Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

BACKGROUND Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. OBJECTIVE To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). DESIGN Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. SETTING General population and genitourinary medicine clinic attenders. PARTICIPANTS Heterosexual women and men. INTERVENTIONS Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). MAIN OUTCOME MEASURES Population prevalence; index case reinfection; and partners treated per index case. RESULTS Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, > 10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. CONCLUSIONS There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. FUNDING The National Institute for Health Research Health Technology Assessment programme.

Governance and the Capacity to Manage Resilience in Regional Social-Ecological Systems

The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: ( 1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; ( 2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and ( 3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?

Towards an SMS-based Social Network for Health Workers in Rural Areas in Myanmar

Seventy percent of the population in Myanmar lives in rural areas. Although health workers are adequately trained, they are overburdened due to understaffing and insufficient supplies. Literature confirms that information and communication technologies can extend the reach of healthcare. In this paper, we present an SMS-based social network that aims to help health workers to interact with other medical professionals through topic-based message delivery. Topics describe interests of users and the content of message. A message is delivered by matching message content with user interests. Users describe topics as ICD- 10 codes, a comprehensive medical taxonomy. In this ICD-10 coded SMS, a set of prearranged codes provides a common language for users to send structured information that fits inside an SMS.

Applying Fuzzy Ontologies to Implement the Social Semantic Web

Because the knowledge in the World Wide Web is continuously expanding, Web Knowledge Aggregation, Representation and Reasoning (abbreviated as KR) is becoming increasingly important. This article demonstrates how fuzzy ontologies can be used in KR to improve the interactions between humans and computers. The gap between the Social and Semantic Web can be reduced, and a Social Semantic Web may become possible. As an illustrative example, we demonstrate how fuzzy logic and KR can enhance technologies for cognitive cities. The underlying notion of these technologies is based on connectivism, which can be improved by incorporating the results of digital humanities research.

A new Stata command for computing and graphing percentile shares

Percentile shares provide an intuitive and easy-to-understand way for analyzing income or wealth distributions. A celebrated example are the top income shares sported by the works of Thomas Piketty and colleagues. Moreover, series of percentile shares, defined as differences between Lorenz ordinates, can be used to visualize whole distributions or changes in distributions. In this talk, I present a new command called pshare that computes and graphs percentile shares (or changes in percentile shares) from individual level data. The command also provides confidence intervals and supports survey estimation.

A new Stata command for computing and graphing percentile shares

Percentile shares provide an intuitive and easy-to-understand way for analyzing income or wealth distributions. A celebrated example is the top income shares sported by the works of Thomas Piketty and colleagues. Moreover, series of percentile shares, defined as differences between Lorenz ordinates, can be used to visualize whole distributions or changes in distributions. In this talk, I present a new command called pshare that computes and graphs percentile shares (or changes in percentile shares) from individual level data. The command also provides confidence intervals and supports survey estimation.

Governance and the Capacity to Manage Resilience in Regional Social-Ecological Systems

The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: ( 1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; ( 2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and ( 3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?

Isotone Recursive Methods for Overlapping Generation Models with Stochastic Nonclassical Production

Based on an order-theoretic approach, we derive sufficient conditions for the existence, characterization, and computation of Markovian equilibrium decision processes and stationary Markov equilibrium on minimal state spaces for a large class of stochastic overlapping generations models. In contrast to all previous work, we consider reduced-form stochastic production technologies that allow for a broad set of equilibrium distortions such as public policy distortions, social security, monetary equilibrium, and production nonconvexities. Our order-based methods are constructive, and we provide monotone iterative algorithms for computing extremal stationary Markov equilibrium decision processes and equilibrium invariant distributions, while avoiding many of the problems associated with the existence of indeterminacies that have been well-documented in previous work. We provide important results for existence of Markov equilibria for the case where capital income is not increasing in the aggregate stock. Finally, we conclude with examples common in macroeconomics such as models with fiat money and social security. We also show how some of our results extend to settings with unbounded state spaces.

