Implementation effects of GFATM-supported HIV/AIDS projects on the health sector, civil society and affected communities in Peru 2004-2007

The emergence of opportunities for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for HIV-related projects has so far generated funding of over US$75 million for three proposals in Peru. The size of this investment creates the need for close monitoring to ensure a reasonable impact. This paper describes the effects of collaboration with the GFATM on key actors involved in HIV-related activities and on decision-making processes; on health sector divisions; on policies and sources of financing; on equity of access; and on stigma and discrimination of vulnerable and affected populations. Data analysed included primary data collected through interviews with key informants, in-depth interviews and group discussions with vulnerable and affected populations, as well as several public documents. Multisectorality, encouraged by the GFATM, is incipient; centralist proposals with limited consultation, a lack of consensus and short preparation times prevail. No accountability mechanisms operate at the Country Coordinating Mechanism (CCM) level regarding CCM members or society as a whole. GFATM-funded activities have required significant input from the public sector, sometimes beyond the capacity of its human resources. A significant increase in HIV funding, in absolute amounts and in fractions of the total budget, has been observed from several sources including the National Treasury, and it is unclear whether this has implied reductions in the budget for other priorities. Patterns of social exclusion of people living with HIV/AIDS are diverse: children and women are more valued; while transgender persons and sex workers are often excluded.

Confort térmico y crecimiento de corderas West African pastoreando con y sin acceso a sombra artificial

Con la finalidad de evaluar el efecto de la presencia o no de sombra durante el pastoreo sobre el crecimiento y confort térmico de corderas mestizas West African, se realizó un estudio utilizando 24 hembras ovinas de 13,08 ± 3,0 kg de peso vivo, las cuales fueron distribuidas al azar en dos tratamientos: SOMBRA: pastoreo en potrero de pasto estrella (Cynodon nlemfluensis) con acceso voluntario a sombra artificial o techo de lona de 36 m2 (3 m2 por animal) y SOL: pastoreo en potrero de pasto estrella sin disponibilidad de sombra natural o artificial. La experiencia se realizó en el Laboratorio-Sección Ovinos de la Facultad de Agronomía - Universidad Central de Venezuela. Los animales se encontraban pastoreando en dos potreros de pasto estrella durante 6 semanas. Las mediciones realizadas fueron: mediciones climáticas tomadas con dos estaciones meteorológicas portátiles (una para cada potrero y la de sombra colocada debajo del techo) que registraban temperatura ambiente (TA, °C), humedad relativa (HR, %) y radiación solar (RS, w/m2), con estas mediciones se estimó el índice de temperatura y humedad o ITH. Temperatura corporal (°C) y frecuencia respiratoria, para estimar el coeficiente de tolerancia al calor (CTC). El crecimiento de las corderas fue evaluado a través de las mediciones: peso vivo (PV), ganancia diaria de peso (GDP), largo corporal (LC), perímetro torácico (PT), altura a la cruz (AC), con las cuales se estimaron los índices de masa corporal 1 (IMC1) e índice de masa corporal 2 (IMC2). En cuanto a las variables climáticas, la TAmax y HR promedio resultaron mayores para SOMBRA que para SOL, en 1,3 °C y 8,1 %, respectivamente (p

Modelling and kinetics studies of a corn-rape blend combustion in an oxy-fuel atmosphere

A kinetic oxy-combustion study of a previously optimized lignocellulose blend is proposed. Kinetic and diffusion control mechanism are considered. The proposed correlations fit properly with the experimental results and diffusion effects are identified as be important enough to be taken into account. Afterwards, with the results obtained in the kinetic study, a detailed consecutive and parallel kinetic scheme is proposed for modelling the oxy-combustion of the blend. A discussion of the temperature and concentration profiles are included. Variation of products final distribution is considered. Smaller particles than 0.001 m are proposed for reducing temperature and concentration profiles and obtaining a good final product distribution. CO2-char reaction is identified as one of the most important step to be optimized for obtaining the lowest final residue. In this study, char is mainly oxidised at 950 K and this situation is attributed to an optimized blending of the bioresidues.

Transrectal doppler ultrasound during prostate biopsy: clinical utility and limitations

OBJECTIVE

To determine the clinical utility and limitations of guided prostate biopsy Power Doppler in patients with elevated serum PSA levels.

