99 resultados para medicinsk abort
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The dominant emotion in violence-threatening situations is confrontational tension/fear (ct/f), which causes most violence to abort, or to be carried out inaccurately and incompetently. For violence to be successful, there must be a pathway around the barrier of ct/f. These pathways include: attacking the weak; audience-oriented staged and controlled fair fights; confrontation-avoiding remote violence; confrontation-avoiding by deception; confrontation-avoiding by absorption in technique. Successfully violent persons, on both sides of the law, are those who have developed these skilled interactional techniques. Since successful violence involves dominating the emotional attention space, only a small proportion of persons can belong to the elite which does most of each type of violence. Macro-violence, including victory and defeat in war, and in struggles of paramilitaries and social movements, is shaped by both material resources and social/emotional resources for maintaining violent organizations and forcing their opponents into organizational breakdown. Social and emotional destruction generally precedes physical destruction.
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Habituelle Aborte Ein Spontanabort ereignet sich bei etwa 15 % aller klinisch festgestellten Schwangerschaften. Vom betroffenen Paar wird er ausnahmslos als äußerst traumatisch erlebt. Insbesondere gilt dies beim habituellen Abort (≥ 3 Aborte in Folge), der etwa 1 % der Schwangerschaften betrifft. In der Hoffnung, weitere Aborte zu verhindern, werden entsprechend große Anstrengungen unternommen, die jeweilige Ursache zu eruieren. Gerinnungsphysiologische Einflüsse Pathophysiologisch spielen nebst organischen und zytogenetischen Anomalien beim Fetus vermutlich auch gerinnungsphysiologische Einflüsse eine ursächliche Rolle, insbesondere erworbene und hereditäre prokoagulatorische Störungen. Diese können das im Rahmen der Schwangerschaft schon physiologisch erhöhte Gerinnungspotenzial zusätzlich verstärken und damit die Blutversorgung des Fetus potenziell behindern, was mit der Gefahr seiner Abstoßung einhergeht. Thrombophilie Auch wenn der diesbezügliche Beweis im Einzelfall schwierig zu erbringen ist, erscheint eine ungünstige Beeinflussung des Abortrisikos durch erworbene und hereditäre Thrombophilien plausibel. Daraus ergibt sich unschwer die Folgerung oder Hoffnung, dass antiaggregatorische und antikoagulatorische Maßnahmen eine günstige Wirkung haben könnten. Der vorliegende Beitrag geht auf die bekannten sowie teils auch nur vermuteten pathophysiologischen Mechanismen und die sich daraus ergebenden therapeutischen bzw. präventiven Möglichkeiten ein.
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Background: The traditional surgical treatment for cervical insufficiency is vaginal placement of a cervical cerclage. However, in a small number of cases a vaginal approach is not possible. A transabdominal approach can become an option for these patients. Laparoscopic cervical cerclage is associated with good pregnancy outcomes but comes at the cost of a higher risk of serious surgical complications. The aim of the present study was to evaluate intraoperative and long-term pregnancy outcomes after laparoscopic cervical cerclage, performed either as an interval procedure or during early pregnancy, using a new device with a blunt grasper and a flexible tip. Methods: All women who underwent laparoscopic cervical cerclage for cervical insufficiency in our institution using the Goldfinger® device (Ethicon Endo Surgery, Somerville, NJ, USA) between January 2008 and March 2014 were included in the study. Data were collected from the patients' medical records and included complications during and after the above-described procedure. Results: Eighteen women were included in the study. Of these, six were pregnant at the time of laparoscopic cervical cerclage. Mean duration of surgery was 55 ± 10 minutes. No serious intraoperative or postoperative complications occurred. All patients were discharged at 2.6 ± 0.9 days after surgery. One pregnancy ended in a miscarriage at 12 weeks of gestation. All other pregnancies ended at term (> 37 weeks of gestation) with good perinatal and maternal outcomes. Summary: Performing a laparoscopic cervical cerclage using a blunt grasper device with a flexible tip does not increase intraoperative complications, particularly in early pregnancy. We believe that use of this device, which is characterized by increased maneuverability, could be an important option to avoid intraoperative complications if surgical access is limited due to the anatomical situation. However, because of the small sample size, further studies are needed to confirm our findings.
