Influencing policy change: the experience of health think tanks in low- and middle-income countries.

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties.

Au-nanocluster emission based glucose sensing.

Fabrication of a glucose biosensor based on Au-cluster emission quenching in the UV region is reported. The glucose biosensor is highly sensitive to ß-d-glucose in 2.5-25.0mM range as confirmed from a linear calibration plot between Au-cluster colloid emission intensity as a function of ß-d-glucose concentration. The interaction of ß-d-glucose with l-cysteine capped Au cluster colloids has been confirmed from their Fourier transformed infrared spectroscopy (FTIR) measurements. It has been found that the biomolecules present in the serum such as ascorbic and uric acids, proteins and peptides do not interfere and affect in glucose estimation as confirmed from their absorption and fluorescence (FL) emission measurements. Practical utility of this sensor based on FL quenching method has been demonstrated by estimating the glucose level in human serum that includes diabetes and the data were found to be comparable or more accurate than those of the pathological data obtained from a local hospital. In addition, this biosensor is useful to detect glucose level over a wide range with sensor response time of the order of nano to picoseconds that is emission lifetime of Au clusters.

Vasopressin for the management of catecholamine-resistant anaphylactic shock.

Severe anaesthetic anaphylaxis is relatively uncommon. Oxygen, fluids and epinephrine are considered to be the mainstay for treatment of cardiovascular collapse and current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of a cardiovascular collapse. Recently, evidence has emerged in the support of the use of vasopressin in cardiopulmonary resuscitation; it is also recommended for the treatment of ventricular fibrillation, septic shock and post-cardiopulmonary bypass distribution shock. Currently, there is no algorithm or guideline for the management of anaphylaxis that include the use of vasopressin. We report a 24-year-old woman who developed severe anaphylactic shock at induction of anaesthesia while undergoing laparoscopic cholecystectomy. Circulation shock was refractory to epinephrine and high doses of pure alpha-agonist phenylephrine and norepinephrine. Single intravenous dose of two units of vasopressin re-established normal circulation and blood pressure.

Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review.

OBJECTIVES: To evaluate the ability of different diagnostic imaging techniques for diagnosing the presence of erosions and osteophytes in the temporomandibular joint (TMJ). METHODS: A systematic search of PubMed, Medline, all Evidence Based Medicine (EBM) reviews, Embase, Web of Sciences and Lilacs identified nine articles that met the selection criteria: some type of TMJ diagnostic imaging, data from autopsy or dry skull TMJs as gold standard, absence of diagnosed systemic arthritis and evaluation of the presence of erosions and/or osteophytes. A hand search of the references of the selected articles was also performed. RESULTS: Selected studies evaluated panoramic imaging (unenhanced and colour-enhanced digital subtraction panoramic imaging), axially corrected sagittal tomography, axially corrected frontal tomography, sagittal MRI, CT, high-resolution ultrasound and cone beam CT (CBCT). CONCLUSIONS: Axially corrected sagittal tomography is currently the imaging modality of choice for diagnosing erosions and osteophytes in the TMJ. CT does not seem to add any significant information to what is obtained from axially corrected sagittal tomography. CBCT might prove to be a cost- and radiation dose-effective alternative to axially corrected sagittal tomography. Combining different radiographic techniques is likely to be more accurate in diagnosing erosions and osteophytes in the TMJ than using a single imaging modality. Diagnostic studies that simultaneously evaluate all of the available TMJ imaging technologies are needed.

Measuring the impact of needle exchange programs among injecting drug users through the National Behavioural Surveillance in Bangladesh.

Bangladesh is a low HIV prevalence country, with buprenorphine injectors having the highest prevalence of HIV at 2.5% as of 1999. Using National HIV Behavioral Surveillance data, the impact of a needle exchange program (NEP) on sharing behavior among injecting drug users in two cities was measured. Results showed positive changes that varied with the different settings. Those who reported utilizing the NEP were compared with those who did not. Differences in Dhaka were significant for the average proportion of needles shared but not for the proportion of men who ever shared in the last week. In Rajshahi, where professional injectors were the norm, the impact of an NEP was greater and affected both the proportion of needles shared as well as the proportion of men never sharing. Behavioral surveillance methods have the potential to measure intervention impact through comparative analysis in certain settings.

Modulation of CD157 expression in multi-lineage myeloid differentiation of promyelocytic cell lines.

