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Background: Superficial cutaneous fungal infections are common dermatologic conditions. A significant proportion do not present with typical clinical findings. However, the 10 potassium hydroxide (KOH) smear, a simple bedside test, is often underused when diagnosing cutaneous fungal infections. Aims: We aimed to evaluate whether KOH smear results altered dermatologists' diagnosis and management, and the factors that influenced its ability to detect cutaneous fungal infections. Methods: A total of 373 patients with suspected cutaneous fungal infection were identified retrospectively from the dermatology database of inpatient referrals in a Singapore tertiary hospital between 1 January 2017 and 30 June 2020. The dermatologists' eventual diagnoses, based on their assessment until 2 months post-discharge to allow consideration of KOH smear results and response to treatment, were taken as a gold standard. Statistical analyses evaluated for changes between initial and eventual diagnoses and management relative to the KOH smear. Use of topical steroids, topical and/or systemic antifungals before skin sampling, and whether sampling was done by dermatologically-trained personnel, were assessed for association with KOH smear positivity in eventually diagnosed cases. Results: The percentage of uncertain diagnoses was reduced, and the use of topical antifungal as the sole treatment significantly changed after the KOH smear result was available. The adjusted odds ratio of a positive KOH smear in eventually diagnosed cases was 0.19 when systemic antifungals were used before skin sampling, and 3.03 if sampling was performed by a dermatologically-trained person. Limitations: Limitations of our study include dependence on retrospective medical records which may result in misclassification bias and the limited generalisability of our results to patients managed by non-dermatologists. Conclusions: KOH smear is a useful adjunct in diagnosing and managing cutaneous fungal infections. Clinicians should consider the presence of confounders affecting KOH smears when making an overall clinical diagnosis. Focused training of personnel on skin sample collection may improve the detection rate of KOH smear. Keywords: Candidiasis, dermatomycoses, Malassezia, potassium hydroxide, tinea, Author(s): Xuan Qi Koh (corresponding author) [1]; Huirong Han [1]; Liang Shen [2]; Nisha S. Chandran [1,3] Introduction Cutaneous fungal infections are one of the most common dermatological conditions referred [...]

Molds must be engineered with precision to achieve optimal results, making mold life a key consideration. Several factors influence injection mold life, including material choice, operating conditions, design, and maintenance. [...]

Historically, the leadership of organizations, including institutions of postsecondary education, has rested within the dominant white, cis-gendered male culture. The first college in the U.S, Harvard University, founded in 1646, [...]

In recent decades, policy-makers have taken policy actions to improve dietary quality and prevent further increases in obesity, type 2 diabetes and other noncommunicable diseases, including policies that require mandatory [...]

The first version of the World Health Organization Model list of essential medicines contained 186 medicines in 1977 and has evolved to include 502 medicines in 2023. Over time, different articles criticized the methods and process for decisions; however, the list holds global relevance as a model list to over 150 national lists. Given the global use of the model list, reflecting on its future role is imperative to understand how the list should evolve and respond to the needs of Member States. In 2023, the model list Expert Committee recommended the World Health Organization (WHO) to initiate a process to revise the procedures for updating the model list and the criteria guiding decisions. Here, we offer an agenda outlining priority areas and a vision for an authoritative model list. The main areas include improving transparency and trustworthiness of the recommendations; strengthening connection to national lists; and continuing the debate on the principles that should guide the model list, in particular the role of cost and price of essential medicines. These reflections are intended to support efforts ensuring the continued impact of this policy tool. [phrase omitted] La premiere version de la Liste modele des medicaments essentiels de l'OMS, publiee par l'Organisation mondiale de la Sante, repertoriait 186 medicaments en 1977 et s'est enrichie jusqu'a en inclure 502 en 2023. Au fil du temps, differents articles ont critique ses methodes et processus decisionnels; toutefois, elle reste importante au niveau mondial, servant de reference a plus de 150 listes nationales. Compte tenu de l'usage international qui en est fait, il est imperatif de reflechir a sa fonction future afin de comprendre comment elle peut evoluer et repondre aux besoins des Etats Membres. En 2023, le Comite d'experts charge de la liste modele a recommande a l'OMS de se lancer dans la revision des procedures de mise a jour de cette liste, ainsi que des criteres appliques aux decisions. Dans le present document, nous proposons un programme qui definit les priorites et les perspectives d'avenir pour que la liste fasse autorite. Parmi les principaux domaines abordes figurent l'amelioration de la transparence et de la fiabilite des recommandations, le renforcement des liens avec les listes nationales et la poursuite du debat sur les principes qui devraient orienter la liste modele, en particulier le role joue par les couts et les prix des medicaments essentiels. Ces reflexions ont pour but de soutenir les efforts permettant a cet instrument politique de conserver son impact. [phrase omitted] La primera version de la Lista Modelo OMS de Medicamentos Esenciales contenia 186 medicamentos en 1977 y ha evolucionado hasta incluir 502 medicamentos en 2023. Con el tiempo, diferentes articulos criticaron los metodos y el proceso de decision; sin embargo, la lista conserva su relevancia mundial como lista modelo para mas de 150 listas nacionales. Dado el uso global de la lista modelo, es imperativo reflexionar sobre su funcion futura para comprender como debe evolucionar la lista y responder a las necesidades de los Estados Miembros. En 2023, el Comite de Expertos de la lista modelo recomendo a la OMS que iniciara un proceso para revisar los procedimientos de actualizacion de la lista modelo y los criterios que guian las decisiones. En este documento, se ofrece un programa en el que se describen las areas prioritarias y la vision de una lista modelo oficial. Entre las principales areas se incluyen la mejora de la transparencia y la fiabilidad de las recomendaciones, el refuerzo de la conexion con las listas nacionales y la continuacion del debate sobre los principios que deben guiar la lista modelo, en particular sobre la funcion del coste y el precio de los medicamentos esenciales. El objetivo de estas reflexiones es apoyar los esfuerzos que aseguren el impacto continuado de esta herramienta politica., Introduction The World Health Organization model list of essential medicines is almost 50 years old. The model list is a normative product of the World Health Organization (WHO), aimed at [...]

