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PubMedDate not supplied

Political analysis of rapid change in Uganda's health financing policy and consequences on service delivery for malaria control.

The aim of this study was to assess the political and social dynamics resulting from the rapid change in user-fee reforms in Uganda and the effects on service delivery for malaria control. Using political mapping and political risk analysis techniques, the study analysed qualitative and quantitative data obtained from secondary data sources and key actors in the policy arena. The results have shown that the feasibility of user-fees in Uganda was undermined by the absence of strong central government leadership and strategies to manage the politics of the reforms. The resultant rapid change in policy adversely affected the recurrent expenditures of health units that previously relied heavily on cost sharing, which led to a chronic shortage of malaria drugs and undermined the ability of health facilities to hire and motivate staff. The study results demonstrate that in order to contribute positively to healthcare delivery goals for malaria control in endemic countries, user-fees require full ownership and strong political leadership by the central government. Decentralization, when merely used as a strategy to navigate the political risks associated with user-fees, is unlikely to succeed without a centrally coordinated and managed process of policy formulation and acceptance involving wider consultations and political management of interest groups.

Communicable Disease Control↗
PubMedDate not supplied

Impact of organizational change on the delivery of reproductive services: a review of the literature.

In order to understand the impact of specific maternal health interventions, it is necessary to understand the likely effect of the health system structure. An important aspect of this structure is the organizational culture. Many systems in low-income countries have been based on a centrally planned and financed system. In recent years a series of organizational changes have been introduced into many systems and these substantially alter the way in which the system operates and impacts on reproductive health care provision. The main changes reviewed in this paper are: (i) decentralization, (ii) privatization and (iii) integration and sector wide approaches. Each of these changes is seen to have important implications for reproductive health. In each case it is clear that the nature of the impact depends crucially on the way it is implemented. Quantifying the impact of these changes remains extremely difficult given the many different ways they can be introduced and the many confounding factors that affect the overall impact. The literature does, however, point to a number of key issues that impinge on the way in which change is likely to affect reproductive health initiatives.

Delivery of Health Care↗
PubMed1994

Prediction of the effects and costs of breast-cancer screening in Germany.

Although breast-cancer screening programmes are now being introduced it is still debated whether this is an appropriate policy for all European countries. Taking into account empirical data from 2 regional pilot screening projects, this study has evaluated the effects and costs of a nationwide breast-cancer screening programme in Germany. Special attention was paid to the decentralized German health-care system and to the influence of attendance, interval and age group. The recent results of the analysis of the Swedish randomized screening trials were used to estimate the improvement in prognosis after early detection of breast cancer. Our analysis shows that a programme providing for the screening of women aged 50-69 at 2-year intervals might be expected to result in a decrease in mortality from breast cancer estimated at 11% for the total German population, representing 2,100 deaths from breast cancer prevented each year. The cost per life-year gained was assessed at between DM 18,800 and DM 25,300 for this scenario; 2 to 3 times less favourable than in the UK and The Netherlands. The sensitivity of mammography was estimated to be 12% lower than in The Netherlands and the attendance rate was calculated at 47% on average. A greater effort to ensure the quality of the screening programme and to improve the invitation system might finally lead to much better results. The mortality reduction might be as much as 18% if the attendance and the sensitivity of the screening could be improved to the Dutch level.

Aged↗
PubMed2001

Phenotypic analysis of the sensitivity of HIV-1 to inhibitors of the reverse transcriptase, protease, and integrase using a self-inactivating virus vector system.

Conventional phenotypic analysis of resistance of the human immunodeficiency virus (HIV) to antiviral therapy is time-consuming and requires culture of infectious virus. Although phenotypic analyses may be desirable, rapid generation of test results and decentralized availability of the test system will be important to achieve utility in the clinical practice. This study describes the design of an alternative phenotypic resistance test using replication incompetent viral vectors. Chimeric HIV vectors containing a marker gene were generated. The env and most of the regulatory and accessory genes of HIV were removed. In addition, the 3'U3 region was deleted to obtain a self-inactivating construct. Cotransfection of the plasmid with a plasmid that provided the vesicular stomatitis virus glycoprotein resulted in the production of replication-incompetent virus vectors. Infection of susceptible cells with the vectors led to marker gene expression. Vector production in the presence of protease (PR) inhibitors, or infection in the presence of reverse transcriptase (RT) or integrase (IN) inhibitors reduced marker gene expression in a dose-dependent manner. Marker gene activity was preserved at higher drug levels if vectors contained RT and PR genes from resistant virus isolates. Sensitivity to nucleoside and non-nucleoside RT inhibitors, protease and integrase inhibitors could be determined in 10 working days. The phenotypic drug resistance test using replication-incompetent HIV vectors significantly speeds up drug resistance measurements and allows testing at reduced biosafety levels. This will make clinical use of phenotypic assessment of antiviral resistance more feasible.

