Antiretroviral therapy (ART) adherence among people living with HIV/AIDS (PLHIV) in the north of Vietnam : a multi-method approach

The antiretroviral therapy (ART) program for People Living with HIV/AIDS (PLHIV) in Vietnam has been scaled up rapidly in recent years (from 50 clients in 2003 to almost 38,000 in 2009). ART success is highly dependent on the ability of the patients to fully adhere to the prescribed treatment regimen. Despite the remarkable extension of ART programs in Vietnam, HIV/AIDS program managers still have little reliable data on levels of ART adherence and factors that might promote or reduce adherence. Several previous studies in Vietnam estimated extremely high levels of ART adherence among their samples, although there are reasons to question the veracity of the conclusion that adherence is nearly perfect. Further, no study has quantitatively assessed the factors influencing ART adherence. In order to reduce these gaps, this study was designed to include several phases and used a multi-method approach to examine levels of ART non-adherence and its relationship to a range of demographic, clinical, social and psychological factors. The study began with an exploratory qualitative phase employing four focus group discussions and 30 in-depth interviews with PLHIV, peer educators, carers and health care providers (HCPs). Survey interviews were completed with 615 PLHIV in five rural and urban out-patient clinics in northern Vietnam using an Audio Computer Assisted Self-Interview (ACASI) and clinical records extraction. The survey instrument was carefully developed through a systematic procedure to ensure its reliability and validity. Cultural appropriateness was considered in the design and implementation of both the qualitative study and the cross sectional survey. The qualitative study uncovered several contrary perceptions between health care providers and HIV/AIDS patients regarding the true levels of ART adherence. Health care providers often stated that most of their patients closely adhered to their regimens, while PLHIV and their peers reported that “it is not easy” to do so. The quantitative survey findings supported the PLHIV and their peers’ point of view in the qualitative study, because non-adherence to ART was relatively common among the study sample. Using the ACASI technique, the estimated prevalence of onemonth non-adherence measured by the Visual Analogue Scale (VAS) was 24.9% and the prevalence of four-day not-on-time-adherence using the modified Adult AIDS Clinical Trials Group (AACTG) instrument was 29%. Observed agreement between the two measures was 84% and kappa coefficient was 0.60 (SE=0.04 and p<0.0001). The good agreement between the two measures in the current study is consistent with those found in previous research and provides evidence of cross-validation of the estimated adherence levels. The qualitative study was also valuable in suggesting important variables for the survey conceptual framework and instrument development. The survey confirmed significant correlations between two measures of ART adherence (i.e. dose adherence and time adherence) and many factors identified in the qualitative study, but failed to find evidence of significant correlations of some other factors and ART adherence. Non-adherence to ART was significantly associated with untreated depression, heavy alcohol use, illicit drug use, experiences with medication side-effects, chance health locus of control, low quality of information from HCPs, low satisfaction with received support and poor social connectedness. No multivariate association was observed between ART adherence and age, gender, education, duration of ART, the use of adherence aids, disclosure of ART, patients’ ability to initiate communication with HCPs or distance between clinic and patients’ residence. This is the largest study yet reported in Asia to examine non-adherence to ART and its possible determinants. The evidence strongly supports recent calls from other developing nations for HIV/AIDS services to provide screening, counseling and treatment for patients with depressive symptoms, heavy use of alcohol and substance use. Counseling should also address fatalistic beliefs about chance or luck determining health outcomes. The data suggest that adherence could be enhanced by regularly providing information on ART and assisting patients to maintain social connectedness with their family and the community. This study highlights the benefits of using a multi-method approach in examining complex barriers and facilitators of medication adherence. It also demonstrated the utility of the ACASI interview method to enhance open disclosure by people living with HIV/AIDS and thus, increase the veracity of self-reported data.

A social marketing approach to value creation in a Well-Women’s health service

Understanding consumer value is imperative in health care as the receipt of value drives the demand for health care services. While there is increasing research into health-care that adopts an economic approach to value, this paper investigates a non-financial exchange context and uses an experiential approach to value, guided by a social marketing approach to behaviour change. An experiential approach is deemed more appropriate for government health-care services that are free and for preventative rather than treatment purposes. Thus instead of using an illness-paradigm to view health services outcomes, we adopt a wellness paradigm. Using qualitative data gathered during 25 depth interviews the authors demonstrate how social marketing thinking has guided the identification of six themes that represent four dimensions of value (functional, emotional, social and altruistic) evident during the health care consumption process of a free government service.

