root canals was also determined accurately. The spatial resolution of the system is around 140 microm. Only around 73 % of the main root canals detected with FD-VCT and 87 % of the roots could be visualized with conventional dental X-rays. None of the side canals, shown with FD-VCT, was detectable on conventional X-rays. In all cases the enamel and dentin of the teeth could be well delineated. No differences in image quality could be discerned between stored and freshly extracted teeth, or between primary and adult teeth. FD-VCT is an innovative diagnostic modality in preclinical and experimental use for non-destructive three-dimensional analysis of teeth. Thanks to the high isotropic spatial resolution compared with conventional X-rays, even the minutest structures, such as side canals, can be detected and evaluated. Potential applications in endodontics include diagnostics and evaluation of all steps of root canal treatment, ranging from trepanation through determination of the length of the root canal to obturation.

The relationship between sexual violence and human immunodeficiency virus (HIV) infection among women using voluntary counseling and testing services in South Wollo Zone, Ethiopia

PubMed Central

2013-01-01

Background Gender based violence affects the health and wellbeing of women across the world on an epidemic scale. While women remain more vulnerable to both sexual violence and risk of HIV infection, they are less able to access health and other welfare services than men. These vulnerabilities are further compounded by social factors, including the low status of women in many communities and their lack of decision-making power, both within the household and in wider society. The objective of this study was to assess the relationship between sexual violence and HIV infection among clients of voluntary counseling and testing (VCT) services in South Wollo Zone, Ethiopia. Methodology A facility based cross sectional study was conducted using quantitative methods on a sample of 647 people living in seven selected districts of South Wollo Zone, Amhara Regional State. Results The study revealed that sexual violence is significantly associated with the risk of HIV infection. The prevalence of lifetime sexual violence, lifetime partner violence, and last 12 months partner violence were 34.6%, 32.3% and 10.5% respectively. Both partner violence and lifetime sexual violence by another perpetrator were associated with HIV. The overall prevalence of HIV among VCT users was 21.5%. Both before (crude analysis) and after the results were adjusted for selected variables, women who experienced sexual violence in the last 12 months by their intimate partner or by another perpetrator is significantly associated with their HIV status. The chances of having HIV was 1.97 times higher among women victims who have a history of lifetime partner violence when compared with women who are not victims; crude odds ratio (COR) = 1.97, 95% Confidence Interval (CI), (1.34 - 2.90). Conclusion The study revealed that sexual violence is significantly associated with the risk of HIV infection. Empowerment of women can be used as an important tool to reduce both sexual violence and HIV. More importantly policy issues must be set by all actors to take action on the mediating variables that interacted with violence to aggravate the transmission of HIV. PMID:23856072

Workplace ART programmes: Why do companies invest in them and are they working?

PubMed

George, Gavin

2006-09-01

Prevalence data indicates that certain sectors within the private sector are particularly affected by HIV/AIDS. Companies in southern Africa began implementing treatment programmes in early 2002 as the corporate sector came to realise the financial imperative of offsetting employee morbidity and mortality. This article sets about to explain the rationale behind antiretroviral treatment (ART) programmes within the private sector while uncovering some of the obstacles businesses face when treating HIV-infected employees. Data suggest that in many cases employees' uptake of voluntary counselling and testing (VCT) and ART are slow. At this early stage of workplace treatment provision, data indicate that employers must seek ways to increase uptake of VCT and treatment in an attempt to make programmes more cost-effective.

The influence of perception and peer support on STI prevention behavior (syphilis case study) in group of MSM at veterans STI-VCT clinic in Medan year 2016

NASA Astrophysics Data System (ADS)

Sukatendel, K.; Napitupulu, T. E.; Rusmalawati; Andayani, L. S.; Yustina, I.

2018-03-01

According to Behavioral and Biological Integrated Surveillance (BBIS) in Indonesia, 2011, there was an increase in syphilis surveillance in men who like to commit sexual intercourse with other men (MSM). It was 13% of the 3% in BBIS 2007 in bad STI prevention behavior. There were 478 MSM have visited STI-VCT clinic in Medan throughout 2015, and syphilis-infected 59 men. This study aims to analyze the influence of perception and peer support on prevention of STI in MSM at Veteran STI-VCT Clinic in Medan, 2016. It was a mixed method quantitative and qualitative study with the cross-sectional approach, enrolled 50 respondents. Data were collected and analyzed with SPSS 19. There was the influence of perception and peer support on STI prevention behavior of MSM group at STI-VCT Veteran Clinic in Medan.

Volume CT (VCT) enabled by a novel diode technology

NASA Astrophysics Data System (ADS)

Ikhlef, Aziz; Zeman, Greg; Hoffman, David; Li, Wen; Possin, George

2005-04-01

One of the results of the latest developments in x-ray tube and detector technology, is the enabling of computed tomography (CT) as a strong non-invasive imaging modality for a new set of clinical applications including cardiac and brain imaging. A common theme among the applications is an ability to have wide anatomical coverage in a single rotation. Large coverage in CT is expected to bring significant diagnostic value in clinical field, especially in cardiac, trauma, pediatric, neuro, angiography, Stroke WorkUp and pulmonary applications. This demand, in turn, creates a need for tile-able and scalable detector design. In this paper, we introduce the design of a new diode, a crucial part of the detector, discuss how it enables wide coverage, its performance in terms of cross-talk, light output response, maximized geometric efficiency, and other CT requirements, and compare it to the traditional design which is front-illuminated diode. We ran extensive simulation and measurement experiments to study the geometric efficiency and assess the cross talk and all other performance parameters Critical To Quality (CTQs) with both designs. We modeled x-ray scattering in the scintillator, light scattering through the septa and optical coupler, and electrical cross talk. We tested the design with phantoms and clinical experiments on a scanner (LightSpeed VCT, GE Healthcare Technologies, Waukesha, WI, USA). Our preliminary results indicate that the new diode design performs as well as the traditional in terms of cross talk and other CTQs. It, also, yields better geometric efficiency and enables tile-able detector design, which is crucial for the VCT. We introduced a new diode design, which is an essential enabler for VCT. We demonstrated the new design is superior to the traditional design for the clinically relevant performance measures.

Access to healthcare for disabled persons. How are blind people reached by HIV services?

PubMed

Saulo, Bryson; Walakira, Eddy; Darj, Elisabeth

2012-03-01

Disabled people are overlooked and marginalised globally. There is a lack of information on blind people and HIV-related services and it is unclear how HIV-services target blind people in a sub-Saharan urban setting. To explore how blind people are reached by HIV-services in Kampala, Uganda. A purposeful sample of blind people and seeing healthcare workers were interviewed, and data on their opinions and experiences were collected. The data were analysed by qualitative content analysis, with a focus on manifest content. Three categories emerged from the study, reaching for HIV information and knowledge, lack of services, and experiences of discrimination. General knowledge on HIV prevention/transmission methods was good; however, there was scepticism about condom use. Blind people mainly relied on others for accessing HIV information, and a lack of special services for blind people to be able to test for HIV was expressed. The health service for blind people was considered inadequate, unequal and discriminatory, and harassment by healthcare staff was expressed, but not sexual abuse. Concerns about disclosure of personal medical information were revealed. Access to HIV services and other healthcare related services for blind people is limited and the objectives of the National Strategic Plan for HIV/AIDS 2007-2012 have not been achieved. There is a need for alternative methods for sensitisation and voluntary counselling and testing (VCT) for blind people. Copyright © 2011 Elsevier B.V. All rights reserved.

HIV Testing among Adolescents in Ndola, Zambia: How Individual, Relational, and Environmental Factors Relate to Demand

ERIC Educational Resources Information Center

Denison, Julie A.; McCauley, Ann P.; Dunnett-Dagg, Wendy A.; Lungu, Nalakwanji; Sweat, Michael D.

2009-01-01

This study examined how individual, relational and environmental factors related to adolescent demand for HIV voluntary counseling and testing (VCT). A cross-sectional survey among randomly selected 16-19-year-olds in Ndola, Zambia, covered individual (e.g., HIV knowledge), environmental (e.g., distance), and relational factors (e.g., discussed…

A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project

PubMed Central

Weiss, Stephen M; Zulu, Robert; Jones, Deborah L; Redding, Colleen A; Cook, Ryan; Chitalu, Ndashi

2015-01-01

Background Widespread voluntary medical male circumcision (VMMC) in Africa could avert an estimated 3·436 million HIV infections and 300,000 deaths over the next 10 years. Most Zambian men, however, have expressed little interest in undergoing VMMC. This study tested the effect of an intervention designed to increase demand for VMMC among these “hard to reach” men. Methods This cluster randomized controlled trial was conducted from 2012 to 2014 in Lusaka, Zambia (HIV prevalence = 20·8%). 13 Community Health Centers (CHCs) were stratified by HIV voluntary counseling and testing (VCT) rates and patient census and randomly assigned (5:5:3) to Experimental, Control or Observation Only conditions. CHC health care providers at all 13 sites received VMMC training. Trial statisticians did not participate in randomization. 800 uncircumcised HIV-, post-VCT men, 400 per condition, were recruited; female partners were invited to participate. The primary outcome was the likelihood of VMMC by 12 months post-intervention. The trial registration is NCT 01688167. Findings 161 participants in the Experimental condition underwent VMMC as compared to 96 Control participants [adjusted odds ratio = 2·45, 95% CI = (1·24, 4·90) p = ·0166]. Post-VMMC condom use among Experimental condition participants increased compared to baseline, with no change among Control participants. No adverse events related to study participation were reported. Interpretation The Spear and Shield intervention combined with VMMC training was associated with a significant increase in the number of VMMCs performed as well as in condom use among “hard to reach” Zambian men. Results support the importance of comprehensive HIV prevention programs that increase supply of and demand for VMMC services. Funding NIH/NIMH R01MH095539. PMID:26120594

SU-E-J-275: Impact of the Intra and Inter Observer Variability in the Delineation of Parotid Glands On the Dose Calculation During Head and Neck Helical Tomotherapy

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

Jodda, A; Piotrowski, T

2014-06-01

Purpose: The intra- and inter-observer variability in delineation of the parotids on the kilo-voltage computed tomography (kVCT) and mega-voltage computed tomography (MVCT) were examined to establish their impact on the dose calculation during adaptive head and neck helical tomotherapy (HT). Methods: Three observers delineated left and right parotids for ten randomly selected patients with oropharynx cancer treated on HT. The pre-treatment kVCT and the MVCT from the first fraction of irradiation were selected to delineation. The delineation procedure was repeated three times by each observer. The parotids were delineated according to the institutional protocol. The analyses included intra-observer reproducibility andmore » inter-structure, -observer and -modality variability of the volume and dose. Results: The differences between the left and right parotid outlines were not statistically significant (p>0.3). The reproducibility of the delineation was confirmed for each observer on the kVCT (p>0.2) and on the MVCT (p>0.1). The inter-observer variability of the outlines was significant (p<0.001) as well as the inter-modality variability (p<0.006). The parotids delineated on the MVCT were 10% smaller than on the kVCT. The inter-observer variability of the parotids delineation did not affect the average dose (p=0.096 on the kVCT and p=0.176 on the MVCT). The dose calculated on the MVCT was higher by 3.3% than dose from the kVCT (p=0.009). Conclusion: Usage of the institutional protocols for the parotids delineation reduces intra-observer variability and increases reproducibility of the outlines. These protocols do not eliminate delineation differences between the observers, but these differences are not clinically significant and do not affect average doses in the parotids. The volumes of the parotids delineated on the MVCT are smaller than on the kVCT, which affects the differences in the calculated doses.« less

SU-F-J-186: Enabling Adaptive IMPT with CBCT-Based Dose Recalculation for H&N and Prostate Cancer Patients

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

Kurz, C; LMU Munich, Munich; Park, Y

2016-06-15

Purpose: To enable adaptive intensity modulated proton therapy for sites sensitive to inter-fractional changes on the basis of accurate CBCT-based proton dose calculations. To this aim two CBCT intensity correction methods are considered: planning CT (pCT) to CBCT DIR and projection correction based on pCT DIR prior. Methods: 3 H&N and 3 prostate cancer patients with CBCT images and corresponding projections were used in this study, in addition to pCT and re-planning CT (rpCT) images (H&N only). A virtual CT (vCT) was generated by pCT to CBCT DIR. In a second approach, the vCT was used as prior for scattermore » correction of the CBCT projections to yield a CBCTcor image. BEV 2D range maps of SFUD IMPT plans were compared. For the prostate cases, the geometric accuracy of the vCT was also evaluated by contour comparison to physician delineation of the CBCTcor and original CBCT. Results: SFUD dose calculations on vCT and CBCTcor were found to be within 3mm for 97% to 99% of 2D range maps. Median range differences compared to rpCT were below 0.5mm. Analysis showed that the DIR-based vCT approach exhibits inaccuracies in the pelvic region due to the very low soft-tissue contrast in the CBCT. The CBCTcor approach yielded results closer to the original CBCT in terms of DICE coefficients than the vCT (median 0.91 vs 0.81) for targets and OARs. In general, the CBCTcor approach was less affected by inaccuracies of the DIR used during the generation of the vCT prior. Conclusion: Both techniques yield 3D CBCT images with intensities equivalent to diagnostic CT and appear suitable for IMPT dose calculation for most sites. For H&N cases, no considerable differences between the two techniques were found, while improved results of the CBCTcor were observed for pelvic cases due to the reduced sensitivity to registration inaccuracies. Deutsche Forschungsgemeinschaft (MAP); Bundesministerium fur Bildung und Forschung (01IB13001)« less

'It is just the way it was in the past before I went to test': a qualitative study to explore responses to HIV prevention counselling in rural Tanzania.

PubMed

Cawley, Caoimhe; Wringe, Alison; Wamoyi, Joyce; Lees, Shelley; Urassa, Mark

2016-06-08

Voluntary counselling and testing (VCT) for HIV first evolved in Western settings, with one aim being to promote behaviours which lower the risk of onward transmission or acquisition of HIV. However, although quantitative studies have shown that the impact of VCT on sexual behaviour change has been limited in African settings, there is a lack of qualitative research exploring perceptions of HIV prevention counselling messages, particularly among clients testing HIV-negative. We conducted a qualitative study to explore healthcare worker, community and both HIV-negative and HIV-positive clients' perceptions of HIV prevention counselling messages in rural Tanzania. This study was carried out within the context of an ongoing community HIV cohort study in Kisesa, northwest Tanzania. Nine group sessions incorporating participatory learning and action (PLA) activities were conducted in order to gain general community perspectives of HIV testing and counselling (HTC) services. Thirty in-depth interviews (IDIs) with HIV-negative and HIV-positive service users explored individual perceptions of HIV prevention counselling messages, while five IDIs were carried out with nurses or counsellors offering HTC in order to explore provider perspectives. Two key themes revolving around socio-cultural and contextual factors emerged in understanding responses to HIV prevention counselling messages. The first included constraints to client-counsellor interactions, which were impeded as a result of difficulties discussing private sexual behaviours during counselling sessions, a hierarchical relationship between healthcare providers and clients, insufficient levels of training and support for counsellors, and client concerns about confidentiality. The second theme related to imbalanced gender-power dynamics, which constrained the extent to which women felt able to control their HIV-related risk. Within the broader social context of a rural African setting, HIV prevention counselling based on a Western model of individual-level agency seems unlikely to make a significant contribution to sexual behaviour change until there is greater recognition by counsellors of the ways in which power dynamics within many relationships influence behaviour change. More culturally relevant counselling strategies and messages and infrastructural improvements such as additional training for counsellors and counselling rooms which ensure privacy and confidentiality, may lead to better outcomes in terms of sexual risk reduction.

Experimental flat-panel high-spatial-resolution volume CT of the temporal bone.

PubMed

Gupta, Rajiv; Bartling, Soenke H; Basu, Samit K; Ross, William R; Becker, Hartmut; Pfoh, Armin; Brady, Thomas; Curtin, Hugh D

2004-09-01

A CT scanner employing a digital flat-panel detector is capable of very high spatial resolution as compared with a multi-section CT (MSCT) scanner. Our purpose was to determine how well a prototypical volume CT (VCT) scanner with a flat-panel detector system defines fine structures in temporal bone. Four partially manipulated temporal-bone specimens were imaged by use of a prototypical cone-beam VCT scanner with a flat-panel detector system at an isometric resolution of 150 microm at the isocenter. These specimens were also depicted by state-of-the-art multisection CT (MSCT). Forty-two structures imaged by both scanners were qualitatively assessed and rated, and scores assigned to VCT findings were compared with those of MSCT. Qualitative assessment of anatomic structures, lesions, cochlear implants, and middle-ear hearing aids indicated that image quality was significantly better with VCT (P < .001). Structures near the spatial-resolution limit of MSCT (e.g., bony covering of the tympanic segment of the facial canal, the incudo-stapedial joint, the proximal vestibular aqueduct, the interscalar septum, and the modiolus) had higher contrast and less partial-volume effect with VCT. The flat-panel prototype provides better definition of fine osseous structures of temporal bone than that of currently available MSCT scanners. This study provides impetus for further research in increasing spatial resolution beyond that offered by the current state-of-the-art scanners.

Knowledge, Attitudes, and Practices of Voluntary HIV Counseling and Testing among Rural Migrants in Shanghai, China

ERIC Educational Resources Information Center

He, Na; Zhang, Jinling; Yao, Jinjian; Tian, Xiuhong; Zhao, Genming; Jiang, Qingwu; Detels, Roger

2009-01-01

A study of knowledge, attitudes and practices (KAP) of voluntary HIV counseling and testing (VCT) among rural migrants was conducted in Shanghai, China. An anonymous questionnaire was administered face-to-face. Among 2,690 participants, 78% reported having had lifetime sexual intercourse with 41.3% of singles reporting sexual intercourse, 9.2%…

Neural control of fast nonlinear systems--application to a turbocharged SI engine with VCT.

PubMed

Colin, Guillaume; Chamaillard, Yann; Bloch, Gérard; Corde, Gilles

2007-07-01

Today, (engine) downsizing using turbocharging appears as a major way in reducing fuel consumption and pollutant emissions of spark ignition (SI) engines. In this context, an efficient control of the air actuators [throttle, turbo wastegate, and variable camshaft timing (VCT)] is needed for engine torque control. This paper proposes a nonlinear model-based control scheme which combines separate, but coordinated, control modules. Theses modules are based on different control strategies: internal model control (IMC), model predictive control (MPC), and optimal control. It is shown how neural models can be used at different levels and included in the control modules to replace physical models, which are too complex to be online embedded, or to estimate nonmeasured variables. The results obtained from two different test benches show the real-time applicability and good control performance of the proposed methods.

HIV and injecting drug use in Indonesia: epidemiology and national response.

PubMed

Afriandi, Irvan; Aditama, Tjandra Yoga; Mustikawati, Dyah; Oktavia, Martiani; Alisjahbana, Bachti; Riono, Pandu

2009-07-01

Indonesia is facing one of the most rapidly growing HIV-epidemics in Asia. Risk behaviour associated with injecting drug use, such as sharing contaminated needles, is the main risk factor for HIV infection. Among the general population the prevalence of HIV-infection is still low (0.2%), but up to 50% or more of the estimated 145.000 - 170.000 injecting drug users are already HIV-positive. Overrepresentation of injecting drug users and continued risk behavior inside Indonesian prisons contribute to spread of HIV. Through sexual contacts, HIV is transmitted from current or previous injecting drug users to their non-injecting sexual partners; 10-20% of this group may already be infected. The national response targeted to limit spread of HIV through injecting drug use has included needle and syringe program (NSP), methadone maintenance treatment (MMT), voluntary counseling and testing (VCT), and outreach program as priority programs. However coverage and utilization of the harm reduction services is still limited, but effective integration with HIV testing and treatment is expanding. By 2008, there were 110 service points for NSP and 24 operational MMT clinics. Nevertheless, utilization of these services has been less satisfactory and their effectiveness has been questioned. Besides effective prevention, HIV- testing and earlier treatment of HIV-seropositve individuals, including those with a history of injecting drug use, will help control the growing HIV-epidemic in Indonesia.

Imaging of the midpalatal suture in a porcine model: flat-panel volume computed tomography compared with multislice computed tomography.

PubMed

Hahn, Wolfram; Fricke-Zech, Susanne; Fialka-Fricke, Julia; Dullin, Christian; Zapf, Antonia; Gruber, Rudolf; Sennhenn-kirchner, Sabine; Kubein-Meesenburg, Dietmar; Sadat-Khonsari, Reza

2009-09-01

An investigation was conducted to compare the image quality of prototype flat-panel volume computed tomography (fpVCT) and multislice computed tomography (MSCT) of suture structures. Bone samples were taken from the midpalatal suture of 5 young (16 weeks) and 5 old (200 weeks) Sus scrofa domestica and fixed in formalin solution. An fpVCT prototype and an MSCT were used to obtain images of the specimens. The facial reformations were assessed by 4 observers using a 1 (excellent) to 5 (poor) rating scale for the weighted criteria visualization of the suture structure. A linear mixed model was used for statistical analysis. Results with P < .05 were considered to be statistically significant. The visualization of the suture of young specimens was significantly better than that of older animals (P < .001). The visualization of the suture with fpVCT was significantly better than that with MSCT (P < .001). Compared with MSCT, fpVCT produces superior results in the visualization of the midpalatal suture in a Sus scrofa domestica model.

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

Bache, S; Rong, J

Purpose: To quantify a radiology team’s assessment of image quality differences between two CT scanner models currently in clinical use, with emphasis on spatial resolution that could be impacted by focal spot size. Methods: Modulation Transfer Functions (MTF) measurements were performed by scanning the impulse source insert module of the Catphan 600 at 120/140 kVp with both large (LFS) and small (SFS) focal spots and reconstructed to 2.5mm and 5.0mm thicknesses on a GE Discovery CT750 HD and a LightSpeed VCT CT scanner. MTFs were calculated by summing the 2D PSF along one-dimension to obtain line-spread-function (LSF), and calculating themore » Fourier Transform of the zero-padded and background corrected LSF. Spatial resolution performance was evaluated by comparing MTF curves, 50% and 10% MTF cutoff, and total area under the MTF curve (AUC). In addition, images of the Catphan high-contrast module and a Kagaku anthropomorphic body phantom were acquired from the HD scanner for visual comparisons. Results: For each scanner model, SFS was superior to LFS spatial resolution with respect to 50%/10% MTF cutoff and AUC. For the HD, 50%/10% cutoff was 4.29/7.22cm-1 for the LFS and 4.43/7.45cm-1 for the SFS. VCT outperformed HD, with 50%/10% cutoff of 4.40/7.29 cm-1 for LFS and 4.62/7.47cm-1 for SFS. Scanner model performance in order of decreasing AUC performance was VCT SFS (7.43), HD SFS (7.20), VCT LFS (7.09) and HD LFS (6.93). Visual evaluations of Kagaku phantom images confirmed that VCT outperformed HD. Conclusion: VCT outperformed HD and small focal spot is desired for either model over large focal spot in term of spatial resolution – in agreement with radiologist feedback of overall image quality. In-depth evaluations of clinical impact and focal spot selection mechanisms is currently being assessed.« less

Koumine exhibits anxiolytic properties without inducing adverse neurological effects on functional observation battery, open-field and Vogel conflict tests in rodents.

PubMed

Chen, Chao-Jie; Zhong, Zhi-Feng; Xin, Zhi-Ming; Hong, Long-Hui; Su, Yan-Ping; Yu, Chang-Xi

2017-04-01

Koumine, an active alkaloid of neurotoxic plant Gelsemium, has been focused on its therapeutic uses, especially in central nervous system. Nevertheless, less is known about the neurological effects of koumine, which hampers its potential therapeutic exploitation. Moreover, as the anxiolytic potential of Gelsemium has raised many critical issues, its active principles on the anxiolytic and other neurological effects need to be further investigated. Here, we used functional observation battery (FOB) of mice to systematically measure the neurological effects of koumine at the effective doses, and then further confirmed its anxiolytic properties in open-field test (OFT) of mice and Vogel conflict test (VCT) of rats. Koumine exhibited anxiolytic-like activities but did not affect other autonomic, neurological and physical functions in FOB. Furthermore, koumine released anxiolytic responses and anti-punishment action in a manner similar to diazepam in OFT and VCT, respectively. The results constitutes solid set of fundamental data further demonstrating anxiolytic properties of koumine at the therapeutic doses without inducing adverse neurological effects, which supports the perspectives for the development of safe and effective koumine medicine against pathological anxiety.

Measuring Decision-Making During Thyroidectomy: Validity Evidence for a Web-Based Assessment Tool.

PubMed

Madani, Amin; Gornitsky, Jordan; Watanabe, Yusuke; Benay, Cassandre; Altieri, Maria S; Pucher, Philip H; Tabah, Roger; Mitmaker, Elliot J

2018-02-01

Errors in judgment during thyroidectomy can lead to recurrent laryngeal nerve injury and other complications. Despite the strong link between patient outcomes and intraoperative decision-making, methods to evaluate these complex skills are lacking. The purpose of this study was to develop objective metrics to evaluate advanced cognitive skills during thyroidectomy and to obtain validity evidence for them. An interactive online learning platform was developed ( www.thinklikeasurgeon.com ). Trainees and surgeons from four institutions completed a 33-item assessment, developed based on a cognitive task analysis and expert Delphi consensus. Sixteen items required subjects to make annotations on still frames of thyroidectomy videos, and accuracy scores were calculated based on an algorithm derived from experts' responses ("visual concordance test," VCT). Seven items were short answer (SA), requiring users to type their answers, and scores were automatically calculated based on their similarity to a pre-populated repertoire of correct responses. Test-retest reliability, internal consistency, and correlation of scores with self-reported experience and training level (novice, intermediate, expert) were calculated. Twenty-eight subjects (10 endocrine surgeons and otolaryngologists, 18 trainees) participated. There was high test-retest reliability (intraclass correlation coefficient = 0.96; n = 10) and internal consistency (Cronbach's α = 0.93). The assessment demonstrated significant differences between novices, intermediates, and experts in total score (p < 0.01), VCT score (p < 0.01) and SA score (p < 0.01). There was high correlation between total case number and total score (ρ = 0.95, p < 0.01), between total case number and VCT score (ρ = 0.93, p < 0.01), and between total case number and SA score (ρ = 0.83, p < 0.01). This study describes the development of novel metrics and provides validity evidence for an interactive Web-based platform to objectively assess decision-making during thyroidectomy.

Evaluation of portable CT scanners for otologic image-guided surgery

PubMed Central

Balachandran, Ramya; Schurzig, Daniel; Fitzpatrick, J Michael; Labadie, Robert F

2011-01-01

Purpose Portable CT scanners are beneficial for diagnosis in the intensive care unit, emergency room, and operating room. Portable fixed-base versus translating-base CT systems were evaluated for otologic image-guided surgical (IGS) applications based on geometric accuracy and utility for percutaneous cochlear implantation. Methods Five cadaveric skulls were fitted with fiducial markers and scanned using both a translating-base, 8-slice CT scanner (CereTom®) and a fixed-base, flat-panel, volume-CT (fpVCT) scanner (Xoran xCAT®). Images were analyzed for: (a) subjective quality (i.e. noise), (b) consistency of attenuation measurements (Hounsfield units) across similar tissue, and (c) geometric accuracy of fiducial marker positions. The utility of these scanners in clinical IGS cases was tested. Results Five cadaveric specimens were scanned using each of the scanners. The translating-base, 8-slice CT scanner had spatially consistent Hounsfield units, and the image quality was subjectively good. However, because of movement variations during scanning, the geometric accuracy of fiducial marker positions was low. The fixed-base, fpVCT system had high spatial resolution, but the images were noisy and had spatially inconsistent attenuation measurements; while the geometric representation of the fiducial markers was highly accurate. Conclusion Two types of portable CT scanners were evaluated for otologic IGS. The translating-base, 8-slice CT scanner provided better image quality than a fixed-base, fpVCT scanner. However, the inherent error in three-dimensional spatial relationships by the translating-based system makes it suboptimal for otologic IGS use. PMID:21779768

Compact Torus Acceleration and Injection Experiment

NASA Astrophysics Data System (ADS)

Fukumoto, Naoyuki; Fujiwara, Makoto; Nagata, Masayoshi; Uyama, Tadao; Oda, Yasushi; Azuma, Kingo

1996-11-01

The spheromak-type compact torus (CT) acceleration and injection experiment has been carried out using the Himeji Institute of Technology Compact Torus Injector (HIT-CTI). We explore the possibility of refueling, density control, current drive, and edge electric field control of tokamak plasma by means of CT injection. In last September the new HIT-CTI was built up to achieve higher speed (Vct>200 km/s) and higher density CT plasmoid by improving the capacitor bank system and eliminating the impurity and neutral particles. At initial formation discharge tests the gun for formation and compression successfully produced a CT plasmoid and injected it between electrodes for acceleration. (Initial velocity Vct.ini. 32 km/s, Bct 1 kG, Rct=5.5 cm). The formation capacitor bank will be upgraded to two 36 mF capacitors operating at 20 kV (14.4 kJ). The acceleration capacitor bank will be also upgraded to two 36 mF capacitors operating at 20 kV (14.4 kJ). The HIT-CTI will be optimized to obtain suitable CT parameters after acceleration (Bct>5 kG, Lct 20 cm, Vct>200 km/s). In the respect of CT parameter measurement magnetic probes and a He-Ne laser interferometer will be employed in order to measure the CT magnetic field, velocity, density, and length. CT acceleration experimental data on the HIT-CTI and the plan of CT injection experiment on the JFT-2M tokamak (JAERI) will be presented at the meeting.

Muscle Strength Enhancement Following Home-Based Virtual Cycling Training in Ambulatory Children with Cerebral Palsy

ERIC Educational Resources Information Center

Chen, Chia-Ling; Hong, Wei-Hsien; Cheng, Hsin-Yi Kathy; Liaw, Mei-Yun; Chung, Chia-Ying; Chen, Chung-Yao

2012-01-01

This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n = 13) or a…

SU-E-I-22: A Comprehensive Investigation of Noise Variations Between the GE Discovery CT750 HD and GE LightSpeed VCT

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

Bache, S; Loyer, E; Stauduhar, P

2015-06-15

Purpose: To quantify and compare the noise properties between two GE CT models-the Discovery CT750 HD (aka HD750) and LightSpeed VCT, with the overall goal of assessing the impact in clinical diagnostic practice. Methods: Daily QC data from a fleet of 9 CT scanners currently in clinical use were investigated – 5 HD750 and 4 VCT (over 600 total acquisitions for each scanner). A standard GE QC phantom was scanned daily using two sets of scan parameters with each scanner over 1 year. Water CT number and standard deviation were recorded from the image of water section of the QCmore » phantom. The standard GE QC scan parameters (Pitch = 0.516, 120kVp, 0.4s, 335mA, Small Body SFOV, 5mm thickness) and an in-house developed protocol (Axial, 120kVp, 1.0s, 240mA, Head SFOV, 5mm thickness) were used, with Standard reconstruction algorithm. Noise was measured as the standard deviation in the center of the water phantom image. Inter-model noise distributions and tube output in mR/mAs were compared to assess any relative differences in noise properties. Results: With the in-house protocols, average noise for the five HD750 scanners was ∼9% higher than the VCT scanners (5.8 vs 5.3). For the GE QC protocol, average noise with the HD750 scanners was ∼11% higher than with the VCT scanners (4.8 vs 4.3). This discrepancy in noise between the two models was found despite the tube output in mR/mAs being comparable with the HD750 scanners only having ∼4% lower output (8.0 vs 8.3 mR/mAs). Conclusion: Using identical scan protocols, average noise in images from the HD750 group was higher than that from the VCT group. This confirms feedback from an institutional radiologist’s feedback regarding grainier patient images from HD750 scanners. Further investigation is warranted to assess the noise texture and distribution, as well as clinical impact.« less

HIV-related behaviors, social support and health-related quality of life among men who have sex with men and women (MSMW): a cross-sectional study in Chongqing, China.

PubMed

Chen, Jiang-Peng; Han, Ming-Ming; Liao, Zi-Jun; Dai, Zhen-Zhen; Liu, Liang; Chen, Hua; Wen, Xiao-Yan; Hu, Shan; Que, Ping; Wen, Wen; Peng, Bin

2015-01-01

Health-related quality of life (HRQOL) has become commonly used both as a concept and as a field of research. However, little is known about the HRQOL of men who have sex with men and women (MSMW). The aim of this study was to examine HIV-related behaviors, social support, and HRQOL status and explore its predictors among MSMW. An anonymous cross-sectional study was conducted by snowball sampling method in 2013. A total of 563 Chinese MSM completed a structured questionnaire. The HRQOL and social support were measured with the Chinese version of the World Health Organization Quality of Life Scale (WHOQOL-BRFE) and the Social Support Rating Scale (SSRS), respectively. Of the 563 MSM analyzed, 77 (13.68%) were MSMW who had a higher proportion of in-marriage and preference for an insertive role as compared with the men who have sex with men only (MSMO) (P<0.05). As high as 70.13% of MSMW had no regular sex partners and 72.73% of MSMW reported engaging in unprotected anal sex in the last six months. 36.36% had tested for HIV, while only 12.99% had accepted HIV voluntary counseling and testing (VCT) services. The scores of objective support and subjective support in MSMW were significantly higher than that of MSMO (P<0.05). No statistically significant difference was found in scores of all the four domains of the HRQOL between MSMW and MSMO. When comparing the HRQOL scores of MSMW with the Chinese general population reference group, the scores of MSMW were significantly lower in physical health domain. In a multivariate regression model, age, monthly income, sexual role, VCT acceptability, subjective support were associated with variability in HRQOL. To improve the HRQOL among MSMW, more attention needs to be paid to those with low social support, low-income, the old and those prefer a receptive role during anal sex populations.

Evolution of the health sector response to HIV in Myanmar: progress, challenges and the way forward.

PubMed

Oo, Htun Nyunt; Hone, San; Fujita, Masami; Maw-Naing, Amaya; Boonto, Krittayawan; Jacobs, Marjolein; Phyu, Sabe; Bollen, Phavady; Cheung, Jacquie; Aung, Htin; Aung Sang, May Thu; Myat Soe, Aye; Pendse, Razia; Murphy, Eamonn

2016-11-28

Critical building blocks for the response to HIV were made until 2012 despite a series of political, social and financial challenges. A rapid increase of HIV service coverage was observed from 2012 to 2015 through collaborative efforts of government and non-governmental organisations (NGOs). Government facilities, in particular, demonstrated their capacity to expand services for antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, tuberculosis and HIV co-infection and methadone-maintenance therapy (MMT). After nearly three decades into the response to HIV, Myanmar has adopted strategies to provide the right interventions to the right people in the right places to maximise impact and cost efficiency. In particular, the country is now using strategic information to classify areas into high-, medium- and low-HIV burden and risk of new infections for geographical prioritisation - as HIV remains concentrated among key population (KP) groups in specific geographical areas. Ways forward include: •Addressing structural barriers for KP to access services, and identifying and targeting KPs at higher risk;•Strengthening the network of public facilities, NGOs and general practitioners and introducing a case management approach to assist KPs and other clients with unknown HIV status, HIV-negative clients and newly diagnosed clients to access the health services across the continuum to increase the number of people testing for HIV and to reduce loss to follow-up in both prevention and treatment;•Increasing the availability of HIV testing and counselling services for KPs, clients of female sex workers (FSW), and other populations at risk, and raising the demand for timely testing including expansion of outreach and client-initiated voluntary counselling and testing (VCT) services;•Monitoring and maximising retention from HIV diagnosis to ART initiation and expanding quality HIV laboratory services, especially viral load;•Prioritising integration of HIV and related services in high-burden areas;•Increasing the proportion of PLHIV receiving testing and treatment at public facilities by improving human resources and increasing public facilities providing these services to ensure sustainability;•Obtaining intelligence and tailoring services in hard-to-reach/under-served areas;•Strengthening planning, monitoring, and coordination capacity especially at regional levels.

The role of community acceptance over time for costs of HIV and STI prevention interventions: analysis of the Masaka Intervention Trial, Uganda, 1996-1999.

PubMed

Terris-Prestholt, Fern; Kumaranayake, Lilani; Foster, Susan; Kamali, Anatoli; Kinsman, John; Basajja, Vincent; Nalweyso, Nora; Quigley, Maria; Kengeya-Kayondo, Jane; Whitworth, James

2006-10-01

The objective of this study is to estimate the annual costs of information, education, and communication (IEC), both community- and school-based; strengthened public and private sexually transmitted infections treatment; condom social marketing (CSM); and voluntary counseling and testing (VCT) implemented in Masaka, Uganda, over 4 years, and to explore how unit costs change with varying population use/uptake. Total economic provider's costs and intervention outputs were collected annually to estimate annual unit costs between 1996 and 1999. In early intervention years, uptake of all activities grew dramatically and continued to grow for public STI treatment, CSM, and VCT. Attendance at IEC performances started to drop in year 4. Unit costs dropped rapidly with increasing uptake of and participation in interventions. When implementing long-term community-based interventions, it is important to take into account that it takes time for communities to scale up their participation, since this can lead to large variations in unit costs.

TH-CD-207B-12: Quantification of Clinical Feedback On Image Quality Differences Between Two CT Scanner Models

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

Bache, S; Liu, X; Loyer, E

Purpose: This work sought to quantify a radiology team’s assessment of image quality differences between two CT scanner models currently in clinical use, with emphasis on noise and low-contrast detectability (LCD). Methods: A water phantom and a Kagaku anthropomorphic body phantom were scanned on GE Discovery CT750 HD and LightSpeed VCT scanners (4 each) with identical scan parameters and reconstructed to 2.5mm/5.0mm thicknesses. Images of water phantom were analyzed at the scanner console with a built-in LCD tool that uses statistical methods to compute requisite CT-number contrast for 95% confidence in detection of a user-defined object size. LCD value wasmore » computed for 5mm, 3mm, and 1mm objects. Analysis of standard deviation and LCD values were performed on Kagaku phantom images within liver, stomach, and spleen. LCD value was computed for 4mm, 3mm, and 1mm objects using a benchmarked MATLAB implementation of the GE scanner-console tool. Results: Water LCD values were larger (poorer performance) for all HD scanners compared to VCT scanners. Mean scanner model difference in requisite CT-number contrast for 5mm, 3mm, and 1mm objects for 5.0mm/2.5mm images was 3.0%/3.4% (p=0.02/p=0.10), 5.3%/5.7% (0.00002/0.02), and 8.5%/8.2% (0.0004/0.002), respectively. Mean standard deviations within Kagaku phantom ROIs were greater in HD compared to VCT images, with mean differences for the liver, stomach, and spleen for 5.0mm/2.5mm of 16%/12% (p=0.04/0.10), 8%/12% (0.15/0.11), and 16%/15% (0.05/0.11), respectively. Mean LCD value difference between HD and VCT scanners over all ROIs for 4mm, 3m, and 1mm objects and 5.0mm/2.5mm was 34%/9%, 16%/8%, and 18%/10%, respectively. HD scanners outperformed VCT scanners only for the 4mm stomach object. Conclusion: Using both water and anthropomorphic phantoms, it was shown that HD scanners are outperformed by VCT scanners with respect to noise and LCD in a consistent and in most cases statistically significant manner. The relationship between statistical and clinical significance demands further work.« less

[Co-infections of HIV, syphilis and HSV-2 among men who have sex with men at the voluntary HIV counseling and testing clinics in Shanghai].

PubMed

Liu, Y; Tang, H F; Ning, Z; Zheng, H; He, N; Zhang, Y Y

2017-10-10

Objective: To understand the prevalence rates of HIV-syphilis and HIV-herpes simplex virus 2 (HSV-2) co-infections and related factors among men having sex with men (MSM) who had visited the voluntary HIV counseling and testing (VCT) clinics in Shanghai, China. Methods: 756 eligible MSM who attended the VCT clinics of Shanghai Municipality and Putuo district during March to August, 2015 were recruited to participate in a cross-sectional survey with questionnaire interview and blood testing for HIV, syphilis and HSV-2. Results: A total of 732 participants completed a valid questionnaire survey. The prevalence rates were 3.3 % (24/732) for HIV/Syphilis co-infection, 1.9 % (14/732) for HIV/HSV-2 co-infection, and 0.7 % (5/732) for HIV/Syphilis/HSV-2 co-infection, respectively. HIV prevalence appeared significantly higher among syphilis-infected participants (45.3 % , 24/53) than those without Syphilis (7.2 % , 61/679) (χ(2)=63.11, P <0.001), and was also significantly higher among HSV-2 infected participants (34.1 % , 14/41) than those without the HSV-2 infection (10.3 % , 71/691) (χ(2)=21.49, P <0.001). Results from the Multivariate regression analysis indicated that participants who were migrants ( OR =3.50, 95 %CI : 1.01-12.17), having had middle school or lower levels of education ( OR =4.46, 95 %CI : 1.54-12.87) or ever used illicit drugs ( OR =4.25, 95 %CI : 1.67-10.82, P =0.002) were under possible risks on HIV and Syphilis co-infection. Those participants who had high middle school or lower levels of education ( OR =6.87, 95 %CI : 1.86-25.42; OR =9.82, 95 %CI : 2.25-42.85) were under risk on HIV and HSV-2 co-infection. Conclusion: HIV/Syphilis and HIV/HSV-2 co-infection were seen among MSM who attended the VCT clinics in Shanghai that called for special attention, especially on migrants, those with low education or illicit drug users.

Long-Term Post-Disturbance Forest Recovery in the Greater Yellowstone Ecosystem Analyzed Using Landsat Time Series Stack

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

Zhao, Feng R.; Meng, Ran; Huang, Chengquan

Forest recovery from past disturbance is an integral process of ecosystem carbon cycles, and remote sensing provides an effective tool for tracking forest disturbance and recovery over large areas. Although the disturbance products (tracking the conversion from forest to non-forest type) derived using the Landsat Time Series Stack-Vegetation Change Tracker (LTSS-VCT) algorithm have been validated extensively for mapping forest disturbances across the United States, the ability of this approach to characterize long-term post-disturbance recovery (the conversion from non-forest to forest) has yet to be assessed. Here in this study, the LTSS-VCT approach was applied to examine long-term (up to 24more » years) post-disturbance forest spectral recovery following stand-clearing disturbances (fire and harvests) in the Greater Yellowstone Ecosystem (GYE). Using high spatial resolution images from Google Earth, we validated the detectable forest recovery status mapped by VCT by year 2011. Validation results show that the VCT was able to map long-term post-disturbance forest recovery with overall accuracy of ~80% for different disturbance types and forest types in the GYE. Harvested areas in the GYE have higher percentages of forest recovery than burned areas by year 2011, and National Forests land generally has higher recovery rates compared with National Parks. The results also indicate that forest recovery is highly related with forest type, elevation and environmental variables such as soil type. Findings from this study can provide valuable insights for ecosystem modeling that aim to predict future carbon dynamics by integrating fine scale forest recovery conditions in GYE, in the face of climate change. Lastly, with the availability of the VCT product nationwide, this approach can also be applied to examine long-term post-disturbance forest recovery in other study regions across the U.S.« less

Long-Term Post-Disturbance Forest Recovery in the Greater Yellowstone Ecosystem Analyzed Using Landsat Time Series Stack

DOE PAGES

Zhao, Feng R.; Meng, Ran; Huang, Chengquan; ...

2016-10-29

Forest recovery from past disturbance is an integral process of ecosystem carbon cycles, and remote sensing provides an effective tool for tracking forest disturbance and recovery over large areas. Although the disturbance products (tracking the conversion from forest to non-forest type) derived using the Landsat Time Series Stack-Vegetation Change Tracker (LTSS-VCT) algorithm have been validated extensively for mapping forest disturbances across the United States, the ability of this approach to characterize long-term post-disturbance recovery (the conversion from non-forest to forest) has yet to be assessed. Here in this study, the LTSS-VCT approach was applied to examine long-term (up to 24more » years) post-disturbance forest spectral recovery following stand-clearing disturbances (fire and harvests) in the Greater Yellowstone Ecosystem (GYE). Using high spatial resolution images from Google Earth, we validated the detectable forest recovery status mapped by VCT by year 2011. Validation results show that the VCT was able to map long-term post-disturbance forest recovery with overall accuracy of ~80% for different disturbance types and forest types in the GYE. Harvested areas in the GYE have higher percentages of forest recovery than burned areas by year 2011, and National Forests land generally has higher recovery rates compared with National Parks. The results also indicate that forest recovery is highly related with forest type, elevation and environmental variables such as soil type. Findings from this study can provide valuable insights for ecosystem modeling that aim to predict future carbon dynamics by integrating fine scale forest recovery conditions in GYE, in the face of climate change. Lastly, with the availability of the VCT product nationwide, this approach can also be applied to examine long-term post-disturbance forest recovery in other study regions across the U.S.« less

A randomized controlled trial to promote long-term contraceptive use among HIV-serodiscordant and concordant positive couples in Zambia.

PubMed

Stephenson, Rob; Vwalika, Bellington; Greenberg, Lauren; Ahmed, Yusuf; Vwalika, Cheswa; Chomba, Elwyn; Kilembe, William; Tichacek, Amanda; Allen, Susan

2011-04-01

Countries facing high HIV prevalence often also experience high levels of fertility and low contraceptive use, suggesting high levels of unmet need for contraceptive services. In particular, the unique needs of couples with one or both partners HIV positive are largely missing from many current family planning efforts, which focus on the prevention of pregnancies in the absence of reduction of the risk of HIV and other sexually transmitted infections (STIs). This article presents an examination of contraceptive method uptake among a cohort of HIV serodiscordant and concordant positive study participants in Zambia. Baseline contraceptive use was low; however, exposure to a video-based intervention that provided information on contraceptive methods and modeled desirable future planning behaviors dramatically increased the uptake of modern contraceptive methods. Including information on family planning in voluntary counseling and testing (VCT) services in addition to tailoring the delivery of family planning information to meet the needs and concerns of HIV-positive women or those with HIV-positive partners is an essential step in the delivery of services and prevention efforts to reduce the transmission of HIV. Family planning and HIV prevention programs should integrate counseling on dual method use, combining condoms for HIV/STI prevention with a long-acting contraceptive for added protection against unplanned pregnancy.

Different role of the ventral medial prefrontal cortex on modulation of innate and associative learned fear.

PubMed

Lisboa, S F; Stecchini, M F; Corrêa, F M A; Guimarães, F S; Resstel, L B M

2010-12-15

Reversible inactivation of the ventral portion of medial prefrontal cortex (vMPFC) of the rat brain has been shown to induce anxiolytic-like effects in animal models based on associative learning. The role of this brain region in situations involving innate fear, however, is still poorly understood, with several contradictory results in the literature. The objective of the present work was to verify in male Wistar rats the effects of vMPFC administration of cobalt chloride (CoCl(2)), a selective inhibitor of synaptic activity, in rats submitted to two models based on innate fear, the elevated plus-maze (EPM) and light-dark box (LDB), comparing the results with those obtained in two models involving associative learning, the contextual fear conditioning (CFC) and Vogel conflict (VCT) tests. The results showed that, whereas CoCl(2) induced anxiolytic-like effects in the CFC and VCT tests, it enhanced anxiety in rats submitted to the EPM and LDB. Together these results indicate that the vMPFC plays an important but complex role in the modulation of defensive-related behaviors, which seems to depend on the nature of the anxiety/fear inducing stimuli. Copyright © 2010 IBRO. Published by Elsevier Ltd. All rights reserved.

Uptake contexts and perceived impacts of HIV testing and counselling among adults in East and Southern Africa: A meta-ethnographic review.

