The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.

BACKGROUND: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. METHODS: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. RESULTS: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. LIMITATIONS: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. CONCLUSIONS: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Integrated vector management for malaria control in Uganda: knowledge, perceptions and policy development.

BACKGROUND: Integrated vector management (IVM) is increasingly being recommended as an option for sustainable malaria control. However, many malaria-endemic countries lack a policy framework to guide and promote the approach. The objective of the study was to assess knowledge and perceptions in relation to current malaria vector control policy and IVM in Uganda, and to make recommendations for consideration during future development of a specific IVM policy. METHODS: The study used a structured questionnaire to interview 34 individuals working at technical or policy-making levels in health, environment, agriculture and fisheries sectors. Specific questions on IVM focused on the following key elements of the approach: integration of chemical and non-chemical interventions of vector control; evidence-based decision making; inter-sectoral collaboration; capacity building; legislation; advocacy and community mobilization. RESULTS: All participants were familiar with the term IVM and knew various conventional malaria vector control (MVC) methods. Only 75% thought that Uganda had a MVC policy. Eighty percent (80%) felt there was inter-sectoral collaboration towards IVM, but that it was poor due to financial constraints, difficulties in involving all possible sectors and political differences. The health, environment and agricultural sectors were cited as key areas requiring cooperation in order for IVM to succeed. Sixty-seven percent (67%) of participants responded that communities were actively being involved in MVC, while 48% felt that the use of research results for evidence-based decision making was inadequate or poor. A majority of the participants felt that malaria research in Uganda was rarely used to facilitate policy changes. Suggestions by participants for formulation of specific and effective IVM policy included: revising the MVC policy and IVM-related policies in other sectors into a single, unified IVM policy and, using legislation to enforce IVM in development projects. CONCLUSION: Integrated management of malaria vectors in Uganda remains an underdeveloped component of malaria control policy. Cooperation between the health and other sectors needs strengthening and funding for MVC increased in order to develop and effectively implement an appropriate IVM policy. Continuous engagement of communities by government as well as monitoring and evaluation of vector control programmes will be crucial for sustaining IVM in the country.

Flo/Stress: an integrated software module to predict stress in electronic products

Software technology that predicts stress in electronic systems and packages, developed as part of TCS Programme, is described. The software is closely integrated within a thermal design tool providing the ability to simulate the coupled effects of airflow, temperature and stress on product performance. This integrated approach to analysis will help decrease the number of design cycles.

An integrated approach to flow, thermal and mechanical modeling of electronics devices

The future success of many electronics companies will depend to a large extent on their ability to initiate techniques that bring schedules, performance, tests, support, production, life-cycle-costs, reliability prediction and quality control into the earliest stages of the product creation process. Earlier papers have discussed the benefits of an integrated analysis environment for system-level thermal, stress and EMC prediction. This paper focuses on developments made to the stress analysis module and presents results obtained for an SMT resistor. Lifetime predictions are made using the Coffin-Manson equation. Comparison with the creep strain energy based models of Darveaux (1997) shows the shear strain based method to underestimate the solder joint life. Conclusions are also made about the capabilities of both approaches to predict the qualitative and quantitative impact of design changes.

Integrated fire and evacuation in maritime environments

When designing a new passenger ship or modifying an existing design, how do we ensure that the proposed design and crew emergency procedures are safe from an evacuation resulting from fire or other incident? In the wake of major maritime disasters such as the Scandinavian Star, Herald of Free Enterprise, Estonia and in light of the growth in the numbers of high density high-speed ferries and large capacity cruise ships, issues concerning the evacuation of passengers and crew at sea are receiving renewed interest. Fire and evacuation models with features such as the ability to realistically simulate the spread of fire and fire suppression systems and the human response to fire sas well as the capability to model human performance in heeled orientations linked to a virtual reality environment that produces realistic visualisations of modelled scenarios are now available and can be used to aid the engineer in assessing ship design and procedures. This paper describes the maritmeEXODUS ship evacuation and the SMARTFIRE fire simulation model and provides an example application demonstrating the use of the models in performing fire and evacuation analysis for a large passenger ship partially based on the requirements of MSC circular 1033. The fire simulations include the action of a water mist system.

