867 resultados para Availability and efficiency
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OBJECTIVES In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries. METHODS AND FINDINGS We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%). CONCLUSIONS Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.
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It is not known how naive B cells compute divergent chemoattractant signals of the T-cell area and B-cell follicles during in vivo migration. Here, we used two-photon microscopy of peripheral lymph nodes (PLNs) to analyze the prototype G-protein-coupled receptors (GPCRs) CXCR4, CXCR5, and CCR7 during B-cell migration, as well as the integrin LFA-1 for stromal guidance. CXCR4 and CCR7 did not influence parenchymal B-cell motility and distribution, despite their role during B-cell arrest in venules. In contrast, CXCR5 played a nonredundant role in B-cell motility in follicles and in the T-cell area. B-cell migration in the T-cell area followed a random guided walk model, arguing against directed migration in vivo. LFA-1, but not α4 integrins, contributed to B-cell motility in PLNs. However, stromal network guidance was LFA-1 independent, uncoupling integrin-dependent migration from stromal attachment. Finally, we observed that despite a 20-fold reduction of chemokine expression in virus-challenged PLNs, CXCR5 remained essential for B-cell screening of antigen-presenting cells. Our data provide an overview of the contribution of prototype GPCRs and integrins during naive B-cell migration and shed light on the local chemokine availability that these cells compute.
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A simple technique was developed to measure the bacteriolytic activities of the digestive fluids of the deposit-feeding polychaete Arenicola marina. Lysis of a cultured environmental isolate, incubated with extracts of gut luminal contents, was monitored spectrophotometrically. Concurrent direct counts were used to verify cell lysis. The ability of extracts from 8 longitudinal sections of the gut to lyse the bacterium was monitored. The digestive ceca, anterior stomach, and posterior stomach regions exhibited high lytic activities, whereas bacteriolytic activities in all other regions of the gut were negligible. Similarly, extracts of surface sediments and fecal castings showed negligible lytic capabilities. The sharply limited distribution of lytic activity implicates the ceca as the source of bacteriolytic agent and suggests a true plug-flow system, with little axial mixing. Questions regarding the fate of lytic agents, which disappear abruptly posterior to the stomach, remain unanswered. Localization of lysis in the gut coupled with estimates of gut residence time permit the calculation that ingested bacteria are exposed to strong lytic activity for approximately 20 min. Incubation of in situ sediment samples with gut fluids corroborates the distributional findings of the in vitro work although the efficiency of lysis is much reduced, possibly due to exopolymer capsules and slimes of natural sedimentary bacteria. Cross-phyletic comparisons of bacteriolytic activities reveal both qualitative and quantitative differences. Much less demarcation of lytic activity is observed in the guts of a holothuroid (Caudina arenata) and a hemichordate (Stereobalanus canadensis), with a pattern more similar to that of A. marina observed in another polychaete, Amphitrite johnstoni. Quantitatively, the polychaetes showed higher levels of activity with rates in A. marina exceeding those of the hemichordate and holothuroid by more than 10-fold.
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Comparing published NAVD 88 Helmert orthometric heights of First-Order bench marks against GPS-determined orthometric heights showed that GEOID03 and GEOID09 perform at their reported accuracy in Connecticut. GPS-determined orthometric heights were determined by subtracting geoid undulations from ellipsoid heights obtained from a network least-squares adjustment of GPS occupations in 2007 and 2008. A total of 73 markers were occupied in these stability classes: 25 class A, 11 class B, 12 class C, 2 class D bench marks, and 23 temporary marks with transferred elevations. Adjusted ellipsoid heights were compared against OPUS as a check. We found that: the GPS-determined orthometric heights of stability class A markers and the transfers are statistically lower than their published values but just barely; stability class B, C and D markers are also statistically lower in a manner consistent with subsidence or settling; GEOID09 does not exhibit a statistically significant residual trend across Connecticut; and GEOID09 out-performed GEOID03. A "correction surface" is not recommended in spite of the geoid models being statistically different than the NAVD 88 heights because the uncertainties involved dominate the discrepancies. Instead, it is recommended that the vertical control network be re-observed.