PubMed

Witzel, T Charles; Lora, Wezzie; Lees, Shelley; Desmond, Nicola

2017-01-01

HIV testing and counselling (HTC) interventions are key to controlling the HIV epidemic in East and Southern Africa where HTC is primarily delivered through voluntary counselling and testing (VCT), provider initiated testing and counselling (PITC), and home-based counselling and testing (HBVCT). Decision making processes around uptake of HTC models must be taken into account when designing new interventions. Counselling in HTC aims to reduce post-test risk taking behaviour and to link individuals to care but its efficacy is unclear. This meta-ethnography aims to understand the contexts of HTC uptake in East and Southern Africa and to analyse the perceived impacts of counselling-based interventions in relation to sexual behaviour and linkage to care. We conducted a systematic literature review of studies investigating HTC in East and Southern Africa from 2003 -April 2014. The search and additional snowballing identified 20 studies that fit our selection criteria. These studies were synthesised through a thematic framework analysis. Twenty qualitative and mixed-methods studies examining impacts of HTC models in East and Southern Africa were meta-synthesised. VCT decisions were made individually while HBVCT decisions were located in family and community units. PITC was associated with coercion from healthcare providers. Low quality counselling components and multiple-intersecting barriers faced by individuals mean that counselling in HTC was not perceived to be effective in reducing post-test risk behaviour and had limited perceived effect in facilitating linkage to care. HBVCT is associated with minimal stigma and should be considered as an area of priority. Counselling components in HTC interventions were effective in transmitting information about HIV and sexual risk, but were perceived as ineffective in addressing the broader personal circumstances preventing sexual behaviour change and modulating access to care.

CT image electron density quantification in regions with metal implants: implications for radiotherapy treatment planning

NASA Astrophysics Data System (ADS)

Jechel, Christopher Alexander

In radiotherapy planning, computed tomography (CT) images are used to quantify the electron density of tissues and provide spatial anatomical information. Treatment planning systems use these data to calculate the expected spatial distribution of absorbed dose in a patient. CT imaging is complicated by the presence of metal implants which cause increased image noise, produce artifacts throughout the image and can exceed the available range of CT number values within the implant, perturbing electron density estimates in the image. Furthermore, current dose calculation algorithms do not accurately model radiation transport at metal-tissue interfaces. Combined, these issues adversely affect the accuracy of dose calculations in the vicinity of metal implants. As the number of patients with orthopedic and dental implants grows, so does the need to deliver safe and effective radiotherapy treatments in the presence of implants. The Medical Physics group at the Cancer Centre of Southeastern Ontario and Queen's University has developed a Cobalt-60 CT system that is relatively insensitive to metal artifacts due to the high energy, nearly monoenergetic Cobalt-60 photon beam. Kilovoltage CT (kVCT) images, including images corrected using a commercial metal artifact reduction tool, were compared to Cobalt-60 CT images throughout the treatment planning process, from initial imaging through to dose calculation. An effective metal artifact reduction algorithm was also implemented for the Cobalt-60 CT system. Electron density maps derived from the same kVCT and Cobalt-60 CT images indicated the impact of image artifacts on estimates of photon attenuation for treatment planning applications. Measurements showed that truncation of CT number data in kVCT images produced significant mischaracterization of the electron density of metals. Dose measurements downstream of metal inserts in a water phantom were compared to dose data calculated using CT images from kVCT and Cobalt-60 systems with and without artifact correction. The superior accuracy of electron density data derived from Cobalt-60 images compared to kVCT images produced calculated dose with far better agreement with measured results. These results indicated that dose calculation errors from metal image artifacts are primarily due to misrepresentation of electron density within metals rather than artifacts surrounding the implants.

The use of megavoltage CT (MVCT) images for dose recomputations

NASA Astrophysics Data System (ADS)

Langen, K. M.; Meeks, S. L.; Poole, D. O.; Wagner, T. H.; Willoughby, T. R.; Kupelian, P. A.; Ruchala, K. J.; Haimerl, J.; Olivera, G. H.

2005-09-01

Megavoltage CT (MVCT) images of patients are acquired daily on a helical tomotherapy unit (TomoTherapy, Inc., Madison, WI). While these images are used primarily for patient alignment, they can also be used to recalculate the treatment plan for the patient anatomy of the day. The use of MVCT images for dose computations requires a reliable CT number to electron density calibration curve. In this work, we tested the stability of the MVCT numbers by determining the variation of this calibration with spatial arrangement of the phantom, time and MVCT acquisition parameters. The two calibration curves that represent the largest variations were applied to six clinical MVCT images for recalculations to test for dosimetric uncertainties. Among the six cases tested, the largest difference in any of the dosimetric endpoints was 3.1% but more typically the dosimetric endpoints varied by less than 2%. Using an average CT to electron density calibration and a thorax phantom, a series of end-to-end tests were run. Using a rigid phantom, recalculated dose volume histograms (DVHs) were compared with plan DVHs. Using a deformed phantom, recalculated point dose variations were compared with measurements. The MVCT field of view is limited and the image space outside this field of view can be filled in with information from the planning kVCT. This merging technique was tested for a rigid phantom. Finally, the influence of the MVCT slice thickness on the dose recalculation was investigated. The dosimetric differences observed in all phantom tests were within the range of dosimetric uncertainties observed due to variations in the calibration curve. The use of MVCT images allows the assessment of daily dose distributions with an accuracy that is similar to that of the initial kVCT dose calculation.

Quantitation of clinical feedback on image quality differences between two CT scanner models.

PubMed

Bache, Steven T; Stauduhar, Paul J; Liu, Xinming; Loyer, Evelyne M; John, Rong X

2017-03-01

The aim of this work was to quantitate differences in image quality between two GE CT scanner models - the LightSpeed VCT ("VCT") and Discovery HD750 ("HD") - based upon feedback from radiologists at our institution. First, 3 yrs of daily QC images of the manufacturer-provided QC phantom from 10 scanners - five of each model - were analyzed for both noise magnitude, measured as CT-number standard deviation, and noise power spectrum within the uniform water section. The same phantom was then scanned on four of each model and analyzed for low contrast detectability (LCD) using a built-in LCD tool at the scanner console. An anthropomorphic phantom was scanned using the same eight scanners. A slice within the abdomen section was chosen and three ROIs were placed in regions representing liver, stomach, and spleen. Both standard deviation of CT-number and LCD value was calculated for each image. Noise magnitude was 8.5% higher in HD scanners compared to VCT scanners. An associated increase in the magnitude of the noise power spectra were also found, but both peak and mean NPS frequency were not different between the two models. VCT scanners outperformed HD scanners with respect to LCD by an average of 13.1% across all scanners and phantoms. Our results agree with radiologist feedback, and necessitate a closer look at our body CT protocols among different scanner models at our institution. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Surveillance of HIV assisted partner services using routine health information systems in Kenya.

PubMed

Cherutich, Peter; Golden, Matthew; Betz, Bourke; Wamuti, Beatrice; Ng'ang'a, Anne; Maingi, Peter; Macharia, Paul; Sambai, Betsy; Abuna, Felix; Bukusi, David; Dunbar, Mathew; Farquhar, Carey

2016-07-20

The utilization of routine health information systems (HIS) for surveillance of assisted partner services (aPS) for HIV in sub-Saharan is sub-optimal, in part due to poor data quality and limited use of information technology. Consequently, little is known about coverage, scope and quality of HIV aPS. Yet, affordable electronic data tools, software and data transmission infrastructure are now widely accessible in sub-Saharan Africa. We designed and implemented a cased-based surveillance system using the HIV testing platform in 18 health facilities in Kenya. The components of this system included an electronic HIV Testing and Counseling (HTC) intake form, data transmission on the Global Systems for Mobile Communication (GSM), and data collection using the Open Data Kit (ODK) platform. We defined rates of new HIV diagnoses, and characterized HIV-infected cases. We also determined the proportion of clients who reported testing for HIV because a) they were notified by a sexual partner b) they were notified by a health provider, or c) they were informed of exposure by another other source. Data collection times were evaluated. Among 4351 clients, HIV prevalence was 14.2 %, ranging from 4.4-25.4 % across facilities. Regardless of other reasons for testing, only 107 (2.5 %) of all participants reported testing after being notified by a health provider or sexual partner. A similar proportion, 1.8 % (79 of 4351), reported partner notification as the only reason for seeking an HIV test. Among 79 clients who reported HIV partner services as the reason for testing, the majority (78.5 %), were notified by their sexual partners. The majority (52.8 %) of HIV-infected patients initiated their HIV testing, and 57.2 % tested in a Voluntary Counseling and Testing (VCT) site co-located in a health facility. Median time for data capture was 4 min (IQR: 3-15), with a longer duration for HIV-infected participants, and there was no reported data loss. aPS surveillance using new technologies is feasible, and could be readily expanded into HIV registries in Kenya and other sub-Saharan countries. Partner services are under-utilized in Kenya but further documentation of coverage and implementation gaps for HIV and aPS services is required.

SU-E-I-17: Evaluation of Commercially Available Extension Plates for the ACR CT Accreditation Phantom

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

Greene-Donnelly, K; Ogden, K

Purpose: To evaluate the impact of commercially available extension plates on Hounsfield Unit (HU) values in the ACR CT accreditation phantom (Model 464, Gammex Inc., Middleton, Wi). The extension plates are intended to improve water HU values in scanners where the traditional solution involves scanning the phantom with an adjacent water or CTDI phantom. Methods: The Model 464 phantom was scanned on 9 different CT scanners at 8 separate sites representing 16 and 64 slice MDCT technology from four CT manufacturers. The phantom was scanned with and without the extension plates (Gammex 464 EXTPLT-KIT) in helical and axial modes. Amore » water phantom was also scanned to verify water HU calibration. Technique was 120 kV tube potential, 350 mAs, and 210 mm display field of view. Slice thickness and reconstruction algorithm were based on site clinical protocols. The widest available beam collimation was used. Regions of interest were drawn on the HU test objects in Module 1 of the phantom and mean values recorded. Results: For all axial mode scans, water HU values were within limits with or without the extension plates. For two scanners (both Lightspeed VCT, GE Medical Systems, Waukesha WI), axial mode bone HU values were above the specified range both with and without the extension plates though they were closer to the specified range with the plates installed. In helical scan mode, two scanners (both GE Lightspeed VCT) had water HU values above the specified range without the plates installed. With the plates installed, the water HU values were within range for all scanners in all scan modes. Conclusion: Using the plates, the Lightspeed VCT scanners passed the water HU test when scanning in helical mode. The benefit of the extension plates was evident in helical mode scanning with GE scanners using a nominal 4 cm beam. Disclosure: The extension plates evaluated in this work were provided free of charge to the authors. The authors have no other financial interest in Gammex Inc.« less

A Randomized Controlled Trial to Promote Long-Term Contraceptive Use Among HIV-Serodiscordant and Concordant Positive Couples in Zambia

PubMed Central

Vwalika, Bellington; Greenberg, Lauren; Ahmed, Yusuf; Vwalika, Cheswa; Chomba, Elwyn; Kilembe, William; Tichacek, Amanda; Allen, Susan

2011-01-01

Abstract Background Countries facing high HIV prevalence often also experience high levels of fertility and low contraceptive use, suggesting high levels of unmet need for contraceptive services. In particular, the unique needs of couples with one or both partners HIV positive are largely missing from many current family planning efforts, which focus on the prevention of pregnancies in the absence of reduction of the risk of HIV and other sexually transmitted infections (STIs). Methods This article presents an examination of contraceptive method uptake among a cohort of HIV serodiscordant and concordant positive study participants in Zambia. Results Baseline contraceptive use was low; however, exposure to a video-based intervention that provided information on contraceptive methods and modeled desirable future planning behaviors dramatically increased the uptake of modern contraceptive methods. Conclusions Including information on family planning in voluntary counseling and testing (VCT) services in addition to tailoring the delivery of family planning information to meet the needs and concerns of HIV-positive women or those with HIV-positive partners is an essential step in the delivery of services and prevention efforts to reduce the transmission of HIV. Family planning and HIV prevention programs should integrate counseling on dual method use, combining condoms for HIV/STI prevention with a long-acting contraceptive for added protection against unplanned pregnancy. PMID:21410332

Clinical Evaluation of Normalized Metal Artifact Reduction in kVCT Using MVCT Prior Images (MVCT-NMAR) for Radiation Therapy Treatment Planning

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

Paudel, Moti Raj, E-mail: mpaudel@ualberta.ca; Mackenzie, Marc; Fallone, B. Gino

Purpose: To evaluate the metal artifacts in diagnostic kilovoltage computed tomography (kVCT) images of patients that are corrected by use of a normalized metal artifact reduction (NMAR) method with megavoltage CT (MVCT) prior images: MVCT-NMAR. Methods and Materials: MVCT-NMAR was applied to images from 5 patients: 3 with dual hip prostheses, 1 with a single hip prosthesis, and 1 with dental fillings. The corrected images were evaluated for visualization of tissue structures and their interfaces and for radiation therapy dose calculations. They were compared against the corresponding images corrected by the commercial orthopedic metal artifact reduction algorithm in a Phillipsmore » CT scanner. Results: The use of MVCT images for correcting kVCT images in the MVCT-NMAR technique greatly reduces metal artifacts, avoids secondary artifacts, and makes patient images more useful for correct dose calculation in radiation therapy. These improvements are significant, provided the MVCT and kVCT images are correctly registered. The remaining and the secondary artifacts (soft tissue blurring, eroded bones, false bones or air pockets, CT number cupping within the metal) present in orthopedic metal artifact reduction corrected images are removed in the MVCT-NMAR corrected images. A large dose reduction was possible outside the planning target volume (eg, 59.2 Gy to 52.5 Gy in pubic bone) when these MVCT-NMAR corrected images were used in TomoTherapy treatment plans without directional blocks for a prostate cancer patient. Conclusions: The use of MVCT-NMAR corrected images in radiation therapy treatment planning could improve the treatment plan quality for patients with metallic implants.« less

Effect of Formula Containing Lactobacillus reuteri DSM 17938 on Fecal Microbiota of Infants Born by Cesarean-Section.

PubMed

Garcia Rodenas, Clara L; Lepage, Melissa; Ngom-Bru, Catherine; Fotiou, Aikaterini; Papagaroufalis, Konstantinos; Berger, Bernard

2016-12-01

Microbiota modulation by probiotics in infants born by cesarean (C)-section is poorly understood. We aimed at assessing the response of C-section-delivered infant microbiota to a formula containing Lactobacillus reuteri Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH (DSM) 17938 and comparing it with that of vaginally delivered infants. Infants delivered by C-section (C) and vaginally (V) were randomized to receive either control formula (CCt, n = 10; VCt, n = 10) or the same formula containing L reuteri (CLr, n = 11; VLr, n = 9) within 72 hours following birth. Stool samples were collected at 2 weeks and 4 months of age. Microbial DNA was extracted, amplified, and pyrosequenced. The phylogenetic profiles of the CLr, VCt, and VLr microbiota were not significantly different at any age but diverged from that of CCt at 2 weeks. Compared with VCt, CCt displayed lower Bifidobacterium and higher Enterobacter, unclassified Enterobacteriaceae, Enterococcus, Clostridium, and unclassified Clostridiaceae relative abundance at 2 weeks, as well as lower Collinsella and higher Enterococcus and Coprococcus abundance at 4 months. The level of most of these taxa was not significantly different between the CLr and the vaginal-delivery groups. Compared with VCt, the only difference observed in VLr microbiota was higher Lactobacillus at the 2 study ages and Coprococcus at 4 months. Our results show that a formula containing L reuteri DSM 17938 does not essentially alter the microbiota in vaginally born infants. In C-section-delivered infants, however, this strain seems to play the role of keystone species by modulating the early development of the microbiota toward the composition found after vaginal delivery.

HIV Risk Perception, Sexual Behavior, and HIV Prevalence among Men-Who-Have-Sex-with-Men at a Community-Based Voluntary Counseling and Testing Center in Kuala Lumpur, Malaysia.

PubMed

Koh, Kwee Choy; Yong, Lit Sin

2014-01-01

We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.6%) medium risk, 11 (30.6%) high risk, and 13 (7.7%) unsure risk). We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk.

Evaluation of normalized metal artifact reduction (NMAR) in kVCT using MVCT prior images for radiotherapy treatment planning.

PubMed

Paudel, M R; Mackenzie, M; Fallone, B G; Rathee, S

2013-08-01

To evaluate the metal artifacts in kilovoltage computed tomography (kVCT) images that are corrected using a normalized metal artifact reduction (NMAR) method with megavoltage CT (MVCT) prior images. Tissue characterization phantoms containing bilateral steel inserts are used in all experiments. Two MVCT images, one without any metal artifact corrections and the other corrected using a modified iterative maximum likelihood polychromatic algorithm for CT (IMPACT) are translated to pseudo-kVCT images. These are then used as prior images without tissue classification in an NMAR technique for correcting the experimental kVCT image. The IMPACT method in MVCT included an additional model for the pair∕triplet production process and the energy dependent response of the MVCT detectors. An experimental kVCT image, without the metal inserts and reconstructed using the filtered back projection (FBP) method, is artificially patched with the known steel inserts to get a reference image. The regular NMAR image containing the steel inserts that uses tissue classified kVCT prior and the NMAR images reconstructed using MVCT priors are compared with the reference image for metal artifact reduction. The Eclipse treatment planning system is used to calculate radiotherapy dose distributions on the corrected images and on the reference image using the Anisotropic Analytical Algorithm with 6 MV parallel opposed 5×10 cm2 fields passing through the bilateral steel inserts, and the results are compared. Gafchromic film is used to measure the actual dose delivered in a plane perpendicular to the beams at the isocenter. The streaking and shading in the NMAR image using tissue classifications are significantly reduced. However, the structures, including metal, are deformed. Some uniform regions appear to have eroded from one side. There is a large variation of attenuation values inside the metal inserts. Similar results are seen in commercially corrected image. Use of MVCT prior images without tissue classification in NMAR significantly reduces these problems. The radiation dose calculated on the reference image is close to the dose measured using the film. Compared to the reference image, the calculated dose difference in the conventional NMAR image, the corrected images using uncorrected MVCT image, and IMPACT corrected MVCT image as priors is ∼15.5%, ∼5%, and ∼2.7%, respectively, at the isocenter. The deformation and erosion of the structures present in regular NMAR corrected images can be largely reduced by using MVCT priors without tissue segmentation. The attenuation value of metal being incorrect, large dose differences relative to the true value can result when using the conventional NMAR image. This difference can be significantly reduced if MVCT images are used as priors. Reduced tissue deformation, better tissue visualization, and correct information about the electron density of the tissues and metals in the artifact corrected images could help delineate the structures better, as well as calculate radiation dose more correctly, thus enhancing the quality of the radiotherapy treatment planning.

Uptake contexts and perceived impacts of HIV testing and counselling among adults in East and Southern Africa: A meta-ethnographic review

PubMed Central

Witzel, T. Charles; Lora, Wezzie; Lees, Shelley; Desmond, Nicola

2017-01-01

Introduction HIV testing and counselling (HTC) interventions are key to controlling the HIV epidemic in East and Southern Africa where HTC is primarily delivered through voluntary counselling and testing (VCT), provider initiated testing and counselling (PITC), and home-based counselling and testing (HBVCT). Decision making processes around uptake of HTC models must be taken into account when designing new interventions. Counselling in HTC aims to reduce post-test risk taking behaviour and to link individuals to care but its efficacy is unclear. This meta-ethnography aims to understand the contexts of HTC uptake in East and Southern Africa and to analyse the perceived impacts of counselling-based interventions in relation to sexual behaviour and linkage to care. Methods We conducted a systematic literature review of studies investigating HTC in East and Southern Africa from 2003 –April 2014. The search and additional snowballing identified 20 studies that fit our selection criteria. These studies were synthesised through a thematic framework analysis. Results Twenty qualitative and mixed-methods studies examining impacts of HTC models in East and Southern Africa were meta-synthesised. VCT decisions were made individually while HBVCT decisions were located in family and community units. PITC was associated with coercion from healthcare providers. Low quality counselling components and multiple-intersecting barriers faced by individuals mean that counselling in HTC was not perceived to be effective in reducing post-test risk behaviour and had limited perceived effect in facilitating linkage to care. Conclusion HBVCT is associated with minimal stigma and should be considered as an area of priority. Counselling components in HTC interventions were effective in transmitting information about HIV and sexual risk, but were perceived as ineffective in addressing the broader personal circumstances preventing sexual behaviour change and modulating access to care. PMID:28207802

Evaluation of normalized metal artifact reduction (NMAR) in kVCT using MVCT prior images for radiotherapy treatment planning

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

Paudel, M. R.; Mackenzie, M.; Rathee, S.

2013-08-15

Purpose: To evaluate the metal artifacts in kilovoltage computed tomography (kVCT) images that are corrected using a normalized metal artifact reduction (NMAR) method with megavoltage CT (MVCT) prior images.Methods: Tissue characterization phantoms containing bilateral steel inserts are used in all experiments. Two MVCT images, one without any metal artifact corrections and the other corrected using a modified iterative maximum likelihood polychromatic algorithm for CT (IMPACT) are translated to pseudo-kVCT images. These are then used as prior images without tissue classification in an NMAR technique for correcting the experimental kVCT image. The IMPACT method in MVCT included an additional model formore » the pair/triplet production process and the energy dependent response of the MVCT detectors. An experimental kVCT image, without the metal inserts and reconstructed using the filtered back projection (FBP) method, is artificially patched with the known steel inserts to get a reference image. The regular NMAR image containing the steel inserts that uses tissue classified kVCT prior and the NMAR images reconstructed using MVCT priors are compared with the reference image for metal artifact reduction. The Eclipse treatment planning system is used to calculate radiotherapy dose distributions on the corrected images and on the reference image using the Anisotropic Analytical Algorithm with 6 MV parallel opposed 5 × 10 cm{sup 2} fields passing through the bilateral steel inserts, and the results are compared. Gafchromic film is used to measure the actual dose delivered in a plane perpendicular to the beams at the isocenter.Results: The streaking and shading in the NMAR image using tissue classifications are significantly reduced. However, the structures, including metal, are deformed. Some uniform regions appear to have eroded from one side. There is a large variation of attenuation values inside the metal inserts. Similar results are seen in commercially corrected image. Use of MVCT prior images without tissue classification in NMAR significantly reduces these problems. The radiation dose calculated on the reference image is close to the dose measured using the film. Compared to the reference image, the calculated dose difference in the conventional NMAR image, the corrected images using uncorrected MVCT image, and IMPACT corrected MVCT image as priors is ∼15.5%, ∼5%, and ∼2.7%, respectively, at the isocenter.Conclusions: The deformation and erosion of the structures present in regular NMAR corrected images can be largely reduced by using MVCT priors without tissue segmentation. The attenuation value of metal being incorrect, large dose differences relative to the true value can result when using the conventional NMAR image. This difference can be significantly reduced if MVCT images are used as priors. Reduced tissue deformation, better tissue visualization, and correct information about the electron density of the tissues and metals in the artifact corrected images could help delineate the structures better, as well as calculate radiation dose more correctly, thus enhancing the quality of the radiotherapy treatment planning.« less

SU-E-T-261: Development of An Automated System to Detect Patient Identification and Positioning Errors Prior to Radiotherapy Treatment

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

Jani, S; Low, D; Lamb, J

2015-06-15

Purpose: To develop a system that can automatically detect patient identification and positioning errors using 3D computed tomography (CT) setup images and kilovoltage CT (kVCT) planning images. Methods: Planning kVCT images were collected for head-and-neck (H&N), pelvis, and spine treatments with corresponding 3D cone-beam CT (CBCT) and megavoltage CT (MVCT) setup images from TrueBeam and TomoTherapy units, respectively. Patient identification errors were simulated by registering setup and planning images from different patients. Positioning errors were simulated by misaligning the setup image by 1cm to 5cm in the six anatomical directions for H&N and pelvis patients. Misalignments for spine treatments weremore » simulated by registering the setup image to adjacent vertebral bodies on the planning kVCT. A body contour of the setup image was used as an initial mask for image comparison. Images were pre-processed by image filtering and air voxel thresholding, and image pairs were assessed using commonly-used image similarity metrics as well as custom -designed metrics. A linear discriminant analysis classifier was trained and tested on the datasets, and misclassification error (MCE), sensitivity, and specificity estimates were generated using 10-fold cross validation. Results: Our workflow produced MCE estimates of 0.7%, 1.7%, and 0% for H&N, pelvis, and spine TomoTherapy images, respectively. Sensitivities and specificities ranged from 98.0% to 100%. MCEs of 3.5%, 2.3%, and 2.1% were obtained for TrueBeam images of the above sites, respectively, with sensitivity and specificity estimates between 96.2% and 98.4%. MCEs for 1cm H&N/pelvis misalignments were 1.3/5.1% and 9.1/8.6% for TomoTherapy and TrueBeam images, respectively. 2cm MCE estimates were 0.4%/1.6% and 3.1/3.2%, respectively. Vertebral misalignment MCEs were 4.8% and 4.9% for TomoTherapy and TrueBeam images, respectively. Conclusion: Patient identification and gross misalignment errors can be robustly and automatically detected using 3D setup images of two imaging modalities across three commonly-treated anatomical sites.« less

Sexually transmitted infections: prevention and management.

PubMed

Jackson, Denis; Dallabetta, Gina; Steen, Richard

2004-02-01

In the early 21st century, STI and HIV have been linked inextricably. Although the focus of this article is STI, some discussion on the diagnosis and management of individuals with HIV infection is necessary. The history of HIV diagnosis in the workplace is checkered. The authors have seen cases of prospective workers being subjected to HIV testing without their knowledge as part of a pre-employment medical examination. If the test came back positive, the men were told that they would not be employed without explanation. This approach is a breech of the human rights of the individual being tested and cannot be condoned. Any HIV testing must be done with the full and informed consent of the individual, with counseling given before and after testing to enable individuals with HIV infection to seek care and protect their families and to give individuals without HIV infection counseling on risk reduction. Men and women who present with an STI are at risk for HIV infection. With increasing options for management and secondary prevention, it is important to recognize people who are at risk. This identification should be done through HIV VCT. The location, funding, and supervision of VCT sites related to workplace populations should be a subject for serious debate. Although fears of mass layoffs after HIV testing largely have been unfounded, it is natural for workers to be fearful, unless there is a clearly articulated policy stating that the company observes and enforces nondiscriminatory practices. The workplace examples show that syndromic STI management, allied to comprehensive prevention programs, can have a genuine and measurable impact on STI prevalence. The potential interventions and partners are listed in Table 2. A community-based, randomized study in Tanzania showed that the institution of a well-managed STI syndromic management program can reduce HIV incidence by up to 40%, in the context of a rising HIV epidemic. Presumptive STI treatment for female sex workers (see Box 1) may prove useful as a short-term measure to reduce high STI prevalence rates while more sustainable preventive and curative services are established. The laboratory diagnosis of STIs remains problematic in the face of commonly available technologies of limited sensitivity and specificity and often substandard quality-assurance practices. For these and other reasons, syndromic management became the recommended strategy for treating STIs. The availability of rapid, accurate, and inexpensive diagnostics, especially for cervical infections for women, would alter management recommendations. Work is being done by the WHO and others to develop and assess low-cost diagnostics. Managing STIs and altering the behavior that leads to STIs are essential elements of any HIV prevention and management program. The issues surrounding a practical, compassionate, and comprehensive HIV program can be difficult. Numerous publications exist to help program managers navigate these issues and appropriately tailor a program to the needs of individual organizations. Some of these publications are listed in the next section.

Sero-prevalence and associated risk factors for hepatitis C virus infection among voluntary counseling testing and anti retroviral treatment clinic attendants in Adwa hospital, northern Ethiopia.

PubMed

Atsbaha, Ataklti Hailu; Asmelash Dejen, Tsehaye; Belodu, Rashmi; Getachew, Konjit; Saravanan, Muthupandian; Wasihun, Araya Gebreyesus

2016-02-23

Hepatitis C virus (HCV) is a major health concern where about 3% of the world's population is infected globally. In Ethiopia the prevalence ranges from 0.9 to 1.3% in the general populations. Human immune deficiency virus (HIV) patients due to their weak immune response are heavily affected by the virus. There is no data on magnitude and associated risk factors for HCV infection among voluntary counseling, testing center and anti retroviral treatment clinic Attendants in the study area. Therefore, the aim of this study was to determine the sero-prevalence and associated risk factors for HCV infection among voluntary counseling testing and anti retroviral treatment clinic attendants Adwa general hospital. Cross sectional study was carried out among 302 participants (151 HIV-negative from VCT and 151 HIV-positive from ART follow up) clinics of Adwa hospital from September to December, 2014. About 5 ml of venous blood samples were collected from study participants for anti HCV antibody tests. Univariate analyses were used to identify associated variables with anti HCV positivity. Variables having p < 0.05 were considered as statistically significant association. Out of the total 302 participants, 52.6% of them were females and 47.4% males. The mean age of the participants was 34.1 year (SD ± 10.5). The overall sero-prevalence of HCV in this study was 4.3%. The prevalence HCV (6.6%) was higher among the ART clinic attendants than the VCT (2%) clinic attendants. History of hospitalization (p = 0.001), tooth extraction (p = 0.018) and blood transfusion (p = 0.041) showed statistically significant association with anti-HCV antibody. HCV sero-prevalence in this study was high. The prevalence was three fold higher among HIV positive patients than their counter parts. Thus, screening of HCV should be done among HIV patients for close monitoring and better management in HIV patients.

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

Paudel, M; currently at University of Toronto, Sunnybrook Health Sciences Center, Toronto, ON; MacKenzie, M

Purpose: High density/high atomic number metallic objects create shading and streaking metal artifacts in the CT image that can cause inaccurate delineation of anatomical structures or inaccurate radiation dose calculation. A modified iterative maximum-likelihood polychromatic algorithm for CT (mIMPACT) that models the energy response of detectors, photon interaction processes and beam polychromaticity has successfully reduced metal artifacts in MVCT. Our extension of mIMPACT in kVCT did not significantly reduce metal artifacts for high density metal like steel. We hypothesize that photon starvation may result in the measured data in a commercial kVCT imaging beam. Methods: We measured attenuation of amore » range of steel plate thicknesses, sandwiched between two 12cm thick solid water blocks, using a Phillips Big Bore CTTM scanner in scout acquisition mode with 120kVp and 200mAs. The transmitted signal (y) was normalized to the air scan signal (y{sub 0}) to get attenuation [i.e., ln(y/y{sub 0})] data for a detector. Results: Below steel plate thickness of 13.4mm, the variations in measured attenuation as a function of view number are characterized by a quantum noise and show increased attenuation with metal thickness. On or above this thickness the attenuation shows discrete levels in addition to the quantum noise. Some views have saturated attenuation value. The histograms of the measured attenuation for up to 36.7mm of steel show this trend. The detector signal is so small that the quantization levels in the analog to digital (A-to-D) converter are visible, a clear indication of photon starvation. Conclusion: Photons reaching the kVCT detector after passing through a thick metal plate are either so low in number that the signal measured has large quantum noise, or are completely absorbed inside the plate creating photon starvation. This is un-interpretable by the mIMPACT algorithm and cannot reduce metal artifacts in kVCT for certain realistic thicknesses of steel hip implants. Moti Raj Paudel is supported by the Vanier Canada Graduate Scholarship, the Endowed Graduate Scholarship in Oncology and the Dissertation Fellowship at the University of Alberta. The authors acknowledge the CIHR operating grant number MOP 53254.« less

SU-G-IeP2-12: The Effect of Iterative Reconstruction and CT Tube Voltage On Hounsfield Unit Values of Iodinated Contrast

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

Ogden, K; Greene-Donnelly, K; Vallabhaneni, D

Purpose: To investigate the effects of changing iterative reconstruction strength and tube voltage on Hounsfield Unit (HU) values of varying concentrations of Iodinated contrast medium in a phantom. Method: Iodinated contrast (Omnipaque 300, GE Healthcare, Princeton NJ) was diluted with distilled water to concentrations of 0.6, 0.9, 1.8, 3.6, 7.2, and 10.8 mg/mL of Iodine. The solutions were scanned in a patient equivalent water phantom on two MDCT scanners: VCT 64 slice (GE Medical Systems, Waukesha, WI) and an Aquilion One 320 slice scanner (Toshiba America Medical Systems, Tustin CA). The phantom was scanned at 80, 100, 120, 140 kVmore » using 400, 255, 180, and 130 mAs, respectively, for the VCT scanner, and 80, 100, 120, and 135 kV using 400, 250, 200, and 150 mAs, respectively, on the Aquilion One. Images were reconstructed at 2.5 mm (VCT) and 0.5 mm (Aquilion One). The VCT images were reconstructed using Advanced Statistical Iterative Reconstruction (ASIR) at 6 different strengths: 0%, 20%, 40%, 60%, 80%, and 100%. Aquilion One images were reconstructed using Adaptive Iterative Dose Reduction (AIDR) at 4 strengths: no AIDR, Weak AIDR, Standard AIDR, and Strong AIDR. Regions of interest (ROIs) were drawn on the images to measure the HU values and standard deviations of the diluted contrast. Second order polynomials were used to fit the HU values as a function of Iodine concentration. Results: For both scanners, there was no significant effect of changing the iterative reconstruction strength. The polynomial fits yielded goodness-of-fit (R2) values averaging 0.997. Conclusion: Changing the strength of the iterative reconstruction has no significant effect on the HU values of Iodinated contrast in a tissue-equivalent phantom. Fit values of HU vs Iodine concentration are useful in quantitative imaging protocols such as the determination of cardiac output from time-density curves in the main pulmonary artery.« less

HIV incidence, risk factors, and motivation for biomedical intervention among gay, bisexual men, and transgender persons in Northern Thailand.

PubMed

Chariyalertsak, Suwat; Kosachunhanan, Natthapol; Saokhieo, Pongpun; Songsupa, Radchanok; Wongthanee, Antika; Chariyalertsak, Chonlisa; Visarutratana, Surasing; Beyrer, Chris

2011-01-01

HIV prevalence among men who have sex with men (MSM) and transgender (TG) persons is high and increasing in Chiang Mai, northern Thailand. To describe demographic, socioeconomic, sexual behavior and interest in future HIV prevention trials among gay and bisexual MSM and TG presenting for HIV testing (VCT) and pre-screening for the iPrEx pre-exposure chemoprophylaxis trail. In 2008-09, MSM/TG participants attending VCT were interviewed and tested for HIV and STI. Univariate and multivariate regression analyses were done to assess associations with HIV infection. A total of 551 MSM clients (56.1% gay, 25.4% TG, and 18.5% bisexual (BS)) were enrolled. The mean age was 23.9 years. HIV prevalence among MSM overall was 12.9% (71/551); 16.5% among gay men, 9.3% among TG, and 6.9% among BS. Consistent use of condom was low, 33.3% in insertive anal sex and 31.9% in receptive anal sex. Interest in participation was high, 86.3% for PrEP, 69.7% for HIV vaccine trials, but 29.9% for circumcision. HIV was independently associated with being gay identified, aOR 2.8, p = 0.037 and with being aged 25-29, aOR 2.7, p = 0.027. Among repeat testers, HIV incidence was 8.2/100 PY, 95% CI, 3.7/100PY to 18.3/100PY. HIV risks and rates varied by self-reported sexual orientation and gender identity. HIV was associated with sexual practices, age, and being gay-identified. These are populations are in need of novel prevention strategies and willing to participate in prevention research.

HIV Incidence, Risk Factors, and Motivation for Biomedical Intervention among Gay, Bisexual Men, and Transgender Persons in Northern Thailand

PubMed Central

Chariyalertsak, Suwat; Kosachunhanan, Natthapol; Saokhieo, Pongpun; Songsupa, Radchanok; Wongthanee, Antika; Chariyalertsak, Chonlisa; Visarutratana, Surasing; Beyrer, Chris

2011-01-01

Background HIV prevalence among men who have sex with men (MSM) and transgender (TG) persons is high and increasing in Chiang Mai, northern Thailand. Objectives To describe demographic, socioeconomic, sexual behavior and interest in future HIV prevention trials among gay and bisexual MSM and TG presenting for HIV testing (VCT) and pre-screening for the iPrEx pre-exposure chemoprophylaxis trail. Methods In 2008–09, MSM/TG participants attending VCT were interviewed and tested for HIV and STI. Univariate and multivariate regression analyses were done to assess associations with HIV infection. Results A total of 551 MSM clients (56.1% gay, 25.4% TG, and 18.5% bisexual (BS)) were enrolled. The mean age was 23.9 years. HIV prevalence among MSM overall was 12.9% (71/551); 16.5% among gay men, 9.3% among TG, and 6.9% among BS. Consistent use of condom was low, 33.3% in insertive anal sex and 31.9% in receptive anal sex. Interest in participation was high, 86.3% for PrEP, 69.7% for HIV vaccine trials, but 29.9% for circumcision. HIV was independently associated with being gay identified, aOR 2.8, p = 0.037 and with being aged 25–29, aOR 2.7, p = 0.027. Among repeat testers, HIV incidence was 8.2/100 PY, 95% CI, 3.7/100PY to 18.3/100PY. Conclusion HIV risks and rates varied by self-reported sexual orientation and gender identity. HIV was associated with sexual practices, age, and being gay-identified. These are populations are in need of novel prevention strategies and willing to participate in prevention research. PMID:21931673

A cross-sectional study of HIV and syphilis infections among male students who have sex with men (MSM) in northeast China: implications for implementing HIV screening and intervention programs

PubMed Central

2011-01-01

Background China has 76.2 million high school and college students, in which the number of reported HIV/AIDS cases is increasing rapidly. Most of these cases are attributed to male-to-male sexual contact. Few studies have explored HIV prevalence and behavioural characteristics of Chinese male students who have sex with men (MSM). Methods A cross-sectional study of MSM high school and college students in Liaoning Province was conducted. Data were collected through face-to-face interviews and blood specimens were obtained and tested for HIV and syphilis. Results There were 436 eligible participants. HIV and syphilis prevalence was 3.0% and 5.0%, respectively. In multivariate analysis, sexual orientation known by family members (OR: 7.3; 95% CI: 1.5-34.6), HIV/AIDS information obtained from clinical doctors (OR: 6.7; 95% CI: 1.7-25.9), HIV/AIDS information obtained through free educational services and materials such as voluntary counseling and testing (VCT) and condom distribution services (OR: 0.2; 95% CI: 0.4-1.0), inconsistent condom use (OR: 5.7; 95%: 1.3-25.3), sexual partner experienced anal bleeding after insertive anal intercourse (OR: 6.8; 95% CI: 1.6-28.4), and history of illegal drug use (OR: 18.9; 95% CI: 2.2-165.3) were found to be significantly associated with HIV infection. Conclusions Greater effort should be made towards stemming the HIV and syphilis epidemics among Chinese student MSM. Immediate screening and comprehensive interventions towards student MSM should be implemented in order to curb the spread of HIV. Family and school-based interventions should be considered to target this educated, yet vulnerable, population. PMID:21554742

Metal artifact suppression in megavoltage computed tomography

NASA Astrophysics Data System (ADS)

Schreiner, L. John; Rogers, Myron; Salomons, Greg; Kerr, Andrew

2005-04-01

There has been considerable interest in megavoltage CT (MVCT) imaging associated with the development of image guided radiation therapy. It is clear that MVCT can provide good image quality for patient setup verification with soft tissue contrast much better than noted in conventional megavoltage portal imaging. In addition, it has been observed that MVCT images exhibit considerably reduced artifacts surrounding metal implants (e.g., surgical clips, hip implants, dental fillings) compared to conventional diagnostic CT images (kVCT). When encountered, these artifacts greatly limit the usefulness of kVCT images, and a variety of solutions have been proposed to remove the artifacts, but these have met with only partial success. In this paper, we investigate the potential for CT imaging in regions surrounding metal implants using high-energy photons from a Cobalt-60 source and from a 4 MV linear accelerator. MVCT and kVCT images of contrast phantoms and a phantom containing a hip prosthesis are compared and analysed. We show that MVCT scans provide good fidelity for CT number quantification in the high-density regions of the images, and in the regions immediately adjacent to the metal implants. They also provide structural details within the high-density inserts and implants. Calculations will show that practical clinical MVCT imaging, able to detect 3% contrast objects, should be achievable with doses of about 2.5cGy. This suggests that MVCT not only has a role in radiotherapy treatment planning and guidance, but may also be indicated for surgical guidance and follow-up in regions where metal implants cannot be avoided.

Combination of CT scanning and fluoroscopy imaging on a flat-panel CT scanner

NASA Astrophysics Data System (ADS)

Grasruck, M.; Gupta, R.; Reichardt, B.; Suess, Ch.; Schmidt, B.; Stierstorfer, K.; Popescu, S.; Brady, T.; Flohr, T.

2006-03-01

We developed and evaluated a prototype flat-panel detector based Volume CT (fpVCT) scanner. The fpVCT scanner consists of a Varian 4030CB a-Si flat-panel detector mounted in a multi slice CT-gantry (Siemens Medical Solutions). It provides a 25 cm field of view with 18 cm z-coverage at the isocenter. In addition to the standard tomographic scanning, fpVCT allows two new scan modes: (1) fluoroscopic imaging from any arbitrary rotation angle, and (2) continuous, time-resolved tomographic scanning of a dynamically changing viewing volume. Fluoroscopic imaging is feasible by modifying the standard CT gantry so that the imaging chain can be oriented along any user-selected rotation angle. Scanning with a stationary gantry, after it has been oriented, is equivalent to a conventional fluoroscopic examination. This scan mode enables combined use of high-resolution tomography and real-time fluoroscopy with a clinically usable field of view in the z direction. The second scan mode allows continuous observation of a timeevolving process such as perfusion. The gantry can be continuously rotated for up to 80 sec, with the rotation time ranging from 3 to 20 sec, to gather projection images of a dynamic process. The projection data, that provides a temporal log of the viewing volume, is then converted into multiple image stacks that capture the temporal evolution of a dynamic process. Studies using phantoms, ex vivo specimens, and live animals have confirmed that these new scanning modes are clinically usable and offer a unique view of the anatomy and physiology that heretofore has not been feasible using static CT scanning. At the current level of image quality and temporal resolution, several clinical applications such a dynamic angiography, tumor enhancement pattern and vascularity studies, organ perfusion, and interventional applications are in reach.

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

Paudel, M; currently at University of Toronto, Sunnybrook Health Sciences Center, Toronto, ON; MacKenzie, M

Purpose: To evaluate the metal artifacts in diagnostic kVCT images of patients that are corrected using a normalized metal artifact reduction method with MVCT prior images, MVCT-NMAR. Methods: An MVCTNMAR algorithm was developed and applied to five patients: three with bilateral hip prostheses, one with unilateral hip prosthesis and one with dental fillings. The corrected images were evaluated for visualization of tissue structures and their interfaces, and for radiotherapy dose calculations. They were also compared against the corresponding images corrected by a commercial metal artifact reduction technique, O-MAR, on a Phillips™ CT scanner. Results: The use of MVCT images formore » correcting kVCT images in the MVCT-NMAR technique greatly reduces metal artifacts, avoids secondary artifacts, and makes patient images more useful for correct dose calculation in radiotherapy. These improvements are significant over the commercial correction method, provided the MVCT and kVCT images are correctly registered. The remaining and the secondary artifacts (soft tissue blurring, eroded bones, false bones or air pockets, CT number cupping within the metal) present in O-MAR corrected images are removed in the MVCT-NMAR corrected images. Large dose reduction is possible outside the planning target volume (e.g., 59.2 Gy in comparison to 52.5 Gy in pubic bone) when these MVCT-NMAR corrected images are used in TomoTherapy™ treatment plans, as the corrected images no longer require directional blocks for prostate plans in order to avoid the image artifact regions. Conclusion: The use of MVCT-NMAR corrected images in radiotherapy treatment planning could improve the treatment plan quality for cancer patients with metallic implants. Moti Raj Paudel is supported by the Vanier Canada Graduate Scholarship, the Endowed Graduate Scholarship in Oncology and the Dissertation Fellowship at the University of Alberta. The authors acknowledge the CIHR operating grant number MOP 53254.« less

Automatic contour propagation using deformable image registration to determine delivered dose to spinal cord in head-and-neck cancer radiotherapy.

PubMed

Yeap, P L; Noble, D J; Harrison, K; Bates, A M; Burnet, N G; Jena, R; Romanchikova, M; Sutcliffe, M P F; Thomas, S J; Barnett, G C; Benson, R J; Jefferies, S J; Parker, M A

2017-07-12

To determine delivered dose to the spinal cord, a technique has been developed to propagate manual contours from kilovoltage computed-tomography (kVCT) scans for treatment planning to megavoltage computed-tomography (MVCT) guidance scans. The technique uses the Elastix software to perform intensity-based deformable image registration of each kVCT scan to the associated MVCT scans. The registration transform is then applied to contours of the spinal cord drawn manually on the kVCT scan, to obtain contour positions on the MVCT scans. Different registration strategies have been investigated, with performance evaluated by comparing the resulting auto-contours with manual contours, drawn by oncologists. The comparison metrics include the conformity index (CI), and the distance between centres (DBC). With optimised registration, auto-contours generally agree well with manual contours. Considering all 30 MVCT scans for each of three patients, the median CI is [Formula: see text], and the median DBC is ([Formula: see text]) mm. An intra-observer comparison for the same scans gives a median CI of [Formula: see text] and a DBC of ([Formula: see text]) mm. Good levels of conformity are also obtained when auto-contours are compared with manual contours from one observer for a single MVCT scan for each of 30 patients, and when they are compared with manual contours from six observers for two MVCT scans for each of three patients. Using the auto-contours to estimate organ position at treatment time, a preliminary study of 33 patients who underwent radiotherapy for head-and-neck cancers indicates good agreement between planned and delivered dose to the spinal cord.

Automatic contour propagation using deformable image registration to determine delivered dose to spinal cord in head-and-neck cancer radiotherapy

NASA Astrophysics Data System (ADS)

Yeap, P. L.; Noble, D. J.; Harrison, K.; Bates, A. M.; Burnet, N. G.; Jena, R.; Romanchikova, M.; Sutcliffe, M. P. F.; Thomas, S. J.; Barnett, G. C.; Benson, R. J.; Jefferies, S. J.; Parker, M. A.

2017-08-01

To determine delivered dose to the spinal cord, a technique has been developed to propagate manual contours from kilovoltage computed-tomography (kVCT) scans for treatment planning to megavoltage computed-tomography (MVCT) guidance scans. The technique uses the Elastix software to perform intensity-based deformable image registration of each kVCT scan to the associated MVCT scans. The registration transform is then applied to contours of the spinal cord drawn manually on the kVCT scan, to obtain contour positions on the MVCT scans. Different registration strategies have been investigated, with performance evaluated by comparing the resulting auto-contours with manual contours, drawn by oncologists. The comparison metrics include the conformity index (CI), and the distance between centres (DBC). With optimised registration, auto-contours generally agree well with manual contours. Considering all 30 MVCT scans for each of three patients, the median CI is 0.759 +/- 0.003 , and the median DBC is (0.87 +/- 0.01 ) mm. An intra-observer comparison for the same scans gives a median CI of 0.820 +/- 0.002 and a DBC of (0.64 +/- 0.01 ) mm. Good levels of conformity are also obtained when auto-contours are compared with manual contours from one observer for a single MVCT scan for each of 30 patients, and when they are compared with manual contours from six observers for two MVCT scans for each of three patients. Using the auto-contours to estimate organ position at treatment time, a preliminary study of 33 patients who underwent radiotherapy for head-and-neck cancers indicates good agreement between planned and delivered dose to the spinal cord.

