Projecting Progress toward the Millennium Development Goals

The Millennium Development Goals have become the frame of reference for most of the development community: the standard by which performance will ultimately be judged. Given their importance, considerable attention has been paid as to whether these goals will be met or not. The overwhelming conclusions from such analyses are not positive. The goals will not be met. There are exceptions — education has expanded rapidly, although questions are raised about quality, and some countries, notably in South East Asia, but also South Asia to a lesser extent, have done well across the board and will meet several of the goals. But many countries, most especially in Africa, will not. The projections show that poverty will become more heavily concentrated in Africa in both relative and absolute terms. In addition, whilst urban poverty will increase, in 2015 poverty will remain a predominately rural phenomenon, with 60-70 per cent of the poor (depending on the measure) living in rural areas. But these projections are based on assumptions, including the assumption of business as usual. Various adverse shocks may result in far worse scenarios. On the other hand, more intensive promotion of propoor policies can mean that the goals might yet be realized.Millennium Development Goals, poverty, developing countries

Projecting Progress toward the Millennium Development Goals

The Millennium Development Goals have become the frame of reference for most of the development community: the standard by which performance will ultimately be judged. Given their importance, considerable attention has been paid as to whether these goals will be met or not. The overwhelming conclusions from such analyses are not positive. The goals will not be met. There are exceptions-education has expanded rapidly, although questions are raised about quality, and some countries, notably in South East Asia, but also South Asia to a lesser extent, have done well across the board and will meet several of the goals. But many countries, most especially in Africa, will not. The projections show that poverty will become more heavily concentrated in Africa in both relative and absolute terms. In addition, whilst urban poverty will increase, in 2015 poverty will remain a predominately rural phenomenon, with 60-70 per cent of the poor (depending on the measure) living in rural areas. But these projections are based on assumptions, including the assumption of business as usual. Various adverse shocks may result in far worse scenarios. On the other hand, more intensive promotion of pro-poor policies can mean that the goals might yet be realized.Millennium Development Goals, poverty projections, mortality, nutrition, poverty, education, health, inequality

Maintaining Momentum to 2015? An impact evaluation of interventions to improve maternal and child health and nutrition in Bangladesh

Bangladesh has experienced rapid fertility decline and reductions in under-five mortality over the last three decades. This impact study unravels the various factors behind these changes. Economic growth has been important, but so have major public sector interventions, notably reproductive health and immunization, supported by external assistance from the World Bank and other agencies. By contrast, nutrition began to improve only in the 1990s and remains high. The Bangladesh Integrated Nutrition Program (BINP) has played a small role, if any, in this progress, which is mainly attributable to higher agricultural productivity.Bangladesh, mortality, fertility, nutrition, health, population

What is the association between sickness absence, mortality and morbidity?

This paper examines the area-level relationships in England and Wales between sickness absence (‘incapacity benefit’), mortality and morbidity. It uses a random sample of incapacity benefit claims, and population counts of mortality and Census morbidity for local government districts. Although there is little correspondence between sickness absence claims by specific cause and mortality, all cause sickness absence has a strong relationship with all cause mortality (male r 0.74, p=0.00; female r 0.64, p=0.00) and it also has a very strong relationship with the Census measures of morbidity: LLTI (male r 0.98, p=0.00; female r 0.97, p=0.00) and ‘not good health’ (male r 0.99, p=0.00; female r 0.96, p=0.00). Incapacity benefit claims by all causes has the potential to provide an ongoing measure of area-level health in England and Wales

A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe objective of the study was to evaluate the therapeutic efficacy of nicotine nasal solution (NNS) for smoking cessation from the stopping day up to 3 months. We also followed the participants for 2 yrs after ceasing smoking to assess what happens after stopping using NNS. In a placebo-controlled, double-blind, 2 yr prospective study, 157 smokers were given either NNS, one dose containing 1 mg of nicotine per 100 microL (n=79), or placebo (n=78). Treatment was continued for up to 1 yr. One day after quitting smoking, the average number of daily doses was 11 in the group assigned NNS and 14 in the group assigned the placebo, and after 6 weeks, 14 and 6 doses, respectively, among abstinent participants still using spray. After 3 months, 65% of the abstainers in the nicotine group were still using the NNS. The abstinence rates were 51, 39 and 29% after 6 weeks, 3 and 6 months, respectively, as compared to 24, 19 and 18% in the placebo group (p=0.0003; p=0.003; p=0.050). The proportion abstinent at the 1 yr (25 vs 17%) and 2 yr follow-ups (19 vs 14%) was higher among those assigned to the nicotine than to the placebo group, but not significantly so for the numbers used in the study. In conclusion, the use of nicotine nasal spray significantly increased the abstinence rate during the first 6 months following the quitting day

Direct comparison of nick-joining activity of the nucleic acid ligases from bacteriophage T4

