Low Level Of Use Research Articles

English

Unless evidence based decisions are made based on local contexts, the low prevalence level of contraceptive use and the corresponding higher total fertility rate will make Ethiopia to remain the most populous country in Africa. The purpose of this study was to assess the status of modern contraceptive use among married women in Debre Birhan district, Ethiopia. A community based cross-sectional study was conducted among married women of reproductive age. Systematic random sampling technique was used to choose 851 study subjects. Before data collection, ethical clearance was obtained from the institution, and data was collected by trained diploma nurses using pretested structured questionnaire and analyzed by statistical package for social sciences (SPSS), version 20. Logistic regression analysis was employed to identify the predictors of modern contraceptive use. Modern contraceptive prevalence rate among married women was 46.9%. Injectables were the most frequently used type of modern contraceptive method (62.9%), followed by intrauterine device (16.8%), pills (14%), norplant (4.3%), male condom (1.2%) and female sterilization (0.8%). Multiple logistic regression model revealed that the need to have more children [AOR 95% CI: 9.27 (5.43 to 15.84)], husband approval [AOR 95% CI: 2.82 (1.67 to 4.80)] and husband-wife communication about contraceptives [AOR 7.32, 95% CI (3.60 to 14.86)] were found to be an independent predictors for the use of modern contraceptives. There were no statistical significant differences between modern contraceptive use and other socio-demographic and reproductive health related variables after an adjustment. Modern contraceptive use declined among married women in the district. The culture of publicly discussing the use of contraceptives and breaking the silence among the people demands substantial efforts. Considering users of contraceptives as deviant also requires paradigm shift in thinking. Key words: Debre-Birhan, married women, modern contraceptive, use.

Student and Nonstudent National Guard Service Members/Veterans and Their Use of Services for Mental Health Symptoms

. Objective: To compare mental health symptoms and service utilization among returning student and nonstudent service members/veterans (SM/Vs). Participants: SM/Vs (N = 1,439) were predominately white (83%) men (92%), half were over age 30 (48%), and 24% were students. Methods: SM/Vs completed surveys 6 months post deployment (October 2011–July 2013). Results: Students and nonstudent SM/Vs did not differ in positive screens for depression, anxiety, hazardous drinking, or posttraumatic stress disorder. Students (n = 81) and nonstudents (n = 265) with mental health symptoms had low levels of mental health service use (eg, Department of Veterans Affairs [VA], civilian, or military facilities), at 47% and 57%. respectively. Fewer students used VA mental health services. Common barriers to treatment seeking included not wanting treatment on military records and embarrassment. Conclusions: Like other returning SM/Vs, student SM/Vs have unmet mental health needs. The discrepancy between potential need and treatment seeking suggests that colleges might be helpful in further facilitating mental health service use for student SM/Vs.

Avian diversity in pine forests along an urban–rural/agriculture-wildland gradient

To understand the role of pine forests in an urban/agricultural matrix for avian diversity conservation, we investigated how avian species richness (number of species) changes along an urban–rural/agriculture-wildland gradient. We conducted bird surveys and vegetation surveys in pine forests in central-east Georgia, during 2010–2011 breeding seasons. We classified an urban–rural/agriculture-wildland gradient into seven classes. We performed the rank analysis of covariance and pairwise comparisons (based on the overlap of 90 % confidence intervals). Significant differences in avian species richness were found among seven classes (P < 0.05). Species richness was lower in pine patches embedded in wildland matrix compared to those in urban and/or agricultural matrix. Lower diversity was associated with relatively low structural diversity of vegetation in pine patches within the wildland matrix. Although most results of pairwise comparisons were insignificant, species richness of shrub nesting species, migrant species, and pine-grassland species was higher at pine patches in a mixture of low level of urban and agricultural land use and/or in low level of agricultural land use. Our results suggest that while pine forests in wildland are crucial habitats for conservation-important species, pine forests in some human-altered landscapes may also play a positive role for avian diversity conservation.

