Lessons Learned From Transitioning PEPFAR Track 1.0 Care and Treatment Programs: Case Studies in Financial Management Capacity Building in Zambia and Botswana.

In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions

Development of a technical assistance framework for building organizational capacity of health programs in resource-limited settings

Background Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs. Methods Qualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation. Results Stakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework. Conclusions A systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs

Predicting death over 8 years in a prospective cohort of HIV-infected women: the Women's Interagency HIV Study.

ObjectivesPredicting mortality in middle-aged HIV-infected (HIV+) women on antiretroviral therapies (ART) is important for understanding the impact of HIV infection. Several health indices have been used to predict mortality in women with HIV infection. We evaluated: (1) an HIV biological index, Veterans Aging Cohort Study (VACS); (2) a physical index, Fried Frailty Index (FFI); and (3) a mental health index, Center for Epidemiologic Studies-Depression (CES-D). Proportional hazards regression analyses were used to predict death and included relevant covariates.DesignProspective, observational cohort.SettingMulticentre, across six sites in the USA.Participants1385 multirace/ethnic ART-experienced HIV+ women in 2005.Primary and secondary outcomesAll deaths, AIDS deaths and non-AIDS deaths up to ~8 years from baseline.ResultsIncluded together in one model, VACS Index was the dominant, significant independent predictor of all deaths within 3 years (HR=2.20, 95% CI 1.83, 2.65, χ2=69.04, p<0.0001), and later than 3 years (HR=1.55, 95% CI 1.30, 1.84, χ2=23.88, p<0.0001); followed by FFI within 3 years (HR=2.06, 95% CI 1.19, 3.57, χ2=6.73, p=0.01) and later than 3 years (HR=2.43, 95% CI 1.58, 3.75, χ2=16.18, p=0.0001). CES-D score was not independently associated with mortality.Conclusions and relevanceThis is the first simultaneous evaluation of three common health indices in HIV+ adults. Indices reflecting physical and biological ageing were associated with death

The structure and duplex context of DNA interstrand crosslinks affects the activity of DNA polymerase eta

Several important anti-tumor agents form DNA interstrand crosslinks (ICLs), but their clinical efficiency is counteracted by multiple complex DNA repair pathways. All of these pathways require unhooking of the ICL from one strand of a DNA duplex by nucleases, followed by bypass of the unhooked ICL by translesion synthesis (TLS) polymerases. The structures of the unhooked ICLs remain unknown, yet the position of incisions and processing of the unhooked ICLs significantly influence the efficiency and fidelity of bypass by TLS polymerases. We have synthesized a panel of model unhooked nitrogen mustard ICLs to systematically investigate how the state of an unhooked ICL affects pol eta activity. We find that duplex distortion induced by a crosslink plays a crucial role in translesion synthesis, and length of the duplex surrounding an unhooked ICL critically affects polymerase efficiency. We report the synthesis of a putative ICL repair intermediate that mimics the complete processing of an unhooked ICL to a single crosslinked nucleotide, and find that it provides only aminimal obstacle for DNA polymerases. Our results raise the possibility that, depending on the structure and extent of processing of an ICL, its bypass may not absolutely require TLS polymerases.ope

Influence of Marketing Mavens on Consumer Switching: Role of Personality

The aim of this paper is to relate the concept of Marketing Mavens with consumer switching. The Paper examines the influence of different personality factors based on different categories of Market Mavens on customer switching. Our research investigate the role Personality of Market Maven considering fivefactor model comprised of five personality dimensions (OCEAN), and Myer Briggs Type indicator (MBTI). MBTI, also known as four opposite pairs or dichotomies of personality dimensions, being one and other OCEAN, in our research are studied using different levels Involvement (High, Low) of consumer and Value of offering (High End/ Low End) associated with Consumer Switching. A Marketing Maven’s influence on a consumer will differ according to their personality with level of a consumer’s involvement and type of a product being offered based on its value. For Example, we suggest that Marketing Mavens who are having too much of information will tend to be perspective and not Judgmental. Similarly, for low end/low involvement products maven will be more of Sensing and Thinking Personality trait, but for high end products he will tend to be Intuitive and feeling and hence will influence Switching accordingly

Study of machine parameters in twin-screw extruder for pulses based extrudate

Legumes are prime source of plant proteins, calories and other nutrients. Extrusion cooking of legumes increases the digestibility of legume protein. Extrusion technology has been applied to generate analogues of foods made from animal products, as well as snacks using blends of various plant raw materials e.g. oil seeds [soybeans, peanut with a cereal flour]. Present work was under taken for producing extruded product from pigeon pea. The legumes viz. pigeon pea and Bengal gram were cleaned and ground to required particle size by multipurpose grinder mill to pass through sieve ASTM No. 20. The moisture content of sample was adjusted to 14% moisture level (w.b.). Before extrusion, the feed was allowed to come to ambient temperature and then remixed, after checking its moisture content. The twin-screw food extruder was used and then different extrudates were prepared using feed rate and feed moisture. The effect in incorporation of dehulled pigeon pea product character tics was studied. The bulk density and tapping density of pigeon pea flour was found to be 0.4809×10-3 g/mm3 and 0.719×10-3 g/mm3 respectively. Then the moisture content of pigeon pea flour was calculated and found to be 9.08% (w.b.) and different sample were prepared of 14% and 20% (w.b.). Now the thousand kernels was determined and found to be at average of 30.778. The dimension were taken on the basis of length, width, and thickness and calculated at the average of 4.47 mm, 4.221 mm, and 1.82 mm

Quinary Prevention and Lower Segment Cesarean Section

Lower segment cesarean section (LSCS) is a safe mode of delivery and has definite indications. However, at times, patients do not accept the advice to undergo elective or emergency LSCS, as appropriate. This leads to avoidable complications and cost. This communication discusses the style and salient features of counseling patients to understand and accept LSCS, as part of informed consent-taking. This discussion is geared towards obstetric care providers who encounter LSCS hesitancy in spite of having explained the indication(s) for surgery