Assessing the Quality of Care for Pneumonia in Integrated Community Case Management: A Cross-Sectional Mixed Methods Study

Background

Pneumonia is the leading infectious cause of mortality in children under five worldwide. Community-level interventions, such as integrated community case management, have great potential to reduce the burden of pneumonia, as well as other diseases, especially in remote populations. However, there are still questions as to whether community health workers (CHW) are able to accurately assess symptoms of pneumonia and prescribe appropriate treatment. This research addresses limitations of previous studies using innovative methodology to assess the accuracy of respiratory rate measurement by CHWs and provides new evidence on the quality of care given for children with symptoms of pneumonia. It is one of few that assesses CHW performance in their usual setting, with independent re-examination by experts, following a considerable period of time post-training of CHWs.

Methods

In this cross-sectional mixed methods study, 1,497 CHW consultations, conducted by 90 CHWs in two districts of Luapula province, Zambia, were directly observed, with measurement of respiratory rate for children with suspected pneumonia recorded by video. Using the video footage, a retrospective reference standard assessment of respiratory rate was conducted by experts. Counts taken by CHWs were compared against the reference standard and appropriateness of the treatment prescribed by CHWs was assessed. To supplement observational findings, three focus group discussions and nine in depth interviews with CHWs were conducted.

Results and Conclusion

The findings support existing literature that CHWs are capable of measuring respiratory rates and providing appropriate treatment, with 81% and 78% agreement, respectively, between CHWs and experts. Accuracy in diagnosis could be strengthened through further training and the development of improved diagnostic tools appropriate for resource-poor settings.     

MICB基因多态性与乳腺癌的易感关联性研究

目的:研究海南汉族人群MICB等位基因的多态性与乳腺癌易感性之间的关联性。方法:采用PCRSSP(PCR sequence-specific primers)和PCR-SBT(PCR sequence-based typing)方法对样本MICB等位基因的多态性进行检测。结果:乳腺癌患者中检出14种MICB等位基因;和对照组相比较,MICB*002和MICB*014等位基因在乳腺癌患者组分布频率较少,MICB*002和MICB*014等位基因可能对乳腺癌不易感(MICB*002:OR=0.31,95%CI:0.19-0.51,Pc0.05;MICB*014:OR=0.32,95%CI:0.17-0.60,Pc0.05)。MICB*016和MICB*003等位基因在乳腺癌患者组分布较多;MICB*016和MICB*003等位基因可能对乳腺癌易感(MICB*016:OR=10.68,95%CI:2.52-45.28,Pc0.05;MICB*003:OR=3.57,95%CI:1.34-9.49,Pc0.05);MICB*002/002和MICB*014/014基因型可能对乳腺癌不易感(MICB*002/002:OR=0.12,95%CI:0.04-0.36,Pc0.05;MICB*014/014:OR=0.30,95%CI:0.10-0.89,Pc0.05)。结论:MICB等位基因的多态性与乳腺癌的易感性之间存在关联性。     

MICB基因多态性与肺癌的易感关联性研究

目的:研究海南汉族人群MICB等位基因的多态性与肺癌易感性之间的关联性。方法:采用PCR-SSP(PCR sequence-specific primers)和PCR-SBT(PCR sequence-based typing)方法对样本MICB等位基因的多态性进行检测。结果:肺癌患者中检出14种MICB等位基因;和对照组相比较,MICB*00502等位基因在肺癌患者组分布频率较少(43.5%vs 57.8%),MICB*016等位基因在肺癌患者组分布较多(5.9%vs 0.6%);MICB*016等位基因可能对肺癌易感(OR=11.19,95%CI:2.59-48.24,Pc0.05);MICB*00502等位基因可能对肺癌不易感(MICB*00502:OR=0.56,95%CI:0.42-0.76,Pc0.05)。结论:MICB等位基因的多态性与肺癌的易感性之间存在关联性。     

A comparison of techniques for assessing dispersal behaviour in gundis: revealing dispersal patterns in the absence of observed dispersal behaviour

Knowledge of the dispersal status of group members is important to understanding how sociality may have evolved within a species. I assessed the effectiveness of four techniques for elucidating dispersal behaviour in a rock-dwelling rodent ( Ctenodactylus gundi ) with small group sizes (2–10 animals): genetic parentage assignment, haplotype data and kinship analyses, assignment testing, and F -statistics. The first two methods provided the greatest insight into gundi dispersal behaviour. Assignment testing and F -statistics proved of limited use for elucidating fine-scale dispersal, but could detect large-scale patterns despite low sex-biased dispersal intensity (1.9 : 1) because of moderate genetic differentiation among groups ( F _ST = 0.10). Findings are discussed in light of current dispersal theory. In general, gundi dispersal is plastic, and seems to be dependent on body weight (for males), group composition, and scale of analysis (total dispersal events recorded within the population were almost twice the immigration rate into the population). Most groups were comprised of a single matriline and one immigrant male. Immigrant rather than philopatric males bred with group females. Dispersal among groups was male-biased, but dispersal or philopatry could occur by either sex. During a drought, both sexes delayed dispersal and cooperative social units formed. Whether such behaviour resulted directly from the drought or not remains unclear, however, since comparative information was not available from nondrought years. Combining fine-scale analyses with information on large-scale patterns provided substantial insight into gundi dispersal behaviour despite the limited movement of animals during a drought, and may prove useful for elucidating dispersal behaviour in other social animals.     

