Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings

OBJECTIVE: To describe the electronic medical databases used in antiretroviral therapy (ART) programmes in lower-income countries and assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up. METHODS: In 15 countries of Africa, South America and Asia, a survey was conducted from December 2006 to February 2007 on the use of electronic medical record systems in ART programmes. Patients enrolled in the sites at the time of the survey but not seen during the previous 12 months were considered lost to follow-up. The quality of the data was assessed by computing the percentage of missing key variables (age, sex, clinical stage of HIV infection, CD4+ lymphocyte count and year of ART initiation). Associations between site characteristics (such as number of staff members dedicated to data management), measures to reduce loss to follow-up (such as the presence of staff dedicated to tracing patients) and data quality and loss to follow-up were analysed using multivariate logit models. FINDINGS: Twenty-one sites that together provided ART to 50 060 patients were included (median number of patients per site: 1000; interquartile range, IQR: 72-19 320). Eighteen sites (86%) used an electronic database for medical record-keeping; 15 (83%) such sites relied on software intended for personal or small business use. The median percentage of missing data for key variables per site was 10.9% (IQR: 2.0-18.9%) and declined with training in data management (odds ratio, OR: 0.58; 95% confidence interval, CI: 0.37-0.90) and weekly hours spent by a clerk on the database per 100 patients on ART (OR: 0.95; 95% CI: 0.90-0.99). About 10 weekly hours per 100 patients on ART were required to reduce missing data for key variables to below 10%. The median percentage of patients lost to follow-up 1 year after starting ART was 8.5% (IQR: 4.2-19.7%). Strategies to reduce loss to follow-up included outreach teams, community-based organizations and checking death registry data. Implementation of all three strategies substantially reduced losses to follow-up (OR: 0.17; 95% CI: 0.15-0.20). CONCLUSION: The quality of the data collected and the retention of patients in ART treatment programmes are unsatisfactory for many sites involved in the scale-up of ART in resource-limited settings, mainly because of insufficient staff trained to manage data and trace patients lost to follow-up.

The Amplifier - v. 6, no. 13

In this issue...Copper Lounge, Small Business Administration, Copper Guards, Marcus Daly, cheating, Student Wive's Club, Red Rooster, Frank Larvie, M- Day

Universally Applicable Model for the Quantitative Determination of Lake Sediment Composition Using Fourier Transform Infrared Spectroscopy

ABSTRACT: Fourier transform infrared spectroscopy (FTIRS) can provide detailed information on organic and minerogenic constituents of sediment records. Based on a large number of sediment samples of varying age (0�340 000 yrs) and from very diverse lake settings in Antarctica, Argentina, Canada, Macedonia/Albania, Siberia, and Sweden, we have developed universally applicable calibration models for the quantitative determination of biogenic silica (BSi; n = 816), total inorganic carbon (TIC; n = 879), and total organic carbon (TOC; n = 3164) using FTIRS. These models are based on the differential absorbance of infrared radiation at specific wavelengths with varying concentrations of individual parameters, due to molecular vibrations associated with each parameter. The calibration models have low prediction errors and the predicted values are highly correlated with conventionally measured values (R = 0.94�0.99). Robustness tests indicate the accuracy of the newly developed FTIRS calibration models is similar to that of conventional geochemical analyses. Consequently FTIRS offers a useful and rapid alternative to conventional analyses for the quantitative determination of BSi, TIC, and TOC. The rapidity, cost-effectiveness, and small sample size required enables FTIRS determination of geochemical properties to be undertaken at higher resolutions than would otherwise be possible with the same resource allocation, thus providing crucial sedimentological information for climatic and environmental reconstructions.

Compliance of cigarette smokers with scheduled visits for supportive periodontal therapy.