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India's public sector banks (PSBs) are compared unfavorably with their private sector counterparts, domestic and foreign. This comparison rests, for the most part, on financial measures of performance, and such a comparison provides much of the rationale for privatization of PSBs.In this paper, we attempt a comparison between PSBs and their private sector counterparts based on measures of productivity that use quantities of outputs and inputs. We employ two measures of productivity: Tornqvist and Malmquist total factor productivity growth. We attempt these comparisons over the period 1992-2000, comparing PSBs with both domestic private and foreign banks. Out of a total of four comparisons we have made, there are no differences in three cases, PSBs do better in two, and foreign banks in one. To put it differently, PSBs are seen to be at a disadvantage in only one out of six comparisons. It is difficult, therefore, to sustain the proposition that efficiency and productivity have been lower in public sector banks relative to their peers in the private sector.
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This paper empirically estimates and analyzes various efficiency scores of Indian banks during 1997-2003 using data envelopment analysis (DEA). During the 1990s India's financial sector underwent a process of gradual liberalization aimed at strengthening and improving the operational efficiency of the financial system. It is observed, none the less, that Indian banks are still not much differentiated in terms of input or output oriented technical efficiency and cost efficiency. However, they differ sharply in respect of revenue and profit efficiencies. The results provide interesting insight into the empirical correlates of efficiency scores of Indian banks. Bank size, ownership, and the fact of its being listed on the stock exchange are some of the factors that are found to have positive impact on the average profit efficiency and to some extent revenue efficiency scores are. Finally, we observe that the median efficiency scores of Indian banks in general and of bigger banks in particular have improved considerably during the post-reform period.
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Widely publicized reports of fresh MBAs getting multiple job offers with six-figure annual salaries leave a long-lasting general impression about the high quality of selected business schools. While such spectacular achievement in job placement rightly deserves recognition, one should not lose sight of the resources expended in order to accomplish this result. In this study, we employ a measure of Pareto-Koopmans global efficiency to evaluate the efficiency levels of the MBA programs in Business Week's top-rated list. We compute input- and output-oriented radial and non-radial efficiency measures for comparison. Among three tier groups, the schools from a higher tier group on average are more efficient than those from lower tiers, although variations in efficiency levels do occur within the same tier, which exist over different measures of efficiency.
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Preventable Hospitalizations (PHs) are hospitalizations that can be avoided with appropriate and timely care in the ambulatory setting and hence are closely associated with primary care access in a community. Increased primary care availability and health insurance coverage may increase primary care access, and consequently may be significantly associated with risks and costs of PHs. Objective. To estimate the risk and cost of preventable hospitalizations (PHs); to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs, first alone and then simultaneously; and finally, to estimate the impact of expansions in primary care availability and health insurance coverage on the burden of PHs among non-elderly adult residents of Harris County. Methods. The study population was residents of Harris County, age 18 to 64, who had at least one hospital discharge in a Texas hospital in 2008. The primary independent variables were availability of primary care physicians, availability of primary care safety net clinics and health insurance coverage. The primary dependent variables were PHs and associated hospitalization costs. The Texas Health Care Information Collection (THCIC) Inpatient Discharge data was used to obtain information on the number and costs of PHs in the study population. Risk of PHs in the study population, as well as average and total costs of PHs were calculated. Multivariable logistic regression models and two-step Heckman regression models with log-transformed costs were used to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs respectively, while controlling for individual predisposing, enabling and need characteristics. Predicted PH risk and cost were used to calculate the predicted burden of PHs in the study population and the impact of expansions in primary care availability and health insurance coverage on the predicted burden. Results. In 2008, hospitalized non-elderly adults in Harris County had 11,313 PHs and a corresponding PH risk of 8.02%. Congestive heart failure was the most common PH. PHs imposed a total economic burden of $84 billion at an average of $7,449 per PH. Higher primary care safety net availability was significantly associated with the lower risk of PHs in the final risk model, but only in the uninsured. A unit increase in safety net availability led to a 23% decline in PH odds in the uninsured, compared to only a 4% decline in the insured. Higher primary care physician availability was associated with increased PH costs in the final cost model (β=0.0020; p<0.05). Lack of health insurance coverage increased the risk of PH, with the uninsured having 30% higher odds of PHs (OR=1.299; p<0.05), but reduced the cost of a PH by 7% (β=-0.0668; p<0.05). Expansions in primary care availability and health insurance coverage were associated with a reduction of about $1.6 million in PH burden at the highest level of expansion. Conclusions. Availability of primary care resources and health insurance coverage in hospitalized non-elderly adults in Harris County are significantly associated with the risk and costs of PHs. Expansions in these primary care access factors can be expected to produce significant reductions in the burden of PHs in Harris County.^
