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The demographic impact of AIDS in sub-Saharan Africa: short- and long-term projections.

"This paper describes the methodology used to incorporate AIDS mortality in recently revised World Bank population projections.... The paper first reviews different approaches for projecting AIDS and its demographic consequences. This is followed by a summary of an epidemiological model that simulates the spread of HIV used in this analysis, and a demographic model that translates mortality from AIDS into population outcomes. These models are then used in a set of simulations, from which the effect of current HIV prevalence on projected future mortality is extracted. Finally, the extracted equations linking current HIV prevalence with future mortality indicators are applied to sub-Saharan countries with a measurable level of current HIV prevalence."

Acquired Immunodeficiency Syndrome↗

Further thoughts on simplicity and complexity in population projection models.

"This article is a review of--and response to--a special issue of Mathematical Population Studies that focused on the relative performance of simpler vs. more complex population projection models. I do not attempt to summarize or comment on each of the articles in the special issue, but rather present an additional perspective on several points: definitions of simplicity and complexity, empirical evidence regarding population forecast accuracy, the costs and benefits of disaggregation, the potential benefits of combining forecasts, criteria for evaluating projection models, and issues of economic efficiency in the production of population projections."

Cost-Benefit Analysis↗

Community-oriented primary care. Implementation of a national rural demonstration.

A major objective of community-oriented primary care (COPC) is to focus the clinical practice on the health care problems of the community that the practice serves. The COPC process defines the community of interest, identifies and prioritizes community health problems, and implements and evaluates interventions. Under sponsorship from the W. K. Kellogg Foundation, the COPC National Rural Demonstration Program was established to explore the feasibility of implementing COPC in 13 rural practices. An evaluation of the program found that local communities played critical roles in defining and implementing COPC interventions. These interventions were most often focused on health promotion/illness prevention activities. At most sites, clinical practices were limited in their ability to incorporate COPC activities by staff and physician turnover and the extensive patient demands on the time of rural primary care physicians. While the COPC process proceeded at different rates across the sites, after 2 1/2 years of grant funding, most sites continued to devote the majority of their resources to designing and implementing interventions. Thus, it appears that coordination by dedicated nonphysician staff and more than 2 years of effort are required to implement COPC concepts in rural practices in underserved areas.

Community Health Services↗

Current challenges of human tumour banking.

Tumour Banks (TB) are called upon to play a central role in Oncological translational research. TB have been existing since Pathology Departments started storing blocks of tissue samples, but in keeping this role they must face some urgent challenges including: an updated definition of hospital TB, integration into clinical trials and projects of excellence, networking and a new framework for ethics and laws. Current TB definition includes not only tissue storage, but also a series of hospital protocols that allow molecular studies of tumour and normal samples. The real value of these protocols and samples appears with scientific projects of excellence and integrated in clinical trials. Most of these trials need for a large number of cases with homogeneously treated tissue samples in the context of multicentre and multinational projects. Thereby, networking appears the best solution for TB to expand. Networking implies standardised technical procedures, a strict quality control programme, homogeneous ethic requirements and an open mentality for sharing. In the international setting the major challenge for networking is the various laws and customs in the different countries. To bring these diverse legislation together is, perhaps, the most important challenge for TB Networking in the very close future.

Biopsy↗

Building consensus in environmental impact assessment through multicriteria modeling and sensitivity analysis.

Multicriteria decision analysis (MCDA) increasingly is being applied in environmental impact assessment (EIA). In this article, two MCDA techniques, stochastic analytic hierarchy process and compromise programming, are combined to ascertain the environmental impacts of and to rank two alternative sites for Mexico City's new airport. Extensive sensitivity analyses were performed to determine the probability of changes in rank ordering given uncertainty in the hierarchy structure, decision criteria weights, and decision criteria performances. Results demonstrate that sensitivity analysis is fundamental for attaining consensus among members of interdisciplinary teams and for settling debates in controversial projects. It was concluded that sensitivity analysis is critical for achieving a transparent and technically defensible MCDA implementation in controversial EIA.

Aircraft↗

Problems of depopulation of rural areas in Poland after 1950.

"This paper considers the course of rural-to-urban migration processes in Poland from 1950 to 1988 against the background of the general demographic transformations in the country. It also considers changes in the population of particular voivodships (provinces) and [gminas] (communes) over the period 1970-1985, with an indication of the spatial concentration of the phenomenon. It concludes with a forecast of trends to the year 2000, based on these observed changes."

Demography↗

[Tumoral angiogenesis: physiopathology, prognostic value and therapeutic perspectives].