Problem Violence against women is a global health problem. Effectively preventing such violence requires locally adapted strategies. Approach The World Health Organization in Indonesia, in collaboration with United Nations (UN) Population Fund, UN Women, United Nations Children's Fund, United Nations Development Programme and Joint United Nations Programme on HIV/AIDS, launched capacity-building initiatives to introduce RESPECT as an evidence-based framework to address violence against women. The initiatives included stakeholder engagement, module development, sensitization training, a workshop and evaluation sessions. These sessions introduced RESPECT strategies to government officials, UN officers and community representatives, mapped best practices and developed action plans. Local setting Indonesia has a substantial burden of violence against women, despite numerous laws and policies to combat it. The 2021 Indonesian violence against women survey showed that 26.1% (3341/12 800) of women aged 15-64 years had experienced violence in their lifetime, with 8.7% (1114/12 800) experiencing violence in the past year. Relevant changes The initiatives to introduce RESPECT led to securing government support, and verbal commitment was given by the Director for the Protection of Women's Rights against Domestic Violence and Vulnerability to integrate RESPECT into the 2025-2029 National Development Plan and National Strategy for Reducing Violence Against Women. Lessons learnt RESPECT can be adapted to local contexts through customization and capacity-building and by ensuring initial government support, dedicated personnel, resource allocation and use of established relationships with key stakeholders. Improved research, monitoring and evaluation are vital to promote evidence-informed decision-making, together with community engagement and multistakeholder collaboration. The UN can facilitate these efforts. [phrase omitted] Probleme La violence a l'egard des femmes est un probleme de sante mondial. Lutter efficacement contre de telles violences necessite des strategies adaptees aux differents contextes locaux. Approche En collaboration avec le Fonds des Nations unies pour la population (FNUAP), l'ONU Femmes, le Fonds des Nations unies pour l'enfance, le Programme des Nations unies pour le developpement et le Programme commun des Nations Unies sur le VIH/sida, l'Organisation mondiale de la Sante en Indonesie a lance une serie d'initiatives de renforcement des capacites afin d'instaurer RESPECT, un cadre methodologique fonde sur des faits dont le but est de lutter contre les violences envers les femmes. Parmi ces initiatives figuraient l'implication des parties prenantes, le developpement de modules, une formation a la sensibilisation, un atelier et des sessions d'evaluation. Ces sessions ont servi a presenter les strategies RESPECT a des responsables du gouvernement, des fonctionnaires de l'ONU et des representants des communautes, a identifier les meilleures pratiques et a elaborer des plans d'action. Environnement local Malgre de nombreuses lois et politiques visant a lutter contre la violence envers les femmes, elle demeure un veritable fleau en Indonesie. Une enquete menee en 2021 dans le pays a montre que 26,1% (3341/12 800) des femmes agees de 15 a 64 ans avaient subi des violences au cours de leur vie, et que 8,7% (1114/12 800) y avaient ete confrontees au cours de l'annee ecoulee. Changements significatifs Les initiatives visant a mettre en place RESPECT ont permis d'assurer le soutien du gouvernement, tandis que le directeur charge de la protection des droits des femmes contre les violences domestiques et les facteurs de vulnerabilite s'est engage verbalement a integrer RESPECT dans le Plan national de developpement et la Strategie nationale de reduction de la violence a l'egard des femmes 2025-2029. Lecons tirees Le cadre methodologique RESPECT peut etre adapte aux differents contextes locaux par le biais de la personnalisation et du renforcement des capacites, mais aussi en veillant a obtenir l'appui initial du gouvernement, en disposant d'un personnel specialise, en attribuant des ressources et en utilisant les relations etablies avec les principales parties prenantes. Lamelioration de la recherche, du suivi et de l'evaluation est cruciale pour promouvoir des processus decisionnels etayes par des faits, tout comme l'implication des communautes et la collaboration multilaterale. LONU peut contribuer a ces efforts. [phrase omitted] Situacion La violencia contra las mujeres es un problema sanitario mundial. Para prevenirla de manera eficaz se necesitan estrategias adaptadas a las circunstancias locales. Enfoque La Organizacion Mundial de la Salud en Indonesia, en colaboracion con el Fondo de Poblacion de las Naciones Unidas (ONU), ONU Mujeres, el Fondo de las Naciones Unidas para la Infancia, el Programa de las Naciones Unidas para el Desarrollo y el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA, emprendio iniciativas de capacitacion para introducir RESPECT como marco basado en evidencias para abordar la violencia contra las mujeres. Las iniciativas incluyeron la participacion de las partes interesadas, el desarrollo de modulos, formacion de sensibilizacion, un taller y sesiones de evaluacion. En estas sesiones se presentaron las estrategias de RESPECT a funcionarios del gobierno, oficiales de las Naciones Unidas y representantes de la comunidad, se trazaron las mejores practicas y se desarrollaron planes de accion. Marco regional Indonesia tiene una carga considerable de violencia contra las mujeres, a pesar de las numerosas leyes y politicas para contrarrestarla. La encuesta sobre violencia contra las mujeres realizada en Indonesia en 2021 mostro que el 26,1% (3341/12 800) de las mujeres de entre 15 y 64 anos habian sufrido violencia a lo largo de su vida, y el 8,7% (1114/12 800) en el ultimo ano. Cambios importantes Las iniciativas para introducir RESPECT llevaron a conseguir el apoyo del gobierno. Ademas, el Director para la Proteccion de los derechos de la mujer contra la violencia domestica y la vulnerabilidad se comprometio verbalmente a integrar RESPECT en el Plan nacional de desarrollo 2025-2029 y en la Estrategia nacional para reducir la violencia contra la mujer. Lecciones aprendidas Se puede adaptar RESPECT a los contextos locales mediante la personalizacion y el desarrollo de capacidades, y garantizando el apoyo inicial del gobierno, la dedicacion de personal, la asignacion de recursos y el uso de las relaciones establecidas con las principales partes interesadas. La mejora de la investigacion, el seguimiento y la evaluacion son vitales para promover la toma de decisiones basada en evidencias, junto con la participacion de la comunidad y la colaboracion de multiples partes interesadas. La ONU puede facilitar estos esfuerzos., Introduction Violence against women is a global health problem rooted in gender inequality. (1) Preventing violence against women in Indonesia is a distinct challenge: despite the existence of laws and [...]