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Mode switches are used to partition the system’s behavior into different modes to reduce the complexity of large embedded systems. Such systems operate in multiple modes in which each one corresponds to a specific application scenario; these are called Multi-Mode Systems (MMS). A different piece of software is normally executed for each mode. At any given time, the system can be in one of the predefined modes and then be switched to another as a result of a certain condition. A mode switch mechanism (or mode change protocol) is used to shift the system from one mode to another at run-time. In this thesis we have used a hierarchical scheduling framework to implement a multi-mode system called Multi-Mode Hierarchical Scheduling Framework (MMHSF). A two-level Hierarchical Scheduling Framework (HSF) has already been implemented in an open source real-time operating system, FreeRTOS, to support temporal isolation among real-time components. The main contribution of this thesis is the extension of the HSF featuring a multimode feature with an emphasis on making minimal changes in the underlying operating system (FreeRTOS) and its HSF implementation. Our implementation uses fixed-priority preemptive scheduling at both local and global scheduling levels and idling periodic servers. It also now supports different modes of the system which can be switched at run-time. Each subsystem and task exhibit different timing attributes according to mode, and upon a Mode Change Request (MCR) the task-set and timing interfaces of the entire system (including subsystems and tasks) undergo a change. A Mode Change Protocol specifies precisely how the system-mode will be changed. However, an application may not only need to change a mode but also a different mode change protocol semantic. For example, the mode change from normal to shutdown can allow all the tasks to be completed before the mode itself is changed, while changing a mode from normal to emergency may require aborting all tasks instantly. In our work, both the system mode and the mode change protocol can be changed at run-time. We have implemented three different mode change protocols to switch from one mode to another: the Suspend/resume protocol, the Abort protocol, and the Complete protocol. These protocols increase the flexibility of the system, allowing users to select the way they want to switch to a new mode. The implementation of MMHSF is tested and evaluated on an AVR-based 32 bit board EVK1100 with an AVR32UC3A0512 micro-controller. We have tested the behavior of each system mode and for each mode change protocol. We also provide the results for the performance measures of all mode change protocols in the thesis. RESUMEN Los conmutadores de modo son usados para particionar el comportamiento del sistema en diferentes modos, reduciendo así la complejidad de grandes sistemas empotrados. Estos sistemas tienen multiples modos de operación, cada uno de ellos correspondiente a distintos escenarios y para distintas aplicaciones; son llamados Sistemas Multimodales (o en inglés “Multi-Mode Systems” o MMS). Normalmente cada modo ejecuta una parte de código distinto. En un momento dado el sistema, que está en un modo concreto, puede ser cambiado a otro modo distinto como resultado de alguna condicion impuesta previamente. Los mecanismos de cambio de modo (o protocolos de cambio de modo) son usados para mover el sistema de un modo a otro durante el tiempo de ejecución. En este trabajo se ha usado un modelo de sistema operativo para implementar un sistema multimodo llamado MMHSF, siglas en inglés correspondientes a (Multi-Mode Hierarchical Scheduling Framework). Este sistema está basado en el HSF (Hierarchical Scheduling Framework), un modelo de sistema operativo con jerarquía de dos niveles, implementado en un sistema operativo en tiempo real de libre distribución llamado FreeRTOS, capaz de permitir el aislamiento temporal entre componentes. La principal contribución de este trabajo es la ampliación del HSF convirtiendolo en un sistema multimodo realizando los cambios mínimos necesarios sobre el sistema operativo FreeRTOS y la implementación ya existente del HSF. Esta implementación usa un sistema de planificación de prioridad fija para ambos niveles de jerarquía, ocupando el tiempo entre tareas con un “modo reposo”. Además el sistema es capaz de cambiar de un modo a otro en tiempo de ejecución. Cada subsistema y tarea son capaces de tener distintos atributos de tiempo (prioridad, periodo y tiempo de ejecución) en función del modo. Bajo una demanda de cambio de modo (Mode Change Request MCR) se puede variar el set de tareas en ejecución, así como los atributos de los servidores y las tareas. Un protocolo de cambio de modo espeficica precisamente cómo será cambiado el sistema de un modo a otro. Sin embargo una aplicación puede requerir no solo un cambio de modo, sino que lo haga de una forma especifica. Por ejemplo, el cambio de modo de “normal” a “apagado” puede permitir a las tareas en ejecución ser finalizadas antes de que se complete la transición, pero sin embargo el cambio de “normal” a “emergencia” puede requerir abortar todas las tareas instantaneamente. En este trabajo ambas características, tanto el modo como el protocolo de cambio, pueden ser cambiadas en tiempo de ejecución, pero deben ser previamente definidas por el desarrollador. Han sido definidos tres protocolos de cambios: el protocolo “suspender/continuar”, protocolo “abortar” y el protocolo “completar”. Estos protocolos incrementan la flexibilidad del sistema, permitiendo al usuario seleccionar de que forma quieren cambiar hacia el nuevo modo. La implementación del MMHSF ha sido testada y evaluada en una placa AVR EVK1100, con un micro-controlador AVR32UC3A0. Se ha comprobado el comportamiento de los distintos modos para los distintos protocolos, definidos previamente. Como resultado se proporcionan las medidades de rendimiento de los distintos protocolos de cambio de modo.