Effects of congressional modernization laws on public access to innovative medical device technologies

The Federal Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid (CMS) play key roles in making Class III, medical devices available to the public, and they are required by law to meet statutory deadlines for applications under review. Historically, both agencies have failed to meet their respective statutory requirements. Since these failures affect patient access and may adversely impact public health, Congress has enacted several “modernization” laws. However, the effectiveness of these modernization laws has not been adequately studied or established for Class III medical devices. ^ The aim of this research study was, therefore, to analyze how these modernization laws may have affected public access to medical devices. Two questions were addressed: (1) How have the FDA modernization laws affected the time to approval for medical device premarket approval applications (PMAs)? (2) How has the CMS modernization law affected the time to approval for national coverage decisions (NCDs)? The data for this research study were collected from publicly available databases for the period January 1, 1995, through December 31, 2008. These dates were selected to ensure that a sufficient period of time was captured to measure pre- and post-modernization effects on time to approval. All records containing original PMAs were obtained from the FDA database, and all records containing NCDs were obtained from the CMS database. Source documents, including FDA premarket approval letters and CMS national coverage decision memoranda, were reviewed to obtain additional data not found in the search results. Analyses were conducted to determine the effects of the pre- and post-modernization laws on time to approval. Secondary analyses of FDA subcategories were conducted to uncover any causal factors that might explain differences in time to approval and to compare with the primary trends. The primary analysis showed that the FDA modernization laws of 1997 and 2002 initially reduced PMA time to approval; after the 2002 modernization law, the time to approval began increasing and continued to increase through December 2008. The non-combined, subcategory approval trends were similar to the primary analysis trends. The combined, subcategory analysis showed no clear trends with the exception of non-implantable devices, for which time to approval trended down after 1997. The CMS modernization law of 2003 reduced NCD time to approval, a trend that continued through December 2008. This study also showed that approximately 86% of PMA devices do not receive NCDs. ^ As a result of this research study, recommendations are offered to help resolve statutory non-compliance and access issues, as follows: (1) Authorities should examine underlying causal factors for the observed trends; (2) Process improvements should be made to better coordinate FDA and CMS activities to include sharing data, reducing duplication, and establishing clear criteria for “safe and effective” and “reasonable and necessary”; (3) A common identifier should be established to allow tracking and trending of applications between FDA and CMS databases; (4) Statutory requirements may need to be revised; and (5) An investigation should be undertaken to determine why NCDs are not issued for the majority of PMAs. Any process improvements should be made without creating additional safety risks and adversely impacting public health. Finally, additional studies are needed to fully characterize and better understand the trends identified in this research study.^

Pensar su tiempo, deshilvanar el orden social

Edgardo Antonio Vigo fue un artista plástico que utilizó distintas técnicas y formas de expresión, como la poesía visual, las performances urbanas, el arte correo, la escritura de manifiestos y otros textos, así como la edición de revistas, entre otras actividades. Vigo produjo su poética en clave de rebeldía de su tiempo, especialmente entre los '60 y '70, pero su rebelión transcurrió también por fuera del estereotipo más consolidado para la época. La obra de Vigo retoma algunos procedimientos de las vanguardias, como la utilización del objeto ya hecho, el uso de espacios alternativos de producción y difusión de sus obras, el abandono casi completo del formato de cuadro, entre otros. Interesa pensar en este trabajo de qué modo esta apropiación de técnicas y procedimientos previos, se combina con otra ruptura dirigida no sólo al sistema artístico, sino también al orden social. En este sentido, la obra de Vigo piensa su tiempo. ;Así como tematizó ciertos acontecimientos de relevancia política de los ámbitos nacional e internacional, también realizó una operación novedosa en su obra: la utilización del discurso judicial-administrativo. Se analizan en este trabajo algunos de sus usos en acciones artísticas. Concluimos en que se trató de una materia que incorporaría en su poética para desnaturalizarla de su lugar original, aristocrático y privatista. En este sentido, toma un aspecto no menor del funcionamiento del orden social disociándolo de su lugar normal y, al ofrecerlo a todos a través de acciones artísticas, permite una apropiación descentrada, fuera de los límites impuestos por su naturaleza

Information Management and Mediation in a Digital Reference Service Focused in Social Sciences