Parametric study on the performance of green residential buildings in China

The parametric study of the indoor environment of green buildings focuses on the quantitative and qualitative improvement of residential building construction in China and the achievement of indoor thermal comfort at a low level of energy use. This study examines the effect of the adaptive thermal comfort of indoor environment control in hot summer and cold winter (HSCW) zones. This work is based on a field study of the regional thermal assessment of two typical cases, the results of which are compared with simulated results of various scenarios of “energy efficiency” strategy and “healthy housing” environmental control. First, the simulated results show that the adaptive thermal comfort of indoor environment control is actually balanced in terms of occupancy, comfort, and energy efficiency. Second, adaptive thermal comfort control can save more energy for heating or cooling than other current healthy housing environmental controls in China׳s HSCW zone. Moreover, a large proportion of energy use is based on the subjective thermal comfort demand of occupants in any building type. Third, the building shape coefficient cannot dominate energy savings. The ratio of the superficial area of a building to the actual indoor floor area has a significant positive correlation with and affects the efficiency of building thermal performance.

Investigation of stakeholders' awareness and adoption of Inherently Safer Design (ISD) principles in South African utility industry projects

The paper examines the level of awareness of stakeholders in adopting Inherently Safer Design (ISD) principles in the Project Life Cycle Management (PLCM) of South African Energy utility projects. It seeks to understand whether stakeholders in the latter stages of the Project Life Cycle are competent to make design change decisions on these projects. ISD principles are essentially useful for reducing risks and as such, safety experts have acknowledged it as an excellent approach in the design process. However, there are no known efforts to date that attempt to integrate ISD concepts into PLCM. This paper seeks to fill this gap. This study, through the review of extant literature establishes that ISD principles can be used in project procurement, and adopts a quantitative survey approach in obtaining information from stakeholders in the South African utility industry. Findings reveal that the principles of inherent safety are permeating into the management of South African utility projects but the level of awareness and its adoption are below optimal levels. It also emerged that there is a divergent awareness of ISD strategies amongst PLCM stakeholders and that the design engineers are better informed about the ISD approach of eliminating risks and hazards in the industrial systems studied than other stakeholders. The findings also indicate that the level of awareness of stakeholders of ISD principles is greater within earlier project phases. Based on these findings, the paper concludes that the hazards witnessed within the project execution and finalization phases could be as a result of the low levels of awareness, divergent views and lower use of ISD strategies by PLCM stakeholders. It is suggested that the level of awareness of the principles, concepts, basics and benefits of integrating ISD into PLCM be raised amongst stakeholders functioning within utility industry project procurement in South Africa and that design changes be limited to the earlier phases of utility project procurement.

Association of amount and duration of NRT use in smokers with cigarette consumption and motivation to stop smoking: A national survey of smokers in England

IntroductionClinical trials have found that the use of nicotine replacement therapy (NRT) to reduce cigarette consumption results in significant declines in cigarette consumption and increases smokers' propensity to quit. However, observational “real-world” studies have found much smaller effects. This may be because of low levels of NRT use. This study examined the association between amount and duration of NRT use amongst those attempting to reduce their cigarette consumption with motivation to quit and cigarette consumption. MethodsData came from 2,158 smokers who took part in the Smoking Toolkit Study. A representative survey of smokers in England aged 16+. ResultsOnly 54.4% of patch users and 32.2% of non-transdermal NRT users reported using NRT with a frequency that would be expected to substantially influence cigarette consumption (4+ units per day for acute NRT forms and at least daily for transdermal patches). Those using the patch at or above this threshold smoked 1.3 cigarettes per day fewer than those using it below the threshold (p=0.059), whilst those using non-transdermal NRT at or above this threshold smoked 0.9 cigarettes less per day (p=0.022). In both cases, those using NRT more frequently had greater motivation to quit. Less than 1/5th of participants reported using a combination of NRT products. Use of NRT long-term was associated with lower motivation to quit and higher cigarette consumption. ConclusionSmokers attempting to reduce their cigarette intake are underusing NRT and this is associated with cigarette consumption and motivation to quit. These findings may explain why population-based studies have failed to report similar findings to clinical trials.

Self-perceived Listening Comprehension Strategies Used by Iranian EFL Students

Numerous studies are available on L2 learners’ strategy use; however, there is no study investigating the Iranian tertiary level EFL learners’ listening strategy use. The present paper reports the findings of a cross-sectional study that explored a group of Iranian EFL learners’ (n = 100) use of listening comprehension strategies. The instrument that was used for collecting the data was called the Listening Strategy Use Questionnaire (LSUQ) by Nowrouzi, Tam, Nimehchisalem, and Zareian (2014). The instrument divides listening strategies into cognitive, metacognitive, and socio-affective categories. Based on the results, on average the respondents reported low levels of self-perceived use of cognitive, metacognitive, and socio-affective strategies. The results indicate a serious need to focus more on the students’ listening comprehension skills in general and their listening strategies in particular.

