A conceptual framework to assess the effectiveness of HIV prevention

Aim: The relative effectiveness of different methods of prevention of HIV transmission is a subject of debate that is renewed with the integration of each new method. The relative weight of values and evidence in decision-making is not always clearly defined. Debate is often confused, as the proponents of different approaches address the issue at different levels of implementation. This paper defines and delineates the successive levels of analysis of effectiveness, and proposes a conceptual framework to clarify debate. Method / Issue: Initially inspired from work on contraceptive effectiveness, a first version of the conceptual framework was published in 1993 with definition of the Condom Effectiveness Matrix (Spencer, 1993). The framework has since integrated and further developed thinking around distinctions made between efficacy and effectiveness and has been applied to HIV prevention in general. Three levels are defined: theoretical effectiveness (ThE), use-effectiveness (UseE) and population use-effectiveness (PopUseE). For example, abstinence and faithfulness, as proposed in the ABC strategy, have relatively high theoretical effectiveness but relatively low effectiveness at subsequent levels of implementation. The reverse is true of circumcision. Each level is associated with specific forms of scientific enquiry and associated research questions: basic and clinical sciences with ThE; clinical and social sciences with UseE; epidemiology and social, economic and political sciences with PopUseE. Similarly, the focus of investigation moves from biological organisms, to the individual at the physiological and then psychological, social and ecological level, and finally takes as perspective populations and societies as a whole. The framework may be applied to analyse issues on any approach. Hence, regarding consideration of HIV treatment as a means of prevention, examples of issues at each level would be: ThE: achieving adequate viral suppression and non-transmission to partners; UseE: facility and degree of adherence to treatment and medical follow-up; PopUseE: perceived validity of strategy, feasibility of achieving adequate population coverage. Discussion: Use of the framework clarifies the questions that need to be addressed at all levels in order to improve effectiveness. Furthermore, the interconnectedness and complementary nature of research from the different scientific disciplines and the relative contribution of each become apparent. The proposed framework could bring greater rationality to the prevention effectiveness debate and facilitate communication between stakeholders.

IPH response to the Strategic Review of Health Inequalities in England post 2010

IPH contributed to the Strategic Review of Health Inequalities in England being carried out by Professor Sir Michael Marmot, Chair of the Commission on the Social Determinants of Health.  IPH acknowledges the immense work done by the Review team and welcomes the opportunity to inform its work. We see the review as a vital opportunity to provide a “catalyst for concerted action” not only in England but in its near neighbours in Northern Ireland and Ireland. Health inequalities are rife across the UK and Ireland despite a range of developments in policy and practice designed to create more equal opportunities for health. We commend the approach taken in the Review, which applies scientific rigour and the combined expertise of a number of defined task groups to seek solutions to the vexing challenge of health inequality.

Imaging of Anorectal Malformations: Finding the Way out of the Labyrinth

Purpose/Aim: To review the embryological basis of a wide spectrum of anorectal malformations (ARM), to provide anatomical schemas showing the possiblelocations of fistulas in boys and girls and to present the typical imaging findings of these complex anomalies using various imaging methods with emphasis on3T-MRI.Content Organization: 1. Embryology. 2. Imaging techniques. 3. Normal 3T-MRI pelvic anatomy. 4. Ano-rectal malformations in boys: - Classification -Anatomic schemas of location of fistulas. - Imaging studies. 5. Ano-rectal malformations in girls: - Classification - Anatomic schemas of location of fistulas. -Imaging studies. 6. Imaging of Currarino syndrome. 7. Imaging of Vacterl syndrome.Summary: ARM are a group of complex anatomical alterations characterized by an abnormal separation of genitourinary system from hindgut. The major teachingpoints of this pictorial essay are to show: - The normal anatomy of the pelvis floor and the sphincter muscle complex in 3T-MRI. - Anatomic schemas of thedifferent types of ARM in boys and girls. - Imaging findings of a wide spectrum of ARM using a multimodality approach. including colostogramm, voidingcystourethrogramm and MRI of the pelvis.