[Automated mapping of urban forests' disturbance and recovery in Nanjing, China].

PubMed

Lyu, Ying-ying; Zhuang, Yi-lin; Ren, Xin-yu; Li, Ming-shi; Xu, Wang-gu; Wang, Zhi

2016-02-01

Using Landsat TM/ETM dense time series observations spanning from 1987 to 2011, taking Laoshan forest farm and Purple Mountain as the research objects, the landsat ecosystem disturbance adaptive processing system (Ledaps) algorithm was used to generate surface reflectance datasets, which were fed to the vegetation change tracker model (VCT) model to derive urban forest disturbance and recovery products over Nanjing, followed by an intensive validation of the products. The results showed that there was a relatively high spatial agreement for forest disturbance products mapped by VCT, ranging from 65.4% to 95.0%. There was an apparent fluctuating forest disturbance and recovery rate over time, and the change trend of forest disturbance occurring at the two sites was roughly similar, but forest recovery was obviously different. Forest coverage in Purple Mountain was less than that in Laoshan forest farm, but the forest disturbance and recovery rates in Laoshan forest farm were larger than those in Purple Mountain.

Barriers and facilitators for men to attend prenatal care and obtain HIV voluntary counseling and testing in Brazil.

PubMed

Yeganeh, Nava; Simon, Mariana; Mindry, Deborah; Nielsen-Saines, Karin; Chaves, Maria Cristina; Santos, Breno; Melo, Marineide; Mendoza, Brenna; Gorbach, Pamina

2017-01-01

Providing HIV voluntary counseling and testing (VCT) to men who attend their partner's prenatal care is an intervention with potential to reduce HIV transmission to women and infants during the vulnerable period of pregnancy. Little is known about the acceptability of this intervention in global settings outside of Africa. We conducted in-depth qualitative interviews to evaluate potential barriers and facilitators to prenatal care attendance for HIV VCT with 20 men who did and 15 men who did not attend prenatal care with their partners at Hospital Conceiçao in Porto Alegre, Brazil. Men were recruited at the labor and delivery unit at Hospital Conceiçao via a scripted invitation while visiting their newborn infant. Interviews lasted from 35-55 minutes and were conducted in Portuguese by a local resident trained extensively in qualitative methods. All interviews were transcribed verbatim, translated, and then analyzed using Atlast.ti software. An analysis of themes was then conducted using direct quotes and statements. We applied and adapted the AIDS Risk Reduction Theoretical Model and HIV Testing Decisions Model to the qualitative data to identify themes in the 35 interviews. If offered HIV testing during prenatal care, all men in both groups stated they would accept this intervention. Yet, individual, relationship and systemic factors were identified that affect these Brazilian men's decision to attend prenatal care, informing our final conceptual model. The men interviewed had a general understanding of the value of HIV prevention of mother to child transmission. They also described open and communicative relationships with their significant others and displayed a high level of enthusiasm towards optimizing the health of their expanding family. The major barriers to attending prenatal care included perceived stigma against HIV infected individuals, men's lack of involvement in planning of the pregnancy as well as inconvenient scheduling of prenatal care, due to conflicting work schedules. Brazilian men displayed high levels of HIV-related knowledge as well as open communication about HIV testing; especially when compared to findings from African studies. Future efforts should reorient prenatal care towards providing care to the entire family with a clear focus on protecting the infant from preventable diseases. Formally inviting men to prenatal care and providing them an acceptable medical excuse from work may enhance male involvement.

Barriers and facilitators for men to attend prenatal care and obtain HIV voluntary counseling and testing in Brazil

PubMed Central

Simon, Mariana; Mindry, Deborah; Nielsen-Saines, Karin; Chaves, Maria Cristina; Santos, Breno; Melo, Marineide; Mendoza, Brenna; Gorbach, Pamina

2017-01-01

Background Providing HIV voluntary counseling and testing (VCT) to men who attend their partner's prenatal care is an intervention with potential to reduce HIV transmission to women and infants during the vulnerable period of pregnancy. Little is known about the acceptability of this intervention in global settings outside of Africa. Methods We conducted in-depth qualitative interviews to evaluate potential barriers and facilitators to prenatal care attendance for HIV VCT with 20 men who did and 15 men who did not attend prenatal care with their partners at Hospital Conceiçao in Porto Alegre, Brazil. Men were recruited at the labor and delivery unit at Hospital Conceiçao via a scripted invitation while visiting their newborn infant. Interviews lasted from 35–55 minutes and were conducted in Portuguese by a local resident trained extensively in qualitative methods. All interviews were transcribed verbatim, translated, and then analyzed using Atlast.ti software. An analysis of themes was then conducted using direct quotes and statements. We applied and adapted the AIDS Risk Reduction Theoretical Model and HIV Testing Decisions Model to the qualitative data to identify themes in the 35 interviews. Results If offered HIV testing during prenatal care, all men in both groups stated they would accept this intervention. Yet, individual, relationship and systemic factors were identified that affect these Brazilian men's decision to attend prenatal care, informing our final conceptual model. The men interviewed had a general understanding of the value of HIV prevention of mother to child transmission. They also described open and communicative relationships with their significant others and displayed a high level of enthusiasm towards optimizing the health of their expanding family. The major barriers to attending prenatal care included perceived stigma against HIV infected individuals, men’s lack of involvement in planning of the pregnancy as well as inconvenient scheduling of prenatal care, due to conflicting work schedules. Conclusions Brazilian men displayed high levels of HIV-related knowledge as well as open communication about HIV testing; especially when compared to findings from African studies. Future efforts should reorient prenatal care towards providing care to the entire family with a clear focus on protecting the infant from preventable diseases. Formally inviting men to prenatal care and providing them an acceptable medical excuse from work may enhance male involvement. PMID:28414738

Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa.

PubMed

de Mello Schier, Alexandre R; de Oliveira Ribeiro, Natalia P; Coutinho, Danielle S; Machado, Sergio; Arias-Carrión, Oscar; Crippa, Jose A; Zuardi, Antonio W; Nardi, Antonio E; Silva, Adriana C

2014-01-01

Anxiety and depression are pathologies that affect human beings in many aspects of life, including social life, productivity and health. Cannabidiol (CBD) is a constituent non-psychotomimetic of Cannabis sativa with great psychiatric potential, including uses as an antidepressant-like and anxiolytic-like compound. The aim of this study is to review studies of animal models using CBD as an anxiolytic-like and antidepressant-like compound. Studies involving animal models, performing a variety of experiments on the above-mentioned disorders, such as the forced swimming test (FST), elevated plus maze (EPM) and Vogel conflict test (VCT), suggest that CBD exhibited an anti-anxiety and antidepressant effects in animal models discussed. Experiments with CBD demonstrated non-activation of neuroreceptors CB1 and CB2. Most of the studies demonstrated a good interaction between CBD and the 5-HT1A neuro-receptor.

Impact evaluation of a sexually transmitted disease preventive intervention among female sex workers in Hohhot, China.

PubMed

Shi, Yuhui; Guo, Shuyi; Bo, Fubao; Zhang, Xingguang; Cao, Wangnan; Wang, Peiyang

2013-01-01

The aim of this study was to evaluate the impact of HIV and sexually transmitted disease (STD) prevention interventions among female sex workers (FSWs) in the city of Hohhot in northern China. Three serial cross-sectional surveys were conducted in 2006, 2007, and 2008 among FSWs. A questionnaire was administered to the FSWs, and HIV and syphilis tests were performed for all participants. Intervention activities including condom promotion and provision, increased condom availability and accessibility, and voluntary HIV counseling and testing (VCT) were carried out among FSWs. There were 624 participants in the 2006 survey, 444 in the 2007 survey, and 451 in the 2008 survey. The United Nations General Assembly Special Session (UNGASS) indicators for FSWs increased from 13.9% in 2006 to 37.7% in 2008 (p<0.001). The average rate of consistent condom use with commercial clients in the month preceding the interview increased significantly from 39.8% in 2006 to 59.6% in 2008 (p<0.001). Not a single HIV-positive case was found among the FSWs over these 3 years, and the prevalence of syphilis decreased remarkably from 9.5% in 2006 to 1.3% in 2008. Logistic regression analysis showed that sauna or hair salon work venues, receiving services from intervention programs, and accepting HIV tests were factors associated with consistent condom use. The findings suggest that consistent condom use and awareness of HIV/AIDS prevention-related knowledge among FSWs have been improved by the intervention. Further prioritized and combined prevention programs aimed at FSWs are needed in order to prevent the HIV/AIDS epidemic spreading in the general population in China. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda.

PubMed

Bunnell, Rebecca; Ekwaru, John Paul; Solberg, Peter; Wamai, Nafuna; Bikaako-Kajura, Winnie; Were, Willy; Coutinho, Alex; Liechty, Cheryl; Madraa, Elizabeth; Rutherford, George; Mermin, Jonathan

2006-01-02

The impact of antiretroviral therapy (ART) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown. To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART. A prospective cohort study was performed in rural Uganda. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, participants' HIV plasma viral load and partner-specific sexual behaviors were assessed. Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated, based on established viral load-specific transmission rates. Six months after initiating ART, risky sexual behavior reduced by 70% [adjusted risk ratio, 0.3; 95% confidence interval (CI), 0.2-0.7; P = 0.0017]. Over 85% of risky sexual acts occurred within married couples. At baseline, median viral load among those reporting risky sex was 122 500 copies/ml, and at follow-up, < 50 copies/ml. Estimated risk of HIV transmission from cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa.

Hydrogel-beta-TCP scaffolds and stem cells for tissue engineering bone.

PubMed

Weinand, Christian; Pomerantseva, Irina; Neville, Craig M; Gupta, Rajiv; Weinberg, Eli; Madisch, Ijad; Shapiro, Frederic; Abukawa, Harutsugi; Troulis, Maria J; Vacanti, Joseph P

2006-04-01

Trabecular bone is a material of choice for reconstruction after trauma and tumor resection and for correction of congenital defects. Autologous bone grafts are available in limited shapes and sizes; significant donor site morbidity is another major disadvantage to this approach. To overcome these limitations, we used a tissue engineering approach to create bone replacements in vitro, combining bone-marrow-derived differentiated mesenchymal stem cells (MSCs) suspended in hydrogels and 3-dimensionally printed (3DP) porous scaffolds made of beta-tricalcium-phosphate (beta-TCP). The scaffolds provided support for the formation of bone tissue in collagen I, fibrin, alginate, and pluronic F127 hydrogels during culturing in oscillating and rotating dynamic conditions. Histological evaluation including toluidine blue, alkaline phosphatase, and von Kossa staining was done at 1, 2, 4, and 6 weeks. Radiographic evaluation and high-resolution volumetric CT (VCT) scanning, expression of bone-specific genes and biomechanical compression testing were performed at 6 weeks. Both culture conditions resulted in similar bone tissue formation. Histologically collagen I and fibrin hydrogels specimens had superior bone tissue, although radiopacities were detected only in collagen I samples. VCT scan revealed density values in all but the Pluronic F127 samples, with Houndsfield unit values comparable to native bone in collagen I and fibrin glue samples. Expression of bone-specific genes was significantly higher in the collagen I samples. Pluronic F127 hydrogel did not support formation of bone tissue. All samples cultured in dynamic oscillating conditions had slightly higher mechanical strength than under rotating conditions. Bone tissue can be successfully formed in vitro using constructs comprised of collagen I hydrogel, MSCs, and porous beta-TCP scaffolds.

Health diplomacy the adaptation of global health interventions to local needs in sub-Saharan Africa and Thailand: Evaluating findings from Project Accept (HPTN 043)

PubMed Central

2012-01-01

Background Study-based global health interventions, especially those that are conducted on an international or multi-site basis, frequently require site-specific adaptations in order to (1) respond to socio-cultural differences in risk determinants, (2) to make interventions more relevant to target population needs, and (3) in recognition of ‘global health diplomacy' issues. We report on the adaptations development, approval and implementation process from the Project Accept voluntary counseling and testing, community mobilization and post-test support services intervention. Methods We reviewed all relevant documentation collected during the study intervention period (e.g. monthly progress reports; bi-annual steering committee presentations) and conducted a series of semi-structured interviews with project directors and between 12 and 23 field staff at each study site in South Africa, Zimbabwe, Thailand and Tanzania during 2009. Respondents were asked to describe (1) the adaptations development and approval process and (2) the most successful site-specific adaptations from the perspective of facilitating intervention implementation. Results Across sites, proposed adaptations were identified by field staff and submitted to project directors for review on a formally planned basis. The cross-site intervention sub-committee then ensured fidelity to the study protocol before approval. Successfully-implemented adaptations included: intervention delivery adaptations (e.g. development of tailored counseling messages for immigrant labour groups in South Africa) political, environmental and infrastructural adaptations (e.g. use of local community centers as VCT venues in Zimbabwe); religious adaptations (e.g. dividing clients by gender in Muslim areas of Tanzania); economic adaptations (e.g. co-provision of income generating skills classes in Zimbabwe); epidemiological adaptations (e.g. provision of ‘youth-friendly’ services in South Africa, Zimbabwe and Tanzania), and social adaptations (e.g. modification of terminology to local dialects in Thailand: and adjustment of service delivery schedules to suit seasonal and daily work schedules across sites). Conclusions Adaptation selection, development and approval during multi-site global health research studies should be a planned process that maintains fidelity to the study protocol. The successful implementation of appropriate site-specific adaptations may have important implications for intervention implementation, from both a service uptake and a global health diplomacy perspective. PMID:22716131

Resource needs and gap analysis in achieving universal access to HIV/AIDS services: a data envelopment analysis of 45 countries.

PubMed

Zeng, Wu; Shepard, Donald S; Avila-Figueroa, Carlos; Ahn, Haksoon

2016-06-01

-To manage the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) epidemic, international donors have pledged unprecedented commitments for needed services. The Joint United Nations Programme on HIV/AIDS (UNAIDS) projected that low- and middle-income countries needed $25 billion to meet the 2010 HIV/AIDS goal of universal access to AIDS prevention and care, using the resource needs model (RNM). -Drawing from the results from its sister study, which used a data envelopment analysis (DEA) and a Tobit model to evaluate and adjust the technical efficiency of 61 countries in delivering HIV/AIDS services from 2002 to 2007, this study extended the DEA and developed an approach to estimate resource needs and decompose the performance gap into efficiency gap and resource gap. In the DEA, we considered national HIV/AIDS spending as the input and volume of voluntary counseling and testing (VCT), prevention of mother to child transmission (PMTCT) and antiretroviral treatment (ART) as the outputs. An input-oriented DEA model was constructed to project resource needs in achieving 2010 HIV/AIDS goal for 45 countries using the data in 2006, assuming that all study countries maximized efficiency. -The DEA approach demonstrated the potential to include efficiency of national HIV/AIDS programmes in resource needs estimation, using macro-level data. Under maximal efficiency, the annual projected resource needs for the 45 countries was $6.3 billion, ∼47% of their UNAIDS estimate of $13.5 billion. Given study countries' spending of $3.9 billion, improving efficiency could narrow the gap from $9.6 to $2.4 billion. The results suggest that along with continued financial commitment to HIV/AIDS, improving the efficiency of HIV/AIDS programmes would accelerate the pace to reach 2010 HIV/AIDS goals. The DEA approach provides a supplement to the AIDS RNM to inform policy making. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Improving automated disturbance maps using snow-covered landsat time series stacks

Treesearch

Kirk M. Stueve; Ian W. Housman; Patrick L. Zimmerman; Mark D. Nelson; Jeremy Webb; Charles H. Perry; Robert A. Chastain; Dale D. Gormanson; Chengquan Huang; Sean P. Healey; Warren B. Cohen

2012-01-01

Snow-covered winter Landsat time series stacks are used to develop a nonforest mask to enhance automated disturbance maps produced by the Vegetation Change Tracker (VCT). This method exploits the enhanced spectral separability between forested and nonforested areas that occurs with sufficient snow cover. This method resulted in significant improvements in Vegetation...

Repeat HIV Testing at Voluntary Testing and Counseling Centers in Croatia: Successful HIV Prevention or Failure to Modify Risk Behaviors?

PubMed Central

Matković Puljić, Vlatka; Kosanović Ličina, Mirjana Lana; Kavić, Marija; Nemeth Blažić, Tatjana

2014-01-01

HIV testing plays a critical role in preventing the spread of the virus and identifying infected individuals in need of care. Voluntary counseling and testing centers (VCTs) not only conduct testing but they also provide counseling. Since a proportion of people who test negative for HIV on their previous visit will return for retesting, the frequency of retesting and the characteristics of those who retest may provide insights into the efficacy of testing and counseling strategies. In this cross-sectional, retrospective study of 1,482 VCT clients in Croatia in 2010, 44.3% had been tested for HIV before. The rate of repeat HIV testing is lower in Croatia than in other countries. Men who have sex with men (MSM) clients, those with three or more sexual partners in the last 12 months, consistent condom users with steady partners, and intravenous drug users were more likely to be repeat testers. This finding suggests that clients presenting for repeat HIV testing are those who self-identify as being at a higher risk of infection. Our data showed that testing positive for HIV was not associated with repeat testing. However, the effects of repeat testing on HIV epidemiology needs to be explored. PMID:24705595

The role of HIV-related knowledge and ethnicity in determining HIV risk perception and willingness to undergo HIV testing among rural women in Burkina Faso.

PubMed

Sarker, Malabika; Milkowski, Andrea; Slanger, Tracy; Gondos, Adam; Sanou, Aboubakary; Kouyate, Bocar; Snow, Rachel

2005-06-01

We conducted a random community based survey of 300 young (15-29 years) rural women in Nouna, Burkina Faso. Only one-third of women were aware that a person could have HIV without having symptoms and these women were significantly more likely to classify themselves to be at high risk for getting HIV. Furthermore, multiple partners, Bwaba ethnicity and having mentioned a health worker as a source of HIV information were significantly associated with perceived high personal risk. Perceived willingness to participate in VCT was high (69%). The dissemination of information on the asymptomatic nature of HIV infection could potentially be very important in forming risk perception, awareness, and their willingness to participate in HIV interventions.

Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya.

PubMed

Muhula, Samuel; Memiah, Peter; Mbau, Lilian; Oruko, Happiness; Baker, Bebora; Ikiara, Geoffrey; Mungai, Margaret; Ndirangu, Meshack; Achwoka, Dunstan; Ilako, Festus

2016-05-04

We examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya. We analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method. Majority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %-6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV. Health facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC.

HIV screening among newly diagnosed TB patients: a cross sectional study in Lima, Peru.

PubMed

Ramírez, Suzanne; Mejía, Fernando; Rojas, Marlene; Seas, Carlos; Van der Stuyft, Patrick; Gotuzzo, Eduardo; Otero, Larissa

2018-03-20

Since 2006, the Peruvian National TB program (NTP) recommends voluntary counseling and testing (VCT) for all tuberculosis (TB) patients. Responding to the differential burden of both diseases in Peru, TB is managed in peripheral health facilities while HIV is managed in referral centers. This study aims to determine the coverage of HIV screening among TB patients and the characteristics of persons not screened. From March 2010 to December 2011 we enrolled new smear-positive pulmonary TB adults in 34 health facilities in a district in Lima. NTP staff offered VCT to all TB patients. Patients with an HIV positive result were referred for confirmation tests and management. We interviewed patients to collect their demographic and clinical characteristics and registered if patients opted in or out of the screening. Of the 1295 enrolled TB patients, nine had a known HIV diagnosis. Of the remaining, 76.1% (979) were screened for HIV. Among the 23.9% (307) not screened, 38.4% (118) opted out of the screening. TB patients at one of the health care facilities of the higher areas of the district (OR = 3.38, CI 95% 2.17-5.28 for the highest area and OR = 2.82, CI 95% 1.78-4.49 for the high area) as well as those reporting illegal drug consumption (OR = 1.65, CI 95% 1.15-2.37) were more likely not to be screened. Twenty-four were HIV positive (1.9% of all patients 1295, or 2.4% of those screened). Of 15 patients diagnosed with HIV during the TB episode, ten were enrolled in an HIV program. The median time between the result of the HIV screening and the first consultation at the HIV program was 82 days (IQR, 32-414). The median time between the result of the HIV screening and antiretroviral initiation was 148.5 days (IQR 32-500). An acceptable proportion of TB patients were screened for HIV in Lima. Referral systems of HIV positive patients should be strengthened for timely ART initiation.

HIV testing of construction workers in the Western Cape, South Africa.

PubMed

Bowen, Paul; Govender, Rajen; Edwards, Peter; Cattell, Keith

2015-01-01

With an infection rate estimated at 14%, the South African construction industry is one of the economic sectors most adversely affected by the HIV/AIDS pandemic. Construction workers are considered a high-risk group. The provision and uptake of voluntary counselling and testing (VCT) is critical to reducing transmission rates. This study examined the testing behaviour of site-based construction workers in terms of demographic and lifestyle risk behaviour characteristics to help inform better strategies for work-based interventions by construction firms. A total of 512 workers drawn from six firms operating on 18 construction sites in the Western Cape province participated in the study. Twenty-seven per cent of the participants reported never having been tested for HIV. Results indicate that females (aOR = 4.45, 95% CI, 1.25-15.82), older workers (aOR = 1.40, 95% CI, 1.08-1.81), permanent workers (aOR = 1.67, 95% CI, 1.11-2.50) and workers whom had previously used a condom (aOR = 1.93, 95% CI, 1.02-3.65) were significantly more likely to have been tested. Ethnicity was not significantly related to prior testing. Identification of these subgroups within the industry has implications for the development of targeted work-based intervention programmes to promote greater HIV testing among construction workers in South Africa.

SU-E-I-23: A General KV Constrained Optimization of CNR for CT Abdominal Imaging

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

Weir, V; Zhang, J

Purpose: While Tube current modulation has been well accepted for CT dose reduction, kV adjusting in clinical settings is still at its early stage. This is mainly due to the limited kV options of most current CT scanners. kV adjusting can potentially reduce radiation dose and optimize image quality. This study is to optimize CT abdomen imaging acquisition based on the assumption of a continuous kV, with the goal to provide the best contrast to noise ratio (CNR). Methods: For a given dose (CTDIvol) level, the CNRs at different kV and pitches were measured with an ACR GAMMEX phantom. Themore » phantom was scanned in a Siemens Sensation 64 scanner and a GE VCT 64 scanner. A constrained mathematical optimization was used to find the kV which led to the highest CNR for the anatomy and pitch setting. Parametric equations were obtained from polynomial fitting of plots of kVs vs CNRs. A suitable constraint region for optimization was chosen. Subsequent optimization yielded a peak CNR at a particular kV for different collimations and pitch setting. Results: The constrained mathematical optimization approach yields kV of 114.83 and 113.46, with CNRs of 1.27 and 1.11 at the pitch of 1.2 and 1.4, respectively, for the Siemens Sensation 64 scanner with the collimation of 32 x 0.625mm. An optimized kV of 134.25 and 1.51 CNR is obtained for a GE VCT 64 slice scanner with a collimation of 32 x 0.625mm and a pitch of 0.969. At 0.516 pitch and 32 x 0.625 mm an optimized kV of 133.75 and a CNR of 1.14 was found for the GE VCT 64 slice scanner. Conclusion: CNR in CT image acquisition can be further optimized with a continuous kV option instead of current discrete or fixed kV settings. A continuous kV option is a key for individualized CT protocols.« less

Amygdalar activation of group I metabotropic glutamate receptors produces anti- and pro-conflict effects depending upon animal sex in a sexually dimorphic conditioned conflict-based anxiety model.

PubMed

De Jesús-Burgos, María I; González-García, Stephanie; Cruz-Santa, Yanira; Pérez-Acevedo, Nivia L

2016-04-01

Women are more susceptible than men to develop anxiety disorders, however, the mechanisms involved are still unclear. In this study, we investigated the role of group I metabotropic glutamate receptors (mGluRs), a target for anxiety disorders, and whether estradiol may modulate conflict-based anxiety in female rats by using the Vogel Conflict Test (VCT). We used ovariectomized female rats with high (OVX+EB) and low (OVX) estradiol levels and intact male rats to evaluate sex differences. Infusion of (S)-3,5-Dihydroxyphenylglycine (DHPG), a group I mGluR agonist, into the basolateral amygdala, a region involved in anxiety-responses, statistically increased the number of shocks in OVX, but not OVX+EB female rats at 0.1, nor at 1.0 μM. In contrast, DHPG statistically decreased the number of shocks in male rats at 1.0 μM only. DHPG (0.1 μM) increased the number of recoveries in OVX, but not OVX+EB or male rats. Sex differences were detected for the number of shocks, recoveries and punished licks, where female rats displayed more conflict than male rats. Western blot analyses showed that protein expression of mGluR1, but not mGluR5 was higher in OVX+EB>OVX>male rats in the amygdala, whereas no significant differences were detected in the hippocampus, olfactory bulb and/or the periaqueductal gray. Therefore, DHPG produced paradoxical effects that are sex dependent; producing anxiolytic-like effects in female rats, while anxiogenic-like effects in male rats according to the VCT. These results highlight the importance of including female experimental models to underpin the neural circuitry of anxiety according to sex and for the screening of novel anxiolytic compounds. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

HIV/AIDS related commodities supply chain management in public health facilities of Addis Ababa, Ethiopia: a cross-sectional survey.

PubMed

Berhanemeskel, Eyerusalem; Beedemariam, Gebremedhin; Fenta, Teferi Gedif

2016-01-01

A wide range of pharmaceutical products are needed for diagnosis, treatment, and prevention of HIV/AIDS. However, interrupted supplies and stock-outs are the major challenges in the supply chain of ARV medicines and related commodities. The aim of this study was to assess the supply chain management of HIV/AIDS related commodities in public health facilities of Addis Ababa, Ethiopia. A descriptive cross-sectional survey complemented by qualitative method was conducted in 24 public health facilities (4 hospitals and 20 health centers). A semi-structured questionnaire and observation check list were used to collect data on HIV/AIDS related service, reporting and ordering; receiving, transportation and storage condition of ARV medicines and test kits; and supportive supervision and logistics management information system. In addition, in-depth interview with flexible probing techniques was used to complement the quantitative data with emphasis to the storage condition of ARV medicines and test kits. Quantitative data was analyzed using SPSS version-20. Analysis of qualitative data involved rigorous reading of transcripts in order to identify key themes and data was analyzed using thematic approach. The study revealed that 16 health centers and one hospital had recorded and reported patient medication record. Six months prior to the study, 14 health centers and 2 hospitals had stopped VCT services for one time or more. Three hospitals and 18 health centers claimed to have been able to submit the requisition and report concerning ARV medicines to Pharmaceutical Fund and Supply Agency according to the specific reporting period. More than three-fourth of the health centers had one or more emergency order of ARV medicines on the day of visit, while all of hospitals had emergency order more than 3 times within 6 months prior to the study. All of the hospitals and nearly half of the health centers had an emergency order of test kits more than 3 times in the past 6 months. Overall, nearly 3/4th of the health facilities faced stock-out of one or more ARV medicines and test kits on the day of visit. There was no adequate data on patient medication record and stock status of HIV/AIDS related commodities. Moreover there were frequent stock-outs of ARV medicines and HIV test kits, which was an indicator of the weak supply chain management. Hospitals and health centers, therefore, should devise a system to capture and make use of patient medication record and stock status information so as to ensure continuous supply of the commodities.

Systematic Review of Couple-Based HIV Intervention and Prevention Studies: Advantages, Gaps, and Future Directions

PubMed Central

El-Bassel, Nabila

2015-01-01

We conducted a systematic review of couple-based HIV biobehavioral (skills-building, VCT, and adherence) and biomedical (ART, circumcision) prevention and intervention studies designed to reduce sexual-and drug-risk behaviors and HIV transmission and acquisition. Of the 11,162 papers identified in the search, 93 peer-reviewed papers met the inclusion criteria and yielded a total of 33 studies conducted globally. Biobehavioral couple-based prevention and intervention studies have been efficacious in reducing sexual- and drug-risk behaviors, increasing access to HIV testing and care, and improving adherence. Biomedical couple-based studies were found to reduce HIV incidence among HIV-negative sex partners and viral load among HIV-positive partners. Despite much progress, couple-based HIV prevention and intervention studies remain limited; a number of methodological gaps exist and studies focusing on MSM, people who inject drugs, and sex workers are scarce. PMID:24980246

[Expressions of CXCL16/CXCR6 and CXCL12/CXCR4 in first-trimester human trophoblast cells].

PubMed

Huang, Yu; Li, Da-jin; Wang, Ming-yan; Cheng, Hai-dong

2006-06-01

To investigate the transcription and protein expressions of chemokines CXCL16, CXCL12 and their receptors CXCR6, CXCR4 in first-trimester human cytotrophoblast cells and human choriocarcinoma cell line JAR. Transcriptions of CXCR6, CXCL16, CXCR4, CXCL12 in purified first-trimester human trophoblast cells and JAR line were assessed by semi-quantitative RT-PCR, and protein expressions of CXCR6, CXCL16, CXCR4, CXCL12 were analyzed in primary cultured villous cytotrophoblasts (VCT), extravillous cytotrophoblasts (EVCT), JAR line and placentas by immunostaining. CXCR6 and CXCR4 were highly transcribed in primary cultured trophoblast cells with mRNA relative level of 1.12 +/- 0.25 and 1.08 +/- 0.11 respectively, and their ligands CXCL16 and CXCL12 were transcribed moderately with mRNA relative level of 0.89 +/- 0.11 and 0.78 +/- 0.10 respectively. It was demonstrated that CXCL16, CXCL12, CXCR6 and CXCR4 were expressed in primary cultured VCT, EVCT, JAR line and placentas by immunostaining. The co-expression of CXCL16/CXCR6 and CXCL12/CXCR4 in trophoblast cells may play a role in the proliferation and differentiation of first-trimester trophoblast cells in a manner of autocrine.

Sexual and reproductive health and HIV/AIDS risk perception in the Malawi tourism industry.

PubMed

Bisika, Thomas

2009-06-01

Malawi has for a long time relied on agriculture for the generation of foreign exchange. Due to varied reasons like climate change, the Malawi government has, therefore, identified tourism as one way of boosting foreign exchange earnings and is already in the process of developing the sector especially in the area of ecotourism. However, tourism is associated with increasing prostitution, drug abuse and a whole range of other sexual and reproductive health (SRH) problems such as teenage pregnancies, HIV/AIDS and sexually transmitted infections (STIs). This paper examines the knowledge, attitudes, practices and behaviour as well as risk perceptions associated with HIV/AIDS, sexually transmitted infections and unwanted pregnancies among staff in the tourism industry and communities around tourist facilities in Malawi. The study was descriptive in nature and used both qualitative and quantitative research methods. The qualitative methods involved in-depth interviews and focus group discussions. The quantitative technique employed a survey of 205 purposively selected subjects from the tourism sector. The study concludes that people in the tourism sector are at high risk of HIV/AIDS, sexually transmitted infections and unwanted pregnancies and should be considered as a vulnerable group. The study further observes that this group of people has not adopted behaviours that can protect them from HIV/AIDS, sexually transmitted infections and unwanted pregnancies although there is high demand for voluntary counselling and testing (VCT) which offers a very good entry point for HIV prevention and treatment in the tourism sector. The study recommends that a comprehensive tourism policy covering tourists, employees and communities around tourist facilities is required. Such a policy should address the rights of HIV infected employees and the provision of prevention and treatment services for HIV/AIDS and STIs as well as a broad range of SRH and family planning services especially the condom which offers dual protection for pregnancy and STIs including HIV.

AIDS communications through social networks: catalyst for behaviour changes in Uganda.

PubMed

Low-Beer, Daniel; Stoneburner, Rand L

2004-05-01

To investigate distinctive communications through social networks which may be associated with population behaviour changes and HIV prevalence declines in Uganda compared to other countries. We undertook a comparative analysis of demographic and HIV behavioural data collected in Demographic and Health Surveys (DHS III) in Uganda, Kenya, Tanzania, Malawi, Zambia and Zimbabwe as well as Knowledge, Attitudes and Behaviours (KABP) surveys in Uganda in 1989 and 1995. AIDS behaviours, social communications and channels for communication about AIDS and people with AIDS were analysed by age, sex and country. Modelling was developed to investigate at what stage of the epidemic a majority of people will know someone with AIDS, given differing communication patterns through social networks. Finally AIDS reporting and Voluntary Counselling and Testing (VCT) trends were analysed to assess if the impact of social communications worked through clinical services and interventions or more directly at the population level in community contexts. Uganda showed unique patterns of communications through social networks including a shift from mass and institutional to personal channels for communicating about AIDS, 1989-1995. This was associated with higher levels of knowing someone with AIDS through social networks and, in turn, positive risk ratios for behaviour change including reducing casual sex and condom use. Youth had distinctively high levels of knowing someone with AIDS in Uganda, suggesting widespread community communication across age groups. Patterns of disclosure, AIDS diagnosis and reporting were influential on social communications about AIDS. Over 90%, 45% or under 20% of people know someone with AIDS at peak HIV incidence and high AIDS mortality, depending on whether communications through social networks are extensive or restricted. There are distinctive patterns for communicating through social networks about AIDS and people with AIDS in Uganda. They appear to work directly at population level rather than in response to clinical interventions and testing and may be important in the uptake of the latter services. This communication response provides an important basis for HIV prevention if it is to be scaled to the population level. Vertical prevention (and even treatment) interventions need to engage more closely with local, horizontal communication and behavioural responses to AIDS. Communication programmes have to take root at the level of social networks working though local networks of meetings, chiefs, churches and health personnel as well as the media. Mobilising basic social communications may be a necessary resource (as much as services and finance) to scale HIV prevention and treatment to the population level.

HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana.

PubMed

Dapaah, Jonathan Mensah; Senah, Kodjo A

2016-07-16

While most studies on HIV/AIDS often identify stigmatization and patients' unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible consequences of accessing health care by sero-positives. This paper examines the socio-psychological trauma patients experience in their desire to access health care in two health facilities in the Ashanti Region of Ghana. Through participant observation, informal conversation and in-depth interviews, data were collected from health workers and clients of the voluntary counselling (VCT) and antiretroviral therapy units in the two hospitals. The data gathered were analysed and categorized into themes and supported with illustrative quotes obtained from health workers and clients. The study found that the mere presence of a person at the HIV counselling centre or clinic is enough for the person to be labelled as or suspected to be HIV patient. It demonstrates that stigmatization may occur not only in the community but also overtly or covertly, in the health facility itself. Consequently, for many HIV/AIDS patients, access to antiretroviral therapy and treatment of related nosocomial infections are problematic. Besides, the study found that many clients and potential users of services were uncomfortable with the quality of care given by some health workers, especially as they overtly and covertly breached confidentiality about their clients' health status. This has compelled many patients and potential users of the services to adopt a modus vivendi that provides them access to some care services while protecting their identity. The paper argues that by examining issues relating to privacy and confidentiality in the provision of care for and use of services by seropositives, more light will be shed on the whys of the limited uptake of HIV-related health care services in Ghana.

Wide coverage by volume CT: benefits for cardiac imaging

NASA Astrophysics Data System (ADS)

Sablayrolles, Jean-Louis; Cesmeli, Erdogan; Mintandjian, Laura; Adda, Olivier; Dessalles-Martin, Diane

2005-04-01

With the development of new technologies, computed tomography (CT) is becoming a strong candidate for non-invasive imaging based tool for cardiac disease assessment. One of the challenges of cardiac CT is that a typical scan involves a breath hold period consisting of several heartbeats, about 20 sec with scanners having a longitudinal coverage of 2 cm, and causing the image quality (IQ) to be negatively impacted since beat to beat variation is high likely to occur without any medication, e.g. beta blockers. Because of this and the preference for shorter breath hold durations, a CT scanner with a wide coverage without the compromise in the spatial and temporal resolution of great clinical value. In this study, we aimed at determining the optimum scan duration and the delay relative to beginning of breath hold, to achieve high IQ. We acquired EKG data from 91 consecutive patients (77 M, 14 F; Age: 57 +/- 14) undergoing cardiac CT exams with contrast, performed on LightSpeed 16 and LightSpeed Pro16. As an IQ metric, we adopted the standard deviation of "beat-to-beat variation" (stdBBV) within a virtual scan period. Two radiologists evaluated images by assigning a score of 1 (worst) to 4 best). We validated stdBBV with the radiologist scores, which resulted in a population distribution of 9.5, 9.5, 31, and 50% for the score groups 1, 2, 3, and 4, respectively. Based on the scores, we defined a threshold for stdBBV and identified an optimum combination of virtual scan period and a delay. With the assumption that the relationship between the stdBBV and diagnosable scan IQ holds, our analysis suggested that the success rate can be improved to 100% with scan durations equal or less than 5 sec with a delay of 1 - 2 sec. We confirmed the suggested conclusion with LightSpeed VCT (GE Healthcare Technologies, Waukesha, WI), which has a wide longitudinal coverage, fine isotropic spatial resolution, and high temporal resolution, e.g. 40 mm coverage per rotation of 0.35 sec. Under the light of this study, LightSpeed VCT lends itself to be a clinically tested unique platform to achieve routine cardiac imaging.

Modeling Platform Dynamics and Physiological Response to Short Arm Centrifugation

DTIC Science & Technology

1994-03-01

the "venous pump." There is no provision for such a muscular pumping action in the current version of the model, thus this effect is not apparent in...VCt; Dick, DE. Difference-Differential Equations for Fluid Flow in Distensible Tubes. IEEE Trans. Bio-Med. Engr. 14(4): 171-177; 1967. 29. Snyder, MF...Flow in Distensible Tube. IEEE Transactions on efo-Nedical C... Engineering. Vol WNE-14, NO. 3, pp 1M1-177. Jut 1967. C... C... Re - 1*SmCPtl(Sepi

Employees' perceptions of the Aid-for-AIDS disease-management programme, South Africa.

PubMed

Rothberg, Alan; Van Huyssteen, Karen

2008-11-01

It is estimated that 18-20% of South Africa's more than 5 million HIV-positive individuals are formally employed. Disease management programmes for these employees vary in scope and sophistication, with services provided by the employer, or third-party specialist disease managers, or through medical aid schemes. This study surveyed 215 HIV-positive employees in two organisations contracted to the Aid for AIDS (AfA) disease management programme through their in-house medical aid schemes. The two organisations differed in their overall approach to HIV and AIDS: one mainly relies on on-site access to voluntary counselling and testing (VCT) and AfA's management of registered HIV-positive employees, while the other has invested in and actively developed a comprehensive programme that also extends to families and the community as well as links employees to the AfA programme. Responses received from 28 of the 215 employees surveyed indicate that fear of disclosure of one's HIV status and of stigmatisation are reasons for late registration with the AfA programme or non-utilisation of other available support programmes. Respondents mentioned that confidence in the employer's ability to maintain confidentiality was also an issue. Respondents' important suggestions for change included: a) on-site educational and awareness programmes for management personnel and staff in order to reduce HIV discrimination and stigmatisation; b) information directed at HIV-positive employees publicising the benefits and effectiveness of medical treatment; c) support groups for HIV-positive employees; and d) management personnel to engage with HIV-infected employees who are willing to take an active role in staff education and the development of workplace policies and programmes.

HIV-related characteristics among female partners of injecting drug users in Kelantan, Malaysia: a descriptive study.

PubMed

Mohd Nasarruddin, Aishah; Wan Mohammad, Wan Mohd Zahiruddin; Nik Hussain, Nik Hazlina; Ali, Siti Hawa; Zubir, Hazura Mat

2015-01-01

Kelantan, a northeastern state in Peninsular Malaysia, is one of the states that has been acutely hit by injecting drug user (IDU)-driven HIV epidemic, in addition to having a high number of infected women in Malaysia. This cross-sectional study describes the socio-demographic characteristics, HIV risk factors, risk perception, and adoption of preventive behaviors among female partners of IDUs in Kelantan. Out of 101 women, the majority of them are from low socioeconomic background and have no other risk factors besides heterosexual HIV transmission from their male IDU partners. Although 45.5% have not been tested for HIV and more than half (53.5%) of them did not use condoms during sexual intercourse, only 44.6% of the women perceived themselves to be at risk of being infected with HIV. Most of the women (86.1%) were willing to undergo voluntary counseling and testing (VCT). Female partners of IDUs continue to be vulnerable to HIV due to having sexual contact with IDUs, and also due to their socioeconomic position in the community. To prevent HIV transmission among female partners of IDUs, consolidating HIV prevention efforts from multiple approaches is needed.

Automatic insertion of simulated microcalcification clusters in a software breast phantom

NASA Astrophysics Data System (ADS)

Shankla, Varsha; Pokrajac, David D.; Weinstein, Susan P.; DeLeo, Michael; Tuite, Catherine; Roth, Robyn; Conant, Emily F.; Maidment, Andrew D.; Bakic, Predrag R.

2014-03-01

An automated method has been developed to insert realistic clusters of simulated microcalcifications (MCs) into computer models of breast anatomy. This algorithm has been developed as part of a virtual clinical trial (VCT) software pipeline, which includes the simulation of breast anatomy, mechanical compression, image acquisition, image processing, display and interpretation. An automated insertion method has value in VCTs involving large numbers of images. The insertion method was designed to support various insertion placement strategies, governed by probability distribution functions (pdf). The pdf can be predicated on histological or biological models of tumor growth, or estimated from the locations of actual calcification clusters. To validate the automated insertion method, a 2-AFC observer study was designed to compare two placement strategies, undirected and directed. The undirected strategy could place a MC cluster anywhere within the phantom volume. The directed strategy placed MC clusters within fibroglandular tissue on the assumption that calcifications originate from epithelial breast tissue. Three radiologists were asked to select between two simulated phantom images, one from each placement strategy. Furthermore, questions were posed to probe the rationale behind the observer's selection. The radiologists found the resulting cluster placement to be realistic in 92% of cases, validating the automated insertion method. There was a significant preference for the cluster to be positioned on a background of adipose or mixed adipose/fibroglandular tissues. Based upon these results, this automated lesion placement method will be included in our VCT simulation pipeline.

Loss of Matrix Metalloproteinase-13 Attenuates Murine Radiation-Induced Pulmonary Fibrosis

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

Flechsig, Paul; Hartenstein, Bettina; Teurich, Sybille

2010-06-01

Purpose: Pulmonary fibrosis is a disorder of the lungs with limited treatment options. Matrix metalloproteinases (MMPs) constitute a family of proteases that degrade extracellular matrix with roles in fibrosis. Here we studied the role of MMP13 in a radiation-induced lung fibrosis model using a MMP13 knockout mouse. Methods and Materials: We investigated the role of MMP13 in lung fibrosis by investigating the effects of MMP13 deficiency in C57Bl/6 mice after 20-Gy thoracic irradiation (6-MV Linac). The morphologic results in histology were correlated with qualitative and quantitative results of volume computed tomography (VCT), magnetic resonance imaging (MRI), and clinical outcome. Results:more » We found that MMP13 deficient mice developed less pulmonary fibrosis than their wildtype counterparts, showed attenuated acute pulmonary inflammation (days after irradiation), and a reduction of inflammation during the later fibrogenic phase (5-6 months after irradiation). The reduced fibrosis in MMP13 deficient mice was evident in histology with reduced thickening of alveolar septi and reduced remodeling of the lung architecture in good correlation with reduced features of lung fibrosis in qualitative and quantitative VCT and MRI studies. The partial resistance of MMP13-deficient mice to fibrosis was associated with a tendency towards a prolonged mouse survival. Conclusions: Our data indicate that MMP13 has a role in the development of radiation-induced pulmonary fibrosis. Further, our findings suggest that MMP13 constitutes a potential drug target to attenuate radiation-induced lung fibrosis.« less

Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing, China: a Cross-sectional Study.

PubMed

Ren, Xian Long; Wu, Zun You; Mi, Guo Dong; McGoogan, Jennifer; Rou, Ke Ming; Zhao, Yan

2017-06-01

To examine HIV self-testing uptake and its determinates among men who have sex with men (MSM) in Beijing, China. A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio (AOR) and 95% confidence interval (CI). Among the 5,996 MSM included in the study, 2,383 (39.7%) reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income (AOR = 1.49; CI = 1.10-2.02; P = 0.010), large number of male sex partners (⋝ 2: AOR = 1.24; CI = 1.09-1.43; P = 0.002), sexual activity with commercial male sex partners (⋝ 2: AOR = 1.94; CI = 1.34 -2.82; P = 0.001), long-term drug use (AOR = 1.42; CI = 1.23-1.62; P < 0.001), and long-term HIV voluntary counseling and testing (VCT) attendance (AOR = 3.62; CI = 3.11-4.22; P < 0.001) were all associated with increased odds of HIV self-testing uptake. The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020. Copyright © 2017 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

How to quantify the transition phase during golf swing performance: Torsional load affects low back complaints during the transition phase.

PubMed

Sim, Taeyong; Choi, Ahnryul; Lee, Soeun; Mun, Joung Hwan

2017-10-01

The transition phase of a golf swing is considered to be a decisive instant required for a powerful swing. However, at the same time, the low back torsional loads during this phase can have a considerable effect on golf-related low back pain (LBP). Previous efforts to quantify the transition phase were hampered by problems with accuracy due to methodological limitations. In this study, vector-coding technique (VCT) method was proposed as a comprehensive methodology to quantify the precise transition phase and examine low back torsional load. Towards this end, transition phases were assessed using three different methods (VCT, lead hand speed and X-factor stretch) and compared; then, low back torsional load during the transition phase was examined. As a result, the importance of accurate transition phase quantification has been documented. The largest torsional loads were observed in healthy professional golfers (10.23 ± 1.69 N · kg -1 ), followed by professional golfers with a history of LBP (7.93 ± 1.79 N · kg -1 ), healthy amateur golfers (1.79 ± 1.05 N · kg -1 ) and amateur golfers with a history of LBP (0.99 ± 0.87 N · kg -1 ), which order was equal to that of the transition phase magnitudes of each group. These results indicate the relationship between the transition phase and LBP history and the dependency of the torsional load magnitude on the transition phase.

Correlation between coronal and apical arch form and degree of divergence: a volumetric computed tomography analysis

PubMed Central

LOMBARDO, L.; VERONESI, F.; CANDOTTO, V.; NARDONE, M.; SICILIANI, G.

2017-01-01

SUMMARY Purpose. To determine the existence of any correlation between the degree of divergence and apical and coronal arch form using cone-beam computed tomography (CBCT). Materials and methods. A total of 176 (88 coronal and 88 apical) CBCT scans pertaining to a sample of 44 subjects (16 males and 28 females), of which 26 were Class I, 14 Class II and 4 Class III, were analysed. A lateral projection of the skull was obtained from each VCT and cephalometric tracing was performed (according to Ricketts) so as to divide the sample into subgroups based on the degree of divergence (11 short-faced, 18 norm-faced and 15 long-faced subjects). Dahlberg’s index values were calculated and Student’s t-test for paired data was applied. Results. On the whole, the hyperbolic cosine curve was found to be the most representative of the arch forms considered. Conclusions. A correlation between degree of divergence and the arch form of the apical and, especially, coronal portions of both the upper and lower jaws was revealed. PMID:29682260

[The role of multidetector computer tomography in diagnosis of acute pancreatitis].