Objective To compare uptake of the voluntary Health Star Rating front-of-pack nutrition labelling system with uptake of a mostly mandatory country-of-origin label in Australia over a similar period. Methods We used data on numbers and proportions of products carrying health stars and country-of-origin labelling recorded annually between 2015 and 2023 through surveys of four large Australian food retailers. We determined the proportion of products with health stars and country-of-origin labels for each year by dividing the number of products carrying each label by the total number eligible to carry that label. Findings The uptake of the voluntary Health Star Rating increased steadily between 2014 and 2018, reaching a maximum of 42% (8587/20 286) of products in 2021 before decreasing to 39% (8572/22 147) in 2023. Mandatory country-of-origin labelling uptake rose rapidly and was found on 93% (17 567/18 923) of products in 2023. In categories where country- of-origin labelling was voluntary, uptake by 2023 was 48% (3313/6925). In our 2023 sample of 22 147 products, 11 055 (50%) carried country-of-origin labelling only, 7466 (35%) carried both health star and country-of-origin labelling, 1106 (5%) carried health star labels only and 2520 (11%) carried neither label. Conclusion The experience with country-of-origin labelling shows that widespread and rapid food labelling change can be achieved when required by law. The Australian government should mandate the Health Star Rating without delay. Australia's experience supports other jurisdictions in implementing mandatory front-of-pack nutrition labelling as well as updates to global guidance to recognize mandatory labelling as best-practice in delivering benefits to consumers. [phrase omitted] Objectif Comparer, au cours de la meme periode, l'adoption en Australie du systeme d'etiquetage nutritionnel facultatif Health Star Rating, a l'avant des emballages, avec celle de l'etiquetage mentionnant le pays d'origine, generalement obligatoire. Methodes Nous avons exploite les donnees relatives a la quantite et au pourcentage de produits arborant les etoiles du Health Star Rating et la mention du pays d'origine, recoltees sur une base annuelle entre 2015 et 2023 lors d'enquetes menees aupres de quatre grands magasins d'alimentation australiens. Nous avons ensuite calcule le pourcentage de produits munis d'etoiles et d'une mention du pays d'origine pour chaque annee en divisant le nombre de produits portant chaque etiquette par le nombre total de produits susceptibles d'en etre pourvus. Resultats L'adoption du systeme d'etiquetage nutritionnel facultatif Health Star Rating a augmente de facon constante entre 2014 et 2018, parvenant a un maximum de 42% (8587/20 286) en 2021 avant de redescendre a 39% (8572/22 147) en 2023. Quant a l'etiquetage obligatoire concernant le pays d'origine, son adoption a rapidement grimpe pour atteindre 93% (17 567/18 923) des produits en 2023. Dans les categories ou la mention du pays d'origine n'etait pas obligatoire, le pourcentage d'adoption en 2023 s'elevait a 48% (3313/6925). Dans notre echantillon de 2023, constitue de 22 147 produits, 11 055 (50%) n'indiquaient que le pays d'origine, 7466 (35%) presentaient les deux types d'etiquetage, 1106 (5%) n'affichaient que les etoiles du Health Star Rating et 2520 (11%) ne possedaient aucune des deux etiquettes. Conclusion L'experience menee sur la mention du pays d'origine montre qu'un changement d'etiquetage alimentaire rapide et largement repandu peut etre obtenu par le biais d'une obligation legale. Le gouvernement australien doit donc imposer le systeme Health Star Rating au plus vite. Cette experience encourage egalement d'autres juridictions a instaurer un etiquetage nutritionnel obligatoire a l'avant des emballages, ainsi qu'a mettre a jour les directives mondiales afin d'ajouter cette mesure aux bonnes pratiques benefiques pour les consommateurs. [phrase omitted] Objetivo Comparar la adopcion del sistema voluntarlo de etiquetado frontal nutricional Health Star Ratlng con la adopcion de una etiqueta del pais de origen mayoritariamente obligatoria en Australia durante un periodo similar. Metodos Se utilizaron datos sobre el numero y el porcentaje de productos que llevan etiquetas con estrellas de salud y el pais de origen registrados cada ano entre 2015 y 2023 a traves de encuestas a cuatro de los principales minoristas de alimentos australianos. Se determino el porcentaje de productos con etiquetas de estrellas de salud y del pais de origen de cada ano dividiendo el numero de productos que llevaban cada etiqueta por el numero total de productos elegibles para llevarla. Resultados La adopcion de la clasificacion voluntaria Health Star Rating aumento de forma constante entre 2014 y 2018, alcanzando un maximo del 42% (8587/20 286) de los productos en 2021 antes de disminuir al 39% (8572/22 147) en 2023. El etiquetado obligatorio del pais de origen aumento rapidamente y se encontro en el 93% (17 567/18 923) de los productos en 2023. En las categorias en las que el etiquetado del pais de origen era voluntario, la adopcion en 2023 fue del 48% (3313/6925). En la muestra de 2023, compuesta por 22 147 productos, 11 055 (50%) solo llevaban el etiquetado del pais de origen, 7466 (35%) llevaban tanto el etiquetado de las estrellas de salud como el del pais de origen, 1106 (5%) solo llevaban el etiquetado de las estrellas de salud y 2520 (11%) no llevaban ninguna de estas etiquetas. Conclusion La experiencia con el etiquetado del pais de origen demuestra que se puede conseguir un cambio rapido y generalizado en el etiquetado de los alimentos cuando asi lo exige la ley. El gobierno australiano deberia exigir la clasificacion Health Star Rating sin demora. La experiencia de Australia apoya a otras jurisdicciones en la implementacion del etiquetado frontal nutricional obligatorio, asi como en la actualizacion de las directrices mundiales para reconocer esta medida como una de las mejores practicas en beneficio de los consumidores., Introduction Unhealthy diets are a leading cause of death and disability globally. (1) Current food environments are characterized by unprecedented availability, accessibility and affordability of prepackaged and often ultraprocessed foods [...]

Abstract Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) facilitates the removal of common bile duct (CBD) calculi by endoscopy. When ERCP fails, exploration of CBD is required for the clearance of CBD calculi. The optimum way for the exploration of CBD is by choledochoscopy. Dedicated flexible or rigid choledochoscopes are expensive and available only in few places in India. Since 1991, we subjected patients with suspected CBD calculi to ERCP, followed by laparoscopic cholecystectomy (LC). Patients in whom ERCP failed to clear CBD were subjected to open exploration of CBD using any easily available, suitable, straight rigid scope for choledochoscopy. Patients and Methods: Since March 1991, out of 8866 patients with cholelithiasis, 862 underwent ERCP. Ninety-six patients in whom ERCP failed to clear CBD underwent open exploration of CBD. In each case of exploration of CBD, choledochoscopy was performed using a straight rigid scope, either a cystoscope, paediatric cystoscope, hysteroscope or 5-mm laparoscopy telescope with a 5-mm cannula. Results: The CBD clearance was complete in 95 patients, and one patient had an impacted calculus at the ampulla. CBD explorations were followed by choledochoduodenostomy, T-tube placement or suturing of choledochotomy. No residual calculi were observed after such exploration. Conclusion: From our results, we advocate the following algorithm for CBD calculi in resource-limited settings. Subject patients with CBD calculi to ERCP followed by LC. In case of failed ERCP, open exploration of CBD with choledochoscopy using any suitable rigid scope. Dedicated flexible or rigid choledochoscope is not essential. This approach is cost-effective and successful. Keywords: Choledocholithiasis, choledochoscopy, endoscopic retrograde cholangiopancreatography, stone clearance, Author(s): Vinay Gangadhar Mehendale (corresponding author) [1]; Manoj S. Kamdar [2]; Sharad Narayan Shenoy [2] INTRODUCTION The prevalence of residual or missed common bile duct (CBD) stones post-treatment is a [...]

Abstract Introduction: Petersen's hernia is a rare and serious complication that can occur after radical gastrectomy and digestive tract reconstruction for gastric cancer. This article summarises the symptoms, diagnosis and treatment of Petersen's hernia after surgery for gastric cancer. Patients and Methods: A retrospective analysis was conducted on 11 male patients who were diagnosed with Petersen's hernia and underwent surgical treatment at our hospital from January 2020 to December 2022. Their clinical manifestations, perioperative conditions and follow-up after treatment were collected. Results: The median age was 58.5 years (range: 45-73), and the median time since gastrectomy was 24 months (range: 4-125). Open distal gastrectomy (45.5) and open total gastrectomy (27.3) were the most common procedures. Roux-en-Y (81.8) was the predominant anastomosis method. All patients underwent emergency surgery within a median time of 30 h (range: 4-45). Intestine necrosis occurred in 36.4 of cases, with a perioperative death rate of 27.3. Conclusion: Petersen's hernia after gastric cancer surgery can quickly lead to necrotising intestinal obstruction and poor prognosis. Enhanced abdominal computed tomography should be performed as soon as possible, and early exploratory laparotomy should be done to avoid intestinal necrosis. Routine closure of the mesenteric defect after gastric cancer resection can prevent the occurrence of Petersen's hernia. This article highlights the need for increased awareness and preventive measures to minimise the occurrence of Petersen's hernia in gastric cancer patients. It emphasises the importance of early detection and appropriate management strategies for improved patient outcomes. Keywords: Digestive tract reconstruction, gastrectomy, gastric cancer, internal hernia, Petersen's hernia, Author(s): Mingran Zhang [1]; Yue Fan [2]; Jun Li [1]; Liu Yong (corresponding author) [1] INTRODUCTION Gastric cancer is one of the most common malignant tumours worldwide. In fact, it [...]

