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PubMed2003

Statistical evaluation of the Predictive Toxicology Challenge 2000-2001.

MOTIVATION: The development of in silico models to predict chemical carcinogenesis from molecular structure would help greatly to prevent environmentally caused cancers. The Predictive Toxicology Challenge (PTC) competition was organized to test the state-of-the-art in applying machine learning to form such predictive models. RESULTS: Fourteen machine learning groups generated 111 models. The use of Receiver Operating Characteristic (ROC) space allowed the models to be uniformly compared regardless of the error cost function. We developed a statistical method to test if a model performs significantly better than random in ROC space. Using this test as criteria five models performed better than random guessing at a significance level p of 0.05 (not corrected for multiple testing). Statistically the best predictor was the Viniti model for female mice, with p value below 0.002. The toxicologically most interesting models were Leuven2 for male mice, and Kwansei for female rats. These models performed well in the statistical analysis and they are in the middle of ROC space, i.e. distant from extreme cost assumptions. These predictive models were also independently judged by domain experts to be among the three most interesting, and are believed to include a small but significant amount of empirically learned toxicological knowledge. AVAILABILITY: PTC details and data can be found at: http://www.predictive-toxicology.org/ptc/.

Algorithms↗
PubMed1997

Three countries' experience with Norplant introduction.

Despite international efforts to plan for Norplant introduction, the method has drawn the attention of critics of family planning programmes, and has raised several issues for debate since it was introduced into family planning programmes. The experiences of three countries with the introduction of Norplant highlight some of the unique features of the method that have affected its introduction. Indonesia, Bangladesh and the United States represent diverse cultural settings and systems of family planning provision. Experience in each country has highlighted the need to focus on quality of care for clients, most notably the need for good counselling and attention to removal as well as insertion. The cost of Norplant also has influenced its introduction in each country. Another issue includes the need to work with women's health advocacy groups, which is illustrated particularly in Bangladesh. Finally, the role of litigation in the United States, and its potential role in influencing Norplant introduction in other countries, is discussed. These three countries' experience illustrate the importance of understanding the programmatic context of contraceptive introduction.

Adolescent↗
PubMed1997

The impact of charging for insecticide on the Gambian National Impregnated Bednet Programme.

During the second year of the Gambian National Impregnated Bednet Programme (NIBP) charges for insecticide ($0.50 per net) were introduced into the half of the primary health care villages in the country where insecticide have been provided free of charge the previous year. Free insecticide was provided in the remaining villages that had acted as controls during the previous year. In villages where insecticide was provided free, 77% of nets were treated with insecticide. In contrast, in villages where charges were made coverage was only 14%. During the first year of the NIBP, mortality in children was significantly lower in villages where insecticide was provided free than in the control villages. Introduction of a charge for insecticide into the first group of villages and the provision of free insecticide in the latter abolished this difference. The cash income of rural Gambians is very limited and payment of even $2-3 for insecticide treatment for all the bednets in a household represents a substantial outlay. Further education on the benefits of treatment of nets and/or the provision of cheaper insecticide will be required before the full benefits of this powerful new malaria control measure can be fully realised in the Gambia.

Bedding and Linens↗
PubMed2005

Bypassing districts? Implications of sector-wide approaches and decentralization for integrating gender equity in Uganda and Kenya.

While the concept of gender mainstreaming has gained acceptance among many national and international development organizations, many obstacles are faced in translating the concept into tangible improvements in the health and well-being of women and men. This paper presents two qualitative case studies, one from Kenya and one from Uganda, of experiences of mainstreaming gender at district level; experiences which are set against the context of decentralization and sector-wide approaches (SWAPs). The conceptual framework of social movement theory, as used by Hafner-Burton and Pollack, is drawn upon to analyze the findings of both case studies. This paper has been written in conjunction with a paper by Theobald et al. which explores gender mainstreaming at national level.

Female↗
PubMed2005

Engendering the bureaucracy? Challenges and opportunities for mainstreaming gender in Ministries of Health under sector-wide approaches.

The increasing ascendancy of 'gender mainstreaming' as the central approach to improving gender equity has largely determined strategies to integrate a gender focus in sector-wide approaches (SWAps). This paper explores the impetus for and process of gender mainstreaming in SWAps in the Ministries of Health in Uganda, Ghana, Malawi and Mozambique, and outlines some achievements and challenges. The shifting and contested relationships between the Ministry of Health, donors and other government ministries (such as Ministries of Finance and Ministries of Women's Affairs/Gender) are important in shaping the opportunities and constraints faced in gender mainstreaming. The refocusing of resource allocation to different sectors has led to changes in the balance of power between the various actors at the national level, with diverse implications for promoting gender equity in health. Some of the achievements to date and ongoing challenges are explored through concrete examples from different countries. These include: the development of structures for mainstreaming, including the dilemmas of the 'focal points' approach and the role of national gender mainstreaming machinery; the need for training and building capacity to identify and address gender issues, which involves engaging with new languages and concepts, and developing new skills; building alliances, consensus and momentum; integrating gender concerns into policy and planning documents; and promoting gender equity in human resources in the health sector. Cross-cutting themes underlying these challenges are the need for gender-specific information and ways to finance mainstreaming strategies. Implications are drawn for ways forward, without losing sight of the challenge of translating discourses of gender mainstreaming, and its central ideal of social transformation, into pragmatic strategies in the bureaucratic environment.

Africa↗
PubMed2003

Gene expression differences in quiescent versus regenerating hair cells of avian sensory epithelia: implications for human hearing and balance disorders.

