Prevalence of HIV type 1 drug resistance mutations in treatment-naïve and experienced patients from resource-limited settings with universal access to antiretroviral therapy: a survey in two small Brazilian cities

Concerns have been raised that universal availability of antiretroviral agents in resource-limited settings might lead to the emergence and spread of resistant strains. We present the largest survey on human immunodeficiency virus type 1 (HIV-1) resistance among treatment-naïve and experienced patients followed in small, relatively underprivileged cities in Brazil with universal availability to standard of care antiretroviral combinations. Samples were collected between 2004 and 2006 from 95 patients followed in the cities of Saquarema and Santo Antonio de Pádua, state of Rio de Janeiro. A proviral fragment encompassing protease and reverse transcriptase (RT) regions was generated and drug susceptibility level was inferred. Among 50 strains from drug-naïve subjects, one (2%) had intermediate-level resistance to RT inhibitors. Among 38 patients on therapy as of sampling, 28 (73.7%) had plasma viral load (PVL) below detection limit (26 of whom without evidence of resistance mutations) and 11 (28.9%) harbored strains with reduced susceptibility. Only two strains harbored both protease and RT inhibitor mutations. Among seven patients who were off-treatment as of sampling, two (28.5%) harbored strains with reduced susceptibility to RT inhibitors. The relatively high frequency of undetectable PVL among patients on treatment and the overall low prevalence of resistance-associated mutations are reassuring. Continued surveillance, however, is necessary.

A two-week workshop to promote cardiovascular disease prevention programs in countries with limited resources.

Training is a crucial tool for building the capacity necessary for prevention and control of cardiovascular diseases (CVDs) in developing countries. This paper summarizes some features of a 2-week workshop aimed at enabling local health professionals to initiate a comprehensive CVD prevention and control program in a context of limited resources. The workshops have been organized in the regions where CVD prevention programs are being contemplated, in cooperation with health authorities of the concerned regions. The workshop's content includes a broad variety of issues related to CVD prevention and control, and to program development. Strong emphasis is placed on "learning by doing," and groups of 5-6 participants conduct a small-scale epidemiological study during the first week; during the second week, they draft a virtual program of CVD prevention and control adapted to the local situation. This practice-oriented workshop focuses on building expertise among anticipated key players, strengthening networks among relevant health professionals, and advocating the urgent need to tackle the emerging CVD epidemic in developing countries.

On the Optimal Order of Natural Resource Use When the Capacity of the Inexhaustible Substitute is Limited.

Consider a general equilibrium framework where the marginal cost of extraction from several deposits of an exhaustible resource is constant in terms of an inexhaustible perfect substitute and differs between deposits. the instantaneous rate of production form the inexhaustible resource is subject to a capacity constraint.

The competitiveness of domestic rice production in East Africa: A domestic resource cost approach in Uganda

The rapid increase of rice imports in sub-Saharan Africa under the unstable situation in the world rice market during the 2000s has made it an important policy target for the countries in the region to increase self-sufficiency in rice in order to enhance food security. Whether domestic rice production can be competitive with imported rice is a serious question in East African countries that lie close, just across the Arabian Sea, to major rice exporting countries in South Asia. This study investigates the international competitiveness of domestic rice production in Uganda in terms of the domestic resource cost ratio. The results show that rainfed rice cultivation, which accounts for 95% of domestic rice production, does not have a comparative advantage with respect to rice imported from Pakistan, the largest supplier of imported rice to Uganda. However, the degree of non-competitiveness is not serious, and a high possibility exists for Uganda’s rainfed rice cultivation to become internationally competitive by improving yield levels by applying more modern inputs and enhancing labour productivity. Irrigated rice cultivation, though very limited in area, is competitive even under the present input-output structure when the cost of irrigation infrastructure is treated as a sunk cost. If the cost of installing irrigation infrastructure and its operation and maintenance is taken into account, the types of irrigation development that are economically feasible are not large-scale irrigation projects, but are small- and microscale projects for lowland rice cultivation and rain-water harvesting for upland rice cultivation.