Anti-HIV Agents↗
PubMed2025

Analysis of Variants' Dynamic Using the CLIMB Database in COVID-19 Patients Admitted to Hospitals of Barts Health NHS Trust.

The COVID-19 pandemic, caused by SARS-CoV-2, has led to significant global health challenges. This study analyzes the dynamics of SARS-CoV-2 variants among patients admitted to Barts Health National Health Service (NHS) Trust hospitals using data from the CLIMB-COVID decentralized digital infrastructure allowing precise identification of SARS-CoV-2 variants. A total of 423 patients admitted between October 2020 and March 2021 were included in the study and divided into two groups: the alpha lineage group, which comprised the B.1.1.7 variant, and the other lineages group, which included all other variants. Whole-genome sequencing of SARS-CoV-2 genomes was conducted using the COVID-CLIMB pipelines. Clinical outcomes, such as mortality rates and deterioration within 28 days, were analyzed. To ensure robust findings, analyzes were adjusted for confounding factors, including age and comorbidities. Our findings revealed a significant increase in mortality with age for the alpha lineage and other lineages. The study underscores the importance of age adjustment in clinical studies to accurately assess the impact of different variants. Consistent genomic sequencing and data completeness are crucial for obtaining reliable results and guiding public health responses. These insights are vital for improving patient outcomes and providing a truthful picture of the pandemic, informing both current and future healthcare strategies.

Humans↗
PubMed1987

Recovery of cholinesterases in soman-injected superior cervical ganglion of the rat in the presence and absence of innervation.

We have previously described the procedure for quantitative separation of extracellular and intracellular ChEs using mild treatment of rat superior cervical ganglion with papain. Here, this procedure was used in order to investigate the recovery of ChEs in the two pools after irreversible inhibition by soman which was directly injected into the ganglion. After such treatment only ganglion ChEs were totally inhibited, whereas the activity of ChEs in preganglionic neurons and their axons remained unaffected. Comparing in innervated and decentralized ganglia the pattern of recovery rate and ultrastructural reappearance of ChEs after local inhibition, with that reported after systemic ChEs inhibition, it was possible to distinguish between the indirect effects of innervation on the recovery rate and pattern of ChEs of ganglion origin and the direct contribution to the total ganglion enzyme activity of ChEs originating in the preganglionic elements. The absence of nerve contracts affects mostly extracellular activity, particularly AChE, whereas the intracellular activity of AChE was only slightly decreased and the activity of nsChE was somewhat increased. This increase coincides with the enhanced cytochemical reaction of nsChE in some nonneuronal cells in the ganglion. Actinomycyn D decreased the rate of initial rapid phase of recovery of intracellular ChEs when injected in the ganglion daily for three days, whereas the recovery of extracellular ChEs was already decreased the first day of Actinomycyn D application. This indicates that the externalization of the enzyme is more affected than its synthesis by inhibition the translation step.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Muscarinic receptor transcript and protein density in hypertrophied and atrophied rat urinary bladder.

AIMS: Our previous studies showed that bladder hypertrophy shifts the muscarinic receptor subtype mediating contraction from M(3) towards M(2) along with increased M(2) and decreased M(3) protein concentration. We quantified mRNA for M(1) through M(5) receptors to determine whether the changes in M(2) and M(3) protein levels was due to changes in transcription. METHODS: Bladder hypertrophy was induced by bladder outlet obstruction (BOO), major pelvic ganglion electrocautery (DEN), and major pelvic ganglion decentralization (DEC). Bladder atrophy was induced by ureteral diversion (DIV). Additional groups included denervated and diverted (DEN-DIV), sham operated (SHAM), and normal (NOR) controls. Transcripts were quantified using a multiplex ribonuclease protection assay (RPA) and receptor protein density was determined by immunoprecipitation. Receptor transcripts were expressed per unit total RNA. RESULTS: Although all five receptor subtype transcripts were detected in all experimental groups, the densities of M(1), M(4), and M(5) were much lower than for the M(2) and M(3) subtype. There were more M(2) receptor transcripts than all the others, consistent with M(2) protein determinations. M(2) transcripts were significantly increased in DEN and BOO bladders. Surprisingly, M(3) transcripts were also significantly increased in BOO. There was a significant correlation (r=0.98, P<0.001) between protein density and transcript density for the M(2) but not the M(3) receptor among the different experimental groups. CONCLUSIONS: Changes in mRNA concentration are reflected by changes in protein density for the M(2) receptor but not for the M(3) receptor. Extrapolation of functional effects from transcript density data is invalid for M(3) mediated bladder contractions.