AIM To evaluate the compliance of cigarette smokers with scheduled visits for supportive periodontal therapy (SPT). MATERIALS AND METHODS Qualitative and quantitative analyses of compliance with scheduled SPT visits were performed using retrospective data from patients undergoing dental hygiene treatment at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland 1985-2011. RESULTS A total of 1336 patients were identified with 32.1% (n = 429) being smokers, 23.1% (n = 308) former smokers and 44.8% (n = 599) non-smokers. Qualitatively, significantly less smokers returned for SPT than non-smokers or former smokers (p = 0.0026), whereas 25.9% (n = 346) never returned for SPT. Further quantitative analysis of patients returning twice or more (n = 883) revealed that the overall mean %-compliance was 69.8% (SD ±22.04),whereas smokers complied with 67.0% (SD ±22.00), former smokers with 69.7% (SD ±22.03), and non-smokers with 71.7% (SD ±21.92) reaching statistical significance (p = 0.0111). Confounder adjusted analysis, however, revealed that older age (p = 0.0001), female gender (p = 0.0058), longer SPT intervals (p < 0.0001) and higher severity of periodontal disease (p < 0.0001) had a much greater impact on %-compliance than smoking (p = 0.7636). CONCLUSIONS This study suggests that qualitatively, smokers return less likely for SPT than non-smokers or former smokers while quantitatively, a lower mean %-compliance of smokers attending scheduled SPT visits may be attributed to confounders.

Norm enforcement in the city revisited: An international field experiment of altruistic punishment, norm maintenance, and broken windows

In laboratory experiments, people are willing to sanction norms at a cost—a behavioral tendency called altruistic punishment. However, the degree to which these findings can be generalized to real-world interactions is still debated. Only a small number of field experiments have been conducted, and initial results suggest that punishment is less frequent outside of the lab. This study replicates one of the first field experiments on altruistic punishment and builds ties to research on norm compliance and the broken windows theory. The original study addressed the enforcement of the anti-littering norm in Athens. We replicate this study in Bern, Zurich, and New York City. As an extension, we investigate how the experimental context (clean vs littered) impacts social norm enforcement. As a second extension, we investigate how opportunity structure impacts the maintenance of the anti-littering norm. Findings indicate that norms are universally enforced, although significantly less than in the standard laboratory experiment,and that enforcement is significantly more common in Switzerland than in New York. Moreover, individuals prefer more subtle forms of enforcement to direct punishment. We also find that enforcement is less frequent in littered than in clean contexts, suggesting that broken windows might not only foster deviant behavior but also weaken informal social control. Finally, we find that opportunity structure can encourage people to maintain norms, as indicated by the fact that people are more likely to voluntarily pick up litter when it is closer to a trash bin.

A Student Manual for Venture Consulting

This manual is written to provide students taking the venture consulting class a better understanding of how to consult a small or medium sized business. It covers topics such as how to find a client, how to determine the business problem, how to collect data from customers as well as managers and employees, and how to come up with solution recommendations. By reading the manual, students will gain a better understanding of the consulting industry and will have a guide to help them through the project.

Ethnicity, Governance and the Provision of Public Goods

Ethnicity is an important institution and one that impacts on the quality of governance. This paper focuses on the behavior of ethnic groups and specifically on their impact on the provision of public goods. The paper shows that ethnic heterogeneity results in under-provision of non-excludable public goods. On the other hand, such societies associate with provision of patronage goods. The paper proposes some areas of research such the economics of ethnic institutions, empirical evidence of the role ethnic groups on public goods provision, tax compliance and institutional reforms to improve governance.

Investigating the effects of the 2007 Texas tobacco tax increase on the smoking behavior of adults

Smoking is major cause of premature mortality and morbidity in the United States. The health consequences of tobacco usage are increasingly concentrated in minority and lower socioeconomic groups. One of the most effective means of deterring tobacco consumption and generating revenue to fund prevention activities is the levying of excise taxes. In 2007 the state of Texas increased the excise tax on cigarettes by $1.00 per pack. This study sought to determine if there was a significant effect on smoking prevalence in the state by examining Behavioral Risk Factor Surveillance System (BRFSS) data for two years leading up to the tax increase-2005 and 2006- and two years post tax increase -2007 and 2008. Results were compared against a chi square distribution and three multiple logistic regression models were created to adjust for race/ethnicity, age, education and income. Results from this study show that there was not a significant decrease in smoking prevalence for most of the groups stratified by age, income and ethnicity. There was not a significant decrease in the younger adults aged 18-34 by income, ethnicity, or education. Smoking prevalence increased for some groups, e.g., Hispanic females. In the regression models, the tax effect was not significant. While overall prevalence decreased by 9%, there were not significant reductions among non-White or Hispanic survey participants. Taxed sales dropped by approximately 17% according to the Texas Comptroller. Without BRFSS data measuring daily cigarette consumption among current smokers, now not assessed, it is impossible to determine whether the discrepancy in reported prevalence and taxes sales is attributable to consumption of fewer cigarettes among smokers or tax avoidance.^