INTRODUCTION: Angiogenesis activation plays a crucial role in tumoral growth and metastases dissemination. This review summarizes and analyzes current knowledge on molecular mechanisms related to angiogenesis and the prognostic value of its effectors. It also focuses on the therapeutical relevance of various drugs that might inhibit angiogenesic processes. CURRENT KNOWLEDGE AND KEY POINTS: Tumor angiogenesis involves complex interactions between tumoral, stromal, endothelial cells, fibroblasts and the extracellular matrix. Normal and malignant angiogenesis depends on the balance of proangiogenic and antiangiogenic factors. Endothelial cells are activated by growth factors, such as Vascular Endothelial Growth Factor (VEGF), and proliferate; they release proteases able to induce degradation of the basement membrane and extracellular matrix, and undergo migration and tubulogenesis. Angiostatin and endostatin are two powerful inhibitors of angiogenesis in experimental models. Assessment of intratumoral microvessel density and quantification of angiogenic factors, including VEGF, are of prognostic value in most cancers, particularly in breast cancer. However, the use of these prognosis markers in clinical practice is still controversial due to the lack of prospective studies and to technical limits inherent to the scoring and standardization of immunohistochemical methods. FUTURE PROSPECTS AND PROJECTS: Better understanding of the molecular basis of angiogenesis allows the development of new therapeutical strategies. Biochemical targets of antiangiogenic therapy are: the interaction between angiogenic factors and their receptors; the interaction of endothelial cells with the extracellular matrix; and intracellular signaling pathways. Angiogenesis inhibitors may not cause tumor regression, but inhibit cellular growth and produce "disease dormancy". Extensive phase I to III clinical trials involving antiangiogenesis therapy are in progress.

Angiogenesis Inducing Agents↗

Hospital pharmacy automation: collective mobility or collective control?

This study examines the relationship between new technology and pharmacy's changing role in the division of labour in health care. Does automation advance pharmacy's collective mobility project and transition to its new role as a clinical rather than a merely technical profession? Alternatively, does it threaten pharmacy's cultural authority and control of medication dispensing? Does technology serve as an artifact demarcating occupational and gender boundaries in the drug distribution labour process? These issues were examined through qualitative case studies conducted at three hospital pharmacies located in mid-sized Canadian health care facilities. All three institutions had implemented automated drug distribution technology in the expectation that it would allow more pharmacist's time to be shifted from dispensing-related to clinical activities. It was found that pharmacists had attempted to maintain control of their labour process and had resisted peripheralization from drug dispensing. Technological processes did serve as artifacts reinforcing occupational demarcations as well as professional solidarity vis a vis hospital administrators although its impact on gender boundaries was less evident.

Automation↗

Skull radiology in patients with facial trauma.

In a retrospective study the primary radiographs of 723 patients with facial fracture were analyzed. In all, 392 (54%) skull radiographs were performed on these patients, in which only 26 (6.6%) skull fractures - 23 linear and 3 basal were detected. Skull radiographs taken particularly in connection with simple nasal fractures were found unnecessary. In fractures of the mandible the overuse of skull radiographs was obvious. Some 44% of skull radiographs were considered unsatisfactory mainly due to technical errors. It is concluded that for the majority of patients with facial trauma, projections applicable to facial fracture should be performed. Skull radiographs are recommended for multiply injured patients with facial trauma due to associated injuries.

Facial Bones↗

Theileriosis control modelling (experiences from Southern Province, Zambia).

Effects of different tick-borne disease control strategies on cattle productivity are simulated based on a 30-year herd projection, calculated by a modified Markov Chain model. Input data can be grouped in technical, economic and epidemiological parameters. The output is a set of economic parameters such as benefit/cost ratio (BCR), net present value (NPV) of the profit, internal rate of return (IRR), total economic cost (TEC) as well as graphs showing animal production over time. Shadow prices are obtained for input and output in kind. Throughout the calculations a distinction is made between transactions in cash and transactions in kind. A case study was run for Southern Province, Zambia, to illustrate the model. Either vector control or treatment, or a combination of these, controls theileriosis at farm level after natural infection. Preventive immunization against the parasite is also possible. Although the calculations are based on a mixture of data obtained from literature, field experience, expert opinion and assumptions, the importance of theileriosis control is clearly indicated. Immunization gives better economic results than chemotherapy. Vector control can only be used as a last resort.

Animals↗

Pilot-scale demonstration of a two-stage methanotrophic bioreactor for biodegradation of trichloroethylene in groundwater.