In the heart of Kenya's vibrant agricultural landscape lies a fundamental aspect crucial for food security, cultural heritage, and economic resilience: the right to seed. Embedded within the fabric of traditional farming practices, the right to seed encompasses the freedom of farmers to save, exchange, and utilize traditional and farmer-bred seeds. In Kenya, as in many other countries, this right is not only a legal concept but a cornerstone of agricultural sovereignty. However, its preservation faces challenges in the face of globalization, corporate interests, and evolving intellectual property regimes. Yet, amidst these challenges, significant strides are being made, with collaborative efforts at the global level, particularly through initiatives led by the Convention on Biological Diversity (CBD) and the International Treaty on Plant Genetic Resources for Food and Agriculture (ITPGRFA), aimed at promoting and protecting farmers' rights. Every smallholder farmer has the right to safe, nutritious and healthy food and the ability to sustain themselves and their societies with the existing endorsed resources. The concept of farmers' rights came out as a subject of debate in international agricultural circles, spearheaded by the Food and Agriculture Organisation of the United Nations (FAO). This includes the right to save, use, exchange and sell farm-saved seed and propagating materials, the right to protect traditional knowledge among others. In developing countries, the right to seed is a fundamental aspect of agricultural sovereignty and food security. This still emulates the subject debate from FAO. However, attention in scientific literature and policy circles for both seeds and farmers' rights are compromised. This paper employs mediation analysis to explore the causal relationship between seed rights, farmers' rights, and food sovereignty, highlighting the pivotal role of smallholder farmers in shaping sustainable food systems. The findings underscore the importance of inclusive policies that prioritize farmers' rights and empower local communities to sustainably manage their seed resources. Key words: Farmer-managed seeds, seed banks, Access, smallholder farmers and benefit-sharing, INTRODUCTION In developing countries, the right to seed is a fundamental aspect of agricultural sovereignty and food security. It encompasses the freedom to save, exchange, and sell traditional and farmer [...]

The term behavioral and psychological symptoms of dementia (BPSD) describes a constellation of symptoms and behaviors that occur in more than 90% of individuals with dementia. (1) BPSD is associated [...]

Educational institutions can implement the ISO 45001 management system to ensure a safe and healthy environment for all individuals involved. This article proposes a gap analysis method to identify gaps between the existing and desired health and safety conditions in an educational institution. To test the applicability of the method, data from a sample of five high schools in the Merzifon District of Amasya Province in Turkey were used. The results of the gap analysis reveal a notable gap between the existing occupational health and safety conditions and the standards proposed by ISO 45001 in some of the selected educational institutions. This finding highlights the need for these educational institutions to implement the appropriate measures to close this gap. Keywords: gap analysis, ISO 45001, occupational health and safety, education sector, Turkey, Introduction The International Organization for Standardization (ISO) published the ISO 45001 occupational health and safety management system (OHSMS) standard in March 2018, replacing the outdated OHSMS 18001 (ISO, 2018). Unlike [...]

INTRODUCTION 1301 I. THE MONITOR MODEL 1307 A. Challenges of Venture Investing 1307 B. Monitoring as a Solution 1309 1. Equity Incentives 1309 2. Staged Financing 1309 3. Preferred Stock [...], Venture capitalists ("VCs") are increasingly abandoning their traditional role as monitors of their portfolio companies. They are giving startup founders more equity and control and promising not to replace them with outside executives. At the same time, startups are taking unprecedented risks--defying regulators, scaling in unsustainable ways, and racking up billion-dollar losses. These trends raise doubts about the dominant model of VC behavior, which claims that VCs actively monitor startups to reduce the risk of moral hazard and adverse selection. We propose a new theory in which VCs use their role in corporate governance to persuade risk-averse founders to pursue high-risk strategies. VCs are motivated to take risks because most of the gains in venture funds come from the exponential growth of one or two outlier companies. By contrast, founders are reluctant to gamble because they bear firm-specific risk that cannot be diversified. To compensate founders for their risk exposure, VCs offer an implicit bargain in which the founders agree to pursue high-risk strategies and, in exchange, the VCs provide them private benefits. VCs can promise to give founders early liquidity when their startup grows, job security when it struggles, and a soft landing if it fails. In our model, VCs who develop a founder-friendly reputation have a competitive advantage in ex ante pricing but are more exposed to poor performance ex post due to suboptimal monitoring. Stakeholders who are not party to the VC-founder bargain--and society at large--are forced to bear uncompensated risk.

Introduction I. Evolution of municipal government in Newfoundland and Labrador 1. Settlement of Newfoundland and Labrador: A general history 2. Governmental institutions in the Colonial Era: The protomunicipal system 3. [...], Newfoundland and Labrador is unique among Canadian provinces in its municipallevel governmental structures, and in particular, its substantial lack thereof. The province does not have a system of counties or an operating form of regional government. Many areas of the province operate without a formal municipal government and avoid property taxation by operating on a limited fee-for-service model of local government, or in some cases a total lack of sub-provincial government. Tens of thousands of residents live within this tax-free model today. This paper explores how this anomalous situation came to be, the issues it creates in modern society and how these issues are dealt with in practice. Terre-Neuve-et-Labrador est unique parmi les provinces canadiennes en ce qui concerne les structures gouvernementales au niveau municipal, et en particulier leur absence quasi totale. La province ne dispose pas d'un syst me de comt s ou d'une forme op rationnelle de gouvernement r gional. De nombreuses r gions de la province fonctionnent sans administration municipale ofcielle et vitent l'imp t foncier en appliquant un mod le limit de paiement l'acte de l'administration locale ou, dans certains cas, une absence totale d'administration infraprovinciale. Des dizaines de milliers d'habitants vivent aujourd'hui dans le cadre de ce mod le d'exon ration fiscale. Dans pr sent article, nous explorons la gen se de cette situation anormale, les probl mes qu'elle engendre dans la soci t moderne et la mani re dont ces probl mes sont trait s dans la pratique.

Introduction I. The data sharing examples 1. Private financial data and national statistics: The case of StatCan 2. Mobility data and public health: The case of PHAC II. Discussion 1. [...], Governments increasingly seek to use personal data sourced from the private sector for purposes that range from the generation of statistics to municipal planning. The data collected by companies is often high volume and rich in detail. Location and mobility data--which have many applications--are collected by multiple private sector actors, from cellular service providers to app developers and data brokers. Financial sector organizations amass rich data about the spending and borrowing habits of consumers. Even genetic data is collected by private sector companies. The range of available data is constantly growing as more and more data is harvested, and as companies seek secondary markets for their data. This paper explores issues raised by public sector access to and use of personal data held by the private sector. The analysis is framed around two examples from Canada that involved actual or attempted access by government agencies to private sector personal data for public purposes. The first involved Statistics Canada's attempt to collect and use data held by credit monitoring companies and financial institutions to generate economic statistics. The second was the use, during the COVID-19 pandemic, of mobility data by the Public Health Agency of Canada (PHAC) to assess the effectiveness of public health policies in reducing the transmission of COVID-19 during lockdowns. Each of these instances led to public outcry and to investigation or inquiry. The paper examines the legal bases for the use of private sector data by government, the safeguards available to protect privacy, and the framing of concerns over the use of these data by different interested parties. Given that legal frameworks for data sharing may not keep pace with data needs and methods, this paper also takes a normative approach which examines whether and in what circumstances such data sharing should take place. Les gouvernements cherchent de plus en plus utiliser les donn es personnelles provenant du secteur priv des fins qui vont de la production de statistiques la planification municipale. Les donn es collect es par les entreprises sont souvent volumineuses et tr s d taill es. Les donn es de localisation et de mobilit --qui ont de nombreuses applications--sont collect es par de multiples acteurs du secteur priv , des fournisseurs de services cellulaires aux d veloppeurs d'applications et aux courtiers en donn es. Les organisations du secteur financier accumulent de riches donn es sur les habitudes de d pense et d'emprunt des consommateurs. M me les donn es g n tiques sont collect es par des entreprises du secteur priv . L' ventail des donn es disponibles ne cesse de s' largir, car de plus en plus de donn es sont collect es et les entreprises cherchent des march s secondaires pour leurs donn es. Dans le pr sent article, nous explorons les questions soulev es par l'acc s du secteur public aux donn es personnelles d tenues par le secteur priv et par leur utilisation. L'analyse s'articule autour de deux exemples canadiens qui impliquent l'acc s r el ou la tentative d'acc s par des agences gouvernementales des donn es personnelles du secteur priv des fins publiques. Le premier concerne la tentative de Statistique Canada de collecter et d'utiliser des donn es d tenues par des soci t s de surveillance du cr dit et des institutions financi res pour produire des statistiques conomiques. La seconde est l'utilisation, pendant la pand mie de COVID-19, de donn es sur la mobilit par l'Agence de sant publique du Canada (ASPC) pour valuer l'efficacit des politiques de sant publique dans la r duction de la transmission de la COVID-19 pendant les fermetures d' tablissements. Chacun de ces cas a suscit des protestations publiques et a donn lieu une enqu te ou une investigation. Dans l'article, nous examinons les bases juridiques de l'utilisation des donn es du secteur priv par le gouvernement, les garanties disponibles pour prot ger la vie priv e et la formulation des pr occupations relatives l'utilisation de ces donn es par les diff rentes parties int ress es. tant donn que les cadres juridiques pour le partage des donn es peuvent ne pas suivre l' volution des besoins et des m thodes en mati re de donn es, nous adoptons galement une approche normative qui examine si et dans quelles circonstances un tel partage de donn es devrait avoir lieu.

