Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Virtual Infrastructures as a Service enabling Converged Optical Networks and Data Centres

Abstract Cloud computing service emerged as an essential component of the Enterprise {IT} infrastructure. Migration towards a full range and large-scale convergence of Cloud and network services has become the current trend for addressing requirements of the Cloud environment. Our approach takes the infrastructure as a service paradigm to build converged virtual infrastructures, which allow offering tailored performance and enable multi-tenancy over a common physical infrastructure. Thanks to virtualization, new exploitation activities of the physical infrastructures may arise for both transport network and Data Centres services. This approach makes network and Data Centres’ resources dedicated to Cloud Computing to converge on the same flexible and scalable level. The work presented here is based on the automation of the virtual infrastructure provisioning service. On top of the virtual infrastructures, a coordinated operation and control of the different resources is performed with the objective of automatically tailoring connectivity services to the Cloud service dynamics. Furthermore, in order to support elasticity of the Cloud services through the optical network, dynamic re-planning features have been provided to the virtual infrastructure service, which allows scaling up or down existing virtual infrastructures to optimize resource utilisation and dynamically adapt to users’ demands. Thus, the dynamic re-planning of the service becomes key component for the coordination of Cloud and optical network resource in an optimal way in terms of resource utilisation. The presented work is complemented with a use case of the virtual infrastructure service being adopted in a distributed Enterprise Information System, that scales up and down as a function of the application requests.

Bloodstream infection in paediatric cancer centres--leukaemia and relapsed malignancies are independent risk factors.

UNLABELLED In a prospective multicentre study of bloodstream infection (BSI) from November 01, 2007 to July 31, 2010, seven paediatric cancer centres (PCC) from Germany and one from Switzerland included 770 paediatric cancer patients (58% males; median age 8.3 years, interquartile range (IQR) 3.8-14.8 years) comprising 153,193 individual days of surveillance (in- and outpatient days during intensive treatment). Broviac catheters were used in 63% of all patients and Ports in 20%. One hundred forty-two patients (18%; 95% CI 16 to 21%) experienced at least one BSI (179 BSIs in total; bacteraemia 70%, bacterial sepsis 27%, candidaemia 2%). In 57%, the BSI occurred in inpatients, in 79% after conventional chemotherapy. Only 56 % of the patients showed neutropenia at BSI onset. Eventually, patients with acute lymphoblastic leukaemia (ALL) or acute myeloblastic leukaemia (AML), relapsed malignancy and patients with a Broviac faced an increased risk of BSI in the multivariate analysis. Relapsed malignancy (16%) was an independent risk factor for all BSI and for Gram-positive BSI. CONCLUSION This study confirms relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. On a unit level, data on BSIs in this high-risk population derived from prospective surveillance are not only mandatory to decide on empiric antimicrobial treatment but also beneficial in planning and evaluating preventive bundles. WHAT IS KNOWN • Paediatric cancer patients face an increased risk of nosocomial bloodstream infections (BSIs). • In most cases, these BSIs are associated with the use of a long-term central venous catheter (Broviac, Port), severe and prolonged immunosuppression (e.g. neutropenia) and other chemotherapy-induced alterations of host defence mechanisms (e.g. mucositis). What is New: • This study is the first multicentre study confirming relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. • It describes the epidemiology of nosocomial BSI in paediatric cancer patients mainly outside the stem cell transplantation setting during conventional intensive therapy and argues for prospective surveillance programmes to target and evaluate preventive bundle interventions.

Environmental assessment of low speed policies for motor vehicle mobility in city centres

streets in local residential areas in large cities, real traffic tests for pollutant emissions and fuel consumption have been carried out in Madrid city centre. Emission concentration and car activity were simultaneously measured by a Portable Emissions Measurement System. Real life tests carried out at different times and on different days were performed with a turbo-diesel engine light vehicle equipped with an oxidizer catalyst and using different driving styles with a previously trained driver. The results show that by reducing the speed limit from 50 km h-1 to 30 km h-1, using a normal driving style, the time taken for a given trip does not increase, but fuel consumption and NOx, CO and PM emissions are clearly reduced. Therefore, the main conclusion of this work is that reducing the speed limit in some narrow streets in residential and commercial areas or in a city not only increases pedestrian safety, but also contributes to reducing the environmental impact of motor vehicles and reducing fuel consumption. In addition, there is also a reduction in the greenhouse gas emissions resulting from the combustion of the fuel.