Animals↗
PubMed1989

Structural plasticity at crustacean neuromuscular synapses.

Crustacean motor axons innervate muscle fibers via a multiplicity of synaptic terminals which release small but variable amounts of transmitter. Differences in release performance appear to be correlated with the size of synaptic contacts and presynaptic dense bars (active zones). These structural parameters proliferate via sprouting from existing synaptic terminals and relocate to ever more distal sites during development and growth of an identified axon. Moreover, alterations in number of synaptic contacts and active zones occur in adults following stimulation or decentralization, demonstrating structural plasticity of crustacean neuromuscular synapses.

Animals↗
PubMed1993

Regulation of substance P is similar to that of vasoactive intestinal peptide after axotomy or explantation of the rat superior cervical ganglion.

The regulation of the expression of substance P (SP) in the rat superior cervical ganglion was compared to that of vasoactive intestinal peptide (VIP) in vivo after axotomy and in vitro after explantation. Previous studies have demonstrated that both neuropeptides increase after explantation, depolarization, and decentralization; however, whereas VIP expression increases after postganglionic axotomy, SP expression reportedly does not. To compare the effect of axotomy on these two peptides directly, the content of both was determined in individual ganglia at various times after surgery. The level of VIP-like immunoreactivity (IR) is increased at 2 days, reaches a peak at 6 days, and then declines by 14 days to approximately half its peak value. The level of SP-IR also increases 2 days after axotomy, but returns to control values by day 6. The increase in SP-IR is accompanied by an increase in beta-preprotachykinin mRNA, suggesting that the elevation in SP content is due, at least in part, to enhanced peptide synthesis. Immunocytochemical localization of SP-IR revealed the presence of immunoreactive principal neurons in axotomized, but not in sham-operated ganglia. Similarities in the regulation of these two neuropeptides were also investigated in organ culture by examining the effects of dexamethasone and interleukin-1 beta on VIP content, since the former has been shown to prevent the increase in SP in culture, while the latter has been found to enhance this increase (Kessler, Adler, Bell, et al., 1983, Neuroscience 9:309-321; Freidin and Kessler, 1991, Proc. Natl. Acad. Sci. USA 88:3200-3203; Hart, Shadiack, and Jonakait, 1991, J. Neurosci. Res. 29:282-291). As with SP expression, dexamethasone reduces the increase in VIP expression, while interleukin-1 beta increases it. Thus, both in vivo and in vitro, similar changes in VIP and SP expression are observed following a number of experimental manipulations, suggesting that expression of the two peptides is regulated by qualitatively similar mechanisms in sympathetic neurons.

Animals↗
PubMed1995

Communication between continuing care organizations.

Communication between health care providing organizations is fundamental to discharge planning and continuity of care, but has been reported to be inadequate. Using a classic communication model, the content of communication between hospitals and home health agencies was examined in 300 closed home care records and compared to referral content desired by practitioners. Discharge planners sent about half of the referral information recommended by the literature. Referrals consisted primarily of background data, some medical data, even less nursing care data, and almost no psychosocial data. No referral form was used by the hospital in over one third of the cases. Discrepancies existed between what client care data practitioners identified as important or desirable and the data they actually received. As responsibility for providing health care is decentralized and shared by multiple organizations, communication between providers will play a greater role in ensuring continuity of care. The findings suggest that adoption of standardized, written referral forms might facilitate clear and complete communication.

Communication↗
PubMed2002

Womens' preference in Down syndrome screening.