Methodological biases in estimating the relationship between alcohol consumption and breast cancer: the role of drinker misclassification errors in meta-analytic results.

While alcohol consumption has been linked to breast cancer in women, few studies have controlled for possible biases created by including former or occasional drinkers in the abstainer reference group. We explored the potential for such misclassification errors as sources of bias in estimates of the alcohol-breast cancer relationship. Meta-analyses of population case-control, hospital case-control, and cohort studies to examine relationships between level of alcohol use and breast cancer morbidity and/or mortality in groups of studies with and without different misclassification errors. Of 60 studies identified, only 6 were free of all misclassification errors. The abstainer reference group was biased by the inclusion of former drinkers in 49 studies, occasional drinkers (<10g ethanol [EtOH] per week) in 22 and by both these groups in 18. Occasional drinkers were also mixed with light or hazardous-level drinkers in 22 studies. Unbiased estimates of the odds ratio (OR) for breast cancer were 1.011 (95% confidence interval [CI]: 0.891 to 1.148) among former drinkers (n=11) and 1.034 (95% CI: 1.003 to 1.064) among occasional drinkers (n=17). Hazardous-level drinking (>20g<41g EtOH/d) was not significantly associated with breast cancer in studies with occasional drinker bias. However, in studies free from occasional drinker bias, the OR for breast cancer was 1.085 (95% CI: 1.015 to 1.160) for low-level (<21g/d) drinkers (n=17), 1.374 (95% CI: 1.319 to 1.431) for hazardous-level drinkers (n=26), and 1.336 (95% CI: 1.228 to 1.454) for harmful-level (>40g/d) drinkers (n=9). While the great majority of studies of the alcohol-breast cancer link include misclassification errors, only misclassification of occasional drinkers was found to bias risk estimates significantly. Estimates based on error-free studies confirmed that low, hazardous and harmful levels of alcohol use each significantly increase the risk of breast cancer.

Understanding variability in adolescent women's sexually transmitted infection-related perceptions and behaviors associated with main sex partners.

It is not well understood whether characteristics of adolescent main partnerships differ categorically from one relationship to the next or whether observed differences in sexually transmitted infection (STI)-related perceptions and sexual behaviors between main partnerships results from a failure to capture variability within adolescent main partnerships. The objective of this study was to examine the extent to which female adolescents' STI-related feelings, perceptions, and sexual behavior associated with main sex partners varied over the course of their relationship. A cohort of adolescent women aged 16 to 19 years at baseline, recruited from health clinics or community venues, completed daily diaries on a Smartphone continuously for 18 months. Participants reported daily on their partner-specific feelings of closeness, trust, commitment, perceived risk for acquiring a sexually transmitted disease (PRSTD), perception of partner concurrency (PPC), and condom use for their main sexual partners. Relationships from 49 participants were used to examine variability over time in STI-related feelings, perceptions, and behavior. Overall, relationships were characterized by high levels of trust, closeness, and commitment and low levels of PPC, PRSTD, and condom use. However, for all but PRSTD, there was more variation (>50%) within than between relationships for each of these measures, although variability of PRSTD was high (47.1%). Residual variability for all perceptions and behaviors remained significant after controlling for trends over time. Diary data illustrate wide day-to-day fluctuations in feelings of intimacy, PPCs, PRSTDs, and condom use indicating that these are dynamic attributes of adolescent romantic relationships.

Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study.