An efficient use of virtualization in grid/cloud environments

Grid is a hardware and software infrastructure that provides dependable, consistent, pervasive, and inexpensive access to high-end computational resources. Grid enables access to the resources but it does not guarantee any quality of service. Moreover, Grid does not provide performance isolation; job of one user can influence the performance of other user’s job. The other problem with Grid is that the users of Grid belong to scientific community and the jobs require specific and customized software environment. Providing the perfect environment to the user is very difficult in Grid for its dispersed and heterogeneous nature. Though, Cloud computing provide full customization and control, but there is no simple procedure available to submit user jobs as in Grid. The Grid computing can provide customized resources and performance to the user using virtualization. A virtual machine can join the Grid as an execution node. The virtual machine can also be submitted as a job with user jobs inside. Where the first method gives quality of service and performance isolation, the second method also provides customization and administration in addition. In this thesis, a solution is proposed to enable virtual machine reuse which will provide performance isolation with customization and administration. The same virtual machine can be used for several jobs. In the proposed solution customized virtual machines join the Grid pool on user request. Proposed solution describes two scenarios to achieve this goal. In first scenario, user submits their customized virtual machine as a job. The virtual machine joins the Grid pool when it is powered on. In the second scenario, user customized virtual machines are preconfigured in the execution system. These virtual machines join the Grid pool on user request. Condor and VMware server is used to deploy and test the scenarios. Condor supports virtual machine jobs. The scenario 1 is deployed using Condor VM universe. The second scenario uses VMware-VIX API for scripting powering on and powering off of the remote virtual machines. The experimental results shows that as scenario 2 does not need to transfer the virtual machine image, the virtual machine image becomes live on pool more faster. In scenario 1, the virtual machine runs as a condor job, so it easy to administrate the virtual machine. The only pitfall in scenario 1 is the network traffic.

What about people in European Regional Science?

The 51st ERSA Conference held in Barcelona in 2011 was one of the largest ever. Here, by examining the characteristics of the conference, this paper identifies the main trends in Regional Science at a moment in which the discipline is renewing its efforts to provide responses in a complex, globalised world in which cities and regions are acquiring greater and greater importance. This paper follows in the tradition of a long list of studies that have examined the nature of the field of Regional Science and draws on a broad array of sources of information: the delegates’ demographic details, the conference program itself, a satisfaction survey conducted among delegates, a quality survey addressed to those chairing the sessions and, finally, a bibliometric database including each author signing a paper presented at the conference. With this information we describe the ERSA delegates: their relative youthfulness; the areas in which women are taking on a more important role; the countries and regions of the world that have the most dominant profile in Regional Science today; the thematic areas that are being driven by professionals as opposed to academics; the relevance of regional economic growth and innovation as trending topics in the field; the growing frequency of co-authorship and, consequently, of scientific collaboration; and, finally, and perhaps most importantly, the continuous enhancement of the quality of the work being undertaken in the discipline. Indeed, following on from this description, the results of the regression analysis conducted show that for ERSA delegates what matters most is quality, and this must be the direction that future conferences should move toward. Ultimately, therefore, ERSA conferences are comprehensive, all-embracing occasions, representing an ideal opportunity for regional scientists to present their work to each other and to network.

Address by Michea¡l Martin to the Conference - Legislating for Tobacco Free Society