OBJECTIVE: To determine the knowledge of pregnant women about prenatal tests, and what tests they would choose if offered. Also, the preference of pregnant women for second-trimester or first-trimester screening was assessed. PATIENTS AND METHODS: Pregnant women receiving antenatal care in a decentralized primary care system (n=80), and pregnant women that were offered a prenatal diagnosis at the Academic Medical Centre (n=195), were asked to complete a questionnaire. RESULTS: The response rate was over 80%. Most women in both groups preferred a screening test for Down syndrome to be performed in the first trimester of pregnancy. A combination of nuchal translucency measurement and first-trimester serum screening was the option of choice. The screening possibilities for Down syndrome were less well known to the women in the low-risk group compared with the women in the high-risk group. The offer of a prenatal screening test would have been declined by more than 30% of women at low risk for carrying a fetus with Down syndrome. CONCLUSIONS: Our results show that women prefer screening for Down syndrome to be performed in the first trimester of pregnancy, using both serum and ultrasound tests. In women at low risk for Down syndrome the knowledge of prenatal screening methods was less, as well as the acceptance of prenatal screening being lower.

Adult↗
PubMed1995

Organizational issues.

A strong organizational and decentralized administrative philosophy is is the underpinning of growth, program development, and quality.

Chicago↗
PubMed2026

Integrating Biobanking Into Conservation Practice: The Development and Impact of the EAZA Biobank.

Zoological biobanks are becoming essential tools in conservation, offering a means to preserve genetic material and support in situ population management amid accelerating biodiversity loss. With rapid advances in genomics, cryopreservation, and assisted reproduction technologies, biobanks enable a proactive approach to providing insurance against genetic erosion and facilitating future research, supplementation, and genetic rescue. However, to be effective, zoological biobanks must be purposefully designed, strategically integrated into conservation frameworks such as the Convention on Biological Diversity (CBD) Kunming-Montreal Global Biodiversity Framework (KMGBF), and regularly evaluated for coverage and impact. Using the EAZA Biobank as an example, we outline the structure, development, and collaborative foundations that have enabled its rapid growth, built on community support and conservation impact. Leveraging EAZA's institutional network and data-sharing platforms such as ZIMS, the Biobank employs a decentralized, four-hub model of zoological institutions storing samples. A gap analysis, integrating threat status, breeding programs, genomic data repositories, and phylogenetic diversity, highlights current sampling strengths and deficiencies and guides future collection priorities. The integration of specimen-specific genomic data and the EAZA Biobank Cryonetwork of institutions with expertise in storing and generating gametes and cell lines will expand the Biobank's role in population management and conservation. Zoological biobanks must now evolve alongside advances in biotechnology and genomics. Sample collection strategies should serve conservation needs and anticipate future applications in genomics, cryobiology, and conservation medicine, linking biospecimens with the wealth of data generated from them. This approach should be scalable beyond EAZA, forming the foundation of a global standardized biobanking framework. Ultimately, zoological biobanks are not merely repositories of the past-they are essential infrastructures shaping the future potential of species conservation.

EAZA↗
PubMed2000

Mechanisms of dispersed central-place foraging in polydomous colonies of the Argentine ant.

Many species of ants occupy multiple nests, a condition known as polydomy. Because of their decentralized structure, polydomous colonies may be removed from some of the constraints associated with classic central-place foraging. We used laboratory and field experiments to assess the mechanisms involved in dispersed central-place foraging in polydomous colonies of the Argentine ant Linepithema humile, a widespread invasive species. Both in the laboratory and in the field, Argentine ants established new nests at sites located near food. Laboratory colonies of L. humile redistributed workers, brood and resources among nests in response to the spatial heterogeneity of food resources. In addition, laboratory colonies formed recruitment trails between nests in the context of foraging, providing a mechanism for the transport of material between nests. This highly flexible system of allocating nests, workers and brood throughout a colony's foraging area potentially increases foraging efficiency and competitive ability. The importance of polydomy as a determinant of competitive ability is underscored by its prevalence among ecologically dominant ants, including most, if not all, highly invasive species. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1998

Regular and irregular refractive powers of the front and back surfaces of the cornea.

