7 research outputs found
Resenha: Engaging with the politics of water governance
Get PDFReview of "Engaging with the politics of water governance"ZWARTEVEEN, M.; KEMERINK‐SEYOUM, J.S.; KOOY, M.; EVERS, J.; GUERRERO, T.A.; BATUBARA, B.; BIZA, A.; BOAKYE‐ANSAH, A.; FABER, S.; CABRERA FLAMINI, A.; CUADRADO‐QUESADA, G.; FANTINI, E.; GUPTA, J.; HASAN, S.; ter HORST, R.; JAMALI, H.; JASPERS, F.; OBANI, P.; SCHWARTZ, K.; SHUBBER, Z.; SMIT, H.; TORIO, P.; TUTUSAUS, M.; WESSELINK, A. Engaging with the politics of water governance. Wiley Interdisciplinary Reviews: Water, v. 4, n. 6, p. 1-9, 2017.Recebido em: abril/2018.Aprovado em: janeiro/2019
Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis.
Get PDFINTRODUCTION: There is conflicting evidence and practice regarding the use of the non-nucleoside reverse transcriptase inhibitors (NNRTI) efavirenz (EFV) and nevirapine (NVP) in first-line antiretroviral therapy (ART). METHODS: We systematically reviewed virological outcomes in HIV-1 infected, treatment-naive patients on regimens containing EFV versus NVP from randomised trials and observational cohort studies. Data sources include PubMed, Embase, the Cochrane Central Register of Controlled Trials and conference proceedings of the International AIDS Society, Conference on Retroviruses and Opportunistic Infections, between 1996 to May 2013. Relative risks (RR) and 95% confidence intervals were synthesized using random-effects meta-analysis. Heterogeneity was assessed using the I(2) statistic, and subgroup analyses performed to assess the potential influence of study design, duration of follow up, location, and tuberculosis treatment. Sensitivity analyses explored the potential influence of different dosages of NVP and different viral load thresholds. RESULTS: Of 5011 citations retrieved, 38 reports of studies comprising 114 391 patients were included for review. EFV was significantly less likely than NVP to lead to virologic failure in both trials (RR 0.85 [0.73-0.99] I(2) = 0%) and observational studies (RR 0.65 [0.59-0.71] I(2) = 54%). EFV was more likely to achieve virologic success than NVP, though marginally significant, in both randomised controlled trials (RR 1.04 [1.00-1.08] I(2) = 0%) and observational studies (RR 1.06 [1.00-1.12] I(2) = 68%). CONCLUSION: EFV-based first line ART is significantly less likely to lead to virologic failure compared to NVP-based ART. This finding supports the use of EFV as the preferred NNRTI in first-line treatment regimen for HIV treatment, particularly in resource limited settings
Dosimetric study of SIB-IMRT versus SIB-3DCRT for breast cancer with breath-hold gated technique
Get PDFBackground and Purpose: 3-dimensional conformal therapy (3DCRT) is widely employed radiation therapy technique for breast cancer, but there is still need to minimize the doses to organ at risk (OAR) using 3DCRT. A few clinical studies have discussed using intensity modulated radiation therapy (IMRT) to address this shortfall. Simultaneous integrated boost (SIB) has been used in head and neck and prostate cancer, and there is a growing interest in using SIB for breast cancer too. This study aimed to compare SIB-IMRT versus SIB-3DCRT for breast cancer patients. Materials and Methods: SIB-3DCRT treatment plans were created for 36 consecutive patients. Dose was prescribed as 45 Gy in 25 fractions to the planning target volume (PTV)-1 and 60 Gy in 25 fractions to PTV-2. Treatment plans were normalized to 95% of PTV volume receiving 95% of the prescription dose. The conformity index (CI), homogeneity index (HI), lung dose, heart dose, left anterior descending artery(LAD) dose, and low dose volume and integral dose of normal healthy tissue were recorded and analyzed. Results: With the use of IMRT technique, there was an improvement in CI (0.14) when compared to CI of 3DCRT (0.18; p = 0.01). However, there was no significant difference in the HI (p = 0.45). On average, the V20Gy of ipsilateral lung was 37.9 % for 3DCRT and 22.4 % (p < 0.01) for IMRT, whereas the V20Gy of total lung (ipsilateral + contralateral) was 21.8% for 3DCRT and 12.14 (p < 0.01) for IMRT. Similarly, average V40Gy of heart was 7.5 % for 3DCRT and 2.13 % (p = 0.01) for IMRT. The LAD maximum dose to left side breast patients, on average, was 39.5 Gy for 3DCRT and 29.17 Gy (p = 0.03) for IMRT. The average number of monitor units was about 180 for 3DCRT and 1441 (p < 0.01) for IMRT. Conclusion: IMRT for breast cancer treatment is feasible. In comparison to 3DCRT, IMRT can reduce the maximum dose to the target volume, and dose to the OAR. However, 3DCRT technique is superior in terms of low dose volume, integral dose, and treatment time. With the use of breath-hold gated technique in IMRT, it can further improve the target coverage and reduction of doses to the heart, lung, and LAD. SIB technique could reduce the overall treatment duration by about one week.----------------------------------Cite this article as:Moorthy S, Sakr H, Hasan S, Samuel J, Al-Janahi S, Murthy N. Dosimetric study of SIB-IMRT versus SIB-3DCRT for breast cancer with breath-hold gated technique. Int J Cancer Ther Oncol 2013;1(1):010110. DOI: http://dx.doi.org/10.14319/ijcto.0101.1