The sensory receptors for hearing and balance are the hair cells of the cochlea and vestibular organs of the inner ear. Permanent hearing and balance deficits can be triggered by genetic susceptibilities or environmental factors such as infection. Unlike mammalian hair cells that have a limited capacity for regeneration, the vestibular organ of the avian ear is constantly undergoing hair cell regeneration, whereas the avian cochlea undergoes regeneration only when hair cells are damaged. In order to gain insights into the genetic programs that govern the regenerative capacity of hair cells, we interrogated custom human cDNA microarrays with sensory epithelial cell targets from avian inner ears. The arrays contained probes from conserved regions of approximately 400 genes expressed primarily in the inner ear and approximately 1500 transcription factors (TF). Highly significant differences were observed for 20 inner-ear genes and more than 80 TFs. Genes up-regulated in the cochlea included BMP4, GATA3, GSN, FOXF1 and PRDM7. Genes up-regulated in the utricle included SMAD2, KIT, beta-AMYLOID, LOC51637, HMG20B and CRIP2. Many of the highly significant changes were validated by Q-PCR and in situ methods. Some of the observed changes implicated a number of known biochemical pathways including the c-kit pathway previously observed in melanogenesis. Twenty differentially expressed TFs map to chromosomal regions harboring uncloned human deafness loci, and represent novel candidates for hearing loss. The approach described here also illustrates the power of utilizing conserved human cDNA probes for cross-species comparisons.

Animals↗
PubMed2004

Multiple gestation and infertility treatment: registration, reflection and reaction--the Belgian project.

Multiple pregnancies associated with infertility treatment are recognized as an adverse outcome and are responsible for morbidity and mortality related to prematurity and very low birthweight population. Due to the epidemic of iatrogenic multiple births, the incidence of maternal, perinatal and childhood morbidity and mortality has increased. This results in a hidden healthcare cost of infertility therapy and this may lead to social and political concern. Reducing the number of embryos transferred and the use of natural cycle IVF will surely decrease the number of multiple gestations. Consequently, optimized cryopreservation programmes will be essential. For non-IVF hormonal stimulation, responsible for more than one-third of all multiple pregnancies after infertility treatment, a strict ovarian stimulation protocol aiming at mono-ovulation is crucial. Multifetal pregnancy reduction is an effective method to reduce high order multiplets but carries its own risk of medical and emotional complications. Excellent data collection of all infertility treatments is needed in our discussion with policy makers. The Belgian project, in which reimbursement of assisted reproduction technology-related laboratory activities is linked to a transfer policy aiming at substantial multiple pregnancy reduction, is a good example of cost-efficient health care through responsible, well considered clinical practice.

Belgium↗
PubMed2002

Emergency relief during Europe's famine of 1817 anticipated crisis-response mechanisms of today.

Humanitarian professionals continue to seek best practice guidelines for famine relief. Many emergency interventions in developing countries draw on recent lessons from the 20th century, although attention has also been paid to historical experiences such as the 19th century evolution of India's Famine Codes and responses to Ireland's famine of the 1840s. This presentation goes further back in time to examine public responses to the pan-European famine of 1816-1817. It finds that many of the experimental actions set in place at that time contributed to a growing public acceptance of the role of government action in times of crisis, while establishing a variety of viable approaches that continue to be used today.

Emergencies↗
PubMed2005

Differential improvement among countries in child stunting is associated with long-term development and specific interventions.

Stunting represents growth failure resulting from poor nutrition and health during the pre- and postnatal periods. Initiatives since 1980 have steadily reduced malnutrition and consequent retardation of child growth, but 1 of 3 preschool children worldwide remains stunted. Countries have varied substantially in progress achieved in reducing stunting. This study aimed to understand which underlying (i.e., proximal) and basic (i.e., distal) national factors have been most important in explaining this variation among countries, and the relation between the 2 sets of factors. Eighty-five developing countries with at least 2 surveys for stunting >4 y apart were included from the WHO Global Database on Child Growth. The analytic data set with independent variables from several sources was constructed to match closely by year for each country to initial and final stunting data. Full-information maximum likelihood estimated multiple linear regression models while accounting for missing data in independent variables. The final model explained 65.5% of the variance of change in stunting, and included both underlying and basic variables: initial and change in immunization rate, initial and change in safe water rate, initial female literacy rate, initial government consumption, initial income distribution, and the initial proportion of the economy devoted to agriculture. Although factors that were important for reducing stunting in the past may not necessarily be the ones that are important in the future, these results suggest that it possible for substantial progress to be made in reducing the current high prevalence of stunting by investing in both long-term development and in specific interventions.

Agriculture↗
PubMed1998

Can we deworm this wormy world?

While programmes such as the Rockefeller campaign were specifically targeted at a particular parasite species, the current trend is towards the simultaneous control of all the major geohelminth species. New, broad-spectrum, low-cost anthelmintics and new understanding of epidemiology have led to more cost-effective and sustainable strategies. The WHO, UNICEF and the World Bank all now support global and regional efforts to achieve control of morbidity from intestinal worms. In this paper, we aim to show what's new in clinical helminthology and what has brought about the great improvement in the success of the new approaches to control.

Adolescent↗
PubMedDate not supplied

Case management in the GI Clinic.

Nursing case management has been in practice since the 1800s when it was first created to coordinate and improve healthcare delivery to the poor and immigrant populations in the United States. In the 1950s and again in 1972, the government mandated programs that provided a community-based continuum of care for the mentally ill and elderly populations. Historically a community service, nursing case management moved into the acute care setting in the 1980s when Medicare implemented its prospective payment system organized as diagnosis-related groups, thus prompting hospitals to use nurse case managers to coordinate care and ultimately reduce costs.

Adult↗