Requirements and design of an integrated European environmental information communication system, (IEEICS)

The needs for various forms of information systems relating to the European environment and ecosystem are reviewed, and limitations indicated. Existing information systems are reviewed and compared in terms of aims and functionalities. We consider TWO technical challenges involved in attempting to develop an IEEICS. First, there is the challenge of developing an Internet-based communication system which allows fluent access to information stored in a range of distributed databases. Some of the currently available solutions are considered, i.e. Web service federations. The second main challenge arises from the fact that there is general intra-national heterogeneity in the definitions adopted, and the measurement systems used throughout the nations of Europe. Integrated strategies are needed.

Models and tools for an integrated European environmental management and decision support system, (IEEMDSS)

This work proceeds from the assumption that a European environmental information and communication system (EEICS) is already established. In the context of primary users (land-use planners, conservationists, and environmental researchers) we ask what use may be made of the EEICS for building models and tools which is of use in building decision support systems for the land-use planner. The complex task facing the next generation of environmental and forest modellers is described, and a range of relevant modelling approaches are reviewed. These include visualization and GIS; statistical tabulation and database SQL, MDA and OLAP methods. The major problem of noncomparability of the definitions and measures of forest area and timber volume is introduced and the possibility of a model-based solution is considered. The possibility of using an ambitious and challenging biogeochemical modelling approach to understanding and managing European forests sustainably is discussed. It is emphasised that all modern methodological disciplines must be brought to bear, and a heuristic hybrid modelling approach should be used so as to ensure that the benefits of practical empirical modelling approaches are utilised in addition to the scientifically well-founded and holistic ecosystem and environmental modelling. The data and information system required is likely to end up as a grid-based-framework because of the heavy use of computationally intensive model-based facilities.

A life cycle model for product-service systems design

Western manufacturing companies are developing innovative ways of delivering value that competes with the low cost paradigm. One such strategy is to deliver not only products, but systems that are closely aligned with the customer value proposition. These systems are comprised of integrated products and services, and are referred to as Product-Service Systems (PSS). A key challenge in PSS is supporting the design activity. In one sense, PSS design is a further extension of concurrent engineering that requires front-end input from the additional downstream sources of product service and maintenance. However, simply developing products and service packages is not sufficient: the new design challenge is the integrated system. This paper describes the development of a PSS data structure that can support this integrated design activity. The data structure is implemented in a knowledge base using the Protégé knowledge base editor.

Manufacturing knowledge verification in design support systems

This paper identifies the need for a verification methodology for manufacturing knowledge in design support systems; and proposes a suitable methodology based on the concept of ontological commitment and the PSL ontology (ISO/CD18629). The use of the verification procedures within an overall system development methodology is examined, and an understanding of how various categories of manufacturing knowledge (typical to design support systems) map onto the PSL ontology is developed. This work is also supported by case study material from industrial situations, including the casting and machining of metallic components. The PSL ontology was found to support the verification of most categories of manufacturing knowledge, and was shown to be particularly suited to process planning representations. Additional concepts and verification procedures were however needed to verify relationships between products and manufacturing processes. Suitable representational concepts and verification procedures were therefore developed, and integrated into the proposed knowledge verification methodology.

The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems

Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.

Methods: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis.

Results: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change.

Conclusion: Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.

Factores determinantes del uso de Internet en la comercialización del aceite de oliva. Análisis del sector en Cataluña

Las cooperativas son entidades con una gran presencia económica y social en España, y tienen una gran influencia en la economía rural de las zonas donde están ubicadas. El principal objetivo del presente trabajo es el análisis del uso de las nuevas tecnologías por parte de las cooperativas agroalimentarias, centrándose en las productoras de aceite de oliva para determinar los principales factores que condicionan su comportamiento en la Red. En el presente estudio se analizan sus sitios web y se determina qué tipo de información aporta, tanto datos generales como datos de comercialización. A partir de los resultados obtenidos, se busca la relación que pueda existir entre el tamaño de la cooperativa, su actividad exportadora o la actividad de comercio electrónico con la presencia online, mediante una regresión logística. De esta manera podremos conocer si realmente la implantación de nuevas tecnologías en las cooperativas permite desarrollar una óptima actividad económica.

