Who tests, who doesn't, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania.

BACKGROUND: Optimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania. METHODS: Between December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who did not access MVCT. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing, between the two groups. RESULTS: MVCT clients reported greater HIV exposure risk (OR 1.20 [1.04 to 1.38] for males; OR 1.11 [1.03 to 1.19] for females). Female MVCT clients were more likely to report low household expenditures (OR 1.47 [1.04 to 2.05]), male clients reported higher rates of unstable income sources (OR 1.99 [1.22 to 3.24]). First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested (OR 2.17 [1.05 to 4.48] for males; OR 5.95 [2.85 to 12.45] for females). HIV-related stigma, fears of testing or test disclosure, and not being able to leave work were strongly associated with non-participation in MVCT (ORs from 0.11 to 0.84). CONCLUSIONS: MVCT attracted clients with increased exposure risk and fewer economic resources; HIV related stigma and testing-related fears remained barriers to testing. MVCT did not disproportionately attract either first-time or frequent repeat testers. Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk populations.

Model sensitivity and uncertainty analysis using roadside air quality measurements

Most of the air quality modelling work has been so far oriented towards deterministic simulations of ambient pollutant concentrations. This traditional approach, which is based on the use of one selected model and one data set of discrete input values, does not reflect the uncertainties due to errors in model formulation and input data. Given the complexities of urban environments and the inherent limitations of mathematical modelling, it is unlikely that a single model based on routinely available meteorological and emission data will give satisfactory short-term predictions. In this study, different methods involving the use of more than one dispersion model, in association with different emission simulation methodologies and meteorological data sets, were explored for predicting best CO and benzene estimates, and related confidence bounds. The different approaches were tested using experimental data obtained during intensive monitoring campaigns in busy street canyons in Paris, France. Three relative simple dispersion models (STREET, OSPM and AEOLIUS) that are likely to be used for regulatory purposes were selected for this application. A sensitivity analysis was conducted in order to identify internal model parameters that might significantly affect results. Finally, a probabilistic methodology for assessing urban air quality was proposed.

Healthcare: rejection of privatisation and patient fees in Central Europe

Since 2006, there have been successful campaigns against commercialisation of public health services in the four central European countries – Czech Republic, Hungary, Poland and Slovakia.

Municipal services: organisations, companies and alternatives

A review of the impact of international institutions and multinational companies on municipal services worldwide, and of campaigns for alternatives.

DISCOVERY 2010: Spatial and temporal variability in a dynamic polar ecosystem

The Scotia Sea has been a focus of biological- and physical oceanographic study since the Discovery expeditions in the early 1900s. It is a physically energetic region with some of the highest levels of productivity in the Southern Ocean. It is also a region within which there have been greater than average levels of change in upper water column temperature. We describe the results of three cruises transecting the central Scotia Sea from south to north in consecutive years and covering spring, summer and autumn periods. We also report on some community level syntheses using both current-day and historical data from this region. A wide range of parameters were measured during the field campaigns, covering the physical oceanography of the region, air–sea CO2 fluxes, macro- and micronutrient concentrations, the composition and biomass of the nano-, micro- and mesoplankton communities, and the distribution and biomass of Antarctic krill and mesopelagic fish. Process studies examined the effect of iron-stress on the physiology of primary producers, reproduction and egestion in Antarctic krill and the transfer of stable isotopes between trophic layers, from primary consumers up to birds and seals. Community level syntheses included an examination of the biomass-spectra, food-web modelling, spatial analysis of multiple trophic layers and historical species distributions. The spatial analyses in particular identified two distinct community types: a northern warmer water community and a southern cold community, their boundary being broadly consistent with the position of the Southern Antarctic Circumpolar Current Front (SACCF). Temperature and ice cover appeared to be the dominant, over-riding factors in driving this pattern. Extensive phytoplankton blooms were a major feature of the surveys, and were persistent in areas such as South Georgia. In situ and bioassay measurements emphasised the important role of iron inputs as facilitators of these blooms. Based on seasonal DIC deficits, the South Georgia bloom was found to contain the strongest seasonal carbon uptake in the ice-free zone of the Southern Ocean. The surveys also encountered low-production, iron-limited regions, a situation more typical of the wider Southern Ocean. The response of primary and secondary consumers to spatial and temporal heterogeneity in production was complex. Many of the life-cycles of small pelagic organisms showed a close coupling to the seasonal cycle of food availability. For instance, Antarctic krill showed a dependence on early, non-ice-associated blooms to facilitate early reproduction. Strategies to buffer against environmental variability were also examined, such as the prevalence of multiyear life-cycles and variability in energy storage levels. Such traits were seen to influence the way in which Scotia Sea communities were structured, with biomass levels in the larger size classes being higher than in other ocean regions. Seasonal development also altered trophic function, with the trophic level of higher predators increasing through the course of the year as additional predator-prey interactions emerged in the lower trophic levels. Finally, our studies re-emphasised the role that the simple phytoplankton-krill-higher predator food chain plays in this Southern Ocean region, particularly south of the SACCF. To the north, alternative food chains, such as those involving copepods, macrozooplankton and mesopelagic fish, were increasingly important. Continued ocean warming in this region is likely to increase the prevalence of such alternative such food chains with Antarctic krill predicted to move southwards.