PubMed

Lohanikhina, K Iu; Hordiienko, K P; Kozarenko, T M

2014-10-01

With the objective to improve the diagnostic semiotics of an acute pancreatitis (AP) 35 patients were examined, using 64-cut computeric tomograph Lightspeed VCT (GE, USA) with intravenous augmentation in arterial and portal phases. Basing on analysis of the investigations conducted, using multidetector computeric tomography (MDCT), the AP semiotics was systematized, which is characteristic for oedematous and destructive forms, diagnosed in 19 (44.2%) and 16 (45.8%) patients, accordingly. The procedure for estimation of preservation of the organ functional capacity in pancreonecrosis pres- ence was elaborated, promoting rising of the method diagnostic efficacy by 5.3 - 9.4%.

Empowering the people: development of an HIV peer education model for low literacy rural communities in India.

PubMed

Van Rompay, Koen K A; Madhivanan, Purnima; Rafiq, Mirriam; Krupp, Karl; Chakrapani, Venkatesan; Selvam, Durai

2008-04-18

Despite ample evidence that HIV has entered the general population, most HIV awareness programs in India continue to neglect rural areas. Low HIV awareness and high stigma, fueled by low literacy, seasonal migration, gender inequity, spatial dispersion, and cultural taboos pose extra challenges to implement much-needed HIV education programs in rural areas. This paper describes a peer education model developed to educate and empower low-literacy communities in the rural district of Perambalur (Tamil Nadu, India). From January to December 2005, six non-governmental organizations (NGO's) with good community rapport collaborated to build and pilot-test an HIV peer education model for rural communities. The program used participatory methods to train 20 NGO field staff (Outreach Workers), 102 women's self-help group (SHG) leaders, and 52 barbers to become peer educators. Cartoon-based educational materials were developed for low-literacy populations to convey simple, comprehensive messages on HIV transmission, prevention, support and care. In addition, street theatre cultural programs highlighted issues related to HIV and stigma in the community. The program is estimated to have reached over 30,000 villagers in the district through 2051 interactive HIV awareness programs and one-on-one communication. Outreach workers (OWs) and peer educators distributed approximately 62,000 educational materials and 69,000 condoms, and also referred approximately 2844 people for services including voluntary counselling and testing (VCT), care and support for HIV, and diagnosis and treatment of sexually-transmitted infections (STI). At least 118 individuals were newly diagnosed as persons living with HIV (PLHIV); 129 PLHIV were referred to the Government Hospital for Thoracic Medicine (in Tambaram) for extra medical support. Focus group discussions indicate that the program was well received in the communities, led to improved health awareness, and also provided the peer educators with increased social status. Using established networks (such as community-based organizations already working on empowerment of women) and training women's SHG leaders and barbers as peer educators is an effective and culturally appropriate way to disseminate comprehensive information on HIV/AIDS to low-literacy communities. Similar models for reaching and empowering vulnerable populations should be expanded to other rural areas.

United States Forest Disturbance Trends Observed Using Landsat Time Series

NASA Technical Reports Server (NTRS)

Masek, Jeffrey G.; Goward, Samuel N.; Kennedy, Robert E.; Cohen, Warren B.; Moisen, Gretchen G.; Schleeweis, Karen; Huang, Chengquan

2013-01-01

Disturbance events strongly affect the composition, structure, and function of forest ecosystems; however, existing U.S. land management inventories were not designed to monitor disturbance. To begin addressing this gap, the North American Forest Dynamics (NAFD) project has examined a geographic sample of 50 Landsat satellite image time series to assess trends in forest disturbance across the conterminous United States for 1985-2005. The geographic sample design used a probability-based scheme to encompass major forest types and maximize geographic dispersion. For each sample location disturbance was identified in the Landsat series using the Vegetation Change Tracker (VCT) algorithm. The NAFD analysis indicates that, on average, 2.77 Mha/yr of forests were disturbed annually, representing 1.09%/yr of US forestland. These satellite-based national disturbance rates estimates tend to be lower than those derived from land management inventories, reflecting both methodological and definitional differences. In particular the VCT approach used with a biennial time step has limited sensitivity to low-intensity disturbances. Unlike prior satellite studies, our biennial forest disturbance rates vary by nearly a factor of two between high and low years. High western US disturbance rates were associated with active fire years and insect activity, while variability in the east is more strongly related to harvest rates in managed forests. We note that generating a geographic sample based on representing forest type and variability may be problematic since the spatial pattern of disturbance does not necessarily correlate with forest type. We also find that the prevalence of diffuse, non-stand clearing disturbance in US forests makes the application of a biennial geographic sample problematic. Future satellite-based studies of disturbance at regional and national scales should focus on wall-to-wall analyses with annual time step for improved accuracy.

Sci—Thur AM: YIS - 08: Constructing an Attenuation map for a PET/MR Breast coil

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

Patrick, John C.; Imaging, Lawson Health Research Institute, Knoxville, TN; London Regional Cancer Program, Knoxville, TN

2014-08-15

In 2013, around 23000 Canadian women and 200 Canadian men were diagnosed with breast cancer. An estimated 5100 women and 55 men died from the disease. Using the sensitivity of MRI with the selectivity of PET, PET/MRI combines anatomical and functional information within the same scan and could help with early detection in high-risk patients. MRI requires radiofrequency coils for transmitting energy and receiving signal but the breast coil attenuates PET signal. To correct for this PET attenuation, a 3-dimensional map of linear attenuation coefficients (μ-map) of the breast coil must be created and incorporated into the PET reconstruction process.more » Several approaches have been proposed for building hardware μ-maps, some of which include the use of conventional kVCT and Dual energy CT. These methods can produce high resolution images based on the electron densities of materials that can be converted into μ-maps. However, imaging hardware containing metal components with photons in the kV range is susceptible to metal artifacts. These artifacts can compromise the accuracy of the resulting μ-map and PET reconstruction; therefore high-Z components should be removed. We propose a method for calculating μ-maps without removing coil components, based on megavoltage (MV) imaging with a linear accelerator that has been detuned for imaging at 1.0MeV. Containers of known geometry with F18 were placed in the breast coil for imaging. A comparison between reconstructions based on the different μ-map construction methods was made. PET reconstructions with our method show a maximum of 6% difference over the existing kVCT-based reconstructions.« less

Attitudes and practices on HIV preventions among students of higher education institutions in Ethiopia: the case of Addis Ababa University.

PubMed

Regassa, Nigatu; Kedir, Seman

2011-06-01

The main objective of this cross-sectional study is to assess higher education students' attitudes, their practice on preventive measures against HIV/AIDS; and examined factors affecting attitude and practice of the students related to HIV/AIDS prevention. The 606 study participants were drawn from Addis Ababa University, which is the oldest and biggest public university in Ethiopia, through multistage sampling. Data were collected using survey quantitative (questionnaire) and qualitative (FGDs), and subsequently, analysis of the data was made through the use of descriptive statistics (Frequency and logistic regression model). The findings of the study revealed that 207 (34.2%) of respondents were sexually active during the survey. Of these, 144 (23.8%) of them had sexual intercourse with their partner or someone in the last 6 months. The mean and median age at first sex debut was computed as 17.8 and 18.0 years respectively. About 489 (80.7%) did not perceive being at risk of contracting HIV/AIDS. But 65.5% of the respondent had favorable attitude on HIV prevention. 359 (59.2%) of the respondents had experienced at least one of the three HIV prevention practice. Of which, more than half (52.4%) adopted abstinence as top preventive measure. The result also showed that out of the total respondents 47.2% had been tested for HIV/AIDS and more than 80% have willingness to take VCT service for HIV/AIDS. As to the multivariate analysis result; sex, previous residence, religious participation, pornographic viewing, currently alcohol intake, chewing khat and cigarette smoking were found to be determinant of AAU students' attitude on HIV prevention. Similarly, age, having pocket money, pornographic film show and currently khat chewing were determinants of practices on HIV prevention. Finally, based on the findings, the study has forwarded some workable recommendations.

Prevalence of Adverse Drug Reactions to Highly Active Antiretroviral Therapy (HAART) among HIV Positive Patients in Imam Khomeini Hospital of Tehran, Iran.

PubMed

Koochak, Hamid E; Babaii, Azita; Pourdast, Alia; Golrokhy, Raheleh; Rasoolinejad, Mehrnaz; Khodaei, Sepideh; Moghadam, Saeed R J; Taheri, Reza R; Seyed Alinaghi, Seyed Ahmad

2017-01-01

The present study assessed the prevalence of adverse drug reactions (ADRs) among HIV positive patients taking antiretroviral therapy referred to Imam Khomeini Hospital in Tehran, Iran. This is a cross sectional study regarding side effects of Highly Active Antiretroviral Therapy (HAART) in HIV positive patients referred to Voluntary Counseling and Testing (VCT) center in Imam Khomeini Hospital of Tehran, Iran during a period of the year 2009 to 2010. Two hundred patients under antiretroviral treatment evaluated for the side effects of drug based on available records, face to face interviews and written lab data. Data was collected from a sample of 200 HIV positive patients (72% male). Injection drug use was the most common route of HIV transmission. Co-Infections with Hepatitis C virus (HCV) found in the majority of patients (60.5%). Tuberculosis was the most prevalent opportunistic infection. One hundred eighty eight (94%) patients experienced at least one adverse drug reaction. The most frequent clinical and paraclinical findings were skin rash (28%) and abnormal liver function tests (36%). Given the high prevalence of adverse drug reactions among HIV positive patients taking antiretroviral therapy (ART) in this study, clinicians should be aware of ADRs at the initiation of ART as complications can affect patients' adherence to the therapy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Empowering the people: Development of an HIV peer education model for low literacy rural communities in India

PubMed Central

Van Rompay, Koen KA; Madhivanan, Purnima; Rafiq, Mirriam; Krupp, Karl; Chakrapani, Venkatesan; Selvam, Durai

2008-01-01

Background Despite ample evidence that HIV has entered the general population, most HIV awareness programs in India continue to neglect rural areas. Low HIV awareness and high stigma, fueled by low literacy, seasonal migration, gender inequity, spatial dispersion, and cultural taboos pose extra challenges to implement much-needed HIV education programs in rural areas. This paper describes a peer education model developed to educate and empower low-literacy communities in the rural district of Perambalur (Tamil Nadu, India). Methods From January to December 2005, six non-governmental organizations (NGO's) with good community rapport collaborated to build and pilot-test an HIV peer education model for rural communities. The program used participatory methods to train 20 NGO field staff (Outreach Workers), 102 women's self-help group (SHG) leaders, and 52 barbers to become peer educators. Cartoon-based educational materials were developed for low-literacy populations to convey simple, comprehensive messages on HIV transmission, prevention, support and care. In addition, street theatre cultural programs highlighted issues related to HIV and stigma in the community. Results The program is estimated to have reached over 30 000 villagers in the district through 2051 interactive HIV awareness programs and one-on-one communication. Outreach workers (OWs) and peer educators distributed approximately 62 000 educational materials and 69 000 condoms, and also referred approximately 2844 people for services including voluntary counselling and testing (VCT), care and support for HIV, and diagnosis and treatment of sexually-transmitted infections (STI). At least 118 individuals were newly diagnosed as persons living with HIV (PLHIV); 129 PLHIV were referred to the Government Hospital for Thoracic Medicine (in Tambaram) for extra medical support. Focus group discussions indicate that the program was well received in the communities, led to improved health awareness, and also provided the peer educators with increased social status. Conclusion Using established networks (such as community-based organizations already working on empowerment of women) and training women's SHG leaders and barbers as peer educators is an effective and culturally appropriate way to disseminate comprehensive information on HIV/AIDS to low-literacy communities. Similar models for reaching and empowering vulnerable populations should be expanded to other rural areas. PMID:18423006

Implementing family-focused HIV care and treatment: the first 2 years' experience of the mother-to-child transmission-plus program in Abidjan, Côte d'Ivoire

PubMed Central

Tonwe-Gold, Besigin; Ekouevi, Didier Koumavi; Amani-Bosse, Clarisse; Toure, Siaka; Koné, Mamadou; Becquet, Renaud; Leroy, Valériane; Toro, Patricia; Dabis, François; El Sadr, Wafaa M.; Abrams, Elaine J.

2009-01-01

Summary Objectives To describe a family-focused approach to HIV care and treatment and report on the first two years’ experience of implementing the MTCT-Plus program in Abidjan, Côte d’Ivoire. Program implementation New effective models of care are being sought to provide successful strategies to deliver safe, efficient and appropriate HIV care and treatment in resource limited settings. The MTCT-Plus Initiative aims to engage pregnant and postpartum women identified as HIV-infected to initiate comprehensive HIV care and treatment for the woman and her family. Main outcomes Between August 2003 and August 2005, 605 HIV-infected pregnant or post-partum women and 582 HIV-exposed infants were enrolled. Amongst 568 male partners reported alive by enrolled women, 300 (52%) were aware of their wife’s HIV status and 169 (30%) have been tested for HIV. Amongst these partners, 88 (53%) were found to be HIV-infected and 69 (78%) were enrolled into the program. Overall only 10% of the women were enrolled together with their infected partner. On the other hand, a success of the program was also to involve a significant number of seronegative men (half of those who came for VCT) in the care of their families. Amongst 1,624 children <15 years reported alive by their mothers (excluding the last newborn infants of the most recent pregnancy systematically screened for HIV), only 146 (10.8%) were brought in for HIV testing, of whom 18 (12.3%) were found to be HIV-infected. Lessons learned and challenges The family-focused model of HIV care pays attention to the needs of families and household members. The program was successful in enrolling HIV women, their partners and infants in continuous follow-up. However engaging partners and family members of newly enrolled women into care involves numerous challenges outlined in the cascade of necessary events that must take place to achieve this goal. This involves the difficult issue of disclosure of HIV status by women to their partners and family members. Further efforts are required to understand barriers for families accessing HIV services as strategies to improve partner involvement and provide access to care for other children in the households are needed in this West African urban setting. PMID:19236666

NOTE: Optimization of megavoltage CT scan registration settings for thoracic cases on helical tomotherapy

NASA Astrophysics Data System (ADS)

Woodford, Curtis; Yartsev, Slav; Van Dyk, Jake

2007-08-01

This study aims to investigate the settings that provide optimum registration accuracy when registering megavoltage CT (MVCT) studies acquired on tomotherapy with planning kilovoltage CT (kVCT) studies of patients with lung cancer. For each experiment, the systematic difference between the actual and planned positions of the thorax phantom was determined by setting the phantom up at the planning isocenter, generating and registering an MVCT study. The phantom was translated by 5 or 10 mm, MVCT scanned, and registration was performed again. A root-mean-square equation that calculated the residual error of the registration based on the known shift and systematic difference was used to assess the accuracy of the registration process. The phantom study results for 18 combinations of different MVCT/kVCT registration options are presented and compared to clinical registration data from 17 lung cancer patients. MVCT studies acquired with coarse (6 mm), normal (4 mm) and fine (2 mm) slice spacings could all be registered with similar residual errors. No specific combination of resolution and fusion selection technique resulted in a lower residual error. A scan length of 6 cm with any slice spacing registered with the full image fusion selection technique and fine resolution will result in a low residual error most of the time. On average, large corrections made manually by clinicians to the automatic registration values are infrequent. Small manual corrections within the residual error averages of the registration process occur, but their impact on the average patient position is small. Registrations using the full image fusion selection technique and fine resolution of 6 cm MVCT scans with coarse slices have a low residual error, and this strategy can be clinically used for lung cancer patients treated on tomotherapy. Automatic registration values are accurate on average, and a quick verification on a sagittal MVCT slice should be enough to detect registration outliers.

Radiation Budget Instrument (RBI) for JPSS-2

NASA Technical Reports Server (NTRS)

Georgieva, Elena; Priestley, Kory; Dunn, Barry; Cageao, Richard; Barki, Anum; Osmundsen, Jim; Turczynski, Craig; Abedin, Nurul

2015-01-01

Radiation Budget Instrument (RBI) will be one of five instruments flying aboard the JPSS-2 spacecraft, a polar-orbiting sun-synchronous satellite in Low Earth Orbit. RBI is a passive remote sensing instrument that will follow the successful legacy of the Clouds and Earth's Radiant Energy System (CERES) instruments to make measurement of Earth's short and longwave radiation budget. The goal of RBI is to provide an independent measurement of the broadband reflected solar radiance and Earth's emitted thermal radiance by using three spectral bands (Shortwave, Longwave, and Total) that will have the same overlapped point spread function (PSF) footprint on Earth. To ensure precise NIST-traceable calibration in space the RBI sensor is designed to use a visible calibration target (VCT), a solar calibration target (SCT), and an infrared calibration target (ICT) containing phase change cells (PCC) to enable on-board temperature calibration. The VCT is a thermally controlled integrating sphere with space grade Spectralon covering the inner surface. Two sides of the sphere will have fiber-coupled laser diodes in the UV to IR wavelength region. An electrical substitution radiometer on the integrating sphere will monitor the long term stability of the sources and the possible degradation of the Spectralon in space. In addition the radiometric calibration operations will use the Spectralon diffusers of the SCT to provide accurate measurements of Solar degradation. All those stable on-orbit references will ensure that calibration stability is maintained over the RBI sensor lifetime. For the preflight calibration the RBI will view five calibration sources - two integrating spheres and three CrIS (Cross-track Infrared Sounder ) -like blackbodies whose outputs will be validated with NIST calibration approach. Thermopile are the selected detectors for the RBI. The sensor has a requirement to perform lunar calibration in addition to solar calibration in space in a way similar to CERES instruments approach. To monitor climate change and to get stable and traceable results, it is critical to assure stable calibration over instrument lifetime.

Two Domains of the V Protein of Virulent Canine Distemper Virus Selectively Inhibit STAT1 and STAT2 Nuclear Import▿

PubMed Central

Röthlisberger, Anne; Wiener, Dominique; Schweizer, Matthias; Peterhans, Ernst; Zurbriggen, Andreas; Plattet, Philippe

2010-01-01

Canine distemper virus (CDV) causes in dogs a severe systemic infection, with a high frequency of demyelinating encephalitis. Among the six genes transcribed by CDV, the P gene encodes the polymerase cofactor protein (P) as well as two additional nonstructural proteins, C and V; of these V was shown to act as a virulence factor. We investigated the molecular mechanisms by which the P gene products of the neurovirulent CDV A75/17 strain disrupt type I interferon (IFN-α/β)-induced signaling that results in the establishment of the antiviral state. Using recombinant knockout A75/17 viruses, the V protein was identified as the main antagonist of IFN-α/β-mediated signaling. Importantly, immunofluorescence analysis illustrated that the inhibition of IFN-α/β-mediated signaling correlated with impaired STAT1/STAT2 nuclear import, whereas the phosphorylation state of these proteins was not affected. Coimmunoprecipitation assays identified the N-terminal region of V (VNT) responsible for STAT1 targeting, which correlated with its ability to inhibit the activity of the IFN-α/β-mediated antiviral state. Conversely, while the C-terminal domain of V (VCT) could not function autonomously, when fused to VNT it optimally interacted with STAT2 and subsequently efficiently suppressed the IFN-α/β-mediated signaling pathway. The latter result was further supported by a single mutation at position 110 within the VNT domain of CDV V protein, resulting in a mutant that lost STAT1 binding while retaining a partial STAT2 association. Taken together, our results identified the CDV VNT and VCT as two essential modules that complement each other to interfere with the antiviral state induced by IFN-α/β-mediated signaling. Hence, our experiments reveal a novel mechanism of IFN-α/β evasion among the morbilliviruses. PMID:20427537

Reliability, Validity and Usefulness of 30–15 Intermittent Fitness Test in Female Soccer Players

PubMed Central

Čović, Nedim; Jelešković, Eldin; Alić, Haris; Rađo, Izet; Kafedžić, Erduan; Sporiš, Goran; McMaster, Daniel T.; Milanović, Zoran

2016-01-01

PURPOSE: The aim of this study was to examine the reliability, validity and usefulness of the 30–15IFT in competitive female soccer players. METHODS: Seventeen elite female soccer players participated in the study. A within subject test-retest study design was utilized to assess the reliability of the 30–15 intermittent fitness test (IFT). Seven days prior to 30–15IFT, subjects performed a continuous aerobic running test (CT) under laboratory conditions to assess the criterion validity of the 30–15IFT. End running velocity (VCT and VIFT), peak heart rate (HRpeak) and maximal oxygen consumption (VO2max) were collected and/or estimated for both tests. RESULTS: VIFT (ICC = 0.91; CV = 1.8%), HRpeak (ICC = 0.94; CV = 1.2%), and VO2max (ICC = 0.94; CV = 1.6%) obtained from the 30–15IFT were all deemed highly reliable (p > 0.05). Pearson product moment correlations between the CT and 30–15IFT for VO2max, HRpeak and end running velocity were large (r = 0.67, p = 0.013), very large (r = 0.77, p = 0.02) and large (r = 0.57, p = 0.042), respectively. CONCLUSION: Current findings suggest that the 30–15IFT is a valid and reliable intermittent aerobic fitness test of elite female soccer players. The findings have also provided practitioners with evidence to support the accurate detection of meaningful individual changes in VIFT of 0.5 km/h (1 stage) and HRpeak of 2 bpm. This information may assist coaches in monitoring “real” aerobic fitness changes to better inform training of female intermittent team sport athletes. Lastly, coaches could use the 30–15IFT as a practical alternative to laboratory based assessments to assess and monitor intermittent aerobic fitness changes in their athletes. PMID:27909408

[The characteristics of Vibrio cholerae isolated in Dagestan in 1994].

PubMed

Podosinnikova, L S; Mazrukho, B L; Lomov, Iu M; Khanum'ian, T A; Voronezhskaia, L G; Kudriakova, T A; Makedonova, L D; Mironova, A V

1995-01-01

A high degree of resistance to cholera diagnostic phages and carriership of prophages characteristic of V. cholerae eltor strains vct+ were shown to be the specific features V. cholerae isolated in Daghestan during the period of June-October 1994. Among the strains under study, isolated respectively in 12 and 18 out of 19 regions of Daghestan, a high proportion was found to have resistance to tetracycline (65%) and chloramphenicol (28.6%). Moreover, some strains were found to be resistant to furagin and erythromycin. Out of 242 strains resistant to antibacterial preparations, 163 strains were found to have multiple resistance. Gentamicin, cipropfloxacin and doxicycline were shown to have high in vitro activity with respect to the strains under study.

Design, Development, and Evaluation of Lightweight Hydraulic System Hardware. Phase I.

DTIC Science & Technology

1981-01-01

THE COPY FURNISHED TO DTIC CONTAINED A SIGNIFICANT * NUMBER OF PAGES WHICH DO NOT REPRODUCE LEGIBLY. LA Ci l UNCLASSIFIED ECURITV CL ASSIFICArION (IF...RiICTOR CYO/ OAI ~ ~ ~ ~ ~ ON WAY37(?,F F cosrLL LTN ~qs 30S RAICTORA’/C7lORo ONE WRY wA YY 3 CO~rCAI VVALV ) LA F -P LJA7t/)R LFFR CYrRLE I-mp.-~fO...ogy) r05-𔃿-- ZO36 LaV6 869AiI CA1/P 14/P55 SWI VCt 0/r.ITeM-147 St/CrN T/VI/C 2/5- 22307 bv/MoNT LA /GIG. co $-753175 POWER’ R,9KYe (A’l ) 20-I 03 IAG

Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors.

PubMed

Egbe, Thomas Obinchemti; Tazinya, Rose-Mary Asong; Halle-Ekane, Gregory Edie; Egbe, Eta-Nkongho; Achidi, Eric Akum

2016-01-01

We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.

Cross-sectional study assessing HIV-related knowledge, attitudes and behavior in the Namibian truck transport sector: Readjusting HIV prevention programs in the workplace.

PubMed

Kiderlen, Til R; Conteh, Michael; Roll, Stephanie; Seeling, Stefanie; Weinmann, Stefan

2015-01-01

The objectives of this study were to assess the current status of HIV-related knowledge, attitudes, and behavior (KAB) of employees in the private transport sector in Namibia and to compare companies with established HIV workplace program (WPPs) with those that have recently initiated the implementation of such programs. The study was designed as a cross-sectional questionnaire-based survey. Between January and March 2011, the survey was conducted in the Namibian truck transport sector in six companies of different sizes. The participants were selected randomly from the workforce. Data collection was based on a KAB questionnaire. The range of correct answers to the survey concerning the knowledge of HIV transmission was 67-95%. Twenty percent of the employees had never been tested for HIV. Additionally, risky sexual behaviors were quite prevalent and included having multiple concurrent partners and the use of sex for incentives. This study revealed that drivers and laborers were especially at risk for such behaviors. The employees of companies with established WPPs were tested for HIV more often than those of companies with new WPPs; however, aside from this difference, only minor differences were observed between the two groups. The findings of this study highlight the need for on-going HIV information and prevention campaigns that focus on the special needs of mobile and low-income workers. WPPs should be tailored accordingly and shift their focus to more practical approaches, such as voluntary counseling and testing (VCT), to increase their effectiveness. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Developing an Internet-Based Chemistry Class

NASA Astrophysics Data System (ADS)

Patterson, Mary Jane

2000-05-01

With the increasing popularity of Internet-based classes, more faculty are being asked to develop them (1). In Texas, the Virtual College of Texas (http://www.vct.org) even provides a forum that allows community colleges to advertise their distance-learning classes, and it paves the way for a college to offer a distance-learning class from any other college in the state. The two colleges simply work out a Memorandum of Understanding, mutually deciding how to administer the class, divide fees, set enrollment limits, among other details. While some classes are easily adapted to an Internet format, lab sciences raise a number of issues that must be tackled before a quality course can be developed in this new medium. I will raise some of those issues and offer a few possibilities.

A GPU based high-resolution multilevel biomechanical head and neck model for validating deformable image registration

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

Neylon, J., E-mail: jneylon@mednet.ucla.edu; Qi, X.; Sheng, K.

Purpose: Validating the usage of deformable image registration (DIR) for daily patient positioning is critical for adaptive radiotherapy (RT) applications pertaining to head and neck (HN) radiotherapy. The authors present a methodology for generating biomechanically realistic ground-truth data for validating DIR algorithms for HN anatomy by (a) developing a high-resolution deformable biomechanical HN model from a planning CT, (b) simulating deformations for a range of interfraction posture changes and physiological regression, and (c) generating subsequent CT images representing the deformed anatomy. Methods: The biomechanical model was developed using HN kVCT datasets and the corresponding structure contours. The voxels inside amore » given 3D contour boundary were clustered using a graphics processing unit (GPU) based algorithm that accounted for inconsistencies and gaps in the boundary to form a volumetric structure. While the bony anatomy was modeled as rigid body, the muscle and soft tissue structures were modeled as mass–spring-damper models with elastic material properties that corresponded to the underlying contoured anatomies. Within a given muscle structure, the voxels were classified using a uniform grid and a normalized mass was assigned to each voxel based on its Hounsfield number. The soft tissue deformation for a given skeletal actuation was performed using an implicit Euler integration with each iteration split into two substeps: one for the muscle structures and the other for the remaining soft tissues. Posture changes were simulated by articulating the skeletal structure and enabling the soft structures to deform accordingly. Physiological changes representing tumor regression were simulated by reducing the target volume and enabling the surrounding soft structures to deform accordingly. Finally, the authors also discuss a new approach to generate kVCT images representing the deformed anatomy that accounts for gaps and antialiasing artifacts that may be caused by the biomechanical deformation process. Accuracy and stability of the model response were validated using ground-truth simulations representing soft tissue behavior under local and global deformations. Numerical accuracy of the HN deformations was analyzed by applying nonrigid skeletal transformations acquired from interfraction kVCT images to the model’s skeletal structures and comparing the subsequent soft tissue deformations of the model with the clinical anatomy. Results: The GPU based framework enabled the model deformation to be performed at 60 frames/s, facilitating simulations of posture changes and physiological regressions at interactive speeds. The soft tissue response was accurate with a R{sup 2} value of >0.98 when compared to ground-truth global and local force deformation analysis. The deformation of the HN anatomy by the model agreed with the clinically observed deformations with an average correlation coefficient of 0.956. For a clinically relevant range of posture and physiological changes, the model deformations stabilized with an uncertainty of less than 0.01 mm. Conclusions: Documenting dose delivery for HN radiotherapy is essential accounting for posture and physiological changes. The biomechanical model discussed in this paper was able to deform in real-time, allowing interactive simulations and visualization of such changes. The model would allow patient specific validations of the DIR method and has the potential to be a significant aid in adaptive radiotherapy techniques.« less

MO-E-17A-09: Has Cancer Risk for Pediatric CT Increased Or Decreased? An Analysis of Cohort Data From 2004-2013

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

Brady, S; Kaufman, R

Purpose: To analyze CT radiation dosimetry trends in a pediatric population imaged with modern (2004-2013) CT technology Methods: The institutional review board approved this retrospective review. Two cohorts of pediatric patients that received CT scans for treatment or surveillance for Wilms tumor (n=73) or Neuroblastoma (n=74) from 2004–2013 were included in this study. Patients were scanned during this time period on a GE Ultra (8 slice; 2004–2007), a GE VCT (2008–2011), or a GE VCT-XTe (2011–2013). Each patient's individual or combined chest, abdomen, and pelvic CT exams (n=4138) were loaded onto a PACS workstation (Intelerad, Canada) and measured to calculatemore » their effective diameter and SSDE. Patient SSDE was used to estimate patient organ dosimetry based on previously published data. Patient's organ dosimetry were sorted by gender, weight, age, scan protocol (i.e., chest, abdomen, or pelvis), and CT scanner technology and averaged accordingly to calculate population averaged absolute and effective dose values. Results: Patient radiation dose burden calculated for all genders, weights, and ages decreased at a rate of 0.2 mSv/year (4.2 mGy/year; average organ dose) from 2004–2013; overall levels decreased by 50% from 3.0 mSv (60.0 mGy) to 1.5 mSv (25.9 mGy). Patient dose decreased at equal rates for both male and female, and for individual scan protocols. The greatest dose savings was found for patients between 0–4 years old (65%) followed by 5-9 years old (45%), 10–14 years old (30%), and > 14 years old (21%). Conclusion: Assuming a linear-nothreshold model, there always will be potential risk of cancer induction from CT. However, as demonstrated among these patient populations, effective and organ dose has decreased over the last decade; thus, potential risk of long-term side effects from pediatric CT examinations has also been reduced.« less

Methods for CT automatic exposure control protocol translation between scanner platforms.

PubMed

McKenney, Sarah E; Seibert, J Anthony; Lamba, Ramit; Boone, John M

2014-03-01

An imaging facility with a diverse fleet of CT scanners faces considerable challenges when propagating CT protocols with consistent image quality and patient dose across scanner makes and models. Although some protocol parameters can comfortably remain constant among scanners (eg, tube voltage, gantry rotation time), the automatic exposure control (AEC) parameter, which selects the overall mA level during tube current modulation, is difficult to match among scanners, especially from different CT manufacturers. Objective methods for converting tube current modulation protocols among CT scanners were developed. Three CT scanners were investigated, a GE LightSpeed 16 scanner, a GE VCT scanner, and a Siemens Definition AS+ scanner. Translation of the AEC parameters such as noise index and quality reference mAs across CT scanners was specifically investigated. A variable-diameter poly(methyl methacrylate) phantom was imaged on the 3 scanners using a range of AEC parameters for each scanner. The phantom consisted of 5 cylindrical sections with diameters of 13, 16, 20, 25, and 32 cm. The protocol translation scheme was based on matching either the volumetric CT dose index or image noise (in Hounsfield units) between two different CT scanners. A series of analytic fit functions, corresponding to different patient sizes (phantom diameters), were developed from the measured CT data. These functions relate the AEC metric of the reference scanner, the GE LightSpeed 16 in this case, to the AEC metric of a secondary scanner. When translating protocols between different models of CT scanners (from the GE LightSpeed 16 reference scanner to the GE VCT system), the translation functions were linear. However, a power-law function was necessary to convert the AEC functions of the GE LightSpeed 16 reference scanner to the Siemens Definition AS+ secondary scanner, because of differences in the AEC functionality designed by these two companies. Protocol translation on the basis of quantitative metrics (volumetric CT dose index or measured image noise) is feasible. Protocol translation has a dependency on patient size, especially between the GE and Siemens systems. Translation schemes that preserve dose levels may not produce identical image quality. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

SU-E-J-127: Real-Time Dosimetric Assessment for Adaptive Head-And-Neck Treatment Via A GPU-Based Deformable Image Registration Framework

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

Qi, S; Neylon, J; Chen, A

2014-06-01

Purposes: To systematically monitor anatomic variations and their dosimetric consequences during head-and-neck (H'N) radiation therapy using a GPU-based deformable image registration (DIR) framework. Methods: Eleven H'N IMRT patients comprised the subject population. The daily megavoltage CT and weekly kVCT scans were acquired for each patient. The pre-treatment CTs were automatically registered with their corresponding planning CT through an in-house GPU-based DIR framework. The deformation of each contoured structure was computed to account for non-rigid change in the patient setup. The Jacobian determinant for the PTVs and critical structures was used to quantify anatomical volume changes. Dose accumulation was performed tomore » determine the actual delivered dose and dose accumulation. A landmark tool was developed to determine the uncertainty in the dose distribution due to registration error. Results: Dramatic interfraction anatomic changes leading to dosimetric variations were observed. During the treatment courses of 6–7 weeks, the parotid gland volumes changed up to 34.7%, the center-of-mass displacement of the two parotids varied in the range of 0.9–8.8mm. Mean doses were within 5% and 3% of the planned mean doses for all PTVs and CTVs, respectively. The cumulative minimum/mean/EUD doses were lower than the planned doses by 18%, 2%, and 7%, respectively for the PTV1. The ratio of the averaged cumulative cord maximum doses to the plan was 1.06±0.15. The cumulative mean doses assessed by the weekly kVCTs were significantly higher than the planned dose for the left-parotid (p=0.03) and right-parotid gland (p=0.006). The computation time was nearly real-time (∼ 45 seconds) for registering each pre-treatment CT to the planning CT and dose accumulation with registration accuracy (for kVCT) at sub-voxel level (<1.5mm). Conclusions: Real-time assessment of anatomic and dosimetric variations is feasible using the GPU-based DIR framework. Clinical implementation of this technology may enable timely plan adaption and potentially lead to improved outcome.« less

Characteristics and knowledge about HIV/AIDS and drug abuse associated with inmates education level within prison populations in Singkawang, West Borneo in 2006.

PubMed

Sigarlaki, Herke G

2008-07-01

to identify the characteristics and knowledge of inmates within prison population in Singkawang city about HIV/AIDS and drugs associated with their education level. a cross-sectional study with 240 respondents was conducted in Singkawang City, West Borneo. The subjects were inmates of prison population. They were interviewed by co-assistant doctors who completed the questionnaire forms about various aspects of knowledge about HIV/AIDS and drugs, including the application of standardized scales on subject characteristics. Data was prepared by using Microsoft Excel 2000 and all data were evaluated by univariate and bivariate analyses. The presentation will be shown in table. at the end of 2006, 91.25% respondents were male and mostly were Malay ethnic group. Moreover, 32.08% of them had formal educational background of Senior High School. Approximately 83.33% of respondents had discovered their status of HIV/AIDS by voluntary counseling and testing (VCT). Their level of knowledge about HIV/AIDS issue particularly that AIDS is caused by HIV was 90.42%. Approximately 48.33% respondents agreed that the risk factor for drug abuse was living with a family member who had taken up smoking and alcoholic consumption. our data indicate that higher education level has better contribution to the better knowledge about HIV/AIDS and drugs.

Absolute extinction and the influence of environment - Dark cloud sight lines toward VCT 10, 30, and Walker 67

NASA Technical Reports Server (NTRS)

Cardelli, Jason A.; Clayton, Geoffrey C.

1991-01-01

The range of validity of the average absolute extinction law (AAEL) proposed by Cardelli et al. (1988 and 1989) is investigated, combining published visible and NIR data with IUE UV observations for three lines of sight through dense dark cloud environments with high values of total-to-selective extinction. The characteristics of the data sets and the reduction and parameterization methods applied are described in detail, and the results are presented in extensive tables and graphs. Good agreement with the AAEL is demonstrated for wavelengths from 3.4 microns to 250 nm, but significant deviations are found at shorter wavelengths (where previous studies of lines of sight through bright nebulosity found good agreement with the AAEL). These differences are attributed to the effects of coatings on small-bump and FUV grains.

Framework for rapid assessment and adoption of new vector control tools.

PubMed

Vontas, John; Moore, Sarah; Kleinschmidt, Immo; Ranson, Hilary; Lindsay, Steve; Lengeler, Christian; Hamon, Nicholas; McLean, Tom; Hemingway, Janet

2014-04-01

Evidence-informed health policy making is reliant on systematic access to, and appraisal of, the best available research evidence. This review suggests a strategy to improve the speed at which evidence is gathered on new vector control tools (VCTs) using a framework based on measurements of the vectorial capacity of an insect population to transmit disease. We explore links between indicators of VCT efficacy measurable in small-scale experiments that are relevant to entomological and epidemiological parameters measurable only in large-scale proof-of-concept randomised control trials (RCTs). We hypothesise that once RCTs establish links between entomological and epidemiological indicators then rapid evaluation of new products within the same product category may be conducted through smaller scale experiments without repetition of lengthy and expensive RCTs. Copyright © 2014 Elsevier Ltd. All rights reserved.

SU-E-T-268: Proton Radiosurgery End-To-End Testing Using Lucy 3D QA Phantom

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

Choi, D; Gordon, I; Ghebremedhin, A

2014-06-01

Purpose: To check the overall accuracy of proton radiosurgery treatment delivery using ready-made circular collimator inserts and fixed thickness compensating boluses. Methods: Lucy 3D QA phantom (Standard Imaging Inc. WI, USA) inserted with GaFchromicTM film was irradiated with laterally scattered and longitudinally spread-out 126.8 MeV proton beams. The tests followed every step in the proton radiosurgery treatment delivery process: CT scan (GE Lightspeed VCT), target contouring, treatment planning (Odyssey 5.0, Optivus, CA), portal calibration, target localization using robotic couch with image guidance and dose delivery at planned gantry angles. A 2 cm diameter collimator insert in a 4 cm diametermore » radiosurgery cone and a 1.2 cm thick compensating flat bolus were used for all beams. Film dosimetry (RIT114 v5.0, Radiological Imaging Technology, CO, USA) was used to evaluate the accuracy of target localization and relative dose distributions compared to those calculated by the treatment planning system. Results: The localization accuracy was estimated by analyzing the GaFchromic films irradiated at gantry 0, 90 and 270 degrees. We observed 0.5 mm shift in lateral direction (patient left), ±0.9 mm shift in AP direction and ±1.0 mm shift in vertical direction (gantry dependent). The isodose overlays showed good agreement (<2mm, 50% isodose lines) between measured and calculated doses. Conclusion: Localization accuracy depends on gantry sag, CT resolution and distortion, DRRs from treatment planning computer, localization accuracy of image guidance system, fabrication of ready-made aperture and cone housing. The total deviation from the isocenter was 1.4 mm. Dose distribution uncertainty comes from distal end error due to bolus and CT density, in addition to localization error. The planned dose distribution was well matched (>90%) to the measured values 2%/2mm criteria. Our test showed the robustness of our proton radiosurgery treatment delivery system using ready-made collimator inserts and fixed thickness compensating boluses.« less

Nonredundant Roles of Iron Acquisition Systems in Vibrio cholerae

PubMed Central

Peng, Eric D.; Wyckoff, Elizabeth E.; Mey, Alexandra R.; Fisher, Carolyn R.

2015-01-01

Vibrio cholerae, the causative agent of the severe diarrheal disease cholera, thrives in both marine environments and the human host. To do so, it must encode the tools necessary to acquire essential nutrients, including iron, under these vastly different conditions. A number of V. cholerae iron acquisition systems have been identified; however, the precise role of each system is not fully understood. To test the roles of individual systems, we generated a series of mutants in which only one of the four systems that support iron acquisition on unsupplemented LB agar, Feo, Fbp, Vct, and Vib, remains functional. Analysis of these mutants under different growth conditions showed that these systems are not redundant. The strain carrying only the ferrous iron transporter Feo grew well at acidic, but not alkaline, pH, whereas the ferric iron transporter Fbp promoted better growth at alkaline than at acidic pH. A strain defective in all four systems (null mutant) had a severe growth defect under aerobic conditions but accumulated iron and grew as well as the wild type in the absence of oxygen, suggesting the presence of an additional, unidentified iron transporter in V. cholerae. In support of this, the null mutant was only moderately attenuated in an infant mouse model of infection. While the null mutant used heme as an iron source in vitro, we demonstrate that heme is not available to V. cholerae in the infant mouse intestine. PMID:26644383

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

Persson, Mats, E-mail: mats.persson@mi.physics.kth

Purpose: The highest photon fluence rate that a computed tomography (CT) detector must be able to measure is an important parameter. The authors calculate the maximum transmitted fluence rate in a commercial CT scanner as a function of patient size for standard head, chest, and abdomen protocols. Methods: The authors scanned an anthropomorphic phantom (Kyoto Kagaku PBU-60) with the reference CT protocols provided by AAPM on a GE LightSpeed VCT scanner and noted the tube current applied with the tube current modulation (TCM) system. By rescaling this tube current using published measurements on the tube current modulation of a GEmore » scanner [N. Keat, “CT scanner automatic exposure control systems,” MHRA Evaluation Report 05016, ImPACT, London, UK, 2005], the authors could estimate the tube current that these protocols would have resulted in for other patient sizes. An ECG gated chest protocol was also simulated. Using measured dose rate profiles along the bowtie filters, the authors simulated imaging of anonymized patient images with a range of sizes on a GE VCT scanner and calculated the maximum transmitted fluence rate. In addition, the 99th and the 95th percentiles of the transmitted fluence rate distribution behind the patient are calculated and the effect of omitting projection lines passing just below the skin line is investigated. Results: The highest transmitted fluence rates on the detector for the AAPM reference protocols with centered patients are found for head images and for intermediate-sized chest images, both with a maximum of 3.4 ⋅ 10{sup 8} mm{sup −2} s{sup −1}, at 949 mm distance from the source. Miscentering the head by 50 mm downward increases the maximum transmitted fluence rate to 5.7 ⋅ 10{sup 8} mm{sup −2} s{sup −1}. The ECG gated chest protocol gives fluence rates up to 2.3 ⋅ 10{sup 8} − 3.6 ⋅ 10{sup 8} mm{sup −2} s{sup −1} depending on miscentering. Conclusions: The fluence rate on a CT detector reaches 3 ⋅ 10{sup 8} − 6 ⋅ 10{sup 8} mm{sup −2} s{sup −1} in standard imaging protocols, with the highest rates occurring for ECG gated chest and miscentered head scans. These results will be useful to developers of CT detectors, in particular photon counting detectors.« less

HIV related risk behaviours among taxi drivers and their assistants in Addis Ababa, Ethiopia: descriptive cross-sectional survey.

PubMed

Lakew, Yihunie; Tamene, Habtamu

2014-04-08

Risk taking behaviours in relation to HIV among the mobile population is a growing public health concern in many developing countries, including Ethiopia. The aim of this study was to describe risky sexual behaviours and associated factors among male taxi drivers and assistants in Addis Ababa. A descriptive cross-sectional survey design with multistage cluster sampling procedure was employed to select 615 individuals for interview. Seventy six percent of the respondents were sexually active. Nearly 31% of the respondents reported casual sex and 7% of them did not use a condom with their most recent casual sex partner. More than half (58.5%) of the respondents had no condom use efficacy. Condom breakage and/or slippage during sex had been encountered by 44% of respondents with casual partners and sex during menstruation had ever occurred among 17% of respondents. Eleven percent had experienced sex with female sex workers. Thirty-three percent of the respondents were unfaithful to their spouse/steady partners. Multivariate analysis revealed that living with parents [AOR 95% CI; 2(1.14-3.60)], non-khat chewers [AOR 95% CI; 3.7(2.13-6.31)], never taken VCT [AOR 95% CI; 3.5(1.84-6.72)], middle-class monthly cash gain [AOR 95% CI; 0.5(0.25-0.98)] and more years of experience working on a taxi [AOR 95% CI; 0.17(0.60-0.47)] were statistically significant to influence lifetime abstinence. Non-khat chewers [AOR 95% CI; 0.53(0.37-0.78)], never taken VCT [AOR 95% CI; 0.54(0.36-0.88)] and higher monthly cash gain [AOR 95% CI; 2.9(1.14-7.19)] had a statistically significant association with condom use efficacy. Living with parents [AOR 95% CI; 2(1.31-3.72)], living with friends [AOR 95% CI; 6.4(3.13-12.89)] and non-khat chewers [AOR 95% CI; 2(1.34-3.53)] were risk factors found to be associated with faithfulness. Risky sexual behaviours in this sub-population were considerable and associated factors were found to be multidimensional. Therefore, there is a need for robust intervention strategies such as tailored serial radio program targeting taxi drivers and their assistants.

Barriers to involvement of men in ANC and VCT in Khayelitsha, South Africa.

PubMed

Mohlala, Boshishi K F; Gregson, Simon; Boily, Marie-Claude

2012-01-01

We used qualitative methods to assess pregnant women and men's attitudes, feelings, beliefs, experiences and reactions to male partners' involvement in antenatal clinic (ANC) in Khayelitsha, Cape Town, South Africa. The aims of these studies were to determine barriers to male partners' attendance of ANC with their pregnant female partners and to identify possible strategies to overcome these barriers. Findings from the qualitative studies demonstrated that pregnant women were keen to invite their male sexual partners and that men would attend if invited. The main barrier to male participation was lack of awareness and the healthcare facility environment. The findings of these studies emphasized the need to increase awareness among men in Khayelitsha of the need for male attendance of ANC and the need to address the barriers to male attendance of ANC. It was clear that community sensitization programmes coupled with improvement of the health facility environment to be receptive to men are essential for increasing male attendance of ANC.

The Virtual Anemia Trial: An Assessment of Model‐Based In Silico Clinical Trials of Anemia Treatment Algorithms in Patients With Hemodialysis

PubMed Central

Topping, Alice; Kappel, Franz; Thijssen, Stephan; Kotanko, Peter

2018-01-01

In silico approaches have been proposed as a novel strategy to increase the repertoire of clinical trial designs. Realistic simulations of clinical trials can provide valuable information regarding safety and limitations of treatment protocols and have been shown to assist in the cost‐effective planning of clinical studies. In this report, we present a blueprint for the stepwise integration of internal, external, and ecological validity considerations in virtual clinical trials (VCTs). We exemplify this approach in the context of a model‐based in silico clinical trial aimed at anemia treatment in patients undergoing hemodialysis (HD). Hemoglobin levels and subsequent anemia treatment were simulated on a per patient level over the course of a year and compared to real‐life clinical data of 79,426 patients undergoing HD. The novel strategies presented here, aimed to improve external and ecological validity of a VCT, significantly increased the predictive power of the discussed in silico trial. PMID:29368434

When the clinic becomes a home. Successful VCT and ART services in a stressful environment.