The genome of bacteriophage T4 encodes three polynucleotide ligases, which seal the backbone of nucleic acids during infection of host bacteria. The T4Dnl (T4 DNA ligase) and two RNA ligases [T4Rnl1 (T4 RNA ligase 1) and T4Rnl2] join a diverse array of substrates, including nicks that are present in double-stranded nucleic acids, albeit with different efficiencies. To unravel the biochemical and functional relationship between these proteins, a systematic analysis of their substrate specificity was performed using recombinant proteins. The ability of each protein to ligate 20 bp double-stranded oligonucleotides containing a single-strand break was determined. Between 4 and 37 °C, all proteins ligated substrates containing various combinations of DNA and RNA. The RNA ligases ligated a more diverse set of substrates than T4Dnl and, generally, T4Rnl1 had 50-1000-fold lower activity than T4Rnl2. In assays using identical conditions, optimal ligation of all substrates was at pH 8 for T4Dnl and T4Rnl1 and pH 7 for T4Rnl2, demonstrating that the protein dictates the pH optimum for ligation. All proteins ligated a substrate containing DNA as the unbroken strand, with the nucleotides at the nick of the broken strand being RNA at the 3'-hydroxy group and DNA at the 5'-phosphate. Since this RNA-DNA hybrid was joined at a similar maximal rate by T4Dnl and T4Rnl2 at 37 °C, we consider the possibility that this could be an unexpected physiological substrate used during some pathways of 'DNA repair'

The effect of a short educational intervention on the use of urinary catheters: a prospective cohort study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesTo assess the effectiveness of implementation of evidence-based recommendations to reduce catheter-associated urinary tract infections (CAUTIs).Prospective cohort study, conducted in 2010-12, with a before and after design.A major referral university hospital.Data were collected before (n = 244) and 1 year after (n = 255) the intervention for patients who received urinary catheters.The intervention comprised two elements: (i) aligning doctors' and nurses' knowledge of indications for the use of catheters and (ii) an educational effort consisting of three 30- to 45-minute sessions on evidence-based practice regarding catheter usage for nursing personnel on 17 medical and surgical wards.The main outcome measures were the proportion of (i) admitted patients receiving urinary catheters during hospitalization, (ii) catheters inserted without indication, (iii) inpatient days with catheter and (iv) the incidence of CAUTIs per 1000 catheter days. Secondary outcome measures were the proportion of (i) catheter days without appropriate indication and (ii) patients discharged with a catheter.There was a reduction in the proportion of inpatient days with a catheter, from 44% to 41% (P = 0.006). There was also a reduction in the proportion of catheter days without appropriate indication (P < 0.001) and patients discharged with a catheter (P = 0.029). The majority of catheters were inserted outside the study wards.A short educational intervention was feasible and resulted in significant practice improvements in catheter usage but no reduction of CAUTIs. Other measures than CAUTI may be more sensitive to detecting important practice changes.Icelandic Nurses' Association Research Fund Landspitali University Hospital Research Fund Ministry of Welfare in Icelan

Simple and efficient synthesis of 5′ pre-adenylated DNA using thermostable RNA ligase

We report a simple method of enzymatic synthesis of pre-adenylated DNA linkers/adapters for next-generation sequencing using thermostable RNA ligase from Methanobacterium thermoautotrophicum (MthRnl). Using RNA ligase for the reaction instead of the existing chemical or T4 DNA ligase-based methods allows quantitative conversion of 5′-phosphorylated single-stranded DNA (ssDNA) to the adenylated form. The MthRnl adenylation reaction is specific for ATP and either ssDNA or RNA. In the presence of Mg+2, the reaction has a pH optimum of 6.0–6.5. Unlike reactions that use T4 DNA ligase, this protocol does not require synthesis of a template strand for adenylation. The high yield of the reaction simplifies isolation and purification of the adenylated product. Conducting the adenylation reaction at the elevated temperature (65°C) reduces structural constraints, while increased ATP concentrations allow quantitative adenylation of DNA with a 3′-unprotected end

MicroRNA expression in a phosphaturic mesenchymal tumour

Phosphaturic mesenchymal tumours are a heterogeneous set of bone and soft tissue neoplasms that can cause a number of paraneoplastic syndromes such as tumour induced osteomalacia. The term phosphaturic comes from the common finding that these tumours secrete high levels of fibroblast growth factor 23 which causes renal phosphate wasting leading to hypophosphatemia. Phosphaturic mesenchymal tumours are rare and diagnosis is difficult. A very active 68 year old male presented with bone pain and muscle weakness. He was hypophosphataemic and total alkaline phosphatase was markedly elevated. The patient was placed on vitamin D supplementation but his condition progressed. In the fifth year of presentation the patient required the use of a wheelchair and described “explosive” bone pain on physical contact. Serum 1,25 dihydroxyvitamin D was low and serum fibroblast growth factor 23 was significantly elevated, raising suspicion of a phosphaturic mesenchymal tumour. A lesion was detected in his left femoral head and the patient underwent a total hip replacement. The patient displayed a rapid improvement to his condition and during a three year follow up period he returned to an active lifestyle. As molecular testing may help provide a robust diagnosis and is particularly useful in rare diseases we took a next generation sequencing approach to identify a differential expression of small RNAs in the resected tumour. Small RNAs are non-coding RNA molecules that play a key role in regulation of gene expression and can be used as specific biomarkers. We found an upregulation of miR-197. We also found a downregulation of miR-20b, miR-144 and miR-335 which is a small RNA profile typical of osteosarcoma. MiR-21, the most frequently upregulated microRNA in cancer, was downregulated. We conclude that the specific small RNA profile is typical of osteosarcoma except for the downregulation of oncogenic miR-21. Transcriptional plasticity of miR-197, which is computationally predicted to target fibroblast growth factor 23 messenger RNA, may be upregulated in a cellular effort to correct the ectopic expression of the protein