U.S. National Institutes of Health Core Consolidation–Investing in Greater Efficiency

The U.S. National Institutes of Health (NIH) invests substantial resources in core research facilities (cores) that support research by providing advanced technologies and scientific and technical expertise as a shared resource. In 2010, the NIH issued an initiative to consolidate multiple core facilities into a single, more efficient core. Twenty-six institutions were awarded supplements to consolidate a number of similar core facilities. Although this approach may not work for all core settings, this effort resulted in consolidated cores that were more efficient and of greater benefit to investigators. The improvements in core operations resulted in both increased services and more core users through installation of advanced instrumentation, access to higher levels of management expertise; integration of information management and data systems; and consolidation of billing; purchasing, scheduling, and tracking services. Cost recovery to support core operations also benefitted from the consolidation effort, in some cases severalfold. In conclusion, this program of core consolidation resulted in improvements in the effective operation of core facilities, benefiting both investigators and their supporting institutions.     

Conflicts of interest in health care: who guards the guardians?

Conflicts of interest are rife in all areas of human endeavor, including medicine. Dealing with them is often difficult, because various disclosure remedies are sometimes too weak, while explicit prohibitions against participation in certain forms of research could block the needed synergies between scientists who work in universities, government, and industry. The situation is made still more difficult, because any effort to control one set of conflicts will necessarily generate another in its stead, as is well captured in Juvenal's famous question, "Who will guard the guardians?" That problem is more acute today, because many of our social watchdogs are in fact complex organizations that are rife with their own internal conflicts of interest. The problem is acute for the FDA, for example, which so fears the release of harmful drugs that it often keeps beneficial ones off the market. The problem can also arise in connection with the review of medical research by major journals, which is well illustrated by the recent effort of the New England Journal of Medicine to attack a Vioxx study it published in order to protect its own reputation.     

Development of pertussis vaccine production and control in the National Institute of Public Health in the Netherlands during the years 1950–1962

The development of the pertussis vaccine production in the National Institute of Public Health in the Netherlands since 1953, and the results with the consecutive lots of vaccine in the mouse protection test and the U.S.A. toxicity test are described. The results in the latter test are compared with the results of a locally developed guinea pig toxicity test. Special attention is given to the difficulties encountered when the U.S.A. toxicity test is used for adsorbed DPT vaccines. The potency data of all lots of DPT vaccines produced since 1958 fall within the limits of the potency test as prescribed in the U.S.A. Minimum Requirements. There are indications that the increased potency of the vaccine may have led to a lower mortality rate of pertussis.     

Patterns of human–coyote conflicts in the Denver Metropolitan Area

In many cities throughout North America, human–coyote conflicts are an emerging problem. Little research has described temporal and spatial patterns of human–coyote conflicts, although such information can be an important step in developing and optimizing management efforts. We used reports from 22 entities within the Denver Metropolitan Area (DMA) in Colorado that provided information on coyote observations (signs, sightings, and encounters) and conflicts (incidents, pet-attacks, and human-attacks). Our objectives were to 1) define, quantify, and map categories of coyote observations and conflicts, and 2) investigate temporal and spatial patterns of conflicts, particularly related to land cover types and housing density classes. We compiled 4,006 coyote reports, including 78 signs (1.9%), 3,023 sightings (75.5%), 395 encounters (9.9%), 26 incidents (0.6%), 471 pet-attacks (11.8%), and 13 human-attacks (0.3%). We found a strong seasonal pattern with reports of both observations and conflicts highest during December–March and lowest during July–September. Numbers of coyote conflicts were disproportionately greater in open space and development land cover types (in contrast to natural and agricultural land cover) and in suburban housing areas (in contrast to urban, exurban, and rural areas). Hotspots of coyote conflicts were apparent in the southern region of the DMA, possibly because coyotes had better access to development, and hence interaction with residents, via natural areas bordering urban areas; reporting bias may have also influenced this outcome. Our results will help target management efforts, particularly those focused on people (e.g., education), but also highlight the critical need for improved methods of collecting conflict information via a standardized reporting mechanism to help reduce bias. © 2012 The Wildlife Society.     

Taking the brakes off-are IC foundries in the industry's best interest?

Following up last issue's editorial topic, GaAs evangelism, another prime driving factor for the IC industry is the need for more design freedom. Before any new technology can be taken up, there must be enough engineers out there versed in the methodology. This obvious statement begs the question: where does this knowledge come from? Most noticeably from the IC foundries who are, for the most part, keen to restrict the spread of this knowledge outside their “club” of users. Is this in the best interest of progress in the GaAs industry as a whole?     

What Are the Roles and Responsibilities of the Media in Disseminating Health Information?

BACKGROUND TO THE DEBATE: In December 2004 three news stories in the popular press suggested that the side effects of single-dose nevirapine, which has been proven to prevent mother-to-child transmission of HIV, had been covered up. Many HIV experts believed that the stories were unwarranted and that they would undermine use of the drug, leading to a rise in neonatal HIV infection. The controversy surrounding these stories prompted the PLoS Medicine editors to ask health journalists, and others with an interest in media reporting of health, to share their views on the roles and responsibilities of the media in disseminating health information.     