Although moderate alcohol use is associated with protection against myocardial infarction (MI), it is not known whether this effect is generalizable to populations worldwide. It is also uncertain whether differences in the pattern of alcohol use (and in particular heavy episodic consumption) between different regions negate any beneficial effect. We included 12 195 cases of first MI and 15 583 age- and sex-matched controls from 52 countries. Current alcohol use was associated with a reduced risk of MI (compared with nonusers: adjusted odds ratio, 0.87; 95% confidence interval, 0.80-0.94; P=0.001); however, the strength of this association was not uniform across different regions (region-alcohol interaction P<0.001). Heavy episodic drinking (≥6 drinks) within the preceding 24 hours was associated with an increased risk of MI (odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P=0.01). This risk was particularly elevated in older individuals (for age >65 years: odds ratio, 5.3; 95% confidence interval, 1.6-18; P=0.008). In most participants, low levels of alcohol use are associated with a moderate reduction in the risk of MI; however, the strength of this association may not be uniform across different countries. An episode of heavy drinking is associated with an increased risk of acute MI in the subsequent 24 hours, particularly in older individuals.

Symptoms of tobacco dependence among middle and high school tobacco users: results from the 2012 National Youth Tobacco Survey.

A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users. To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students. Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design. Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2-4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3-5 days compared to those who only used it for 1-2 of the past 30 days. A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.

Health-Risk Behaviors Among High School Athletes and Preventive Services Provided During Sports Physicals

IntroductionPreparticipation examinations (PPEs), or sports physicals, present opportunities for health care providers to identify and discuss common adolescent health-risk behaviors. We sought to examine the prevalence of health-risk behaviors among high school athletes and the proportion of providers who address these behaviors during PPEs. MethodFor this descriptive study we used data from two statewide surveys: a survey of adolescents (n = 46,492) and a survey of nurse practitioners and physicians (n = 561). ResultsThe most prevalent risk behaviors reported by student athletes were low levels of physical activity (70%), bullying perpetration (41%), and alcohol use (41%). Most providers (≥75%) addressed many common risk behaviors during PPEs but fewer addressed bullying, violence, and prescription drug use. Topics discussed differed by provider type and patient population. DiscussionMany providers addressed critical threats to adolescent health during PPEs, but findings suggest potential disconnects between topics addressed during PPEs and behaviors of athletes.

The effect of performance measurement systems on firm performance: A cross-sectional and a longitudinal study

Performance measurement (PM) systems have been popularized over the last 20 years and the operations management literature is replete with discussion of metrics and measurement systems. Yet, a comprehensive nomological network relating types of PM system uses to organizational capabilities and performance is lacking. Furthermore, there is scant empirical evidence attesting to the explanatory efficacy of PM systems as it relates to organizational performance. We view PM system uses through the lenses of the Resource Orchestration Theory (ROT) and explore specific relationships of underlying variables by relying on the Organizational Information Processing Theory (OIPT). Resting on the extant literature, we identify two types of uses which include Diagnostic Use (the review of critical performance variables in order to maintain, alter, or justify patterns in an organizational activity) and interactive use (a forward-looking activity exemplified by active and frequent involvement of top management envisioning new ways to orchestrate organizational resources for competitive advantage) and relate them along with their interaction (i.e., dynamic tension) to organizational capabilities. We further link capabilities to target performance, which subsequently impacts organizational performance (operationalized through both perceptual and objective financial performance measures). The nomological network is tested via a cross sectional study (386 Italian firms) while the efficacy of PM systems to explain organizational performance is examined by using longitudinal panel data approaches over a 10 year period. There is sufficient evidence to suggest that the use of PM systems leads to improved capabilities, which then impact performance. Contrary to the extant literature, however, we discovered that Diagnostic Use appears to be the most constructive explanatory variable for capabilities. On the other hand, in light of a longitudinal study, we also uncovered that Diagnostic Use experienced depreciating returns as far as objective financial measures are concerned. Also, when high levels of Diagnostic Use were coupled with low levels of Interactive Use, they produced the lowest levels of organizational capabilities. Conversely, high levels of both types of PM system use generated extraordinary high levels of capabilities. There is sufficient evidence to suggest that organizations cannot rely merely on Diagnostic Use of PM systems. We also learned that the effects of PM systems (measured via adaptation) fade unless high learning rates are applied. We offer detailed recommendations for future research which have theoretical as well as empirical implications.

