WHO accused of stifling debate about infant feeding

International specialists in infant feeding expressed concern that the policy of WHO of establishing partnerships with private industry has gone too far, with the result that debate about the infant food industry's role in marketing breast milk substitutes is being stifled. Specialists, who want the WHO to recommend exclusive breast-feeding to babies up to 6 months, claim that at a recent joint meeting on infant feeding they were prevented from discussing the issue. In addition, some papers intended for the meeting were edited so that they were less critical to the infant food industry. Although 20 of the 28 consultants signed a statement saying that scientific evidence was now sufficient to warrant changing of the current WHO recommendation on the introduction of complementary feeding from age 4-6 months to about 6 months, no discussion was allowed. In response, a spokesman for the WHO stated that the current recommendation of WHO on the duration of exclusive breast-feeding was excluded in the discussion because of the WHO?s research that is under way in this connection. As far as the alleged censorship of the background papers is concerned, he explained that WHO documents have to conform to a high standard of scientific objectivity and balance. Lastly, WHO cited that the food industry continues to play an important and constructive role in relation to infant feeding.     

The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa

BACKGROUND: Since November 2009, WHO recommends that adults infected with HIV should initiate antiretroviral therapy (ART) at CD4+ cell counts of ≤350 cells/μl rather than ≤200 cells/μl. South Africa decided to adopt this strategy for pregnant and TB co-infected patients only. We estimated the impact of fully adopting the new WHO guidelines on HIV epidemic dynamics and associated costs. METHODS AND FINDING: We used an established model of the transmission and control of HIV in specified sexual networks and healthcare settings. We quantified the model to represent Hlabisa subdistrict, KwaZulu-Natal, South Africa. We predicted the HIV epidemic dynamics, number on ART and program costs under the new guidelines relative to treating patients at ≤200 cells/μl for the next 30 years. During the first five years, the new WHO treatment guidelines require about 7% extra annual investments, whereas 28% more patients receive treatment. Furthermore, there will be a more profound impact on HIV incidence, leading to relatively less annual costs after seven years. The resulting cumulative net costs reach a break-even point after on average 16 years. CONCLUSIONS: Our study strengthens the WHO recommendation of starting ART at ≤350 cells/μl for all HIV-infected patients. Apart from the benefits associated with many life-years saved, a modest frontloading appears to lead to net savings within a limited time-horizon. This finding is robust to alternative assumptions and foreseeable changes in ART prices and effectiveness. Therefore, South Africa should aim at rapidly expanding its healthcare infrastructure to fully embrace the new WHO guidelines.     

The ethics of blood donation: Does altruism suffice?

Is the recommendation of the WHO, endorsed by all member states, that all blood donations should be voluntary and non-compensated ethically coherent and realizable in practice? In a recent paper, Farrugia et al have argued for a plurality of both compensated and non-compensated systems, claiming that, from both an ethical and practical perspective, the classical concept of the ‘the gift relationship’, advocated over 40 years ago by Richard Titmuss, is unnecessary and inadequate. This paper focuses on the ethical aspects of this debate, considering the concepts of altruism, reciprocity and social solidarity as they apply to the procurement of blood and blood products, as well as evidence regarding safety of different sources of blood and the motivations of regular donors. It concludes with a discussion of the view summarized in a recent publication by Campbell (2009), that, although the body may be monetized, doing so would result in a loss of human value.     

Absence of 2009 Pandemic H1N1 Influenza A Virus in Fresh Pork

The emergence of the pandemic 2009 H1N1 influenza A virus in humans and subsequent discovery that it was of swine influenza virus lineages raised concern over the safety of pork. Pigs experimentally infected with pandemic 2009 H1N1 influenza A virus developed respiratory disease; however, there was no evidence for systemic disease to suggest that pork from pigs infected with H1N1 influenza would contain infectious virus. These findings support the WHO recommendation that pork harvested from pandemic influenza A H1N1 infected swine is safe to consume when following standard meat hygiene practices.     

Education and WHO Recommendations for Fruit and Vegetable Intake Are Associated with Better Cognitive Function in a Disadvantaged Brazilian Elderly Population: A Population-Based Cross-Sectional Study

Brazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in São Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400grams/day or ≥400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes ≥400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and “years of education and physical activity” and “years of education and blood levels of HDL” So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.     

