A comparison of three hearing aid manufacturers' recommended first fit to two generic prescriptive targets with the pediatric population

The purpose of this study is to compare three hearing aid manufacturers' recommended "First Fit" to the generic recommended fittings by DSL i/o and NAL-NL1 for a 12 month old child with varying degrees of sensorineural hearing loss.

Cross-cultural comparison of three medicinal floras and implications for bioprospecting strategies

Ethnopharmacological relevance One of the major drawbacks of using ethnomedicinal data to direct testing of plants which may find pharmaceutical use is that certain plants without bioactivity might be traditionally used. An accepted way of highlighting bioactive plants is to compare usage in different cultures. This approach infers that presumed independent discovery by different cultures provides evidence for bioactivity. Although several studies have made cross-cultural comparisons, they focussed on closely related cultures, where common patterns might be the result of common cultural traditions. The aim of this study was to compare three independent ethnomedicinal floras for which similarities can be more robustly interpreted as independent discoveries, and therefore likely to be indication for efficacy. Materials and methods Data from the literature were compiled about the ethnomedicinal floras for three groups of cultures (Nepal, New Zealand and the Cape of South Africa), selected to minimise historical cultural exchange. Ethnomedicinal applications were divided in 13 categories of use. Regression and binomial analyses were performed at the family level to highlight ethnomedicinal “hot” families. General and condition-specific analyses were carried out. Results from the three regions were compared. Results Several “hot” families (Anacardiaceae, Asteraceae, Convolvulaceae, Clusiaceae, Cucurbitaceae, Euphorbiaceae, Geraniaceae, Lamiaceae, Malvaceae, Rubiaceae, Sapindaceae, Sapotaceae and Solanaceae) were recovered in common in the general analyses. Several families were also found in common under different categories of use. Conclusions Although profound differences are found in the three ethnomedicinal floras, common patterns in ethnomedicinal usage are observed in widely disparate areas of the world with substantially different cultural traditions. As these similarities are likely to stem from independent discoveries, they strongly suggest that underlying bioactivity might be the reason for this convergent usage. The global distribution of prominent usage of families used in common obtained by this study and the wider literature is strong evidence that these families display exceptional potential for discovery of previously overlooked or new medicinal plants and should be placed in high priority in bioscreening studies and conservation schemes.

“There’s something very familiar about all this”: generic play and performance in the Back to the Future trilogy (Robert Zemeckis, 1985, 1989, 1990)

The Back to the Future Trilogy incorporates several different generic elements, including aspects of the fifties teen movie, science fiction, comedy and the western. These different modes playfully intertwine with each other creating a complex world of repetitions, echoes and modulations. This essay seeks to interrogate the construction of generic elements and the play between them through a close analysis of a repeated performance. Genre is signalled through various strategies employed within the construction of mise-en-scène, a significant portion of this, as I would like to argue, is transmitted through performance. The material detail of a performance – incorporating gesture, movement, voice, and even surrounding elements such as costume – as well as the way it its presented within a film is key to the establishment, invocation and coherence of genre. Furthermore, attention to the complexity of performance details, particularly in the manner in which they reverberate across texts, demonstrates the intricacy of genre and its inherent mutability. The Back to the Future trilogy represents a specific interest in the flexibility of genre. Within each film, and especially across all three, aspects of various genres are interlaced through both visual and narrative detail, thus constructing a dense layer of references both within and without the texts. To explore this patterning in more detail I will interrogate the contribution of performance to generic play through close analysis of Thomas F. Wilson’s performance of Biff/Griff/Burford Tannen and his central encounter with Marty McFly (Michael J. Fox) in each film. These moments take place in a fifties diner, a 1980s retro diner and a saloon respectively, each space contributing the similarities and differences in each repetition. Close attention to Wilson’s performance of each related character, which contains both modulations and repetitions used specifically to place each film’s central generic theme, demonstrates how embedded the play between genres and their flexibility is within the trilogy.

Life-history strategies associated to reproduction of three Hyphessobrycon species (Characidae) in lentic environments of upper Paraná River basin

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Three Strategies for Promoting Intellectual Engagement in Advanced Undergraduate Seminars

With the humanities increasingly contested, we must adopt pedagogical approaches that promote the integral role of humanistic inquiry in student academic achievement. Whether they explore the eighteenth-century novel, cultural artifacts of the Third Republic, or sociopolitical controversies in contemporary literature, the three models described in this article propose innovative learning strategies for advanced undergraduate French and Francophone Studies seminars that fulfill the humanistic goals of the American university. From directed close reading exercises to analysis of the historical archive to creative exploratory writing, these activities engage students intellectually with complex cultural and narrative materials from diverse traditions and periods.

Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models

Background: WHO's 2013 revisions to its Consolidated Guidelines on antiretroviral drugs recommend routine viral load monitoring, rather than clinical or immunological monitoring, as the preferred monitoring approach on the basis of clinical evidence. However, HIV programmes in resource-limited settings require guidance on the most cost-effective use of resources in view of other competing priorities such as expansion of antiretroviral therapy coverage. We assessed the cost-effectiveness of alternative patient monitoring strategies. Methods: We evaluated a range of monitoring strategies, including clinical, CD4 cell count, and viral load monitoring, alone and together, at different frequencies and with different criteria for switching to second-line therapies. We used three independently constructed and validated models simultaneously. We estimated costs on the basis of resource use projected in the models and associated unit costs; we quantified impact as disability-adjusted life years (DALYs) averted. We compared alternatives using incremental cost-effectiveness analysis. Findings: All models show that clinical monitoring delivers significant benefit compared with a hypothetical baseline scenario with no monitoring or switching. Regular CD4 cell count monitoring confers a benefit over clinical monitoring alone, at an incremental cost that makes it affordable in more settings than viral load monitoring, which is currently more expensive. Viral load monitoring without CD4 cell count every 6—12 months provides the greatest reductions in morbidity and mortality, but incurs a high cost per DALY averted, resulting in lost opportunities to generate health gains if implemented instead of increasing antiretroviral therapy coverage or expanding antiretroviral therapy eligibility. Interpretation: The priority for HIV programmes should be to expand antiretroviral therapy coverage, firstly at CD4 cell count lower than 350 cells per μL, and then at a CD4 cell count lower than 500 cells per μL, using lower-cost clinical or CD4 monitoring. At current costs, viral load monitoring should be considered only after high antiretroviral therapy coverage has been achieved. Point-of-care technologies and other factors reducing costs might make viral load monitoring more affordable in future. Funding: Bill & Melinda Gates Foundation, WHO.

STRATEGIES FOR THE TRANSFER OF APPROPRIATE TECHNOLOGY TO DEVELOPING COUNTRIES: THE IMPLEMENTATION AND DEVELOPMENT OF ENVIRONMENTAL HEALTH PROGRAMS IN TUNISIA

This dissertation focuses on Project HOPE, an American medical aid agency, and its work in Tunisia. More specifically this is a study of the implementation strategies of those HOPE sponsored projects and programs designed to solve the problems of high morbidity and infant mortality rates due to environmentally related diarrheal and enteric diseases. Several environmental health programs and projects developed in cooperation with Tunisian counterparts are described and analyzed. These include (1) a paramedical manpower training program; (2) a national hospital sanitation and infection control program; (3) a community sewage disposal project; (4) a well reconstruction project; and (5) a solid-waste disposal project for a hospital.^ After independence, Tunisia, like many developing countries, encountered several difficulties which hindered progress toward solving basic environmental health problems and prompted a request for aid. This study discusses the need for all who work in development programs to recognize and assess those difficulties or constraints which affect the program planning process, including those latent cultural and political constraints which not only exist within the host country but within the aid agency as well. For example, failure to recognize cultural differences may adversely affect the attitudes of the host staff towards their work and towards the aid agency and its task. These factors, therefore, play a significant role in influencing program development decisions and must be taken into account in order to maximize the probability of successful outcomes.^ In 1969 Project HOPE was asked by the Tunisian government to assist the Ministry of Health in solving its health manpower problems. HOPE responded with several programs, one of which concerned the training of public health nurses, sanitary technicians, and aids at Tunisia's school of public health in Nabeul. The outcome of that program as well as the strategies used in its development are analyzed. Also, certain questions are addressed such as, what should the indicators of success be, and when is the time right to phase out?^ Another HOPE program analyzed involved hospital sanitation and infection control. Certain generic aspects of basic hospital sanitation procedures were documented and presented in the form of a process model which was later used as a "microplan" in setting up similar programs in other Tunisian hospitals. In this study the details of the "microplan" are discussed. The development of a nation-wide program without any further need of external assistance illustrated the success of HOPE's implementation strategies.^ Finally, although it is known that the high incidence of enteric disease in developing countries is due to poor environmental sanitation and poor hygiene practices, efforts by aid agencies to correct these conditions have often resulted in failure. Project HOPE's strategy was to maximize limited resources by using a systems approach to program development and by becoming actively involved in the design and implementation of environmental health projects utilizing "appropriate" technology. Three innovative projects and their implementation strategies (including technical specifications) are described.^ It is advocated that if aid agencies are to make any progress in helping developing countries basic sanitation problems, they must take an interdisciplinary approach to progrm development and play an active role in helping counterparts seek and identify appropriate technologies which are socially and economically acceptable. ^

Strategies for dealing with personnel reductions in state mental health agencies : three case studies /

"National Institute of Mental Health"--Cover.