Managing the project learning paradox : a set-theoretic approach toward project knowledge transfer

Managing project-based learning is becoming an increasingly important part of project management. This article presents a comparative case study of 12 cases of knowledge transfer between temporary inter-organizational projects and permanent parent organizations. Our set-theoretic analysis of these data yields two major findings. First, a high level of absorptive capacity of the project owner is a necessary condition for successful project knowledge transfer, which implies that the responsibility for knowledge transfer seems to in the first place lie with the project parent organization, not with the project manager. Second, none of the factors are sufficient by themselves. This implies that successful project knowledge transfer is a complex process always involving configurations of multiple factors. We link these implications with the view of projects as complex temporary organizational forms in which successful project managers need to cope with complexity by simultaneously paying attention to both relational and organizational processes.

A 'click approach' to the generation of novel profluorescent nitroxides

This project focused on the first application of the copper catalyzed azide alkyne cycloaddition reaction for the generation of novel profluorescent systems. Through this approach four novel profluorescent nitroxides were prepared both rapidly and in good yield from coumarin and nitroxide CuAAC coupling partners. Specifically, 7-hydroxy, 7-diethylamino, 6-bromo and unsubstituted coumarin analogues bearing an azide group in the 3-position were prepared and conjugatively joined to an alkyne isoindoline nitroxide previously reported by our group. To explore the impact of the nitroxide moiety on the fluorescence of these systems, methoxyamine analogues of the corresponding nitroxide analogues were prepared. Spectrophotometric analysis of these methoxyamine analogues revealed that the aromatic systems possessed high quantum yields. However, the quantum yield efficiency was found to be dependent on the presence of electron donating substituents in the 7-position of the coumarin motif, which enhanced the charge-transfer character of the system. Furthermore, spectrophotometric analysis of nitroxide analogues demonstrated that the triazole effectively mediated fluorophore-nitroxide communication, as evidenced by the low quantum yield values of the nitroxide analogues. These results suggest that this technique can be used to conjugatively join any azide bearing fluorescent system with the key alkyne isoindoline coupling partner allowing for the rapid generation of diverse profluorescent systems.

Pedagogy of introductory computer programming : a people-first approach

Students struggle with learning to program. In recent years, not only has there been a dramatic drop in the number of students enrolling in IT and Computer Science courses, but attrition from these courses continues to be significant. Introductory programming subjects traditionally have high failure rates and as they tend to be core to IT and Computer Science courses can be a road block for many students to their university studies. Is programming really that difficult — or are there other barriers to learning that have a serious and detrimental effect on student progression? In-class experiments were conducted in introductory programming units to confirm our hypothesis that that pair-programming would benefit students' learning to program. We investigated the social and cultural barriers to learning programming by questioning students' perceptions of confidence, difficulty and enjoyment of programming. The results of paired and non-paired students were compared to determine the effect of pair-programming on learning outcomes. Both the empirical and anecdotal results of our experiments strongly supported our hypothesis.

Introducing a small and medium enterprises syllabi design: an enterprise systems hands-on approach

There is increasing attention to the importance of Enterprise Systems (ES) and Information Systems (IS) for Small and Medium Enterprises (SMEs). The same attention must be addressed in IS graduate curriculum. Studies reveal that despite healthy demand from the industry for IS management expertise, most IS graduates are ill-equipped to meet the challenges of modern organizations. The majority of contemporary firms, represented by SMEs, seek employees with a balance of business process knowledge and ES software skills. This article describes a curriculum that teaches Information Technology (IT) and IS managementconcepts in a SMEs context. The curriculum conceptualises a ‘learn-by-doing’ approach, to provide business process and ES software specific knowledge for its students. The approach recommends coverage of traditional content related to SMEs’’ operations, strategies, IT investment and management issues while providing an increased focus on strategic use of enterprise IT. The study addresses to an extent, the perennial challenge of updating IS curriculum, given the rapid pace of technological change.