PubMed

Dapaah, Jonathan Mensah; Spronk, Rachel

2016-12-01

With the upscaling of antiretroviral therapy (ART) in resource-poor countries, many HIV-positive persons in Ghana have been accessing treatment in hospitals. Prevalence is relatively low compared to other African countries, 1.30%. HIV/AIDS remains heavily stigmatised in Ghana, which influences the provision and use of ART. This article investigates how HIV-positive persons accessing care and treatment go about their everyday lives in the ART clinic and how they have eventually come to see the clinic as a safe place that they call 'home'. The study took place in two Ghanaian hospitals in the Ashanti Region which in 2013 had the country's highest HIV prevalence rate of 1.30% [Ghana Health Service [GHS]/National AIDS Control Programme [NACP] (2013). 2013 HIV Sentinel Survey Report, Accra, Ghana]. It was conducted through ethnographic research, with data gathered in the two facilities through participant observation, conversations and in-depth interviews. It took place over a period of 15 months, between 2007 and 2010. In all, 24 health workers and 22 clients were interviewed in depth, while informal conversations were held with many others. The findings show that clients have adopted the clinic as a second home and used it to carry out various activities in order to avoid identification and stigmatisation as People Living with AIDS (PLWA). The most dramatic outcome was that, contrary to Ghanaian norms and values, people turned to non-kin for assistance. Accordingly, fellow clients and health personnel, rather than relatives, have become their 'therapy management group' [Janzen, J. M. (1987). Therapy Management: Concept, Reality, Process. Medical Anthropology Quarterly, 1(1), 68-84]. The clients have thus created a fictive family within the clinic - made up of health workers (as 'parents'), the clients themselves (as 'children') and the peer educators (as 'aunts' and 'uncles'). In the face of persistent stigma associated with HIV infection in Ghana, the use of the clinic as a 'home' has on the one hand helped those receiving treatment to maintain their position, respect and reputation within their families and community, while on the other it prevents PLWA from disclosing. The study concludes that compassion is an important element in the professionalisation of healthcare workers in low-prevalence countries.

When the clinic becomes a home. Successful VCT and ART services in a stressful environment

PubMed Central

Dapaah, Jonathan Mensah; Spronk, Rachel

2016-01-01

Abstract With the upscaling of antiretroviral therapy (ART) in resource-poor countries, many HIV-positive persons in Ghana have been accessing treatment in hospitals. Prevalence is relatively low compared to other African countries, 1.30%. HIV/AIDS remains heavily stigmatised in Ghana, which influences the provision and use of ART. This article investigates how HIV-positive persons accessing care and treatment go about their everyday lives in the ART clinic and how they have eventually come to see the clinic as a safe place that they call ‘home’. The study took place in two Ghanaian hospitals in the Ashanti Region which in 2013 had the country’s highest HIV prevalence rate of 1.30% [Ghana Health Service [GHS]/National AIDS Control Programme [NACP] (2013). 2013 HIV Sentinel Survey Report, Accra, Ghana]. It was conducted through ethnographic research, with data gathered in the two facilities through participant observation, conversations and in-depth interviews. It took place over a period of 15 months, between 2007 and 2010. In all, 24 health workers and 22 clients were interviewed in depth, while informal conversations were held with many others. The findings show that clients have adopted the clinic as a second home and used it to carry out various activities in order to avoid identification and stigmatisation as People Living with AIDS (PLWA). The most dramatic outcome was that, contrary to Ghanaian norms and values, people turned to non-kin for assistance. Accordingly, fellow clients and health personnel, rather than relatives, have become their ‘therapy management group’ [Janzen, J. M. (1987). Therapy Management: Concept, Reality, Process. Medical Anthropology Quarterly, 1(1), 68–84]. The clients have thus created a fictive family within the clinic – made up of health workers (as ‘parents’), the clients themselves (as ‘children’) and the peer educators (as ‘aunts’ and ‘uncles’). In the face of persistent stigma associated with HIV infection in Ghana, the use of the clinic as a ‘home’ has on the one hand helped those receiving treatment to maintain their position, respect and reputation within their families and community, while on the other it prevents PLWA from disclosing. The study concludes that compassion is an important element in the professionalisation of healthcare workers in low-prevalence countries. PMID:27598327

Upgrade to iterative image reconstruction (IR) in MDCT imaging: a clinical study for detailed parameter optimization beyond vendor recommendations using the adaptive statistical iterative reconstruction environment (ASIR) Part2: The chest.

PubMed

Mueck, F G; Michael, L; Deak, Z; Scherr, M K; Maxien, D; Geyer, L L; Reiser, M; Wirth, S

2013-07-01

To compare the image quality in dose-reduced 64-row CT of the chest at different levels of adaptive statistical iterative reconstruction (ASIR) to full-dose baseline examinations reconstructed solely with filtered back projection (FBP) in a realistic upgrade scenario. A waiver of consent was granted by the institutional review board (IRB). The noise index (NI) relates to the standard deviation of Hounsfield units in a water phantom. Baseline exams of the chest (NI = 29; LightSpeed VCT XT, GE Healthcare) were intra-individually compared to follow-up studies on a CT with ASIR after system upgrade (NI = 45; Discovery HD750, GE Healthcare), n = 46. Images were calculated in slice and volume mode with ASIR levels of 0 - 100 % in the standard and lung kernel. Three radiologists independently compared the image quality to the corresponding full-dose baseline examinations (-2: diagnostically inferior, -1: inferior, 0: equal, + 1: superior, + 2: diagnostically superior). Statistical analysis used Wilcoxon's test, Mann-Whitney U test and the intraclass correlation coefficient (ICC). The mean CTDIvol decreased by 53 % from the FBP baseline to 8.0 ± 2.3 mGy for ASIR follow-ups; p < 0.001. The ICC was 0.70. Regarding the standard kernel, the image quality in dose-reduced studies was comparable to the baseline at ASIR 70 % in volume mode (-0.07 ± 0.29, p = 0.29). Concerning the lung kernel, every ASIR level outperformed the baseline image quality (p < 0.001), with ASIR 30 % rated best (slice: 0.70 ± 0.6, volume: 0.74 ± 0.61). Vendors' recommendation of 50 % ASIR is fair. In detail, the ASIR 70 % in volume mode for the standard kernel and ASIR 30 % for the lung kernel performed best, allowing for a dose reduction of approximately 50 %. © Georg Thieme Verlag KG Stuttgart · New York.

A National Disturbance Modeling System to Support Ecological Carbon Sequestration Assessments

NASA Astrophysics Data System (ADS)

Hawbaker, T. J.; Rollins, M. G.; Volegmann, J. E.; Shi, H.; Sohl, T. L.

2009-12-01

The U.S. Geological Survey (USGS) is prototyping a methodology to fulfill requirements of Section 712 of the Energy Independence and Security Act (EISA) of 2007. At the core of the EISA requirements is the development of a methodology to complete a two-year assessment of current carbon stocks and other greenhouse gas (GHG) fluxes, and potential increases for ecological carbon sequestration under a range of future climate changes, land-use / land-cover configurations, and policy, economic and management scenarios. Disturbances, especially fire, affect vegetation dynamics and ecosystem processes, and can also introduce substantial uncertainty and risk to the efficacy of long-term carbon sequestration strategies. Thus, the potential impacts of disturbances need to be considered under different scenarios. As part of USGS efforts to meet EISA requirements, we developed the National Disturbance Modeling System (NDMS) using a series of statistical and process-based simulation models. NDMS produces spatially-explicit forecasts of future disturbance locations and severity, and the resulting effects on vegetation dynamics. NDMS is embedded within the Forecasting Scenarios of Future Land Cover (FORE-SCE) model and informs the General Ensemble Biogeochemical Modeling System (GEMS) for quantifying carbon stocks and GHG fluxes. For fires, NDMS relies on existing disturbance histories, such as the Landsat derived Monitoring Trends in Burn Severity (MTBS) and Vegetation Change Tracker (VCT) data being used to update LANDFIRE fuels data. The MTBS and VCT data are used to parameterize models predicting the number and size of fires in relation to climate, land-use/land-cover change, and socioeconomic variables. The locations of individual fire ignitions are determined by an ignition probability surface and then FARSITE is used to simulate fire spread in response to weather, fuels, and topography. Following the fire spread simulations, a burn severity model is used to determine annual changes in biomass pools. Vegetation succession among LANDFIRE vegetation types is initiated using burn perimeter and severity data at the end of each annual simulation. Results from NDMS are used to update land-use/land-cover layers used by FORE-SCE and also transferred to GEMS for quantifying and updating carbon stocks and greenhouse gas fluxes. In this presentation, we present: 1) an overview of NDMS and its role in USGS's national ecological carbon sequestration assessment; 2) validation of NDMS using historic data; and 3) initial forecasts of disturbances for the southeastern United States and their impacts on greenhouse gas emissions, and post-fire carbon stocks and fluxes.

Determination of service standard time for liquid waste parameter in certification institution

NASA Astrophysics Data System (ADS)

Sembiring, M. T.; Kusumawaty, D.

2018-02-01

Baristand Industry Medan is a technical implementation unit under the Industrial and Research and Development Agency, the Ministry of Industry. One of the services often used in Baristand Industry Medan is liquid waste testing service. The company set the standard of service 9 working days for testing services. At 2015, 89.66% on testing services liquid waste does not meet the specified standard of services company. The purpose of this research is to specify the standard time of each parameter in testing services liquid waste. The method used is the stopwatch time study. There are 45 test parameters in liquid waste laboratory. The measurement of the time done 4 samples per test parameters using the stopwatch. From the measurement results obtained standard time that the standard Minimum Service test of liquid waste is 13 working days if there is testing E. coli.

High-definition computed tomography for coronary artery stents imaging compared with standard-definition 64-row multidectector computed tomography: an initial in vivo study.

PubMed

Yang, Wen Jie; Zhang, Huan; Xiao, Hua; Li, Jian Ying; Liu, Yan; Pan, Zi Lai; Chen, Ke Min

2012-01-01

The evaluation of coronary stents by computed tomography (CT) remains difficult. We assessed the imaging performance of a high-definition CT scanner (HDCT) by comparing with a conventional 64-row standard-definition CT (SDCT). One hundred thirty-eight consecutive stented patients underwent coronary CT angiography, among whom 66 patients were examined by HDCT, and 72 patients by SDCT (LightSpeed VCT XT; GE Healthcare, Waukesha, Wis). The image quality score, the inner stent diameter (ISD), and the radiation dose were analyzed. All data were statistically tested by SPSS 13.0 software (SPSS Inc, Chicago, Ill). In 72 patients examined using SDCT, 135 stents were detected; in 66 patients examined using HDCT, 119 stents were detected. The image quality score on HDCT was significantly better than that on SDCT (1.4 [SD, 0.7] vs 1.9 [SD, 0.8]). The ISD on HDCT was significantly higher than that on SDCT (1.8 [SD, 0.5] vs 1.6 [SD, 0.4]). There was no significant difference of either image quality score or ISD between the HDCT and SDCT groups in stents with 2.5-mm diameter. Images on HDCT showed significantly better image quality score and larger ISD than images on SDCT in 2.75-, 3-, and 3.5-mm stents. For patients examined by retrospective electrocardiogram-gated technique, the radiation dose on HDCT was significantly lower than that on SDCT (11.3 [SD, 2.9] vs 15.1 [SD, 3.8] mSv). High-definition CT scanner offered improved image quality and measurement accuracy for imaging coronary stents compared with conventional SDCT, providing higher spatial resolution and lower dose for evaluating coronary stents with 2.75- to 3.5-mm diameter.

Neuropeptide Y in the central nucleus of amygdala regulates the anxiolytic effect of agmatine in rats.

PubMed

Taksande, Brijesh G; Kotagale, Nandkishor R; Gawande, Dinesh Y; Bharne, Ashish P; Chopde, Chandrabhan T; Kokare, Dadasaheb M

2014-06-01

In the present study, modulation of anxiolytic action of agmatine by neuropeptide Y (NPY) in the central nucleus of amygdala (CeA) is evaluated employing Vogel's conflict test (VCT) in rats. The intra-CeA administration of agmatine (0.6 and 1.2µmol/rat), NPY (10 and 20pmol/rat) or NPY Y1/Y5 receptors agonist [Leu(31), Pro(34)]-NPY (30 and 60pmol/rat) significantly increased the number of punished drinking licks following 15min of treatment. Combination treatment of subeffective dose of NPY (5pmol/rat) or [Leu(31), Pro(34)]-NPY (15pmol/rat) and agmatine (0.3µmol/rat) produced synergistic anxiolytic-like effect. However, intra-CeA administration of selective NPY Y1 receptor antagonist, BIBP3226 (0.25 and 0.5mmol/rat) produced anxiogenic effect. In separate set of experiment, pretreatment with BIBP3226 (0.12mmol/rat) reversed the anxiolytic effect of agmatine (0.6µmol/rat). Furthermore, we evaluated the effect of intraperitoneal injection of agmatine (40mg/kg) on NPY-immunoreactivity in the nucleus accumbens shell (AcbSh), lateral part of bed nucleus of stria terminalis (BNSTl) and CeA. While agmatine treatment significantly decreased the fibers density in BNSTl, increase was noticed in AcbSh. In addition, agmatine reduced NPY-immunoreactive cells in the AcbSh and CeA. Immunohistochemical data suggest the enhanced transmission of NPY from the AcbSh and CeA. Taken together, this study suggests that agmatine produced anxiolytic effect which might be regulated via modulation of NPYergic system particularly in the CeA. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

Measles virus V protein blocks Jak1-mediated phosphorylation of STAT1 to escape IFN-{alpha}/{beta} signaling

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

Caignard, Gregory; Guerbois, Mathilde; Labernardiere, Jean-Louis

2007-11-25

Viruses have evolved various strategies to escape the antiviral activity of type I interferons (IFN-{alpha}/{beta}). For measles virus, this function is carried by the polycistronic gene P that encodes, by an unusual editing strategy, for the phosphoprotein P and the virulence factor V (MV-V). MV-V prevents STAT1 nuclear translocation by either sequestration or phosphorylation inhibition, thereby blocking IFN-{alpha}/{beta} pathway. We show that both the N- and C-terminal domains of MV-V (PNT and VCT) contribute to the inhibition of IFN-{alpha}/{beta} signaling. Using the two-hybrid system and co-affinity purification experiments, we identified STAT1 and Jak1 as interactors of MV-V and demonstrate thatmore » MV-V can block the direct phosphorylation of STAT1 by Jak1. A deleterious mutation within the PNT domain of MV-V (Y110H) impaired its ability to interact and block STAT1 phosphorylation. Thus, MV-V interacts with at least two components of IFN-{alpha}/{beta} receptor complex to block downstream signaling.« less

The Virtual Anemia Trial: An Assessment of Model-Based In Silico Clinical Trials of Anemia Treatment Algorithms in Patients With Hemodialysis.

PubMed

Fuertinger, Doris H; Topping, Alice; Kappel, Franz; Thijssen, Stephan; Kotanko, Peter

2018-04-01

In silico approaches have been proposed as a novel strategy to increase the repertoire of clinical trial designs. Realistic simulations of clinical trials can provide valuable information regarding safety and limitations of treatment protocols and have been shown to assist in the cost-effective planning of clinical studies. In this report, we present a blueprint for the stepwise integration of internal, external, and ecological validity considerations in virtual clinical trials (VCTs). We exemplify this approach in the context of a model-based in silico clinical trial aimed at anemia treatment in patients undergoing hemodialysis (HD). Hemoglobin levels and subsequent anemia treatment were simulated on a per patient level over the course of a year and compared to real-life clinical data of 79,426 patients undergoing HD. The novel strategies presented here, aimed to improve external and ecological validity of a VCT, significantly increased the predictive power of the discussed in silico trial. © 2018 The Authors CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

Dynamics and interactions of ibuprofen in cyclodextrin nanosponges by solid-state NMR spectroscopy

PubMed Central

Ferro, Monica; Pastori, Nadia; Punta, Carlo; Melone, Lucio; Panzeri, Walter; Rossi, Barbara; Trotta, Francesco

2017-01-01

Two different formulations of cyclodextrin nanosponges (CDNS), obtained by polycondensation of β-cyclodextrin with ethylenediaminetetraacetic acid dianhydride (EDTAn), were treated with aqueous solutions of ibuprofen sodium salt (IbuNa) affording hydrogels that, after lyophilisation, gave two solid CDNS-drug formulations. 1H fast MAS NMR and 13C CP-MAS NMR spectra showed that IbuNa was converted in situ into its acidic and dimeric form (IbuH) after freeze-drying. 13C CP-MAS NMR spectra also indicated that the structure of the nanosponge did not undergo changes upon drug loading compared to the unloaded system. However, the 13C NMR spectra collected under variable contact time cross-polarization (VCT-CP) conditions showed that the polymeric scaffold CDNS changed significantly its dynamic regime on passing from the empty CDNS to the drug-loaded CDNS, thus showing that the drug encapsulation can be seen as the formation of a real supramolecular aggregate rather than a conglomerate of two solid components. Finally, the structural features obtained from the different solid-state NMR approaches reported matched the information from powder X-ray diffraction profiles. PMID:28228859

Dynamics and interactions of ibuprofen in cyclodextrin nanosponges by solid-state NMR spectroscopy.

PubMed

Ferro, Monica; Castiglione, Franca; Pastori, Nadia; Punta, Carlo; Melone, Lucio; Panzeri, Walter; Rossi, Barbara; Trotta, Francesco; Mele, Andrea

2017-01-01

Two different formulations of cyclodextrin nanosponges (CDNS), obtained by polycondensation of β-cyclodextrin with ethylenediaminetetraacetic acid dianhydride (EDTAn), were treated with aqueous solutions of ibuprofen sodium salt (IbuNa) affording hydrogels that, after lyophilisation, gave two solid CDNS-drug formulations. 1 H fast MAS NMR and 13 C CP-MAS NMR spectra showed that IbuNa was converted in situ into its acidic and dimeric form (IbuH) after freeze-drying. 13 C CP-MAS NMR spectra also indicated that the structure of the nanosponge did not undergo changes upon drug loading compared to the unloaded system. However, the 13 C NMR spectra collected under variable contact time cross-polarization (VCT-CP) conditions showed that the polymeric scaffold CDNS changed significantly its dynamic regime on passing from the empty CDNS to the drug-loaded CDNS, thus showing that the drug encapsulation can be seen as the formation of a real supramolecular aggregate rather than a conglomerate of two solid components. Finally, the structural features obtained from the different solid-state NMR approaches reported matched the information from powder X-ray diffraction profiles.

Quantitative evaluation of ASiR image quality: an adaptive statistical iterative reconstruction technique

NASA Astrophysics Data System (ADS)

Van de Casteele, Elke; Parizel, Paul; Sijbers, Jan

2012-03-01

Adaptive statistical iterative reconstruction (ASiR) is a new reconstruction algorithm used in the field of medical X-ray imaging. This new reconstruction method combines the idealized system representation, as we know it from the standard Filtered Back Projection (FBP) algorithm, and the strength of iterative reconstruction by including a noise model in the reconstruction scheme. It studies how noise propagates through the reconstruction steps, feeds this model back into the loop and iteratively reduces noise in the reconstructed image without affecting spatial resolution. In this paper the effect of ASiR on the contrast to noise ratio is studied using the low contrast module of the Catphan phantom. The experiments were done on a GE LightSpeed VCT system at different voltages and currents. The results show reduced noise and increased contrast for the ASiR reconstructions compared to the standard FBP method. For the same contrast to noise ratio the images from ASiR can be obtained using 60% less current, leading to a reduction in dose of the same amount.

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

Ma, Xusheng, E-mail: maxushengtt@163.com; Yang, Xing; Nian, Xiaofeng

Peste des petits ruminants virus (PPRV) causes a fatal disease in small ruminants. V protein of PPRV plays a pivotal role in interfering with host innate immunity by blocking IFNs signaling through interacting with STAT1 and STAT2. In the present study, the results demonstrated that PPRV V protein blocks IFN actions in a dose dependent manner and restrains the translocation of STAT1/2 proteins. We speculate that the translocation inhibition might be caused by the interfering of the downstream of STAT protein. Mutagenesis defines that Cys cluster and Trp motif of PPRV V protein are essential for STAT-mediated IFN signaling. Thesemore » findings give a new sight for the further studies to understand the delicate mechanism of PPRV to escape the IFN signaling. - Highlights: • PPRV V protein inhibits type I IFN production and blocks its activation. • PPRV V protein negatively regulates activation of ISRE and GAS promoter. • PPRV V protein inhibits nuclear translocation of STAT protein by non-degradation. • PNT and VCT domain of PPRV V protein inhibit IFN transduction. • PPRV V protein binds with STAT protein via some conserved motifs.« less

The Effect of Triage on Patient Flow in an Outpatient Clinic.

DTIC Science & Technology

1979-12-01

returns the records to the reception desk, and then checks his in- basket to call his next patient. If lab tests or X-rays are indicated and the patient is...Waiting times 7 Start and end of Provider service time provider service Total service time 8 Lab tests Percentage of lab tests ordered by screener 9 Lab... tests Percentage of lab tests ordered by provider Second provider start Provider service time and end of service Total service time 10 Referral to

46 CFR 56.97-38 - Initial service leak test (reproduces 137.7).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Initial service leak test (reproduces 137.7). 56.97-38... PIPING SYSTEMS AND APPURTENANCES Pressure Tests § 56.97-38 Initial service leak test (reproduces 137.7). (a) An initial service leak test and inspection is acceptable when other types of test are not...

12 CFR 195.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Service test. 195.24 Section 195.24 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT Standards for Assessing Performance § 195.24 Service test. (a) Scope of test. The service test evaluates a savings...

12 CFR 345.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Service test. 345.24 Section 345.24 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY COMMUNITY REINVESTMENT Standards for Assessing Performance § 345.24 Service test. (a) Scope of test. The service test...

12 CFR 345.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Service test. 345.24 Section 345.24 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY COMMUNITY REINVESTMENT Standards for Assessing Performance § 345.24 Service test. (a) Scope of test. The service test...

49 CFR 238.111 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the times and places of the pre-revenue service tests to permit FRA observation of such tests. For... 49 Transportation 4 2010-10-01 2010-10-01 false Pre-revenue service acceptance testing plan. 238... and General Requirements § 238.111 Pre-revenue service acceptance testing plan. (a) Passenger...

49 CFR 238.111 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the times and places of the pre-revenue service tests to permit FRA observation of such tests. For... 49 Transportation 4 2011-10-01 2011-10-01 false Pre-revenue service acceptance testing plan. 238... and General Requirements § 238.111 Pre-revenue service acceptance testing plan. (a) Passenger...

49 CFR 238.111 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the times and places of the pre-revenue service tests to permit FRA observation of such tests. For... 49 Transportation 4 2012-10-01 2012-10-01 false Pre-revenue service acceptance testing plan. 238... and General Requirements § 238.111 Pre-revenue service acceptance testing plan. (a) Passenger...

49 CFR 238.111 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the times and places of the pre-revenue service tests to permit FRA observation of such tests. For... 49 Transportation 4 2014-10-01 2014-10-01 false Pre-revenue service acceptance testing plan. 238... and General Requirements § 238.111 Pre-revenue service acceptance testing plan. (a) Passenger...

49 CFR 238.111 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the times and places of the pre-revenue service tests to permit FRA observation of such tests. For... 49 Transportation 4 2013-10-01 2013-10-01 false Pre-revenue service acceptance testing plan. 238... and General Requirements § 238.111 Pre-revenue service acceptance testing plan. (a) Passenger...

Using fee-for-service testing to generate revenue for the 21st century public health laboratory.

PubMed

Loring, Carol; Neil, R Brock; Gillim-Ross, Laura; Bashore, Matthew; Shah, Sandip

2013-01-01

The decrease in appropriations for state public health laboratories (SPHLs) has become a major concern as tax revenues and, subsequently, state and federal funding, have decreased. These reductions have forced SPHLs to pursue revenue-generating opportunities to support their work. We describe the current state of funding in a sampling of SPHLs and the challenges these laboratories face as they implement or expand fee-for-service testing. We conducted surveys of SPHLs to collect data concerning laboratory funding sources, test menus, fee-for-service testing, and challenges to implementing fee-for-service testing. Most SPHLS receive funding through three revenue sources: state appropriation, federal funding, and fee-for-service testing (cash funds). Among SPHLs, state appropriations ranged from $0 to more than $6 per capita, federal funding ranged from $0.10 to $5 per capita, and revenue from fee-for-service testing ranged from $0 to $4 per capita. The tests commonly performed on a fee-for-service basis included assays for sexually transmitted diseases, mycobacterial cultures, newborn screening, and water testing. We found that restrictive legislation, staffing shortages, inadequate software for billing fee-for-service testing, and regulations on how SPHLs use their generated revenue are impediments to implementing fee-for-service testing. Some SPHLs are considering implementing or expanding fee-for-service testing as a way to recapture funds lost as a result of state and federal budget cuts. This analysis revealed many of the obstacles to implementing fee-for-service testing in SPHLs and the potential impact on SPHLs of continued decreases in funding.

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

7 CFR 868.90 - Fees for certain Federal inspection services.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Laboratory Test Services 1 Laboratory tests Fees (1) Aflatoxin (Quantitative—HPLC) $182.00 (2) Aflatoxin (Quantitative—Test Kit) 87.00 (3) Aflatoxin (Qualitative—Test Kit) 47.00 (4) Appearance and odor 7.00 (5) Ash 17...) Vomitoxin (Quantitative—Test Kit) 81.00 (32) Other laboratory analytical services (per hour per service...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 3 2014-01-01 2014-01-01 false Service test. 228.24 Section 228.24 Banks and...) COMMUNITY REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its...

12 CFR 563e.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Service test. 563e.24 Section 563e.24 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT Standards for Assessing Performance § 563e.24 Service test. (a) Scope of test. The service test evaluates a savings...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 3 2012-01-01 2012-01-01 false Service test. 228.24 Section 228.24 Banks and... REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its assessment area(s) by...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Service test. 228.24 Section 228.24 Banks and... REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its assessment area(s) by...

12 CFR 25.24 - Service test.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Service test. 25.24 Section 25.24 Banks and... DEPOSIT PRODUCTION REGULATIONS Regulations Standards for Assessing Performance § 25.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its...

12 CFR 563e.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Service test. 563e.24 Section 563e.24 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT Standards for Assessing Performance § 563e.24 Service test. (a) Scope of test. The service test evaluates a savings...

12 CFR 228.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false Service test. 228.24 Section 228.24 Banks and... REINVESTMENT (REGULATION BB) Standards for Assessing Performance § 228.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its assessment area(s) by...

12 CFR 25.24 - Service test.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Service test. 25.24 Section 25.24 Banks and... DEPOSIT PRODUCTION REGULATIONS Regulations Standards for Assessing Performance § 25.24 Service test. (a) Scope of test. The service test evaluates a bank's record of helping to meet the credit needs of its...

Dynamics of national forests assessed using the Landsat record: Case studies in eastern United States

USGS Publications Warehouse

Huang, C.; Goward, S.N.; Schleeweis, K.; Thomas, N.; Masek, J.G.; Zhu, Z.

2009-01-01

The national forests (NFs) in the United States are protected areas managed for multiple purposes, and therefore are subject to both natural and anthropogenic disturbances. Monitoring forest changes arising from such disturbances and the post-disturbance recovery processes is essential for assessing the conditions of the NFs and the effectiveness of management approaches. In this study, we used time series stacks of Landsat images (LTSS) to evaluate the dynamics of seven NFs in eastern United States, including the De Soto NF, the Talladega NF, the Francis Marion NF, and the Uwharrie NF in southeastern U.S., and the Chequamegon NF, the Hiawatha NF, and the Superior NF in northern U.S. Each LTSS consisted of 12–14 Landsat images acquired for the same location, spanning from 1984 to 2006 with a nominal interval of one image every 2 years. Each LTSS was analyzed using a vegetation change tracker (VCT) algorithm to map forest disturbance. Accuracy assessments of the derived disturbance maps revealed that they had overall accuracy values of about 80%, with most of the disturbance classes having user's accuracies ranging from 70% to 95%. The producer's accuracies were generally lower, with the majority being in the range between 50% and 70%. While this may suggest that the disturbance maps could slightly underestimate disturbances, a more detailed assessment of the omission errors revealed that the majority of the disagreements were due to minor disturbances like thinning or storm damages that were identified by the image analysts but were not captured by the VCT algorithm.The derived disturbance year maps revealed that while each of the seven NFs consisted of 90% or more forest land, significant portions of the forests were disturbed since 1984. Mapped disturbances accounted for about 30%–45% of total land area in the four NFs in southeastern U.S. and about 10%–20% in the three NFs in northern U.S. The disturbance rates were generally higher in the buffer zones surrounding each NF, and varied considerably over time. The time series approach employed in this study represents a new approach for monitoring forest resources using the Landsat or similar satellite data records. The disturbance products derived using this approach were spatially explicit and contained much more temporal details than conventional bi-temporal change products, and likely will be found more useful by many users including ecologists and resources managers. The high disturbance rates found in the southeastern U.S. suggest that this region may have a more significant role in modulating the atmospheric carbon budget than currently recognized.

Using a detailed uncertainty analysis to adjust mapped rates of forest disturbance derived from Landsat time series data (Invited)

NASA Astrophysics Data System (ADS)

Cohen, W. B.; Yang, Z.; Stehman, S.; Huang, C.; Healey, S. P.

2013-12-01

Forest ecosystem process models require spatially and temporally detailed disturbance data to accurately predict fluxes of carbon or changes in biodiversity over time. A variety of new mapping algorithms using dense Landsat time series show great promise for providing disturbance characterizations at an annual time step. These algorithms provide unprecedented detail with respect to timing, magnitude, and duration of individual disturbance events, and causal agent. But all maps have error and disturbance maps in particular can have significant omission error because many disturbances are relatively subtle. Because disturbance, although ubiquitous, can be a relatively rare event spatially in any given year, omission errors can have a great impact on mapped rates. Using a high quality reference disturbance dataset, it is possible to not only characterize map errors but also to adjust mapped disturbance rates to provide unbiased rate estimates with confidence intervals. We present results from a national-level disturbance mapping project (the North American Forest Dynamics project) based on the Vegetation Change Tracker (VCT) with annual Landsat time series and uncertainty analyses that consist of three basic components: response design, statistical design, and analyses. The response design describes the reference data collection, in terms of the tool used (TimeSync), a formal description of interpretations, and the approach for data collection. The statistical design defines the selection of plot samples to be interpreted, whether stratification is used, and the sample size. Analyses involve derivation of standard agreement matrices between the map and the reference data, and use of inclusion probabilities and post-stratification to adjust mapped disturbance rates. Because for NAFD we use annual time series, both mapped and adjusted rates are provided at an annual time step from ~1985-present. Preliminary evaluations indicate that VCT captures most of the higher intensity disturbances, but that many of the lower intensity disturbances (thinnings, stress related to insects and disease, etc.) are missed. Because lower intensity disturbances are a large proportion of the total set of disturbances, adjusting mapped disturbance rates to include these can be important for inclusion in ecosystem process models. The described statistical disturbance rate adjustments are aspatial in nature, such that the basic underlying map is unchanged. For spatially explicit ecosystem modeling, such adjustments, although important, can be difficult to directly incorporate. One approach for improving the basic underlying map is an ensemble modeling approach that uses several different complementary maps, each derived from a different algorithm and having their own strengths and weaknesses relative to disturbance magnitude and causal agent of disturbance. We will present results from a pilot study associated with the Landscape Change Monitoring System (LCMS), an emerging national-level program that builds upon NAFD and the well-established Monitoring Trends in Burn Severity (MTBS) program.

49 CFR 232.505 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Pre-revenue service acceptance testing plan. 232... § 232.505 Pre-revenue service acceptance testing plan. (a) General; submission of plan. Except as... its system the operating railroad or railroads shall submit a pre-revenue service acceptance testing...

Direct-to-consumer sales of genetic services on the Internet.

PubMed

Gollust, Sarah E; Wilfond, Benjamin S; Hull, Sara Chandros

2003-01-01

PURPOSE The increasing use of the Internet to obtain genetics information and to order medical services without a prescription, combined with a rise in direct-to-consumer marketing for genetic testing, suggests the potential for the Internet to be used to sell genetic services. METHODS A systematic World Wide Web search was conducted in May 2002 to assess the availability of genetic services sold directly to consumers on the Internet. RESULTS Out of 105 sites that offered genetic services directly, most offered non-health-related services, including parentage confirmation testing (83%), identity testing (56%), and DNA banking (24%); however, health-related genetic tests were offered through 14 sites (13%). The health-related genetic tests available ranged from standard tests, such as hemochromatosis and cystic fibrosis, to more unconventional tests related to nutrition, behavior, and aging. Of these 14 sites, 5 described risks associated with the genetic services and 6 described the availability of counseling. CONCLUSIONS The availability of direct sales of health-related genetic tests creates the potential for inadequate pretest decision making, misunderstanding test results, and access to tests of questionable clinical value.

Direct-to-consumer sales of genetic services on the Internet

PubMed Central

Gollust, Sarah E.; Wilfond, Benjamin S.; Hull, Sara Chandros

2016-01-01

Purpose The increasing use of the Internet to obtain genetics information and to order medical services without a prescription, combined with a rise in direct-to-consumer marketing for genetic testing, suggests the potential for the Internet to be used to sell genetic services. Methods A systematic World Wide Web search was conducted in May 2002 to assess the availability of genetic services sold directly to consumers on the Internet. Results Out of 105 sites that offered genetic services directly, most offered non–health-related services, including parentage confirmation testing (83%), identity testing (56%), and DNA banking (24%); however, health-related genetic tests were offered through 14 sites (13%). The health-related genetic tests available ranged from standard tests, such as hemochromatosis and cystic fibrosis, to more unconventional tests related to nutrition, behavior, and aging. Of these 14 sites, 5 described risks associated with the genetic services and 6 described the availability of counseling. Conclusions The availability of direct sales of health-related genetic tests creates the potential for inadequate pretest decision making, misunderstanding test results, and access to tests of questionable clinical value. PMID:12865763

77 FR 64366 - Market Test of Experimental Product-Metro Post

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-19

... POSTAL SERVICE Market Test of Experimental Product--Metro Post AGENCY: Postal Service TM . ACTION: Notice. SUMMARY: The Postal Service gives notice of a market test of an experimental product in... Service[supreg] hereby gives notice that, pursuant to 39 U.S.C. 3641(c)(1), it will begin a market test of...

Designing testing service at baristand industri Medan’s liquid waste laboratory

NASA Astrophysics Data System (ADS)

Kusumawaty, Dewi; Napitupulu, Humala L.; Sembiring, Meilita T.

2018-03-01

Baristand Industri Medan is a technical implementation unit under the Industrial and Research and Development Agency, the Ministry of Industry. One of the services often used in Baristand Industri Medan is liquid waste testing service. The company set the standard of service is nine working days for testing services. At 2015, 89.66% on testing services liquid waste does not meet the specified standard of services company because of many samples accumulated. The purpose of this research is designing online services to schedule the coming the liquid waste sample. The method used is designing an information system that consists of model design, output design, input design, database design and technology design. The results of designing information system of testing liquid waste online consist of three pages are pages to the customer, the recipient samples and laboratory. From the simulation results with scheduled samples, then the standard services a minimum of nine working days can be reached.

Service-learning's impact on dental students' attitude towards community service.

PubMed

Coe, J M; Best, A M; Warren, J J; McQuistan, M R; Kolker, J L; Isringhausen, K T

2015-08-01

This study evaluated service-learning programme's impact on senior dental students' attitude towards community service at Virginia Commonwealth University (VCU) School of Dentistry. Experience gained through service-learning in dental school may positively impact dental students' attitude towards community service that will eventually lead into providing care to the underserved. Two surveys (pre- and post-test) were administered to 105 senior dental students. For the first survey (post-test), seventy-six students of 105 responded and reported their attitude towards community service immediately after the service-learning programme completion. Three weeks later, 56 students of the 76 responded to the second survey (retrospective pre-test) and reported their recalled attitude prior to the programme retrospectively. A repeated-measure mixed-model analysis indicated that overall there was improvement between pre-test and post-test. Scales of connectedness, normative helping behaviour, benefits, career benefits and intention showed a significant pre-test and post-test difference. An association between attitude towards community service and student characteristics such as age, gender, ethnicity and volunteer activity was also examined. Only ethnicity showed an overall significant difference. White dental students appear to have a differing perception of the costs of community service. The service-learning programme at VCU School of Dentistry has positively impacted senior dental students' attitude towards community service. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Service-learning’s Impact on Dental Students’ Attitude toward Community Service

PubMed Central

Coe, J. M.; Best, A. M.; Warren, J. J.; McQuistan, M. R.; Kolker, J. L.; Isringhausen, K. T.

2014-01-01

Introduction This study evaluated service-learning program’s impact on senior dental students’ attitude toward community service at Virginia Commonwealth University (VCU) School of Dentistry. Experience gained through service-learning in dental school may positively impact dental students’ attitude toward community service that will eventually lead into providing care to the underserved. Materials and methods Two surveys (pre and post-test) were administered to 105 senior dental students. For the first survey (post-test), seventy six students out of 105 responded and reported their attitude toward community service immediately after the service-learning program completion. Three weeks later, fifty six students out of the 76 responded to the second survey (retrospective pre-test) and reported their recalled attitude prior to the program retrospectively. Results A repeated-measure mixed-model analysis indicated that overall there was improvement between pre-test and post-test. Scales of connectedness, normative helping behavior, benefits1, career benefits, and intention showed a significant pre-test and post-test difference. An association between attitude toward community service and student characteristics such as age, gender, ethnicity, and volunteer activity was also examined. Only ethnicity showed an overall significant difference. White dental students appear to have a differing perception of the costs of community service. Conclusions The service-learning program at VCU School of Dentistry has positively impacted senior dental students’ attitude toward community service. PMID:25142286

Are there any differences between different testing sites? A cross-sectional study of a Norwegian low-threshold HIV testing service for men who have sex with men.

PubMed

Moseng, Bera Ulstein; Bjørnshagen, Vegar

2017-10-06

To describe a Norwegian low-threshold HIV testing service targeting men who have sex with men (MSM). After the HIV testing consultation, all users of the HIV testing service were invited to answer the study questionnaire. The study setting included the sites where testing was performed, that is, the testing service's office in Oslo, cruising areas, bars/clubs and in hotels in other Norwegian cities. MSM users of the testing service. Data were collected on demographics, HIV testing and sexual behaviour as well as the participant's motivations for choosing to take an HIV test at this low-threshold HIV testing service. The data are stratified by testing site. 1577 HIV testing consultations were performed, the study sample consisted of 732 MSM users. 11 tested positive for HIV. 21.7% had a non-western background, 27.1% reported having a non-gay sexual orientation. 21.9% had 10 or more male sexual partners during the last year, 27.9% reported also having had a female sexual partner. 56.4% reported having practised unprotected anal intercourse during the last 6 months. 20.1% had never tested for HIV before. Most of these user characteristics varied by testing sites. The Norwegian low-threshold testing service recruits target groups that are otherwise hard to reach with HIV testing. This may indicate that the testing service contributes to increase HIV testing rates among MSM in Norway. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Anticipating the potential for positive uptake and adaptation in the implementation of a publicly funded online STBBI testing service: a qualitative analysis.

PubMed

Chabot, Cathy; Gilbert, Mark; Haag, Devon; Ogilvie, Gina; Hawe, Penelope; Bungay, Vicky; Shoveller, Jean A

2018-01-30

Online health services are a rapidly growing aspect of public health provision, including testing for sexually transmitted and other blood-borne infections (STBBI). Generally, healthcare providers, policymakers, and clients imbue online approaches with great positive potential (e.g., encouraging clients' agency; providing cost-effective services to more clients). However, the promise of online health services may vary across contexts and be perceived in negative or ambiguous ways (e.g., risks to 'gold standard' care provision; loss of provider control over an intervention; uncertainty related to budget implications). This study examines attitudes and perceptions regarding the development of a novel online STBBI testing service in Vancouver, Canada. We examine the perceptions about the intervention's potential by interviewing practitioners and planners who were engaged in the development and initial implementation of this testing service. We conducted in-depth interviews with 37 healthcare providers, administrators, policymakers, and community-based service providers engaged in the design and launch of the new online STBBI testing service. We also conducted observations during planning and implementation meetings for the new service. Thematic analysis techniques were employed to identify codes and broader discursive themes across the interview transcripts and observation notes. Some study participants expressed concern that the potential popularity of the new testing service might increase demand on existing sexual health services or become fiscally unsustainable. However, most participants regarded the new service as having the potential to improve STBBI testing in several ways, including reducing waiting times, enhancing privacy and confidentiality, appealing to more tech-savvy sub-populations, optimizing the redistribution of demands on face-to-face service provision, and providing patient-centred technology to empower clients to seek testing. Participants perceived this online STBBI testing service to have the potential to improve sexual health care provision. But, they also anticipated actions-and-reactions, revealing a need to monitor ongoing implementation dynamics. They also identified the larger, potentially system-transforming dimension of the new technology, which enables new system drivers (consumers) and reduces the amount of control health care providers have over online STBBI testing compared to conventional in-person testing.

The Parasol Protocol: An Implementation Science Study of HIV Continuum of Care Interventions for Gay Men and Transgender Women in Burma/Myanmar

PubMed Central

Naing, Soe; Clouse, Emily; Thu, Kaung Htet; Mon, Sandra Hsu Hnin; Tun, Zin Min; Baral, Stefan; Paing, Aung Zayar; Beyrer, Chris

2017-01-01

Background Efforts to improve HIV diagnosis and antiretroviral therapy (ART) initiation among people living with HIV and reduce onward transmission of HIV rely on innovative interventions along multiple steps of the HIV care continuum. These innovative methods are particularly important for key populations, including men who have sex with men (MSM) and transgender women (TW). The HIV epidemic in Myanmar is concentrated among key populations, and national efforts now focus on reducing stigma and improving engagement of MSM and TW in HIV prevention and care. Objective This study aims to test the use of several innovations to address losses in the HIV care continuum: (1) use of respondent-driven sampling (RDS) to reach and engage MSM and TW in HIV testing, (2) HIV self-testing (HIVST) to increase HIV testing uptake and aid early diagnosis of infection, (3) community-based CD4 point-of-care (POC) technology to rapidly stage HIV disease for those who are HIV infected, and (4) peer navigation support to increase successful health system navigation for HIV-infected MSM and TW in need of ART or HIV engagement in care. Methods To assess the effect of HIVST, we will implement a randomized trial in which MSM and TW adults in the greater Yangon metropolitan area who are HIV uninfected will be recruited via RDS (N=366). Participants will complete a baseline socio-behavioral survey and will be randomized to standard, voluntary counseling and testing (VCT) or to HIVST. Biologic specimens will be collected during this baseline visit for confirmatory testing using dried blood spots. Participants will be asked to return to the study office to complete a second study visit in which they will report their HIV test result and answer questions on the acceptability of the assigned testing method. Aim 1 participants with confirmed HIV infection and who are not engaged in care (N=49) will be offered direct enrollment into Aims 2 and 3, which include immediate CD4 POC and the option for peer navigation, respectively. Aims 2 and 3 participants will be prospectively followed for 12 months with data collection including interviewer-administered sociobehavioral survey, CD4 POC, and viral load testing occurring biannually. Participants who accept peer navigation will be compared to those who decline peer navigation. Analyses will estimate the impact of CD4 POC on engagement in care and the impact of peer navigation on ART adherence and viral load. Results Formative qualitative research was conducted in June and September 2015 and led to further refinement of recruitment methods, HIVST instructions and counseling, and peer navigation methods. Aim 1 recruitment began in November 2015 with subsequent enrollment into Aims 2 and 3 and is currently ongoing. Conclusions These innovative interventions may resolve gaps in the HIV care continuum among MSM and TW and future implementation may aid in curbing the HIV epidemic among MSM and TW in Myanmar. PMID:28526661

Reasons for compliance or noncompliance with advice to test for hepatitis C via an internet-mediated blood screening service: a qualitative study.

PubMed

Zuure, Freke R; Heijman, Titia; Urbanus, Anouk T; Prins, Maria; Kok, Gerjo; Davidovich, Udi

2011-05-10

Hepatitis C virus (HCV) is mainly transmitted by exposure to infected blood, and can lead to liver cirrhosis and liver cancer. Since the onset of HCV and the development of liver cirrhosis usually are asymptomatic, many HCV-infected individuals are still undiagnosed. To identify individuals infected with HCV in the general population, a low threshold, internet-mediated blood testing service was set up. We performed a qualitative study examining reasons for compliance and noncompliance with advice to test for HCV via the online blood testing service. Semistructured telephone interviews were conducted with 33 website visitors who had been advised to test for HCV (18 testers, 15 non-testers). Transcribed interviews were analyzed qualitatively and interpreted using psychosocial theories of health behavior. Reasons for testing pertaining to the online service were: the testing procedure is autonomous, personalized test advice is provided online, reminder emails are sent, and there is an online planning tool. Reasons for testing not specific to the online service were: knowing one's status can prevent liver disease and further transmission of HCV, HCV is curable, testing can provide reassurance, physical complaints are present, and there is liver disease in one's social environment. Service-related reasons for not testing pertained to inconvenient testing facilities, a lack of commitment due to the low threshold character of the service, computer/printing problems, and incorrectly interpreting an online planning tool. The reasons for not testing that are not specific to the online service were: the belief that personal risk is low, the absence of symptoms, low perceived urgency for testing and treatment, fear of the consequences of a positive test result, avoiding threatening information, and a discouraging social environment. Features specific to the online service played a significant role in motivation to test for HCV above and beyond the more conventional perceived health benefits of HCV testing. However, some online specific features were considered problematic and need to be adapted. Methods and strategies for dealing with these impeding factors and for improving compliance with testing via the online service are outlined.

Reasons for compliance or noncompliance with advice to test for hepatitis C via an internet-mediated blood screening service: a qualitative study

PubMed Central

2011-01-01

Background Hepatitis C virus (HCV) is mainly transmitted by exposure to infected blood, and can lead to liver cirrhosis and liver cancer. Since the onset of HCV and the development of liver cirrhosis usually are asymptomatic, many HCV-infected individuals are still undiagnosed. To identify individuals infected with HCV in the general population, a low threshold, internet-mediated blood testing service was set up. We performed a qualitative study examining reasons for compliance and noncompliance with advice to test for HCV via the online blood testing service. Methods Semistructured telephone interviews were conducted with 33 website visitors who had been advised to test for HCV (18 testers, 15 non-testers). Transcribed interviews were analyzed qualitatively and interpreted using psychosocial theories of health behavior. Results Reasons for testing pertaining to the online service were: the testing procedure is autonomous, personalized test advice is provided online, reminder emails are sent, and there is an online planning tool. Reasons for testing not specific to the online service were: knowing one's status can prevent liver disease and further transmission of HCV, HCV is curable, testing can provide reassurance, physical complaints are present, and there is liver disease in one's social environment. Service-related reasons for not testing pertained to inconvenient testing facilities, a lack of commitment due to the low threshold character of the service, computer/printing problems, and incorrectly interpreting an online planning tool. The reasons for not testing that are not specific to the online service were: the belief that personal risk is low, the absence of symptoms, low perceived urgency for testing and treatment, fear of the consequences of a positive test result, avoiding threatening information, and a discouraging social environment. Conclusions Features specific to the online service played a significant role in motivation to test for HCV above and beyond the more conventional perceived health benefits of HCV testing. However, some online specific features were considered problematic and need to be adapted. Methods and strategies for dealing with these impeding factors and for improving compliance with testing via the online service are outlined. PMID:21569224

42 CFR 410.32 - Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Procedural Terminology published by the American Medical Association. (vii) Diagnostic tests performed by a... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.32 Diagnostic x-ray tests, diagnostic laboratory...

42 CFR 410.32 - Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Procedural Terminology published by the American Medical Association. (vii) Diagnostic tests performed by a... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.32 Diagnostic x-ray tests, diagnostic laboratory...