CD157/BST-1 is expressed on mature myeloid cells but not on their precursors in vivo. Also CD38, a homologous gene to CD157, is upregulated in promyelocytic HL-60 cells by the monocyte and granulocyte differentiation-inducing 1alpha,25dihydroxyvitamin D3 (VD3) and all-trans retinoic acid (ATRA), respectively. We have examined whether CD157 expression is upregulated when the promyeloid HL-60 and/or U937 cells are induced to differentiate into mature phenotypes in vitro. VD3 treatment irreversibly upregulated the expression of CD157 in HL-60 cells but not in U937 cells in a time- and concentration-dependent manner when analyzed by flow cytometry, immunoblotting and/or RT-PCR. Different monocyte and granulocyte lineage inducers induced CD157 expression to varying extents while the macrophage differentiation-inducing phorbol 12-myristate 13-acetate (PMA) induced its down-regulation. Time-kinetics of VD3 treatment of HL-60 cells showed that the appearance of CD157 and CD11b (a differentiation marker) antigens were not substantial up to 24 hours but increased subsequently although the appearance of CD38 became significant within 6 hours. Two-color staining of VD3-treated HL-60 cells displayed an apparently linear correlation between CD157 and CD11b expression. Dibutyryl cAMP (cAMP agonist) and forskolin (cAMP-increasing agent) augmented the VD3-dependent induction of CD157 and CD11b expression while PGE1 (cAMP-decreasing agent) inhibited it, suggesting the involvement of a cAMP-dependent mechanism in VD3-induced CD157 upregulation. Co-treatment of HL-60 cells with VD3 plus TNF-alpha or ara-C produced an additive effect on CD157 upregulation. The upregulated CD157 in the VD3-differentiated HL-60 cells was able to activate CD157-dependent tyrosine kinase signal when cross-linked with anti-CD157 antibody.

Effect of aging on tryptophan hydroxylase in rat brain: implications on serotonin level.

Tryptophan hydroxylase (TrpH) catalyzes a rate-limiting step in the biogenesis of serotonin. The main objective of this study is to investigate the effect of aging on the activity of TrpH in serotonergic-enriched brain regions such as midbrain, pons, and medulla. TrpH activity was monitored by incubating various concentrations of tryptophan in a fixed amount of brain homogenate from midbrain, pons, and medulla of 2-month (young), 12-month (mature), and 24-month (old) rats (pH 7.4, 37 degrees C). The product 5-hydroxytryptophan was quantitated using a reversed phase HPLC equipped with an electrochemical detection system. Michaelis-Menton constants, K(m) and V(max), were calculated using the Lineweaver-Burk plot. The affinity (K(m)) of the enzyme significantly declined in midbrain and pons of old rats (141.1 +/- 2. 6, 126.0 +/- 10.8 microM) relative to mature rats (22.4 +/- 7.7, 38. 2 +/- 4.7 microM). However, no change was observed in medulla of old rats. The V(max) of TrpH in pons of all three age group rats was fairly constant. However, the V(max) of midbrain was significantly elevated, whereas that of medulla was reduced in old rats relative to mature rats. Clearance formation, a ratio of V(max) to K(m), of 5-hydroxytryptophan declined significantly in midbrain, pons, and medulla of old rats relative to mature rats. A combined effect of inefficient phosphorylation and oxidative damage of TrpH enzyme may be responsible for lower TrpH activity in aging brain. Such alterations in TrpH activity may reduce the level of serotonin in brain, which may be linked to late-life depression and other brain disorders, such as Alzheimer and Parkinson diseases.

Novel kinetics, behaviour and cell-type specificity of CD157-mediated tyrosine kinase signalling.

CD157, a recently characterized leukocyte surface antigen, has recently been shown to induce tyrosine phosphorylation of a 130-kDa protein (p130) when cross-linked with its antibody (ligand). We have further investigated the detailed kinetics, behaviour and cell-type specificity of this CD157-stimulated p130 phosphorylation. We demonstrate that CD157-mediated p130 phosphorylation is ligand independent in recombinant CD157-expressing CHO, MCA102 and COS-7 cells but is ligand dependent in HL-60-differentiated monocytes (mHL-60) having enhanced CD157 expression. This p130 phosphorylation is activated only at lower temperatures (0-4 degrees C) in MCA102, COS-7 and mHL-60 cells but is temperature insensitive in CHO cells. We further demonstrate that the CHO/CD157 cell clones have approximately 22-28% slower rates of proliferation than that of a CHO/mock clone. But the MCA102 cell proliferation remains unaffected by CD157 expression. We postulate that the difference in the temperature sensitivity of p130 phosphorylation can be responsible for the discrepancy in the rates of MCA102/CD157 and CHO/CD157 cell proliferation.

Functional expression of secreted mouse BST-1 in yeast.