Superintendent Mike Miles took the reins of Houston Independent School District in June 2023--to much fanfare and resistance--as part of a takeover by the Texas Education Agency. Houston is ed [...]

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Background: Ingrown toenail is a nail disorder that commonly affects great toenails. Surgical modalities are commonly used as first-line treatment. A conservative approach is preferable as surgical procedures lead to pain and affect routine activities. Our aim is to study the efficacy of a new conservative technique using steri-strip[sup.TM] for the treatment of mild to moderate ingrown toenails as an outpatient procedure. Methods: Fifty patients presenting with stage 1-2 ingrown toenails were treated with the ‘steri-strip sling technique'. Steri-strip[sup.TM] is inserted between the disto-lateral edge of the nail plate and nail fold and secured with an elastic bandage. The dressing is kept till the nail edge grows over the nail fold and stops penetrating the skin. Patients were reviewed every week for a month after the treatment and monthly thereafter. The final result was assessed at 6 months. The success of treatment was assessed clinically and by patient satisfaction levels. Results: Fifty patients were treated and followed up. Immediately after the procedure, all patients reported significant relief in pain. After 6 months, 46 out of 50 patients were satisfied with the treatment and showed no recurrence. No complications were reported. Conclusion: The ‘Steri-strip[sup.TM] sling technique' is a simple and effective outpatient procedure for the management of mild to moderate ingrown toenails. Keywords: Ingrown toenails, onychocryptosis, steri-strip, Author(s): Eeshaan Ranjan (corresponding author) [1]; Sandeep Arora [2]; Neha Sharma [3]; Durga M. Tripathy [4]; Shekhar Neema [5]; Shailendra Srivastava [1]; Reetu Agarwal [1] Introduction Onychocryptosis or ingrown toenails [...]

Background and Objectives: Functional dissociative seizures (FDS) are very common in neurology clinics, they straddle both neurology and psychiatry. In India, scarce resources and guidelines are available for effectively conveying their diagnosis and management, which leads to a substantial gap in care. We aimed to provide an instructional module for FDS, tailored to clinicians, patients, and caregivers in Hindi, to enhance communication of diagnosis and facilitate suitable management strategies. Methods: The instructional module development process was based on clinical settings and expert opinions. A standard translation process was performed to ensure the linguistic and cultural equivalence. Validation was carried out by a panel of 15 validators, comprising 13 neurologists and two psychiatrists, to identify key psychoeducation components and their significance. They were provided a questionnaire consisting of five questions that were related to completeness, understandability, legibility, clarification, and usefulness of educational material for clinicians, patients, and caregivers. Items were rated using a 5-point Likert scale. Results: There was agreement on four items (Q1, Q3, Q4, and Q5), whereas approximately 85% of the validators agreed on the remaining one item (Q2). The instructional module demonstrated high content validity as indicated by both item level-content validity index (0.98) and scale-level content validity index (0.97), alongside content validity ratio and modified kappa statistics. Conclusions: The developed Hindi instructional module for FDS serves as a valuable tool to enhance the communication of FDS diagnosis and dispel misconceptions. This offers a comprehensive resource for clinicians, patients, and caregivers in India, potentially bridging gap in FDS care. Keywords: Instructional module, Functional Dissociative seizures, conversion disorder, World Health Organization, content validity ratio, Author(s): Manjari Tripathi (corresponding author) [1]; Sandhya Sharma [1]; Avinash Ganapule [1]; Rekha Dwivedi [1]; Kirandeep Kaur [1]; Vasundhara Shukla [2]; Saranya Gomathy [1]; Prarthana Chandra [3]; Rajesh Kumar Singh [...]

Weather variations have posed enormous barriers to water resources, availability of food, human health, infrastructure, and natural environment. These phenomena underscore the need for climate smart practices in South Africa. The study examined in context, the socio-economic determinants, and acceptance of climate smart agriculture practices in Mzinti, Nkomazi Local Municipality South Africa. From a known population of 455 farmers, 212 samples were selected for the survey and considered realistic for the study. This survey comprised questions that were clear, unbiased, and relevant to the research questions. Enumerators were further briefed on the study objectives and the importance of consistent and ethical data collection. The team comprised of four primary data enumerators. A pilot survey with 20 randomly selected smallholder farmers was undertaken to identify and address any questionnaire that may be ambiguous. Based on this pilot, minor revisions were made to improve the questionnaire and ensure accurate reflection of intended variables, thus enhancing the reliability of the data collection instrument. A randomized sampling method was employed to select respondents who participated in the study. This allowed every participant to have a fair chance of being chosen. The study used the structured questionnaire, and the field survey was done between the month of April 2023 and July 2023. Descriptive statistics: frequency count, tables, and percentages, were used to explain the socio-economic determinants for acceptance of climate smart agriculture practices. The hypothesized variables were assessed using the binary logistic regression to determine the correlation between the socio-demographic characteristics and dependent variables. The result revealed that age (p< 0.007), crop yield (p Key words: Climate, acceptance, smart practices, determinants, environment, farmers, agriculture, education, INTRODUCTION Africa is considered one of the continents with food insecurity primarily due to its reliance on agriculture for sustenance [1]. As a result, many governments emphasize the need to [...]

