Online sexual health services are an emerging area of service delivery. Theory of change critically analyses programmes by specifying planned inputs and articulating the causal pathways that link these to anticipated outcomes. It acknowledges the changing and contested nature of these relationships.We developed two versions of a theory of change for an online sexual health service. The first articulated the theory presented in the original programme proposal and the second documented its development in the early stages of implementation through interviews with key programme stakeholders.The programme proposal described an autonomous and empowered user completing a sexual health check using a more convenient, accessible and discreet online service and a shift from clinic based to online care. The stakeholder interviews confirmed this and described new and more complex patterns of service use as the online service creates opportunities for providers to contact users outside of the traditional clinic visit and users move between online and clinic based care. They described new types of user/provider relationships which we categorised as: those influenced by an online retail culture; those influenced by health promotion outreach and surveillance and those acknowledging the need for supported access.Co-development of clinic and online services to support complex patterns of service use.Developing access to online services for those who could use them with support.Understanding user experience of sexual health services as increasing user autonomy and choice in some situations; creating exclusion and a need for support in others and intrusiveness and a lack of control in still others.This analysis of stakeholder views on the likely the impacts of online sexual health services suggests three areas for further thinking and research.This work has influenced the evaluation of this programme which will focus on; mapping patterns of use to understand how users move between the online and clinic based services; barriers to use of online services among some populations and how to overcome these; understanding user perceptions of autonomy in relation to online services. Increasing demand for sexual health services, limited resources for sexual health care  and new Online sexual health services are thought to be less expensive than similar services delivered in clinic settings  and to iIn 2013 we started developing and evaluating an online sexual health service linked to a telephone and clinic-based service in an area of South East London with a young, multi-ethnic population experiencing high levels of socio-economic deprivation and with very high levels of sexual ill health. This programme proposes a web based sexual health service with a linked telephone service and direct referral into local clinics when required. The service is planned to evolve through small-scale prototype development and testing. As recommended for the evaluation of complex interventions we sought to generate a conceptual model for the intervention, link this to the published evidence and the local context and then monitor its development during programme implementation .Identifying long term goalsBackwards mapping and connecting outcomesIdentifying assumptionsWe developed a theory of change to articulate the conceptual model underpinning the programme and its development. Theory of change critically analyses new programmes by articulating the causal pathways that link specified inputs to anticipated outcomes. It acknowledges the need to test these relationships for new programmes and their development during implementation –12. TheoThis process informed our evaluation strategy for the programme by identifying key outcomes, process indicators and assumptions that required testing.Van Belle et al.  recommenThe proposed long term goals of the programme were identified from the original funding bid, developed by the two London borough public health departments and two NHS foundation trusts providing specialist sexual health services. We (PB and JS) read and re-read this document to identify the planned inputs and anticipated outputs described in the document and the steps that connected them. We developed a series of diagrams to describe these linkages and the assumptions that underpinned them. We imported the document into qualitative data analysis software Nvivo  and coded this material using our coding frameworks based on early versions of our theory of change diagrams to check the relationship between our initial theory of change and the text of the bid. We completed several cycles of causal model development and modification to ensure that our diagram accurately reflected the information in the bid. Finally we identified the key assumptions that underpinned the linkages in our causal model as important areas for evaluation.Having developed an initial version of the theory of change from the programme funding bid we then repeated a modified version of this process during programme implementation using interviews with stakeholders as our data source.Four clinicians in local services Three senior managers within clinical servicesThree senior managers within local government, public health and commissioningFour potential service users sampled to include individuals from the populations most at risk of sexual ill health in the local area; men who have sex with men, young people, and those from black and minority ethnic groupsWe recruited our interview participants to reflect the full range of stakeholders for the project including;All of the 14 stakeholders who were invited to complete individual interviews accepted our invitation. Each participant provided written informed consent. Interviews began with the interviewer describing the planned service inputs . These were listed on the left hand side of a large sheet of paper. Participants were then asked to list all of the outcomes, both positive and negative that they anticipated from this input. These were listed on the right hand side of the paper. By asking what needed to happen for the input to lead to the anticipated outcome and why this needed to happen participants were encouraged to map this relationship and to reflect on the assumptions that underpinned it . As thisOur qualitative analysis used the framework approach , a matriEthical approval for this research was granted by King’s College London research ethics committee (Ref: BDM/13/14-42).that potential users have private internet access and sufficient health literacy to use an online facilitythat the online service is more convenient and discrete than use of clinical services, at least for some people; that the pattern of service use replicatesthat online services cost less than clinic based servicesthat the loss of health professional contact associated with online services is acceptable to users.The theory of change developed from the programme funding application articulated a causal chain with more convenient and discreet sexual health testing leading to increased uptake of testing and treatment, coupled with consistent health promotion advice to generate the final outcome of reduced STI transmission Fig. . It refeThe theory of change developed from the stakeholder interviews supported the idea of online services as more convenient and more discrete The participants predicted new patterns of service use and new forms of user/provider interaction. Rather than a straightforward shift of activity from one service to another they thought users would choose to move between services for example complementing a clinic visit with online information or an online sexual health check with a visit to the clinic for reassurance or support.‘I’ve tried to find out information online, for clients here, and there is some information on NHS Direct, but unless you can actually spell chlamydia or gonorrhoea, or syphilis; it’s actually quite hard to find information”.This more complex view of how users might choose to use services questioned the simple cost effectiveness analysis proposed in the initial bid. Stakeholders described the additional responsibilities associated with self management, loss of support/reassurance/empathy that might be part of a clinical consultation and missed opportunities to identify additional unmet need, for example, advice and referral for those experiencing intimate partner violence.They described new roles for clinic staff with provider driven, technology mediated, contacts such as reminders to take treatment or notify partners or follow up offers of tests or support. They emphasised the potential inequity of access to online services and the possibilities for providing additional remote support for those who might be able to use the service with help. These new approaches to service use were associated with descriptions of user/provider relationship. We summarised these as an ‘online retail approach’ that emphasises patient autonomy and choice; a ‘public health promotion/surveillance’ approach that emphasises outreach to support behaviour change or monitoring of service access and a ‘supported care’ approach that references a need for health care professional mediated support during use of the online service Table .Based on the stakeholder interviews we developed a second theory of change that incorporates this thinking see Fig. . This emThe development of these two versions of the theory of change for this programme contributes to service development, implementation and evaluation. It identifies the development of support packages to enable online service use as a priority for service development; the co-development of online and clinic based services as a priority within the implementation strategy and the need to document new patterns of service use as clients move between clinic and online options as a priority for evaluation.The rationale for the development of online services as described in the two versions of our theory of change is based on a number of key assumptions. The architects of the original bid assume; private internet access, health literacy, an online service that is convenient and discrete, online services that are cost effective and the acceptability of loss of a consultation. These are supported by evidence from both similar interventions and other relevant sources. National statistics show that 76 % of UK adults accessed the internet daily in the 2014 and 96 % of 16 to 24 year olds access the internet via mobile device  but a 20The modified theory of change has three further assumptions essential to these new causal pathways; that users are willing to take on new responsibility for their own sexual health care; that remote support will enable new online users and that clinic processes will adapt to the new online service provision. The stakeholder interviews echo issues raised in the published literature on the potential of internet services to disproportionately enable some users to take on increased responsibility for their own health care , 32. ThoThe stakeholder interviews document what is potentially lost through use of online services and while suggesting that everyone should have access also suggests that not everyone will want to have access. This echoes the critiques of telemedicine and e-health that describe the potential loss of agency that comes from allowing digital health technologies into the home . The revFinally the stakeholder interviews suggest that online service introduction should be considered as part of a dynamic sexual health economy and not a stand-alone service. The clinic is likely to experience changes in its users, the problems they present and the clinic staff and processes available to respond as clients move between the online, telephone and face to face service. This is not a bolt on service but a change to the whole system of sexual health service provision and close working between the different elements of the system will be essential. A 2014 review of the literature suggests that co-development of online and clinic based services has received little attention to date but is an emerging area of focus in the development of online health services , 40.Co-development of clinic and online services to support complex patterns of service use.Developing access to online services for those who could use them with support.Understanding user experience of sexual health services as increasing user autonomy and choice in some situations; creating exclusion and a need for support in others and intrusiveness and a lack of control in still others.By documenting the development of the theory of change during implementation we identified three elements of online services that would benefit from further research.This work has influenced the evaluation of this programme which will focus on; mapping patterns of use to understand how users move between the online and clinic based services; barriers to use of online services among some populations and how to overcome these; understanding user perceptions of autonomy in relation to online services.