Use of electrophoresis in polyacrylomide gel (SDS_PAGE) for evaluating IgG structure--the main component of human intravenous immunoglobulin

For the assessment of the structure of IgG particles in the immunoglobulin preparation for intravenous use (Bioglobulin) electrophoresis in polyacrylamide gel (SDS-PAGE) was applied in place of filtration on Sephadex G-200 gel. The method serves for determination of the molecular weight of polypeptide chains under conditions of reduction. The method is rapid, sensitive and of high resolution. Six batches of the preparation were examined finding that IgG monomers and dimers accounted for over 90%, with IgG aggregates about 3% and degradation products about 1%. The obtained values comply with the recommendation of the WHO and requirements in the latest edition of Europea Pharmacopaes.     

Information Filtering via Heterogeneous Diffusion in Online Bipartite Networks

The rapid expansion of Internet brings us overwhelming online information, which is impossible for an individual to go through all of it. Therefore, recommender systems were created to help people dig through this abundance of information. In networks composed by users and objects, recommender algorithms based on diffusion have been proven to be one of the best performing methods. Previous works considered the diffusion process from user to object, and from object to user to be equivalent. We show in this work that it is not the case and we improve the quality of the recommendation by taking into account the asymmetrical nature of this process. We apply this idea to modify the state-of-the-art recommendation methods. The simulation results show that the new methods can outperform these existing methods in both recommendation accuracy and diversity. Finally, this modification is checked to be able to improve the recommendation in a realistic case.     

Enquête sur les pratiques du spermogramme en France

An extensive investigation was performed by numerous public as well private biological laboratories. 214 answers were collected. Most of them corresponded to laboratories analysing less than 5 spermiograms per week. Only 74 of them can be considered as specialised in this field. Among the questions, those conserning sperm conservation, viscosity and motylity evaluation, spermatozoa count, rate of teratospermia, study of rund cells revealed marked differences in the routine practice. These differences can affect the diagnostic value of the spermiogram. To reach ab harmonisation of the results, some recommendations are proposed by the working group. First, treatment and microscopic examinations should be carried out at 37 °C; WHO recommendation should be followed for the motility and teratospermia rate evaluation. A common format is also proposed to present results conserning the spermiocytogram, contributing to improve the standardisation.     

Optimizing Online Social Networks for Information Propagation

Online users nowadays are facing serious information overload problem. In recent years, recommender systems have been widely studied to help people find relevant information. Adaptive social recommendation is one of these systems in which the connections in the online social networks are optimized for the information propagation so that users can receive interesting news or stories from their leaders. Validation of such adaptive social recommendation methods in the literature assumes uniform distribution of users'' activity frequency. In this paper, our empirical analysis shows that the distribution of online users'' activity is actually heterogenous. Accordingly, we propose a more realistic multi-agent model in which users'' activity frequency are drawn from a power-law distribution. We find that previous social recommendation methods lead to serious delay of information propagation since many users are connected to inactive leaders. To solve this problem, we design a new similarity measure which takes into account users'' activity frequencies. With this similarity measure, the average delay is significantly shortened and the recommendation accuracy is largely improved.     

长双歧杆菌DD98冻干保护剂优化及菌粉保存稳定性研究

以长双歧杆菌DD98为研究对象,通过对冻干保护剂配方的优化,冻干菌粉的存活率提高到90%以上。通过进一步稳定性研究,采用保护剂优化配方制备的冻干菌粉在4℃保存24个月后,活菌数仍在1.0×10^10 CFU/g以上,在25℃条件下可以保存12个月,双歧杆菌的存活率在1.0×10^6CFU/g以上,符合FAO/WHO建议食品益生菌活菌数应在1.0×10^6 CFU/g^1.0×10^7CFU/g的标准。     

How Many People Living with HIV Will Be Additionally Eligible for Antiretroviral Treatment in Karnataka State,India as per the World Health Organization 2013 Guidelines?