The role of a firm's absorptive capacity and the technology transfer process in clusters: How effective are technology centres in low-tech clusters?

This paper analyses how the internal resources of small- and medium-sized enterprises determine access (learning processes) to technology centres (TCs) or industrial research institutes (innovation infrastructure) in traditional low-tech clusters. These interactions basically represent traded (market-based) transactions, which constitute important sources of knowledge in clusters. The paper addresses the role of TCs in low-tech clusters, and uses semi-structured interviews with 80 firms in a manufacturing cluster. The results point out that producer–user interactions are the most frequent; thus, the higher the sector knowledge-intensive base, the more likely the utilization of the available research infrastructure becomes. Conversely, the sectors with less knowledge-intensive structures, i.e. less absorptive capacity (AC), present weak linkages to TCs, as they frequently prefer to interact with suppliers, who act as transceivers of knowledge. Therefore, not all the firms in a cluster can fully exploit the available research infrastructure, and their AC moderates this engagement. In addition, the existence of TCs is not sufficient since the active role of a firm's search strategies to undertake interactions and conduct openness to available sources of knowledge is also needed. The study has implications for policymakers and academia.

A quality assessment system for fresh fruits in hypermarkets and fruit trading centres.

When the fresh fruit reaches the final markets from the suppliers, its quality is not always as good as it should, either because it has been mishandled during transportation or because it lacks an adequate quality control at the producer level, before being shipped. This is why it is necessary for the final markets to establish their own quality assessment system if they want to ensure to their customers the quality they want to sell. In this work, a system to control fruit quality at the last level of the distribution channel has been designed. The system combines rapid control techniques with laboratory equipment and statistical sampling protocols, to obtain a dynamic, objective process, which can substitute advantageously the quality control inspections carried out visually by human experts at the reception platform of most hypermarkets. Portable measuring equipment have been chosen (firmness tester, temperature and humidity sensors...) as well as easy-to-use laboratory equipment (texturometer, colorimeter, refractometer..,) combining them to control the most important fruit quality parameters (firmness, colour, sugars, acids). A complete computer network has been designed to control all the processes and store the collected data in real time, and to perform the computations. The sampling methods have been also defined to guarantee the confidence of the results. Some of the advantages of a quality assessment system as the proposed one are: the minimisation of human subjectivity, the ability to use modern measuring techniques, and the possibility of using it also as a supplier's quality control system. It can be also a way to clarify the quality limits of fruits among members of the commercial channel, as well as the first step in the standardisation of quality control procedures.

Heterogeneous architecture for the optimization of large-scale graph processing data centres