Aircraft Cost Modelling using the Genetic Causal Technique within a Systems Engineering Approach

The paper is primarily concerned with the modelling of aircraft manufacturing cost. The aim is to establish an integrated life cycle balanced design process through a systems engineering approach to interdisciplinary analysis and control. The cost modelling is achieved using the genetic causal approach that enforces product family categorisation and the subsequent generation of causal relationships between deterministic cost components and their design source. This utilises causal parametric cost drivers and the definition of the physical architecture from the Work Breakdown Structure (WBS) to identify product families. The paper presents applications to the overall aircraft design with a particular focus on the fuselage as a subsystem of the aircraft, including fuselage panels and localised detail, as well as engine nacelles. The higher level application to aircraft requirements and functional analysis is investigated and verified relative to life cycle design issues for the relationship between acquisition cost and Direct Operational Cost (DOC), for a range of both metal and composite subsystems. Maintenance is considered in some detail as an important contributor to DOC and life cycle cost. The lower level application to aircraft physical architecture is investigated and verified for the WBS of an engine nacelle, including a sequential build stage investigation of the materials, fabrication and assembly costs. The studies are then extended by investigating the acquisition cost of aircraft fuselages, including the recurring unit cost and the non-recurring design cost of the airframe sub-system. The systems costing methodology is facilitated by the genetic causal cost modeling technique as the latter is highly generic, interdisciplinary, flexible, multilevel and recursive in nature, and can be applied at the various analysis levels required of systems engineering. Therefore, the main contribution of paper is a methodology for applying systems engineering costing, supported by the genetic causal cost modeling approach, whether at a requirements, functional or physical level.

Antioxidant activity of coffee model systems

Coffee model systems prepared from combinations of chlorogenic acid (CGA), N-alpha-acetyl-1-arginine (A), sucrose (S), and cellulose (C) were roasted at 240 degreesC for 4 min prior to analysis by UV-visible spectrophotometry, capillary zone electrophoresis (CZE), and the ABTS radical cation decolorization assay. The A/CGA/S/C and A/S/C systems were also fractionated by gel filtration chromatography. Antioxidant activity of the systems showed a positive, nonlinear relationship with the amount of CGA remaining after roasting. Sucrose degradation was a major source of color in the heated systems. There was no relationship between antioxidant activity and color generation.

Effect of pH, temperature, and moisture on the formation of volatile compounds in glycine/glucose model systems

Mixtures of glycine, glucose, and starch were extrusion cooked using sodium hydroxide at 0, 3, and 6 g/L of extruder water feed, 18% moisture, and 120, 150, and 180 degreesC target die temperatures, giving extrudates with pH values of 5.6, 6.8, and 7.4. Freeze-dried equimolar solutions of glucose and glycine were heated either dry or after equilibration to similar to 13% moisture at 180 degreesC in a reaction-tube system designed to mimic the heating profile in an extruder. Volatile compounds were isolated onto Tenax and analyzed by gas chromatography-mass spectrometry. For the extrudates, total yields of volatiles increased with decreasing pH at 180 degreesC, reached a maximum at pH 6.S at 150 degreesC, and increased with increasing pH at 120 degreesC. Amounts increased with temperature at all pH values. Pyrazines were the most abundant class for all sets of conditions (54-79% of total volatiles). Pyrroles, ketones, furans, oxazoles, and pyridines were also identified. Yields of volatiles from the reaction-tube samples increased by > 60% in the moist system. Levels of individual classes also increased in the presence of moisture, except pyrazines, which decreased similar to3.5-fold. Twenty-one of the compounds were common to the reaction-tube samples and the extrudates.