The biogeochemical structuring role of horizontal stirring: Lagrangian perspectives on iron delivery downstream of the Kerguelen Plateau

Field campaigns are instrumental in providing ground truth for understanding and modeling global ocean biogeochemical budgets. A survey however can only inspect a fraction of the global oceans, typically a region hundreds of kilometers wide for a temporal window of the order of (at most) several weeks. This spatiotemporal domain is also the one in which the mesoscale activity induces through horizontal stirring a strong variability in the biogeochemical tracers, with ephemeral, local contrasts which can easily mask the regional and seasonal gradients. Therefore, whenever local in situ measures are used to infer larger-scale budgets, one faces the challenge of identifying the mesoscale structuring effect, if not simply to filter it out. In the case of the KEOPS2 investigation of biogeochemical responses to natural iron fertilization, this problem was tackled by designing an adaptive sampling strategy based on regionally optimized multisatellite products analyzed in real time by specifically designed Lagrangian diagnostics. This strategy identified the different mesoscale and stirring structures present in the region and tracked the dynamical frontiers among them. It also enabled back trajectories for the ship-sampled stations to be estimated, providing important insights into the timing and pathways of iron supply, which were explored further using a model based on first-order iron removal. This context was essential for the interpretation of the field results. The mesoscale circulation-based strategy was also validated post-cruise by comparing the Lagrangian maps derived from satellites with the patterns of more than one hundred drifters, including some adaptively released during KEOPS2 and a subsequent research voyage. The KEOPS2 strategy was adapted to the specific biogeochemical characteristics of the region, but its principles are general and will be useful for future in situ biogeochemical surveys.

Linking Research and Marketing: A Pharmaceutical Innovation

This chapter describes in very general terms the integration of clinical research and marketing, drawing on books by marketers and recent cases that have come to the public eye. The tools that have been used to accomplish this integration over the past half-century are various, but they all stem from a realization that in a rational world centered on health there need be no intrinsic divide between research and marketing. Most obviously, marketing drugs to physicians, who are professionals acting within their own spheres, depends crucially on research. Physicians respond, and need to see themselves as responding, to fact, figures, and studies. The well-chosen images and vehicles for marketing campaigns must be subordinated to research. Yet at the same time research is a means of increasing sales.