The refractive status of the posterior corneal surface has not been well studied. The purpose of this study is to quantitatively evaluate the regular and irregular astigmatism of the posterior corneal surface. In 50 normal human eyes, topography of the anterior and posterior corneal surface was measured with the scanning-slit videokeratoscope. Using Fourier series harmonic analysis, dioptric data on a mire ring were decomposed into spherical component, regular astigmatism, asymmetry (tilt or decentration), and higher order irregularity. The obtained values for the central 3.0 mm of the posterior corneal surface were -6.55+/-0.32 D (spherical component), 0.18+/-0.16 D (regular astigmatism), 0.40+/-0.22 D (asymmetry), and 0.02+/-0.02 D (higher order irregularity). The posterior to anterior ratios of these parameters were 13.6+/-0.6%, 35.0+/-41.3%, 45.8+/-56.9%, and 39.9+/-39.8%, respectively. The ratio of the spherical component was significantly lower than the other three parameters (P<0.001, Wilcoxon signed-rank test), indicating that non-spherical components (regular and irregular astigmatism) of the posterior corneal surface are not negligible in the optical quality of the cornea. The current results can serve as the control data and reference for the future clinical studies of optical characteristics of the cornea as a whole.

Adult↗
PubMed1999

The effect of site and type of nerve injury on spinal glial activation and neuropathic pain behavior.

A number of rat peripheral neuropathy models have been developed to simulate human neuropathic pain conditions. The current study sought to determine the relative importance of site versus type of peripheral nerve injury in eliciting mechanical allodynia and spinal glial responses. Rats received one of seven different surgical treatments at the L5 spinal level: spinal nerve cryoneurolysis, spinal nerve tight ligation, dorsal root cryoneurolysis, dorsal root tight ligation, dorsal root transection, ventral root tight ligation, or laminectomy/dural incision sham. Foot-lift response frequency to mechanical stimulation of the ipsilateral hindpaw was assessed postlesion on days 1, 3, 5, and 7. L5 spinal cords were retrieved for immunohistochemical analysis of microglial (OX-42) and astrocytic (anti-glial fibrillary acidic protein) responses. Both types of spinal nerve lesion, freeze and tight ligation, produced rapid and profound mechanical allodynia with intense glial responses. Dorsal root lesions also resulted in intense mechanical allodynia; however, glial responses were almost exclusively astrocytic. Ventral root tight ligation and sham provoked no marked behavioral changes and only sporadic glial responses. Direct dorsal horn communication with the dorsal root ganglion was not a crucial factor in the development of mechanical allodynia, since decentralization of the L5 DRG by complete L5 dorsal root lesion produced profound mechanical sensitization. Conversely, microglial activation responses appear to be dependent upon dorsal root ganglion-mediated signals and, contrary to behavioral responses, were robust only when the lesion was made peripheral to the cell body. Astrocytic activation was always observed following axonal injury and reliably coexisted with behavioral responses.

Animals↗
PubMed2001

Heterogeneous database integration in biomedicine.

The rapid expansion of biomedical knowledge, reduction in computing costs, and spread of internet access have created an ocean of electronic data. The decentralized nature of our scientific community and healthcare system, however, has resulted in a patchwork of diverse, or heterogeneous, database implementations, making access to and aggregation of data across databases very difficult. The database heterogeneity problem applies equally to clinical data describing individual patients and biological data characterizing our genome. Specifically, databases are highly heterogeneous with respect to the data models they employ, the data schemas they specify, the query languages they support, and the terminologies they recognize. Heterogeneous database systems attempt to unify disparate databases by providing uniform conceptual schemas that resolve representational heterogeneities, and by providing querying capabilities that aggregate and integrate distributed data. Research in this area has applied a variety of database and knowledge-based techniques, including semantic data modeling, ontology definition, query translation, query optimization, and terminology mapping. Existing systems have addressed heterogeneous database integration in the realms of molecular biology, hospital information systems, and application portability.

Computational Biology↗
PubMed1995

Perceived reachability for self and for others by 3- to 5-year-old children and adults.

Ability to perceive the distance at which an object is within reach was assessed in 3-, 4-, and 5-year-old children and adults. In different situations, subjects had to judge whether an object placed in the vertical or horizontal plane was reachable for themselves or for someone else (the experimenter). Adults as well as children differentiated between the limits of their own prehensile space and those of another person. At all ages, children tend to attribute systematically more reachability to the adult experimenter. Furthermore, both children and adults systematically underestimate reachability for others in a horizontal presentation of the object. For all age groups, judgments of reachability for self are bodily scaled and based on perceived degrees of behavioral freedom for self and for others. From 3 years of age, children are shown to resemble adults in their ability to perceive what objects afford for action, either for self or for others. These results are interpreted as further evidence of early allocentrism (i.e., spatial decentration and perspective taking) in the context of a practical task.

Adult↗