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Improving influenza surveillance in sub-Saharan Africa
Steffen,C; Debellut,F; Gessner,BD; Kasolo,FC; Yahaya,AA; Ayebazibwe,N; Bassong,O; Cardoso,Y; Kebede,S; Manoncourt,S; Vandemaele,KA; Mounts,AW;
Bulletin of the World Health Organization , 2012, DOI: 10.1590/S0042-96862012000400014
Abstract: problem: little is known about the burden of influenza in sub-saharan africa. routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-saharan african populations. approach: a project known as strengthening influenza sentinel surveillance in africa (sisa) was launched in angola, cameroon, ghana, nigeria, rwanda, senegal, sierra leone and zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. these countries received technical support through remote supervision and onsite visits. consultants worked closely with health ministries, the world health organization, national influenza laboratories and other stakeholders involved in influenza surveillance local setting: influenza surveillance systems in the target countries were in different stages of development when sisa was launched. senegal, for instance, had conducted virological surveillance for years, whereas sierra leone had no surveillance activity at all. relevant changes: working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. lessons learnt: targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.
Improving Equipment Effectiveness Through TPM
M.M. Ravikumar,A. Bhaskar
International Business Management , 2012,
Abstract: In the present high stress, turbulent business environment well run organizations strive to continually to enhance their capabilities to create excellent value for the customers by improving the cost effectiveness of the operations. Maintenance is thus a vital support function in business, especially increasingly large investments are being required in physical assets. In this case, the line may be running, but it is not producing the quantity it should. Yield losses consist of losses due to rejects and poor start up behavior in the line producing the products. These losses leads to low values of the Overal Equipment s Effectiveness (OEE) which provides a n indication of how effective the production process is. TPM helps to raise the value of the OEE by supplying a structure to facilitate the assessment of those losses and subsequently giving priority to dealing with the more serious offenders. An application of TPM leads to both short and long term improvements. TPM seeks to encourage the setting of ambitious, but attainable goals for raising the value of the OEE and to measure any deviation in what is achieved relative to the original objective.
POSSIBILITIES OF IMPROVING THE METHODS AND TECHNIQUES USED IN THE SURVEILLANCE OF CREDIT RISK MANAGEMENT  [PDF]
Bolocan Mihail - Dragos,Balogh Peter
Annals of the University of Oradea : Economic Science , 2010,
Abstract: Through their daily activities, credit institutions are subject to various risks which could affect both the bank and the whole banking system, national and transnational. The activity field of the banks, marked by volatility, by the internationalization and liberalization of the financial markets, is in a continuous change. The contagion effect, as it has been proved by the spread of the financial crisis effects, determines the surveillance authorities to pay increased attention to the financial risks and implicitly to the systemic risk. In this study, to start with, there shall be presented some aspects regarding the banking rating systems used by the surveillance authorities and then some ways of improving the models of managing credit risk in banks. In the end, there will be demonstrated that the risk profile of the banking institution has a determining role in the management of the credit portfolio.
Modeling the Cost-Effectiveness of the Integrated Disease Surveillance and Response (IDSR) System: Meningitis in Burkina Faso  [PDF]
Zana C. Somda,Helen N. Perry,Nancy R. Messonnier,Mamadou H. Djingarey,Salimata Ouedraogo Ki,Martin I. Meltzer
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0013044
Abstract: Effective surveillance for infectious diseases is an essential component of public health. There are few studies estimating the cost-effectiveness of starting or improving disease surveillance. We present a cost-effectiveness analysis the Integrated Disease Surveillance and Response (IDSR) strategy in Africa.