Vulnerability of African maize yield to climate change and variability during 1961–2010

Because of the necessity of feeding growing populations, there is a critical need to assess the variation and vulnerability of crop yields to potential climate change. Databases of maize yields and climate variables in the maize growing seasons were used to assess the vulnerability of African maize yields to climate change and variability with different levels of management at country scale between 1961 and 2010. The ratios of time-series trends or standard deviations of detrended yield deviation and climate variables including temperature (Tmean), precipitation (P) and standardized precipitation evapotranspiration index (SPEI) were used to analyze the vulnerability of maize yields to climate change and variability for each country in Africa. Most countries, where soil fertility had been declining owing to low levels of fertilizer use over many years and limited water resources, had decreasing maize yields. The negative impacts of increasing temperature and decreasing precipitation and SPEI on maize yields progressively increased at the whole continent scale over the time period studied. During the maize growing seasons 1961–2010, each 1°C of Tmean increase resulted in yield losses of over 10% in eight countries and 5-10% in 10 countries, but yields increased by more than 5% in four relatively cool countries. Decreases of 10% average P resulted in more than 5% decreases in yields in 20 countries and each decrease of 0.5 SPEI resulted in over 30% losses of maize yields in 32 countries. Greater Tmean or P or SPEI variability in Africa may also bring about greater fluctuations in yield. In addition, countries with better management, which would be expected to have better yields, may be more vulnerable to yield losses due to adverse physical conditions. Better irrigation and fertilizer application will be important to sustain higher yields in the future, as will the development of maize varieties with greater heat and drought tolerance.

Beraprost Sodium (Prostaglandin I2 analogue) Delays Deterioration of allograft Dysfunction in Kidney Transplant Recipient Treated With Calcineurin Inhibitors.

Purpose: Calcineurin inhibitors(CNIs) have considerably improved renal allograft survival. However, long-term use of CNIs can cause nephrotoxicity. The purpose of this study was to evaluate the effect of beraprost sodium(prostaglandin I2 analogue) on renal allograft in patients treated with CNIs. Methods: In this prospective, open-label, comparative, single center study, 40 patients who underwent first kidney-only transplants were included. They were divided randomly into two groups: control and treatment group. The patients in treatment group received beraprost sodium(120μg/day) for a year. The changes of estimated glomerular filtration rate(eGFR), blood pressure, and histologic results were compared between two groups. Results Ninteen patients in treatment group and 14 patients in control group completed the study. All, except one patient in control group treated cyclosporine, were treated with tacrolimus and the trough levels were in the range of 4.8-5.8ng/ml. The decline in eGFR was significantly lower in treatment group than that of control(62.9±14.15 to 61.8 ±14.96, vs. 68.8±15.31 to 62.8±15.17ml/min/1.73m2,P=0.048). The changes of blood pressure did not differ between two groups. From histologic results, the mean scores for arteriolar hyaline were decreased in treatment group and progressed in control group, however, the differences could not reach the statistical differences(0.21±0.535 to 0.11±0.315 vs. 0 to 0.14±0.363,P=0.105). The mean scores for interstitial fibrosis and tubular atrophy(IFTA), glomuerulosclerosis were not significantly different between two groups. However, the proportion of patients with IFTA score higher than one was increased in control and maintained in treatement group. The scores for epithelial-mesenchymal transition markers(vimentin, ß-catenin) were decreased in treatment group and progressed in control group, however, the differences could not reach the statistical differences. Conclusions Beraprost sodium has a beneficial effect on renal allograft function in patients exposed to CNIs. However, the change of structural damage is not obvious with the conditions of low levels of CNIs and short-term use of beraprost sodium. Further follow-up is needed to demonstrate the changes of structural damage.

PUBLIC POLICY AND IMPACTS ON ADOPTION OF SUSTAINABLE BUILT ENVIRONMENTS: LEARNING FROM THE CONSTUCTION INDUSTRY PLAYMAKERS

Sustainable practices in the built environment are becoming a more common phenomona as market penetration of green buildings grow. Despite the reported benefits of green buildings, barriers to sustainability still exist. To motivate wider adoption of sustainable built environments, this research studies public policy and its impacts. The study aims to understand the links between public policy, construction playmakers' (e.g., organizations', institutions', business owners', and developers') motivation to build green, and growth of sustainable built environments in the United States. As a step forward in this direction, this paper focuses on the case of Michigan and explores construction playmakers' motivations to build and/or occupy sustainable buildings and how effective current public policy in Michigan is at addressing these motivations. There is little research on the links among legislation, construction playmakers' motivation to build green, and the growth of sustainable built environment in the United States. This article's findings show that: 1) green building costs are still the most frequently-reported barrier to green building, 2) property developers are significantly less likely to utilize green building practices than other construction playmakers, 3) single-family residential buildings were the least likely building type to receive green certifications, and 4) construction playmakers report low levels of green policy awareness and use despite the presence of relevant public policies. These findings will provide direction for policy makers and advocates in creating policy that will effectively promote green building construction.