Jean-Paul Chretien and colleagues argue that recent Ebola and Zika virus outbreaks highlight the importance of data sharing in scientific research. The recent outbreaks caused by Ebola and Zika viruses highlighted the importance of medical and public health research in accelerating outbreak control and prompted calls for researchers to share data rapidly and widely during public health emergencies.Effective preparation for emergencies requires the routine practice of data sharing in scientific research.Key impediments to data sharing, such as long-standing academic norms and human and technical resource limitations, cannot immediately be surmounted when an emergency occurs.Ongoing research that does not directly relate to an emergency now may be critical for the next unpredictable outbreak.As part of emergency preparedness, the scientific community should support ongoing initiatives that address major obstacles to data sharing and should embrace open science practices in both emergency and nonemergency research.In February 2016, Wellcome Trust organized a pledge among leading scientific organizations and health agencies encouraging researchers to release data relevant to the Zika outbreak as rapidly and widely as possible pdm09) originating in Mexico—and we can be sure there are more surprises to come. Opening all research provides the best chance to accelerate discovery and development that will help during the next surprise.


It is hypothesised that intraerythrocytic malaria parasite metabolism is not just fulfilling the need for ATP generation, but is highly evolved to support rapid proliferation, similar to what is seen in other rapidly proliferating cells such as cancer cells. Evidence is presented that deregulated glycolytic activity coupled with impaired mitochondrial metabolism is a metabolic strategy to generate glycolytic intermediates essential for rapid biomass generation for schizogony.1 and dihydroorotate dehydrogenase-targeting drug development programmes and within the context of current target product profiles for the malaria elimination agenda.The role of the parasite mitochondrion during key stages of the parasite life cycle makes it an attractive target for the development of novel prophylaxis, treatment and transmission blocking drugs. Using a targeted pharmacometabolomic approach, additional mitochondrial targets with therapeutic potential are identified and the potential of the development of inhibitors against these novel targets is discussed in the context of recent experiences with bc


The systematic review by Bleich and colleagues contributes to the much needed evidence supporting management of patients with multiple chronic conditions — multimorbidity. Although the review’s focus is the United States, it addresses an issue that is highly relevant to all health care systems and raises important questions about how we can design systems to address the needs of this vulnerable group . LiteratThe systematic review of Bleich et al provides evidence from 27 studies that examined 5 models of care and suggests that care management, case management, and disease management are promising models for people with multimorbidity. This finding seems to fit with our intuitive sense that care coordination will reduce the challenges experienced by people with multiple chronic conditions, related polypharmacy, and high use of health care services . In addiThe review of Bleich et al also highlights the heterogeneity within the population of people with multiple chronic conditions and their overlap with other patient groups in relation to disability and frailty. Definitions of multimorbidity and related constructs such as comorbidity continue to be debated , but theAn additional key issue that Bleich et al discuss is the need for appropriate comparison or control groups to allow for robust evaluation. Ideally, randomized trials would be employed that use cluster and stepped wedge designs where appropriate. Only 13 of the 27 studies included in this review were randomized controlled trials (RCTS), which may partially explain the differences between Bleich’s review and the related Cochrane review. The Cochrane review included only RCTs and not less robust study designs, and the included studies were from a wider range of countries, including the United States . VariatiThe systematic review of Bleich et al highlights the need for further evidence to support policy and management of patients with complex multimorbidity. In the meantime, studies should be designed to allow robust evaluation of interventions and should build on the evidence from this and related reviews that suggest a health care focus on patient-centered outcomes for patients with multimorbidity.


In Australia’s War against Rabbits, Brian Cooke details the emergence of rabbit hemorrhagic disease (RHD) in Asia and Europe and subsequent efforts to introduce RHD virus into Australia and New Zealand for rabbit control in the 1990s. The book documents the ecologic adaption between a virus and its animal host and provides cogent examples of our inability to contain the spread of (what was thought to be) a well-understood virus after it escaped into the environment.The first failed containment effort ensued after the virus jumped from a quarantine compound on Wardang Island to the coast of South Australia 3 km away. Despite a program carefully designed to counter unplanned spread of RHD virus on the Australian mainland (Operation Garter), the virus prevailed. Uncontained spread also followed an intentional and illegal release of RHD virus in New Zealand in 1997 when a farmer with intractable rabbit problems allegedly smuggled the virus in from Australia. After the outbreak started, instead of helping the New Zealand government control RHD, farmers reportedly used blenders to make “rabbit smoothies” and actively spread RHD virus by applying these slurries to carrot baits.The book is generally well written and heavily referenced and contains many anecdotes penned by a scientist obviously passionate about his work. The flow of the narrative can sometimes be erratic, however, veering from amusing personal stories to a didactic recounting of the taxonomy of rabbit parasites or legislation relevant to pest control in Australia. Australia’s War against Rabbits is best suited for professionals with a keen interest in rabbits, fleas, and their pathogens.


We were interested in exploring the use of timing or delays in learning in neural networks. The work was developed by wondering about the effects of glia on network learning in the human brain. To investigate this idea, we created a Multilayer Perceptron (MLP)-based  feedforw


RARHA (REDUCING ALCOHOL RELATED HARM) is a Joint Action (JA) (2014-2016) funded under the EU Health Programme and by EU Member States to address some commonly identified priorities to reduce levels of alcohol related harm in the EU. The work package 5 contributes towards increased understanding among public health policy makers of the scientific basis and practical implications of the use of drinking guidelines as a public health measure, and towards more aligned messages to the general population, subgroups and health professionals.The objectives are to evaluate the presence (or not) of guidelines on EIBI for HHAC on the basis of the existing and available EU projects/documents  (1-4) and by additional information based on ad hoc survey across European Union Member States.A country specific questionnaire has been developed by the National Observatory on Alcohol for confirming the available sources of EU projects or documents and for collecting and/or upgrading information on drinking guidelines used in the context of EIBI. The form has been submitted by email to the country representatives of the Committee on National Alcohol Policy and Action as members with qualified experience and competence. Participants have been asked to check the validity of the information provided by the country questionnaire reported as "review of available sources" and to provide the most updated and reliable information for their Country (The survey started on May 2014).Twenty-nine out of 31 European countries selected , replied to the RARHA questionnaire. Twenty countries have a governmental organization responsible for preparing clinical guidelines for managing HHAC; twenty-two countries have multidisciplinary guidelines approved or endorsed by at least one health care professional body or scientific society and 22 countries have guidelines or recommendations for BI/treatment.The collected information represent the scientific basis and practical implications of the use of drinking guidelines as a public health measure. It serves to clarify the science underpinnings and practical/policy implications concerning low risk drinking guidelines, and work towards consensus on good practice principles in the use of drinking guidelines as a public health measure to help reduce HHAC. This activity, finalized to provide a more aligned messages to the general population, subgroups and health professionals, is ongoing (Rarha Delphi survey).


Using interpolation and collocation techniques, a continuous scheme is developed and used to obtain discrete methods which are applied via the Block unification approach to obtain approximations to the resulting large system of ODEs. Several test problems are investigated to elucidate the solution process.In this article, the boundary value method is applied to solve three dimensional elliptic and hyperbolic partial differential equations. The partial derivatives with respect to two of the spatial variables ( The general three dimensional problem (without cross derivatives) is given asThe numerical approximation of  has recementclass2pt{minimy and z variable with mesh spacings The method of lines approach is commonly used for solving PDEs whereby the PDEs is converted into a system of ODEs by replacing the appropriate derivatives by finite difference approximations. Our objective is to convert the 3D PDEs into a system of ODEs by replacing two of the spatial derivatives by central difference approximations. The resulting system is then solved using the BVM. Specifically, we discretize the k and whose k additional conditions are not only imposed at the beginning of the integration process but also at the end so that they form a discrete analog of the continuous boundary value problems. Thus, they are used for the numerical approximation of both initial and boundary value problems. They have been used for the solution of first order 1D initial and boundary value problems and their convergence and linear stability properties have been fully discussed in Brugnano and Trigiante 7), we handitions  on 11),,\documenThe coefficients given in  are specWe note that the method  is locald system  over thementclasspt{minimaWe discuss the convergence of the BVMs in the following theoremLet be an approximation of the solution vector for the system obtained on a partition from the method  is the local truncation error vector of the formulas in  for nonlinear problems.Step 4 The solution of  and with zero boundary values on the entire We consider the Laplace equation with non zero forcing term in Zhang  and whosmentclass2pt{minimmentclass2pt{minimNext, we consider the following Sine-Gordon equation given in Cui \documententclass1pt{minimaentclass1pt{minimaWe also consider the following equation given in Cui \documentWe also consider the singularly perturbed convection diffusion equation given in Mohanty and Singh \documentThe singularly perturbed elliptic boundary value problem given in Mohanty and Singh \documentIn this paper, we have developed a highly accurate 3D problem solver. This has been achieved by the discretization of two of the spatial variables and the construction of a continuous BVM via the interpolation and collocation approach for solving the resulting semidiscretized system. The results given in "