Background

The National AIDS control programme (NACP) in India is currently following the World Health Organization (WHO) 2010 antiretroviral therapy (ART) guidelines. In 2013, the WHO revised its recommendations for initiating ART among people living with HIV (PLHIV) by increasing the threshold for ART initiation to a CD4 count ≤500 cells/uL. For certain patient groups, ART is recommended irrespective of CD4 count (PLHIV with active tuberculosis, hepatitis B virus infection, pregnant and breast feeding women, children aged under five years and those living in a sero-discordant relationship). In this operational research, we assess the effect of applying this recommendation on the number of PLHIV additionally eligible for ART.

Methods

This was a cross-sectional analysis of routinely collected programme data from all PLHIV registered in Karnataka State (population 60 million), India in 2012.

Results

Of 37,044 PLHIV, 27,074 (73%) were eligible for initiating ART as per WHO-2010 criteria. As per the WHO-2013 criteria (CD4 count ≤500 and all pregnant women and under-five children irrespective of CD4 count), an additional 5104 (14%) HIV-infected people would be eligible for initiating ART. There were no data to inform the additional patient load due to sero-discordance.

Conclusion

Adopting the WHO-2013 guidelines for India has important resource implications. However, given the significant patient and programmatic benefits of adopting the new guidelines, this has been considered favourably by the NACP in India and steps are being planned to integrate ART care into the general health system to cope with the increased numbers of patients.     

Baby food industry lobbies WHO on breast feeding advice

In the existing WHO guidelines, complementary feeding at 4-6 months is advocated. However, many nutrition specialists believe that these guidelines lead to complementary foods being offered from the age of 3 months, or even earlier, subsequently suggesting that the WHO should change its recommendations to about 6 months. To this effect, the International Association of Infant Food Manufacturers lobbied the WHO to delay any change to its recommendations on the optimal length of exclusive breast-feeding. Their message states that any action dealing with Infant and Young Child Nutrition should be delayed until the World Health Assembly 2002. Supporting facts to justify the message argue the importance of an international study on infant growth being carried out by the WHO, which should be finished by 2002. Nevertheless, several nutrition specialists believe that the scientific evidence to support a change in the WHO policy already exists and that such a study was not set up to determine the optimal length of exclusive breast-feeding.     

WHO Study Group on cell substrates for production of biologicals, Geneva, Switzerland, 11–12 June 2007

For many years, the World Health Organization (WHO) has provided global leadership in defining technical specifications for quality assurance and safety of biological medicines produced in cell substrates. Current WHO requirements for the use of animal cells as substrates for production of vaccines and other biologicals were adopted by the WHO Expert Committee on Biological Standardization in 1996 (WHO TRS 878). Since then, significant progress especially in the development of vaccines in novel continuous cell lines of mammalian origin as well as in insect cells has been made and consequently there is an increasing need for the re-evaluation of existing criteria for the acceptability of such cell lines. In addition there is also a need to consider new issues in cell substrate safety arising from these new cell types and developments in technology and scientific knowledge. In response to these demands, the WHO Study Group on Cell Substrates was formed in 2006 to initiate revision of WHO requirements and to address the need for further research in this area. At its second meeting on 11-12 June 2007, the Study Group reviewed scientific data that would form the basis for new recommendations and made a number of proposals for further investigations. The Study Group is working on the preparation of a revised WHO document, and a broad consultation with regulators, manufacturers, and other relevant parties is planned for 2008.     

Evaluation of cell substrates for the production of biologicals: Revision of WHO recommendations: Report of the WHO Study Group on Cell Substrates for the Production of Biologicals, 22–23 April 2009, Bethesda,USA