Maize forms a key component in poultry feed formulation in Ghana. Nonetheless, there is an existing challenge of low-quality maize due to insect infestation and mycotoxin contamination resulting in poor chicken growth and performance including diminished egg laying. This study compared the effectiveness of ZeroFly[R] Hermetic (ZFH) storage bags to polypropylene (PP) bags to mitigate insect pest and mycotoxin levels over a 6-month storage period. The study was conducted in three-layer poultry farms in Dormaa Ahenkro, Bono Region, Ghana. One storehouse was used in each poultry farm. In each storehouse, there were thirty-two 100-kg-capacity ZFH and same number of 100-kg PP bags, each containing 100 kg of maize, that is, altogether sixty-four 100-kg-capacity bags in each storehouse. The experiment was set up in a Randomized Complete Block Design with two treatments (ZFH and PP bags), three replications (storehouses), and two sub-replications. In each storehouse, two bags in each treatment were destructively sampled monthly. After 6 months of storage, the predominant insects found were Sitophilus spp. and Sitotroga cerealella, and a larger mean number of insects (live and dead) per 500-g sample was found in the PP bags (149.67 [+ or -] 8.67), compared to ZFH bags; 4.67 [+ or -] 0.73. The percentage of insect damaged kernels after 6 months was significantly higher in PP bags (67.67 [+ or -] 2.62) than ZFH bags (5.00 [+ or -] 0.50). Weight loss in the Pp bags was > 30%, compared to < 0.3% in ZFH bags. Aflatoxin and fumonisin levels of maize in both types of bags were below the recommended safe threshold of 15 ppb and 4 ppm, respectively. The moisture content of maize in ZFH bags was maintained over the 6-month period whereas that of maize in PP bags increased. Also, crude protein, crude fat, and carbohydrate levels in maize were higher in ZFH bags than PP bags. Data showed ZFH bags conserved maize quality better than the PP bags thereby making maize wholesome for food and feed. Further research to compare the growth and performance of layer poultry in terms of egg laying related to diets of feed from maize stored in ZHF and PP bags is recommended. Key words: Post-harvest loss, stored product insect pest, mycotoxin, poultry, white maize, INTRODUCTION Ghana is among the top three producers of maize in West Africa [1]. The crop is a staple food and makes a substantial contribution to the diets of both [...]

Response to AJFAND editorial EDITOR'S NOTE - Vol 24, No. 8, August 2024 The Editorial ' Zero Hunger by 2030 - SDG 2 - We are off target, AGAIN' states [...]

Child stunting is a critical concern with far-reaching consequences for the developmental prospects of affected children. To address this issue, Indonesia has initiated a targeted program to support rural families. This program's two-fold approach includes aiding with dietary needs and delivering counseling services via Community Health Centers. The primary aim of the current study was to explore the determinants that promote or inhibit engagement with this stunting prevention initiative. Methodologically, the research encompassed 10 direct observations, 45 focus group discussions, and 23 in-depth interviews to gather comprehensive data. The participants were drawn from a cross-section of the rural populace, including households, village government officials, and healthcare providers. Feedback on the program was predominantly positive, with participants demonstrating favorable perceptions towards it. Notably, the program's contribution to improving household health was apparent, serving as an impetus for active participation. Nevertheless, the research identified significant barriers to program engagement, namely the existence of social behaviors that were at odds with the program's objectives and a widespread deficit in the understanding of the importance of nutritional food security. These factors present considerable challenges to fully realizing the program's potential impact. Direct observations highlighted the program's effectiveness in regions with strong community health infrastructure. Focus group discussions underscored the importance of cultural sensitivity in program implementation, as local customs and traditions significantly influenced participation levels. In-depth interviews with healthcare providers shed light on logistical challenges, such as inconsistent supply chains for nutritional supplements and gaps in training for health workers. Village government officials emphasized the need for greater inter-agency coordination to streamline services and reduce redundancy. Despite these challenges, the program's strengths were evident. Participants appreciated the holistic approach, combining immediate dietary support with educational components aimed at fostering sustainable health practices. For the program to achieve broader success, it must address the identified barriers through targeted interventions, such as enhanced community education campaigns, improved logistical support, and greater cultural integration into program design. Key words: Prevention, rural, food security, society, nutrition, stunting, qualitative, Indonesia, INTRODUCTION The right of every child to adequate growth, nutrition, and health is paramount, yet this right is often unmet, particularly in low-income and developing countries where malnutrition fuels the [...]

Tabletop exercises examining weather-related hazards are not uncommon but are often built around somewhat generic scenarios that only touch on the meteorological communication environment at a very shallow level. A recent exercise in central Oklahoma sought to change that. A local emergency manager, personnel from a National Weather Service (NWS) forecast office, and a severe weather researcher with a background in exercise design and facilitation worked together to create and deliver a realistic severe weather simulation. Exercise participants were exposed to detailed forecast information via NWSChat--a dedicated communication tool used to connect NWS forecasters, emergency managers, and media members for real-time information sharing. NWS forecasters were able to both actively play in the exercise due to the use of NWSChat and observe how local decision-makers interpreted and utilized the impact-based decision support service (IDSS) graphics and short-term forecast updates. The collaborative approach of developing a detailed scenario with numerous real- world IDSS graphics, along with the use of NWSChat for real-time delivery, resulted in overwhelmingly positive feedback from the participants. The local emergency management office identified numerous areas for improvement in communicating real-time forecast information across their jurisdiction, along with gaps in current plans and resources. Meanwhile, the NWS forecast office had the opportunity to experiment with using the new NWSChat platform in a high- impact severe weather environment before a real-world event took place. Forecasters also gained insight into current IDSS graphic interpretation, noting areas for improved messaging to end users, such as adding storm motion to existing severe weather graphics. KEYWORDS: Communications/ decision making; Emergency preparedness; Emergency response, 1. Introduction Tabletop exercises are an important tool for emergency managers to ensure jurisdictional readiness for future incidents. These exercises often involve multiple agencies or stakeholders representing various parts of [...]