Joint Ordnance Test Procedure (JOTP)-010 Safety and Suitability for Service Assessment Testing for Shoulder Launched Munitions

DTIC Science & Technology

2016-05-09

electromagnetic environment for which they are designed to be used. These tests are performed on a powered weapon during simulated normal operation and are...010B SAFETY AND SUITABILITY FOR SERVICE ASSESSMENT TESTING FOR SHOULDER LAUNCHED MUNITIONS Joint Services Munition Safety Test Working Group JOTP...12 6.8 Test Sample Quantities .......................................................... 13 7. PRE- AND POST - TEST INSPECTIONS

76 FR 71087 - Market Test of Experimental Product: “First-Class Tracer”

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-16

... POSTAL SERVICE Market Test of Experimental Product: ``First-Class Tracer'' AGENCY: Postal Service \\TM\\. ACTION: Notice. SUMMARY: The Postal Service gives notice of a market test of an experimental... ``First-Class Tracer'' experimental product on or after December 7, 2011. The Postal Service has filed...

76 FR 22739 - Postal Service Market Test

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-22

... POSTAL REGULATORY COMMISSION [Docket No. MT2011-4; Order No. 717] Postal Service Market Test...-filed Postal Service proposal to conduct a limited market test involving a postage-refund guarantee for certain senders of First-Class Mail and Standard Mail. This document describes the proposed test...

Understanding patient choices for attending sexually transmitted infection testing services: a qualitative study

PubMed Central

Pollard, Alex; Miners, Alec; Richardson, Daniel; Fisher, Martin; Cairns, John; Smith, Helen

2012-01-01

Objectives To establish which aspects of sexually transmitted infection (STI) testing services are important to STI testing service users. Methods 10 focus groups consisting of previous or existing users of STI testing services were conducted in community settings in the south east of England. Groups were quota sampled based on age, gender and sexual orientation. Data were analysed using Framework Analysis. Results 65 respondents (58% men) participated. Perceived expertise of staff was the key reason for attendance at genitourinary medicine services rather than general practice. Although some respondents voiced a willingness to test for STIs within general practice, the apparent limited range of tests available in general practice and the perceived lack of expertise around sexual health appeared to discourage attendance at general practice. The decision of where to test for STIs was also influenced by past experience of testing, existing relationships with general practice, method of receiving test results and whether the patient had other medical conditions such as HIV. Conclusions No one type of STI testing service is suitable for all patients. This is recognised by policymakers, and it now requires commissioners and providers to make services outside of genitourinary medicine clinics more acceptable and attractive to patients, in particular to address the perceived lack of expertise and limited range of STIs tests available at alternative testing sites. PMID:22628665

Variation in healthcare services for specialist genetic testing and implications for planning genetic services: the example of inherited retinal dystrophy in the English NHS.

PubMed

Harrison, Mark; Birch, Stephen; Eden, Martin; Ramsden, Simon; Farragher, Tracey; Payne, Katherine; Hall, Georgina; Black, Graeme Cm

2015-04-01

This study aims to identify and quantify the extent of current variation in service provision of a genetic testing service for dominant and X-linked retinal dystrophies in the English National Health Service (NHS). National audit data (all test requests and results (n = 1839) issued between 2003 and 2011) and survey of English regional genetic testing services were used. Age- and gender-adjusted standardised testing rates were calculated using indirect standardisation, and survey responses were transcribed verbatim and data collated and summarised. The cumulative incidence rate of testing in England was 4.5 per 100,000 population for males and 2.6 per 100,000 population for females. The standardised testing rate (STR) varied widely between regions of England, being particularly low in the North-east (STR 0.485), with half as many tests as expected based on the size and demographic distribution of the population and high in the South-east (STR 1.355), with 36 % more tests than expected. Substantial and significantly different rates of testing were found between regional populations. Specific policy mechanisms to promote, monitor and evaluate the regional distribution of access to genetic and genomic testing are required. However, commissioners will require information on the scope and role of genetic services and the population at risk of the conditions for which patients are tested.

47 CFR 74.14 - Service or program tests.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Service or program tests. 74.14 Section 74.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO, AUXILIARY, SPECIAL BROADCAST AND OTHER PROGRAM DISTRIBUTIONAL SERVICES General; Rules Applicable to All Services in Part 74 § 74.14 Service o...

47 CFR 74.14 - Service or program tests.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Service or program tests. 74.14 Section 74.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO, AUXILIARY, SPECIAL BROADCAST AND OTHER PROGRAM DISTRIBUTIONAL SERVICES General; Rules Applicable to All Services in Part 74 § 74.14 Service o...

Joint Service Magazine Advertising Test. Spring 1978.

DTIC Science & Technology

1979-04-01

This is a test of the relative efficiency and effectiveness of joint Service advertising versus solo Service advertising of the Active Services...Subtests conducted were performance of page versus spread advertisements and four box versus three-line business reply cards. Call back research was conducted to validate findings of the major test. (Author)

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

U.S. Forest Service termiticide tests

Treesearch

Terence Wagner

2003-01-01

The U.S. Forest Service has been testingchemicals for termite control since 1939. Today its termiticide testing program is nationally recognized for providing unbiased efficacy data for product registration using standardized tests, sites, and evaluation procedures. Virtually all termiticides undergo Forest Service testing before being registered by EPA. Termiticides...

Manned Systems Utilization Analysis. Study 2.1: Space Servicing Pilot Program Study. [for automated payloads

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1975-01-01

Space servicing automated payloads was studied for potential cost benefits for future payload operations. Background information is provided on space servicing in general, and on a pilot flight test program in particular. An fight test is recommended to demonstrate space servicing. An overall program plan is provided which builds upon the pilot program through an interim servicing capability. A multipayload servicing concept for the time when the full capability tug becomes operational is presented. The space test program is specifically designed to provide low-cost booster vehicles and a flight test platform for several experiments on a single flight.

Patient- and cohort-specific dose and risk estimation for abdominopelvic CT: a study based on 100 patients

NASA Astrophysics Data System (ADS)

Tian, Xiaoyu; Li, Xiang; Segars, W. Paul; Frush, Donald P.; Samei, Ehsan

2012-03-01

The purpose of this work was twofold: (a) to estimate patient- and cohort-specific radiation dose and cancer risk index for abdominopelvic computer tomography (CT) scans; (b) to evaluate the effects of patient anatomical characteristics (size, age, and gender) and CT scanner model on dose and risk conversion coefficients. The study included 100 patient models (42 pediatric models, 58 adult models) and multi-detector array CT scanners from two commercial manufacturers (LightSpeed VCT, GE Healthcare; SOMATOM Definition Flash, Siemens Healthcare). A previously-validated Monte Carlo program was used to simulate organ dose for each patient model and each scanner, from which DLP-normalized-effective dose (k factor) and DLP-normalized-risk index values (q factor) were derived. The k factor showed exponential decrease with increasing patient size. For a given gender, q factor showed exponential decrease with both increasing patient size and patient age. The discrepancies in k and q factors across scanners were on average 8% and 15%, respectively. This study demonstrates the feasibility of estimating patient-specific organ dose and cohort-specific effective dose and risk index in abdominopelvic CT requiring only the knowledge of patient size, gender, and age.

42 CFR 410.32 - Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... in the 80000 series of the Current Procedural Terminology published by the American Medical... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.32 Diagnostic x-ray tests, diagnostic laboratory...

49 CFR 1242.04 - Special tests.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 9 2014-10-01 2014-10-01 false Special tests. 1242.04 Section 1242.04... BETWEEN FREIGHT SERVICE AND PASSENGER SERVICE FOR RAILROADS 1 General § 1242.04 Special tests. When the separation of common expense accounts between freight and passenger services is based upon special tests or...

42 CFR 410.32 - Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Procedural Terminology published by the American Medical Association. (3) Levels of supervision. Except where... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.32 Diagnostic x-ray tests, diagnostic laboratory...

49 CFR 1242.04 - Special tests.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 9 2012-10-01 2012-10-01 false Special tests. 1242.04 Section 1242.04... BETWEEN FREIGHT SERVICE AND PASSENGER SERVICE FOR RAILROADS 1 General § 1242.04 Special tests. When the separation of common expense accounts between freight and passenger services is based upon special tests or...

Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States.

PubMed

Levy, Matthew E; Wilton, Leo; Phillips, Gregory; Glick, Sara Nelson; Kuo, Irene; Brewer, Russell A; Elliott, Ayana; Watson, Christopher; Magnus, Manya

2014-05-01

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.

Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States

PubMed Central

Wilton, Leo; Phillips, Gregory; Glick, Sara Nelson; Kuo, Irene; Brewer, Russell A.; Elliott, Ayana; Watson, Christopher; Magnus, Manya

2015-01-01

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed. PMID:24531769

7 CFR 91.4 - Kinds of services.

Code of Federal Regulations, 2014 CFR

2014-01-01

... in performing commodity testing services. (c) Quality assurance reviews. The Science and Technology..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS.... Analytical laboratory testing services under the regulations in this subchapter consist of microbiological...

7 CFR 91.4 - Kinds of services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... in performing commodity testing services. (c) Quality assurance reviews. The Science and Technology..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS.... Analytical laboratory testing services under the regulations in this subchapter consist of microbiological...

7 CFR 91.4 - Kinds of services.

Code of Federal Regulations, 2012 CFR

2012-01-01

... in performing commodity testing services. (c) Quality assurance reviews. The Science and Technology..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS.... Analytical laboratory testing services under the regulations in this subchapter consist of microbiological...

7 CFR 91.4 - Kinds of services.

Code of Federal Regulations, 2013 CFR

2013-01-01

... in performing commodity testing services. (c) Quality assurance reviews. The Science and Technology..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS.... Analytical laboratory testing services under the regulations in this subchapter consist of microbiological...

42 CFR 84.95 - Service time test; open-circuit apparatus.

Code of Federal Regulations, 2013 CFR

2013-10-01

... classified according to the length of time it supplies air or oxygen to the breathing machine. (c) The... 42 Public Health 1 2013-10-01 2013-10-01 false Service time test; open-circuit apparatus. 84.95...-Contained Breathing Apparatus § 84.95 Service time test; open-circuit apparatus. (a) Service time will be...

42 CFR 84.95 - Service time test; open-circuit apparatus.

Code of Federal Regulations, 2012 CFR

2012-10-01

... classified according to the length of time it supplies air or oxygen to the breathing machine. (c) The... 42 Public Health 1 2012-10-01 2012-10-01 false Service time test; open-circuit apparatus. 84.95...-Contained Breathing Apparatus § 84.95 Service time test; open-circuit apparatus. (a) Service time will be...

42 CFR 84.95 - Service time test; open-circuit apparatus.

Code of Federal Regulations, 2014 CFR

2014-10-01

... classified according to the length of time it supplies air or oxygen to the breathing machine. (c) The... 42 Public Health 1 2014-10-01 2014-10-01 false Service time test; open-circuit apparatus. 84.95...-Contained Breathing Apparatus § 84.95 Service time test; open-circuit apparatus. (a) Service time will be...

42 CFR 84.95 - Service time test; open-circuit apparatus.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Service time test; open-circuit apparatus. 84.95...-Contained Breathing Apparatus § 84.95 Service time test; open-circuit apparatus. (a) Service time will be measured with a breathing machine as described in § 84.88. (b) The open-circuit apparatus will be...

42 CFR 84.95 - Service time test; open-circuit apparatus.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Service time test; open-circuit apparatus. 84.95...-Contained Breathing Apparatus § 84.95 Service time test; open-circuit apparatus. (a) Service time will be measured with a breathing machine as described in § 84.88. (b) The open-circuit apparatus will be...

Millennials in the Fire Service: The Effectiveness of Fire Service Recruiting, Testing, and Retention

DTIC Science & Technology

2017-12-01

to effectively attract and retain millennials is in question. Stale marketing and static testing processes may be contributing to smaller hiring pools...ABSTRACT Modern-day fire service methods’ ability to effectively attract and retain millennials is in question. Stale marketing and static testing... Marketing of the Testing Process ..............................................................50  Table 6.  Type of Testing Process

49 CFR 236.101 - Purpose of inspection and tests; removal from service of relay or device failing to meet test...

Code of Federal Regulations, 2010 CFR

2010-10-01

.../or equipment is maintained in condition to perform its intended function. Electronic device, relay... service of relay or device failing to meet test requirements. 236.101 Section 236.101 Transportation Other... Inspections and Tests; All Systems § 236.101 Purpose of inspection and tests; removal from service of relay or...

49 CFR 234.247 - Purpose of inspections and tests; removal from service of relay or device failing to meet test...

Code of Federal Regulations, 2010 CFR

2010-10-01

... operations over the grade crossing resume. (c) Any electronic device, relay, or other electromagnetic device... service of relay or device failing to meet test requirements. 234.247 Section 234.247 Transportation Other... Inspections and Tests § 234.247 Purpose of inspections and tests; removal from service of relay or device...

Can Internet-Based Sexual Health Services Increase Diagnoses of Sexually Transmitted Infections (STI)? Protocol for a Randomized Evaluation of an Internet-Based STI Testing and Results Service.

PubMed

Wilson, Emma; Free, Caroline; Morris, Tim P; Kenward, Michael G; Syred, Jonathan; Baraitser, Paula

2016-01-15

Ensuring rapid access to high quality sexual health services is a key public health objective, both in the United Kingdom and internationally. Internet-based testing services for sexually transmitted infections (STIs) are considered to be a promising way to achieve this goal. This study will evaluate a nascent online STI testing and results service in South East London, delivered alongside standard face-to-face STI testing services. The aim of this study is to establish whether an online testing and results services can (1) increase diagnoses of STIs and (2) increase uptake of STI testing, when delivered alongside standard face-to-face STI testing services. This is a single-blind randomized controlled trial. We will recruit 3000 participants who meet the following eligibility criteria: 16-30 years of age, resident in the London boroughs of Lambeth and Southwark, having at least one sexual partner in the last 12 months, having access to the Internet and willing to take an STI test. People unable to provide informed consent and unable to read and understand English (the websites will be in English) will be excluded. Baseline data will be collected at enrolment. This includes participant contact details, demographic data (date of birth, gender, ethnicity, and sexual orientation), and sexual health behaviors (last STI test, service used at last STI test and number of sexual partners in the last 12 months). Once enrolled, participants will be randomly allocated either (1) to an online STI testing and results service (Sexual Health 24) offering postal self-administered STI kits for chlamydia, gonorrhoea, syphilis, and HIV; results via text message (short message service, SMS), except positive results for HIV, which will be delivered by phone; and direct referrals to local clinics for treatment or (2) to a conventional sexual health information website with signposting to local clinic-based sexual health services. Participants will be free to use any other interventions or services during the trial period. At 6 weeks from randomization we will collect self-reported follow-up data on service use, STI tests and results, treatment prescribed, and acceptability of STI testing services. We will also collect objective data from participating STI testing services on uptake of STI testing, STI diagnoses and treatment. We hypothesise that uptake of STI testing and STI diagnoses will be higher in the intervention arm. Our hypothesis is based on the assumption that the intervention is less time-consuming, more convenient, more private, and incur less stigma and embarrassment than face-to-face STI testing pathways. The primary outcome measure is diagnosis of any STI at 6 weeks from randomization and our co-primary outcome is completion of any STI test at 6 weeks from randomization. We define completion of a test, as samples returned, processed, and results delivered to the intervention and/or clinic settings. We will use risk ratios to calculate the effect of the intervention on our primary outcomes with 95% confidence intervals. All analyses will be based on the intention-to-treat (ITT) principle. This study is funded by Guy's and St Thomas' Charity and it has received ethical approval from NRES Committee London-Camberwell St Giles (Ref 14/LO/1477). Research and Development approval has been obtained from Kings College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust. Results are expected in June 2016. This study will provide evidence on the effectiveness of an online STI testing and results service in South East London. Our findings may also be generalizable to similar populations in the United Kingdom. International Standard Randomized Controlled Trial Number (ISRCTN): 13354298; http://www.isrctn.com/ISRCTN13354298 (Archived by WebCite at http://www.webcitation.org/6d9xT2bPj).

76 FR 2930 - Market Test of Experimental Product: “Gift Cards”

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-18

... POSTAL SERVICE Market Test of Experimental Product: ``Gift Cards'' AGENCY: Postal Service \\TM\\. ACTION: Notice. SUMMARY: The Postal Service gives notice of a market test of an experimental product in... notice pursuant to 39 U.S.C. 3641(c)(1) that it will begin a market test of its ``Gift Cards...

7 CFR 91.37 - Standard hourly fee rate for laboratory testing, analysis, and other services.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 3 2012-01-01 2012-01-01 false Standard hourly fee rate for laboratory testing... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.37 Standard hourly fee rate for laboratory testing, analysis, and other services. (a) The...

7 CFR 91.37 - Standard hourly fee rate for laboratory testing, analysis, and other services.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 3 2014-01-01 2014-01-01 false Standard hourly fee rate for laboratory testing... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.37 Standard hourly fee rate for laboratory testing, analysis, and other services. (a) The...

7 CFR 91.37 - Standard hourly fee rate for laboratory testing, analysis, and other services.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 3 2013-01-01 2013-01-01 false Standard hourly fee rate for laboratory testing... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.37 Standard hourly fee rate for laboratory testing, analysis, and other services. (a) The...

7 CFR 91.37 - Standard hourly fee rate for laboratory testing, analysis, and other services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Standard hourly fee rate for laboratory testing... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.37 Standard hourly fee rate for laboratory testing, analysis, and other services. (a) The...

47 CFR 87.299 - Scope of service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Scope of service. 87.299 Section 87.299 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AVIATION SERVICES Flight Test Stations § 87.299 Scope of service. The use of flight test stations is restricted to the...

77 FR 27738 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... qualitative testing mortgage servicing related model forms and disclosures. DATES: Written comments must be...: Qualitative Testing of Mortgage Servicing Related Model Forms and Disclosures. OMB Number: 3170-0018. Abstract: The Bureau seeks to allow for qualitative testing of mortgage servicing related model forms and...

76 FR 3679 - Market Test of Experimental Product: “Marketing Mail Made Easy”

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

... POSTAL SERVICE Market Test of Experimental Product: ``Marketing Mail Made Easy'' AGENCY: Postal Service TM . ACTION: Notice. SUMMARY: The Postal Service gives notice of a market test of an experimental...[supreg] hereby gives notice pursuant to 39 U.S.C. 3641(c)(1) that it will begin a market test of its...

HIV Testing, HIV Positivity, and Linkage and Referral Services in Correctional Facilities in the United States, 2009–2013

PubMed Central

Seth, Puja; Figueroa, Argelia; Wang, Guoshen; Reid, Laurie; Belcher, Lisa

2016-01-01

Background Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)–funded HIV testing and service delivery in correctional facilities. Methods Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. Results Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. Conclusions Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease. PMID:26462190

78 FR 41129 - Market Test of Experimental Product - International Merchandise Return Service-Non-Published Rates

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-09

...--Non-Published Rates AGENCY: U.S. Postal Service\\TM\\. ACTION: Notice. SUMMARY: The Postal Service hereby gives notice of a market test for International Merchandise Return Service--Non-Published Rates in... Return Service (IMRS) Non-published Rate (NPR) experimental product on August 15, 2013. The Postal...

Accelerated life assessment of coating on the radar structure components in coastal environment.

PubMed

Liu, Zhe; Ming, ZhiMao

2016-07-04

This paper aimed to build an accelerated life test scheme and carry out quantitative analysis between accelerated life test in the laboratory and actual service for the coating composed of epoxy primer and polyurethane paint on structure components of some kind of radar served in the coastal environment of South China Sea. The accelerated life test scheme was built based on the service environment and failure analysis of the coating. The quantitative analysis between accelerated life test and actual service was conducted by comparing the gloss loss, discoloration, chalking, blistering, cracking and electrochemical impedance spectroscopy of the coating. The main factors leading to the coating failure were ultraviolet radiation, temperature, moisture, salt fog and loads, the accelerated life test included ultraviolet radiation, damp heat, thermal shock, fatigue and salt spray. The quantitative relationship was that one cycle of the accelerated life test was equal to actual service for one year. It was established that one cycle of the accelerated life test was equal to actual service for one year. It provided a precise way to predict actual service life of newly developed coatings for the manufacturer.

Testing and reference model analysis of FTTH system

NASA Astrophysics Data System (ADS)

Feng, Xiancheng; Cui, Wanlong; Chen, Ying

2009-08-01

With rapid development of Internet and broadband access network, the technologies of xDSL, FTTx+LAN , WLAN have more applications, new network service emerges in endless stream, especially the increase of network game, meeting TV, video on demand, etc. FTTH supports all present and future service with enormous bandwidth, including traditional telecommunication service, traditional data service and traditional TV service, and the future digital TV and VOD. With huge bandwidth of FTTH, it wins the final solution of broadband network, becomes the final goal of development of optical access network.. Fiber to the Home (FTTH) will be the goal of telecommunications cable broadband access. In accordance with the development trend of telecommunication services, to enhance the capacity of integrated access network, to achieve triple-play (voice, data, image), based on the existing optical Fiber to the curb (FTTC), Fiber To The Zone (FTTZ), Fiber to the Building (FTTB) user optical cable network, the optical fiber can extend to the FTTH system of end-user by using EPON technology. The article first introduced the basic components of FTTH system; and then explain the reference model and reference point for testing of the FTTH system; Finally, by testing connection diagram, the testing process, expected results, primarily analyze SNI Interface Testing, PON interface testing, Ethernet performance testing, UNI interface testing, Ethernet functional testing, PON functional testing, equipment functional testing, telephone functional testing, operational support capability testing and so on testing of FTTH system. ...

Evaluation of direct-to-consumer low-volume lab tests in healthy adults.

PubMed

Kidd, Brian A; Hoffman, Gabriel; Zimmerman, Noah; Li, Li; Morgan, Joseph W; Glowe, Patricia K; Botwin, Gregory J; Parekh, Samir; Babic, Nikolina; Doust, Matthew W; Stock, Gregory B; Schadt, Eric E; Dudley, Joel T

2016-05-02

Clinical laboratory tests are now being prescribed and made directly available to consumers through retail outlets in the USA. Concerns with these test have been raised regarding the uncertainty of testing methods used in these venues and a lack of open, scientific validation of the technical accuracy and clinical equivalency of results obtained through these services. We conducted a cohort study of 60 healthy adults to compare the uncertainty and accuracy in 22 common clinical lab tests between one company offering blood tests obtained from finger prick (Theranos) and 2 major clinical testing services that require standard venipuncture draws (Quest and LabCorp). Samples were collected in Phoenix, Arizona, at an ambulatory clinic and at retail outlets with point-of-care services. Theranos flagged tests outside their normal range 1.6× more often than other testing services (P < 0.0001). Of the 22 lab measurements evaluated, 15 (68%) showed significant interservice variability (P < 0.002). We found nonequivalent lipid panel test results between Theranos and other clinical services. Variability in testing services, sample collection times, and subjects markedly influenced lab results. While laboratory practice standards exist to control this variability, the disparities between testing services we observed could potentially alter clinical interpretation and health care utilization. Greater transparency and evaluation of testing technologies would increase their utility in personalized health management. This work was supported by the Icahn Institute for Genomics and Multiscale Biology, a gift from the Harris Family Charitable Foundation (to J.T. Dudley), and grants from the NIH (R01 DK098242 and U54 CA189201, to J.T. Dudley, and R01 AG046170 and U01 AI111598, to E.E. Schadt).

Evaluation of direct-to-consumer low-volume lab tests in healthy adults

PubMed Central

Kidd, Brian A.; Hoffman, Gabriel; Zimmerman, Noah; Li, Li; Morgan, Joseph W.; Glowe, Patricia K.; Botwin, Gregory J.; Parekh, Samir; Babic, Nikolina; Doust, Matthew W.; Stock, Gregory B.; Schadt, Eric E.; Dudley, Joel T.

2016-01-01

BACKGROUND. Clinical laboratory tests are now being prescribed and made directly available to consumers through retail outlets in the USA. Concerns with these test have been raised regarding the uncertainty of testing methods used in these venues and a lack of open, scientific validation of the technical accuracy and clinical equivalency of results obtained through these services. METHODS. We conducted a cohort study of 60 healthy adults to compare the uncertainty and accuracy in 22 common clinical lab tests between one company offering blood tests obtained from finger prick (Theranos) and 2 major clinical testing services that require standard venipuncture draws (Quest and LabCorp). Samples were collected in Phoenix, Arizona, at an ambulatory clinic and at retail outlets with point-of-care services. RESULTS. Theranos flagged tests outside their normal range 1.6× more often than other testing services (P < 0.0001). Of the 22 lab measurements evaluated, 15 (68%) showed significant interservice variability (P < 0.002). We found nonequivalent lipid panel test results between Theranos and other clinical services. Variability in testing services, sample collection times, and subjects markedly influenced lab results. CONCLUSION. While laboratory practice standards exist to control this variability, the disparities between testing services we observed could potentially alter clinical interpretation and health care utilization. Greater transparency and evaluation of testing technologies would increase their utility in personalized health management. FUNDING. This work was supported by the Icahn Institute for Genomics and Multiscale Biology, a gift from the Harris Family Charitable Foundation (to J.T. Dudley), and grants from the NIH (R01 DK098242 and U54 CA189201, to J.T. Dudley, and R01 AG046170 and U01 AI111598, to E.E. Schadt). PMID:27018593

47 CFR 74.13 - Equipment tests.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Equipment tests. 74.13 Section 74.13 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES EXPERIMENTAL RADIO, AUXILIARY, SPECIAL BROADCAST AND OTHER PROGRAM DISTRIBUTIONAL SERVICES General; Rules Applicable to All Services in Part 74 § 74.13 Equipment tests. (...

75 FR 16874 - Market Test of “Samples Co-Op Box” Experimental Product

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

... POSTAL SERVICE Market Test of ``Samples Co-Op Box'' Experimental Product AGENCY: Postal Service TM . ACTION: Notice. SUMMARY: The Postal Service gives notice of a market test of an experimental product in... pursuant to 39 U.S.C. 3641(c)(1) that it will begin a market test of its ``Samples Co-Op Box'' experimental...

Structural Assessment of Knowledge and Skill

DTIC Science & Technology

1992-08-01

Street San Diego, CA 92152-6800 Chicago, IL 60616 Dr. Menucha Birenbaum Educational Testing Serv. Library, Code 231 Dr. Lorraine 0. Eyde Princeton, NJ...University Dr. Norman Frederiksen Educational Testing Service Rosedale Road Department of Psychology Educational Testing Service Princeton, NJ 08541... Psychology Educational Testing Service Arlington, VA 22207 Carnegie-Mellon University Princeton, NJ 08541 5000 Forbes Avenue Dr. Delwyn Harnisch Pittsburgh

46 CFR 54.05-20 - Impact test properties for service of 0 °F and below.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 2 2012-10-01 2012-10-01 false Impact test properties for service of 0 °F and below. 54.05-20 Section 54.05-20 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING PRESSURE VESSELS Toughness Tests § 54.05-20 Impact test properties for service of 0 °F and below. (a) Test energy. The impact energies of...

Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective?

PubMed

Magnussen, Lesley; Ehiri, John E; Ejere, Henry O D; Jolly, Pauline E

2004-01-01

The objective of this study was to summarize and critically assess the effects of interventions to prevent HIV/AIDS among adolescents in less developed countries. Reports of studies that evaluated interventions for preventing HIV/AIDS/STDs among persons aged 11-25 years were obtained from online computer databases, by searching conference proceedings and relevant journals, and by following up references cited in published reports. Studies were included if they investigated any educational, behavioral, psychosocial or other intervention that aimed to prevent or reduce HIV/AIDS/STD among persons aged 11-25 years in a less developed country. Only studies that included a control group, and which involved pre- and post-intervention assessments were included. Outcome measures included: (i) changes in safe sex practices (abstinence, condom use, limitation of sexual partners, avoidance of casual sex), (ii) knowledge about HIV/AIDS transmission and prevention methods, (iii) perception of HIV/AIDS/STD risks, (iv) self-efficacy with regard to condom negotiation and refusal of sex, (v) uptake of voluntary counseling and testing (VCT), and (vi) reduction in incidence of HIV/AIDS/STDs. Studies were assessed in terms of intervention format (e.g., education, role-play, video), duration, and setting (school or community). Reported improvements in outcome measures in intervention versus control groups were assessed. Sixteen studies met the inclusion criteria. Thirteen of these were conducted in Africa and three in Latin America. Twelve of the sixteen studies were school-based, and four were community-based. The interventions reviewed were not resoundingly successful in achieving their goals of increasing knowledge of HIV/AIDS, altering attitudes, improving negotiation and communication skills, or in influencing positive behavior evidenced through consistent condom use, abstinence, or reducing the number of partners. Considering the importance of HIV/AIDS prevention among adolescents, design of evaluation studies of programs in less developed countries need to be improved. The use of randomized controlled trials or other rigorous approaches for evaluating population-based behavioral interventions (e.g., Solomon Four design) is recommended.

Upgrade to iterative image reconstruction (IR) in abdominal MDCT imaging: a clinical study for detailed parameter optimization beyond vendor recommendations using the adaptive statistical iterative reconstruction environment (ASIR).

PubMed

Mueck, F G; Körner, M; Scherr, M K; Geyer, L L; Deak, Z; Linsenmaier, U; Reiser, M; Wirth, S

2012-03-01

To compare the image quality of dose-reduced 64-row abdominal CT reconstructed at different levels of adaptive statistical iterative reconstruction (ASIR) to full-dose baseline examinations reconstructed with filtered back-projection (FBP) in a clinical setting and upgrade situation. Abdominal baseline examinations (noise index NI = 29; LightSpeed VCT XT, GE) were intra-individually compared to follow-up studies on a CT with an ASIR option (NI = 43; Discovery HD750, GE), n = 42. Standard-kernel images were calculated with ASIR blendings of 0 - 100 % in slice and volume mode, respectively. Three experienced radiologists compared the image quality of these 567 sets to their corresponding full-dose baseline examination (- 2: diagnostically inferior, - 1: inferior, 0: equal, + 1: superior, + 2: diagnostically superior). Furthermore, a phantom was scanned. Statistical analysis used the Wilcoxon - the Mann-Whitney U-test and the intra-class correlation (ICC). The mean CTDIvol decreased from 19.7 ± 5.5 to 12.2 ± 4.7 mGy (p < 0.001). The ICC was 0.861. The total image quality of the dose-reduced ASIR studies was comparable to the baseline at ASIR 50 % in slice (p = 0.18) and ASIR 50 - 100 % in volume mode (p > 0.10). Volume mode performed 73 % slower than slice mode (p < 0.01). After the system upgrade, the vendor recommendation of ASIR 50 % in slice mode allowed for a dose reduction of 38 % in abdominal CT with comparable image quality and time expenditure. However, there is still further dose reduction potential for more complex reconstruction settings. © Georg Thieme Verlag KG Stuttgart · New York.

Termite testing continues

Treesearch

Terence L. Wagner; Joe Mulrooney; Chris Petereson

2002-01-01

The United States Department of Agriculture Forest Service's termiticide testing program provides unbiased efficacy data for product registration using standardized tests, sites and evaluation procedures. Virtually all termiticides undergo Forest Service tests prior to registration.

Telehealth physician oversight over direct to consumer testing: doctors working with patients towards patient empowerment.

PubMed

Chung, Rick

2012-06-01

Patient empowerment has increased the demand for direct to consumer (DTC) laboratory testing. Multiple professional societies and advocacy groups have raised concerns over how DTC laboratory testing is being offered to consumers without proper physician oversight. Physician telehealth services can properly oversee DTC laboratory testing in a safe and medically sound manner. Using telehealth protocols and standards established by professional health organizations and state regulators, physician telehealth oversight in DTC laboratory test ordering can be effective to increase patient access to healthcare services. With proper physician oversight in test interpretation, post-test counseling, and information collaboration, DTC laboratory testing can remain a reliable and convenient option for consumers. Working within the channel of distribution of most DTC laboratory testing, physician telehealth services can properly oversee DTC laboratory testing in a safe and medically sound manner to ensure that proper test interpretation, counseling, and information collaboration are achieved. Physician telehealth services can properly oversee DTC laboratory testing to ensure that proper test interpretation, counseling, and information collaboration are achieved.

Availability and acceptability of HIV counselling and testing services. A qualitative study comparing clients' experiences of accessing HIV testing at public sector primary health care facilities or non-governmental mobile services in Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Leon, Natalie; Naidoo, Pren; Jennings, Karen; Burger, Ronelle; Beyers, Nulda

2015-09-02

The South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services. This qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT). The sample consisted of 12 females and 4 males with an age range of 19-60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services. Realised access to HCT is dependent on availability and acceptability of HCT services. Those who utilised either a NGO mobile service or a public PHC facility perceived both service types as available and acceptable. Mobile NGO services provided an accessible opportunity for those who would otherwise not have tested at that time. Policy makers should consider the perceptions and experiences of those accessing HCT services when increasing access to HCT.

47 CFR 87.307 - Cooperative use of facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES AVIATION SERVICES Flight Test Stations § 87.307 Cooperative use of facilities. (a) The Commission will license only one flight test land station per airport, except as provided in paragraph (d) of this section. (b) Flight test land stations located at an airport are required to provide service without...

9 CFR 113.6 - Animal and Plant Health Inspection Service testing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Animal and Plant Health Inspection Service testing. 113.6 Section 113.6 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... STANDARD REQUIREMENTS Applicability § 113.6 Animal and Plant Health Inspection Service testing. A...

9 CFR 113.6 - Animal and Plant Health Inspection Service testing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Animal and Plant Health Inspection Service testing. 113.6 Section 113.6 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... STANDARD REQUIREMENTS Applicability § 113.6 Animal and Plant Health Inspection Service testing. A...

9 CFR 113.6 - Animal and Plant Health Inspection Service testing.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Animal and Plant Health Inspection Service testing. 113.6 Section 113.6 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... STANDARD REQUIREMENTS Applicability § 113.6 Animal and Plant Health Inspection Service testing. A...

9 CFR 113.6 - Animal and Plant Health Inspection Service testing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Animal and Plant Health Inspection Service testing. 113.6 Section 113.6 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... STANDARD REQUIREMENTS Applicability § 113.6 Animal and Plant Health Inspection Service testing. A...

9 CFR 113.6 - Animal and Plant Health Inspection Service testing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Animal and Plant Health Inspection Service testing. 113.6 Section 113.6 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... STANDARD REQUIREMENTS Applicability § 113.6 Animal and Plant Health Inspection Service testing. A...

The Parasol Protocol: An Implementation Science Study of HIV Continuum of Care Interventions for Gay Men and Transgender Women in Burma/Myanmar.

PubMed

Wirtz, Andrea L; Naing, Soe; Clouse, Emily; Thu, Kaung Htet; Mon, Sandra Hsu Hnin; Tun, Zin Min; Baral, Stefan; Paing, Aung Zayar; Beyrer, Chris

2017-05-17

Efforts to improve HIV diagnosis and antiretroviral therapy (ART) initiation among people living with HIV and reduce onward transmission of HIV rely on innovative interventions along multiple steps of the HIV care continuum. These innovative methods are particularly important for key populations, including men who have sex with men (MSM) and transgender women (TW). The HIV epidemic in Myanmar is concentrated among key populations, and national efforts now focus on reducing stigma and improving engagement of MSM and TW in HIV prevention and care. This study aims to test the use of several innovations to address losses in the HIV care continuum: (1) use of respondent-driven sampling (RDS) to reach and engage MSM and TW in HIV testing, (2) HIV self-testing (HIVST) to increase HIV testing uptake and aid early diagnosis of infection, (3) community-based CD4 point-of-care (POC) technology to rapidly stage HIV disease for those who are HIV infected, and (4) peer navigation support to increase successful health system navigation for HIV-infected MSM and TW in need of ART or HIV engagement in care. To assess the effect of HIVST, we will implement a randomized trial in which MSM and TW adults in the greater Yangon metropolitan area who are HIV uninfected will be recruited via RDS (N=366). Participants will complete a baseline socio-behavioral survey and will be randomized to standard, voluntary counseling and testing (VCT) or to HIVST. Biologic specimens will be collected during this baseline visit for confirmatory testing using dried blood spots. Participants will be asked to return to the study office to complete a second study visit in which they will report their HIV test result and answer questions on the acceptability of the assigned testing method. Aim 1 participants with confirmed HIV infection and who are not engaged in care (N=49) will be offered direct enrollment into Aims 2 and 3, which include immediate CD4 POC and the option for peer navigation, respectively. Aims 2 and 3 participants will be prospectively followed for 12 months with data collection including interviewer-administered sociobehavioral survey, CD4 POC, and viral load testing occurring biannually. Participants who accept peer navigation will be compared to those who decline peer navigation. Analyses will estimate the impact of CD4 POC on engagement in care and the impact of peer navigation on ART adherence and viral load. Formative qualitative research was conducted in June and September 2015 and led to further refinement of recruitment methods, HIVST instructions and counseling, and peer navigation methods. Aim 1 recruitment began in November 2015 with subsequent enrollment into Aims 2 and 3 and is currently ongoing. These innovative interventions may resolve gaps in the HIV care continuum among MSM and TW and future implementation may aid in curbing the HIV epidemic among MSM and TW in Myanmar. ©Andrea L Wirtz, Soe Naing, Emily Clouse, Kaung Htet Thu, Sandra Hsu Hnin Mon, Zin Min Tun, Stefan Baral, Aung Zayar Paing, Chris Beyrer. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 17.05.2017.

Testing as a Service with HammerCloud

NASA Astrophysics Data System (ADS)

Medrano Llamas, Ramón; Barrand, Quentin; Elmsheuser, Johannes; Legger, Federica; Sciacca, Gianfranco; Sciabà, Andrea; van der Ster, Daniel

2014-06-01

HammerCloud was designed and born under the needs of the grid community to test the resources and automate operations from a user perspective. The recent developments in the IT space propose a shift to the software defined data centres, in which every layer of the infrastructure can be offered as a service. Testing and monitoring is an integral part of the development, validation and operations of big systems, like the grid. This area is not escaping the paradigm shift and we are starting to perceive as natural the Testing as a Service (TaaS) offerings, which allow testing any infrastructure service, such as the Infrastructure as a Service (IaaS) platforms being deployed in many grid sites, both from the functional and stressing perspectives. This work will review the recent developments in HammerCloud and its evolution to a TaaS conception, in particular its deployment on the Agile Infrastructure platform at CERN and the testing of many IaaS providers across Europe in the context of experiment requirements. The first section will review the architectural changes that a service running in the cloud needs, such an orchestration service or new storage requirements in order to provide functional and stress testing. The second section will review the first tests of infrastructure providers on the perspective of the challenges discovered from the architectural point of view. Finally, the third section will evaluate future requirements of scalability and features to increase testing productivity.

Suggestions for Job and Curriculum Ladders in Health Center Ambulatory Care: A Pilot Test of the Health Services Mobility Study Methodology.

ERIC Educational Resources Information Center

Gilpatrick, Eleanor

This report contains the results of a pilot test which represents the first complete field test of methodological work begun in October 1967 under a Federal grant for the purpose of job analysis in the health services. This 4-year Health Services Mobility Study permitted basic research, field testing, practical application, and policy involvement…

Telecommunications Systems Career Ladder, AFSC 307XO.

DTIC Science & Technology

1981-01-01

standard test tone levels perform impulse noise tests make in-service or out-of- service quality check.s on composite signal transmission levels Even...service or out-of- service quality control (QC) reports maintain trouble and restoration record forms (DD Form 1443) direct circuit or system checks...include: perform fault isolation on analog circuits make in-service or out-of- service quality checks on voice frequency carrier telegraph (VFCT) terminals

Development and Implementation of a Pharmacist-Managed Clinical Pharmacogenetics Service

PubMed Central

Crews, Kristine R.; Cross, Shane J.; McCormick, John N.; Baker, Donald K.; Molinelli, Alejandro R.; Mullins, Richard; Relling, Mary V.; Hoffman, James M.

2011-01-01

Purpose The development and implementation of a pharmacist-managed Clinical Pharmacogenetics service is described. Summary Therapeutic drug monitoring (TDM) is a well-accepted role of the pharmacist. Pharmacogenetics, the study of genetic factors that influence the variability in drug response among patients, is a rapidly evolving discipline that integrates knowledge of pharmacokinetics and pharmacodynamics with modern advances in genetic testing. There is growing evidence for the clinical utility of pharmacogenetics, and pharmacists can play an essential role in the thoughtful application of pharmacogenetics to patient care. A pharmacist-managed Clinical Pharmacogenetics service was designed and implemented. The goal of the service is to provide clinical pharmacogenetic testing for gene products important to the pharmacodynamics of medications used in our patients. The service is modeled after and integrated with an already established Clinical Pharmacokinetics service. All clinical pharmacogenetic test results are first reported to one of the pharmacists, who reviews the result and provides a written consult. The consult includes an interpretation of the result and recommendations for any indicated changes to therapy. In 2009, 136 clinical pharmacogenetic tests were performed, consisting of 66 TPMT tests, 65 CYP2D6 tests, and 5 UGT1A1 tests. Our service has been met with positive clinician feedback. Conclusion Our experience demonstrates the feasibility of the design and function of a pharmacist-managed Clinical Pharmacogenetics service at an academic specialty hospital. The successful implementation of this service highlights the leadership role that pharmacists can take in moving pharmacogenetics from research to patient care, thereby potentially improving patient outcomes. PMID:21200062

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis.

PubMed

Barnard, Sharmani; Free, Caroline; Bakolis, Ioannis; Turner, Katy M E; Looker, Katharine J; Baraitser, Paula

2018-02-07

Online services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of users of online services and compares them with users of clinic services. We conducted a cross-sectional analysis of routinely collected data on STI testing activity from online and clinic sexual health services in Lambeth and Southwark between 1January 2016 and 31March 2016. Activity was included for chlamydia, gonorrhoea, HIV and syphilis testing for residents of the boroughs aged 16 years and older. Logistic regression models were used to explore potential associations between type of service use with age group, gender, ethnic group, sexual orientation, positivity and Index of Multiple Deprivation (IMD) quintiles. We used the same methods to explore potential associations between return of complete samples for testing with age group, gender, ethnic group, sexual orientation and IMD quintiles among online users. 6456 STI tests were carried out by residents in the boroughs. Of these, 3582 (55.5%) were performed using clinic services and 2874 (44.5%) using the online service. In multivariate analysis, online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Of the individuals that ordered a kit from the online service, 72.5% returned sufficient samples. In multivariate analysis, returners were more likely than non-returners to be aged >20 years and white British. Nearly half (44.5%) of all basic STI testing was done online, although the characteristics of users of clinic and online services differed and positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

"What took you so long?" The impact of PEPFAR on the expansion of HIV testing and counseling services in Africa.

PubMed

Marum, Elizabeth; Taegtmeyer, Miriam; Parekh, Bharat; Mugo, Nelly; Lembariti, Salama; Phiri, Mannasseh; Moore, Jan; Cheng, Alison S

2012-08-15

HIV testing and counseling services in Africa began in the early 1990s, with limited availability and coverage. Fears of stigma and discrimination, complex laboratory systems, and lack of available care and treatment services hampered expansion. Use of rapid point-of-care tests, introduction of services to prevent mother-to-child transmission, and increasing provision of antiretroviral drugs were key events in the late 1990s and early 2000s that facilitated the expansion of HIV testing and counseling services. Innovations in service delivery included providing HIV testing in both clinical and community sites, including mobile and home testing. Promotional campaigns were conducted in many countries, and evolutions in policies and guidance facilitated expansion and uptake. Support from President's Emergency Plan for AIDS Relief and national governments, other donors, and the Global Fund for AIDS, Tuberculosis, and Malaria contributed to significant increases in the numbers of persons tested in many countries. Quality of both testing and counseling, limited number of health care workers, uptake by couples, and effectiveness of linkages and referral systems remain challenges. Expansion of antiretroviral treatment, especially in light of the evidence that treatment contributes to prevention of transmission, will require greater yet strategic coverage of testing services, especially in clinical settings and in combination with other high-impact HIV prevention strategies. Continued support from President's Emergency Plan for AIDS Relief, governments, and other donors is required for the expansion of testing needed to achieve international targets for the scale-up of treatment and universal access to knowledge of HIV status.

76 FR 2148 - Xilinx, Inc. Including On-Site Leased Workers of TEKsystems, Albuquerque, NM; Notice of Revised...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-12

..., for integrated circuit test engineers and test equipment engineers for a Product and Test Engineering... engineering services. In the request for reconsideration, workers alleged that the subject firm has shifted abroad the supply of services like and directly competitive with the internal-use engineering services...

75 FR 65526 - Xilinx, Inc., Including On-Site Leased Workers of TEKsystems, Albuquerque, NM; Notice of Revised...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-25

..., for integrated circuit test engineers and test equipment engineers for a Product and Test Engineering... engineering services. In the request for reconsideration, workers alleged that the subject firm has shifted abroad the supply of services like and directly competitive with the internal-use engineering services...

7 CFR 91.37 - Standard hourly fee rate for laboratory testing, analysis, and other services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Standard hourly fee rate for laboratory testing, analysis, and other services. 91.37 Section 91.37 Agriculture Regulations of the Department of Agriculture... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and...

7 CFR 800.75 - Kinds of official inspection and weighing services.

Code of Federal Regulations, 2012 CFR

2012-01-01

... carrier or container is clean; dry; free of infestation, rodents, toxic substances, and foreign odor; and... containers loaded aboard a carrier; and (3) if practicable, sealing the carrier for security. (k) Test weight... Report of Test. (l) Railroad track scale testing service. This service consists of official personnel (1...

7 CFR 800.75 - Kinds of official inspection and weighing services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... carrier or container is clean; dry; free of infestation, rodents, toxic substances, and foreign odor; and... containers loaded aboard a carrier; and (3) if practicable, sealing the carrier for security. (k) Test weight... Report of Test. (l) Railroad track scale testing service. This service consists of official personnel (1...

7 CFR 800.75 - Kinds of official inspection and weighing services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... carrier or container is clean; dry; free of infestation, rodents, toxic substances, and foreign odor; and... containers loaded aboard a carrier; and (3) if practicable, sealing the carrier for security. (k) Test weight... Report of Test. (l) Railroad track scale testing service. This service consists of official personnel (1...

7 CFR 800.75 - Kinds of official inspection and weighing services.

Code of Federal Regulations, 2013 CFR

2013-01-01

... carrier or container is clean; dry; free of infestation, rodents, toxic substances, and foreign odor; and... containers loaded aboard a carrier; and (3) if practicable, sealing the carrier for security. (k) Test weight... Report of Test. (l) Railroad track scale testing service. This service consists of official personnel (1...

7 CFR 800.75 - Kinds of official inspection and weighing services.

Code of Federal Regulations, 2014 CFR

2014-01-01

... carrier or container is clean; dry; free of infestation, rodents, toxic substances, and foreign odor; and... containers loaded aboard a carrier; and (3) if practicable, sealing the carrier for security. (k) Test weight... Report of Test. (l) Railroad track scale testing service. This service consists of official personnel (1...

42 CFR 84.96 - Service time test; closed-circuit apparatus.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Service time test; closed-circuit apparatus. 84.96...-Contained Breathing Apparatus § 84.96 Service time test; closed-circuit apparatus. (a) The closed-circuit apparatus will be classified according to the length of time it supplies adequate breathing gas to the...

42 CFR 84.96 - Service time test; closed-circuit apparatus.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Service time test; closed-circuit apparatus. 84.96...-Contained Breathing Apparatus § 84.96 Service time test; closed-circuit apparatus. (a) The closed-circuit apparatus will be classified according to the length of time it supplies adequate breathing gas to the...