Evaluating cell substrates for producing vaccines and other biologicals is one of the critical aspects in assuring quality and safety of these products. As part of its mission in setting standards for biological products, WHO provides recommendations for manufacturing and evaluating biologicals. Regular updates of the guidance documents are important to manufacturers and regulators worldwide. WHO Expert Committee on Biological Standardization (ECBS) identified a need for revising the requirements for cell substrates (WHO TRS 878, annex 1). In response, WHO established a Study Group (SG) in 2006 that prepared an updated set of recommendations for using cell substrates for the production of biologicals. A summary of the proposed changes that the SG made in 2007 is available at WHO web site (http://www.who.int/biologicals/publications/meetings/areas/vaccines/cells/en/index.html). Draft revised recommendations were circulated to regulators, manufacturers and other experts for comments in April 2009.The SG held its third meeting on 22–23 April 2009 to review progress in the revision and to propose further improvements. In addition, the experts discussed the need for reference preparations, reference cell banks, and standardization of testing methodologies. The SG proposed clarifications of the rationale for in vivo testing as well as the potential for applying new methods for in vitro testing for detecting microbial agents. In line with this, WHO should conduct review of the current manufacturers' practice in using tests for microbial agents and interpreting these results. Additionally, WHO should take a lead in developing an International Standard for nucleic acid amplification test (NAT) for detecting mycoplasma contamination in cell substrates. WHO Collaborating Centers will lead this initiative, involving other relevant institutions in this area. Finally, advice on the replacement of the WHO Vero reference cell bank 10–87 with respect to the source of cells and re-characterization of the bank was provided. The intended use of the replacement cell bank would be the same as for the current cell bank, which is to serve as a source of well-characterized cells for establishing master cell banks for the production of biologicals. The SG will report outcomes of its discussion to the ECBS at its next meeting in October 2009 for further considerations and advice regarding the proposed course of action.     

Monitoring Sub-Saharan African Physician Migration and Recruitment Post-Adoption of the WHO Code of Practice: Temporal and Geographic Patterns in the United States

Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians’ locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician “brain drain”, it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians.     

Syndecan-1 expression in human glioma is correlated with advanced tumor progression and poor prognosis

Syndecan-1 has been implicated in tumorigenesis and progression of various human malignancies. Recent studies have demonstrated that syndecan-1 may have a different function and biological activity depending on the specific tumor type. Therefore, the aim of this study was to investigate the clinical significance of syndecan-1 in human gliomas. One hundred and sixteen glioma patients (26 World Health Organization (WHO) grade I, 30 WHO grade II, 30 WHO grade III, and 30 WHO grade IV) and 15 normal brain specimens acquired from 15 patients undergoing surgery for epilepsy as control were collected. Immunohistochemistry assay, quantitative real-time PCR and Western blot analysis were carried out to detect the expression of syndecan-1 at gene and protein levels in glioma samples with different WHO grades. Syndecan-1 gene and protein levels were both higher in glioma tissues compared to controls (both P < 0.001). In addition, its expression levels increased with ascending tumor WHO grades according to the results of immunohistochemistry assay, quantitative real-time PCR and Western blot analysis. Moreover, the survival rate of syndecan-1-positive patients was significantly lower than that of syndecan-1-negative patients (P = 0.006). We further confirmed that the increased expression of syndecan-1 was an independent prognostic indicator in glioma by multivariate analysis (P = 0.01). Our data suggest for the first time that the increased expression of syndecan-1 at gene and protein levels is correlated with advanced tumor progression and poor outcome in patients with glioma. Syndecan-1 might serve as a potential prognosis predictor of this dismal tumor.     

Retooling National TB Control Programmes (NTPs) with New Diagnostics: The NTP Perspective

Background

A delay is evident between the development of new policies on TB diagnostics and their implementation at country level. The Stop TB Partnership would benefit from information from national TB program (NTP) managers on progress towards implementation of new recommendations as well as the opportunities and challenges encountered in the process.

Methods and Findings

To solicit information on the introduction of new TB diagnostics at country level, questionnaires were sent out to NTP managers of high-burden TB countries and a subset of managers was interviewed. The results indicate that about 50% of high-burden TB countries are using the TB diagnostic tools newly recommended by the World Health Organization (WHO). Most NTP managers reported that new diagnostics would only be implemented when officially endorsed by the WHO. All countries have plans to adopt newly endorsed diagnostics at reference laboratory level, while approaches to optimize smear microscopy at lower levels of the health service are given less attention. NTP managers reported diverse challenges to the implementation of new diagnostics.

Conclusions

More information on the obstacles and advantages of introducing new diagnostic tools should be provided to NTP managers to ensure the rational adoption of new diagnostics. A single recommendation covering the introduction of a package of diagnostic tools might be preferable to NTP managers and facilitate implementation in high-burden TB countries.     