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La usabilidad es un atributo de calidad de un sistema software que llega a ser crítico en sistemas altamente interactivos. Desde el campo de la Interacción Persona-Ordenador se proponen recomendaciones que permiten alcanzar un nivel adecuado de usabilidad en un sistema. En la disciplina de la Ingeniería de Software se ha establecido que algunas de estas recomendaciones afectan a la funcionalidad principal de los sistemas y no solo a la interfaz de usuario. Este tipo de recomendaciones de usabilidad se deben tener en cuenta desde las primeras actividades y durante todo el proceso de desarrollo, así como se hace con atributos tales como la seguridad, la facilidad de mantenimiento o el rendimiento. Desde la Ingeniería de Software se han hecho estudios y propuestas para abordar la usabilidad en las primeras actividades del desarrollo. En particular en la educción de requisitos y diseño de la arquitectura. Estas propuestas son de un alto nivel de abstracción. En esta investigación se aborda la usabilidad en actividades avanzadas del proceso de desarrollo: el diseño detallado y la programación. El objetivo de este trabajo es obtener, formalizar y validar soluciones reutilizables para la usabilidad en estas actividades. En este estudio se seleccionan tres funcionalidades de usabilidad identificadas como de alto impacto en el diseño: Abortar Operación, Retroalimentación de Progreso y Preferencias. Para la obtención de elementos reutilizables se utiliza un método inductivo. Se parte de la construcción de aplicaciones web particulares y se induce una solución general. Durante la construcción de las aplicaciones se mantiene la trazabilidad de los elementos relacionados con cada funcionalidad de usabilidad. Al finalizar se realiza un análisis de elementos comunes, y los hallazgos se formalizan como patrones de diseño orientados a la implementación y patrones de programación en cada uno de los lenguajes utilizados: PHP, VB .NET y Java. Las soluciones formalizadas como patrones se validan usando la metodología de estudio de casos. Desarrolladores independientes utilizan los patrones para la inclusión de las tres funcionalidades de usabilidad en dos nuevas aplicaciones web. Como resultado, los desarrolladores pueden usar con éxito las soluciones propuestas para dos de las funcionalidades: Abortar Operación y Preferencias. La funcionalidad Retroalimentación de Progreso no puede ser implementada completamente. Se concluye que es posible obtener elementos reutilizables para la implementación de cada funcionalidad de usabilidad. Estos elementos incluyen: escenarios de aplicación, que son la combinación de casuísticas que generan las funcionalidades de usabilidad, responsabilidades comunes necesarias para cubrir los escenarios, componentes comunes para cumplir con las responsabilidades, elementos de diseño asociados a los componentes y el código que implementa el diseño. Formalizar las soluciones como patrones resulta útil para comunicar los hallazgos a otros desarrolladores y los patrones se mejoran a través de su utilización en nuevos desarrollos. La implementación de funcionalidades de usabilidad presenta características que condicionan su reutilización, en particular, el nivel de acoplamiento de la funcionalidad de usabilidad con las funcionalidades de la aplicación, y la complejidad interna de la solución. ABSTRACT Usability is a critical quality attribute of highly interactive software systems. The humancomputer interaction field proposes recommendations for achieving an acceptable system usability level. The discipline of software engineering has established that some of these recommendations affect not only the user interface but also the core system functionality. This type of usability recommendations must be taken into account as of the early activities and throughout the software development process as in the case of attributes like security, ease of maintenance or performance. Software engineering has conducted studies and put forward proposals for tackling usability in the early development activities, particularly requirements elicitation and architecture design. These proposals have a high level of abstraction. This research addresses usability in later activities of the development process: detailed design and programming. The goal of this research is to discover, specify and validate reusable usability solutions for detailed design and programming. Abort Operation, Feedback and Preferences, three usability functionalities identified as having a high impact on design, are selected for the study. An inductive method, whereby a general solution is induced from particular web applications built for the purpose, is used to discover reusable elements. During the construction of the applications, the traceability of the elements related to each usability functionality is maintained. At the end of the process, the common and possibly reusable elements are analysed. The findings are specified as implementation-oriented design patterns and programming patterns for each of the languages used: PHP, VB .NET and Java. The solutions specified as patterns are validated using the case study methodology. Independent developers use the patterns in order to build the three usability functionalities into two new web applications. As a result, the developers successfully use the proposed solutions for two of the functionalities: Abort Operation and Preferences. The Progress Feedback functionality cannot be fully implemented. We conclude that it is possible to discover reusable elements for implementing each usability functionality. These elements include: application scenarios, which are combinations of cases that generate usability functionalities, common responsibilities to cover the scenarios, common components to fulfil the responsibilities, design elements associated with the components and code implementing the design. It is useful to specify solutions as patterns in order to communicate findings to other developers, and patterns improve through further use in other development projects. Reusability depends on the features of usability functionality implementation, particularly the level of coupling of the usability functionality with the application functionalities and the internal complexity of the solution.