Gestão de informação : O caso das empresas participantes do programa de incubação de empresas daUniversidade Federal de Goiás

The main objective of this paper is to point out the information management strategic profile of companies participating in the program of business incubation of Universidade Federal de Goiás (PROINE-UFG). This new alignment of social network aims to promote the competitiveness of micro and small business by approaching them to the knowledge producers that, in the Brazilian case, are the universities. The strategic information aligning model, proposed by Marchand, was used as the theoretical framework. The research took the design of a case study, as it limited to study the UFG incubation program. Nine companies of PROINE-UFG were investigated. The main conclusions are that the PROINE-UFG companies have a tendency of proactivity. Nevertheless the financial and technological resources are scarce to monitor the external environment as demanded by the strategy. They use few information sources and the interaction with the university is still incipient

Promoción de la inclusión social a través de programas sociales : Los casos del 'Banco Popular de la Buena Fe' y 'Argentina trabaja'

Este trabajo indaga en clave comparativa las propuestas de inclusión social presentes en dos programas impulsados por el Ministerio de Desarrollo Social de la Nación: el 'Banco Popular de la Buena Fe' y el 'Argentina Trabaja'. El mismo se elaboró a partir de metodología cualitativa, especialmente a través del análisis de documentos ministeriales y de la observación participante en distintos contextos vinculados con su implementación en un municipio de la Provincia de Buenos Aires. Ambos programas se asemejan en que buscan incluir a sus beneficiarios en el mercado de trabajo, aunque difieren en sus estrategias: mientras que el 'Banco Popular' impulsa el microemprendimiento, el programa 'Argentina Trabaja' propone involucrar a sus destinatarios en empresas cooperativas. A su vez, en su afán por diferenciarse de otros programas sociales promovidos por el Estado en etapas previas (principalmente en la década de los noventa), ambos intentan generar valores y prácticas enmarcadas dentro de la 'economía social'

Gestão de informação : O caso das empresas participantes do programa de incubação de empresas daUniversidade Federal de Goiás

The main objective of this paper is to point out the information management strategic profile of companies participating in the program of business incubation of Universidade Federal de Goiás (PROINE-UFG). This new alignment of social network aims to promote the competitiveness of micro and small business by approaching them to the knowledge producers that, in the Brazilian case, are the universities. The strategic information aligning model, proposed by Marchand, was used as the theoretical framework. The research took the design of a case study, as it limited to study the UFG incubation program. Nine companies of PROINE-UFG were investigated. The main conclusions are that the PROINE-UFG companies have a tendency of proactivity. Nevertheless the financial and technological resources are scarce to monitor the external environment as demanded by the strategy. They use few information sources and the interaction with the university is still incipient

Promoción de la inclusión social a través de programas sociales : Los casos del 'Banco Popular de la Buena Fe' y 'Argentina trabaja'

Este trabajo indaga en clave comparativa las propuestas de inclusión social presentes en dos programas impulsados por el Ministerio de Desarrollo Social de la Nación: el 'Banco Popular de la Buena Fe' y el 'Argentina Trabaja'. El mismo se elaboró a partir de metodología cualitativa, especialmente a través del análisis de documentos ministeriales y de la observación participante en distintos contextos vinculados con su implementación en un municipio de la Provincia de Buenos Aires. Ambos programas se asemejan en que buscan incluir a sus beneficiarios en el mercado de trabajo, aunque difieren en sus estrategias: mientras que el 'Banco Popular' impulsa el microemprendimiento, el programa 'Argentina Trabaja' propone involucrar a sus destinatarios en empresas cooperativas. A su vez, en su afán por diferenciarse de otros programas sociales promovidos por el Estado en etapas previas (principalmente en la década de los noventa), ambos intentan generar valores y prácticas enmarcadas dentro de la 'economía social'