This paper investigates the current relationship between information management and information mediation along with the digital reference service through a case study which took place in an academic library. The concept of information mediation is herein analyzed, since a conceptual examination provides elements that will help people to comprehend and evaluate the concerned service. The information professional plays a very important role in the mediation aforementioned, which may be directly or indirectly; consciously or unconsciously; by himself/herself or plurally; individually or inserted into a group ? in all such manners that mediator facilitates the acquisition of information, fully or partially satisfying a user?s need of all sorts of knowledge. Meanwhile, we here approach information management from a scope that points out a description over performed activities concerned to policies and procedures put into effect until the service evaluation by proposing a criterion for such point. Finally, we outline a few actions to be implemented in long-term perspective, which goal is to continually ameliorate such assistance, taking in account the human factor

Imaginario social en la publicidad web de los e-readers

Se exploran las significaciones imaginarias que se materializan en los discursos publicitarios sobre los aparatos lectores de libros electrónicos comúnmente denominados "e-readers". Se parte de la hipótesis de que se cruzan significaciones imaginarias asociadas tanto al imaginario neotecnológico de las tecnologías digitales (Cabrera, 2006, 2011) como a lo que podríamos denominar el imaginario del "orden de los libros" (Chartier, 2000, 2005). Para realizar la exploración se analizan los discursos publicitarios de las páginas Web de tres casos: las marcas Kindle de Amazon, Kobo y Bq de Movistar. Se concluye que los e-readers son aparatos que participan del imaginario neotecnológico y vienen a integrar el complejo de las tecnologías digitales para la vida cotidiana, y que remiten también en gran medida a las significaciones imaginarias que dieron lugar a la hegemonía del papel en la cultura occidental por más de cinco siglos.

Imaginario social en la publicidad web de los e-readers

Se exploran las significaciones imaginarias que se materializan en los discursos publicitarios sobre los aparatos lectores de libros electrónicos comúnmente denominados "e-readers". Se parte de la hipótesis de que se cruzan significaciones imaginarias asociadas tanto al imaginario neotecnológico de las tecnologías digitales (Cabrera, 2006, 2011) como a lo que podríamos denominar el imaginario del "orden de los libros" (Chartier, 2000, 2005). Para realizar la exploración se analizan los discursos publicitarios de las páginas Web de tres casos: las marcas Kindle de Amazon, Kobo y Bq de Movistar. Se concluye que los e-readers son aparatos que participan del imaginario neotecnológico y vienen a integrar el complejo de las tecnologías digitales para la vida cotidiana, y que remiten también en gran medida a las significaciones imaginarias que dieron lugar a la hegemonía del papel en la cultura occidental por más de cinco siglos.

Information Management and Mediation in a Digital Reference Service Focused in Social Sciences

This paper investigates the current relationship between information management and information mediation along with the digital reference service through a case study which took place in an academic library. The concept of information mediation is herein analyzed, since a conceptual examination provides elements that will help people to comprehend and evaluate the concerned service. The information professional plays a very important role in the mediation aforementioned, which may be directly or indirectly; consciously or unconsciously; by himself/herself or plurally; individually or inserted into a group ? in all such manners that mediator facilitates the acquisition of information, fully or partially satisfying a user?s need of all sorts of knowledge. Meanwhile, we here approach information management from a scope that points out a description over performed activities concerned to policies and procedures put into effect until the service evaluation by proposing a criterion for such point. Finally, we outline a few actions to be implemented in long-term perspective, which goal is to continually ameliorate such assistance, taking in account the human factor

Imaginario social en la publicidad web de los e-readers

Se exploran las significaciones imaginarias que se materializan en los discursos publicitarios sobre los aparatos lectores de libros electrónicos comúnmente denominados "e-readers". Se parte de la hipótesis de que se cruzan significaciones imaginarias asociadas tanto al imaginario neotecnológico de las tecnologías digitales (Cabrera, 2006, 2011) como a lo que podríamos denominar el imaginario del "orden de los libros" (Chartier, 2000, 2005). Para realizar la exploración se analizan los discursos publicitarios de las páginas Web de tres casos: las marcas Kindle de Amazon, Kobo y Bq de Movistar. Se concluye que los e-readers son aparatos que participan del imaginario neotecnológico y vienen a integrar el complejo de las tecnologías digitales para la vida cotidiana, y que remiten también en gran medida a las significaciones imaginarias que dieron lugar a la hegemonía del papel en la cultura occidental por más de cinco siglos.