Linking public issues with private troubles: panel studies in developing countries

Accompanying the call for increased evidence-based policy the developed world is implementing more longitudinal panel studies which periodically gather information about the same people over a number of years. Panel studies distinguish between transitory and persistent states (e.g. poverty, unemployment) and facilitate causal explanations of relationships between variables. However, they are complex and costly. A growing number of developing countries are now implementing or considering starting panel studies. The objectives of this paper are to identify challenges that arise in panel studies, and to give examples of how these have been addressed in resource-constrained environments. The main issues considered are: the development of a conceptual framework which links macro and micro contexts; sampling the cohort in a cost-effective way; tracking individuals; ethics and data management and analysis. Panel studies require long term funding, a stable institution and an acceptance that there will be limited value for money in terms of results from early stages, with greater benefits accumulating in the study's mature years. Copyright © 2003 John Wiley & Sons, Ltd.

Addressing animal health knowledge gaps in Southern Countries: the creation of a 2D animal health resource room

Livestock are a key asset for the global poor. However, access to relevant information is a critical issue for both livestock development practitioners and the poor themselves. Therefore, the following paper details the creation of an on-line Animal Health Resource Room. The aim was to create an immersive environment, which mimics the benefits of a 3D Virtual Learning Environment without the constraints on download times. Therefore, in the following paper key issues in the dissemination of such a platform such as connectivity and speed are explored within the wider context of the development of the tool itself.

Transitions towards co-management: the process of marine resource management devolution in three east African countries

Communities are increasingly empowered with the ability and responsibility of working with national governments to make decisions about marine resources in decentralized co-management arrangements. This transition toward decentralized management represents a changing governance landscape. This paper explores the transition to decentralisation in marine resource management systems in three East African countries. The paper draws upon expert opinion and literature from both political science and linked social-ecological systems fields to guide exploration of five key governance transition concepts in each country: (1) drivers of change; (2) institutional arrangments; (3 institutional fit; (4) actor interactions; and (5) adaptive management. Key findings are that decentralized management in the region was largely donor-driven and only partly tranferred power to local stakeholders. However, increased accountability created a degree of democracy in regards to natural resource governance that was not previously present. Additionally, increased local-level adaptive management has emerged in most systems and, to date, this experimental management has helped to change resource user's views from metaphysical to more scientific cause-and-effect attribution of changes to resource conditions.

An aggregate resource efficiency perspective on sustainability: a Sustainable Value application to the EU-15 countries

The Sustainable Value approach integrates the efficiency with regard to environmental, social and economic resources into a monetary indicator. It gained significant popularity as evidenced by diverse applications at the corporate level. However, its introduction as a measure adhering to the strong sustainability paradigm sparked an ardent debate. This study explores its validity as a macroeconomic strong sustainability measure by applying the Sustainable Value approach to the EU-15 countries. Concretely, we assessed environmental, social and economic resources in combination with the GDP for all EU-15 countries from 1995 to 2006 for three benchmark alternatives. The results show that several countries manage to adequately delink resource use from GDP growth. Furthermore, the remarkable difference in outcome between the national and EU-15 benchmark indicates a possible inefficiency of the current allocation of national resource ceilings imposed by the European institutions. Additionally, by using an effects model we argue that the service degree of the economy and governmental expenditures on social protection and research and development are important determinants of overall resource efficiency. Finally, we sketch out three necessary conditions to link the Sustainable Value approach to the strong sustainability paradigm.

How resource rich countries attract foreign direct investments: a study of Western Asian countries and strategies of industrialization and diversification

Fuel is a self-depleting resource and long term dependency on this commodity alone will not suffice. An export trade oriented approach can lead to faster industrialization while diversification leads to economic sustainable growth. This research seeks to understand how countries compete for foreign direct investments, and how certain activities have the most impact in the competitive global marketplace. Research suggests that when companies decide to invest abroad, they seek only to find countries that facilitate their strategic objectives. The results conclude with appropriate levels of government accountability, credibility and visibility with the private sector, foreign direct investment is attracted by policy advocacy and policy reform. By reviewing countries such as United Arab Emirates in direct comparison to Western Asian countries, including Kuwait and Iraq with high levels of fuel exports, along with Qatar with optimistic marketplace indicators and plentitude of skills and capabilities – research seems to suggest that despite high capabilities and attractive GDP, promotional investment activities yield the highest returns using policy advocacy and reform.