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La calidad es uno de los principales retos de la construcción de software. En la Ingeniería del Software (IS) se considera a la usabilidad como un atributo de calidad. Al principio se veía a la usabilidad como un requisito no funcional.Se asumía que la usabilidad era una propiedad exclusiva de la presentación de la información.Se creía que separando la capa de presentación del resto, se podía desarrollar un producto software usable.Debido a la naturaleza del sistema y a las necesidades del usuario, a menudo se debe ir más lejos y no basta con tener en cuenta la presentación para obtener un software usable. La comunidad de la Interacción Personar Ordenador (IPO) ha propuesto recomendaciones para mejorar la usabilidad. Algunas de esas recomendaciones tienen impacto directo en la funcionalidad del producto software. En estudios recientes también se ha evaluado la relación entre la usabilidad y los requisitos funcionales. Estas investigaciones sugieren que la usabilidad debe ser tenida en cuenta desde las etapas iniciales de la construcción para evitar costosos cambios posteriores. La incorporación de las características de usabilidad agrega cierta complejidad al proceso de desarrollo. El presente trabajo evalúa la posibilidad de usar patrones para la incorporación de usabilidad en el desarrollo de un producto software. Concretamente se evalúan los siguientes patrones de programación de usabilidad (PPUs): Abort Operation,Progress Feedback y Preferences. Se utilizan unas Pautas de Desarrollo de Mecanismos de Usabilidad(PDMUs) para estos tres mecanismos de usabilidad. Estas pautas poponen patrones para la educción y posterior incorporación de la usabilidad en las distintas fases de la programación. En esta investigación se aborda el desarrollo de un producto software desde la deducción de requisitos hasta la implementación. En cada fase se incorporan los mecanismos de usabilidad de acuerdo a las recomendaciones de las PDMUs. Mediante el desarrollo de un software real se ha evaluado la factibilidad del uso de las PDMUs obteniendo como resultado propuestas de mejoras en estas pautas. Se evalúa asimismo el esfuerzo de incorporación de los mecanismos de usabilidad. Cada evaluación aporta datos que proporcionan una estimación del esfuerzo adicional requerido para incorporar cada mecanismo de usabilidad en el proceso de desarrollo del software.---ABSTRACT---Quality is a major challenge in software construction. Software engineers consider usability to be a quality attribute. Originally, usability was viewed as a nonr functional requirement. Usability was assumed to be simply an information presentation property. There was a belief that a usable software product could be developed by separating the presentation layer from the rest of the system. Depending on the system type and user needs, however, usability often runs deeper, and it is not enough to consider just presentation to build usable software. The humanrcomputer interaction (HCI) community put forward a list of recommendations to improve usability. Some such recommendations have a direct impact on software product functionality. Recent studies have also evaluated the relationship between usability and functional requirements. This research suggests that usability should be taken into account as of the early stages of software construction to prevent costly rework later on. The inclusion of usability features is an added complication to the development process. The research reported here evaluates the possibility of using patterns to incorporate usability into a software product. Specifically, it evaluates the following usability programming patterns (UPPs): Abort Operation, Progress Feedback and Preferences. Usability Mechanism Development Guides (USDG) are applied to these three usability mechanisms. These guides propose patterns for eliciting and later incorporating usability into the different software development phases, including programming. The reported research addresses the development of a software product from requirements elicitation through to implementation. Usability mechanisms are incorporated into each development phase in accordance with USDG recommendations. A real piece of software was developed to test the feasibility of using USDGs, outputting proposals for improving the guides. Each evaluation yields data providing an estimate of the additional workload required to incorporate each usability mechanism into the software development process.