Calling for resistance: The political economy of Indian and Canadian call centre industries

Call centres have in the last three decades come to define the interaction between corporations, governments, and other institutions and their respective customers, citizens, and members. From telemarketing to tele-health services, to credit card assistance, and even emergency response systems, call centres function as a nexus mediating technologically enabled labour practices with the commodification of services. Because of the ubiquitous nature of the call centre in post-industrial capitalism, the banality of these interactions often overshadows the nature of work and labour in this now-global sector. Advances in telecommunication technologies and the globalization of management practices designed to oversee and maintain standardized labour processes have made call centre work an international phenomenon. Simultaneously, these developments have dislocated assumptions about the geographic and spatial seat of work in what is defined here as the new international division of knowledge labour. The offshoring and outsourcing of call centre employment, part of the larger information technology and information technology enabled services sectors, has become a growing practice amongst governments and corporations in their attempts at controlling costs. Leading offshore destinations for call centre work, such as Canada and India, emerged as prominent locations for call centre work for these reasons. While incredible advances in technology have permitted the use of distant and “offshore” labour forces, the grander reshaping of an international political economy of communications has allowed for the acceleration of these processes. New and established labour unions have responded to these changes in the global regimes of work by seeking to organize call centre workers. These efforts have been assisted by a range of forces, not least of which is the condition of work itself, but also attempts by global union federations to build a bridge between international unionism and local organizing campaigns in the Global South and Global North. Through an examination of trade union interventions in the call centre industries located in Canada and India, this dissertation contributes to research on post-industrial employment by using political economy as a juncture between development studies, critical communications, and labour studies.

The divulgation of hygiene-sanitation matters at the start of Spanish radio (1933-1957)

The work analyse from a journalistic point of view the history radio divulgation of health during the Second Republic and the start of the Franco era. For it, printed sources of the health broadcast conferences have been analysed. The most frequently used radio genre was a combination of informative monologue and monologue opinion. Questions relating to maternal-juvenile health were the most disseminated. In general, the radio language employed responded to the needs for clarity, as well as adapting the message to the target audience. With Francoism, the political slogans were incorporated and the gender discussions were given more importance.

Generation of a transient short pulse X-ray laser using a traveling-wave sub-ps pump pulse

This paper summarises die main results obtained during the two experimental campaigns on TCE X-ray lasers that we have carried out since the last Kyoto X-ray laser Conference in 1998. A two-color (2 omega /1 omega) pumping configuration was tested and led to the observation of a strong lasing line at 16 nm, identified to a 4f-4d transition in Ni-like Ag. A strong x 300-400 enhancement of the 13.9 nm Ni-like 4d-4p lasing emission was obtained when a traveling wave short pulse pumping was applied. Finally the temporal history of the 13.9 nm laser pulse was measured with a high-resolution Streak camera, A very short 2 ps X-ray laser pulse was directly demonstrated for the first time.

Grassroots mobilisations against waste disposal sites in Greece

The government of Greece has gained notoriety for its failure to implement EU environmental directives in general, and is criticised specifically for its lack of an effective plan for the safe disposal of waste. Local mobilisations against a series of planned 'Sanitary Waste Disposal Sites' (HETAs) in three municipalities of Attica are examined. Should such protests be classified as NIMBY (not in my backyard)? Or do they present broader claims of justice and equity? Qualitative analysis of the protesters' on-line campaign material reveals that while these mobilisations do demonstrate some NIMBY characteristics, such campaigns should rather be perceived as ad hoc mobilisations reflective of tensions of late modernity. The public's mistrust of science and concerns about democratic deficit and accountability, as well as different perceptions of risk, are prominent.

The effect of increased dietary fruit and vegetable consumption on endothelial activation, inflammation and oxidative stress in hypertensive volunteers

Background and aims

Public health campaigns recommend increased fruit and vegetable (FV) consumption as an effective means of cardiovascular risk reduction. During an 8 week randomised control trial among hypertensive volunteers, we noted significant improvements in endothelium-dependent vasodilatation with increasing FV consumption. Circulating indices of inflammation, endothelial activation and insulin resistance are often employed as alternative surrogates for systemic arterial health. The responses of several such biomarkers to our previously described FV intervention are reported here.
Methods and results

Hypertensive volunteers were recruited from medical outpatient clinics. After a common 4 week run-in period during which FV consumption was limited to 1 portion per day, participants were randomised to 1, 3 or 6 portions daily for 8 weeks. Venous blood samples for biomarker analyses were collected during the pre and post-intervention vascular assessments. A total of 117 volunteers completed the 12 week study. Intervention-related changes in circulating levels of high sensitivity C-reactive protein (hsCRP), soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), von Willebrand factor (vWF) and plasminogen activator inhibitor-1 (PAI-1) did not differ significantly between FV groups. Similarly, there were no significant between group differences of change in homeostasis model assessment (HOMA) scores.
Conclusions

Despite mediating a significant improvement in acetylcholine induced vasodilatation, increased FV consumption did not affect a calculated measure of insulin resistance or concentrations of the circulating biomarkers measured during this study. Functional indices of arterial health such as endothelium-dependent vasomotion are likely to provide more informative cardiovascular end-points during short-term dietary intervention trials.

Negotiation of risk in sexual relationships and reproductive decision-making amongst HIV sero-different couples

The paper focuses on the ways in which medical discourses of HIV transmission risk, personal bodily meanings and reproductive decision-making are re-negotiated within the context of sero-different relationships, in which one partner is known to be HIV-positive. Eighteen in-depth interviews were conducted with 10 individuals in Northern Ireland during 2008–2009. Drawing on an embodied sociological approach, the findings show that physical pleasure, love, commitment, a desire to conceive without medical interventions and a dislike of condoms within regular ongoing relationships, shaped individuals' sense of biological risk. In addition, the subjective logic that a partner had not previously become infected through unprotected sex prior to knowledge of HIV status and the added security of an undetectable viral load significantly impacted upon women's and, especially, men's decisions to have unprotected sex in order to conceive. The findings speak to the importance of reframing public health campaigns and clinical counselling discourses on HIV risk transmission to acknowledge how couples negotiate this risk, alongside pleasure and commitment within ongoing relationships.

The Social Politics of Breastfeeding: Norms, Situations and Policy Implications

This paper aims to explore the assumptions concerning the dynamics of human action underpinning breastfeeding promotion campaigns in the UK. Drawing on qualitative interviews with mothers, the ways in which three problematic assumptions shape both the promotion and experience of contemporary breastfeeding promotion campaigns are explored, in the light of Joas’s theorisation of action’s creativity and pragmatism. Public health efforts to establish breastfeeding as a rational standard against which good mothering can be judged, in ways which rely on a de-contextualised understanding of human action as instrumentally rational, where bodies are imagined as pliable instruments of human intentions, are explored as they play out in the experiences of women embarking on motherhood. The paper concludes that a target-driven health-promotion policy, relying on a mechanistic account of social and emotional life, is contributing to the burden of early motherhood in ways that are not conducive to infant and maternal health and attachment.

Contesting public accountability: A dialogical exploration of accountability and social housing

This paper analyses the interaction between neoliberal inspired reforms of public services and the mechanisms for achieving public accountability. Where once accountability was exercised through the ballot box, now in the neoliberal age managerial and market based forms of accountability predominate. The analysis identifies resistance from civil society campaigns to the neoliberal restructuring of public services which leads to public accountability (PA) becoming a contested arena. To develop this analysis a re-theorisation of PA, as a relationship where civil society seeks to control the state, is explored in the context of social housing in England over the past thirty years. Central to this analysis is a dialogical analysis of key documents from a social housing regulator and civil society campaign. The analysis shows that the current PA practices are an outcome of both reforms from the government and resistance from civil society (in the shape of tenants’ campaigns). The outcome of which is to tell the story of the changes in PA (and accountability) centring on an analysis of discourse. Thus, the paper moves towards answering the question – what has happened to PA during the neoliberal age?