Diversity management: Challenges, benefits, and the role of human resource management in Brazilian organizations

Purpose The objective of this study was to analyze the major challenges and benefits of diversity management in Brazilian companies by assessing the role of human resources. Design/methodology/approach A total of 15 case studies were carried out on companies that operate in Brazil. Brazil is a country with considerable diversity and multiracial backgrounds. Findings It was found that diversity management in Brazilian companies is still an emerging issue, and the major challenges are related to discriminatory actions taken by coworkers. Among the 15 companies studied, only four had adopted a consistent set of diversity management and human resources practices. These four companies were the only companies to affirm that diversity management requires the strong support of top management and continuous organization to sustain efforts toward incorporating diversity. Originality/value Research studies on diversity management in Brazil are scarce. The findings of this study, however, can be useful to academic professionals and company directors in countries that exhibit similar characteristics to those of Brazil, or to those who are interested in learning more about Brazil. © 2011 Emerald Group Publishing Limited. All rights reserved.

Information and communication technology for disaster risk management in the Caribbean: subregional solutions to the challenge of limited human resource capacity

This document was adapted from a paper originally presented to the 8th Annual Caribbean Conference of Comprehensive Disaster Management, held in Montego Bay, Jamaica in December, 2013. It summarizes several activities that ECLAC has undertaken to assess the current state of information and communications technology (ICT) in the field of disaster risk management (DRM) as practiced in the Caribbean. These activities included an in-depth study that encompassed a survey of disaster management organizations in the region, an Expert Group Meeting attended by the heads of several national disaster offices, and a training workshop for professionals working in DRM in the Caribbean. One of the notable conclusions of ECLAC’s investigation on this topic is that the lack of human capacity is the single largest constraint that is faced in the implementation of ICT projects for DRM in the Caribbean. In considering strategies to address the challenge of limited human capacity at a regional level, two separate issues are recognized – the need to increase the ICT capabilities of disaster management professionals, and the need to make ICT specialists available to disaster management organizations to advise and assist in the implementation of technology-focused projects. To that end, two models are proposed to engage with this issue at a regional level. The first entails the establishment of a network of ICT trainers in the Caribbean to help DRM staff develop a strategic understanding of how technology can be used to further their organizational goals. The second is the development of “Centres of Excellence” for ICT in the Caribbean, which would enable the deployment of specialized ICT expertise to national disaster management offices on a project-by-project basis.

Assessing the replacement of lead in solders: effects on resource use and human health

Human health and environmental concerns are not usually considered at the same time. Tin-lead solders are still widely used in several countries, including Brazil, by manufacturers of electronic assemblies. One of the options to reduce or eliminate lead from the manufacturing environment is its replacement with lead-free alloys. This paper applies emergy synthesis and the DALY indicator (Disability Adjusted Life Years) to assess the impact of manufacturing soft solder using tin, lead and other metals on the environment and on human health. The results are presented together with the company's financial results and the results calculated from the Brazilian statistical value of life. The calculation of emergy per unit showed that more resources are used to produce one ton of lead-free solders than to produce one ton of tin-lead solders, with and without the use of consumer waste recovered through a reverse logistics system. The assessment of air emissions during solder production shows that the benefits of the lead-free solution are limited to the stages of manufacturing and assembling. The tin-lead solder appears as the best option in terms of resource use efficiency and with respect to emissions into the atmosphere when the mining stage is included. A discussion on the influence of the system's boundaries on the decision-making process for materials substitution is presented. (C) 2012 Elsevier Ltd. All rights reserved.

Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings

Objectives: We assessed mortality associated with immunologic and virologic patterns of response at 6 months of highly active antiretroviral therapy (HAART) in HIV-infected individuals from resource-limited countries in Africa and South America. Methods: Patients who initiated HAART between 1996 and 2007, aged 16 years or older, and had at least 1 measurement (HIV-1 RNA plasma viral load or CD4 cell count) at 6 months of therapy (3-9 month window) were included. Therapy response was categorized as complete, discordant (virologic only or immunologic only), and absent. Associations between 6-month response to therapy and all-cause mortality were assessed by Cox proportional hazards regression. Robust standard errors were calculated to account for intrasite correlation. Results: A total of 7160 patients, corresponding to 15,107 person-years, were analyzed. In multivariable analysis adjusted for age at HAART initiation, baseline clinical stage and CD4 cell count, year of HAART initiation, clinic, occurrence of an AIDS-defining condition within the first 6 months of treatment, and discordant and absent responses were associated with increased risk of death. Conclusions: Similar to reports from high-income countries, discordant immunologic and virologic responses were associated with intermediate risk of death compared with complete and no response in this large cohort of HIV-1 patients from resource-limited countries. Our results support a recommendation for wider availability of plasma viral load testing to monitor antiretroviral therapy in these settings.