Building a platform for translational research in chronic noncommunicable diseases to address population health: lessons from NHLBI supported CRONICAS in Peru.
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ABSTRACT:
SUBMITTER: Miranda JJ
PROVIDER: S-EPMC4356013 | biostudies-literature | 2015 Mar
REPOSITORIES: biostudies-literature
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Building a platform for translational research in chronic noncommunicable diseases to address population health: lessons from NHLBI supported CRONICAS in Peru.
Miranda J Jaime JJ Bernabé-Ortiz Antonio A Diez-Canseco Francisco F Málaga Germán G Cardenas María K MK Carrillo-Larco Rodrigo M RM Pesantes M Amalia MA Araya Ricardo R Boggio Oscar O Checkley William W García Patricia J PJ León-Velarde Fabiola F Lescano Andrés G AG Montori Victor V Pan William W Rivera-Chira Maria M Sacksteder Katherine K Smeeth Liam L García Héctor H HH Gilman Robert H RH
Global heart 20150301 1
The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the U.S. National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognized center of excellence conducting quality and innovative research and generating high-impact evidence for health. The center's identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structur ...[more]
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Project description:BackgroundThe monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18).MethodsNNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises.ResultsTotal of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities.ConclusionBoth private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.
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Project description:One of the biggest perceived challenges in building megastructures, such as the space elevator, is the unavailability of materials with sufficient tensile strength. The presumed necessity of very strong materials stems from a design paradigm which requires structures to operate at a small fraction of their maximum tensile strength (usually, 50% or less). This criterion limits the probability of failure by giving structures sufficient leeway in handling stochastic components, such as variability in material strength and/or external forces. While reasonable for typical engineering structures, low working stress ratios-defined as operating stress as a fraction of ultimate tensile strength-in the case of megastructures are both too stringent and unable to adequately control the failure probability. We draw inspiration from natural biological structures, such as bones, tendons and ligaments, which are made up of smaller substructures and exhibit self-repair, and suggest a design that requires structures to operate at significantly higher stress ratios, while maintaining reliability through a continuous repair mechanism. We outline a mathematical framework for analysing the reliability of structures with components exhibiting probabilistic rupture and repair that depend on their time-in-use (age). Further, we predict time-to-failure distributions for the overall structure. We then apply this framework to the space elevator and find that a high degree of reliability is achievable using currently existing materials, provided it operates at sufficiently high working stress ratios, sustained through an autonomous repair mechanism, implemented via, e.g. robots.
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