High rates of abortion and low levels of contraceptive use among adolescent female sex workers in Kunming, China: A cross-sectional analysis

Objectives In China, considerable stigma surrounds sexual activity, contraception use and abortion among young unmarried women, and sex work remains illegal. This study examines characteristics of adolescent female sex workers (FSWs) associated with contraceptive use and abortion in Kunming, China.Methods This cross-sectional study was conducted between July 2010 and February 2011. Adolescent FSWs were recruited using snowball and convenience sampling. We present descriptive statistics, comparative analyses of socio-demographic and reproductive characteristics of respondents who had or had not used modern contraceptives, and assessed factors associated with prior abortion using simple odds ratios (ORs) and multivariate logistic regression adjustments.Results Twenty-seven percent of adolescent FSWs had never used any modern contraceptive. Condoms (69%) and oral contraceptives (38%) were most commonly reported, and less than 3% had ever relied on an intrauterine device. We found low rates of dual protection (34%). About half of the respondents reported one or more lifetime abortions. Inconsistent condom use, frequent alcohol use and longer-term cohabitation were associated with prior abortion.Conclusions Low consistent utilisation of modern contraceptives and of dual protection, and high rates of abortion, highlight the urgent need for early contact and continuous provision of comprehensive reproductive health services for adolescent FSWs.Chinese 摘 要 目的 在中国，性行为、使用避孕工具及流产对于年轻未婚女性来说是巨大的耻辱，且性工作仍然是违法的。本研究调查了中国昆明年轻女性性工作者（FSWs）的使用避孕用品和流产的相关特点。方法 该横断面研究于2010年7月至2011年2月进行。我们采用雪球式抽样和便利抽样选取年轻FSWs。我们对被调查者（使用或未使用过现代避孕用品）的社会人口特征和生殖特征进行描述统计和比较分析，并利用单一比值比（ORs）和多元逻辑回归调整评估与先前流产相关的因素。结果 27%的年轻FSWs从未使用过任何现代避孕工具。报告中最常见的是避孕套（69%）和口服避孕药（38%），3%以下的被调查者依赖子宫内节育器。我们发现双 重 保护率很低（34%）。约一半的被调查者报告了一次及以上的流产。先前的流产与未 坚持使用避孕套、频繁饮酒和较长期的同居相关。结论 现代避孕用品的低使用率和低双重保护率以及高流产率，突出说明了年轻女性性工作者对于全面的生殖健康服务的早期接触和相关规定的持续保障的迫切需要。

Cost-effectiveness of silicone and alginate impressions for complete dentures

ObjectiveThe aim of this study was to assess the cost effectiveness of silicone and alginate impressions for complete dentures. MethodsCost effectiveness analyses were undertaken alongside a UK single centre, double blind, controlled, crossover clinical trial. Taking the perspective of the healthcare sector, effectiveness is measured using the EuroQol (EQ-5D-3L) which provides a single index value for health status that may be combined with time to produce quality adjusted life years (QALYs); and Oral Health Impact Profile (OHIP-EDENT). Incremental cost effectiveness ratios are presented representing the additional cost per one unit gained. ResultsMean cost was higher in the silicone impression group (£388.57 vs. £363.18). Negligible between-group differences were observed in QALY gains; the silicone group had greater mean OHIP-EDENT gains. The additional cost using silicone was £3.41 per change of one point in the OHIP-EDENT. ConclusionsThe silicone group was more costly, driven by the cost of materials. Changes in the EQ-5D and QALY gains over time and between arms were not statistically significant. Change in OHIP-EDENT score showed greater improvement in the silicone group and the difference between arms was statistically significant. Given negligible QALY gains and low level of resource use, results must be treated with caution. It is difficult to make robust claims about the comparative cost-effectiveness. Clinical significanceSilicone impressions for complete dentures improve patients’ quality of life (OHIP-EDENT score). The extra cost of silicone impressions is £30 per patient. Dentists, patients and health care funders need to consider the clinical and financial value of silicone impressions. Different patients, different dentists, different health funders will have individual perceptions and judgements.ISRCTN01528038.NIHR-RfPB grant PB-PG-0408-16300.This article forms part of a project for which the author (TPH) won the Senior Clinical Unilever Hatton Award of the International Assocation for Dental Research, Capetown, South Africa, June 2014.