Problem By 31 December 2021, only 5.5% (861 879/15 670 530) of the Somali population had been fully vaccinated against coronavirus disease 2019 (COVID-19). Approach To rapidly increase COVID-19 vaccine coverage in 2022, the health ministry and its partners (World Health Organization and United Nations Children&apos;s Fund) adopted a more responsive strategy. This strategy included careful microplanning, better targeting of populations and providing people-centred vaccination services close to their homes. These services were combined with childhood vaccination and basic health-care provision using the existing polio network and community health workers. Additionally, a digital tool for recording COVID-19 vaccination data and a mobile phone-based electronic registration system were introduced. Local setting Somalia, a fragile and conflict-affected state, faced challenges when implementing COVID-19 vaccination, including inexperience in managing mass adult vaccination, inadequate infrastructure and health workforce. Furthermore, insecurity in some areas and severe drought resulted in large-scale displacement of people. Relevant changes The implementation of a more context-specific strategy helped Somalia reach substantially more people with COVID-19 vaccination and 42.1% coverage by 31 December 2022. Additionally, 84 600 zero- dose children received their first childhood vaccine during the integrated campaigns. The increased coverage has led to public health benefits that outweigh the investment in the COVID-19 vaccination campaigns. Lessons learnt Successful roll-out of adult vaccination is achievable even in a fragile and conflict-affected setting through implementation of a tailored contextualized approach. Key factors include good microplanning, use of digital tools, better population-targeting, bundling vaccines together and delivering vaccination services close to people&apos;s homes. Probleme Au 31 decembre 2021, seulement 5,5% (861 879/15 670 530) des Somaliens etaient totalement vaccines contre la maladie a coronavirus 2019 (COVID-19). Approche Afin d&apos;accroitre rapidement la couverture vaccinale contre la COVID-19 en 2022, le Ministere de la Sante et ses partenaires (l&apos;Organisation mondiale de la Sante et le Fonds des Nations Unies pour l&apos;enfance) ont adopte une strategie plus reactive. Celle-ci comprenait une microplanification minutieuse, un meilleur ciblage des populations et la fourniture de services de vaccination centres sur les personnes, a proximite de leur domicile. Ces services etaient combines a une vaccination des enfants et a des soins de base, grace au reseau actuel de lutte contre la polio et des agents de sante communautaires. En outre, un outil numerique d&apos;acquisition des donnees relatives a la vaccination contre la COVID-19 ainsi qu&apos;un systeme d&apos;enregistrement electronique via telephone mobile ont ete deployes. Environnement local La Somalie, un Etat fragile et en conflit, a ete confrontee a des difficultes de mise en reuvre de la vaccination contre la COVID-19, notamment en raison de son manque d&apos;experience dans la gestion de campagnes de vaccination massive des adultes, de ses infrastructures inadaptees et d&apos;une penurie de soignants. De plus, l&apos;insecurite qui regne dans certaines regions et la secheresse extreme ont entraine des deplacements a grande echelle. Changements significatifs L&apos;instauration d&apos;une strategie mieux adaptee au contexte a aide la Somalie a vacciner nettement plus de gens contre la COVID-19, et a atteindre 42,1% de couverture vaccinale au 31 decembre 2022. Par ailleurs, 84 600 enfants <> ont recu leur premier vaccin pediatrique durant les campagnes combinees. L&apos;amelioration de la couverture vaccinale a engendre de nombreux benefices pour la sante publique, depassant l&apos;investissement dans les campagnes de vaccination contre la COVID-19. Lecons tirees En definissant une approche contextualisee et sur mesure, il est possible de proceder a la vaccination des adultes, meme dans une region fragile et en conflit. Parmi les facteurs cles figurent une bonne microplanification, le recours aux outils numeriques, un meilleur ciblage des populations, le regroupement des vaccins et la mise a disposition de services de vaccination non loin des habitations. Situacion A 31 de diciembre de 2021, solo el 5,5% (861 879/15 670 530) de la poblacion somali habia sido completamente vacunada contra la enfermedad por coronavirus de 2019 (COVID-19). Enfoque Para aumentar rapidamente la cobertura de la vacuna contra la COVID-19 en 2022, el Ministerio de Sanidad y sus asociados (la Organizacion Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia) adoptaron una estrategia mas receptiva. Esta estrategia incluia una cuidadosa microplanificacion, una mejor seleccion de las poblaciones y la prestacion de servicios de vacunacion centrados en las personas y cercanos a sus hogares. Los servicios se combinaron con la vacunacion infantil y la prestacion de atencion sanitaria basica mediante la red antipoliomielitica existente y los agentes de salud comunitarios. Ademas, se introdujeron una herramienta digital para registrar los datos de vacunacion contra la COVID-19 y un sistema de registro electronico por telefono movil. Marco regional Somalia, un estado fragil y afectado por conflictos, atraveso dificultades a la hora de implementar la vacunacion contra la COVID-19, como la inexperiencia en la gestion de la vacunacion masiva de adultos, la falta de infraestructuras y de personal sanitario. Asimismo, la inseguridad en algunas regiones y la grave sequia provocaron desplazamientos de poblacion a gran escala. Cambios importantes La implementacion de una estrategia mas adaptada al contexto ayudo a Somalia a llegar a un numero mucho mayor de personas con la vacunacion contra la COVID-19 y a una cobertura del 42,1% a 31 de diciembre de 2022. Ademas, 84 600 ninos con dosis cero recibieron su primera vacuna infantil durante las campanas integradas. El aumento de la cobertura ha propiciado beneficios para la salud publica que superan la inversion en las campanas de vacunacion contra la COVID-19. Lecciones aprendidas El despliegue exitoso de la vacunacion de adultos es posible incluso en un entorno fragil y afectado por conflictos mediante la implementacion de un enfoque contextualizado y adaptado. Los factores clave consisten en una buena microplanificacion, el uso de herramientas digitales, una mejor orientacion de la poblacion, la agrupacion de vacunas y la prestacion de servicios de vacunacion cerca de los hogares., Introduction Somalia received its first 300 000 doses of coronavirus disease 2019 (COVID-19) vaccines from the COVID-19 Vaccines Global Access (COVAX) initiative on 15 March 2021, (1) and the first [...]

Objective To develop a framework and index for measuring universal health coverage (UHC) at the district level in India and to assess progress towards UHC in the districts. Methods We adapted the framework of the World Health Organization and World Bank to develop a district-level UHC index ([UHC.sub.d]). We used routinely collected health survey and programme data in India to calculate [UHC.sub.d] for 687 districts from geometric means of 24 tracer indicators in five tracer domains: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access; and financial risk protection. [UHC.sub.d] is on a scale of 0% to 100%, with higher scores indicating better performance. We also assessed the degree of inequality within districts using a subset of 14 tracer indicators. The disadvantaged subgroups were based on four inequality dimensions: wealth quintile, urban-rural location, religion and social group. Findings The median [UHC.sub.d] was 43.9% (range: 26.4 to 69.4). Substantial geographical differences existed, with districts in southern states having higher [UHC.sub.d] than elsewhere in India. Service coverage indicator levels were greater than 60%, except for noncommunicable diseases and for service capacity and access. Health insurance coverage was limited, with about 10% of the population facing catastrophic and impoverishing health expenditure. Substantial wealth-based disparities in UHC were seen within districts. Conclusion Our study shows that UHC can be measured at the local level and can help national and subnational government develop prioritization frameworks by identifying health-care delivery and geographic hotspots where limited progress towards UHC is being made. Objectif Elaborer un cadre et un Indice servant a mesurer la couverture sanitaire universelle (CSU) a l&apos;echelle des districts en Inde, et evaluer les progres effectues dans ce domaine. Methodes Nous avons adapte le cadre de l&apos;Organisation mondiale de la Sante et de la Banque mondiale pour mettre au point un indice de CSU par district ([CSU.sub.d]). Nous avons utilise des donnees recueillies systematiquement dans le cadre d&apos;un programme et d&apos;une enquete sur la sante en Inde pour calculer le [CSU.sub.d] de 687 districts, en partant des moyennes geometriques de 24 indicateurs tracants relevant de cinq categories: sante reproductive, maternelle, neonatale et infantile; maladies infectieuses; maladies non transmissibles; capacite et acces aux services; et enfin, protection contre les risques financiers. Le [CSU.sub.d] est compris entre 0 et 100%, les scores les plus eleves indiquant de meilleures performances. Nous avons egalement evalue le degre d&apos;inegalite au sein des districts a l&apos;aide d&apos;un sous-ensemble de 14 indicateurs tracants. Les sous-groupes defavorises reposaient sur quatre formes d&apos;inegalite: quintiles de richesse, implantation urbaine ou rurale, groupe religieux et groupe social. Resultats Le [CSU.sub.d] median etait de 43,9% (ecart: 26,4 a 69,4). Nous avons observe des variations geographiques considerables, les districts des Etats du sud affichant un meilleur [CSU.sub.d] que partout ailleurs en Inde. Lindicateur relatif a la couverture des services depassait les 60%, saufpour les maladies non transmissibles ou encore la capacite et l&apos;acces aux services. De son cote, la couverture d&apos;assurance-maladie etait limitee, environ 10% de la population etant confrontee a des depenses de sante catastrophiques entrainant un appauvrissement. Enfin, d&apos;importantes disparites dans la CSU ont ete constatees a l&apos;interieur des districts. Conclusion Notre etude montre que la CSU peut etre mesuree a l&apos;echelle locale, ce qui peut aider les autorites locales et nationales a hierarchiser les priorites en identifiant les prestations de soins de sante et les zones geographiques a risque ou l&apos;evolution vers une CSU se fait attendre. Objetivo Desarrollar un marco y un indice para medir la cobertura sanitaria universal (CSU) a nivel de distrito en India y evaluar los avances hacia la CSU en los distritos. Metodos Se adapto el marco de la Organizacion Mundial de la Salud y del Banco Mundial para desarrollar un indice de cobertura sanitaria universal a nivel de distrito ([CSU.sub.d]). Se utilizaron datos de encuestas y programas de salud recopilados sistematicamente en India para calcular el [CSU.sub.d] de 687 distritos a partir de medias geometricas de 24 indicadores de seguimiento en cinco ambitos de seguimiento: salud reproductiva, materna, neonatal e infantil; enfermedades infecciosas; enfermedades no transmisibles; capacidad y acceso a los servicios; y proteccion contra riesgos financieros. El CSU, esta en una escala de 0 a 100%, y los puntajes mas altos indican un mejor desempeno. Tambien se evaluo el grado de desigualdad dentro de los distritos utilizando un subconjunto de 14 indicadores de seguimiento. Los subgrupos desfavorecidos se basaron en cuatro dimensiones de desigualdad: quintil de riqueza, ubicacion urbano-rural, religion y grupo social. Resultados El promedio de [CSU.sub.d] fue del 43,9% (rango: 26,4 a 69,4). Existian diferencias geograficas significativas: los distritos de los estados del sur tenian un [CSU.sub.d] mas alto que los del resto de India. Los niveles de los indicadores de cobertura de servicios eran superiores al 60%, excepto para las enfermedades no transmisibles y para la capacidad y el acceso a los servicios. La cobertura del seguro sanitario era limitada, y alrededor del 10% de la poblacion se enfrentaba a gastos sanitarios catastroficos y empobrecedores. Se observaron disparidades significativas en la CSU segun el nivel de riqueza dentro de los distritos. Conclusion Este estudio demuestra que la CSU puede medirse a escala local y puede ayudar a los gobiernos nacionales y subnacionales a desarrollar marcos de priorizacion mediante la identificacion de los puntos criticos geograficos y de prestacion de asistencia sanitaria en los que los avances hacia la CSU son limitados., Introduction Universal health coverage (UHC) has emerged as a major goal in global health within the post-2015 millennium development agenda. (1) The objectives of UHC are typically defined by three [...]

