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Dynamic XML-based exchange of relational data: application to the Human Brain Project.

This paper discusses an approach to exporting relational data in XML format for data exchange over the web. We describe the first real-world application of SilkRoute, a middleware program that dynamically converts existing relational data to a user-defined XML DTD. The application, called XBrain, wraps SilkRoute in a Java Server Pages framework, thus permitting a web-based XQuery interface to a legacy relational database. The application is demonstrated as a query interface to the University of Washington Brain Project's Language Map Experiment Management System, which is used to manage data about language organization in the brain.

Brain↗

Should governments subsidize the use of insecticide-impregnated mosquito nets in Africa? Implications of a cost-effectiveness analysis.

Recent large-scale field trials show that mosquito nets impregnated with insecticide can substantially reduce all-cause mortality in children in malaria-endemic areas in Africa. This paper considers the cost-effectiveness of impregnated nets, initially from the perspective of a government programme which would distribute nets free of charge and organize and fund re-impregnation on an annual basis. The calculations show that with the reductions in all-cause mortality observed in the trials, complete government subsidy of nets through a vertical programme would represent an efficient use of scarce resources for most combinations of assumptions. However, alternative ways of financing and organizing the use of impregnated nets are also possible and may be more cost-effective than vertical delivery. Distribution of nets and insecticide might be less costly than required for a vertical programme by integrating delivery with other types of government health programmes, with private sector delivery systems for other types of products, or with government systems developed for other sectors such as agriculture. Further, not all the costs need to be met by governments, as costs could be shared with donors, NGOs and the beneficiaries. The major conclusion is that impregnated nets would save a large number of lives in malaria endemic areas, they are an efficient use of scare resources, and ways of encouraging their use need to be developed and tested.

Africa↗

Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

Abortion, Legal↗

Cerebral palsy improvement achieved by coordination dynamics therapy.

Low-intensity coordination dynamics therapy, including crawling, treadmill walking, jumping on spring-board and exercising on a special coordination dynamics therapy device, was applied for 3 months (4 hours therapy per week) to 8 cerebral palsy patients (average age 15 years, range 7-27). All patients improved. The organization of the CNS, quantified by the low-load coordination dynamics between arm and leg turning movements, when exercising on the special coordination dynamics therapy device, improved by 46 +/- 17% (range 33-60%) for forward and by 48 +/- 15% (range 22-66%) for backward moving. Also improved the exercised crawling, jumping and walking, although not as much as the CNS organization quantified by coordination dynamics. The motor programs of the tibialis anterior, gastrocnemius, biceps brachii, and triceps brachii muscles, measured by surface electromyography (sEMG), improved only little. Evidence is provided for sEMG being a very suitable tool for optimizing the movement performance and the therapy since sEMG records show under what exercise conditions the recorded motor programs are best. However coordination dynamics, i.e. the integrative parameter for quantifying CNS organization, is better to show the progress in CNS functioning than movement and EMG improvements. When the patients stopped therapy, the value of their coordination dynamics, worsened 24% after 6 months. In one patient the coordination dynamics therapy was continued intensively for further 3 month, including 20 hours exercise per week. The value of the coordination dynamics even improved altogether by 85% and 82% for forward and backward turning movements respectively, and simultaneously movements, vegetative (sleep) and higher mental functions (aggressivity, learning capacity) showed strong improvements. The improvements of coordination dynamics for low-intensity therapy (46%, for forward movements) and additional high-intensity therapy (85%) lie within the recovery range for stroke (70%) and brain injury (69%) after 3 months of intensive coordination dynamics therapy. There is therefore indication that the CNS functioning in cerebral palsy patients can be improved by learning as much as the CNS functioning can be repaired by re-learning in stroke and brain injury. The improvement of the CNS functioning suggests that cerebral palsy can partly be cured if intensive coordination dynamics therapy is administered for 1 to 2 years. It is further suggested that inabilities, including mental inability, are diseases which can partly be cured rather than inabilities.

Adolescent↗

Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies.

OBJECTIVE: To determine the rate of pregnancy and outcome in teenagers in areas of different socioeconomic conditions, and to assess the implication for achievement of government and local targets in reducing unwanted pregnancies in teenagers. DESIGN: Records of pregnancies were obtained from hospital discharge files and rates of live and still births and abortions calculated for each postcode sector. Postcodes were grouped by categories of deprivation and by local government district. SETTING: Tayside, Scotland. SUBJECTS: Teenage girls admitted to National Health Service hospitals for delivery or abortion in 1980-90. MAIN OUTCOME MEASURES: Conception in girls aged under 16 by area of residence and relative proportion leading to live births or terminations. Rate of different outcomes in girls under the age of 20 by area of residence. RESULTS: The pregnancy rate in girls aged under 16 was three times as high, and in all girls under 20 six times as high in the most deprived areas as in the most affluent areas. The proportion of teenage pregnancies ending in abortions was higher in the affluent areas, where two out of three ended in abortion compared with one out of four in the deprived areas. CONCLUSIONS: Although there was a higher pregnancy rate in teenagers in more deprived areas, the proportion ending in abortion was greater in more affluent areas, possibly due to social and parental pressure. The wide geographical variation in patterns of teenage pregnancy indicates the need for a small area rather than a regional approach to setting targets and devising measures of achieving them.

Abortion, Legal↗

Impact of the national family planning program on fertility in rural Korea: a multivariate areal analysis.

The impact of the previous three years' input of the national family planning program on 1975 fertility levels in rural Korea was assessed using multivariate areal analysis techniques. Program input had a measurable negative effect on fertility, but the magnitude of the effect was lower than that of nonprogram factors. Holding availability of nonprogram methods of fertility limitation constant strengthened the impact of program input. It was suggested that the effect of the national program was statistically obscured by the selective concentration of program input in high-fertility, physician-poor areas.

Adult↗

Influences on family planning acceptance: an analysis of background and program factors in Malaysia.

Which factors have the greater influence on family planning performance: fixed background variables such as racial composition, urbanization, and mortality, which are affected by level of development, or program inputs such as assignment of personnel and location of clinics, which are subject to manipulation by administrators? An analysis of differences in family planning acceptance among 70 districts of Malaysia shows that two main program-manipulable variables--level of personnel deployment and accessibility of clinics--have the largest direct effect upon acceptance levels. Variations in background factors explain a smaller proportion.

Contraception Behavior↗

Sterilization regret in the Dominican Republic: looking for quality-of-care issues.

This report approaches the concept of quality of care by looking at the covariates of sterilization regret in the Dominican Republic according to the results from the 1991 Demographic and Health Survey. The main variables observed are the women's satisfaction with sterilization, their decisionmaking process, sterilization experience, use of family planning, and socioeconomic characteristics. The more detailed measurement and analysis of the outcomes of care point to a need for improvement in the public program effort with regard to sterilization. Substantial proportions of women were sterilized who were younger than 30, who had three or fewer living children, and who had the operation before they had used any other method of contraception. Because a greater proportion of sterilization regret is observed among these groups, women must be enabled to make a free and informed decision about sterilization by means of programs that offer a more balanced choice of methods, as well as better counseling, education, and access to high-quality services.

Adolescent↗