MATERIALS AND METHOD

Prospective study. From April 2012 to May 2013, 111 men over 45 years of age with serum PSA level greater than 4.0ng/dl who underwent a transrectal prostate biopsy were included. The hypoechoic nodules in the peripheral region were considered positive on the gray scale. Subsequently, the study was conducted with the Power Doppler, where the vascularization of suspicious images was analyzed for sampling. In addition, samples were taken from the suspected areas when performing the digital rectal examination. We calculated sensitivity, specificity, positive predictive value and negative predictive value of the three tests (digital rectal examination, standard gray scale ultrasound and power Doppler).

RESULTS

Prostate cancer was diagnosed in 48 of the 111 patients (43%). Fifty-nine cases (53%) were defined as positive with the Power Doppler. Of these, 39 (66%) corresponded to a diagnosis of prostate adenocarcinoma. The Power Doppler was positive in 39 cases of the 48 patients diagnosed with cancer and the gray scale ultrasound was positive in 31 cases. Overall sensitivity of the power Doppler was 81%, specificity 68%, PPV 66% and NPV 82%, which was higher compared to the other methods (P<.05).

CONCLUSION

Currently, prostate biopsy using Power Doppler does not seem to identify prostate cancer with sufficient accuracy to omit the guided systematic biopsy gray scale, the combined use of these methods being preferable.

Study of the effects of proline, phenylalanine, and urea foliar application to Tempranillo vineyards on grape amino acid content. Comparison with commercial nitrogen fertilisers

The aim of this work was to study the influence of foliar application of different nitrogen sources on grape amino acid content. The nitrogen sources applied to Tempranillo grapevines were proline, phenylalanine, urea, and two commercial nitrogen fertilisers, both without and with amino acids in their formulations. All treatments were applied at veraison and one week later. Proline treatment did not affect the must nitrogen composition. However, phenylalanine and urea foliar application enhanced the plants' synthesis of most of the amino acids, producing similar effects. In addition, the spray of commercial nitrogen fertilisers over leaves also induced a rise in grape amino acid concentrations regardless of the presence or absence of amino acids in their formulation. The most effective treatments were phenylalanine and urea followed by nitrogen fertilisers. This finding is of oenological interest for improved must nitrogen composition, ensuring better fermentation kinetics and most likely enhancing wine quality.

Signatures of volcanism and aridity in the evolution of an insular pine (Pinus canariensis Chr. Sm. Ex DC in Buch)

Oceanic islands of volcanic origin provide useful templates for the study of evolution because they are subjected to recurrent perturbations that generate steep environmental gradients that may promote adaptation. Here we combine population genetic data from nuclear genes with the analysis of environmental variation and phenotypic data from common gardens to disentangle the confounding effects of demography and selection to identify the factors of importance for the evolution of the insular pine P. canariensis. Eight nuclear genes were partially sequenced in a survey covering the entire species range, and phenotypic traits were measured in four common gardens from contrasting environments. The explanatory power of population substrate age and environmental indices were assessed against molecular and phenotypic diversity estimates. In addition, neutral genetic variability (FST) and the genetic differentiation of phenotypic variation (QST) were compared in order to identify the evolutionary forces acting on these traits. Two key factors in the evolution of the species were identified: (1) recurrent volcanic activity has left an imprint in the genetic diversity of the nuclear genes; (2) aridity in southern slopes promotes local adaptation in the driest localities of P. canariensis, despite high levels of gene flow among populations.

High temperature stability of anatase in titania-alumina semiconductors with enhanced photodegradation of 2, 4-dichlorophenoxyacetic acid

The incorporation of aluminum acetylacetonate as alumina source during the gelation of titanium alkoxide reduces the nucleation sites for the formation of large rutile crystals on temperatures ranging from 400 to 800°C. As a result, the aggregation of anatase crystals is prevented at high temperature. A relationship among the specific surface area, pore size, energy band gap, crystalline structure and crystallite size as the most relevant parameters are evaluated and discussed. According to the results for the photocatalytic degradation of 2,4-dichlorophenoxyacetic acid, the specific surface area, pore size, Eg band gap are not determinant in the photocatalytic properties. It was found that the anatase crystallite size is the mores important parameter affecting the degradation efficiency.

Self-rated health and mortality: a follow-up study of a Spanish population

OBJECTIVES

Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population.

STUDY DESIGN

Longitudinal study.

METHODS

A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations.

RESULTS

Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability.