A two-stage methanotrophic bioreactor system was developed for remediation of water contaminated with TCE and other chlorinated, volatile, aliphatic hydrocarbons. The first stage of the reactor was a suspended-growth culture vessel using a bubbleless methane-transfer device. The second stage was a plug-flow bioreactor supplied with contaminated groundwater and cell suspension from the culture vessel. The test objectives were to determine the applicability of microbial culture conditions reported in the literature for continuous, pilot-scale TCE treatment; the technical feasibility of plug-flow bioreactor design for treatment of TCE; and the projected economic competitiveness of the technology considering the cost of methane for growth of methanotrophs. The methanotrophic organism used in the study was Methylosinus trichosporium OB3b. Information on system operation was obtained in bench tests prior to conducting the pilot tests. In bench- and pilot-scale tests, variability in the degree of TCE degradation and difficulty in maintaining the microbial culture activity led to short periods of satisfactory biotreatment. Further development of the microbial culture system will be required for long-term operation. During transient periods of high TCE degradation activity, the bioreactor concept proved feasible by exhibiting both a high degree of TCE biodegradation (typically about 90% at influent TCE concentrations of 0.5-4 ppm) and a close approximation to first-order reactor kinetics throughout the length of the reactor. Actual methane usage in the pilot-scale reactor resulted in projected methane costs of $0.33 per 1000 gallons of water treated. This cost theoretically would be reduced by system modifications. The theoretical minimum methane cost was approximately $0.05 per 1000 gallons.

Biodegradation, Environmental↗

Nipple reconstruction: technical aspects and evolution in 14 patients.

BACKGROUND: During breast reconstruction after mastectomy, the long-term deterioration of the projection of neonipples led the authors to modify Thomas's technique in its design and use. METHODS: The results were evaluated after at least 10 months, in 14 patients, by comparative measurement of diameters and projection of the neonipple and contralateral nipple. RESULTS: In two cases, the authors had a 3-mm loss of height; in six cases, the authors had a variation of 1 mm compared with the referent nipple; and the heights appeared identical in the six other cases. The height variation was thus lower or equal to 1 mm compared with the contralateral nipple in 80 percent of cases. There was no or little diameter variation of approximately 1 mm in 12 cases (85.7 percent). CONCLUSION: This technique allows rebuilding of a nipple that remains identical to the contralateral nipple over the long run.

Female↗

Mapping complex traits in diseases of the hair and skin.

The past decade has witnessed the ascendance of human genetics in modern medicine, and at the forefront of this movement is the identification of genetic factors underlying inherited diseases. The methods of genetic mapping and positional cloning have made the discovery of genes with alleles that cause simple Mendelian diseases commonplace. The elucidation of the genetic basis of such disorders has vitalized both human genetics and the entire medical community as the field has gained prominence. The fact remains, however, that diseases resulting from the action of alleles of a single gene comprise only a minor percentage of traits that are medically relevant to humanity. The majority of these are multifactorial "complex traits", which result from the aggregate contribution of an unknown number of genes interacting with each other and with the environment. The current challenge has become one of parlaying successes in the mapping of Mendelian diseases into the discovery of genes whose alleles predispose the development of a complex disease. In light of this challenge, this review summarizes the methods and addresses some of the central issues of complex trait mapping, while using examples from dermatologically-relevant complex traits such as psoriasis and alopecia. Additionally, current technical and theoretical advances as well as the potential impact of the Human Genome Project will be discussed.

Animals↗

Salt fluoridation--an alternative in automatic prevention of dental caries.

Despite great improvements in terms of reduced prevalence and amount of dental caries in populations worldwide, problems still persist particularly among the underprivileged groups of both developed and developing countries. Research and practical experience gained in several countries have demonstrated however, that dental caries can be prevented effectively through establishment of fluoride programmes. Water fluoridation, salt fluoridation, milk fluoridation and use of affordable fluoridated toothpastes play the major roles in public health. The present paper outlines the relevance and some practical aspects in relation to implementation of salt fluoridation programmes. The World Health Organisation Oral Health Programme provides technical assistance to countries in the process of planning, implementing and evaluating salt fluoridation projects.

Adolescent↗

Analysing the developing brain transcriptome with the GenePaint platform.

We discuss technical means by which the complexity of gene and protein signalling cascades can be projected onto the complex structure of the mammalian brain. We argue that this requires both robotics and novel computational tools to register images of gene expression, annotate expression patterns and quantify gene expression. When sufficiently enriched and detailed, such gene expression/neuroanatomical atlases are hypothesis-generating tools and contain in themselves much of the information needed to investigate function in normal and genetically or otherwise modified brains. To be successful and useful, data-rich and comprehensive gene expression/neuroanatomical atlases have to be web accessible and structured in a way that allows the application of data exploration and mining tools.

Animals↗

Correlative scanning and transmission electron microscopic study on the ependymal surface of Cebus apella.

Topographical variations of the ependymal surface of the whole brain ventricular system of Cebus apella, a wild Brazilian species, were studied at the scanning electron microscope after CO2 critical point drying and carbon-gold coating. Certain selected areas were also studied at the transmission electron microscope, following standard technical procedures. We observed distinct patterns in the distribution of cilia, microvilli, other cell projections, and the so called supraependymal structures. Based on the morphological findings, functional considerations are made.

Animals↗