Whilst extant literature demonstrates the aetiology, incidence and outcomes of eating disorders in women, with evidence showing the impacts on pregnancy, the fetus and parenthood adjustment, there is a paucity of research regarding how women make meaning of the experience. A phenomenological study provided a description of the pregnancy experience as perceived by a cohort of women with diagnosed eating disorders. Data were collected via semi structured interviews with women with a known diagnosis of an eating disorder either in the past or present and who had been pregnant within the previous twelve months. Data were analysed using constant comparative approach seeking themes and patterns.The study identified fourteen key themes that describe the women's experience of living with an eating disorder while pregnant. These themes included a basic description of the pregnancy journey itself; the use of metaphor; perceptions of motherhood; concerns about the baby; and body image. In addition, eating disorder behaviour; eating disorder status; secrets; wishes; misconceptions; support; emotions; health professionals' interactions and healthcare improvements were also identified. It is important that healthcare providers have an awareness that pregnant women may be undergoing personal distress and to be sensitive to the specific needs of women with eating disorders. This study has raised awareness of this issue and provided a baseline for further research in the area.Learning from Consumers stream of the 2014 ANZAED Conference.This abstract was presented in the


The rapid advancement of sequencing technologies has not been without challenges. The extensive size of genomes as well as the need to comprehend the vast complexities of genomic information has fostered the need to utilize more robust computational methods and statistical analysis tools. In a gene expression study involving multiple treatments, a time series analysis of differentially expressed genes provides great insights into the replicates. Such information is useful in identifying the potential sources of variation that cannot be easily extrapolated from a generalized experimental approach. It is also essential to be able to group the identified gene expression patterns in order to attain meaningful interpretations.The experiment employs the use of R software to identify gene expression patterns in a dataset involving parathyroid tumor treatments . The tre


Approximately 80% of human food is composed of crops, which are dominated by cereals that collectively make up 50% of global food production , identification of stress proteins, and the analysis of post translational modifications (PTMs) of proteins Figure .Understanding how plant cells sense and respond to abiotic stress is not only fundamental to our understanding of stress tolerance, but has the potential to yield novel approaches to improve crop productivity. Cellular proteomics plays an essential role in determining the functions of cellular compartments and the mechanisms underlying protein/gene targeting and trafficking.Currently, numerous organ-specific proteomic analyses of abiotic stress in crops have contributed to our understanding of the response mechanisms of crops to abiotic stresses  from specific cells or tissues, an appropriate sampling method needs to be first developed to obtain relatively pure subcellular fractions from this material. A promising sampling method is laser capture microdissection (LCM), which can isolate specific cell types of interest from sectioned specimens of heterogeneous tissues under direct microscopic visualization with the assistance of a laser beam  will make it possible to use a systems biology approach to understand crop responses to abiotic stresses.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The death of a baby before or shortly after birth is associated with profound long lasting grief for parents, similar to any child death. The majoA recent metasynthesis of the qualitative literature surrounding parents’ experiences of care highlighted the value of additional emotional and psychological support from healthcare providers in improving care in pregnancy after stillbirth or neonatal death. However,Interim findings of this programme raise the issue of equity in provision of appropriate and sensitive care for parents in subsequent pregnancies who utilise UK maternity services. Data suggests that many parents receive inadequate emotional and psychological support and therefore there is a need to improve the evidence base underpinning care. The findings of this study will directly inform the development of specific interventions to improve antenatal support and promote positive birthing experiences and the development of a clinical care pathway to improve the care of women and their families in pregnancy following perinatal loss.


Optimal medical treatment and personalised holistic patient care in an even balance is the ultimate management vision of Europa Uomo, the European prostate coalition, for all patients diagnosed with prostate cancer.The professional advice and support given on evidence based medicine is the easiest part of the education. We always provide a short but clear overview of the three main prostate diseases: prostatitis, benign prostate hyperplasia (BPH) and prostate cancer (PCa) and their relationship to Prostate Specific Antigen (PSA). The emphasis that we diagnose far more BPH then PCa has an immediate calming effect on the patient concerning ‘abnormal’ PSA results. Extending on the urological impeccable track record on BPH treatment with zero mortality and excellent quality of life outcomes is a good introduction to a prostate cancer diagnosis. The second emphasis on PCa as a complex disease with different biological forms is complimentary information. Concluding with the knowledge that most forms are indolent or low risk as compared to intermediate or high risk disease leads to an optimistic dialogue on prognostic factors and primary treatments of PCa .Some optimism and clarity are needed as our increased knowledge on prognostic factors and the many forms of primary treatment ranging from active surveillance to combination treatments of surgery and radiotherapy make a shared treatment decision a complex issue in the doctor-patient dialogue. There are few facts and many uncertainties which require the expertise of teamwork focused on the individual patient. There is medical and societal consensus that cancer is best treated by a multidisciplinary team confirming the improved outcome results recorded in multidisciplinary clinical trials , 3. The There are obvious benefits in integrated cancer management for the patients in a one stop shop where a full state-of-the-art program provides not only a consultation with the different experts on your diagnosis and treatment but at the same time access to innovative, tested health technology.However it is possible that the physician loses some autonomy in turning into a team player with the danger of losing ‘the colloque singulier’, the personal bond of trust between doctor and patient. This loss is already present in our health management as a direct consequence of advanced health technology where the patient has to put blind trust in the hands of an acknowledged expert. It is part of our modern lifestyle when we board airplanes or call for cabs.Can we save our holistic patient-centered care in the development of PCU? The model should connect intra  and extra (civil society) mural services. The latter include all professional and lay stakeholders in community health care.Two factors facilitate the link between medical management and patient care. Health literacy is one of most underrated factors to improve outcomes . It is lWhile we expect our patient responsibilities to facilitate clinical trials, translational research and save scarce health resources we feel that all innovative treatment should report on quality of life and cost-efficiency next to the desired efficacy.Last but not least we want to emphasize the facilitating role that nursing and patient groups can play between the PCU and community health and social care. The development of PCU´s provides an opportunity for a best practice forum with transparent pathways and outcomes.


Evidence demonstrated that many aspects of drug abuse and dependence involve changes in glutamate neurotransmission. Neuroadaptations of the glutamatergic system are critical in alcohol dependence, tolerance and withdrawal   regulates the majority of extracellular glutamate  rats to measure the effectiveness of ceftriaxone in reducing alcohol consumption. These rats naturally prefer drink alcohol to plain water. After 5 weeks of a constant free choice of alcohol, the rats develop alcohol dependence. We administered ceftriaxone to the rats each day for 5 days and measured their alcohol consumption. P rats treated with ceftriaxone reduced their alcohol intake as compared to rats treated with physiological saline solution  was found downregulated in animal consumed alcohol for 5 weeks (Alhaddad et al., Furthermore, studies have shown that adenosine plays an important role in regulating the activity of neurons and controlling neurotransmitters, including GABA, glutamate and dopamine (for review see Nam et al., Alcohol abuse and dependence continue to be significant public health concerns. Thus, a better understanding of their neurobiology would facilitate the development of interventions targeting prevention and/or treatment of these major health issues. Here, we focused on the glutamatergic system as therapeutic target for the treatment of alcohol dependence. We have identified potential therapeutic compounds that may have beneficial effects for treating alcohol addiction. We believe that a focus on the glutamatergic system as a prime candidate for mediating drug and alcohol dependence.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Revelations that the majority of the world's two billion Christians currently live in developing countries may have important implications for global neglected tropical disease control and elimination initiatives.In December 2011, the Pew Research Center's Forum on Religion & Public Life produced a landmark report titled “Global Christianity: A Report on the Size and Distribution of the World's Christian Population” Prior to the Pew Forum's findings, I reported on an unexpectedly high burden of disease resulting from neglected tropical diseases in Catholic-majority countries Shown in The latest information from WHO's Preventive Chemotherapy and Transmission Control (PCT) Databank allows us to superimpose onto the Pew Forum findings the number people who require treatment for either intestinal helminth infections For Chagas disease—predominantly a disease of the LAC region, which is overwhelmingly Christian—almost all of the cases (96%) are found in Latin American nations The findings confirm that approximately one billion Christians who live in developing countries of Africa, Asia, and the Americas are highly vulnerable to NTDs. These diseases, which are highly destabilizing and associated with chronic and debilitating effects, represent a major force that traps the world's poorest Christians in poverty.Today, both the intestinal helminth infections and schistosomiasis are being targeted through regular and periodic mass drug administration (“preventive chemotherapy”), costing less than 50 cents per person; but WHO estimates that currently only 35% of the world's population eligible for preventive chemotherapy actually receives essential NTD medicines Christian institutions and organizations could have an important role in expanding the control or treatment of NTDs among the 1.3 billion Christians estimated to live in the Global South. As was pointed out earlier, both local archdioceses of the Catholic Church and Catholic charities have been involved in implementing deworming and other preventive chemotherapy strategies Today, the NTDs represent some of the most common afflictions of global Christianity. It is especially noteworthy that Chagas disease and HAT are today almost exclusively a disease of impoverished Christians. Through NTDs, a renewed dialogue with faith-based organizations that work in developing countries and elements of the hierarchy of the Christian Church could make an important difference in global Christianity and the lives of the world's poorest people.