A general method for controlling the genome-wide type I error rate in linkage and association mapping experiments in plants

Control of the genome-wide type I error rate (GWER) is an important issue in association mapping and linkage mapping experiments. For the latter, different approaches, such as permutation procedures or Bonferroni correction, were proposed. The permutation test, however, cannot account for population structure present in most association mapping populations. This can lead to false positive associations. The Bonferroni correction is applicable, but usually on the conservative side, because correlation of tests cannot be exploited. Therefore, a new approach is proposed, which controls the genome-wide error rate, while accounting for population structure. This approach is based on a simulation procedure that is equally applicable in a linkage and an association-mapping context. Using the parameter settings of three real data sets, it is shown that the procedure provides control of the GWER and the generalized genome-wide type I error rate (GWER(k)).     

2N一4N嵌合体小鼠及其在基因功能研究上的应用

2N-4N嵌合体是由二倍体(2N)的胚胎细胞(或ES细胞)与四倍体(4N)的胚胎细胞组构成的一种拯救型嵌合体。这种嵌合体由于4N胚胎细胞独特的胚外组织发育特性,从而可获得完全源自2N细胞成份的仔鼠(或胎儿)。这一特性最终在ES细胞转基因的基因功能研究中极具重要价值。综述了2N-4N嵌合体研究进展及其在基因功能研究领域的应用。     

植物细胞质雄性不育及其育性恢复的分子生物学研究进展

植物细胞质雄性不育（CMS）和恢复系统在作物杂交种子生产中具有重要的意义。综述了目前已发现的与植物CMS相关的线粒体DNA位点,育性恢复基因对CMS相关DNA位点表达的影响,育性恢复基因的分子标记定位、克隆,及育性恢复分子机理等方面的研究进展,并讨论了恢复基因在植物分子育种上的应用。     

与油菜细胞质雄性不育相关的DNA位点和育性恢复基因的研究进展

细胞质雄性不育(cytoplasmic male sterility,CMS)在油菜杂交种子生产中具有重要的意义.文章主要从目前已发现的与油菜CMS相关的线粒体DNA位点,育性恢复基因对CMS相关DNA位点表达的影响,育性恢复基因的分子标记定位和育性恢复基因的克隆4个方面综述了近年来油菜CMS的研究进展.并就该领域今后的研究方向进行了探讨.     

Three-Dimensional Framework of Vigor,Organization, and Resilience (VOR) for Assessing Rangeland Health: A Case Study from the Alpine Meadow of the Qinghai-Tibetan Plateau,China

Rangeland health assessments play an important role in providing qualitative and quantitative data about ecosystem attributes and rangeland management. The objective of this study is to test the feasible of a modified model and visualize the health in a three-dimensional model. A modified Costanza model was employed, and eight indicators, including the biomass, biodiversity, and carrying capacity [associated with the vigor, organization, and resilience (VOR)] were applied. An entropy method was also developed to calculate the weight of each indicator, and a three-dimensional framework was applied to visualize the indicators and health index. The conceptual model was demonstrated using data from a case study on the alpine rangeland of the Qinghai-Tibetan Plateau, one of the globally important grassland biomes being severely degraded by natural and human factors. The health indices of four grassland plots at different levels of degradation were calculated using a modified approach to measuring their VOR. The results indicated that the least disturbed plot was relatively healthy compared to the other plots. In addition, the health indices presented in the three-dimensional VOR framework decreased in a consistent manner across the four plots along the disturbance gradients. Such rangeland health assessments should be integrated with management efforts to insure their long-term sustainable use.     

血友病A基因治疗载体研究现状

血友病A是X染色体隐性遗传出血性疾病。其发病原因是患者血液中先天缺乏凝血因子FⅧ。用于血友病A基因治疗研究的载体有病毒载体和非病毒载体,目前研究较多的是病毒载体,主要有逆转录病毒载体和慢病毒载体,腺病毒载体及腺相关病毒载体等。非病毒载体主要有质粒、脂质体、转座子等。文章拟对血友病A基因治疗各载体的特点和研究进展作一综述。     

A Comparison of Methodologies for the Study of Functional Transmitter Neurochemistry in Human Brain