BST-1, a bone marrow stromal cell surface antigen, is a glycosyl phosphotidylinositol-anchored protein that stimulates pre-B-cell growth and has adenosine diphosphate (ADP)-ribosyl cyclase and cyclic ADP-ribose (cADPR) hydrolase activity. The two enzymatic activities are responsible for the synthesis and hydrolysis of cADPR, a novel second messenger of calcium release from intracellular calcium stores. The expression and characterization of human BST-1 in certain mammalian cell lines have been reported. We have expressed the murine BST-1 in yeast as a 6 x His-tagged secreted protein. The recombinant protein has been purified and subjected to structural and functional characterization. It has an apparent molecular mass of 38.5 kDa on SDS-PAGE gel stained with Coomassie blue and is recognized on Western blots by a rabbit polyclonal antibody against BST-1. Deglycosylation of the protein with N-glycanase produces a ladder of bands with molecular sizes ranging from 32 to 39 kDa. The protein possesses the ADP-ribosyl cyclase activity as measured using nicotinamide guanine dinucleotide as substrate.

Relationships among calving season, heat load, energy balance and postpartum ovulation of dairy cows in a subtropical environment.

The study was designed to examine the relationships among calving season, energy balance, temperature humidity index (THI), and postpartum ovulation in high producing cows in a subtropical environment. Holstein cows calving in a feedlot dairy in southeast Queensland during winter (n = 23) and summer (n = 21) were monitored during the first 9 weeks of lactation. Cows were weighed and blood samples collected twice weekly: plasma progesterone, plasma metabolites related to energy and mineral balance, and haematological measurements were performed. Milk production was measured, body condition score was estimated, and trans-rectal ultrasound examinations of the ovaries were each undertaken once a week. The interval between calving and first ovulation was significantly longer in cows calving in summer (22.8 vs. 17.6 days, P < 0.05). Interval from calving to the first postpartum ovulation (FOVL) was inversely related to the mean plasma glucose concentration for the first 9 weeks after calving (GLU): FOVL = 80.0-17.9GLU, (R2 = 0.25, P < 0.001). Plasma progesterone concentration during the life of the second corpus luteum after calving was negatively correlated with THI during the first 2 weeks after calving (r = 0.55, P < 0.001). Plasma glucose concentration (GLU) was negatively correlated with milk yield (MYD) and rectal temperature (RT), and positively correlated with plasma calcium concentration (Ca) according to the following regression equation. GLU = 33.1 - 0.02MYD + 0.91Ca - 0.48RT, (R2 = 0.58, P = 0.0001).

Determinants of weaning age in rural Bangladesh.

Weaning at an appropriate age with appropriate foods is vital for the growth and health of infants. Weaning beliefs and practices were studied in two representative rural villages in Bangladesh by interviews with 180 mothers with infants between 4 and 12 months of age. Maternal parity and family size were not found to be related to weaning age. Family income and maternal education were consistently related to appropriate weaning. Bivariate controlled analysis showed that a mismatch between mothers' responses and actual weaning behavior toward infants 4-6 months old could be attributed to family poverty.

PIP: Interviews with 180 mothers from the villages of Digarkanda and Bhatibarea in Bangladesh were conducted in 1989 in order to collect representative information on rural weaning practices and to examine the impact of socioeconomic and demographic factors on weaning age. Attitudes toward an appropriate time for weaning varied. 19 out of 80 mothers with infants aged under 6 months considered weaning appropriate at under 6 months of age. About 85% of mothers thought weaning ought to occur by 12 months of age. 40% of mothers had weaned or were planning on weaning infants by 12 months of age. 16 out of 80 mothers had babies on a weaning diet. 73% of mothers with babies under 6 months of age who had not weaned yet thought their babies were not ready yet for weaning, and 19% thought the babies would be harmed by early weaning. 8% of mothers indicated poverty was the reason for not weaning their babies. Monthly family income was found to be statistically significantly related to weaning, regardless of educational level. This strong relationship was in contrast to the very few who revealed that poverty was a reason for not weaning. Maternal education only had an impact at high income levels. Only 19% indicated cultural taboo as a reason for not weaning infants that otherwise were of appropriate age.

The bactericidal effect of N-acetyl-beta-D-glucosaminidase on bacteria.

The bactericidal activity of N-acetyl-beta-D-glucosaminidase (NAGase) on some of the potential bacterial pathogens of the cow was determined. NAGase treatment significantly decreased the mean log10 number of Actinomyces pyogenes (P less than 0.01) and Staphylococcus aureus (P less than 0.05) after 2 and 4 hours of incubation at 37 degrees C. Similarly NAGase treatment significantly (P less than 0.05) reduced the mean log10 number of Streptococcus agalactiae and Pseudomonas aeruginosa after 4 hours incubation at 37 degrees C. NAGase did not reduce the numbers of Escherichia coli or Enterobacter aerogenes after either 2 or 4 hours incubation. Since NAGase and presumably other lysosomal enzymes are free on normal mucosal surfaces such as the uterus it is suggested that this direct bactericidal activity may be an important component of the normal defense mechanisms.