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We have reported some type II restriction-modification (RM) gene complexes on plasmids resist displacement by an incompatible plasmid through postsegregational host killing. Such selfish behavior may have contributed to the spread and maintenance of RM systems. Here we analyze the role of regulatory genes (C), often found linked to RM gene complexes, in their interaction with the host and the other RM gene complexes. We identified the C gene of EcoRV as a positive regulator of restriction. A C mutation eliminated postsegregational killing by EcoRV. The C system has been proposed to allow establishment of RM systems in new hosts by delaying the appearance of restriction activity. Consistent with this proposal, bacteria preexpressing ecoRVC were transformed at a reduced efficiency by plasmids carrying the EcoRV RM gene complex. Cells carrying the BamHI RM gene complex were transformed at a reduced efficiency by a plasmid carrying a PvuII RM gene complex, which shares the same C specificity. The reduction most likely was caused by chromosome cleavage at unmodified PvuII sites by prematurely expressed PvuII restriction enzyme. Therefore, association of the C genes of the same specificity with RM gene complexes of different sequence specificities can confer on a resident RM gene complex the capacity to abort establishment of a second, incoming RM gene complex. This phenomenon, termed “apoptotic mutual exclusion,” is reminiscent of suicidal defense against virus infection programmed by other selfish elements. pvuIIC and bamHIC genes define one incompatibility group of exclusion whereas ecoRVC gene defines another.
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The adeno-associated virus (AAV) genome integrates site specifically into a defined region of human chromosome 19 (termed AAVS1). Using a functional assay for AAV integration into AAVS1 DNA propagated as an episome, we obtained evidence that a 33-nucleotide AAVS1 DNA sequence contains the minimum signal required for targeted integration. The recombination signal comprises a DNA-binding motif for the AAV regulatory Rep protein [Rep binding site (RBS)] separated by an eight-nucleotide spacer from a sequence that can act as a substrate for Rep endonucleolytic activity [terminal resolution site (TRS)]. Mutations in either the AAVS1-encoded RBS or TRS elements abort targeted integration. Since both the RBS and TRS elements are present in the viral origin of replication and are required for AAV replication, targeted integration into chromosome 19 AAVS1 DNA may involve a replicative type of recombination that is discussed. An additional chromosome 19 element, which is responsible for DNA rearrangements in episomes propagating AAVS1 DNA, was identified and shown not to be required for AAV episomal integration, despite its location adjacent to the recombination signal.
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Immunization with Plasmodium sporozoites that have been attenuated by gamma-irradiation or specific genetic modification can induce protective immunity against subsequent malaria infection. The mechanism of protection is only known for radiation-attenuated sporozoites, involving cell-mediated and humoral immune responses invoked by infected hepatocytes cells that contain long-lived, partially developed parasites. Here we analyzed sporozoites of Plasmodium berghei that are deficient in P36p (p36p(-)), a member of the P48/45 family of surface proteins. P36p plays no role in the ability of sporozoites to infect and traverse hepatocytes, but p36p(-) sporozoites abort during development within the hepatocyte. Immunization with p36p(-) sporozoites results in a protective immunity against subsequent challenge with infectious wild-type sporozoites, another example of a specifically genetically attenuated sporozoite (GAS) conferring protective immunity. Comparison of biological characteristics of p36p(-) sporozoites with radiation-attenuated sporozoites demonstrates that liver cells infected with p36p(-) sporozoites disappear rapidly as a result of apoptosis of host cells that may potentiate the immune response. Such knowledge of the biological characteristics of GAS and their evoked immune responses are essential for further investigation of the utility of an optimized GAS-based malaria vaccine.
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At head of title: Hygiea; medicinsk och farmacevtisk mȧnadsskrift utgiften af Svenska läkaresällskapet.
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Imprint varies.
