A comparative analysis of outpatient costs in HIV treatment programs

OBJECTIVE: To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. METHODS: A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. RESULTS: Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector. CONCLUSION: The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.

Contribution of graduate programs in plant breeding to the education of plant breeders in Brazil

The success of agribusiness in Brazil in recent decades is unquestionable. Although the country has always had favorable conditions for agriculture (land, water and climate), this success has only come about recently, due to scientific research, which has resulted in considerable increases in yield and in improvement of product quality, as well as making the occupation of new agricultural frontiers possible. A decisive factor for development of agriculture in the country was the creation of EMBRAPA in 1973, which, in a few years, led to considerable demand for researchers with training in graduate programs. Among them are plant breeders, who came to exercise their activity throughout the country and in all ecosystems. The training of plant breeders was only possible because, as from the middle of the 1960s, the country began a wide-ranging education program, with the creation of several graduate programs in genetics and plant breeding.

Research and theory driven insights: ten suggestions for L2 reading instruction

[EN]Research and theory on second language reading has reached heightened dimensions in recent years. It is through reading that learners access much information concerning the target language and culture, and consequently reading is an important part of almost all language programs across stages of acquisition. The purpose of this article is to offer informed suggestions for the foreign language instructor of reading. The ideas given in this paper constitute a collaborative project that developed as part of a graduate seminar on L2 Reading and Writing taught at Washington University in St. Louis.

The implementation of effective dual-language programs

[EN]This research investigates the ways of implementing dual-language programs and the schools’ internal procedures of evaluating them. Previous studies have examined the effectiveness of bilingual programs (Genovesee et al. 2005; Howard et al. 2005; Krashen 2004). However, there is little still known about schools’ procedures that systematize the organizational aspect of such programs. The Mixed Methods Research (MMR) approach was applied in this study to analyze data collected through questionnaires, interviews, and case studies.

Coordinated Control of Robotic Swarms in Unknown Environments

This thesis gathers the work carried out by the author in the last three years of research and it concerns the study and implementation of algorithms to coordinate and control a swarm of mobile robots moving in unknown environments. In particular, the author's attention is focused on two different approaches in order to solve two different problems. The first algorithm considered in this work deals with the possibility of decomposing a main complex task in many simple subtasks by exploiting the decentralized implementation of the so called \emph{Null Space Behavioral} paradigm. This approach to the problem of merging different subtasks with assigned priority is slightly modified in order to handle critical situations that can be detected when robots are moving through an unknown environment. In fact, issues can occur when one or more robots got stuck in local minima: a smart strategy to avoid deadlock situations is provided by the author and the algorithm is validated by simulative analysis. The second problem deals with the use of concepts borrowed from \emph{graph theory} to control a group differential wheel robots by exploiting the Laplacian solution of the consensus problem. Constraints on the swarm communication topology have been introduced by the use of a range and bearing platform developed at the Distributed Intelligent Systems and Algorithms Laboratory (DISAL), EPFL (Lausanne, CH) where part of author's work has been carried out. The control algorithm is validated by demonstration and simulation analysis and, later, is performed by a team of four robots engaged in a formation mission. To conclude, the capabilities of the algorithm based on the local solution of the consensus problem for differential wheel robots are demonstrated with an application scenario, where nine robots are engaged in a hunting task.

Content and English Language Integrated Learning: The use of Moodle in Aircraft Maintenance Training Programs

The aim of this work is to develop a prototype of an e-learning environment that can foster Content and Language Integrated Learning (CLIL) for students enrolled in an aircraft maintenance training program, which allows them to obtain a license valid in all EU member states. Background research is conducted to retrace the evolution of the field of educational technology, analyzing different learning theories – behaviorism, cognitivism, and (socio-)constructivism – and reflecting on how technology and its use in educational contexts has changed over time. Particular attention is given to technologies that have been used and proved effective in Computer Assisted Language Learning (CALL). Based on the background research and on students’ learning objectives, i.e. learning highly specialized contents and aeronautical technical English, a bilingual approach is chosen, three main tools are identified – a hypertextbook, an exercise creation activity, and a discussion forum – and the learning management system Moodle is chosen as delivery medium. The hypertextbook is based on the technical textbook written in English students already use. In order to foster text comprehension, the hypertextbook is enriched by hyperlinks and tooltips. Hyperlinks redirect students to webpages containing additional information both in English and in Italian, while tooltips show Italian equivalents of English technical terms. The exercise creation activity and the discussion forum foster interaction and collaboration among students, according to socio-constructivist principles. In the exercise creation activity, students collaboratively create a workbook, which allow them to deeply analyze and master the contents of the hypertextbook and at the same time create a learning tool that can help them, as well as future students, to enhance learning. In the discussion forum students can discuss their individual issues, content-related, English-related or e-learning environment-related, helping one other and offering instructors suggestions on how to improve both the hypertextbook and the workbook based on their needs.

Effects of the two production programs 'Naturafarm' and 'conventional' on the prevalence of non-perforating abomasal lesions in Swiss veal calves at slaughter

Non-perforating abomasal lesions are a considerable problem affecting more than half the population of veal calves. The objective of the present study was to assess the prevalence of pyloric and fundic abomasal lesions in Swiss veal calves at slaughter and to compare the occurrence of non-perforating abomasal lesions between two different production programs ('Naturafarm' and 'conventional'). 'Conventional'-production settings met the minimal standards as defined by the Swiss animal welfare legislation, whereas 'Naturafarm' production complied with increased animal welfare requirements. In order to identify risk factors for the development of abomasal lesions, information on management, housing, and feeding was obtained by a questionnaire. A total of 125 abomasa were randomly selected in one large abattoir. They were examined macroscopically, and the occurence of lesions in either the fundic or pyloric region of the abomasum was recorded separately. Animals raised in the 'conventional'-production setting revealed a significantly higher prevalence of lesions in the fundic part. Factors significantly affecting the prevalence of non-perforating lesions in the fundic part were the 'conventional'-production environment, including missing access to an outside pen, missing access to water and straw as the only roughage, feeding by bucket and the liquid milk by-product Protofit in combination with the powder Sprayfit.

Pathways to vicimization. Lessons learned from research in kindergarten

During the last decade interest in bully/victim problems has grown tremendously and still, studies addressing this issue in the years preceding elementary school areextremely rare. Despite obvious methodological challenges, the study of bullying and victimization in settings such as kindergarten opens up unique opportunities to understand early processes in the pathways to victimization, and to investigate different social and individual risk factors and their interactions in the very beginnings of bullying patterns. In this presentation, key findings that shed light on early vulnerability factors for victimization and factors that may maintain bullying patterns will be addressed. First, results from our and others’ studies in kindergarten are generally consistent with results in school. Second, our studies show that patterns of reactions when children witness victimization are already present in kindergarten settings. Third, all findings confirm that bully-victims must be regarded as being distinct from passive victims and other aggressive children (i.e. bullies) already at kindergarten age. Our studies indicate that bully-victims have significantly more problems associated with ADHD or with a lack of behavioral regulation than all their peers and that they clearly differ from bullies in terms of the type of aggression they display. Furthermore, our longitudinal data show different pathways to victimization for victims and bully-victims. This knowledge of early risk factors and pathways mustbe taken into consideration in future research and may contribute to the improvement of prevention programs.

Sarcoptes-World Molecular Network (Sarcoptes-WMN): integrating research on scabies

Parasites threaten human and animal health globally. It is estimated that more than 60% of people on planet Earth carry at least one parasite, many of them several different species. Unfortunately, parasite studies suffer from duplications and inconsistencies between different investigator groups. Hence, groups need to collaborate in an integrated manner in areas including parasite control, improved therapy strategies, diagnostic and surveillance tools, and public awareness. Parasite studies will be better served if there is coordinated management of field data and samples across multidisciplinary approach plans, among academic and non-academic organizations worldwide. In this paper we report the first 'Living organism-World Molecular Network', with the cooperation of 167 parasitologists from 88 countries on all continents. This integrative approach, the 'Sarcoptes-World Molecular Network', seeks to harmonize Sarcoptes epidemiology, diagnosis, treatment, and molecular studies from all over the world, with the aim of decreasing mite infestations in humans and animals.

Life Events and Interdependent Lives: Implications for Research and Intervention

The central thesis of this article is that a single life event has the capacity to affect and change not one but several lives. This thesis is related to theory on attachment, roles, and convoys. The concept of life-event webs is introduced to capture the complex relations between individuals within networks such as families. Research challenges presented by the life-event web perspective include defining networks, assessing the impact of events on each member, and treating the web, not the individual, as the unit of analysis. The web perspective implies that intervention programs should be focused not on the individual but on the web.

Self-efficacy as a predictor of outcome after residential treatment programs for alcohol dependence: simply ask the patient one question!

Self-efficacy has been identified as one of the most consistent variables that predict the outcome of alcohol treatment. However, many previous studies in this field failed to control for other important predictors (e.g., dependences severity, psychiatric symptoms, and treatment goal). Our study's first goal was to evaluate the predictive value of self-efficacy when most other relevant variables were statistically controlled. The second goal was to compare the predictive values of self-efficacy assessed with the Situational Confidence Questionnaire (SCQ), and general self-efficacy assessed with a single question.

Quality of analgesic treatment in patients with advanced prostate cancer: do we do a better job now? The Swiss Group for Clinical Cancer Research (SAKK) experience

GOALS OF WORK: The aim of this study was to evaluate pain intensity and the application of the WHO guidelines for cancer pain treatment in patients with prostate cancer treated at Swiss cancer centers. MATERIALS AND METHODS: We analyzed a series of five multicenter phase II clinical trials which examined the palliative effect of different chemotherapies in patients with advanced hormone-refractory prostate carcinoma. Of 170 patients, 1,018 visits were evaluable for our purpose, including ratings of pain intensity by patients and prescribed analgesics. MAIN RESULTS: No or mild pain was indicated by patients in 36 to 55% of the visits, more than mild pain in 30 to 46%. In 21% of the visits, the WHO pain treatment criteria (treatment according to one of the three steps; oral, rectal or transdermal application of the main dose; administration on a regular schedule) were fulfilled, and the Cleeland index was positive according to all recommendations. In 6% of the visits, neither the WHO criteria were fulfilled nor was the Cleeland index positive. This indicates insufficient pain treatment not following the WHO guidelines and that the prescribed analgesics were not sufficiently potent for the rated pain intensity. CONCLUSIONS: In this selective Swiss sample, the standard of analgesic treatment is high. However, there is still scope for improvement. This cannot solely be solved by improving the knowledge of the physicians. Programs to change the patients' attitude towards cancer pain, training to improve the physicians' communication skills, and institutional changes may be promising strategies.

United States certificate programs in technical communication : a feminist-sophistic investigation

Technical communication certificates are offered by many colleges and universities as an alternative to a full undergraduate or graduate degree in the field. Despite certificates’ increasing popularity in recent years, however, surprisingly little commentary exists about them within the scholarly literature. In this work, I describe a survey of certificate and baccalaureate programs that I performed in 2008 in order to develop basic, descriptive data on programs’ age, size, and graduation rates; departmental location; curricular requirements; online offerings; and instructor status and qualifications. In performing this research, I apply recent insights from neosophistic rhetorical theory and feminist critiques of science to both articulate, and model, a feminist-sophistic methodology. I also suggest in this work that technical communication certificates can be theorized as a particularly sophistic credential for a particularly sophistic field, and I discuss the implications of neosophistic theory for certificate program design and administration.

MARVIN: a medical research application framework based on open source software

This paper describes the open source framework MARVIN for rapid application development in the field of biomedical and clinical research. MARVIN applications consist of modules that can be plugged together in order to provide the functionality required for a specific experimental scenario. Application modules work on a common patient database that is used to store and organize medical data as well as derived data. MARVIN provides a flexible input/output system with support for many file formats including DICOM, various 2D image formats and surface mesh data. Furthermore, it implements an advanced visualization system and interfaces to a wide range of 3D tracking hardware. Since it uses only highly portable libraries, MARVIN applications run on Unix/Linux, Mac OS X and Microsoft Windows.

Potentials and limitations of coordinated spatial and non-spatial information

Information management and geoinformation systems (GIS) have become indispensable in a large majority of protected areas all over the world. These tools are used for management purposes as well as for research and in recent years have become even more important for visitor information, education and communication. This study is divided into two parts: the first part provides a general overview of GIS and information management in a selected number of national park organizations. The second part lists and evaluates the needs of evolving large protected areas in Switzerland. The results show a wide use of GIS and information management tools in well established protected areas. The more isolated use of singular GIS tools has increasingly been replaced by an integrated geoinformation management. However, interview partners pointed out that human resources for GIS in most parks are limited. The interviews also highlight uneven access to national geodata. The view of integrated geoinformation management is not yet fully developed in the park projects in Switzerland. Short-term needs, such as software and data availability, motivate a large number of responses collected within an exhaustive questionnaire. Nevertheless, the need for coordinated action has been identified and should be followed up. The park organizations in North America show how an effective coordination and cooperation might be organized.