Informed consent: time for more transparency
Yusuf Yazici, Hasan Yazici
Arthritis Research & Therapy , 2010, DOI: 10.1186/ar3004
Abstract: The World Health Organization has developed a single international standard for the information that authors of clinical trials must disclose [1]. The informed consent form (original or subsequent versions if the trial protocol necessitates) is not among the listed items. More recent schemes to expand registration of clinical trials also do not include full disclosure of informed consent forms [2,3]. We strongly feel that the exclusion of informed consent is a serious omission in our current attempt to make clinical trials more transparent; we give four specific reasons in support of this view:1. The patients and the public should know whether the study involves a medication that has already been shown to be effective in other similar studies. Informed consent forms are supposed to include this information to help patients make an informed decision about the possible benefit they may get from participating in the trial. Although all clinical trials should ideally be conducted with the goal of improving medical knowledge, other reasons for clinical trials, including simple promotion, are seen [4]. There is little scientific or societal gain in repeating clinical trials with medications that have already shown efficacy [5].2. There can be considerable variation in how informed consent is addressed by investigators from different cultures and socioeconomic settings, even within the same multinational trial [6]. These differences can become more important and worrisome when drug trials are conducted in developing countries [7] where the investigators and sponsors might be more relaxed as to ethical standards of human experimentation. Transparency of the informed consent forms may facilitate the local and international surveillance of unethical scientific conduct.3. There are examples of clinical trials that appear unnecessarily prolonged after the evidence is already available for a clear beneficial effect. We had expressed such concern for a major drug trial in rheumat
Improving instructional effectiveness with computer-mediated communication  [cached]
Som Naidu,John Barrett,Peter Olseb
Research in Learning Technology , 1995, DOI: 10.3402/rlt.v3i2.9611
Abstract: A critical question that often faces educational technologists is how to deliver excellence in teaching and subject-matter content to learners. A corollary to this question is how and what instructional technologies can be brought to address this search for particular contexts? While there is a wide range of instructional delivery technologies we can choose from, our choice must be carefully considered. The number of factors to be considered are too many to list here, but must include a cognizance of the nature of the content or skill that comprises the subject matter of instruction, the learners, the time and their place of study, and the costs of the delivery mode, both for the learners and the institution. This paper reports our experience of the first phase of a three-phased integration of Computer- Mediated Communication (CMC) aimed at improving instructional effectiveness.
Transfer of Training: Improving the Effectiveness of Employee Training in Nepal  [PDF]
Bhawani Shankar Subedi
Journal of Education and Research , 2008, DOI: 10.3126/jer.v1i0.7951
Abstract: This paper presents a summary, conclusions and recommendations of a recent doctoral study titled ‘Transfer of Training: Improving the Effectiveness of Employee Training in Nepal’. The purpose of this study was to examine the extent of transfer and to identify factors influencing it in the context of civil and corporate sector organizations of Nepal. This cross sectional descriptive research included stratified random samples of organizations from four development regions of Nepal. Data were collected from 299 cases (56 managers, 78 supervisors and 165 employees, who received training within the last twelve months) using a mail survey, on-site survey, personal interviews, focus group discussions, training evaluation models, and observations for the verification of workplace evidences of transfer or non-transfer of the training. DOI: http://dx.doi.org/10.3126/jer.v1i0.7951 Journal of Education and Research 2008, Vol. 1, No. 1, pp. 51-61
Estimation of Influenza Vaccine Effectiveness from Routine Surveillance Data  [PDF]
Heath Kelly, Kylie Carville, Kristina Grant, Peter Jacoby, Thomas Tran, Ian Barr
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0005079
Abstract: Background Influenza vaccines are reviewed each year, and often changed, in an effort to maintain their effectiveness against drifted influenza viruses. There is however no regular review of influenza vaccine effectiveness during, or at the end of, Australian influenza seasons. It is possible to use a case control method to estimate vaccine effectiveness from surveillance data when all patients in a surveillance system are tested for influenza and their vaccination status is known. Methodology/Principal Findings Influenza-like illness (ILI) surveillance is conducted during the influenza season in sentinel general practices scattered throughout Victoria, Australia. Over five seasons 2003–7, data on age, sex and vaccination status were collected and nose and throat swabs were offered to patients presenting within three days of the onset of their symptoms. Swabs were tested using a reverse transcriptase polymerase chain reaction (RT-PCR) test. Those positive for influenza were sent to the World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza where influenza virus culture and strain identification was attempted. We used a retrospective case control design in five consecutive influenza seasons, and estimated influenza vaccine effectiveness (VE) for patients of all ages to be 53% (95% CI 38–64), but 41% (95% CI 19–57) adjusted for age group and year. The adjusted VE for all adults aged at least 20 years, the age groups for whom a benefit of vaccination could be shown, was 51% (95% CI 34–63). Comparison of VE estimates with vaccine and circulating strain matches across the years did not reveal any significant differences. Conclusions/Significance These estimates support other field studies of influenza vaccine effectiveness, given that theoretical considerations suggest that these values may underestimate true effectiveness, depending on test specificity and the ratio of the influenza ILI attack rate to the non-influenza ILI attack rate. Incomplete recording of vaccination status and under-representation of children in patients from whom a swab was collected limit the data. Improvements have been implemented for prospective studies.