동절기 수압시험을 대체하는 공기압시험의 적정압력 비교분석에 관한 연구

Using a high-rise building water piping after hydrostatic test of the reliability of the leak to be completed if the pressure is maintained until the leak is not commercially available considered. Due to the nature of high-rise buildings and the construction period will take several years from the lower levels of use of the water supply and fire fighting water pipe construction is in progress, the order of which I do most of the first pipe to the construction and more than three years. So kind of riser pipe is complete, install the valve in the basement by installing an automatic pump to maintain a constant pressure after hydrostatic test and after each floor plumbing piping is complete, the progress of the hydrostatic test without undergoing a separate branch pipe the valve is opened automatically when the number of the pressing pressure of the structure. I kind of do and keep working pressure of pipe until the completion of the construction work to keep the damage to human error when it is intended to prepare. In winter, the frost protection and an alternative to drainage water pipe is damaged or deformed, even if unaware of the finishing work to the building, the use of the damage caused by a leak in a after construction of finish work to be expected. Alternative to reduce this damage if the pressure test without fear of freezing to help maintain long-term commercial pressures may be considered.

HIV among people who inject drugs in the Middle East and North Africa: systematic review and data synthesis.

It is perceived that little is known about the epidemiology of HIV infection among people who inject drugs (PWID) in the Middle East and North Africa (MENA). The primary objective of this study was to assess the status of the HIV epidemic among PWID in MENA by describing HIV prevalence and incidence. Secondary objectives were to describe the risk behavior environment and the HIV epidemic potential among PWID, and to estimate the prevalence of injecting drug use in MENA. This was a systematic review following the PRISMA guidelines and covering 23 MENA countries. PubMed, Embase, regional and international databases, as well as country-level reports were searched up to December 16, 2013. Primary studies reporting (1) the prevalence/incidence of HIV, other sexually transmitted infections, or hepatitis C virus (HCV) among PWIDs; or (2) the prevalence of injecting or sexual risk behaviors, or HIV knowledge among PWID; or (3) the number/proportion of PWID in MENA countries, were eligible for inclusion. The quality, quantity, and geographic coverage of the data were assessed at country level. Risk of bias in predefined quality domains was described to assess the quality of available HIV prevalence measures. After multiple level screening, 192 eligible reports were included in the review. There were 197 HIV prevalence measures on a total of 58,241 PWID extracted from reports, and an additional 226 HIV prevalence measures extracted from the databases. We estimated that there are 626,000 PWID in MENA (range: 335,000-1,635,000, prevalence of 0.24 per 100 adults). We found evidence of HIV epidemics among PWID in at least one-third of MENA countries, most of which are emerging concentrated epidemics and with HIV prevalence overall in the range of 10%-15%. Some of the epidemics have however already reached considerable levels including some of the highest HIV prevalence among PWID globally (87.1% in Tripoli, Libya). The relatively high prevalence of sharing needles/syringes (18%-28% in the last injection), the low levels of condom use (20%-54% ever condom use), the high levels of having sex with sex workers and of men having sex with men (15%-30% and 2%-10% in the last year, respectively), and of selling sex (5%-29% in the last year), indicate a high injecting and sexual risk environment. The prevalence of HCV (31%-64%) and of sexually transmitted infections suggest high levels of risk behavior indicative of the potential for more and larger HIV epidemics. Our study identified a large volume of HIV-related biological and behavioral data among PWID in the MENA region. The coverage and quality of the data varied between countries. There is robust evidence for HIV epidemics among PWID in multiple countries, most of which have emerged within the last decade and continue to grow. The lack of sufficient evidence in some MENA countries does not preclude the possibility of hidden epidemics among PWID in these settings. With the HIV epidemic among PWID in overall a relatively early phase, there is a window of opportunity for prevention that should not be missed through the provision of comprehensive programs, including scale-up of harm reduction services and expansion of surveillance systems.