Burden of HIV-Related cytomegalovirus retinitis in resource-limited settings: A systematic review
No full textBackground. Cytomegalovirus (CMV) is a late-stage opportunistic infection in people living with human immunodeficiency virus (HIV)/AIDS. Lack of ophthalmological diagnostic skills, lack of convenient CMV treatment, and increasing access to antiretroviral therapy have all contributed to an assumption that CMV retinitis is no longer a concern in low- and middle-income settings.Methods. We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries. Eligible studies assessed the occurrence of CMV retinitis by funduscopic examination within a cohort of at least 10 HIV-positive adult patients.Results. We identified 65 studies from 24 countries, mainly in Asia (39 studies, 12 931 patients) and Africa (18 studies, 4325 patients). By region, the highest prevalence was observed in Asia with a pooled prevalence of 14.0% (11.8%-16.2%). Almost a third (31.6%, 95% confidence interval [CI], 27.6%-35.8%) had vision loss in 1 or both eyes. Few studies reported immune status, but where reported CD4 count at diagnosis of CMV retinitis was <50 cells/L in 73.4% of cases. There was no clear pattern of prevalence over time, which was similar for the period 1993-2002 (11.8%; 95% CI, 8%-15.7%) and 2009-2013 (17.6%; 95% CI, 12.6%-22.7%).Conclusions. Prevalence of CMV retinitis in resource low- and middle-income countries, notably Asian countries, remains high, and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programs must ensure capacity to manage the needs of patients who present late for care. © 2013 The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup. com
The principles of screen design for computer-based learning materials.
Get PDFThe critical interface between learners and computer-based learning materials is the
screen. If the display of learning is not effective then learning will be hindered.
Screen design is therefore an important element in the design of computer-based
learning.
This research investigated the three fundamental screen design elements of
text, colour and graphics. A review of literature, experimental design and a limited
survey of computer-based learning materials provided the background for this
research. The experimental materials reflected the results of the review and survey
by using representative subjects, providing a learning focus and employing computerbased materials. Two experiments were undertaken. The Colour and Graphics
experiments considered the effects of a number of variables on learners' behaviour
which included: the use of colour; the size and type of graphics; the learner's prior
knowledge of tutorial subject; and the complexity of the display.
The results of this research showed that colour is a powerful motivating force
as long as it is not used excessively. This was identified as the use of more than
seven colours. Graphics can be used more extensively in current computer-based
learning materials and users preferred representational graphics occupying a quarter
to a half of the screen. However, learners were not prepared to make the effort to
either use analogical graphics to make links with their prior knowledge or to extract
information contained in the structure and form of logical graphics. Subjects were
motivated by representational graphics.
Learners' behaviour in relation to the various screen displays they
encountered was affected by their prior knowledge of the tutorial content. This was
apparent in their choice of options (additional modules) within the tutorial, their
methods of interacting with the material and their responses to individual displays
Engaging with the politics of water governance
Get PDFThe goal of the study is to strengthen the analytical purchase of the term water governance and improve the utility of the concept for describing and analyzing actual water distribution processes. We argue this is necessary as most writing on water governance is more concerned with promoting particular politically inspired agendas of what water governance should be than with understanding what it actually is. We believe that water governance at heart is about political choices as to where water should flow; about the norms, rules and laws on which such choices should be based; about who is best able or qualified to decide about this; and about the kind of societal future such choices support. We identify distributions—of water, voice and authority, and expertise—as the empirical anchor and entry‐point of our conceptualization of water governance. This usefully allows foregrounding questions of equity in water governance discussions and provides the empirical foundation for a meaningful engagement with the politics of water governance
Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey
Get PDFBackground: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020