Effects of intrauterine infusion of Escherichia coli endotoxin in normal cows and in cows with endometritis induced by experimental infection with Streptococcus agalactiae.

Two experiments were carried out to describe the effects of intrauterine infusion of Escherichia coli endotoxin on some aspects of nonspecific uterine defense mechanisms in healthy cyclic cows (Experiment 1) and in cows with induced endometritis by experimental infection with Streptococcus agalactiae (Experiment 2). In Experiments 1 and 2, the mean log(e) total white cell counts (>95% neutrophils) in the uterine flushing fluid of the endotoxin-treated group were significantly increased (P<0.01 and P<0.05, respectively). Streptococcus agalactiae was detected by the Latex Agglutination Test (LAT) in 47% of the samples from uteri experimentally infected with this organism; 12.5% were positive on culture, and only 10% were positive on both tests. With one exception, all the samples with a positive culture were positive to the LAT, but not all samples submitted to the LAT had positive culture. There was a significant (P<0.05) association between endotoxin treatment and the presence of infection detected by the LAT but not with that detected by culture (P>0.05) at 3 to 12 days post infection. Similar results were found at 8 to 16 days post infection. The infection disappeared from the endotoxin-treated group but not from the non-treated group 12 days after the induction of infection. It is concluded that intrauterine E. coli endotoxin infusion might provide an alternative treatment for those cows with endometritis that is refractory to conventional antimicrobial and hormonal therapy. It is also concluded that the LAT is an easier, quicker and more reliable method than bacterial culture for the detection of endometritis caused by Strep. agalactiae , and, possibly, such immunodiagnostic tests may be useful for the detection of other uterine infections.

N-acetyl- beta -D-glucosaminidase activity in the endometrial epithelium of the cow's uterus during the oestrous cycle and pregnancy.

The levels of N-acetyl-beta-D-glucosaminidase (NAGase) were measured in the endometrial epithelial tissue of the bovine uterus during the oestrous cycle and during pregnancy. NAGase levels were significantly (P<0.001) higher in the epithelial tissue of the cow's uterus during the luteal phase of the cycle and during pregnancy than during the non-luteal phase. There were significantly (P<0.001) higher mean NAGase values in the epithelial than the subepithelial layers of the uterus in the two cycle phases and in pregnancy. Leucocyte numbers were significantly (P<0.05 and P<0.001) higher in the cows' uteri during the non-luteal phase than during the luteal phase and pregnancy, respectively. It is concluded that the endometrial epithelial layer is significantly active in terms of NAGase release and that this may be related to increased progesterone concentrations. In addition, the epithelial tissue (not leucocytes) appears to be the main contributor to the total NAGase activity in uterine tissue.

Bovine endometritis: current and future alternative therapy.

Abnormal parturition can be followed by a persistent endometritis which can have deleterious effects on the cow's subsequent reproductive performance. Normal and active uterine defense mechanisms have been reported to be very important for the exclusion of bacterial infection from the uterus and recovery from endometritis developing after parturition. Despite the widespread use of local or systemic antibiotics, antiseptics, sulfonamides and hormones, rates of recovery from endometritis and the cow's subsequent fertility have not increased appreciably. Furthermore, the cost of any treatment, the frequency of its administration and the milk disposal after treatment make their use uneconomic. Alternative therapies which stimulate the natural uterine defense mechanisms have been suggested as treatments of bovine endometritis. These include: (I) Endotoxins such as lipopolysaccharide of E. coli, (II) serum, plasma or hyperimmune serum, (III) polymorphonuclear leucocyte (PMN) extracts and components and (IV) granulocyte-macrophage colony stimulating factors (G-M CSF).

Nuclear magnetic resonance imaging (MRI).

This article discusses the basic concepts of Magnetic Resonance Imaging (MRI) with the intention to introduce the subject to uninitiated. The MRI technique is a powerful noninvasive probe of the body's internal anatomy. In MRI, the images are produced not by X-rays, but through the use of non-ionizing radiowaves that stimulate transitions between spin states of nuclei in a magnetic field when passed through the body. The time required for the nucleus to return to equilibrium gives information about the environment of that nucleus. In this way tissue abnormalities can be determined in vivo. This article covers the basis of MRI phenomena, the concept of magnetic moment of the sample, NMR exalation and emission and the equipment necessary to observe these NMR properties. The primary agents used to increase tissue contrast in MRI are also mentioned. Finally the importance and prospects of this technique in Pakistan have been discussed.