Cost-effectiveness of compression technologies for evidence-informed leg ulcer care: results from the Canadian Bandaging Trial
Pham Ba',Harrison Margaret B,Chen Maggie H,Carley Meg E
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-346
Abstract: Background Venous leg ulcers, affecting approximately 1% of the population, are costly to manage due to poor healing and high recurrence rates. We evaluated an evidence-informed leg ulcer care protocol with two frequently used high compression systems: ‘four-layer bandage’ (4LB) and ‘short-stretch bandage’ (SSB). Methods We conducted a cost-effectiveness analysis using individual patient data from the Canadian Bandaging Trial, a publicly funded, pragmatic, randomized trial evaluating high compression therapy with 4LB (n = 215) and SSB (n = 209) for community care of venous leg ulcers. We estimated costs (in 2009–2010 Canadian dollars) from the societal perspective and used a time horizon corresponding to each trial participant’s first year. Results Relative to SSB, 4LB was associated with an average 15 ulcer-free days gained, although the 95% confidence interval [ 32, 21 days] crossed zero, indicating no treatment difference; an average health benefit of 0.009 QALYs gained [ 0.019, 0.037] and overall, an average cost increase of $420 [$235, $739] (due to twice as many 4LB bandages used); or equivalently, a cost of $46,667 per QALY gained. If decision makers are willing to pay from $50,000 to $100,000 per QALY, the probability of 4LB being more cost effective increased from 51% to 63%. Conclusions Our findings differ from the emerging clinical and economic evidence that supports high compression therapy with 4LB, and therefore suggest another perspective on high compression practice, namely when delivered by trained registered nurses using an evidence-informed protocol, both 4LB and SSB systems offer comparable effectiveness and value for money. Trial registration ClinicalTrials.gov Identifier: NCT00202267
Hemodynamic Surveillance of Ventricular Pacing Effectiveness with the Transvalvular Impedance Sensor  [PDF]
Valeria Calvi,Giovanni Pizzimenti,Marco Lisi,Giuseppe Doria,Ludovico Vasquez,Francesco Lisi,Salvatore Felis,Donatella Tempio,Alfredo Virgilio,Alberto Barbetta,Franco Di Gregorio
Advances in Medicine , 2014, DOI: 10.1155/2014/307168
Abstract: The Transvalvular Impedance (TVI) is derived between atrial and ventricular pacing electrodes. A sharp TVI increase in systole is an ejection marker, allowing the hemodynamic surveillance of ventricular stimulation effectiveness in pacemaker patients. At routine follow-up checks, the ventricular threshold test was managed by the stimulator with the supervision of a physician, who monitored the surface ECG. When the energy scan resulted in capture loss, the TVI system must detect the failure and increase the output voltage. A TVI signal suitable to this purpose was present in 85% of the tested patients. A total of 230 capture failures, induced in 115 patients in both supine and sitting upright positions, were all promptly recognized by real-time TVI analysis (100% sensitivity). The procedure was never interrupted by the physician, as the automatic energy regulation ensured full patient’s safety. The pulse energy was then set at 4 times the threshold to test the alarm specificity during daily activity (sitting, standing up, and walking). The median prevalence of false alarms was 0.336%. The study shows that TVI-based ejection assessment is a valuable approach to the verification of pacing reliability and the autoregulation of ventricular stimulation energy. 1. Introduction The automatic adaptation of ventricular pacing energy to the individual capture threshold has been available in the cardiac stimulation practice for the last two decades. Different systems have been proposed by the industry to prevent unnecessary high pacing output, based either on periodic threshold assessment performed by the implanted device [1, 2] or on capture check at every paced beat [3, 4]. The latter approach offers the additional advantage of continuous surveillance of pacing effectiveness, which increases the patients’ safety and allows the tracking of threshold changes keeping the pulse amplitude slightly above the minimum required for cardiac stimulation. In case of capture loss, a high-energy back up pulse is delivered with a short delay from the failing stimulus [4], so that the electromechanical activity of the heart is promptly restored. In beat-by-beat capture check as well as periodic threshold measurement, the confirmation of capture relies on the detection of pacing-induced active myocardial depolarization, that is, the action potential generated by excited myocardial fibers in the surrounding of the stimulating electrode, generally referred to as evoked potential. The evoked electrical response must be discriminated from the electrode polarization produced by the
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