This review explores the natural products of seagrass that are to be exploited for their bioactive potential. Beside from portraying the presence of a wide array of secondary compounds such as phenols, flavonoids, sterols and lipids from different seagrass species, the focus is on novel natural products projecting towards their biological applications. Though there are a significant number of reports on the abundance of secondary metabolites from seagrass and their bioactive derivatives, only a small number of reports explore their functional and defensive characteristics. Efforts have been made to collate the available information on seagrass natural products and clarify their function and metabolic pathway’s. It is emphasized that metabolic profiling of seagrass should be extensively progressed to obtain a deeper knowledge about the specific roles of each natural product. The investigation of seagrass natural products for their bioactive potential would most likely result in the detection of surprising and unexpected novel chemical structures and clinical leads that may be useful to mankind.


Many papers have used fluorescent probe diffusion to infer membrane viscosity but the measurement is actually an assay of the free volume of the membrane. The free volume is also related to the membrane tension. Thus, changes in probe mobility refer equally well to changes in membrane tension. In complicated structures like cell membranes, it appears more intuitive to consider variations in free volume as referring to the effect of domains structures and interactions with the cytoskeleton than changes in viscosity since tension is a state variable and viscosity is not. Many papers have used fluorescent probe polarization or anisotropy to infer membrane viscosity –8] and  and 8] af by the relationA and B are constants, the latter being about unity. This approach successfully explained the data on temperature and pressure dependence of liquid viscosity. However, the free volume of lipid membranes is directly related to membrane tension so measures of probe mobility also reflect membrane tension  stu stu12] s


Understanding the factors affecting participant attrition in trials is essential for ensuring ethical and effective conduct, appropriate power of the study and successful completion of data collection.The purpose of this research is to explore factors affecting the retention of patients with mental health problems in non-pharmacological randomised controlled trials (RCTs). This paper reports on a qualitative study with staff working on trials aiming to investigate the processes and strategies employed in mental health RCTs.Trialists from universities and research centres in the UK were recruited to take part in this qualitative study. 30 semi-structured interviews were conducted to understand the experiences of staff working on trials, the processes involved in planning and running RCTs and specific issues relevant to clinical research in mental health. The data were analysed using a framework analysis approach.This paper will focus on what retention strategies are used in non-pharmacological mental health trials, how the issue of attrition is dealt with, and what trialists perceive to affect participants’ decisions about staying involved or ceasing their involvement.


Multicenter databases are useful tools for quality improvement programs. Most of this evidence is based on studies in North America and Europe and little is known in other regions. Since 2011, a Brazilian private cardiovascular center has joined an international registry of cardiac surgeries.To evaluate changes in quality indicators and clinical outcomes of cardiac surgery patients after a multifaceted educational program based on reports of an international database.A multifaceted and continuous educational program based on trimestral reports from the international database was implemented in a Brazilian cardiovascular center. A local team targeted reductions in the time of mechanical ventilation (MV), in length of stay and in the number of inappropriate transfusions. A pilot protocol for rational use of blood products based on guidelines was developed in 2011 [From January 2012 to December 2013, 667 CABGs were performed. The predicted risk of in-hospital mortality by the score of the Society of Thoracic Surgeons (validated in the hospital [These results indicate that quality improvement program based on international database reports can improve outcomes in a Brazilian private hospital. Global registries can be useful tools to overcome gaps in clinical practice in different countries.


Stab wounds to the neck can be potentially lethal. They are often associated with vascular injury of the carotid artery and jugular vein. Injury of the vertebral artery is rarely seen. The injury can vary from severe bleeding after transection with hemorrhage into the surrounding soft tissues of the neck to dissection and separation of the intimal lining from the subjacent media of an artery and subsequent occlusion of the vessel. We report a case of traumatic vertebral artery transection managed by minimal invasive balloon occlusion. Injury to the cervical carotid arteries are a well-recognized phenomenon in sharp and even blunt neck trauma. Injury to the vertebral artery is less common. The deep location of the vertebral artery within the neck makes injury relatively less common. This deep location also makes it difficult to detect and manage  ending in a complete stop  if the vertebrobasilar circulation permits this. If the vertebrobasilar circulation is at risk, a covered stent can be placed if the transection can be traversed. If this is unsuccessful a temporary occlusion should be performed to control the bleeding and subsequent definite repair should be performed.


The recognition of facial dysmorphism remains an important skill for clinical geneticists to acquire despite the expanding use of next generation sequencing tools for the identification of gene mutations and related anomalies. Phenotype-genotype correlations, for example, still have an important role to play in diagnosis and prognosis. Facial morphology can now be quickly captured in 3D and analysed with the support of appropriate computer software. This talk will describe how: 3D images of affected individuals can be combined to delineate characteristic facial features of genetic and related conditions; static and dynamic visualisations can help a clinician to identify what is atypical in an individual child’s craniofacial development; quantitative analysis of face shape can assist with diagnosis and the study of phenotype-genotype correlations; links can be established between facial dysmorphism and neuro-cognitive disability arising from genetic anomaly and teratogen exposure.


K-RAS oncogene would save at least US $600 million a year. On the other side, many papers in the course of biomarker discovery projects have been published yet, but only few clinically useful biomarkers have been patented and successful validated for routine clinical practice. The reasons for the limitation to bring biomarkers successful on the market are manifold. Regulatory and scientific hurdles as well as lack in the biomarker validation and lack in the technical validation have been cited as one of the main reasons for the slow growth in this area. Whilst the majority of the published biomarkers will not be translated into diagnostic tests, the growth of biomarker used in clinical diagnostics indicates that the future of the industry will lie in the CDx co-development. The first drug introduced using the CDx co – development – Herceptin  – has now been on the market for several years. Our study focus on some economics and technical factors that should be considered to successfully develop and market a companion diagnostic test, based on lessons learned from recent case studies. A proposed framework of considerations to be addressed at the various stages of developing effective companion diagnostic test is also presented.In view of an urgent need for novel therapeutics that have a positive impact on morbidity and mortality of chronic diseases, the field is now moving more quickly towards clinical translation from biomarker identification to the development of an companion diagostic (CDx) test. The implimentation of such CDx test is driven by smart preclinical validation, a better study design and improved surrogate readouts using currently available methodologies and diagnostic techniques. Moreover, upcoming novel biomarkers and diagnostic technologies will soon permit a more accurate and efficient assessment of disease progression and regression. The ability of biomarkers to improve treatment and reduce health-care costs is potentially greater than in any other area of current medical research. For example, the American Society of Clinical Oncology estimates that routinely testing people with colon cancer for mutations in the


Numerous studies have been conducted in the West on the educational needs of minority students. These studies indicate that students from particular ethnic backgrounds have unsatisfactory educational experiences and various learning difficulties , 2. AlthThis paper investigates South Asian students’ learning experiences and addresses issues of further studies and career preparation through understanding of their educational and vocational aspirations. Semi-structured interviews were carried out with Secondary 4 and 5 South Asian students in one designated and one non-designated school during April and May 2013.The results reveal the diversity of needs among South Asian students during learning. The majority of the South Asian students interviewed aspired to ‘mainstream’ education and occupations, but they were acutely aware of their inability to fulfill their ambitions. Students’ emphasis on making themselves work harder in the pursuit of their aspirations testifies to the entrenched ideology of competitive individualism in local society. Because a limited number of affordable educational services target South Asian students at senior secondary level in the community, this calls for increased investment of the government on after school educational services for South Asian students across all levels of schooling. However, some interviewees were not aware of other educational choices except for mainstream secondary schools and universities.Educators should recognize that academic education is not the best for everyone. There are alternative education programs available for those who do not cope well in the mainstream educational path, and vocational education and training (VET) is a way to improve students’ employability. Schools serving ethnic minority students are recommended to strengthen their career guidance services and make information and knowledge of VET more available to students and parents. These include technical and vocational programs targeting Secondary 3 and Secondary 6 transitions.


High throughput technology makes it possible to monitor metabolites on different experiments and has been widely used to detect differences in metabolites in many areas of biomedical research. Mass spectrometry has become one of the main analytical technique for profiling a wide array of compounds in the biological samples. Extracting relevant biological information from large datasets is one of the challenges. Missing values in metabolomics datasets occur widely and can arise from different sources, including both technical and biological reasons. Mostly the missing value is substituted by the minimum value, and this substitute may lead to different results in the downstream analysis. Different methods tend to give different results. In this study we summarize the statistical analysis of metabolomics data with no missing values and with missing values. With the missing values, we compare the different methods and examine the outcomes based on each method.Analysis was done on 276 metabolites from 10 samples (12 metabolites excluded due to not detected in either group). 204 metabolites had complete information in all samples[Zero gave the least number of significant metabolites whereas Mean gave the most. 55 metabolites were uniquely identified by all methods in the volcano plot; 28 metabolites were similar across all methods.We have shown that the selection of imputation methods to replace MVs may have a dramatic impact on the data. The handling of missing values is an absolutely crucial step in the data pre-processing. Metabolites such as adenylosuccinate, caprylate (8:0) and N-acetylalanine are only detectible by a specific method and may be important in their specific metabolic pathways and so choosing an appropriate method is critical. Also PLS-DA FAD is important for only kNN in predicting the class membership whereas adenine and adenylosuccinate is important only for Zero and Mean Methods. In future studies we will further examine MVs and model an appropriate method such that the correct significant metabolites are captured.


Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. They share the same microscopic characteristics of their central counterparts. Here, we report an ulcerated mass of the maxillary gingiva that on histopathological examination was diagnosed as peripheral developing odontoma or peripheral ameloblastic fibroodontoma. The diagnosis of this tumor is challenging and may lead to unnecessary treatment. An 8-year-old healthy girl was referred to the pathology department for examination of an isolated and ulcerated soft tissue mass of the palatal gingiva in the region of right canine and deciduous first molar, measuring 0.8 × 0.8 cm with unknown duration. There was no history of trauma to the area. The periapical radiograph did not show any intrabony lesion. The mass was excised under local anesthesia with clinical diagnosis of reactive soft tissue lesion most probably pyogenic granuloma (PG) or peripheral ossifying fibroma (POF). The cut surface of the lesion was creamy solid . On histOdontogenic neoplasms are categorized into peripheral and central. The relative frequency of peripheral odontogenic tumors is rare and there is no valid information of their frequency in the literature . SaghravOdontoma and ameloblastic fibroodontoma belong to mixed odontogenic tumors group and are composed of odontogenic epithelium and ectomesenchyme . Some auThe etiology of odontogenic tumors is indefinite and their source is the remnants of dental lamina that reside in the gingiva (rests of Serres) and develop lingually to those of the primary teeth . TherefoThe clinical presentation of this case was similar to PG and POF because of an ulcerated surface and the gingival involvement. In the case described by Kintarak et al. , focal fThe presence of dental tissue outside the alveolar process may be associated with ectopic neural crest cells that are still able to differentiate into tooth germ . It is dThe treatment choice is conservative surgical excision . RecurrePeripheral odontoma and peripheral ameloblastic fibroodontoma are exceedingly rare benign odontogenic lesions that are treated by conservative excision. The proper diagnosis of these lesions is necessary to avoid confusion with true neoplasms especially odontogenic tumors and prevent extensive surgery. Therefore, it is essential for oral pathologists to be familiar with clinical and microscopic characteristics of peripheral odontoma.


Coxiella burnetii will rise.Q fever is a disease with worldwide distribution. The real number of patients with this disease is underestimated due to its nonspecific symptoms and because of the difficulties associated with serological diagnosis. Some of the patients diagnosed in the first stage with Q fever later develop chronic disease. Endocarditis is the most frequent and severe form of chronic Q fever. In the National Institute for Infectious Diseases "Prof. Dr. Matei Balş" the number of patients diagnosed with Q fever has significantly increased in the last few years. The number of cases from the first half of 2014 almost exceeded the whole number recorded in 2013. In these circumstances we expect that the number of cases of endocarditis with Coxiella burnetii).We retrospectively analyzed the patients diagnosed with Q fever with endocarditis in the Matei Balş Institute between 2011 and 2014. Of 89 patients with Q fever, 4 patients met the inclusion criteria (endocarditis plus serologic diagnosis of Coxiella burnetii by ELISA was used as screening test for the etiologic diagnostic that was confirmed by dosing phase I and II IgM and IgG antibodies. All patients initially received empiric therapy with association between betalactams and aminoglycosides. After the etiologic diagnosis was established, the patients were treated with doxycycline in association with ofloxacin/rifampin.All the patients were males with a median age of 58.25 years. All of them lived in urban area and were admitted for prolonged fever. Three out of four patients presented hepatitis with ALT elevation and cholestasis at admission. All blood cultures taken during hospitalization were negative. Endocarditis diagnosis was established after echographic evaluation. In three cases the aortic valve was affected while in the other case the aortic valve was impaired. Detection of IgM antibodies for Coxiella burnetii must be considered as a possible etiologic agent in case of endocarditis with negative blood cultures especially in the context of increasing numbers of patients diagnosed with Q fever. The association between fever, hepatitis and interstitial pneumonia must be an additional argument for considering chronic Q fever with endocardial impairment a possible diagnosis.


Hospitals are the most costly operational and really important units of health system because they consume about 50%-89% of total health resources. Therefore efficient use of resources could help in saving and reallocating the financial and physical resources.The aim of this study was to obtain an overview of hospitals' performance status by applying different techniques, to compare similarities and differences between these methods and suggest the most comprehensive and practical method of appraisal for managers and policy makers.This is a cross sectional study conducted in all hospitals of Ahvaz  during 2007 to 2011. Two kinds of data were collected through separate special checklists. Excel 2007 and Windeap 2.1 software were applied for data analysis.The present findings show that the average of bed occupancy rate (BOR) in the studied hospitals was about 65.91 ± 1.16. The maximum number of inefficient hospitals in the present study happened in the years 2007, 2008 and 2010  but there were two hospitals in the third part of the present graph which had maximum level of efficiency and optimal level of productivity in the years 2007 and 2009. Data Envelopment Analysis (DEA) showed that the mean score of technical efficiency for the studied hospitals is 0.924 ± 0.105 with the minimum of 0.585 ± 0.905 for hospital number 1. Furthermore It shows that only five hospitals (31.25%) reach complete technical efficiency (TE) scores across all five years of 2007-11 (TE = 1).Results of the present and similar studies should be considered for the future planning and resource allocation of Iranian public hospitals. At the same time it is very important to consider need assessment results for each region according to its potentials, population under the coverage and other geographical and cultural indices. Furthermore because of potential limitations of each of the above models it is highly recommended to apply different methods of performance evaluation to reach a complete and real status view of the hospitals for future planning. Health is an absolute right of the all members of the society and health care sector is considered as one of the most significant service sections, so its indicators are considered as one of the main criteria developmental level and social welfare of any country . On the Hospitals are the most costly operational and really important units of health system because they consume about 50%-89% of total health resources . NationaRatio analysis as one of the non parametric technical-efficiency assessment methods, which includes the separate examination of various key measures such as average cost per inpatient day, bed occupancy rate, average length of stay, bed turnover ratio and so on . But as SFA is a parametric linear programming method that uses an integrated data set considering a special form of production function for assessing efficiency but because of some potential challenges, it is suggested to be used along with other techniques . DEA, a This study was conducted to present an overview of the efficiency of all hospitals in Ahvaz  applying Pabon Lasso, DEA and Malmquist indicators to compare similarities and differences between the results obtained by these methods and suggest the most comprehensive and practical ones for managers and policy makers.This cross sectional study was conducted in all 16 hospitals of Ahvaz , Ahvaz, Iran during 2007 to 2011. All of them were specialized hospitals. Hospitals No. 1-8 were affiliated with the Jundishapur University of Medical Sciences in Ahvaz and the rest were nonaffiliated. Two kinds of data were collected through separate special checklists, one for indicators of Pabon Lasso and the other for assessing efficiency according to DEA and both were designed based on the research goals. Pabon lasso is a graphical model for demonstrating hospital performance using three indicators: bed occupancy rate (BOR), bed turnover (BTO) and average length of stay (ALS). This graph compartmentalizes the hospitals into four divisions: The first part stands for those hospitals with low BTO and BOR implying a surplus in hospital beds against the existing demand, however the second sector shows the hospitals with high BTO and low BOR which indicates unnecessary hospitalizations, an oversupply of beds, or using the hospital beds for simply observing patients. The third segment indicates those hospitals with high BTO and BOR that simply means an appropriate level of efficiency, with relatively few vacant beds at any time and finally the last category presents the low BTO and high BOR that may emerge because of admitting patients with chronic diseases or unnecessarily long ALS , bed turn over (BTO), and average length of stay (ALS). The items of these checklists were filled for each of the studied years. Data achieved from the first checklists, was analyzed using Excel 2007 according to Pabon lasso model for presenting the related graphs. Then, another checklist was designed for obtaining the necessary data in order to form an input – oriented DEA model. Variables were categorized as inputs  and bed occupancy rate number of patients and number of operations were considered as outputs. The related data were collected from the statistic's center of the Jundishapur University of Medical Sciences and other hospitals for a total of 16 hospitals during 2007-2011. Windeap 2.1 software was applied for further analysis.Three determinant indicators constructing Pabon Lasso model are presented in In contrast, there were only two hospitals in the third part of the graph which stands for efficiency and optimal level of productivity in the years 2007 and 2009. This number has been increased to three hospitals in 2008 and 2010, and 4 hospitals in 2011 as fully efficient units. Another important finding of this graph is that most of the hospitals were located in the second and the forth zone during 2007 to 2011 which may be due to unnecessary hospitalizations, an oversupply of beds, using the hospital beds for simply observing patients (second zone) or admitting chronic patients with unnecessarily long ALS (forth zone). The aveBeing aware of the hospitals’ performance and efficiency is one of the major concerns of health policy makers and health care manager’, although applying a unique scientific technique for hospital performance evaluation, efficiency estimation and determination of the effective factors has not been achieved yet. All the above methods have their own restrictions alongside their strengths, for example despite DEA's advantages in calculating the relative and not absolute efficiency and incorporating multiple input and output factors and also determining optimum level of practice and performance targets , there aEven though Pabon Lasso gives an instant picture of the hospital, its related indices may be influenced by different factors that cannot be calculated applying this simple model . ConsideMoreover, the maximum number of inefficient hospitals in the present study belonged to the years 2007 and 2008  in contrast with another study on Ahvaz University of Medical Sciences hospitals demonstrating that two hospitals were situated in the first zone in the year 2009 . FurtherThese differences can be justified by the fact that the present study only included 16 hospitals in Ahvaz but Zahiri  includedThis study like other studies performed in Iran showed that there was a surplus in the studied hospitals’ inputs  in the hospitals affiliated with the medical governmental universities . It is oThis finding are justified applying Malmquist index that showed hospital number 2 was presented as the best and hospital number 14 was achieved the worst performance level considering the rate of change in the productivity. So it is recommended to consider the the present results and results of similar studies for the future planning and resource allocation of hospitals. At the same time it is very important to consider need assessment results for each region according to its potentials, population under coverage and other geographical and cultural indices. Furthermore because of potential limitations of each of the above models it is highly recommended to apply different methods of performance evaluation together to reach a complete view of the real status of the hospitals for future planning.