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Large read-only or read-write transactions with a large read set and a small write set constitute an important class of transactions used in such applications as data mining, data warehousing, statistical applications, and report generators. Such transactions are best supported with optimistic concurrency, because locking of large amounts of data for extended periods of time is not an acceptable solution. The abort rate in regular optimistic concurrency algorithms increases exponentially with the size of the transaction. The algorithm proposed in this dissertation solves this problem by using a new transaction scheduling technique that allows a large transaction to commit safely with significantly greater probability that can exceed several orders of magnitude versus regular optimistic concurrency algorithms. A performance simulation study and a formal proof of serializability and external consistency of the proposed algorithm are also presented.^ This dissertation also proposes a new query optimization technique (lazy queries). Lazy Queries is an adaptive query execution scheme which optimizes itself as the query runs. Lazy queries can be used to find an intersection of sub-queries in a very efficient way, which does not require full execution of large sub-queries nor does it require any statistical knowledge about the data.^ An efficient optimistic concurrency control algorithm used in a massively parallel B-tree with variable-length keys is introduced. B-trees with variable-length keys can be effectively used in a variety of database types. In particular, we show how such a B-tree was used in our implementation of a semantic object-oriented DBMS. The concurrency control algorithm uses semantically safe optimistic virtual "locks" that achieve very fine granularity in conflict detection. This algorithm ensures serializability and external consistency by using logical clocks and backward validation of transactional queries. A formal proof of correctness of the proposed algorithm is also presented. ^
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We present our approach to real-time service-oriented scheduling problems with the objective of maximizing the total system utility. Different from the traditional utility accrual scheduling problems that each task is associated with only a single time utility function (TUF), we associate two different TUFs—a profit TUF and a penalty TUF—with each task, to model the real-time services that not only need to reward the early completions but also need to penalize the abortions or deadline misses. The scheduling heuristics we proposed in this paper judiciously accept, schedule, and abort real-time services when necessary to maximize the accrued utility. Our extensive experimental results show that our proposed algorithms can significantly outperform the traditional scheduling algorithms such as the Earliest Deadline First (EDF), the traditional utility accrual (UA) scheduling algorithms, and an earlier scheduling approach based on a similar model.
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Abstract How employees make sense of change is a very complex process. Recently, academics have neglected to research sense making activities in a micro culture implementation context, through the eyes of front line employees. In contrast to a macro view, a micro perspective limits researchers to only look at an individual, departmental or group level. By doing so, we can zoom in on the details of sense making processes that employees use in their daily work life. A macro (organisational) view is based on the notion that there is a general integrated culture that can be found in all organisational units and departments. It is assumed that culture can be researched by using the entire organisation as one single research entity. This thesis challenges this assumption. In case of planned change it is usually the management community who are in charge of the change intervention. Because of their formal hierarchical position, they have the power to abort or initiate change programs. It is perhaps therefore that researchers tend to be focused on the management community rather than on lower level organisational members, such as front line employees. Apart from the micro view, scholars also neglected to research culture change implementation through the eyes of front line employees. This thesis is an attempt to fill these two gaps that currently exists in academic change management publications. The main research question is therefore: From a micro point of view how do front-line employees make sense of the impact of culture change, during the implementation phase? This thesis starts with a literature review which exposes the two main gaps. The most important outcome of this review is that only 2% of the research articles dealt with culture implementation, through the eyes of front line employees. A conceptual research model is built on the integrated sense making theory of Weber and Manning (2001) and the micro variables of Raelin and Cataldo (2011). These theories emphasize elements of sense making in a daily working context. It is likely that front line employees can identify themselves with research elements such as tasks, skills practices, involvement and behaviour. Front line employees were selected, because as lower level organisational members they are usually the change recipients. They are further away from the change initiating scene (usually the management of an organisation) and form a potential sense making ‘hotspot’ that could provide new academic insights. In order to carry out the primary research, two case organisations were selected in the leisure industry. A participative case study research method was chosen. This meant that the researcher worked in the concerning departments of the case organisations. The goal was to observe and interview front line employees, while they were performing their jobs. The most important advantage of this approach is that the researcher temporarily becomes one with the organisation and is therefore able to acquire both formal and informal narratives that front line employees use during sense making activities. It was found that front line employees make sense of organisational change by using a practical approach. They make sense of the change program by carrying out new tasks, developing new skills and sharing best practices. The most noticeable conclusion was that sense making activities predominantly take place at an individual level in relation to change acceptance. Organisational members tend to create a mental equation in order to weigh the advantages against the disadvantages. They evaluate whether the concerning change program is beneficial to them or not. For future research a sense making scheme model is suggested that is based on two methods: an introspection and an action method.
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Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassifi cation. Findings Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1–3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5–2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6–40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7–1·9 million) in 2005, to 1·2 million deaths (1·1–1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued eff orts from governments and international agencies in the next 15 years to end AIDS by 2030.