CONCLUSIONS

SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

Maximising municipal solid waste--legume trimming residue mixture degradation in composting by control parameters optimization

Composting is one of the most successful biological processes for the treatment of the residues enriched in putrescible materials. The optimization of parameters which have an influence on the stability of the products is necessary in order to maximize recycling and recovery of waste components. The influence of the composting process parameters (aeration, moisture, C/N ratio, and time) on the stability parameters (organic matter, N-losses, chemical oxygen demand, nitrate, biodegradability coefficient) of the compost was studied. The composting experiment was carried out using Municipal Solid Waste (MSW) and Legume Trimming Residues (LTR) in 200 L isolated acrylic barrels following a Box-Behnken central composite experimental design. Second-order polynomial models were found for each of the studied compost stability parameter, which accurately described the relationship between the parameters. The differences among the experimental values and those estimated by using the equations never exceeded 10% of the former. Results of the modelling showed that excluding the time, the C/N ratio is the strongest variable influencing almost all the stability parameters studied in this case, with the exception of N-losses which is strongly dependent on moisture. Moreover, an optimized ratio MSW/LTR of 1/1 (w/w), moisture content in the range of 40-55% and moderate to low aeration rate (0.05-0.175 Lair kg(-)(1) min(-1)) is recommended to maximise degradation and to obtain a stable product during co-composting of MSW and LTR.

Mortality and recurrence patterns of breast cancer patients diagnosed under a screening programme versus comparable non-screened breast cancer patients from the same population: analytical survey from 2002 to 2012

Breast cancer screening programmes seem to bring about significant benefits, including decreased mortality, although they may also have some drawbacks such as false-negative and false-positive results. This study aims to compare the clinical outcome of a group of patients undergoing a breast cancer screening programme with that of a synchronous non-screened group of patients matched for age and follow-up period. We studied basic characteristics of epidemiology, immunohistochemistry, loco-regional relapse, distant metastases, disease-free interval and overall and specific mortality. We compared 510 patients in the screened group with 394 non-screened patients, along the period of 2002-2012. Screening was applied on a target population of 49,847 and was based on double-projection, double-read mammograms. Two years were allowed per round. Overall participation for the five rounds considered was 75.2%, with 86.5% coverage, and a total cumulative population of 123,445. The non-participant women amounted 40,794. Tumour detection rate for the screened women was 3.8 per thousand (475/123,445), while the corresponding rate for non-participants was 9.4 per thousand (382/40,797). Incidence of luminal A subtype was 15% higher in screened than that in non-screened patients (95% confidence interval (CI) 8-22%). Conversely, the triple-negative subtype was 6% higher in the non-screened group (95% CI 2-10%). Incidence of breast conservative treatments and sentinel node biopsies was significantly higher in the screened group. Overall mortality was 2.6 times higher in non-screened than that in screened group (95% CI 1.2-5.6) After 10 years of experience with our own screening programme, we believe that included patients receive a benefit versus comparable non-screened breast cancer patients, with acceptable benefit-risk relation.

Pharmacogenomics in colorectal cancer: a genome-wide association study to predict toxicity after 5-fluorouracil or FOLFOX administration

The development of genotyping technologies has allowed for wider screening for inherited causes of variable outcomes following drug administration. We have performed a genome-wide association study (GWAS) on 221 colorectal cancer (CRC) patients that had been treated with 5-fluorouracil (5-FU), either alone or in combination with oxaliplatin (FOLFOX). A validation set of 791 patients was also studied. Seven SNPs (rs16857540, rs2465403, rs10876844, rs10784749, rs17626122, rs7325568 and rs4243761) showed evidence of association (pooled P-values 0.020, 9.426E-03, 0.010, 0.017, 0.042, 2.302E-04, 2.803E-03) with adverse drug reactions (ADRs). This is the first study to explore the genetic basis of inter-individual variation in toxicity responses to the administration of 5-FU or FOLFOX in CRC patients on a genome-wide scale.

Electrical stimulation device as possible treatment for nocturnal bruxism: preliminary results

Nocturnal bruxism (NB) is a temporomandibular disorder characterized by an excessive clenching and involuntary parafunctional grinding of the teeth during sleep. It can cause dental damage and irreversible temporomandibular joint dysfunction. We designed a device that generates electrical stimulation on inhibitory sensory afferents when an EMG signal is measured. This stimulation was applied to the right mental nerve to produce a decrease in the contraction intensity of the mandibular elevation muscles. To measure the intensity of contraction, electromyographic (EMG) signal of the left temporalis anterior (LTa) muscle was used. The results showed that, on average, the percentage decrease in the bruxist group was 30.53% and for the control group was 28.91%. These results indicate that the device implemented generates an important decrease in the muscle contractile activity. Therefore, the device could be useful as a possible treatment to decrease nocturnal bruxism.