RSV is the main cause of childhood lower respiratory infections, globally, an important cause of childhood wheeze and may be responsible for a substantial burden of disease in the very elderly and in adults with chronic medical problems, such as COPD. It is thus responsible for substantial healthcare and social costs. There are currently many companies and academic groups developing and testing candidate vaccines and there is an expectation that these will lead to effective and safe vaccines which will be available to health systems globally in the short – medium term. Despite this, there is an incomplete understanding of RSV disease, especially in adult groups, and large scale data are only available from a few countries and settings leading to low levels of awareness of the importance of this pathogen. We discuss the need for widespread national sentinel systems of RSV surveillance and some means by which this could be achieved. These data will be needed by national policy makers and immunisation advisory groups to guide future priority setting and decision making. Journal of Global Health there is a short series of papers on respiratory syncytial virus infection (RSV). RSV is a major cause of morbidity and mortality worldwide and has been estimated to cause about 34 million episodes of acute lower respiratory infections (ALRI) in young children globally each year, with over 3 million severe enough to cause hospitalisation [In this issue of the lisation . These elisation .In 2015, the World Health Organization (WHO) Product Development for Vaccines Advisory Committee (PDVAC), which scans the horizon for likely important vaccine developments in the coming decade, highlighted RSV as “a pathogen for which there is major vaccine pipeline activity, high technical feasibility, and major disease burden in low and middle income countries (LMICs)”. They summarised the current status of vaccine research as of June 2014 , and thiCurrently, these developments are gaining momentum ahead of action to gather information to raise awareness and inform policy discussions globally. Although RSV disease accounts for very significant health care and social costs globally, there is a low level of recognition of this among government policy makers. Thus, to support these developments there is a need to assemble epidemiological data on RSV through national and other large scale surveillance systems. This could provide data on:• burden of RSV disease by age group, by key risk groups and by geographical setting;• RSV seasonality patterns across the world; and• RSV viral parameters such as subtypes and genotypes.They could also provide baseline data on hospitalisations from RSV ALRI against which the impact of a future vaccine could be assessed at national scale.RSV is not currently a notifiable disease and there are no well–established ongoing surveillance systems in existence. A sophisticated Global Influenza Surveillance and Reporting System (GISRS) functions well with data from over 140 National Influenza Centres globally and with the sharing of over 1 million respiratory samples for influenza detection. The paper by Shi and colleagues in this edition of Journal of Global Health demonstrates that about 90% of ALRIs in children in which RSV is detected can be causally ascribed to RSV. Some of the GISRS sites conduct acute surveillance of Severe Acute Respiratory Infections (SARI) in all age groups and although case definitions and sampling procedures are designed to identify episodes of SARI due to influenza there is the potential to adapt this surveillance system to also identify episodes of ALRI due to RSV. Key issues to address in this adaptation would include the differing seasonal pattern of RSV, the different age pattern of RSV disease (with more emphasis on the first 2 years of life) and the differing clinical presentation of cases (with fever absent in up to 80% of cases in children) . Most seIt is not fully clear how the existing GISRS systems can best be adapted for RSV surveillance but this will at least require the development of separate case definitions and RSV–specific standard operating procedures for identification of the target population, data collection, analysis and reporting. This will require specific study and the new scheme will need to be validated before wide adoption. The proposed global web–based FLuMART platform for sharing epidemiological (FLuID) and virological (FluNet) data could serve as a base from which an RSV information and reporting system could be built. A major advantage of this approach would be the existing excellent linkages to national policy makers globally who already receive weekly reports from GISRS. These developments will need to be supported by RSV reference laboratories which can conduct external quality assurance of participating laboratories. It will be essential to ensure that this development does not degrade the quality, completeness or timeliness of data on influenza since the GISRS data represents a vital public health activity eg, in informing annual influenza vaccine composition and in pandemic preparedness. Thus, it would be prudent to start with pilot projects in a few countries in each global region supported by a few designated RSV reference laboratories and this is the approach currently being proposed by WHO .In high–income countries, in addition to the approach noted above, other options could be feasible. These could include bespoke hospital–based surveillance schemes focused on RSV or, as in Canada (in their Serious Outcomes Surveillance (SOS) and Immunization Monitoring Program ACTive (IMPACT) paediatric surveillance network ), be parReductions in mortality from childhood pneumonia have been the largest single contributor to global falls in post–neonatal child mortality over the past decade and have been due to a variety of factors associated with socio–economic development as well the introduction of new vaccine and other interventions. The development of effective new vaccines and other prevention strategies to tackle RSV have the potential to make major contributions to reducing severe disease and deaths from RSV in children globally. These developments may also have an important impact on cardio–respiratory sequelae due to RSV associated with from the growing tide of non communicable diseases among middle aged and elderly adults globally. It is important that structured data gathering systems are put in place now to gather the essential data that will be required to provide a secure evidence base to guide national, regional and global policy decisions in the near future.


The lack of vascularization in the tissue engineered bone results in poor survival and ossification. Tissue engineered bone can be wrapped in the soft tissue flaps which are rich in blood supply to complete the vascularization in vivo by microsurgical technique, and the surface of the bone graft can be invaded with new vascular network. The intrinsic vascularization can be induced via a blood vessel or an arteriovenous loop located centrally in the bone graft by microsurgical technique. The peripheral nerve especially peptidergic nerve has effect on the bone regeneration. The peptidergic nerve can be used to construct the neurotized tissue engineered bone by implanting the nerve fiber into the center of bone graft. Thus, constructing a highly vascularized and neurotized tissue engineered bone according with the theory of biomimetics has become a useful method for repairing the large bone defect. Many researchers have used the microsurgical techniques to enhance the vascularization and neurotization of tissue engineered bone and to get a better osteogenesis effect. This review aims to summarize the microsurgical techniques mostly used to construct the vascularized and neurotized tissue engineered bone. The seed cells such as bone marrow stem cells in the center of the bone graft will lack enough nutrition and finally die. The osteogenesis is influenced by the process of vascularization and this limits the clinical application of tissue engineered bone. Over the last few years, many researchers have used the microsurgical techniques to enhance the vascularization of tissue engineered bone and get a better reparative effect in bone defect [It is a big challenge for surgeons to repair the large bone defect caused by the trauma, infection, tumor, or other reasons. Autologous bone grafting is considered as the golden standard for the clinical treatment of bone defects –5, but te defect –10. Tisse defect –13. Besie defect . The pere defect –18. So ce defect –21. We aTissue flaps such as fascia flap, muscle flap, and peritoneum flap have rich blood supply and can be used as the vascular bed to enhance the vascularization of tissue engineered bone –24. BefoThere are several kinds of soft tissue flap that can be used to enhance the vascularization of tissue engineered bone. Fascia flap, muscle flap, and periosteum flap are the most commonly used to wrap the bone graft.Fascia flap has rich capillary network and excellent permeability as a most suitable soft tissue flap for enhancing the vascularization. Our group is the first to report the use of fascia flap to enhance the vascularization of tissue engineered bone in the large animal model of goat. We found that pedicled fascia flap could accelerate the revascularization and osteogenesis process of tissue engineered bone in large animal model . Liu et Muscle flap also has rich blood supply and is usually used to repair the soft tissue defect or infected wound in clinical patients. The latissimus dorsi muscle is the most commonly used to wrap the tissue engineered bone. Casabona implanted a porous hydroxyapatite ceramic scaffold with the human bone marrow stromal cells into the latissimus dorsi of athymic mice and found the presence of new spongious bone tissue . TerheydPeriosteum flap also has rich blood supply and can be used to induce bone regeneration. There are many reports about using the periosteum or cultured periosteal cells to enhance the osteogenesis and vascularization of tissue engineered bone –45. A vaAlthough tissue engineered bone grafts can be wrapped in the soft tissue flaps which are rich in blood supply to enhance the vascularization in vivo by microsurgical techniques, only the surface of bone graft can be invaded with new vascular networks and the pattern of the new blood vessels is random. The intrinsic vascularization of bone graft is still not achieved with this method of soft tissue flap wrapping.The intrinsic vascularization can be induced via a blood vessel located centrally in the bone graft by microsurgical technique. There are many reports about the use of the carotid artery, jugular vein, and saphenous vascular bundle in biomaterials resulting in splendid osteogenesis and vascularization of the bone grafts –50. SurgAlthough the method of embedding axial blood vessel is available for enhancing the intrinsic vascularization of tissue engineered bone, the clinical application may be limited by the length and anatomic location of blood vessel. So a new method of arteriovenous (AV) loop has been used to enhance the intrinsic vascularization. This AV loop has been proved to be superior compared to the axial blood vessel both in terms of neovascular density and capacity . This meLike autologous bone grafts, the new vascularized bone graft can be transferred to the bone defect site using the microsurgical techniques. This method of embedding blood vessel or AV loop will facilitate the clinical application of tissue engineered bone and offer new therapeutic strategies for reconstruction of large bone defects.Bone tissue is not only a highly vascularized tissue but also a highly neurotized tissue. By the anatomy study of the bone tissue, many researches have proved that there were dense and intimate networks of nerve in the bone tissue and the nerve networks had contact with bone cells –62. Our β-TCP scaffold to repair a 1.5 cm femur defect in the rabbit. The values of bone mineral density and the neuropeptide were significantly higher in sensory nerve group compared with the motor never group and the blank group. But the ossification and nervalization effects of motor nerve group showed no significant difference compared with that of blank group [β-TCP scaffold. This method could make the neuropeptide, which was produced by the neurons, release from the distal end more easily, and it acted on the BMSCs via its receptors to regulate the metabolism of the bone.The ability of the peptidergic nerve fiber to regulate the function of osteoblasts and blood vessels can be used to construct the neurotized tissue engineered bone by embedding the nerve fiber into the center of bone graft –21. As wnk group . These rnk group . AlthougOur group also evaluated the different effects on the expression of calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) between tissue engineered bone with blood vessel in vivo or with sensory nerve tract. We found implantation of blood vessel into tissue engineered bone could significantly improve the expressions of CGRP and NPY at the early 3 months compared with implantation of sensory tract into tissue-engineered bone, but the differences were not significant at 6 or 12 months postoperatively . We alsoAlthough sensory nerves can enhance the osteogenesis of tissue engineered bone, the neurocyte also needs the oxygen and nutrients. The neurotization of tissue engineered bone needs the vascularization as the preconditions. Masaki connected a silicone gel tube to the sciatic nerves of mice and then placed a small artery that was adjacent to the sciatic nerve into the silicone gel tube through a longitudinal incision to provide oxygen and nutrients to the regenerated nerve . The impThe lack of vascularization and neurotization within the tissue engineered bone results in poor ossification and limits the clinical application of tissue engineered bone. The vascularization of bone grafts can be promoted by soft tissue flap wrapping, blood vessel embedding, and arteriovenous loop embedding centrally in vivo by microsurgical techniques, but this method has the disadvantage of uncertain neurotization effect. The neurotization of bone grafts can be promoted by peptidergic nerve tract embedding centrally in vivo by microsurgical techniques, but this method also has the disadvantage of uncertain vascularization effect. So each method has the superiority and disadvantage. Combination of different methods will be necessary and useful to improve the reparative effect of tissue engineered bone in the large bone defect. We give the concept of constructing the highly vascularized and neurotized tissue engineered bone simultaneously by microsurgical techniques according with the theory of biomimetics. The microsurgical techniques will play a more and more important role in the development of bone tissue engineering and eventually achieve the wide clinical application of tissue engineered bone to repair the bone defect of patients.


Large genomic segments spanning millions of nucleotides commonly differ between any two genomes, including between monozygotic twins  are a prevalent type of SV that make up an extensive portion of genetic diversity. Katju and Bergthorsson  contribuThe divergence of CNVs between populations may help identify candidate regions under selection. Bryk and Tautz  tested tThe evolutionary and functional consequences of CNVs in livestock are an important area of research with economic relevance and are reviewed by Bickhart and Liu . The autFocusing on the evolutionary implications of SVs, Keane et al.  review sGiven that SVs are important to consider when studying genetic diversity and genome evolution, as highlighted by the contributions to this research topic, improvements in SV detection and analysis should be a priority to better evaluate the impact of SVs. Most current methods are poor at defining breakpoints at a fine scale, making it difficult to determine the mechanism of SV formation—an essential requirement for understanding the evolution of SVs. Moreover, the ability to accurately genotype SVs would allow a population genetic framework analysis that can make use of allele frequency changes to determine the evolutionary dynamics of SVs. Despite these limitations, essentially any organism can now be screened for SVs, which will lead to increasing our knowledge on the ecological and evolutionary implications of genomic SVs.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Student dietitians are often very interested in developing skills in the assessment and management of clients with eating disorders. This may be difficult; clients often decline student participation in their care due to the sensitive nature of their condition. Nourishing Networks, a self-directed health professional learning program, was developed to enhance clinician knowledge and management skills for individuals with disordered eating and assist with the formation of local networks of support. This program was adapted and piloted for dietetic students attending placement at the University of Newcastle Department of Rural Health Tamworth. The aim of the program was to enhance the students', knowledge and skills in the management of eating disorders. Students were offered the opportunity to participate in the 10 week program. Results showed all students furthered their knowledge, skills and attitudes towards eating disorders and were better able to determine appropriate treatment plans. This program allowed students to gain tools for working with clients that they would not otherwise be exposed to in their undergraduate degree and associated placements. Future plans include the presentation of an Eating Disorder Interprofessional Learning Module for nursing, medical and allied health students and subsequently offering this 10 week program to these students.


Evolutionary forces shaped the molecular complexity of these natural products that contribute to the exquisite binding of these compounds to biological targets. Starting with the discovery of penicillin by Fleming, we have seen a rapid increase in the discovery and production of natural products and derivatives thereof as antibiotics and other drugs. But once the ‘easy to access’ bioactive compounds have been isolated, the drug discovery pipeline slowed down beginning in the 1990s. Pharmaceutical companies turned away from natural products as screening programmes led to the rediscovery of known structures and development of structurally complex natural products into drugs using synthetic methods proved to be challenging and too expensive if no reliable biological sources were available. Considering the urgent need for the development of new drugs to combat multidrug-resistant pathogens and overcome long-term side-effects and/or reduction in effectiveness of current drugs, unlocking nature's treasure trough of small-molecule chemodiversity will be crucial for next-generation drug development  and from complex microbial ecosystems. Recent work has shown that metagenomic libraries from microbial ecosystems can be successfully arrayed and screened for large biosynthetic gene clusters of interest based on homology to conserved regions of known biosynthetic genes such non-ribosomal peptide synthases or polyketide synthases  that can be grown in the lab will be crucial to develop algorithms for accurate structural annotation. High-resolution transcriptomics analysis of diverse species will enable the construction of gene co-expression networks built on physical distance to seed genes that are frequently associated with natural products biosynthetic pathways  could be a means for the discovery of novel pathways and sequences for broader


In low-income countries, and particularly those in Africa, there are two important landscapes that have changed profoundly in recent years. One is the architecture of global health with its resulting increase in both the volume and complexity of health financing at country level. The second is the accelerating health transition in such countries where the past decade has witnessed declines in child mortality and increases in life expectancy at paces that have never been seen before in any period of history in any society. These health gains are not just a result of improving socio-economic development, but are consequent to important changes in health services and systems that have improved access to and coverage of several efficacious and cost effective essential health interventions funded in part by global health initiatives.The dynamics of this health transition naturally result in very different and continually changing patterns of risk factors and attendant burdens of disease. Unfortunately the improvements in health systems in such countries have not yet included the necessary changes in, or even development of, appropriate means of monitoring the dynamics of the disease and risk factor patterns on a routine basis suitable for forward planning and policy making that will adequately steer development of the future health systems needed to respond to these dynamics. We remain too dependent on burden of disease modelling based on intelligent, but not sufficiently empirical real time data at country level on disease and risk factor dynamics. This is particularly so for cause of death data of acceptable coverage and quality in low-income countries where premature mortality still constitutes the largest share of disease burden DALYs. At the same time, the share of burden constituted by disability is rising rapidly from a much more varied set of causes and risks which are also changing due to demographic transition and other evolving phenomenon such as urbanization and globalization. These dynamics will require very different health systems and policies.This presentation will discuss the need for linking three critical health information sources: 1) radical new approaches to routine longitudinal civil registration and vital statistics for disease burden monitoring, coupled with: 2) periodic national risk factor surveys that link to: 3) new approaches to monitoring district level health service coverage of services needed in response to the changing burdens and risks. Integrating across these data sources would provide the missing information strategy for evidence to feed more responsive health system planning and policy making needed for achieving universal health coverage.


It is widely acknowledged that allopolyploidy via hybridization and genome doubling can easily lead to speciation, as polyploid hybrids can be immediately isolated from diploid parental taxa due to high levels of sterility caused by uneven numbers of chromosome complements in their progeny  of either parent, given long term interaction between and adaptive evolution of flower characters of parental species and pollinators  by attracting hummingbirds due to large red flowers, while I. hexagona is mainly pollinated by bumblebees due to blue flowers, although other isolation barriers such as habitat and environmental isolation are also present  and Fundamental Research Funds for the Central Universities (15lgjc23).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Sepsis is an important cause of mortality and morbidity for preterm and hospitalized newborn babies. Today, no single test satisfies the criteria as being the ideal marker for the early diagnosis of neonatal sepsis. Analysis of the entire metabolome is a promising method for determining metabolic variations correlated with sepsis -6.Works on metabolomics concerning sepsis conducted on animals and humans of different ages (newborn and adults) have recently been published and are presented in Table Present-day methods and procedures for the diagnosis of systemic neonatal infections are hindered by low sensitivity and long response times. Metabolomics is showing promise of becoming a most effective method, even in neonatology and paediatrics.


In this context we define spatial analysis to mean Statistical Inference which takes into account spatial data, including but not limited to spatial exploratory data analysis. Groups in a Cluster randomised trial (CRT) are often defined geographically, giving spatial structure to the data. Taking account of the spatial aspects in the design and analysis of such a trial is important as it may influence results. In addition, the hierarchical structure imposed by the design should be adjusted for in the analysis. Therefore selecting software for spatial analysis of CRTs necessitates the capacity to accommodate for both spatial and clustering effects.The range of spatial software available is broad in focus and capabilities, with a plethora of options to choose from determining what tool to use is not necessarily straight forward. In the last decade due to rapid development of spatial methods in Statistical packages and the expansion of Statistical toolboxes in Geographical Information Systems there is substantial overlap in abilities.This review provides a comparison of current software options offering spatial analytical and visualisation techniques. First giving a brief account of the numerous cartographic visualisation tools, then focusing on what differentiates the capabilities of the analytical software. In regards to the latter we'll give special attention to multi-level modelling in both a Frequentist and Bayesian framework. Therefore demonstrating the flexibility of the options now available for the Analysis of CRTs taking into account spatial aspects.


With advancing age venous wall thickness increases going along with a loss of elastic properties, the arterioles curl and capillary density decreases leading to a reduction of cross sectional area . Even inSo far no biomechanical model exists that investigates the influence of macroscopic and microscopic changes of cerebral blood vessels. That is why we put a model up for discussion that simulates vascular pressure propagation and enables the investigation of altered vascular properties in the context of NPH.A Matlab Simulink model was developed reproducing each vessel section by a distensible compartment. Therefore the cerebral vascular tree was divided into 13 sections from carotid artery to venous sinuses and the pulsatile carotid artery and sinus pressure were inputted as Fourier series. The cross sectional area was varied according to literature data and flow resistance was implemented taking into account the rheological characteristics of blood. The Windkessel function and relaxation properties of vascular walls were integrated by a Voigt model, enabling the variation of wall properties for each section individually. Due to the distensible vessel walls each section interacts with the CSF compartment and autoregulation was implemented by a simple proportional controller. After parameterisation mean pressure and pressure amplitude in the vessel sections showed good accordance with literature values .We have proposed a model of vascular dynamics that is able to identify the impact of altered vascular wall properties and structural changes. Furthermore the effect of different arterial and venous input pressure profiles can be analysed. These parameter analyses are part of our ongoing research.


The images for Figs There is an error in the last sentence of the Deducing Parental Contributions of Alleles at CTCF BS6 subsection under Materials and Methods. The correct sentence is: Comparing these results allows each parental contribution to be deduced, see The panel labels for Figs The publisher apologizes for the errors.


Psychoactive substance addiction presents a challenging public health issue worldwide particularly targeting vulnerable adolescent population  are released at regular times by the National Medicines and Medicinal Devices Agency of Serbia  in comparison to €9,450,094 back in 2004. This finding is wholly justified by previous findings on heavily increased anxiety levels among resident addicts in the former Yugoslav region compared to traditional EU-15 market economies (Jakovljevic et al., Although the situation appears to implicate an extensive public debate in this region, we should be aware of the fact that a large portion of reported consumption is clinically justified with basic mental illness. It would be highly difficult and demanding rigorous methodological approach to exactly identify the proportion of overutilization of these drugs that is attributed to abuse and addiction. Nevertheless, vast net quantity gains in consumed addictive medications in definite ATC groups by far surpass extended burden of associated psychiatric morbidity in recent years (Ristic-Ignjatovic et al., The abuse of potentially addictive medicines correlates with clinicians' decision making principles (Bendtsen et al., The underlying studies providing evidence for this contribution where funded out of The Ministry of Education Science and Technological Development of the Republic of Serbia Grant OI 175014. Publication of results was not contingent to Ministry's censorship or approval.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Children's Health Queensland, Child and Youth Mental Health Service (CHQ CYMHS) Family Based Eating Disorder Clinic is staffed by a multidisciplinary team trained in Family Based Treatment for Anorexia Nervosa (FBT-AN). A diverse range of families present to the clinic for treatment, including families where parents have separated and re-partnered to form reconstituted family groups with shared parenting arrangements. This is an increasingly common presentation to the Clinic regardless of child age, and presents unique challenges in the context of the Family Based Treatment Model. Whilst the Family Based Treatment Model does not focus on family etiological factors, the family unit is viewed as a crucial tool in facilitating recovery from Anorexia Nervosa and central to treatment strategies.This presentation will discuss how Family Based Treatment is undertaken in the Clinic with reconstituted families committed to shared parenting. Case examples will be used to demonstrate the innovative strategies utilised throughout the treatment process. The task of adhering to the principals of evidence based treatment whilst responding to specific challenges for families will be examined. Critical junctures in treatment which require careful attention in order to engage both family systems whilst creating a cohesive team will be explored.Service Initiatives: Child and Adolescent Refeeding and FBT stream of the 2014 ANZAED Conference.This abstract was presented in the


The right therapy for the right patient at the right time is the most important approach for the provision of proper health care. The field of rare diseases is an excellent example, with patients taking a more central role in the discovery and development of treatments for their disease. Limited budgets coupled with high failure rates of medicine development lead us to public-private partnerships as a model to move forward and reduce cost; no stakeholder alone has all knowledge and expertise.The newly founded BioPontis Alliance Rare Disease Foundation presents a scientific and economic partnership model designed to unleash the potential to find cures for rare (pediatric) diseases. The non-profit Foundation has developed an innovation joint venture business and scientific development structure to fill the gap between discovery science and the biomedical industry. The Foundation will establish scientific bridges across the discovery/preclinical development gap as a partner to independent academic and/or patient organizations to develop medicine candidates. The BioPontis Alliance Rare Disease Foundation intends to also establish a financial bridge between the cures ‘push’ of philanthropic resources and the commercial ‘pull’ of private sector.The Foundation will provide a professional drug discovery operation in which the necessary scientific expertise for each product/discovery initiative can be selected and applied to each program. It has a virtual network of contract research companies and academic institutes where development work can be conducted as well as bringing central project management and industry experienced managers to each initiative. With novel licensing practices, the Foundation financially honors the seeding contributions of originating scientists, their host institutions and/or the Patient organization partner. Licensing agreements have already been signed with over 12 leading US academic institutions/hospitals, offering the originators a pro rata share of revenues that are generated from the full intellectual property estate, thus removing many of the misalignments of interests in traditional licensing and sponsored research agreements. Focus on a single goal of creating potential treatments for patients is therefore assured across the BARD Foundation’s model.The BARD Foundation is currently setting up financing and is seeking donations for its operations. While operating for a global patient community and market, we seek contacts with potential financial, scientific and patient organization partners in Europe and other parts of the world.


Key to the clinical management of melanoma is the development of new diagnostic tools that predict individual patient prognosis and select from potential treatments those which may be effective. Identifying individual biomarkers in tumour cells to predict susceptibility to apoptotic cell death has thus far been largely unsuccessful, as apoptosis pathways show a high degree of signalling redundancy.DR_MOMP  and ApopThe combined approach is found to outperform either individual model in predicting strong and weak responses to treatment with cell death inducing drugs.This work may provide a basis for the development of improved prediction tools for clinical treatment outcomes and treatment selection in melanoma.


Critical Care, particularly the article by Gando and colleagues [We read with interest the recent issue of lleagues  about thlleagues  showed dlleagues  and the lleagues  may depeAlthough most patients were considered to be treated with ATT at the early stage of DIC in this study , those tSatoshi GandoWe appreciate the interest of Wada and colleagues in our recently published article studying the JAAM DIC scoring system in patients with severe sepsis . It is nATT: antithrombotic therapy; DIC: disseminated intravascular coagulation; ISTH: International Society of Thrombosis and Haemostasis; JAAM: Japanese Association for Acute Medicine.The authors declare that they have no competing interests.