Engaging middle school students in context-based science : One teacher's approach

In Australia, there is a crisis in science education with students becoming disengaged with canonical science in the middle years of schooling. One recent initiative that aims to improve student interest and motivation without diminishing conceptual understanding is the context-based approach. Contextual units that connect the canonical science with the students’ real world of their local community have been used in the senior years but are new in the middle years. This ethnographic study explored the learning transactions that occurred in one 9th grade science class studying an Environmental Science unit for 11 weeks. Data were derived from field notes, audio and video recorded conversations, interviews, student journals and classroom documents with a particular focus on two selected groups of students. Data were analysed qualitatively through coding for emergent themes. This paper presents an outline of the program and discussion of three assertions derived from the preliminary analysis of the data. Firstly, an integrated, coherent sequence of learning experiences that included weekly visits to a creek adjacent to the school enabled the teacher to contextualise the science in the students’ local community. Secondly, content was predominantly taught on a need-to-know basis and thirdly, the lesson sequence aligned with a model for context-based teaching. Research, teaching and policy implications of these results for promoting the context-based teaching of science in the middle years are discussed.

An FPGA-based approach to multi-objective evolutionary algorithm for multi-disciplinary design optimisation

This paper investigates the field programmable gate array (FPGA) approach for multi-objective and multi-disciplinary design optimisation (MDO) problems. One class of optimisation method that has been well-studied and established for large and complex problems, such as those inherited in MDO, is multi-objective evolutionary algorithms (MOEAs). The MOEA, nondominated sorting genetic algorithm II (NSGA-II), is hardware implemented on an FPGA chip. The NSGA-II on FPGA application to multi-objective test problem suites has verified the designed implementation effectiveness. Results show that NSGA-II on FPGA is three orders of magnitude better than the PC based counterpart.

Activity modelling in crowded environments : a soft decision approach

Probabilistic topic models have recently been used for activity analysis in video processing, due to their strong capacity to model both local activities and interactions in crowded scenes. In those applications, a video sequence is divided into a collection of uniform non-overlaping video clips, and the high dimensional continuous inputs are quantized into a bag of discrete visual words. The hard division of video clips, and hard assignment of visual words leads to problems when an activity is split over multiple clips, or the most appropriate visual word for quantization is unclear. In this paper, we propose a novel algorithm, which makes use of a soft histogram technique to compensate for the loss of information in the quantization process; and a soft cut technique in the temporal domain to overcome problems caused by separating an activity into two video clips. In the detection process, we also apply a soft decision strategy to detect unusual events.We show that the proposed soft decision approach outperforms its hard decision counterpart in both local and global activity modelling.

Assessing population limits : a carrying capacity approach to planning

While purporting to enhance Australia’s sustainability, the federal government’s Population Strategy rejects the assessment of the limiting factors to future population growth, thus avoiding urgent threshold issues such as resource depletion and environmental destruction. A more forward-thinking and whole-system perspective would assess and incorporate critical biophysical limits into governance processes with suitable prioritisation. It would encourage communities to examine their individual and collective responsibilities in the context of these limits in order to most equitably optimise outcomes; and it would employ both a resource-based examination of minimum population requirements, and an impact-based assessment of maximum thresholds. This carrying capacity approach to planning could help guide society towards a more sustainable future.

Analysis of rural activity spaces and transport disadvantage using a multi-method approach

Current knowledge about the relationship between transport disadvantage and activity space size is limited to urban areas, and as a result, very little is known about this link in a rural context. In addition, although research has identified transport disadvantaged groups based on their size of activity space, these studies have, however, not empirically explained such differences and the result is often a poor identification of the problems facing disadvantaged groups. Research has shown that transport disadvantage varies over time. The static nature of analysis using the activity space concept in previous research studies has lacked the ability to identify transport disadvantage in time. Activity space is a dynamic concept; and therefore possesses a great potential in capturing temporal variations in behaviour and access opportunities. This research derives measures of the size and fullness of activity spaces for 157 individuals for weekdays, weekends, and for a week using weekly activity-travel diary data from three case study areas located in rural Northern Ireland. Four focus groups were also conducted in order to triangulate quantitative findings and to explain the differences between different socio-spatial groups. The findings of this research show that despite having a smaller sized activity space, individuals were not disadvantaged because they were able to access their required activities locally. Car-ownership was found to be an important life line in rural areas. Temporal disaggregation of the data reveals that this is true only on weekends due to a lack of public transport services. In addition, despite activity spaces being at a similar size, the fullness of activity spaces of low-income individuals was found to be significantly lower compared to their high-income counterparts. Focus group data shows that financial constraint, poor connections both between public transport services and between transport routes and opportunities forced individuals to participate in activities located along the main transport corridors.