Intergroup conflicts among chimpanzees in Taï National Park: lethal violence and the female perspective

Intercommunity aggression in chimpanzees and primitive warfare in humans possess striking similarities, such as the common occurrence of large male coalitions, systematic control of territory boundaries, and lethal attacks on isolated individuals from neighboring groups. However, an important apparent contrast is the absence of recurrent peaceful interactions between neighboring groups of chimpanzees. We observed a remarkable range of behavior in intergroup encounters among three habituated communities of chimpanzees in Taï National Park, Côte d'Ivoire. Lethal attacks are documented in these study groups for the first time, as well as year‐long exchanges of parous adult females and peaceful intergroup visits of mothers with infants. Demographic factors, including group size and number of adult males, are shown to affect the nature of intergroup interactions in ways not considered previously. A reconsideration of the difference in intergroup interactions between eastern and western chimpanzees is proposed including a more important consideration of the female's perspective. The inclusion of the new complexities in intergroup interactions in chimpanzees allows new parallels to be drawn with the evolution of primitive warfare in humans. Am. J. Primatol. 70:519–532, 2008. © 2008 Wiley‐Liss, Inc.     

Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

Background

Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for ''catastrophic'' health expenditure (CHE), in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.

Methods

We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.

Findings

Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.

Conclusion

During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential to achieve equity of access to healthcare.     

Looking under the bonnet of conservation conflicts: can neuroscience help?

Neuroscience—a branch of biology seemingly distant from nature/wildlife conservation is revolutionised by the ability to visualise the brain activity of humans. Using positron emission tomography (PET), functional magnetic resonance imaging (fMRI) and magnetoencephalograhy (MEG), neuroscience is revealing how humans are wired in ways that have bearing on any problem that involves values; and nature/wildlife conservation is surely one of those. Understanding how the human brain represents and processes morality and sacred values, and responds to conflicts could shed a powerful light on nature/wildlife conservation tactics. Conservation polices typically involve utilitarian considerations. However, research shows that conservation policies based solely on utilitarian considerations are likely to fail as the neurological process of rights and wrongs grates against the process of cost and benefits.     

To What Extent Do Financial Strain and Labour Force Status Explain Social Class Inequalities in Self-Rated Health? Analysis of 20 Countries in the European Social Survey

Introduction

Nordic countries do not have the smallest health inequalities despite egalitarian social policies. A possible explanation for this is that drivers of class differences in health such as financial strain and labour force status remain socially patterned in Nordic countries.

Methods

Our analyses used data for working age (25–59) men (n = 48,249) and women (n = 52,654) for 20 countries from five rounds (2002–2010) of the European Social Survey. The outcome was self-rated health in 5 categories. Stratified by gender we used fixed effects linear regression models and marginal standardisation to instigate how countries varied in the degree to which class inequalities were attenuated by financial strain and labour force status.

Results and Discussion

Before adjustment, Nordic countries had large inequalities in self-rated health relative to other European countries. For example the regression coefficient for the difference in health between working class and professional men living in Norway was 0.34 (95% CI 0.26 to 0.42), while the comparable figure for Spain was 0.15 (95% CI 0.08 to 0.22). Adjusting for financial strain and labour force status led to attenuation of health inequalities in all countries. However, unlike some countries such as Spain, where after adjustment the regression coefficient for working class men was only 0.02 (95% CI −0.05 to 0.10), health inequalities persisted after adjustment for Nordic countries. For Norway the adjusted coefficient was 0.17 (95% CI 0.10 to 0.25). Results for women and men were similar. However, in comparison to men, class inequalities tended to be stronger for women and more persistent after adjustment.

Conclusions

Adjusting for financial security and labour force status attenuates a high proportion of health inequalities in some counties, particularly Southern European countries, but attenuation in Nordic countries was modest and did not improve their relative position.     

Structure of the breeding bird assemblage of a primeval alder swamp in the ?úr National Nature Reserve

The structure of a breeding bird assemblage of a primeval alder swamp in the Šúr National Nature Reserve (the Danube Basin) was studied in the period 1992–1995. A 16 ha forest interior study plot was established for bird censusing. Population abundances were estimated by a combined version of the mapping method from the end of March to the beginning of July. Altogether, 42 breeders were recorded and the mean total density of species total across years was 125.15 ± 12.73 pairs/10 ha (CV = 10.17%). Two species were eudominant (≥ 10%): Sturnus vulgaris and Anas platyrhynchos, and six species were dominant (5% ≤ 10% <): Ficedula albicollis, Fringilla coelebs, Phylloscopus collybita, Parus major, Sylvia atricapilla, Erithacus rubecula. The Shannon diversity index (H′) varied between 3.98–4.10 bites. The evenness index (J′) reached values between 0.79–0.81. Expected species diversity in a random sample of 100 pairs calculated by rarefaction [E (S _{100 pairs})] was 21.35 ± 0.92 species derived as a mean value from the years 1992–1995. The mean rarefaction estimate on the area [E (S _{10 ha})] was 22.75 ± 1.58 species. Bird species richness and diversity were significantly higher in the study plot in comparison to the mean value of European wet alder forests. These results are comparable with the values of structural assemblage parameters of the primeval stands dominated by alder within the Białowieża National Park, Poland.     

Contribution of the Community Health Volunteers in the Control of Buruli Ulcer in Bénin

Background

Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers.

Methodology/Principal Findings

In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems.

Conclusions/Significance

This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU.