Rural health care looks to the future. Issues in the institutionalization and management of rural health care: making technology appropriate

Experimental projects have demonstrated the technical feasibility of systems of accessible, affordable health care. These projects have relied extensively on non-professional community health workers. However, large-scale implementation of these schemes will require new management procedures that are both responsive to rural health needs and congruent with national institutions. This paper identifies the need to establish institutional mechanisms to mobilize essential inputs, promote acceptance by beneficiaries, maintain quality standards, recruit and retain field staff, and achieve accountability for resources. It then outlines methods for developing these institutions. It stresses the need for both formal, bureaucratic organizations and informal organizations of clients. It also identifies the need to consider administrative and institutional resources in determining the appropriateness of a health care technology.     

Chemo-enzymatic synthesis of the Galili epitope Gal(alpha)(1-->3)Galbeta(1-->4)GlcNAc on a homogeneously soluble PEG polymer by a multi-enzyme system.

The alpha-Gal trisaccharide Gal(alpha)(1-->3)Galbeta(1-->4)GlcNAc 11 was synthesized on a homogeneously soluble polymeric support (polyethylene glycol, PEG) by use of a multi-enzyme system consisting of beta-1,4-galactosyltransferase (EC 2.4.1.38), alpha-1,3-galactosyltransferase (EC 2.4.1.151), sucrose synthase (EC 2.4.1.13) and UDP-glucose-4-epimerase (EC 5.1.3.2). In addition workup was simplified by use of dia-ultrafiltration. Thus the advantages of classic chemistry/enzymology and solid-phase synthesis could be united in one. Subsequent hydrogenolytic cleavage afforded the free alpha-Gal trisaccharide.     

Characterization of anf genes specific for the alternative nitrogenase and identification of nif genes required for both nitrogenases in Rhodobacter capsulatus

To identify Rhodobacter capsulatus nif genes necessary for the alternative nitrogenase, strains carrying defined mutations in 32 genes and open reading frames of nif region A, B or C were constructed. The ability of these mutants to grow on nitrogen-free medium with molybdenum (Nif phenotype) or in a nifHDK deletion background on medium without molybdenum (Anf phenotype) was tested. Nine nif genes and nif-associated coding regions are absolutely essential for the alternative nitrogenase. These genes comprise nifV and nifB, the nif-specific ntr system (nifR1, R2, R4) and four open reading frames, which exhibit no homology to known genes. In addition, a significantly reduced activity of both the alternative nitrogenase and the molybdenum-dependent nitrogenase was found for fdxN mutants. By random Tn5 mutagenesis of a nifHDK deletion strain 42 Anf^? mutants were isolated. Southern hybridization experiments demonstrated that 17 of these Tn5 mutants were localized in at least 13 different restriction fragments outside of known nif regions. Ten different Anf^? Tn5 mutations are clustered on a 6 kb DNA fragment of the chromosome designated anf region A. DNA sequence analysis revealed that this region contained the structural genes of the alternative nitrogenase (anfHDGK). The identification of several Tn5 insertions mapping outside of anf region A indicated that at least 10 genes specific for the alternative nitrogenase are present in R. capsulatus.     

Changes in cardiovascular disease risk factors from age 9 to 19 and the influence of television viewing

Objective:

The purpose of this study was to determine if time spent watching television is associated with changes in cardiovascular disease (CVD) risk factors from age 9 to 19.

Design and Methods:

Participants were girls enrolled in the NHLBI Growth and Health Study (n = 1,702), and CVD risk factors were measured at ages 10, 12, 14, 16, and 19. Longitudinal quantile regression was used to determine if television viewing was associated with changes in CVD risk factors over time at the 10th, 25th, 50th, 75th, and 90th percentiles of the CVD risk factors.

Results:

In black girls, television viewing (h/wk) was positively associated with sum of skinfolds (mm) at the 75th (0.22, 99% CI, 0.06‐0.38) and 90th percentiles (0.21, 99% CI, 0.05‐0.36), but not at the 10th, 25th, or 50th percentiles. In white girls, television viewing (h/wk) was positively associated with sum of skinfolds (mm) with the strength of the associations progressively stronger toward the upper tail of the skinfold distribution, adjusting for physical activity and other covariates (10th percentile: 0.08, 99% CI, 0.03‐0.13; 90th percentile: 0.42, 99% CI, 0.24‐0.59). All associations were adjusted for physical activity, dietary factors, sleep, and maturation. No associations were observed between television viewing and changes in systolic blood pressure, triglycerides, or cholesterol levels in black or white girls.

Conclusion:

Girls who spent more time watching television had greater increases in sum of skinfolds from age 9 to 19, independent of physical activity levels and other covariates. The associations observed were stronger at the upper tail of the skinfold distribution.     

Process development for the electroenzymatic synthesis of (R)-methylphenylsulfoxide by use of a 3-dimensional electrode

The electrogeneration of hydrogen peroxide via reduction of dissolved oxygen was carried out in a three-dimensional electrochemical cell using graphite grains as cathode material and combined with the enantioselective oxidation of thioanisole to (R)-methylphenylsulfoxide catalyzed by Chloroperoxidase from Caldariomyces fumago. The relevant parameters for process development (e.g., conductivity of the biotransformation medium) were identified and optimized, leading to an efficient electroenzymatic process with a space-time yield of 104 g x L(-1) x d(-1). The isolated product was produced on gram scale (1.2 g, purity >98%, ee > 98.5%).     

Anastrozole quantification in human plasma by high-performance liquid chromatography coupled to photospray tandem mass spectrometry applied to pharmacokinetic studies

A rapid, sensitive and specific method for quantifying the aromatase inhibitor (anastrozole) in human plasma using dexchlorpheniramine as the internal standard (I.S.) is described herein. The analyte and the I.S. were extracted from 200 microl of human plasma by liquid-liquid extraction using a mixture of diethyl ether:dichloromethane (70:30, v/v) solution. Extracts were removed and dried in the organic phase then reconstituted with 200 microl of acetonitrile:water (50:50; v/v). The extracts were analyzed by high performance liquid chromatography coupled with photospray tandem mass spectrometry (HPLC-MS-MS). Chromatography was performed isocratically on a Genesis, C18 4 microm analytical column (100 mm x 2.1mm i.d.). The method had a chromatographic run time of 2.5 min and a linear calibration curve ranging from 0.05-10 ng ml(-1). The limit of quantification (LOQ) was 0.05 ng ml(-1). This HPLC-MS-MS procedure was used to assess pharmacokinetic studies.     

Functional Recovery Occurs Even After Partial Remyelination of Axon-Meshed Median and Ulnar Nerves in Mice

Upper limb nerve injuries are common, and their treatment poses a challenge for physicians and surgeons. Experimental models help in minimum exploration of the functional characteristics of peripheral nerve injuries of forelimbs. This study was conducted to characterize the functional recovery (1, 3, 7, 10, 14, and 21 days) after median and ulnar nerve crush in mice and analyze the histological and biochemical markers of nerve regeneration (after 21 days). Sensory–functional impairments appeared after 1 day. The peripheral nerve morphology, the nerve structure, and the density of myelin proteins [myelin protein zero (P0) and peripheral myelin protein 22 (PMP22)] were analyzed after 21 days. Cold allodynia and fine motor coordination recovery occurred on the 10th day, and grip strength recovery was observed on the 14th day after injury. After 21 days, there was partial myelin sheath recovery. PMP22 recovery was complete, whereas P0 recovery was not. Results suggest that there is complete functional recovery even with partial remyelination of median and ulnar nerves in mice.