A number of different approaches to the study of functional neurochemistry in human brain are discussed. The advantages and disadvantages of three main techniques are contrasted: (i) using animal tissue preparations as models of the human brain; (ii) using human peripheral tissue preparations as models of dynamic CNS processes; and (iii) studying human tissue, obtained postmortem, directly. Animal models are often readily obtained and reliable, and the high degree of inbreeding of common laboratory animals ensures that they usually yield consistent results. However, there are a number of human disorders for which animal models are either poor or unavailable, and species differences make extrapolation from the animal to the human case difficult. Human peripheral tissue models rely on a degree of homology between peripheral and CNS processes; in most cases, the evidence for such homologies derives from animal, rather than human, studies. Moreover, several examples are known where a peripheral process mimics the equivalent glial cell activity more closely than the neuronal, which can be a serious drawback for studies of neurotransmission. The use of postmortem human brain tissue presents a number of obvious difficulties, resulting from variations in the patient's age, agonal state, sex, preterminal medication, postmortem delay, etc. Human beings are genetically and nutritionally heterogeneous, so that data variability is usually greater here than when using tissue from laboratory animals. However, it is possible to control for a number of these factors, for example, by matching samples for basal metabolic rate and tissue integrity, and recently developed tissue freezing and storage techniques permit the use of within-subject experimental designs to help reduce experimental variation. A range of neurotransmitter functions are well retained in such tissue samples, so that regional variations, differential transmitter activities, drug effects, etc., can be studied in normal tissue samples, as well as in samples taken from cases of neurological and psychiatric disease. This allows, for example, changes in neuroanatomical indices to be correlated with localised alterations in a specific neurotransmitter function. A systematic approach to the analysis and matching of tissue samples is advocated. The three approaches should be considered to be complementary, especially for the study of human brain diseases.     

一例母及其亲子DNA指纹与血清蛋白、酯酶遗传的研究

采用ＤＮＡ指纹分析和聚丙烯酰胺凝胶电泳法,对一例与公驴交配生育了后代的母后代进行了亲缘鉴定和血清蛋白、酯酶遗传的分析。结果可以认定其亲子关系并证实母骡生育的事实。虽然本例母的后代在Ｐｒ、Ａｌ、Ｐａ和Ｈｂ、Ｅｓ等基因座位上的基因表达倾向于驴,但其外貌仍明显地带有种间杂种的特征。因此,尚不能简单地认为其已“回归”为纯种的驴。     

A Structural and Phylogenetic Study of the HO Gene from Saccharomyces bayanus var. uvarum

A novel HO gene (Uv-HO) was cloned from the Saccharomyces bayanus var. uvarum (abbreviated as S. uvarum in this study) type strain. The coding region of Uv-HO showed relatively high homology (95%) to that of the Sb-HO gene (S. bayanus var. bayanus HO), but not to the HO genes of other Saccharomyces sensu stricto species. However, the 5′ and 3′ non-coding region of Uv-HO showed less similarity (79% and 76% respectively) even to those of the most homologous gene Sb-HO. Motifs of the mating-type control and the cell-cycle control were conserved in the 5′ non-coding region of Uv-HO, but numbers and positions of motifs were different from those of Sb-HO. CHEF-Southern analysis showed that all tested strains of S. bayanus species, including S. uvarum, carried the HO gene on the 1,100-kb chromosome. By HO-typing PCR using mixed primers, which provided a rapid and convenient tool for yeast identification, either the Uv-HO gene or the Sb-HO gene was detected in strains of S. bayanus species, but two strains were found to have both types of HO gene in each genome. These results suggest that S. uvarum has a unique sequence, but might share the same chromosome constitution within S. bayanus species, and that S. bayanus is a heterogeneous species, of which some strains might be natural hybrid.     

Bt菌株QCL-1中cry2Ac10基因的克隆、表达和活性研究

目的:从高毒力Bt菌株中克隆cry2Ac10基因,并研究其表达和杀虫活性。方法:以Bt菌株QCL-1质粒为模板,利用cry2特异性引物FY2A5和FY2A3进行PCR扩增,将目的片段克隆到表达载体pET-21b( ),构建T7启动子控制的大肠杆菌重组表达质粒pET21b-cry2Ac。经IPTG诱导后,SDS-PAGE检测基因表达情况,然后对表达产物进行生物活性测定。结果:从菌株QCL-1中克隆出目的基因,该基因的编码框由1 872个碱基组成,编码的蛋白质由623个氨基酸组成,与已报道的Cry2Ac氨基酸同源性为97.4%~99.7%。该基因(GenBank accession EF405952)已被国际Bt基因命名委员会正式命名为cry2Ac10。该基因在大肠杆菌BL21(DE3)中能够正常表达70kDa的蛋白,表达产物对棉铃虫、粘虫和粉纹夜蛾幼虫具有高毒力,同时对甜菜夜蛾幼虫生长有抑制作用,其中对棉铃虫和粘虫初孵幼虫的LC50分别为30.0μg/g和16.7μg/g。结论:成功克隆和表达了cry2Ac10基因,并明确了cry2Ac10蛋白的活性,为该基因的研究和应用奠定基础。     

Comparison of Resubstitution,Data Splitting,the Bootstrap,and the Jackknife as Methods for Estimating Validity Indices of New Marker Tests: A Monte Carlo Study

Estimating the diagnostic efficiency of marker tests on the basis of the training set is an intricate problem of discriminant analysis for which no analytical solution exists. The paper outline the problem, describes various popular estimation procedures and presents the results of computer simulations comparing the estimators with respect to both bias and variance.