Thank you Chairman I would like to extend a warm welcome to our keynote speakers, David Byrne of the European Commission, Derek Yach from the World Health Organisation, and Paul Quinn representing Congressman Marty Meehan who sends his apologies. When we include the speakers who will address later sessions, this is, undoubtedly, one of the strongest teams that have been assembled on tobacco control in Europe. The very strength of the team underlines what I see as a shift – a very necessary shift – in the way we perceive the tobacco issue. For the last twenty years, we have lived out a paradox. It isn´t a social side issue. I make no apology for the bluntness of what I´m saying, and will come back, a little later, to the radicalism I believe we need to bring – nationally – to this issue. For starters, though, I want to lay it on the line that what we´re talking about is an epidemic as deadly as any suffered by human kind throughout the centuries. Slower than some of those epidemics in its lethal action, perhaps. But an epidemic, nonetheless. According to the World Health Organisation tobacco accounted for just over 3 million annual deaths in 1990, rising to 4.023 million annual deaths in 1998. The numbers of deaths due to tobacco will rise to 8.4 million in 2020 and reach roughly 10 million annually by 2030. This is quite simply ghastly. Tobacco kills. It kills in many different ways. It kills increasing numbers of women. It does its damage directly and indirectly. For children, much of the damage comes from smoking by adults where children live, study, play and work. The very least we should be able to offer every child is breathable air. Air that doesn´t do them damage. We´re now seeing a global public health response to the tobacco epidemic. The Tobacco Free Initiative launched by the World Health Organisation was matched by significant tobacco control initiatives throughout the world. During this conference we will hear about the experiences our speakers had in driving these initiatives. This Tobacco Free Initiative poses unique challenges to our legal frameworks at both national and international levels; in particular it raises challenges about the legal context in which tobacco products are traded and asks questions about the impact of commercial speech especially on children, and the extent of the limitations that should be imposed on it. Politicians, supported by economists and lawyers as well as the medical profession, must continue to explore and develop this context to find innovative ways to wrap public health considerations around the trade in tobacco products – very tightly. We also have the right to demand a totally new paradigm from the tobacco industry. Bluntly, the tobacco industry plays the PR game at its cynical worst. The industry sells its products without regard to the harm these products cause. At the same time, to gain social acceptance, it gives donations, endowments and patronage to high profile events and people. Not good enough. This model of behaviour is no longer acceptable in a modern society. We need one where the industry integrates social responsibility and accountability into its day-to-day activities. We have waited for this change in behaviour from the tobacco industry for many decades. Unfortunately the documents disclosed during litigation in the USA and from other sources make very depressing reading; it is clear from them that any trust society placed in the tobacco industry in the past to address the health problems associated with its products was misplaced. This industry appears to lack the necessary leadership to guide it towards just and responsible action. Instead, it chooses evasion, deception and at times illegal activity to protect its profits at any price and to avoid its responsibilities to society and its customers. It has engaged in elaborate ´spin´ to generate political tolerance, scientific uncertainty and public acceptance of its products. Legislators must act now. I see no reason why the global community should continue to wait. Effective legal controls must be laid on this errant industry. We should also keep these controls under review at regular intervals and if they are failing to achieve the desired outcomes we should be prepared to amend them. In Ireland, as Minister for Health and Children, I launched a comprehensive tobacco control policy entitled “Towards a Tobacco Free Society“. OTT?Excessive?Unrealistic? On the contrary – I believe it to be imperative and inevitable. I honestly hold that, given the range of fatal diseases caused by tobacco use we have little alternative but to pursue the clear objective of creating a tobacco free society. Aiming at a tobacco free society means ensuring public and political opinion are properly informed. It requires help to be given to smokers to break the addiction. It demands that people are protected against environmental tobacco smoke and children are protected from any inducement to experiment with this product. Over the past year we have implemented a number of measures which will support these objectives; we have established an independent Office of Tobacco Control, we have introduced free nicotine replacement therapy for low-income earners, we have extended our existing prohibitions on tobacco advertising to the print media with some minor derogations for international publications. We have raised the legal age at which a person can be sold tobacco products to eighteen years. We have invested substantially more funds in health promotion activities and we have mounted sustained information campaigns. We have engaged in sponsorship arrangements, which are new and innovative for public bodies. I have provided health boards with additional resources to let them mount a sustained inspection and enforcement service. Health boards will engage new Directors of Tobacco Control responsible for coordinating each health board´s response and for liasing with the Tobacco Control Agency I set up earlier this year. Most recently, I have published a comprehensive Bill – The Public Health (Tobacco) Bill, 2001. This Bill will, among other things, end all forms of product display and in-store advertising and will require all retailers to register with the new Tobacco Control Agency. Ten packs of cigarettes will be banned and transparent and independent testing procedures of tobacco products will be introduced. Enforcement officers will be given all the necessary powers to ensure there is full compliance with the law. On smoking in public places we will extend the existing areas covered and it is proposed that I, as Minister for Health and Children, will have the powers to introduce further prohibitions in public places such as pubs and the work place. I will also provide for the establishment of a Tobacco Free Council to advise and assist on an ongoing basis. I believe the measures already introduced and those additional ones proposed in the Bill have widespread community support. In fact, you´re going to hear a detailed presentation from the MRBI which will amply illustrate the extent of this support. The great thing is that the support comes from smokers and non-smokers alike. Bottom line, Ladies and Gentlemen, is that we are at a watershed. As a society (if you´ll allow me to play with a popular phrase) we´ve realised it´s time to ´wake up and smell the cigarettes.´ Smell them. See them for what they are. And get real about destroying their hold on our people. The MRBI survey makes it clear that the single strongest weapon we have when it comes to preventing the habit among young people is price. Simple as that. Price. Up to now, the fear of inflation has been a real impediment to increasing taxes on tobacco. It sounds a serious, logical argument. Until you take it out and look at it a little more closely. Weigh it, as it were, in two hands. I believe – and I believe this with a great passion – that we must take cigarettes out of the equation we use when awarding wage increases. I am calling on IBEC and ICTU, on employers and trade unions alike, to move away from any kind of tolerance of a trade that is killing our citizens. At one point in industrial history, cigarettes were a staple of the workingman´s life. So it was legitimate to include them in the ´basket´ of goods that goes to make up the Consumer Price Index. It isn´t legitimate to include them any more. Today, I´m saying that society collectively must take the step to remove cigarettes from the basket of normality, from the list of elements which constitute necessary consumer spending. I´m saying: “We can no longer delude ourselves. We must exclude cigarettes from the considerations we address in central wage bargaining. We must price cigarettes out of the reach of the children those cigarettes will kill.” Right now, in the monthly Central Statistics Office reports on consumer spending, the figures include cigarettes. But – right down at the bottom of the page – there´s another figure. Calculated without including cigarettes. I believe that if we continue to use the first figure as our constant measure, it will be an indictment of us as legislators, as advocates for working people, as public health professionals. If, on the other hand, we move to the use of the second figure, we will be sending out a message of startling clarity to the nation. We will be saying “We don´t count an addictive, killer drug as part of normal consumer spending.” Taking cigarettes out of the basket used to determine the Consumer Price Index will take away the inflation argument. It will not be easy, in its implications for the social partners. But it is morally inescapable. We must do it. Because it will help us stop the killer that is tobacco. If we can do it, we will give so much extra strength to health educators and the new Tobacco Control Association. This new organisation of young people who already have branches in over fifteen counties, is represented here today. The young adults who make up its membership are well placed to advise children of the dangers of tobacco addiction in a way that older generations cannot. It would strengthen their hand if cigarettes move – in price terms – out of the easy reach of our children Finally, I would like to commend so many public health advocates who have shown professional and indeed personal courage in their commitment to this critical public health issue down through the years. We need you to continue to challenge and confront this grave public health problem and to repudiate the questionable science of the tobacco industry. The Research Institute for a Tobacco Free Society represents a new and dynamic form of partnership between government and civil society. It will provide an effective platform to engage and mobilise the many different professional and academic skills necessary to guide and challenge us. I wish the conference every success.