Health-care technology is central to boosting the productivity and quality of health-care systems. In many sub- Saharan African countries, however, medical device management systems are weak or absent. The aim of this article is to illustrate, using a case study, how policy reforms can help ensure policy on health-care technology is translated into everyday practice and how an integrated systems approach can enhance the operation of medical device management. Between 2011 and 2023, a plan to improve medical device management systems in the United Republic of Tanzania was developed and implemented through Swiss-Tanzanian cooperation within the Health Promotion and System Strengthening Project. The availability of biomedical engineers was increased through new training courses and the creation of permanent positions in government. Moreover, additional district and regional maintenance and repair workshops were built, and a National Centre for Calibration and Training was established to ensure the correct functioning of medical devices. The introduction of an electronic medical device management system provided health facilities and the health ministry with data on the operational status of medical devices and the need for repairs and spare parts. Every level of government was encouraged to allocate more human and financial resources to medical device management. Following this decade-long effort, the percentage of functioning equipment increased substantially, and costs were reduced by repairing rather than replacing equipment. The project also demonstrated the value of an integrated, system-strengthening approach that considered personnel, maintenance and repair facilities, documentation and management, and government policy and budgeting. Les technologies jouent un role crucial dans le renforcement de la productivite et de la qualite des systemes de sante. Pourtant, dans de nombreux pays d&apos;Afrique subsaharienne, les systemes de gestion des dispositifs medicaux sont limites, voire inexistants. Cet article a pour but d&apos;illustrer, au moyen d&apos;une etude de cas, comment les reformes peuvent contribuer a faire en sorte que les politiques en matiere de technologies sanitaires soient appliquees au quotidien, et comment une approche integree peut ameliorer la gestion des dispositifs medicaux. Entre 2011 et 2023, un plan visant a developper les systemes de gestion des dispositifs medicaux en Republique-Unie de Tanzanie a ete defini et mis en reuvre en collaboration avec la Suisse, dans le cadre du Projet de Promotion et de Renforcement du Systeme de Sante. De nouvelles formations et la creation de postes permanents au sein du gouvernement ont permis d&apos;accroitre la disponibilite des ingenieurs biomedicaux. En outre, des ateliers supplementaires d&apos;entretien et de reparation ont ete construits dans differentes regions et districts, tandis qu&apos;un Centre National d&apos;Etalonnage et de Formation a ouvert ses portes pour assurer le bon fonctionnement des dispositifs medicaux. Lintroduction d&apos;un systeme electronique de gestion des dispositifs medicaux a fourni aux etablissements de soins de sante et au Ministere de la Sante des donnees concernant le statut operationnel de ces dispositifs, ainsi que les reparations et pieces detachees requises. Chaque niveau de pouvoir a ete encourage a attribuer davantage de ressources humaines et financieres a la gestion des dispositifs medicaux. Au terme de dix ans d&apos;efforts, le pourcentage d&apos;equipements en etat de marche a considerablement augmente et les couts ont diminue grace au recours a la reparation plutot qu&apos;au remplacement. Le projet a egalement demontre l&apos;importance d&apos;une approche integree, qui consiste a renforcer le systeme en tenant compte du personnel, de l&apos;entretien et des installations de reparation, de la documentation et de la gestion, mais aussi de la politique gouvernementale et du budget. La tecnologia aplicada a la atencion sanitaria es fundamental para impulsar la productividad y la calidad de los sistemas sanitarios. Sin embargo, en muchos paises del Africa subsahariana los sistemas de gestion de los productos sanitarios son deficientes o inexistentes. El objetivo de este articulo es ilustrar, mediante un estudio de caso, como las reformas politicas pueden ayudar a garantizar que la politica sobre tecnologia de la atencion sanitaria se convierta en una practica cotidiana y como un enfoque de sistemas integrados puede mejorar el funcionamiento de la gestion de los productos sanitarios. Entre 2011 y 2023, se elaboro un plan para mejorar los sistemas de gestion de los productos sanitarios en la Republica Unida de Tanzania, que se implemento a traves de la cooperacion suizo-tanzana en el marco del Proyecto de Promocion de la Salud y Fortalecimiento del Sistema. Se aumento la disponibilidad de ingenieros biomedicos mediante nuevos cursos de formacion y la creacion de puestos permanentes en el gobierno. Ademas, se construyeron talleres de mantenimiento y reparacion adicionales de distrito y regionales, y se establecio un Centro Nacional de Calibracion y Formacion para garantizar el correcto funcionamiento de los productos sanitarios. La introduccion de un sistema electronico de gestion de productos sanitarios proporciono a los centros sanitarios y al Ministerio de Sanidad datos sobre el estado operativo de los productos sanitarios y la necesidad de reparaciones y piezas de repuesto. Se animo a todos los niveles de gobierno a asignar mas recursos humanos y financieros a la gestion de los productos sanitarios. Tras este esfuerzo de una decada, el porcentaje de equipos en funcionamiento aumento notablemente y los costes se redujeron al reparar los equipos en lugar de sustituirlos. El proyecto tambien demostro el valor de un enfoque integrado de refuerzo del sistema que tenia en cuenta el personal, las instalaciones de mantenimiento y reparacion, la documentacion y la gestion, y la politica y los presupuestos gubernamentales., Introduction Health-care technology includes medical devices, procedures and systems, as well as medicines and vaccines, and involves the application of organized knowledge and skills. (1-3) Such technology plays a crucial [...]

The view directly ahead of me is classically, achingly picturesque: Vesuvius as backdrop, its distinctive outline purple-blue against an azure sky, while in the foreground umbrella pines soften the scene's [...]

Measles virus is one of the most infectious pathogenic agents and has a basic reproduction number ([R.sub.0]) of 12-18, indicating that each infected person could infect 12-18 other susceptible persons [...]

Our Government Affairs program advocates for support of environmental health programs and professionals at federal, state, and local levels of government. We function as a liaison between environmental health professionals [...]