Con el auge del Cloud Computing, las aplicaciones de proceso de datos han sufrido un incremento de demanda, y por ello ha cobrado importancia lograr m�ás eficiencia en los Centros de Proceso de datos. El objetivo de este trabajo es la obtenci�ón de herramientas que permitan analizar la viabilidad y rentabilidad de diseñar Centros de Datos especializados para procesamiento de datos, con una arquitectura, sistemas de refrigeraci�ón, etc. adaptados. Algunas aplicaciones de procesamiento de datos se benefician de las arquitecturas software, mientras que en otras puede ser m�ás eficiente un procesamiento con arquitectura hardware. Debido a que ya hay software con muy buenos resultados en el procesamiento de grafos, como el sistema XPregel, en este proyecto se realizará una arquitectura hardware en VHDL, implementando el algoritmo PageRank de Google de forma escalable. Se ha escogido este algoritmo ya que podr��á ser m�ás eficiente en arquitectura hardware, debido a sus características concretas que se indicaráan m�ás adelante. PageRank sirve para ordenar las p�áginas por su relevancia en la web, utilizando para ello la teorí��a de grafos, siendo cada página web un vértice de un grafo; y los enlaces entre páginas, las aristas del citado grafo. En este proyecto, primero se realizará un an�álisis del estado de la técnica. Se supone que la implementaci�ón en XPregel, un sistema de procesamiento de grafos, es una de las m�ás eficientes. Por ello se estudiará esta �ultima implementaci�ón. Sin embargo, debido a que Xpregel procesa, en general, algoritmos que trabajan con grafos; no tiene en cuenta ciertas caracterí��sticas del algoritmo PageRank, por lo que la implementaci�on no es �optima. Esto es debido a que en PageRank, almacenar todos los datos que manda un mismo v�értice es un gasto innecesario de memoria ya que todos los mensajes que manda un vértice son iguales entre sí e iguales a su PageRank. Se realizará el diseño en VHDL teniendo en cuenta esta caracter��ística del citado algoritmo,evitando almacenar varias veces los mensajes que son iguales. Se ha elegido implementar PageRank en VHDL porque actualmente las arquitecturas de los sistemas operativos no escalan adecuadamente. Se busca evaluar si con otra arquitectura se obtienen mejores resultados. Se realizará un diseño partiendo de cero, utilizando la memoria ROM de IPcore de Xillinx (Software de desarrollo en VHDL), generada autom�áticamente. Se considera hacer cuatro tipos de módulos para que as�� el procesamiento se pueda hacer en paralelo. Se simplificar�á la estructura de XPregel con el fin de intentar aprovechar la particularidad de PageRank mencionada, que hace que XPregel no le saque el m�aximo partido. Despu�és se escribirá el c�ódigo, realizando una estructura escalable, ya que en la computación intervienen millones de páginas web. A continuación, se sintetizar�á y se probará el código en una FPGA. El �ultimo paso será una evaluaci�ón de la implementaci�ón, y de posibles mejoras en cuanto al consumo.

Promotion of intangible heritage as a tool to strengthen revitalisation of historic centres: the case of de Monumenta Programme in the City of Porto Alegre (Rio Grande do Sul State) Brazil

The preservation of tangible cultural heritage does not guarantee effective revitalisation of urban historic areas as a whole. The legacy of our history consists not only of paintings, sculptures, architectural monuments and public spaces, but also the safeguarding of immaterial aspects of social life, such as oral traditions, rituals, practices, knowledge and craft skills. From 1999 to 2013, 26 Brazilian cities benefited from the Monumenta Programme - a national cultural policy that involved institutions, the private sector and the local community. The purpose of the programme was to stimulate economic growth and increase cultural and social development of the historic centres. Moreover, it sought to increase the number of residents in the benefited areas as defined in its agenda (IDB, 1999; MinC & Programa Monumenta, 2006). Using the Historic Centre of Porto Alegre as a case study, this paper examines how this cultural programme enables demographic change through the promotion of intangible cultural heritage, e.g. by supporting educational projects. The demographic flow was analysed using the microdata of the Populations Censuses (years 2000 and 2010) available from the Brazilian Institute of Geography and Statistics. The results showed an increase in low-income residents the areas that participated in the programme. This increase may have been motivated by a set of cultural-educational projects under the auspices of the Monumenta Programme. The retraining of artisans of Alfândega Square, the training of low-income youth for restoration work and the implementation of the "Black Route Museum in Porto Alegre" (Bicca, 2010) are just some examples of what was done to improve the local community's economy, to encourage social cohesion and to enhance the awareness of cultural diversity as a positive and essential value in society.

Clinical outcome in relation to care in centres specialising in cystic fibrosis: cross sectional study

Objectives: To assess the effect on clinical outcome of managing paediatric and adult patients with cystic fibrosis at specialised cystic fibrosis centres.