Changing Cardiovascular Health: National Cardiovascular Health Policy 2010 - 2019

This new cardiovascular policy, Changing Cardiovascular Health covering the period 2010-2019, comes a decade after the first national cardiovascular health strategy, entitled Building Healthier Hearts, was published by the Department of Health in 1999. The new policy is timely given the pace of scientific discovery and related changes in medical practice, changes in health service structures, and patterns and influences on population health behaviours in Ireland over the decade. Cardiovascular health and its maintenance is a microcosm of health more generally. A policy that can improve cardiovascular health and cardiovascular disease management will have beneficial effects for the whole healthcare system and population.Download this document

Wissensvermehrung durch Konzeptentwicklung? Das Beispiel Vergänglichkeit [The contibution of concept development to nursing knowledge? The example of Transitoriness].

To provide nursing practice with evidence, it is important to understand nursing phenomena in detail. Therefore, good descriptions including the identification of characteristics and attributes of nursing phenomena on various levels of abstraction, i. e., concepts, are needed. In this article the significance of concept development for nursing science will be demonstrated by drawing on the example of 'transitoriness'. The evolutionary concept analysis proposed by Rodgers (2000) is introduced in more detail. Drawing on transitoriness, the phenomenon is presented with the help of the evolutionary concept analysis by Rodgers (2000). The phenomenon's characteristics and attributes are identified, as well as potential areas of application. Moreover, areas are outlined, in which interventions for nursing practice can be developed, implemented and evaluated. Thus, nursing practice is updated to include new findings and innovation. Through concept analysis nursing phenomena can be described in more detail, enhanced or broadened for use in nursing practice. Such structured processes as concept analysis can be employed successfully for other nursing phenomena. Concept analyses can lead to the identification of tasks for the respective scientific discipline and professionals. Thus, concept analyses can lead to the concretisation of tasks in nursing.

Hacia una definición inclusiva del e-learning

El estudio tiene como objetivo la construcción de una definición actual e integradora del concepto de e-learning, que sea aceptada por la mayor parte de la comunidad científica y que sirva como referente por los estudiosos y profesionales de esta temática.

Contenidos en comunidades virtuales : análisis de las herramientas y servicios de información

This paper attempts to study and analyze the tools and the information and communication services developed and offered by an evolving digital environment, as are virtual communities. It also seeks to observe the use that is made of all of this in function of to the objectives set out in different kinds of communities. In this way we want to verify whether virtual communities in Spain have reached maturity as tools for the creation and management of digital content. Specifically, we have looked at the diverse typology of these communities (leisure, business, and scientific-academic) and selected a sample of consolidated or paradigmatic cases in Spanish casuistry (Telepolis, CiudadFutura, RedIRIS, ICT) for each type.

Estrategia de la Universidad de Alicante en la promoción del conocimiento abierto

El propòsit d'aquesta comunicació és resumir les diferents iniciatives dutes a terme a la Universitat d'Alacant per a la promoció de l'accés obert a la recerca i la docència generades pels seus membres, així com els diferents incentius destinats a afavorir l'autoarxivament en el seu Repositori institucional, RUA. Fins al moment a la Universitat d'Alacant s'ha optat per realitzar diferents convocatòries amb incentius econòmics, dirigides tant a personal investigador com a docent, en què s'especifica l'obligatorietat d'arxivar en el Repositori els materials generats arran d'aquestes convocatòries. Resumirem els resultats obtinguts fins al moment, indicant els pros i els contres d'aquest sistema d'incentius, i assenyalarem els nous reptes que se'ns presenten a curt i mitjà termini, amb especial referència a la proposició d'un nou model de política a adoptar per l'arxiu i difusió de la producció científica i docent generada a la nostra Universitat.