Internet testing for Chlamydia trachomatis in England, 2006 to 2010.

PubMed

Woodhall, Sarah C; Sile, Bersabeh; Talebi, Alireza; Nardone, Anthony; Baraitser, Paula

2012-12-19

In recent years there has been interest in websites as a means of increasing access to free chlamydia tests through the National Chlamydia Screening Programme (NCSP) in England. We aimed to describe and evaluate online access to chlamydia testing within the NCSP. We analysed NCSP chlamydia testing data (2006-2010) for 15-24 year olds from the 71/95 programme areas in England where site codes were available to identify tests ordered through the internet. The characteristics of people using online testing services in 2010 were compared with those testing in general practice (GP) or community sexual and reproductive health (SRH) services. We evaluated 58 websites offering free chlamydia tests through the NCSP, and 32 offering kits on a commercial basis for signposting to clinical service and health promotion advice offered. Between 2006 and 2010, 5% of all tests in the included programme areas were accessed through the internet. The number of internet tests increased from 18 (<1% of all tests) in 2006 to 59,750 in 2010 (6% of all NCSP tests). In 2010 the proportion of NCSP tests accessed online by programme area ranged from <1% to 38%. The proportion of tests with a positive result on the internet was higher than tests from general practice and comparable to those from community SRH services (internet 7.6%; GP 5.6%; Community SRH 8.2%). A higher proportion of people accessing online testing were male, aged 20-24 and reported >1 sexual partner in the past year. Provision of sexual health information and appropriate signposting for those in need of clinical services varied between websites. Service provision within the NCSP was fragmented with multiple providers serving specific geographical catchment areas. Internet testing reaches a population with a relatively high risk of chlamydia infection and appears acceptable to young men, a group that has been difficult to engage with chlamydia testing. In order to maximise the potential benefit of these services, websites should be consistent with national guidelines and adhere to minimum standards for signposting to clinical care and health promotion information. The current system with multiple providers servicing geographically specific catchment areas is contrary to the geographically unrestricted nature of the internet and potentially confusing for clients.

A Media Mix Test of Paid Radio Advertising for Armed Services Recruitment. Volume II.

DTIC Science & Technology

1976-05-01

This was a test of the effectiveness of paid radio recruiting advertising . The four active military services (Army, Navy, Air Force, Marine Corps...service, awareness and knowledge of specific programs and benefits offered by individual services and awareness of armed forces advertising . (Author)

A Media MIX Test of Paid Radio Advertising for Armed Services Recruitment. Volume 3. Addendum.

DTIC Science & Technology

1976-07-01

This was a test of the effectiveness of paid radio recruiting advertising . The four active military services (Army, Navy, Air Force, Marine Corps...service, awareness and knowledge of specific programs and benefits offered by individual services and awareness of armed forces advertising . (Author)

15 CFR 200.102 - Types of calibration and test services.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., SERVICES, PROCEDURES, AND FEES § 200.102 Types of calibration and test services. (a) NIST has developed... and ranges of physical quantities are described in the NIST Special Publication 250 (SP 250). (See... years NIST has offered to the public new measurement services called measurement assurance programs...

15 CFR 200.102 - Types of calibration and test services.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., SERVICES, PROCEDURES, AND FEES § 200.102 Types of calibration and test services. (a) NIST has developed... and ranges of physical quantities are described in the NIST Special Publication 250 (SP 250). (See... years NIST has offered to the public new measurement services called measurement assurance programs...

15 CFR 200.102 - Types of calibration and test services.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., SERVICES, PROCEDURES, AND FEES § 200.102 Types of calibration and test services. (a) NIST has developed... and ranges of physical quantities are described in the NIST Special Publication 250 (SP 250). (See... years NIST has offered to the public new measurement services called measurement assurance programs...

15 CFR 200.102 - Types of calibration and test services.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., SERVICES, PROCEDURES, AND FEES § 200.102 Types of calibration and test services. (a) NIST has developed... and ranges of physical quantities are described in the NIST Special Publication 250 (SP 250). (See... years NIST has offered to the public new measurement services called measurement assurance programs...

Food Service Worker II (hotel & rest.) 317.884; Food Service Worker (medical ser.) 2-29.16--Technical Report on Standardization of the General Aptitude Test Battery.

ERIC Educational Resources Information Center

Manpower Administration (DOL), Washington, DC. U.S. Training and Employment Service.

The United States Training and Employment Service General Aptitude Test Battery (GATB), first published in 1947, has been included in a continuing program of research to validate the tests against success in many different occupations. The GATB consists of 12 tests which measure nine aptitudes: General Learning Ability; Verbal Aptitude; Numerical…

HIV/AIDS Services in Private Substance Abuse Treatment Programs

PubMed Central

Abraham, Amanda J.; O’Brien, Lauren A.; Bride, Brian E.; Roman, Paul M.

2010-01-01

Background HIV infection among substance abusers is a growing concern in the United States. Little research, however, has examined the provision of HIV/AIDS services in substance abuse treatment programs. Methods This study examines the provision of onsite HIV/AIDS services in a nationally representative sample of 345 privately funded substance abuse treatment programs. Data were collected via face-to-face interviews with administrators and clinical directors of treatment programs in 2007–2008. Results Results show that larger programs and programs with a higher percentage of both African American and injection drug using (IDU) patients were more likely to offer onsite HIV/AIDS support groups and a dedicated HIV/AIDS treatment track. Multinomial logistic regression reveals that the odds of offering onsite HIV testing services were higher for hospital based programs, programs providing medical services onsite, and programs with higher percentages of African American patients, relative to the odds of offering no HIV testing or referring patients to an external provider for HIV testing services. The odds of providing onsite testing were lower for outpatient-only treatment programs, relative to the odds of offering no HIV testing or referring patients to an external provider for HIV testing services. Conclusions Our findings highlight critical barriers to the adoption of onsite HIV/AIDS services and suggest treatment programs are missing the opportunity to significantly impact HIV-related health outcomes. PMID:21145179

Unpacking the Barriers to Reproductive Health Services in Ghana: HIV/STI Testing, Abortion and Contraception.

PubMed

Thatte, Nandita; Bingenheimer, Jeffrey B; Ndiaye, Khadidiatou; Rimal, Rajiv N

2016-06-01

Youth report embarrassment, cost, and poor access as barriers to sexual and reproductive health (SRH) services. Interventions to address barriers like youth friendly services have yet to conclusively demonstrate impact on protective behaviours like condom or contraceptive use. SRH encompasses a range of services so we aimed to assess how perceived barriers differed depending on the service being sought between common services accessed by young people: HIV/STI testing, abortion, and contraception. 1203 Ghanaian youth were interviewed. Data was analysed to identify barriers by service type, demographics, and between high and low HIV prevalence communities. Being embarrassed or shy was the most commonly reported barrier across services. Overall being embarrassed or shy, fear of safety, fear of family finding out and cost were the most reported barriers across all services. Further analysis by service indicated that being embarrassed was a significantly greater barrier for HIV/STI testing and contraception when compared with abortion (p<0.001) and safety concerns and cost were significantly greater barriers for abortion and contraception compared with HIV/STI testing (p<0.001). Efforts to develop interventions that consider the service being sought may help address the range of barriers faced by youth with diverse SRH needs.

Reliability analysis of structures under periodic proof tests in service

NASA Technical Reports Server (NTRS)

Yang, J.-N.

1976-01-01

A reliability analysis of structures subjected to random service loads and periodic proof tests treats gust loads and maneuver loads as random processes. Crack initiation, crack propagation, and strength degradation are treated as the fatigue process. The time to fatigue crack initiation and ultimate strength are random variables. Residual strength decreases during crack propagation, so that failure rate increases with time. When a structure fails under periodic proof testing, a new structure is built and proof-tested. The probability of structural failure in service is derived from treatment of all the random variables, strength degradations, service loads, proof tests, and the renewal of failed structures. Some numerical examples are worked out.

Implementation of a new 'community' laboratory CD4 service in a rural health district in South Africa extends laboratory services and substantially improves local reporting turnaround time.

PubMed

Coetzee, L M; Cassim, N; Glencross, D K

2015-12-16

The CD4 integrated service delivery model (ITSDM) provides for reasonable access to pathology services across South Africa (SA) by offering three new service tiers that extend services into remote, under-serviced areas. ITSDM identified Pixley ka Seme as such an under-serviced district. To address the poor service delivery in this area, a new ITSDM community (tier 3) laboratory was established in De Aar, SA. Laboratory performance and turnaround time (TAT) were monitored post implementation to assess the impact on local service delivery. Using the National Health Laboratory Service Corporate Data Warehouse, CD4 data were extracted for the period April 2012-July 2013 (n=11,964). Total mean TAT (in hours) was calculated and pre-analytical and analytical components assessed. Ongoing testing volumes, as well as external quality assessment performance across ten trials, were used to indicate post-implementation success. Data were analysed using Stata 12. Prior to the implementation of CD4 testing at De Aar, the total mean TAT was 20.5 hours. This fell to 8.2 hours post implementation, predominantly as a result of a lower pre-analytical mean TAT reducing from a mean of 18.9 to 1.8 hours. The analytical testing TAT remained unchanged after implementation and monthly test volumes increased by up to 20%. External quality assessment indicated adequate performance. Although subjective, questionnaires sent to facilities reported improved service delivery. Establishing CD4 testing in a remote community laboratory substantially reduces overall TAT. Additional community CD4 laboratories should be established in under-serviced areas, especially where laboratory infrastructure is already in place.

Does place of service matter? A utilisation and cost analysis of sexually transmissible infection testing from 2012 claims data.

PubMed

Owusu-Edusei, Kwame; Patel, Chirag G; Gift, Thomas L

2016-04-01

Background In this study, a previous study on the utilisation and cost of sexually transmissible infection (STI) tests was augmented by focusing on outpatient place of service for the most utilised tests. Claims for eight STI tests [chlamydia, gonorrhoea, hepatitis B virus (HBV), HIV, human papillomavirus (HPV), herpes simplex virus type 2 (HSV2), syphilis and trichomoniasis] using the most utilised current procedural terminology (CPT) code for each STI from the 2012 MarketScan outpatient table were extracted. The volume and costs by gender and place of service were then summarised. Finally, semi-log regression analyses were used to further examine and compare costs. Females had a higher number of test claims than males in all places of service for each STI. Together, claims from 'Independent Laboratories', 'Office' and 'Outpatient hospital' accounted for over 93% of all the test claims. The cost of tests were slightly (<5%) different between males and females for most places of service. Except for the estimated average cost for 'Outpatient hospital', the estimated average costs for the other categories were significantly lower (15-80%, P<0.01) than the estimated average cost for 'Emergency Room - Hospital' for all the STIs. Among the predominant service venues, test costs from 'Independent Laboratory' and 'Office' were 30% to 69% lower (P<0.01) than those from 'Outpatient Hospital'. Even though the results from this study are not generalisable, our study shows that almost all STI tests from outpatient claims data were performed in three service venues with considerable cost variations.

40 CFR 86.1901 - What testing requirements apply to my engines that have gone into service?

Code of Federal Regulations, 2014 CFR

2014-07-01

... VEHICLES AND ENGINES Manufacturer-Run In-Use Testing Program for Heavy-Duty Diesel Engines § 86.1901 What testing requirements apply to my engines that have gone into service? (a) If you manufacture diesel heavy... engines that have gone into service? 86.1901 Section 86.1901 Protection of Environment ENVIRONMENTAL...

Microstructure evolution and mechanical properties degradation of HPNb alloy after a five-year service

NASA Astrophysics Data System (ADS)

Guo, Jingfeng; Cao, Tieshan; Cheng, Congqian; Meng, Xianming; Zhao, Jie

2018-04-01

The microstructure and mechanical properties of ethylene cracking furnace tube (HPNb alloy) are investigated by scanning electronic microscopy (SEM), tensile tests and Charpy impact tests at room temperature, tensile tests and creep tests at high temperature in this paper. The primary carbides of HPNb alloy coarsened and formed a continuous network after a five-year service. Furthermore, a lot of fine secondary carbides precipitated in the dendrite interior. The primary carbides M7C3 and NbC transformed into M23C6 and G phase after service, respectively. The furnace tube after service exhibits higher yield strength, lower tensile strength, worse ductility and toughness than as-cast tube at room temperature. At high temperature, the tensile strength and yield strength of service tube are higher than as-cast tube, but its tensile elongation is lower. The creep strength of HPNb alloy at high temperature decreases after a five-year service. Both microstructure and mechanical properties of ethylene cracking furnace tube have deteriorated after a five-year service.

78 FR 23884 - Seed Testing Service Program; Request for an Extension of and Revision to a Currently Approved...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-23

... Marketing Service's (AMS) intention to request approval from the Office of Management and Budget (OMB), for... DEPARTMENT OF AGRICULTURE Agricultural Marketing Service [Doc. No. AMS-LS-13-0007] Seed Testing... AGENCY: Agricultural Marketing Service, USDA. ACTION: Request for comments. SUMMARY: In accordance with...

Practice considerations in providing cancer risk assessment and genetic testing in women's health.

PubMed

Mahon, Suzanne M; Crecelius, Mary E

2013-01-01

Providers of women's health services are often confronted with questions about cancer genetic testing. The provision of these services is complex. The process begins with accurate risk assessment and identification of individuals who might benefit from genetic testing services. There are practice, administrative, legal, and ethical considerations that should be considered when developing policies for the referral of at-risk individuals or before deciding to provide genetic services. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review.

PubMed

Ferguson, Laura; Grant, Alison D; Watson-Jones, Deborah; Kahawita, Tanya; Ong'ech, John O; Ross, David A

2012-05-01

To quantify attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services in low- or middle-income countries and to explore the reasons underlying client drop-out by synthesising current literature on this topic. A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000-2010. Only studies meeting pre-defined quality criteria were included. Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub-Saharan Africa. The pathway between testing HIV-positive in pregnancy-related services and accessing long-term HIV-related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38-88% of known-eligible women. Providing 'family-focused care', and integrating CD4 testing and HAART provision into prevention of mother-to-child HIV transmission services appear promising for increasing women's uptake of HIV-related services. Individual-level factors that need to be addressed include financial constraints and fear of stigma. Too few women negotiate the many steps between testing HIV-positive in pregnancy-related services and accessing HIV-related services for themselves. Recent efforts to stem patient drop-out, such as the MTCT-Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services. © 2012 Blackwell Publishing Ltd.

Examination of the Structural Response of the Orion European Service Module to Reverberant and Direct Field Acoustic Testing

NASA Technical Reports Server (NTRS)

McNelis, Mark E.; Hughes, William O.; Larko, Jeffrey M.; Bittinger, Samantha A.; Le-Plenier, Cyprien; Fogt, Vincent A.; Ngan, Ivan; Thirkettle, Anthony C.; Skinner, Mitch; Larkin, Paul

2017-01-01

The NASA Orion Multi-Purpose Crew Vehicle (MPCV), comprised of the Service Module, the Crew Module, and the Launch Abort System, is the next generation human spacecraft designed and built for deep space exploration. Orion will launch on NASAs new heavy-lift rocket, the Space Launch System. The European Space Agency (ESA) is responsible for providing the propulsion sub-assembly of the Service Module to NASA, called the European Service Module (ESM). The ESM is being designed and built by Airbus Safran Launchers for ESA. Traditionally, NASA has utilized reverberant acoustic testing for qualification of spaceflight hardware. The ESM Structural Test Article (E-STA) was tested at the NASA Plum Brook Stations (PBS) Reverberant Acoustic Test Facility in April-May 2016. However, Orion is evaluating an alternative acoustic test method, using direct field acoustic excitation, for the MPCVs Service Module and Crew Module. Lockheed Martin is responsible for the Orion proof-of-concept direct field acoustic test program. The E-STA was exposed to direct field acoustic testing at NASA PBS in February 2017. This paper compares the dynamic response of the E-STA structure and its components to both the reverberant and direct field acoustic test excitations. Advantages and disadvantages of direct field acoustic test excitation method are discussed.

Selective testing of women based on age for genital Chlamydia trachomatis and Neisseria gonorrhoeae infection in a centralized regional microbiology laboratory.

PubMed

Church, Deirdre L; Amante, L; Semeniuk, H; Gregson, D B

2007-04-01

Calgary Laboratory Services, Alberta, Canada, provides microbiology services via a centralized laboratory to the Calgary Health Region. A selective genital Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) testing policy for women >35 years was implemented. The changes in physician ordering practice, the rate of detection of infections, and the test turnaround times were monitored. The volume of tests, the cost/test, and the total service costs accrued in the year before and after this policy change were compared. An immediate impact was a 30% decrease in tests performed due to the laboratory rejecting samples from older women. Subsequently, physicians' practice changed so that tests were ordered when test criteria were met. Detection rates did not change in any age group. A 27.9% decrease in the total service costs resulted in a labor reduction of 0.2 FTE. Selective testing of women >35 years with a low prevalence of CT/GC infection is clinically relevant and cost-effective.

SEQUenCE: a service user-centred quality of care instrument for mental health services.

PubMed

Hester, Lorraine; O'Doherty, Lorna Jane; Schnittger, Rebecca; Skelly, Niamh; O'Donnell, Muireann; Butterly, Lisa; Browne, Robert; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul

2015-08-01

To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. All participants were attending an independent mental health service in Ireland. Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Test-retest reliability, internal consistency and convergent validity of the instrument. The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87). SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Early recognition of coeliac disease through community pharmacies: a proof of concept study.

PubMed

Urwin, Heidi; Wright, David; Twigg, Michael; McGough, Norma

2016-10-01

Setting Fifteen community pharmacies in the UK. Objective Proof of concept study to test the use of community pharmacies for active case finding of patients with coeliac disease. Methods Customers accessing over-the counter and prescription medicines indicated in the treatment of possible symptoms of coeliac disease over a 6 month period were offered a free point of care test. All patients were given advice regarding the test results and those who tested positive were advised to make an appointment with their general practitioner. Patients and pharmacists involved in service provision were asked to complete a satisfaction survey. Pharmacists were additionally invited to undertake interviews to better understand their views on the service. Main outcome measures Feasibility of service, acceptability to stakeholders and proportion testing positive for coeliac disease. Results Of the 551 individuals tested, 52 (9.4 %) tested positive. 277 (50.3 %) were tested for accessing irritable bowel syndrome treatment, 142 (25.8 %) due to presenting for diarrhoea. The proportion of patients testing positive with different symptoms or for different treatments were similar. Of 43 customers who returned the satisfaction survey, all would recommend the service to others, believing the community pharmacy to be a suitable location. Community pharmacists believed that it enabled them to improve relationships with their customers and that medical practices were receptive to the service. Conclusion This proof of concept study has shown that community pharmacies using a point of care test can effectively recognise and refer patients for confirmatory coeliac disease testing with high levels of customer and service provider satisfaction.

Predictive Service Life Tests for Roofing Membranes

NASA Astrophysics Data System (ADS)

Bailey, David M.; Cash, Carl G.; Davies, Arthur G.

2002-09-01

The average service life of roofing membranes used in low-slope applications on U.S. Army buildings is estimated to be considerably shorter than the industry-presumed 20-year design life, even when installers carefully adhere to the latest guide specifications. This problem is due in large part to market-driven product development cycles, which do not include time for long-term field testing. To reduce delivery costs, contractors may provide untested, interior membranes in place of ones proven satisfactory in long-term service. Federal procurement regulations require that roofing systems and components be selected according to desired properties and generic type, not brand name. The problem is that a material certified to have satisfactory properties at installation time will not necessarily retain those properties in service. The overall objective of this research is to develop a testing program that can be executed in a matter of weeks to adequately predict a membrane's long-term performance in service. This report details accelerated aging tests of 12 popular membrane materials in the laboratory, and describes outdoor experiment stations set up for long-term exposure tests of those same membranes. The laboratory results will later be correlated with the outdoor test results to develop performance models and predictive service life tests.

49 CFR 40.15 - May an employer use a service agent to meet DOT drug and alcohol testing requirements?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Employer Responsibilities § 40.15 May an employer use a service agent to meet DOT drug and alcohol testing requirements? (a... 49 Transportation 1 2010-10-01 2010-10-01 false May an employer use a service agent to meet DOT...

Application of Athletic Movement Tests that Predict Injury Risk in a Military Population: Development of Normative Data.

PubMed

Teyhen, Deydre S; Shaffer, Scott W; Butler, Robert J; Goffar, Stephen L; Kiesel, Kyle B; Rhon, Daniel I; Boyles, Robert E; McMillian, Daniel J; Williamson, Jared N; Plisky, Phillip J

2016-10-01

Performance on movement tests helps to predict injury risk in a variety of physically active populations. Understanding baseline measures for normal is an important first step. Determine differences in physical performance assessments and describe normative values for these tests based on military unit type. Assessment of power, balance, mobility, motor control, and performance on the Army Physical Fitness Test were assessed in a cohort of 1,466 soldiers. Analysis of variance was performed to compare the results based on military unit type (Rangers, Combat, Combat Service, and Combat Service Support) and analysis of covariance was performed to determine the influence of age and gender. Rangers performed the best on all performance and fitness measures (p < 0.05). Combat soldiers performed better than Combat Service and Service Support soldiers on several physical performance tests and the Army Physical Fitness Test (p < 0.05). Performance in Combat Service and Service Support soldiers was equivalent on most measures (p < 0.05). Functional performance and level of fitness varied significantly by military unit type. Understanding these differences will provide a foundation for future injury prediction and prevention strategies. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Intimate partner violence against women in eastern Uganda: implications for HIV prevention.

PubMed

Karamagi, Charles A S; Tumwine, James K; Tylleskar, Thorkild; Heggenhougen, Kristian

2006-11-20

We were interested in finding out if the very low antenatal VCT acceptance rate reported in Mbale Hospital was linked to intimate partner violence against women. We therefore set out to i) determine the prevalence of intimate partner violence, ii) identify risk factors for intimate partner violence and iii) look for association between intimate partner violence and HIV prevention particularly in the context of the prevention of mother-to-child transmission of HIV programme (PMTCT). The study consisted of a household survey of rural and urban women with infants in Mbale district, complemented with focus group discussions with women and men. Women were interviewed on socio-demographic characteristics of the woman and her husband, antenatal and postnatal experience related to the youngest child, antenatal HIV testing, perceptions regarding the marital relationship, and intimate partner violence. We obtained ethical approval from Makerere University and informed consent from all participants in the study. During November and December 2003, we interviewed 457 women in Mbale District. A further 96 women and men participated in the focus group discussions. The prevalence of lifetime intimate partner violence was 54% and physical violence in the past year was 14%. Higher education of women (OR 0.3, 95% CI 0.1-0.7) and marriage satisfaction (OR 0.3, 95% CI 0.1-0.7) were associated with lower risk of intimate partner violence, while rural residence (OR 4.4, 95% CI 1.2-16.2) and the husband having another partner (OR 2.4, 95% CI 1.02-5.7) were associated with higher risk of intimate partner violence. There was a strong association between sexual coercion and lifetime physical violence (OR 3.8, 95% CI 2.5-5.7). Multiple partners and consumption of alcohol were major reasons for intimate partner violence. According to the focus group discussions, women fear to test for HIV, disclose HIV results, and request to use condoms because of fear of intimate partner violence. Intimate partner violence is common in eastern Uganda and is related to gender inequality, multiple partners, alcohol, and poverty. Accordingly, programmes for the prevention of intimate partner violence need to target these underlying factors. The suggested link between intimate partner violence and HIV risky behaviours or prevention strategies calls for further studies to clearly establish this relationship.

Post diagnosis reaction, perceived stigma and sexual behaviour of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Northern Nigeria.

PubMed

Iliyasu, Zubairu; Abubakar, Isa S; Musa, Babashani; Aliyu, Muktar H

2011-01-01

The process of becoming aware of one's serostatus, immediate and delayed responses of the individual, family and community have profound implications on health seeking behaviour of PLWHAs especially in developing countries. We investigated post-diagnosis reactions, disclosure, perceived stigmatization and sexual behaviour of PLWHAs in northern Nigeria. A triangulation of methods consisting of structured interviewer questionnaire administered on 205 respondents and two Focus Group Discussions with PLWHAs receiving care at Aminu Kano Teaching Hospital was used. HIV serodiagnosis, immediate and delayed reaction to serostatus and responses of family, friends and community members were elicited in addition to perceived stigma and sexual behaviour. Overall, 111 (54.1%) of the 205 patients were counseled before being tested for HIV infection. Majority of women 59 (51.8%) were tested and informed during antenatal care or 46 (40.4%) following diagnostic workup for symptoms related to AIDS. Most men 69 (75.8%) came to know during diagnostic workup or as part of screening for blood transfusion 5 (5.5%). Up to 37.2% of the respondents had kept their serostatus secret. Disclosures were more likely to mothers (51.9%), sisters (31.0%), brothers (11.0%) and spouses (6.1%). Of all respondents, 149 (72.6%) said they were shocked, afraid, angry and sad while 29 (14.1%) reported being indifferent. A higher proportion of females 68 (59.7%) were shocked, sad and angry than males 36 (39.6%) (P<0.05). Significant reductions occurred over time in the proportion of patients that were sad, afraid and shocked (P<0.05). A higher proportion of mothers (67.0%), sisters (44.2%), friends of the same sex (37.1%), father (27.5%) and spouse (23.7%) were perceived to be sympathetic compared to others (P<0.05). Forty-five (21 .9%) of the respondents were discriminated against. Of this, 22 (48.9%) happened at home, 18 (40.0%) in the workplace and the remaining 17 (37.8%) among friends. Of 85 (41.5%) that were sexually active, 78 (91.8%) reported protecting their partners through use of condoms. The sub-optimal counseling resulted in strong emotional reactions that threatened the strong social support system of PLWHAs. Supportive counseling could improve VCT uptake and well being of PLWHAs in northern Nigeria.

Dose reduction of up to 89% while maintaining image quality in cardiovascular CT achieved with prospective ECG gating

NASA Astrophysics Data System (ADS)

Londt, John H.; Shreter, Uri; Vass, Melissa; Hsieh, Jiang; Ge, Zhanyu; Adda, Olivier; Dowe, David A.; Sabllayrolles, Jean-Louis

2007-03-01

We present the results of dose and image quality performance evaluation of a novel, prospective ECG-gated Coronary CT Angiography acquisition mode (SnapShot Pulse, LightSpeed VCT-XT scanner, GE Healthcare, Waukesha, WI), and compare it to conventional retrospective ECG gated helical acquisition in clinical and phantom studies. Image quality phantoms were used to measure noise, slice sensitivity profile, in-plane resolution, low contrast detectability and dose, using the two acquisition modes. Clinical image quality and diagnostic confidence were evaluated in a study of 31 patients scanned with the two acquisition modes. Radiation dose reduction in clinical practice was evaluated by tracking 120 consecutive patients scanned with the prospectively gated scan mode. In the phantom measurements, the prospectively gated mode resulted in equivalent or better image quality measures at dose reductions of up to 89% compared to non-ECG modulated conventional helical scans. In the clinical study, image quality was rated excellent by expert radiologist reviewing the cases, with pathology being identical using the two acquisition modes. The average dose to patients in the clinical practice study was 5.6 mSv, representing 50% reduction compared to a similar patient population scanned with the conventional helical mode.

[Evaluation of Organ Dose Estimation from Indices of CT Dose Using Dose Index Registry].

PubMed

Iriuchijima, Akiko; Fukushima, Yasuhiro; Ogura, Akio

Direct measurement of each patient organ dose from computed tomography (CT) is not possible. Most methods to estimate patient organ dose is using Monte Carlo simulation with dedicated software. However, dedicated software is too expensive for small scale hospitals. Not every hospital can estimate organ dose with dedicated software. The purpose of this study was to evaluate the simple method of organ dose estimation using some common indices of CT dose. The Monte Carlo simulation software Radimetrics (Bayer) was used for calculating organ dose and analysis relationship between indices of CT dose and organ dose. Multidetector CT scanners were compared with those from two manufactures (LightSpeed VCT, GE Healthcare; SOMATOM Definition Flash, Siemens Healthcare). Using stored patient data from Radimetrics, the relationships between indices of CT dose and organ dose were indicated as each formula for estimating organ dose. The accuracy of estimation method of organ dose was compared with the results of Monte Carlo simulation using the Bland-Altman plots. In the results, SSDE was the feasible index for estimation organ dose in almost organs because it reflected each patient size. The differences of organ dose between estimation and simulation were within 23%. In conclusion, our estimation method of organ dose using indices of CT dose is convenient for clinical with accuracy.

Concept of a selective tumour therapy and its evaluation by near-infrared fluorescence imaging and flat-panel volume computed tomography in mice.

PubMed

Alves, Frauke; Dullin, Christian; Napp, Joanna; Missbach-Guentner, Jeannine; Jannasch, Katharina; Mathejczyk, Julia; Pardo, Luis A; Stühmer, Walter; Tietze, Lutz-F

2009-05-01

Conventional chemotherapy of cancer has its limitations, especially in advanced and disseminated disease and suffers from lack of specificity. This results in a poor therapeutic index and considerable toxicity to normal organs. Therefore, many efforts are made to develop novel therapeutic tools against cancer with the aim of selectively targeting the drug to the tumour site. Drug delivery strategies fundamentally rely on the identification of good-quality biomarkers, allowing unequivocal discrimination between cancer and healthy tissue. At present, antibodies or antibody fragments have clearly proven their value as carrier molecules specific for a tumour-associated molecular marker. This present review draws attention to the use of near-infrared fluorescence (NIRF) imaging to investigate binding specificity and kinetics of carrier molecules such as monoclonal antibodies. In addition, flat-panel volume computed tomography (fpVCT) will be presented to monitor anatomical structures in tumour mouse models over time in a non-invasive manner. Each imaging device sheds light on a different aspect; functional imaging is applied to optimise the dose schedule and the concept of selective tumour therapies, whereas anatomical imaging assesses preclinically the efficacy of novel tumour therapies. Both imaging techniques in combination allow the visualisation of functional information obtained by NIRF imaging within an adequate anatomic framework.

Role of the RS1 sequence of the cholera vibrio in amplification of the segment of plasmid DNA carrying the gene of resistance to tetracycline and the genes of cholera toxin

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

Fil'kova, S.L.; Il'ina, T.S.; Gintsburg, A.L.

1988-11-01

The hybrid plasmid pCO107, representing cointegrate 14(2)-5(2) of two plasmids, an F-derivative (pOX38) and a PBR322-derivative (pCT105) with an RS1 sequence of the cholera vibrio cloned in its makeup, contains two copes of RS1 at the sites of union of the two plasmids. Using a tetracycline resistance marker (Tc/sup R/) of the plasmid pCT105, clones were isolated which have an elevated level of resistance to tetracycline (an increase of from 4- to 30-fold). Using restriction analysis and the Southern blot method of hybridization it was shown that the increase in the level of resistance of tetracycline is associated with themore » amplification of pCT105 portion of the cointegrate, and that the process of amplification is governed by the presence of direct repeats of the RS1 sequence at its ends. The increase in the number of copies of the pCT105 segment, which contains in its composition the genes of cholera toxin (vct), is accompanied by an increase in toxin production.« less

Vct system having closed loop control employing spool valve actuated by a stepper motor

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

Quin, S.B. Jr.; Siemon, E.C.

1993-06-15

An internal combustion engine is described comprising: a crankshaft, the crankshaft being rotable about an axis; a cam shaft, the cam shaft being rotatable about a second axis, the second axis being parallel to the axis, the cam shaft being subject to torque reversals during the rotation thereof; a vane, the vane having at least one lobe, the vane being attached to the cam shaft, being rotatable with the cam shaft and being non-oscillatable with respect to the cam shaft; a housing, the housing being rotatable with the cam shaft and being oscillatable with respect to the cam shaft, themore » housing having at least one recess, the recess receiving the lobe, the lobe being oscillatable within the recess; rotary movement transmitting means for transmitting rotary movement from the crankshaft to the housing; actuating means for varying the position of the housing relative to the cam shaft in reaction to torque reversals in the cam shaft, the actuating means comprising a stepper motor, a lead screw and a proportional spool valve, the position of the spool valve being controlled by the position of the lead screw driven by the stepper motor, the actuating means also delivering hydraulic fluid to the vane; and processing means for controlling the position of the actuating means.« less

Who is 'Molly'? MDMA adulterants by product name and the impact of harm-reduction services at raves.

PubMed

Saleemi, Sarah; Pennybaker, Steven J; Wooldridge, Missi; Johnson, Matthew W

2017-08-01

Methylenedioxymethamphetamine (MDMA), often sold as 'Ecstasy' or 'Molly', is commonly used at music festivals and reported to be responsible for an increase in deaths over the last decade. Ecstasy is often adulterated and contains compounds that increase morbidity and mortality. While users and clinicians commonly assume that products sold as Molly are less-adulterated MDMA products, this has not been tested. Additionally, while pill-testing services are sometimes available at raves, the assumption that these services decrease risky drug use has not been studied. This study analyzed data collected by the pill-testing organization, DanceSafe, from events across the United States from 2010 to 2015. Colorimetric reagent assays identified MDMA in only 60% of the 529 samples collected. No significant difference in the percentage of samples testing positive for MDMA was determined between Ecstasy and Molly. Individuals were significantly less likely to report intent to use a product if testing did not identify MDMA (relative risk (RR) = 0.56, p = 0.01). Results suggest that Molly is not a less-adulterated substance, and that pill-testing services are a legitimate harm-reduction service that decreases intent to consume potentially dangerous substances and may warrant consideration by legislators for legal protection. Future research should further examine the direct effects of pill-testing services and include more extensive pill-testing methods.

HIV Prevention Services and Testing Utilization Behaviors among Men Who Have Sex with Men at Elevated Risk for HIV in Chongqing, China

PubMed Central

Hu, Yifei; Wu, Guohui; Jia, Yujiang; Lu, Rongrong; Xiao, Yan; Raymond, H. F.; Ruan, Yuhua; Sun, Jiangping

2014-01-01

Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services. PMID:24783195

HIV prevention services and testing utilization behaviors among men who have sex with men at elevated risk for HIV in Chongqing, China.

PubMed

Huang, Dayong; Hu, Yifei; Wu, Guohui; Jia, Yujiang; Lu, Rongrong; Xiao, Yan; Raymond, H F; McFarland, Willi; Ruan, Yuhua; Ma, Wei; Sun, Jiangping

2014-01-01

To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2-15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services.

Microteaching and Pre-Service Teachers' Sense of Self-Efficacy in Teaching

ERIC Educational Resources Information Center

Arsal, Zeki

2014-01-01

This study examined the effect of microteaching on pre-service teachers' sense of self-efficacy in teaching using a pre-test/post-test quasi-experimental design. The sample of the study consisted of 70 pre-service teachers on a special education teacher preparation programme. The pre-service teachers in the experimental group were exposed to…

34 CFR 361.54 - Participation of individuals in cost of services based on financial need.

Code of Federal Regulations, 2010 CFR

2010-07-01

... types of vocational rehabilitation services for which the unit has established a financial needs test... service. (3) The designated State unit may not apply a financial needs test, or require the financial... 34 Education 2 2010-07-01 2010-07-01 false Participation of individuals in cost of services based...

Analyzing Educational Testing Service Graduate Major Field Test Results

ERIC Educational Resources Information Center

Thornton, Barry; Arbogast, Gordon

2012-01-01

The Educational Testing Service (ETS) created the Graduate Major Field Test in Business (GMFT-B) for MBA students. This test is administered to all MBA classes at Jacksonville University for the purpose of measuring student academic achievement and growth, as well as to assess educational outcomes. The test is given in the capstone course,…

78 FR 25482 - Notice of Revised Determination on Reconsideration

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

...-PROGRESSIVE SOFTWARE COMPUTING, QUALITY TESTING SERVICES, INC., RAILROAD CONSTRUCTION CO. OF SOUTH JERSEY, INC..., LP, PSCI- Progressive Software Computing, Quality Testing Services, Inc., Railroad Construction Co..., ANDERSON CONSTRUCTION SERVICES, BAKER PETROLITE, BAKERCORP, BELL-FAST FIRE PROTECTION INC., BOLTTECH INC...

Attitudes towards HIV testing via home-sampling kits ordered online (RUClear pilots 2011-12).

PubMed

Ahmed-Little, Y; Bothra, V; Cordwell, D; Freeman Powell, D; Ellis, D; Klapper, P; Scanlon, S; Higgins, S; Vivancos, R

2016-09-01

The burden of disease relating to undiagnosed HIV infection is significant in the UK. BHIVA (British HIV Association) recommends population screening in high prevalence areas, expanding outside traditional antenatal/GUM settings. RUClear 2011-12 piloted expanding HIV testing outside traditional settings using home-sampling kits (dry-blood-spot testing) ordered online. Greater Manchester residents (≥age 16) could request testing via an established, online chlamydia testing service (www.ruclear.co.uk). Participant attitudes towards this new service were assessed. Qualitative methods (thematic analysis) were used to analyse free-text data submitted by participants via hard copy questionnaires issued in all testing kits. 79.9% (2447/3062) participants completed questionnaires, of which 30.9% (756/2447) provided free-text data. Participants overwhelmingly supported the service, valuing particularly accessibility and convenience, allowing individuals to order tests any time of day and self-sample comfortably at home; avoiding the invasive nature of venipuncture and avoiding the need for face-to-face interaction with health services. The pilot was also clinically and cost-effective. Testing via home-sampling kits ordered online (dry-blood-spot testing) was felt to be an acceptable and convenient method for accessing a HIV test. Many individuals undertook HIV testing where they would otherwise not have been tested at all. Expansion of similar services may increase the uptake of HIV testing. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

42 CFR 493.1421 - Condition: Laboratories performing moderate complexity testing; testing personnel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Laboratories performing moderate complexity testing; testing personnel. 493.1421 Section 493.1421 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION...

42 CFR 493.1421 - Condition: Laboratories performing moderate complexity testing; testing personnel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Laboratories performing moderate complexity testing; testing personnel. 493.1421 Section 493.1421 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION...

42 CFR 493.5 - Categories of tests by complexity.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Categories of tests by complexity. 493.5 Section 493.5 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... tests by complexity. (a) Laboratory tests are categorized as one of the following: (1) Waived tests. (2...

42 CFR 493.5 - Categories of tests by complexity.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Categories of tests by complexity. 493.5 Section 493.5 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... tests by complexity. (a) Laboratory tests are categorized as one of the following: (1) Waived tests. (2...

Testing Services

NASA Technical Reports Server (NTRS)

1993-01-01

Trace Laboratories is an independent testing laboratory specializing in testing printed circuit boards, automotive products and military hardware. Technical information from NASA Tech Briefs and two subsequent JPL Technical Support packages have assisted Trace in testing surface insulation resistance on printed circuit board materials. Testing time was reduced and customer service was improved because of Jet Propulsion Laboratory technical support packages.

On the Theory of Ground Anchors

DTIC Science & Technology

1975-01-01

Reinart 46 American Electric Power Service anchor tests 47 Expandable land anchor 51 Anchorages in frozen ground 52 Foundation anchoring in thawed ground...Idealized configuration of Malone anchor 48 54. Standard grillage anchor and pyramid grillage anchor tested by the American Electric Power Service...Corporation 49 55. Configuration of bell anchors tested by the American Electric Power Service Corporation 50 56. Configuration of steel grillage - screw

Quality of Service Control Based on Virtual Private Network Services in a Wide Area Gigabit Ethernet Optical Test Bed

NASA Astrophysics Data System (ADS)

Rea, Luca; Pompei, Sergio; Valenti, Alessandro; Matera, Francesco; Zema, Cristiano; Settembre, Marina

We report an experimental investigation about the Virtual Private LAN Service technique to guarantee the quality of service in the metro/core network and also in the presence of access bandwidth bottleneck. We also show how the virtual private network can be set up for answering to a user request in a very fast way. The tests were performed in a GMPLS test bed with GbE core routers linked with long (tens of kilometers) GbE G.652 fiber links.

In-situ medical simulation for pre-implementation testing of clinical service in a regional hospital in Hong Kong.

PubMed

Chen, P P; Tsui, N Tk; Fung, A Sw; Chiu, A Hf; Wong, W Cw; Leong, H T; Lee, P Sf; Lau, J Yw

2017-08-01

The implementation of a new clinical service is associated with anxiety and challenges that may prevent smooth and safe execution of the service. Unexpected issues may not be apparent until the actual clinical service commences. We present a novel approach to test the new clinical setting before actual implementation of our endovascular aortic repair service. In-situ simulation at the new clinical location would enable identification of potential process and system issues prior to implementation of the service. After preliminary planning, a simulation test utilising a case scenario with actual simulation of the entire care process was carried out to identify any logistic, equipment, settings or clinical workflow issues, and to trial a contingency plan for a surgical complication. All patient care including anaesthetic, surgical, and nursing procedures and processes were simulated and tested. Overall, 17 vital process and system issues were identified during the simulation as potential clinical concerns. They included difficult patient positioning, draping pattern, unsatisfactory equipment setup, inadequate critical surgical instruments, blood products logistics, and inadequate nursing support during crisis. In-situ simulation provides an innovative method to identify critical deficiencies and unexpected issues before implementation of a new clinical service. Life-threatening and serious practical issues can be identified and corrected before formal service commences. This article describes our experience with the use of simulation in pre-implementation testing of a clinical process or service. We found the method useful and would recommend it to others.

Pre-Service Elementary Teachers' Mathematics Content Knowledge: A Predictor of Sixth Graders' Mathematics Performance

ERIC Educational Resources Information Center

Shirvani, Hosin

2015-01-01

This study examined the knowledge of mathematics content of elementary pre-service teachers at a sixth grade level. The researcher administered a mathematics test for sixth graders mandated by the Texas Education Agency to pre-service teachers; the same test was given to sixth graders in Texas. The study found that pre-service teachers performed…

Gender and HIV testing in Burkina Faso: an exploratory study.

PubMed

Obermeyer, Carla Makhlouf; Sankara, Augustin; Bastien, Vincent; Parsons, Michelle

2009-09-01

This study investigated the utilization of services around HIV testing in Burkina Faso through a survey that combined quantitative and qualitative data from 14 selected sites and 299 questionnaires. While some attitudes and behaviors towards HIV testing were similar for women and men, we found lower use of services by men, greater concerns about testing and disclosure on the part of women, and differences between men and women in motivations to test, and the experience of testing and its consequences. The results are discussed in the context of Burkina Faso and in terms of their implications for efforts to improve access to services around HIV.

Models of service delivery for cancer genetic risk assessment and counseling.

PubMed

Trepanier, Angela M; Allain, Dawn C

2014-04-01

Increasing awareness of and the potentially concomitant increasing demand for cancer genetic services is driving the need to explore more efficient models of service delivery. The aims of this study were to determine which service delivery models are most commonly used by genetic counselors, assess how often they are used, compare the efficiency of each model as well as impact on access to services, and investigate the perceived benefits and barriers of each. Full members of the NSGC Familial Cancer Special Interest Group who subscribe to its listserv were invited to participate in a web-based survey. Eligible respondents were asked which of ten defined service delivery models they use and specific questions related to aspects of model use. One-hundred ninety-two of the approximately 450 members of the listserv responded (42.7%); 177 (92.2%) had provided clinical service in the last year and were eligible to complete all sections of the survey. The four direct care models most commonly used were the (traditional) face-to-face pre- and post-test model (92.2%), the face-to-face pretest without face-to-face post-test model (86.5%), the post-test counseling only for complex results model (36.2%), and the post test counseling for all results model (18.3%). Those using the face-to-face pretest only, post-test all, and post-test complex models reported seeing more new patients than when they used the traditional model and these differences were statistically significantly. There were no significant differences in appointment wait times or distances traveled by patients when comparing use of the traditional model to the other three models. Respondents recognize that a benefit of using alternative service delivery models is increased access to services; however, some are concerned that this may affect quality of care.

42 CFR 493.1487 - Condition: Laboratories performing high complexity testing; testing personnel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Laboratories performing high complexity testing; testing personnel. 493.1487 Section 493.1487 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY...

42 CFR 493.1487 - Condition: Laboratories performing high complexity testing; testing personnel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Laboratories performing high complexity testing; testing personnel. 493.1487 Section 493.1487 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY...

The 737 graphite composite flight spoiler flight service evaluation

NASA Technical Reports Server (NTRS)

Coggeshall, R. L.

1982-01-01

A flight service report was prepared which covers the flight service experience of 111 graphite epoxy spoilers on 737 transport aircraft and related ground based environmental exposure of graphite epoxy material specimens. Spoilers were installed on 28 aircraft representing seven major airlines operating throughout the world. Tests of removed spoilers after the seventh year of service continue to indicate modest changes in composite strength properties. Two spoilers were tested, one with 6 and one with 7 years of service, and both had residual strengths that fall within the original static strength scatter band. Both these units had typical service included discrepancies when tested. Based on visual, ultrasonic, and destructive inspection there continues to be no evidence of moisture migration into the honeycomb core and no core corrosion in the deployed units.

Choosing the right laboratory: a review of clinical and forensic toxicology services for urine drug testing in pain management.

PubMed

Reisfield, Gary M; Goldberger, Bruce A; Bertholf, Roger L

2015-01-01

Urine drug testing (UDT) services are provided by a variety of clinical, forensic, and reference/specialty laboratories. These UDT services differ based on the principal activity of the laboratory. Clinical laboratories provide testing primarily focused on medical care (eg, emergency care, inpatients, and outpatient clinics), whereas forensic laboratories perform toxicology tests related to postmortem and criminal investigations, and drug-free workplace programs. Some laboratories now provide UDT specifically designed for monitoring patients on chronic opioid therapy. Accreditation programs for clinical laboratories have existed for nearly half a century, and a federal certification program for drug-testing laboratories was established in the 1980s. Standards of practice for forensic toxicology services other than workplace drug testing have been established in recent years. However, no accreditation program currently exists for UDT in pain management, and this review considers several aspects of laboratory accreditation and certification relevant to toxicology services, with the intention to provide guidance to clinicians in their selection of the appropriate laboratory for UDT surveillance of their patients on opioid therapy.

The revenue generated from clinical chemistry and hematology laboratory services as determined using activity-based costing (ABC) model.

PubMed

Adane, Kasaw; Abiy, Zenegnaw; Desta, Kassu

2015-01-01

The rapid and continuous growth of health care cost aggravates the frequently low priority and less attention given in financing laboratory services. The poorest countries have the highest out-of-pocket spending as a percentage of income. Higher charges might provide a greater potential for revenue. If fees raise quality sufficiently, it can enhance usage. Therefore, estimating the revenue generated from laboratory services could help in capacity building and improved quality service provision. Panel study design was used to determine revenue generated from clinical chemistry and hematology services at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. Activity-Based Costing (ABC) model was used to determine the true cost of tests performed from October 2011 to December 2011 in the hospital. The principle of Activity-based Costing is that activities consume resources and activities consumed by services which incur the costs and hence service takes the cost of resources. All resources with costs are aggregated with the established casual relationships. The process maps designed was restructured in consultation with the senior staffs working and/or supervising the laboratory and pretested checklists were used for observation. Moreover, office documents, receipts and service bills were used while collecting data. The amount of revenue collected from services was compared with the cost of each subsequent test and the profitability or return on investment (ROI) of services was calculated. Data were collected, entered, cleaned, and analyzed using Microsoft Excel 2007 software program and Statistical Software Package for Social Sciences version 19 (SPSS). Paired sample t test was used to compare the price and cost of each test. P-value less than 0.05 were considered as statistically significant. A total of 25,654 specimens were analyzed during 3 months of regular working hours. The total numbers of clinical chemistry and hematology tests performed during the study period were 45,959 (66.1 %) and 23,570 (33.9 %), respectively. Only 274, 386 (25.3 %) Ethiopian Birr (ETB) was recovered from the total cost of 1,086,008.09 ETB incurred on clinical chemistry and hematology laboratory tests. The result showed that, about 133,821 (12.32 %) ETB was revenue not collected from out-of-pocket payments that was paid for the services as a result of under pricing. The result showed that 18 out of 20 laboratory tests were under priced. The cost burden related to free Anti Retro-viral Therapy (ART) services was 285,979.82 (26.3 %) ETB. The cost per test estimated was significantly different to the existing price. About 90 % of the tests were under priced. This information could warn the hospital to reconsider resetting prices of these tests profitability ration less than 1. The revenue collected could help to build capacity, upscale quality, and sustainable service delivery.