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Ocean acidification, the assimilation of atmospheric CO2 by the oceans that decreases the pH and CaCO3 saturation state (Omega) of seawater, is projected to have severe adverse consequences for calcifying organisms. While strong evidence suggests calcification by tropical reef-building corals containing algal symbionts (zooxanthellae) will decline over the next century, likely responses of azooxanthellate corals to ocean acidification are less well understood. Because azooxanthellate corals do not obtain photosynthetic energy from symbionts, they provide a system for studying the direct effects of acidification on energy available for calcification. The solitary azooxanthellate orange cup coral Balanophyllia elegans often lives in low-pH, upwelled waters along the California coast. In an 8-month factorial experiment, we measured the effects of three pCO2 treatments (410, 770, and 1220 µatm) and two feeding frequencies (3-day and 21-day intervals) on "planulation" (larval release) by adult B. elegans, and on the survival, skeletal growth, and calcification of newly settled juveniles. Planulation rates were affected by food level but not pCO2. Juvenile mortality was highest under high pCO2 (1220 µatm) and low food (21-day intervals). Feeding rate had a greater impact on calcification of B. elegans than pCO2. While net calcification was positive even at 1220 µatm (~3 times current atmospheric pCO2), overall calcification declined by ~25-45%, and skeletal density declined by ~35-45% as pCO2 increased from 410 to 1220 µatm. Aragonite crystal morphology changed at high pCO2, becoming significantly shorter but not wider at 1220 µatm. We conclude that food abundance is critical for azooxanthellate coral calcification, and that B. elegans may be partially protected from adverse consequences of ocean acidification in habitats with abundant heterotrophic food.
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This paper presents and proves some fundamental results for independent and-parallelism (IAP). First, the paper treats the issues of correctness and efficiency: after defining strict and non-strict goal independence, it is proved that if strictly independent goals are executed in parallel the solutions obtained are the same as those produced by standard sequential execution. It is also shown that, in the absence of failure, the parallel proof procedure doesn't genérate any additional work (with respect to standard SLDresolution) while the actual execution time is reduced. The same results hold even if non-strictly independent goals are executed in parallel, provided a trivial rewriting of such goals is performed. In addition, and most importantly, treats the issue of compile-time generation of IAP by proposing conditions, to be written at compile-time, to efficiently check strict and non-strict goal independence at run-time and proving the sufficiency of such conditions. It is also shown how simpler conditions can be constructed if some information regarding the binding context of the goals to be executed in parallel is available to the compiler trough either local or program-level analysis. These results therefore provide a formal basis for the automatic compile-time generation of IAP. As a corollary of such results, the paper also proves that negative goals are always non-strictly independent, and that goals which share a first occurrence of an existential variable are never independent.
Availability and uptake of trace elements in a forage rotation under conservation and plough tillage
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After 14 years under conventional plough tillage (CT) or conservation minimum tillage (MT), the soil available Al, Fe, Mn, Cu and Zn (0-5, 5-15 and 15-30 cm layers) and their plant uptake were evaluated during two years in a ryegrass-maize forage rotation in NW Spain (t emperate-humid region). The three-way ANOVA showed that trace element concentrations in soil were mainly influenced by sampling date, followed by soil depth and tillage system (35-73 %, 7-58 % and 3- 11 % of variance explained, respectively). Excepting for Fe (CT) and Al (CT and MT), the elemental concentrations decreased with depth, the stratification being stronger under MT. For soil available Al, Fe, Mn and Cu, the concentrations were higher in CT than in MT (5-15 and 15-30 cm layers) or were not affected by tillage system (0-5 cm). In contrast, the available Zn contents were higher in MT than CT at the soil surface and did not differ in deeper layers. The concentration of Al, Fe and Cu in crops were not influenced by tillage system, which explain 22 % of Mn variance in maize (CT > MT in the more humid year) and 18 % of Zn variance in ryegrass (MT > CT in both years). However, in the summer crop (maize) the concentrations of Fe, Mn and Zn tended to be higher in MT than in CT under drought conditions, while the opposite was true in the year without water limitation. Therefore, under the studied conditions of climate, soil, tillage and crop rotation, little influence of tillage system on crop nutritive value would be expected. To minimize the potential deficiency of Zn (maize) and Cu (maize and ryegrass) on crop yields the inclusion of these micro-nutrients in fertilization schedule is reco mmended, as well as liming to alleviate Al toxicity on maize crops.
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Long-term conservation tillage can modify vertical distribution of nutrients in soil profiles and alter nutrient availability and yields of crops.
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Funded by Natural Research Limited Natural Environment Research Council studentship. Grant Numbers: NE/J500148/1, NE/F021402/1