Standardization of PSA measures: a reappraisal and an experience with WHO calibration of Beckman Coulter Access Hybritech total and free PSA

Prostate-specific antigen (PSA) is the serum biomarker most widely used in prostate diseases. Since there is significant variation in PSA results among non-equimolar assays, the 90:10 ratio of complexed PSA to free PSA (the Stanford standard) was proposed as standardization; this became the basis for the PSA mass standards WHO 96/670 for tPSA and 96/668 for fPSA. Nevertheless, recent publications underlined the lack of interchangeability between different commercial assays, all claimed to be equimolar and calibrated to the WHO standard. Importantly, the WHO calibration yields about 16-20% lower PSA results. Manufacturers that have chosen to calibrate existing assays to the mass value of WHO 96/760 have introduced a significant negative bias compared to the Hybritech assay calibration; this bias is transferred to clinical evaluation if the cutoff of 4 ng/mL, clinically validated for the Hybritech assay, is maintained with the WHO calibration. Beckman Coulter recently provided the option of calibrating the Access Hybritech PSA and Free PSA assays to the WHO standard introducing a different clinical cutoff. Using two different reagent lots, we tested about 200 routine patients for tPSA and fPSA with both calibrations; we also calculated the f/tPSA ratio with both calibrated methods. Moreover, we verified the analytical sensitivity and inter- and intra-assay variability. In accordance with the claim of the manufacturer, the results obtained with the WHO calibration showed a negative bias of about 25% and, as expected, no significant difference was found for % f/tPSA. The same bias was found when retesting samples of the External Quality Assessment Scheme of the Institute of Clinical Physiology of the National Research Council in Pisa. Based on this experience we decided for the moment to keep the Hybritech calibration, in order to avoid cutoff changes during patient follow-up. Moreover, we have started to provide information to clinicians aimed at the alignment of our results with the WHO standardization.     

Évaluation de la qualité méthodologique du Rémic (référentiel en microbiologie médicale — bactériologie et mycologie) <Emphasis Type="Bold">de la Société Française de Microbiologie</Emphasis>, 3<Superscript>e</Superscript> édition (2007)

We have evaluated the methodological quality of the Rémic (microbiology guidelines — bacteriology and mycology) of the Société Française de Microbiologie 2007, using to AGREE criteria, which are consensual at an international level, in particular at the the WHO (World Health Organisation) and at the European Union. The methodological quality of the Rémic is sub-optimal. These shortcomings in quality are mainly observed in AGREE domain n^o 5 (applicability), in AGREE item n^o 5 (patients’ opinions were not considered), and in AGREE item n^o 23 (conflicts of interest were not declared). The users of the Rémic must be aware of these few methodological shortcomings in order for them to be careful before they put its recommendation in practice. In conclusion, we advise the editors of the Rémic to insert at least a methodological chapter in their next édition.     

Robust product recommendation system using modified grey wolf optimizer and quantum inspired possibilistic fuzzy C-means

In recent years, several researchers have developed web-based product recommendation systems to assist customers in product search and selection during online shopping. In addition, the product recommendation systems deliver true personalization by recommending the products based on the other customer’s preferences. This study has investigated how the product recommendation system influences the customer’s decision effort and quality. In this study, the proposed system comprises of five major phases: data collection, pre-processing, key word extraction, keyword optimization and similar data clustering. The input data were collected from amazon customer review dataset. After the data collection, pre-processing was carried-out to enhance the quality of collected amazon data. The pre-processing phase comprises of two systems lemmatization and removal of stop-words & uniform resource locators (URLs). Then, a superior topic modelling method Latent Dirichlet allocation (LDA) along with modified grey wolf optimizer (MGWO) was applied in order to identify the optimal keywords. The extracted key-words were clustered into two forms (positive and negative) by applying a clustering algorithm named as quantum inspired possibilistic fuzzy C-means (QIPFCM). Experimental results showed that the proposed system achieved better performance in the product recommendation system compared to the existing systems in terms of accuracy, precision, recall and f-measure.