78 FR 38355 - Center for Substance Abuse Prevention; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration... given that the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance... methodologies; proficiency testing; best practices experiences; and hair drug testing data. The public is...

Flight service evaluation of composite components on Bell 206L and Sikorsky S-76 helicopters

NASA Technical Reports Server (NTRS)

Baker, D. J.

1983-01-01

Progress on two programs to evaluate composite structural components in flight service on commercial helicopters is described. Thirty-six ship sets of composite components that include the litter door, baggage door, forward fairing, and vertical fin were installed on Bell Model 206L helicopters that are operating in widely different climatic areas. Four horizontal stabilizers and ten tail rotor spars that are production components on the S-76 helicopter were tested after prescribed periods of service to determine the effects of the operating environment on their performance. Concurrent with the flight evaluation, specimens from materials used to fabricate the components were exposed in ground racks and tested at specified intervals to determine the effects of outdoor environments. Results achieved from 14,000 hours of accumulated service on the 206L components, tests on a S-76 horizontal stabilizer after 1600 hours of service, tests on a S-76 tail rotor spar after 2300 hours service, and two years of ground based exposure of material coupons are reported.

An Integrated Tiered Service Delivery Model (ITSDM) Based on Local CD4 Testing Demands Can Improve Turn-Around Times and Save Costs whilst Ensuring Accessible and Scalable CD4 Services across a National Programme

PubMed Central

Glencross, Deborah K.; Coetzee, Lindi M.; Cassim, Naseem

2014-01-01

Background The South African National Health Laboratory Service (NHLS) responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART), has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT), to extend national coverage, improve local turn-around/(TAT) and contain programmatic costs. Methods NHLS Corporate Data Warehouse CD4 data, from 60–70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009–2012. Results An integrated tiered service delivery model (ITSDM) is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (<5 samples/day). Laboratory-based testing is extended with Tier-2/POC-Hubs (processing ≤30–40 CD4 samples/day), consolidating POCT across 8–10 health-clinics with other HIV-related testing and Tier-3/‘community’ laboratories, serving ≤40 health-clinics, processing ≤150 samples/day. Existing Tier-4/‘regional’ laboratories serve ≤100 facilities and process <350 samples/day; Tier-5 are high-volume ‘metro’/centralized laboratories (>350–1500 tests/day, serving ≥200 health-clinics). Tier-6 provides national support for standardisation, harmonization and quality across the organization. Conclusion The ITSDM offers improved local TAT by extending CD4 services into rural/remote areas with new Tier-3 or Tier-2/POC-Hub services installed in existing community laboratories, most with developed infrastructure. The advantage of lower laboratory CD4 costs and use of existing infrastructure enables subsidization of delivery of more expensive POC services, into hard-to-reach districts without reasonable access to a local CD4 laboratory. Full ITSDM implementation across 5 service tiers (as opposed to widespread implementation of POC testing to extend service) can facilitate sustainable ‘full service coverage’ across South Africa, and save>than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers. PMID:25490718

Functional and nonfunctional testing of ATM networks

NASA Astrophysics Data System (ADS)

Ricardo, Manuel; Ferreira, M. E. P.; Guimaraes, Francisco E.; Mamede, J.; Henriques, M.; da Silva, Jorge A.; Carrapatoso, E.

1995-02-01

ATM network will support new multimedia services that will require new protocols, those services and protocols will need different test strategies and tools. In this paper, the concepts of functional and non-functional testers of ATM networks are discussed, a multimedia service and its requirements are presented and finally, a summary description of an ATM network and of the test tool that will be used to validate it are presented.

77 FR 64566 - Market Test of Experimental Product-Metro Post

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... Metro Post. This document describes the proposed test, addresses procedural aspects of the filing, and.... \\1\\ Notice of the United States Postal Service of Market Test of Experimental Product--Metro Post... the Metro Post market test under seal. Notice at 4. The Postal Service classifies Metro Post as a...

47 CFR 73.1530 - Portable test stations [Definition].

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Portable test stations [Definition]. 73.1530 Section 73.1530 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.1530 Portable test stations [Definition]. A portable test station is one...

42 CFR 493.1241 - Standard: Test request.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Standard: Test request. 493.1241 Section 493.1241 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Quality System for Nonwaived Testing Preanalytic Systems § 493.1241 Standard: Test request...

47 CFR 73.1515 - Special field test authorizations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Special field test authorizations. 73.1515 Section 73.1515 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.1515 Special field test authorizations. (a) A special field test...

42 CFR 493.1283 - Standard: Test records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Standard: Test records. 493.1283 Section 493.1283 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Quality System for Nonwaived Testing Analytic Systems § 493.1283 Standard: Test records. (...

42 CFR 493.1291 - Standard: Test report.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Standard: Test report. 493.1291 Section 493.1291 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Quality System for Nonwaived Testing Postanalytic Systems § 493.1291 Standard: Test report....

47 CFR 73.1530 - Portable test stations [Definition].

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Portable test stations [Definition]. 73.1530 Section 73.1530 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.1530 Portable test stations [Definition]. A portable test station is one...

47 CFR 73.1515 - Special field test authorizations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Special field test authorizations. 73.1515 Section 73.1515 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.1515 Special field test authorizations. (a) A special field test...

The Computerized Adaptive Testing System Development Project.

ERIC Educational Resources Information Center

McBride, James R.; Sympson, J. B.

The Computerized Adaptive Testing (CAT) project is a joint Armed Services coordinated effort to develop and evaluate a system for automated, adaptive administration of the Armed Services Vocational Aptitude Battery (ASVAB). The CAT is a system for administering personnel tests that differs from conventional test administration in two major…

Estimating implementation and operational costs of an integrated tiered CD4 service including laboratory and point of care testing in a remote health district in South Africa.

PubMed

Cassim, Naseem; Coetzee, Lindi M; Schnippel, Kathryn; Glencross, Deborah K

2014-01-01

An integrated tiered service delivery model (ITSDM) has been proposed to provide 'full-coverage' of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing < 30-40 samples from 8-10 health-clinics; Tier-3/Community laboratories servicing ∼ 50 health-clinics, processing < 150 samples/day; high-volume centralized laboratories (Tier-4 and Tier-5) processing < 300 or > 600 samples/day and serving > 100 or > 200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of > 24-48 hours. Full service coverage with TAT < 6-hours could be achieved with placement of twenty-seven Tier-1/POC or eight Tier-2/POC-hubs, at a cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured 'full service coverage' and < 24 hour LTR-TAT for the district at $7.42 per-test. Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼ 12-24-hour LTR-TAT, is ∼ $2 more than existing referred services per-test, but 2-4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4 services.

"There is such a thing as asking for trouble": taking rapid HIV testing to gay venues is fraught with challenges.

PubMed

Prost, Audrey; Chopin, Mathias; McOwan, Alan; Elam, Gillian; Dodds, Julie; Macdonald, Neil; Imrie, John

2007-06-01

To explore the feasibility and acceptability of offering rapid HIV testing to men who have sex with men in gay social venues. Qualitative study with in-depth interviews and focus group discussions. Interview transcripts were analysed for recurrent themes. 24 respondents participated in the study. Six gay venue owners, four gay service users and one service provider took part in in-depth interviews. Focus groups were conducted with eight members of a rapid HIV testing clinic staff and five positive gay men. Respondents had strong concerns about confidentiality and privacy, and many felt that HIV testing was "too serious" an event to be undertaken in social venues. Many also voiced concerns about issues relating to post-test support and behaviour, and clinical standards. Venue owners also discussed the potential negative impact of HIV testing on social venues. There are currently substantial barriers to offering rapid HIV tests to men who have sex with men in social venues. Further work to enhance acceptability must consider ways of increasing the confidentiality and professionalism of testing services, designing appropriate pre-discussion and post-discussion protocols, evaluating different models of service delivery, and considering their cost-effectiveness in relation to existing services.

Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial.

PubMed

Wilson, Emma; Free, Caroline; Morris, Tim P; Syred, Jonathan; Ahamed, Irrfan; Menon-Johansson, Anatole S; Palmer, Melissa J; Barnard, Sharmani; Rezel, Emma; Baraitser, Paula

2017-12-01

Internet-accessed sexually transmitted infection testing (e-STI testing) is increasingly available as an alternative to testing in clinics. Typically this testing modality enables users to order a test kit from a virtual service (via a website or app), collect their own samples, return test samples to a laboratory, and be notified of their results by short message service (SMS) or telephone. e-STI testing is assumed to increase access to testing in comparison with face-to-face services, but the evidence is unclear. We conducted a randomised controlled trial to assess the effectiveness of an e-STI testing and results service (chlamydia, gonorrhoea, HIV, and syphilis) on STI testing uptake and STI cases diagnosed. The study took place in the London boroughs of Lambeth and Southwark. Between 24 November 2014 and 31 August 2015, we recruited 2,072 participants, aged 16-30 years, who were resident in these boroughs, had at least 1 sexual partner in the last 12 months, stated willingness to take an STI test, and had access to the internet. Those unable to provide consent and unable to read English were excluded. Participants were randomly allocated to receive 1 text message with the web link of an e-STI testing and results service (intervention group) or to receive 1 text message with the web link of a bespoke website listing the locations, contact details, and websites of 7 local sexual health clinics (control group). Participants were free to use any other services or interventions during the study period. The primary outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and self-reported STI diagnosis at 6 weeks, verified by patient record checks. Secondary outcomes were the proportion of participants prescribed treatment for an STI, time from randomisation to completion of an STI test, and time from randomisation to treatment of an STI. Participants were sent a £10 cash incentive on submission of self-reported data. We completed all follow-up, including patient record checks, by 17 June 2016. Uptake of STI testing was increased in the intervention group at 6 weeks (50.0% versus 26.6%, relative risk [RR] 1.87, 95% CI 1.63 to 2.15, P < 0.001). The proportion of participants diagnosed was 2.8% in the intervention group versus 1.4% in the control group (RR 2.10, 95% CI 0.94 to 4.70, P = 0.079). No evidence of heterogeneity was observed for any of the pre-specified subgroup analyses. The proportion of participants treated was 1.1% in the intervention group versus 0.7% in the control group (RR 1.72, 95% CI 0.71 to 4.16, P = 0.231). Time to test, was shorter in the intervention group compared to the control group (28.8 days versus 36.5 days, P < 0.001, test for difference in restricted mean survival time [RMST]), but no differences were observed for time to treatment (83.2 days versus 83.5 days, P = 0.51, test for difference in RMST). We were unable to recruit the planned 3,000 participants and therefore lacked power for the analyses of STI diagnoses and STI cases treated. The e-STI testing service increased uptake of STI testing for all groups including high-risk groups. The intervention required people to attend clinic for treatment and did not reduce time to treatment. Service innovations to improve treatment rates for those diagnosed online are required and could include e-treatment and postal treatment services. e-STI testing services require long-term monitoring and evaluation. ISRCTN Registry ISRCTN13354298.

9 CFR 113.8 - In vitro tests for serial release.

Code of Federal Regulations, 2010 CFR

2010-01-01

....8 Section 113.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT... Health Inspection Service (APHIS); (3) Establishing satisfactory potency for the product in accordance... potency test by Animal and Plant Health Inspection Service as provided in this paragraph. Products shall...

Requirements for Flight Testing Automated Terminal Service

DOT National Transportation Integrated Search

1977-05-01

This report describes requirements for the flight tests of the baseline Automated Terminals Service (ATS) system. The overall objective of the flight test program is to evaluate the feasibility of the ATS concept. Within this objective there are two ...

Policies of Test Centers and Jurisdictions and GED[R] Candidate Test Performance. GED Testing Service[R] Research Study, 2009-6. Executive Summary

ERIC Educational Resources Information Center

Medhanie, Amanuel; Patterson, Margaret Becker

2009-01-01

The economic and employment outlook for individuals without a high school diploma is bleak. For many of these individuals, passing the General Educational Development (GED) Test is the first step in competing in the increasingly demanding job market. GED test-taking policies vary across test centers and jurisdictions, and have the potential to…

Simulated airline service experience with laminar-flow control leading-edge systems

NASA Technical Reports Server (NTRS)

Maddalon, Dal V.; Fisher, David F.; Jennett, Lisa A.; Fischer, Michael C.

1987-01-01

The first JetStar leading edge flight test was made November 30, 1983. The JetStar was flown for more than 3 years. The titanium leading edge test articles today remain in virtually the same condition as they were in on that first flight. No degradation of laminar flow performance has occurred as a result of service. The JetStar simulated airline service flights have demonstrated that effective, practical leading edge systems are available for future commercial transports. Specific conclusions based on the results of the simulated airline service test program are summarized.

Manager personality, manager service quality orientation, and service climate: test of a model.

PubMed

Salvaggio, Amy Nicole; Schneider, Benjamin; Nishii, Lisa H; Mayer, David M; Ramesh, Anuradha; Lyon, Julie S

2007-11-01

This article conceptually and empirically explores the relationships among manager personality, manager service quality orientation, and climate for customer service. Data were collected from 1,486 employees and 145 managers in grocery store departments (N = 145) to test the authors' theoretical model. Largely consistent with hypotheses, results revealed that core self-evaluations were positively related to managers' service quality orientation, even after dimensions of the Big Five model of personality were controlled, and that service quality orientation fully mediated the relationship between personality and global service climate. Implications for personality and organizational climate research are discussed. (c) 2007 APA

Pilot study of home-based delivery of HIV testing and counseling and contraceptive services to couples in Malawi.

PubMed

Becker, Stan; Taulo, Frank O; Hindin, Michelle J; Chipeta, Effie K; Loll, Dana; Tsui, Amy

2014-12-20

HIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors. This study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences. 89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p < 0.05), parity (p < 0.01), and emotional closeness to partner (p < 0.01) had significant bivariate associations with acceptance of at least one service. Reported condom use at last sex increased from 6% to 25% among couples receiving any intervention. First-ever HIV testing was delivered to 25 women and 69 men, resulting, respectively, in 4 and 11 newly detected infections. Home-based CHCT and CFP were very successful in this pilot study with high proportions of previously untested husbands and wives accepting CHCT and there were virtually no negative outcomes within one week. This study supports the need for further research and testing of home- and couple-based approaches to expand access to HCT and contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.

Feasibility, Benefits, and Limitations of a Penicillin Allergy Skin Testing Service.

PubMed

Narayanan, Prasanna P; Jeffres, Meghan N

2017-06-01

To critically examine the feasibility, benefits, and limitations of an inpatient penicillin skin testing service and how pharmacists can be utilized. A PubMed search was performed from July 2016 through September 2016 using the following search terms: penicillin skin testing, penicillin allergy, β-lactam allergy. Additional references were identified from a review of literature citations. All English-language studies assessing the use of penicillin skin testing as well as management and clinical outcomes of patients with a β-lactam allergy were evaluated. The prevalence of people self-identifying as penicillin allergic ranges from 10% to 20% in the United States. Being improperly labeled as penicillin allergic is associated with higher health care costs, worse clinical outcomes, and an increased prevalence of multidrug-resistant infections. Penicillin skin testing can be a tool used to clarify penicillin allergies and has been demonstrated to be a successful addition to antimicrobial stewardship programs in multiple health care settings. Prior to implementing a penicillin skin testing service, institutions will need to perform a feasibility analysis of who will supply labor and accept the financial burden as well as identify if the positive benefits of a penicillin skin testing service overcome the limitations of this diagnostic test. We conclude that institutions with high percentages of patients receiving non-β-lactams because of penicillin allergy labels would likely benefit the most from a penicillin skin testing service.

Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study

PubMed Central

Molla, Mitike; Berhane, Yemane; Lindtjørn, Bernt

2008-01-01

Background Delaying sexual initiation has been promoted as one of the methods of decreasing risks of HIV among young people. In traditional countries, such as Ethiopia, retaining virginity until marriage is the norm. However, no one has examined the impact of this traditional norm on sexual behaviour and risk of HIV in marriage. This study examined the effect of virginity norm on having sex before marriage and sexual behaviour after marriage among rural Ethiopian youth. Methods We did a cross-sectional survey in 9 rural and 1 urban area using a probabilistic sample of 3,743 youth, 15–24 years of age. Univariate analysis was used to assess associations between virginity norm and gender stratified by area, and between sexual behaviour and marital status. We applied Kaplan-Meier and Cox regression analysis to estimate age at sexual debut and assessed the predictors of premarital sex among the never-married using SPSS. Results We found that maintaining virginity is still a way of securing marriage for girls, especially in rural areas; the odds of belief and intention to marry a virgin among boys was 3–4 times higher among rural young males. As age increased, the likelihood of remaining a virgin decreased. There was no significant difference between married and unmarried young people in terms of number of partners and visiting commercial sex workers. Married men were twice more likely to have multiple sexual partners than their female counterparts. A Cox regression show that those who did not believe in traditional values of preserving virginity (adjusted hazard ratio [AHR] = 2.91 [1.92–4.40]), alcohol drinkers (AHR = 2.91 [1.97–4.29]), Khat chewers (AHR = 2.36 [1.45–3.85]), literates (AHR = 18.01 [4.34–74.42]), and the older age group (AHR = 1.85 [1.19–2.91]) were more likely to have premarital sex than their counterparts. Conclusion Although virginity norms help delay age at sexual debut among rural Ethiopian youth, and thus reduces vulnerability to sexually transmitted infections and HIV infection, vulnerability among females may increase after marriage due to unprotected multiple risky sexual behaviours by spouses. The use of preventive services, such as VCT before marriage and condom use in marriage should be part of the HIV/AIDS prevention and control strategies. PMID:18184425

The Educational Passport.

ERIC Educational Resources Information Center

Summerskill, John

The Educational Passport is a service that is being developed at the Educational Testing Service for students or other individuals in order to facilitate their entry to school or college or employment. The Passport is an accumulative record that the individual prepares and owns and uses. At the Educational Testing Service, photographed documents…

12 CFR 563e.24 - Service test.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of alternative systems for delivering retail banking services (e.g., ATMs, ATMs not owned or operated... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Service test. 563e.24 Section 563e.24 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT Standards for...

12 CFR 345.24 - Service test.

Code of Federal Regulations, 2010 CFR

2010-01-01

... systems for delivering retail banking services (e.g., RSFs, RSFs not owned or operated by or exclusively... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Service test. 345.24 Section 345.24 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY COMMUNITY...

12 CFR 25.24 - Service test.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of alternative systems for delivering retail banking services (e.g., ATMs, ATMs not owned or operated... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Service test. 25.24 Section 25.24 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY COMMUNITY REINVESTMENT ACT AND INTERSTATE...

Idaho out-of-service verification field operational test

DOT National Transportation Integrated Search

2000-02-01

The Out-of-Service Verification Field Operational Test Project was initiated in 1994. The purpose of the project was to test the feasibility of using sensors and a computerized tracking system to augment the ability of inspectors to monitor and contr...

42 CFR 84.99 - Man tests; testing conditions; general requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Man tests; testing conditions; general requirements. 84.99 Section 84.99 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.99...

Reliability Analysis for the Internationally Administered 2002 Series GED Tests. GED Testing Service[R] Research Studies, 2009-3

ERIC Educational Resources Information Center

Setzer, J. Carl; He, Yi

2009-01-01

Reliability Analysis for the Internationally Administered 2002 Series GED (General Educational Development) Tests Reliability refers to the consistency, or stability, of test scores when the authors administer the measurement procedure repeatedly to groups of examinees (American Educational Research Association [AERA], American Psychological…

42 CFR 493.5 - Categories of tests by complexity.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Categories of tests by complexity. 493.5 Section 493.5 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS General Provisions § 493.5 Categories of tests by complexity. (a) Laboratory tests ar...

78 FR 41128 - Market Test of International Merchandise Return Service

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-09

... POSTAL REGULATORY COMMISSION [Docket No. MT2013-2; Order No. 1771] Market Test of International... noticing a recently-filed Postal Service proposal to conduct a market test of a competitive experimental..., pursuant to 39 U.S.C. 3641, announcing its intent to conduct a market test of a competitive experimental...

42 CFR 84.102 - Man test 6; requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Man test 6; requirements. 84.102 Section 84.102 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND... Breathing Apparatus § 84.102 Man test 6; requirements. (a) Man test 6 will be conducted with respect to...

42 CFR 84.102 - Man test 6; requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Man test 6; requirements. 84.102 Section 84.102 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND... Breathing Apparatus § 84.102 Man test 6; requirements. (a) Man test 6 will be conducted with respect to...

42 CFR 84.102 - Man test 6; requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Man test 6; requirements. 84.102 Section 84.102 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND... Breathing Apparatus § 84.102 Man test 6; requirements. (a) Man test 6 will be conducted with respect to...

42 CFR 84.101 - Man test 5; requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Man test 5; requirements. 84.101 Section 84.101 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND... Breathing Apparatus § 84.101 Man test 5; requirements. (a) Test 5 will be conducted to determine the maximum...

42 CFR 84.102 - Man test 6; requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Man test 6; requirements. 84.102 Section 84.102 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND... Breathing Apparatus § 84.102 Man test 6; requirements. (a) Man test 6 will be conducted with respect to...

42 CFR 84.101 - Man test 5; requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Man test 5; requirements. 84.101 Section 84.101 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND... Breathing Apparatus § 84.101 Man test 5; requirements. (a) Test 5 will be conducted to determine the maximum...

42 CFR 84.101 - Man test 5; requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Man test 5; requirements. 84.101 Section 84.101 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND... Breathing Apparatus § 84.101 Man test 5; requirements. (a) Test 5 will be conducted to determine the maximum...

49 CFR 232.505 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... acceptance tests; (3) Correct any safety deficiencies identified by FRA in the design of the equipment or in... principal test objectives shall be to demonstrate that the equipment meets the safety design and performance... 49 Transportation 4 2013-10-01 2013-10-01 false Pre-revenue service acceptance testing plan. 232...

49 CFR 232.505 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... acceptance tests; (3) Correct any safety deficiencies identified by FRA in the design of the equipment or in... principal test objectives shall be to demonstrate that the equipment meets the safety design and performance... 49 Transportation 4 2012-10-01 2012-10-01 false Pre-revenue service acceptance testing plan. 232...

49 CFR 232.505 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... acceptance tests; (3) Correct any safety deficiencies identified by FRA in the design of the equipment or in... principal test objectives shall be to demonstrate that the equipment meets the safety design and performance... 49 Transportation 4 2014-10-01 2014-10-01 false Pre-revenue service acceptance testing plan. 232...

49 CFR 232.505 - Pre-revenue service acceptance testing plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

... acceptance tests; (3) Correct any safety deficiencies identified by FRA in the design of the equipment or in... principal test objectives shall be to demonstrate that the equipment meets the safety design and performance... 49 Transportation 4 2011-10-01 2011-10-01 false Pre-revenue service acceptance testing plan. 232...

Dynamic Testing of In-Situ Composite Floors and Evaluation of Vibration Serviceability Using the Finite Element Method

DTIC Science & Technology

2006-08-21

Dynamic Testing of In-Situ Composite Floors and Evaluation of Vibration Serviceability Using the Finite Element Method By Anthony R. Barrett...Setareh Alfred L. Wicks 21 August 2006 Blacksburg, VA Keywords: vibration, floor, serviceability , walking, modal analysis, fundamental frequency...burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services

Web-Based Activity Within a Sexual Health Economy: Observational Study.

PubMed

Turner, Katy Me; Zienkiewicz, Adam K; Syred, Jonathan; Looker, Katharine J; de Sa, Joia; Brady, Michael; Free, Caroline; Holdsworth, Gillian; Baraitser, Paula

2018-03-07

Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need. The aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead. Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other. Introduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period-2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses. This evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion. ©Katy ME Turner, Adam K Zienkiewicz, Jonathan Syred, Katharine J Looker, Joia de Sa, Michael Brady, Caroline Free, Gillian Holdsworth, Paula Baraitser. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.03.2018.

2005 8th Annual Systems Engineering Conference. Volume 1, Tuesday

DTIC Science & Technology

2005-10-27

Services NCES Discovery Services Federated Search Denotes interface Service NCCP Oktoberfest 2004 101 Task: Global Strike Mission Planning NCCP Oktoberfest...Enterprise Service Management Security Services NCES Discovery Services Federated Search Service Test, cert and accreditation needs to be focused on small

Barriers to HIV testing among male clients of female sex workers in Indonesia.

PubMed

Fauk, Nelsensius Klau; Sukmawati, Anastasia Suci; Berek, Pius Almindu Leki; Ernawati; Kristanti, Elisabeth; Wardojo, Sri Sunaringsih Ika; Cahaya, Isaias Budi; Mwanri, Lillian

2018-05-30

Frequent engagement of men in sexual encounters with female sex workers (FSWs) without using condoms places them at a high risk for HIV infection. HIV testing has been noted to be among important strategies to prevent HIV transmission and acquisition. However, it is known that not all men willingly undertake an HIV test as a way to prevent HIV transmission and/or acquisition. This study aimed to identify barriers to accessing HIV testing services among men who are clients of FSWs (clients) in Belu and Malaka districts, Indonesia. A qualitative inquiry employing face to face open ended interviews was conducted from January to April 2017. The participants (n = 42) were clients of FSWs recruited using purposive and snowball sampling techniques. Data were analysed using a qualitative data analysis framework. Findings indicated three main barriers of accessing HIV testing services by clients. These included: (1) personal barriers (lack of knowledge of HIV/AIDS and HIV testing availability, and unwillingness to undergo HIV testing due to low self-perceived risk of HIV and fear of the test result); (2) health care service provision barriers (lack of trust in health professionals and limited availability of medication including antiretroviral (ARV)); and (3) social barriers (stigma and discrimination, and the lack of social supports). These findings indicated multilevelled barriers to accessing HIV testing services among participants, who are known to be among key population groups in HIV care. Actions to improve HIV/AIDS-related health services accessibility are required. The dissemination of the knowledge and information on HIV/AIDS and improved available of HIV/AIDS-related services are necessary actions to improve the personal levelled barriers. System wide barriers will need improved practices and health policies to provide patients friendly and accessible services. The societal levelled barriers will need a more broad societal approach including raising awareness in the community and enhanced discussions about HIV/AIDS issues in order to normalise HIV in the society.

42 CFR 493.1241 - Standard: Test request.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard: Test request. 493.1241 Section 493.1241 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Quality System for Nonwaived Testing...

42 CFR 493.1241 - Standard: Test request.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Standard: Test request. 493.1241 Section 493.1241 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Quality System for Nonwaived Testing...

40 CFR 92.504 - Right of entry and access.

Code of Federal Regulations, 2010 CFR

2010-07-01

... manufacturer's or remanufacturer's production line testing or auditing program or any procedure or activity... service accumulation, emission test cycles, and maintenance and verification of test equipment calibration... not limited to, clerical, copying, interpretation and translation services; the making available on an...

Provider-initiated HIV testing and counseling in health facilities--what does this mean for the health and human rights of pregnant women?

PubMed

Gruskin, Sofia; Ahmed, Shahira; Ferguson, Laura

2008-04-01

Since the introduction of drugs to prevent vertical transmission of HIV, the purpose of and approach to HIV testing of pregnant women has increasingly become an area of major controversy. In recent years, many strategies to increase the uptake of HIV testing have focused on offering HIV tests to women in pregnancy-related services. New global guidance issued by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) specifically notes these services as an entry point for provider-initiated HIV testing and counseling (PITC). The guidance constitutes a useful first step towards a framework within which PITC sensitive to health, human rights and ethical concerns can be provided to pregnant women in health facilities. However, a number of issues will require further attention as implementation moves forward. It is incumbent on all those involved in the scale up of PITC to ensure that it promotes long-term connection with relevant health services and does not result simply in increased testing with no concrete benefits being accrued by the women being tested. Within health services, this will require significant attention to informed consent, pre- and post-test counseling, patient confidentiality, referrals and access to appropriate services, as well as reduction of stigma and discrimination. Beyond health services, efforts will be needed to address larger societal, legal, policy and contextual issues. The health and human rights of pregnant women must be a primary consideration in how HIV testing is implemented; they can benefit greatly from PITC but only if it is carried out appropriately.

TTCN-3 Based Conformance Testing of Mobile Broadcast Business Management System in 3G Networks

NASA Astrophysics Data System (ADS)

Wang, Zhiliang; Yin, Xia; Xiang, Yang; Zhu, Ruiping; Gao, Shirui; Wu, Xin; Liu, Shijian; Gao, Song; Zhou, Li; Li, Peng

Mobile broadcast service is one of the emerging most important new services in 3G networks. To better operate and manage mobile broadcast services, mobile broadcast business management system (MBBMS) should be designed and developed. Such a system, with its distributed nature, complicated XML data and security mechanism, faces many challenges in testing technology. In this paper, we study the conformance testing methodology of MBBMS, and design and implement a MBBMS protocol conformance testing tool based on TTCN-3, a standardized test description language that can be used in black-box testing of reactive and distributed system. In this methodology and testing tool, we present a semi-automatic XML test data generation method of TTCN-3 test suite and use HMSC model to help the design of test suite. In addition, we also propose an integrated testing method for hierarchical MBBMS security architecture. This testing tool has been used in industrial level’s testing.

10 CFR 26.715 - Recordkeeping requirements for collection sites, licensee testing facilities, and laboratories...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Recordkeeping requirements for collection sites, licensee testing facilities, and laboratories certified by the Department of Health and Human Services. 26.715... laboratories certified by the Department of Health and Human Services. (a) Collection sites providing services...

7 CFR 1755.704 - Requirements applicable to both CCSR and NMR aerial service wires.

Code of Federal Regulations, 2011 CFR

2011-01-01

... service wires. 1755.704 Section 1755.704 Agriculture Regulations of the Department of Agriculture... aerial service wires. (a) Acceptance testing. (1) The tests described in §§ 1755.700 through 1755.704 are intended for acceptance of wire designs and major modifications of accepted designs. What constitutes a...

7 CFR 1755.704 - Requirements applicable to both CCSR and NMR aerial service wires.

Code of Federal Regulations, 2010 CFR

2010-01-01

... service wires. 1755.704 Section 1755.704 Agriculture Regulations of the Department of Agriculture... aerial service wires. (a) Acceptance testing. (1) The tests described in §§ 1755.700 through 1755.704 are intended for acceptance of wire designs and major modifications of accepted designs. What constitutes a...

40 CFR 86.436-78 - Additional service accumulation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... minimum test distance and at the useful life, and, (3) The results of the half life emission tests, when... Regulations for 1978 and Later New Motorcycles, General Provisions § 86.436-78 Additional service accumulation. (a) Additional service up to the useful life will be accumulated under the same conditions as the...

40 CFR 86.436-78 - Additional service accumulation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... minimum test distance and at the useful life, and, (3) The results of the half life emission tests, when... Regulations for 1978 and Later New Motorcycles, General Provisions § 86.436-78 Additional service accumulation. (a) Additional service up to the useful life will be accumulated under the same conditions as the...

Sustaining Software-Intensive Systems

DTIC Science & Technology

2006-05-01

2.2 Multi- Service Operational Test and Evaluation .......................................4 2.3 Stable Software Baseline...or equivalent document • completed Multi- Service Operational Test and Evaluation (MOT&E) for the potential production software package (or OT&E if...not multi- service ) • stable software production baseline • complete and current software documentation • Authority to Operate (ATO) for an

77 FR 54557 - Notice of Intent To Suspend the 2012 Census of Agriculture Content Testing

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-05

... DEPARTMENT OF AGRICULTURE National Agricultural Statistics Service Notice of Intent To Suspend the 2012 Census of Agriculture Content Testing AGENCY: National Agricultural Statistics Service, USDA... 2012 Census of Agriculture Content Testing. FOR FURTHER INFORMATION CONTACT: Joseph T. Reilly...

42 CFR 493.1351 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false General. 493.1351 Section 493.1351 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS... complexity testing, PPM procedures, high complexity testing, or any combination of these tests. [60 FR 20049...

42 CFR 493.1351 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false General. 493.1351 Section 493.1351 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS... complexity testing, PPM procedures, high complexity testing, or any combination of these tests. [60 FR 20049...

47 CFR 73.713 - Program tests.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Program tests. 73.713 Section 73.713 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES International Broadcast Stations § 73.713 Program tests. (a) Upon completion of construction of an international broadcasting station in...

Characteristics of U.S. Substance Abuse Treatment Facilities Offering HIV Services: Results From a National Survey.

PubMed

Cohn, Amy; Stanton, Cassandra; Elmasry, Hoda; Ehlke, Sarah; Niaura, Ray

2016-06-01

Substance use disorders are common among persons with HIV/AIDS. This study examined the prevalence and correlates of the provision of four HIV services in a national sample of substance abuse treatment facilities. Data were from the 2011 National Survey of Substance Abuse Treatment Services. Prevalence estimates indicated that 28% of facilities offered HIV testing, 26% early intervention, 58% HIV/AIDS education, and 8% special programs for HIV/AIDS. Facilities offering inpatient substance abuse care were more than six times as likely to offer HIV testing but not more likely to offer any other type of HIV service. Facilities offering methadone treatment were 2.5 times more likely to offer HIV services. Given the high rates of substance use among persons with HIV, the prevalence of facilities offering HIV services was low in most domains, with different barriers identified in multivariable models. Integrating comprehensive HIV prevention, testing, and support services into programs that address substance abuse is needed.

Engagement of men in antenatal care services: Increased HIV testing and treatment uptake in a community participatory action program in Mozambique

PubMed Central

Audet, Carolyn M.; Blevins, Meridith; Chire, Yazalde Manuel; Aliyu, Muktar H; Vaz, Lara M. E.; Antonio, Elisio; Alvim, Fernanda; Bechtel, Ruth; Wester, C. William; Vermund, Sten H.

2016-01-01

Uptake of HIV testing and antiretroviral therapy (ART) services during antenatal care (ANC) in rural Mozambique is disappointing. To nurture supportive male engagement in ANC services, we partnered with Traditional Birth Attendants and trained a new type of male-to-male community health agent, “Male Champions”, who focused on counseling male partners to create new, male-friendly community norms around engagement in spousal/partner pregnancies. We assessed ANC service uptake using a pre-post intervention design. The intervention was associated with increases in: (1) uptake of provider-initiated counseling and testing among pregnant woman (81% vs. 92%; p<0.001); (2) male engagement in ANC (5% vs. 34%; p<0.001); and (3) uptake of ART (8% vs. 19%; p<0.001). When men accepted HIV testing, rates of testing rose markedly among pregnant women. With the challenges in scale-up of Option B+ in sub-Saharan Africa, similar interventions may increase testing and treatment acceptability during pregnancy. PMID:26906021

Do Persistence and Passion Matter: Evidence from the Educational Testing Service Major Field Test in Business

ERIC Educational Resources Information Center

Ketcham, David; Nigro, Peter; Roberto, Michael

2018-01-01

The authors examined the determinants of success on the Educational Testing Service Major Field Test in Business. The authors find that gender, SAT performance, and concentration are significant predictors of performance. Additionally, they derive proxies for student passion and persistence, and find that the greater the student's passion for…

Apollo 13 post-flight Service Module tests to determine reason for explosion

NASA Technical Reports Server (NTRS)

1970-01-01

Sequence photo from 16mm motion picture film of test at Langley Research Center which seeks to determine mechanism by which Apollo 13 panel was separated from Service Module. The test used a 1/2 scale model with a honeycomb sandwich panel and was conducted in a vacuum (41982); Second photograph in sequence of three of panel separation test at Langley Research Center (41983); Full-scale propogation test at the NASA Manned Spacecraft Center of fire inside the Apollo Service Module oxygen tank. The photograph from a motion picture sequence taken from outside the vessel shows failure of tank conduit with abrupt loss of oxygen pressure (41984); Third photograph in sequence of three showing panel separation test at Langley Research Center (41985).

Cost analysis of a novel HIV testing strategy in community pharmacies and retail clinics.

PubMed

Lecher, Shirley Lee; Shrestha, Ram K; Botts, Linda W; Alvarez, Jorge; Moore, James H; Thomas, Vasavi; Weidle, Paul J

2015-01-01

To document the cost of implementing point-of-care (POC) human immunodeficiency virus (HIV) rapid testing in busy community pharmacies and retail clinics. Providing HIV testing services in community pharmacies and retail clinics is an innovative way to expand HIV testing. The cost of implementing POC HIV rapid testing in a busy retail environment needs to be documented to provide program and policy leaders with adequate information for planning and budgeting. Cost analysis from a pilot project that provided confidential POC HIV rapid testing services in community pharmacies and retail clinics. The pharmacy sites were operated under several different ownership structures (for-profit, nonprofit, sole proprietorship, corporation, public, and private) in urban and rural areas. We included data from the initial six sites that participated in the project. We collected the time spent by pharmacy and retail clinic staff for pretest and posttest counseling in an activity log for time-in-motion for each interaction. Pharmacists and retail clinic staff. HIV rapid testing. The total cost was calculated to include costs of test kits, control kits, shipping, test supplies, training, reporting, program administration, and advertising. The six sites trained 22 staff to implement HIV testing. A total of 939 HIV rapid tests were conducted over a median time of 12 months, of which 17 were reactive. Median pretest counseling time was 2 minutes. Median posttest counseling time was 2 minutes for clients with a nonreactive test and 10 minutes for clients with a reactive test. The average cost per person tested was an estimated $47.21. When we considered only recurrent costs, the average cost per person tested was $32.17. Providing POC HIV rapid testing services required a modest amount of staff time and costs that are comparable to other services offered in these settings. HIV testing in pharmacies and retail clinics can provide an additional alternative venue for increasing the availability and accessibility of HIV testing services in the United States.

Feasibility and acceptability of point of care HIV testing in community outreach and GUM drop-in services in the North West of England: A programmatic evaluation

PubMed Central

2011-01-01

Background In Liverpool, injecting drug users (IDUs), men-who-have-sex-with-men (MSM) and UK Africans experience a disproportionate burden of HIV, yet services do not reach out to these groups and late presentations continue. We set out to: increase testing uptake in targeted marginalized groups through a community and genitourinary medicine (GUM)-based point of care testing (POCT) programme; and conduct a process evaluation to examine service provider inputs and document service user perceptions of the programme. Methods Mixed quantitative, qualitative and process evaluation methods were used. Service providers were trained to use fourth generation rapid antibody/antigen HIV tests. Existing outreach services incorporated POCT into routine practice. Clients completed a semi-structured questionnaire and focus group discussions (FGDs) were held with service providers. Results Between September 2009 and June 2010, 953 individuals underwent POCT (GUM: 556 [59%]; community-based sites: 397 [42%]). Participants in the community were more likely to be male (p = 0.028), older (p < 0.001), of UK African origin (p < 0.001) and IDUs (p < 0.001) than participants from the GUM clinic. Seventeen new HIV diagnoses were confirmed (prevalence = 1.8%), 16 of whom were in risk exposure categories (prevalence: 16/517, 3.1%). Questionnaires and FGDs showed that clients and service providers were supportive of POCT, highlighting benefits of reaching out to marginalised communities and incorporating HIV prevention messages. Conclusions Community and GUM clinic-based POCT for HIV was feasible and acceptable to clients and service providers in a low prevalence setting. It successfully reached target groups, many of whom would not have otherwise tested. We recommend POCT be considered among strategies to increase the uptake of HIV testing among groups who are currently underserved. PMID:21627851

Estimating Implementation and Operational Costs of an Integrated Tiered CD4 Service including Laboratory and Point of Care Testing in a Remote Health District in South Africa

PubMed Central

Cassim, Naseem; Coetzee, Lindi M.; Schnippel, Kathryn; Glencross, Deborah K.

2014-01-01

Background An integrated tiered service delivery model (ITSDM) has been proposed to provide ‘full-coverage’ of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing <30–40 samples from 8–10 health-clinics; Tier-3/Community laboratories servicing ∼50 health-clinics, processing <150 samples/day; high-volume centralized laboratories (Tier-4 and Tier-5) processing <300 or >600 samples/day and serving >100 or >200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Methods Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. Results The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of >24–48 hours. Full service coverage with TAT <6-hours could be achieved with placement of twenty-seven Tier-1/POC or eight Tier-2/POC-hubs, at a cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured ‘full service coverage’ and <24 hour LTR-TAT for the district at $7.42 per-test. Conclusion Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼12–24-hour LTR-TAT, is ∼$2 more than existing referred services per-test, but 2–4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4 services. PMID:25517412

Control of rail integrity by self-adaptive scheduling of rail tests

DOT National Transportation Integrated Search

1990-06-01

A guide for the scheduling of in-service tests of rail to detect defects is presented. The guide is designed for self-adaptation to changing track conditions, as reflected by the total rate of defect occurrence per test, the rate of 'service' defect ...

47 CFR 80.96 - Maintenance tests.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Maintenance tests. 80.96 Section 80.96 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Operating Requirements and Procedures Operating Procedures-General § 80.96 Maintenance tests. Stations are authorized to...

47 CFR 76.1705 - Performance tests (channels delivered).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Performance tests (channels delivered). 76.1705 Section 76.1705 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Documents to be Maintained for Inspection § 76.1705 Performance tests (channels delivered). The...

47 CFR 76.1705 - Performance tests (channels delivered).

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Performance tests (channels delivered). 76.1705 Section 76.1705 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Documents to be Maintained for Inspection § 76.1705 Performance tests (channels delivered). The...

47 CFR 73.712 - Equipment tests.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Equipment tests. 73.712 Section 73.712 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES International Broadcast Stations § 73.712 Equipment tests. (a) During the process of construction of an international broadcasting station, the...

Evolution of System Architectures: Where Do We Need to Fail Next?

NASA Astrophysics Data System (ADS)

Bermudez, Luis; Alameh, Nadine; Percivall, George

2013-04-01

Innovation requires testing and failing. Thomas Edison was right when he said "I have not failed. I've just found 10,000 ways that won't work". For innovation and improvement of standards to happen, service Architectures have to be tested and tested. Within the Open Geospatial Consortium (OGC), testing of service architectures has occurred for the last 15 years. This talk will present an evolution of these service architectures and a possible future path. OGC is a global forum for the collaboration of developers and users of spatial data products and services, and for the advancement and development of international standards for geospatial interoperability. The OGC Interoperability Program is a series of hands-on, fast paced, engineering initiatives to accelerate the development and acceptance of OGC standards. Each initiative is organized in threads that provide focus under a particular theme. The first testbed, OGC Web Services phase 1, completed in 2003 had four threads: Common Architecture, Web Mapping, Sensor Web and Web Imagery Enablement. The Common Architecture was a cross-thread theme, to ensure that the Web Mapping and Sensor Web experiments built on a base common architecture. The architecture was based on the three main SOA components: Broker, Requestor and Provider. It proposed a general service model defining service interactions and dependencies; categorization of service types; registries to allow discovery and access of services; data models and encodings; and common services (WMS, WFS, WCS). For the latter, there was a clear distinction on the different services: Data Services (e.g. WMS), Application services (e.g. Coordinate transformation) and server-side client applications (e.g. image exploitation). The latest testbed, OGC Web Service phase 9, completed in 2012 had 5 threads: Aviation, Cross-Community Interoperability (CCI), Security and Services Interoperability (SSI), OWS Innovations and Compliance & Interoperability Testing & Evaluation (CITE). Compared to the first testbed, OWS-9 did not have a separate common architecture thread. Instead the emphasis was on brokering information models, securing them and making data available efficiently on mobile devices. The outcome is an architecture based on usability and non-intrusiveness while leveraging mediation of information models from different communities. This talk will use lessons learned from the evolution from OGC Testbed phase 1 to phase 9 to better understand how global and complex infrastructures evolve to support many communities including the Earth System Science Community.

29 CFR 4.130 - Types of covered service contracts illustrated.

Code of Federal Regulations, 2014 CFR

2014-07-01

... services. (8) Chemical testing and analysis. (9) Clothing alteration and repair. (10) Computer services... construction). (17) Film processing. (18) Fire fighting and protection. (19) Fueling services. (20) Furniture...) Guard and watchman security service. (24) Inventory services. (25) Keypunching and keyverifying...

29 CFR 4.130 - Types of covered service contracts illustrated.

Code of Federal Regulations, 2013 CFR

2013-07-01

... services. (8) Chemical testing and analysis. (9) Clothing alteration and repair. (10) Computer services... construction). (17) Film processing. (18) Fire fighting and protection. (19) Fueling services. (20) Furniture...) Guard and watchman security service. (24) Inventory services. (25) Keypunching and keyverifying...

29 CFR 4.130 - Types of covered service contracts illustrated.

Code of Federal Regulations, 2010 CFR

2010-07-01

... services. (8) Chemical testing and analysis. (9) Clothing alteration and repair. (10) Computer services... construction). (17) Film processing. (18) Fire fighting and protection. (19) Fueling services. (20) Furniture...) Guard and watchman security service. (24) Inventory services. (25) Keypunching and keyverifying...

Too Many Referrals of Low-risk Women for BRCA1/2 Genetic Services by Family Physicians

PubMed Central

White, Della Brown; Bonham, Vence L.; Jenkins, Jean; Stevens, Nancy; McBride, Colleen M.

2009-01-01

Increasing availability and public awareness of BRCA1/2 genetic testing will increase women’s self-referrals to genetic services. The objective of this study was to examine whether patient characteristics influence family physicians’ (FPs’) referral decisions when a patient requests BRCA1/2 genetic testing. FPs (n = 284) completed a web-based survey in 2006 to assess their attitudes and practices related to using genetics in their clinical practice. Using a 2×2×2 factorial design we tested the effects of a hypothetical patient’s race, level of worry and insurance status on FPs’ decisions to refer her for BRCA1/2 testing. The patient was not appropriate for referral based on USPSTF guidelines. No patient characteristics were associated with FPs’ referral decisions. Although referral was not indicated, only 8% did not refer to genetic services, 92% referred for genetic services, and 50% referred to genetic counseling. FPs regarded it unlikely that the patient carried a mutation. However, 65% of FPs believed if they refused to refer for genetic services it would harm their relationship with the patient. Despite scarce and costly genetic services FPs were likely to inappropriately refer a low-risk patient who requested BRCA1/2 testing. The implications of this inappropriate referral on women’s screening behavior, genetic services, and health care costs are unknown. Clinicians and patients could benefit from education about appropriate use of genetic services so that both are more comfortable with a decision against referral. PMID:18990739

Supplemental Educational Services and Student Test Score Gains: Evidence from a Large, Urban School District

ERIC Educational Resources Information Center

Springer, Matthew G.; Pepper, Matthew J.; Ghosh-Dastidar, Bonnie

2014-01-01

This study examines the effect of supplemental education services (SES) on student test score gains and whether particular subgroups of students benefit more from NCLB tutoring services. Our sample includes information on students enrolled in third through eighth grades nested in 121 elementary and middle schools over a five-year period comprising…