Towards testing the eclectic paradigm on multinational contracting: an approach to reviewing and analysing secondary data

In response to the need to leverage private finance and the lack of competition in some parts of the Australian public sector major infrastructure market, especially in very large economic infrastructure procured using Pubic Private Partnerships, the Australian Federal government has demonstrated its desire to attract new sources of in-bound foreign direct investment (FDI) into the Australian construction market. This paper aims to report on progress towards an investigation into the determinants of multinational contractors’ willingness to bid for Australian public sector major infrastructure projects and which is designed to give an improved understanding of matters surrounding FDI into the Australian construction sector. This research deploys Dunning’s eclectic theory for the first time in terms of in-bound FDI by multinational contractors and as head contractors bidding for Australian major infrastructure public sector projects. Elsewhere, the authors have developed Dunning’s principal hypothesis associated with his eclectic framework in order to suit the context of this research and to address a weakness arising in Dunning’s principal hypothesis that is based on a nominal approach to the factors in the eclectic framework and which fail to speak to the relative explanatory power of these factors. In this paper, an approach to reviewing and analysing secondary data, as part of the first stage investigation in this research, is developed and some illustrations given, vis-à-vis the selected sector (roads, bridges and tunnels) in Australia (as the host location) and using one of the selected home countries (Spain). In conclusion, some tentative thoughts are offered in anticipation of the completion of the first stage investigation - in terms of the extent to which this first stage based on secondary data only might suggest the relative importance of the factors in the eclectic framework. It is noted that more robust conclusions are expected following the future planned stages of the research and these stages including primary data are briefly outlined. Finally, and beyond theoretical contributions expected from the overall approach taken to developing and testing Dunning’s framework, other expected contributions concerning research method and practical implications are mentioned.

Development of a performance model for international construction joint venture : a system dynamics approach

The uncertain and dynamic nature of International Construction Joint Venture (ICJV) performance is evolved with many critical factors which lead to make partner relationships more complex in respect of making decisions to maintain a cohesive environment. Addressing to the fact, a generic system dynamics performance model for ICJV is developed by integrating a number variables as to get an overall impact on performance of ICJV and to make effective decisions based on that. In order to formulate and validate the model both structurally and behaviourally, both qualitative and quantitative data are gathered by conducting intensive interviews from two ICJVs in Thailand. After conducting intensive simulations of model, three major problems are identified related to negative value gap, low productivity in construction and high rate of ineffective information sharing of both ICJVs. Several policies are suggested and integrated application of these policies provides a maximum improvement to performance of the ICJV.

Using a knowledge-based approach : the way healthy communities make decisions

The planning for Knowledge Cities faces significant challenges due to the lack of effective information tools. These challenges are magnified while planning healthy communities. The Australian Health Information Council (AHIC) concluded in its last report that health information needs to be shared more effectively (AHIC, 2008). Some research justifies the use of Decision Support Systems (DSS) as an E-planning tool, particularly in the context of healthy communities. However, very limited research has been conducted in this area to date, especially in terms of evaluating the impact of these tools on decision-makers within the health planning practice. The paper presents the methodological instruments which were developed to measure the impact of the E-planning tool (i.e., Health Decision Support System [HDSS])) on a group of health planners, namely, the Logan Beaudesert Health Coalition (LBHC). The paper is focused on the culture in which decisions were made before and after the intervention of the HDSS. Subsequently, the paper presents the observed impact of the HDSS tool, to facilitate a knowledge-based decision-making approach. This study is an attempt to make some contribution to the Knowledge Cities literature in the context of planning healthy communities by adopting E-planning tools.

A sequential Monte Carlo approach to design for population pharmacokinetics studies

Here we present a sequential Monte Carlo approach that can be used to find optimal designs. Our focus is on the design of phase III clinical trials where the derivation of sampling windows is required, along with the optimal sampling schedule. The search is conducted via a particle filter which traverses a sequence of target distributions artificially constructed via an annealed utility. The algorithm derives a catalogue of highly efficient designs which, not only contain the optimal, but can also be used to derive sampling windows. We demonstrate our approach by designing a hypothetical phase III clinical trial.