Equity of Inpatient Health Care in Rural Tanzania:\ud A Population- and Facility-Based Survey

To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire.Methods: Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region’s general population, using data from a previous population-based survey. Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p < 0.0001), obstetric inpatients (p < 0.0001), other inpatients (p < 0.0001), and fee-exempt inpatients (p < 0.001) were significantly different than the wealth distribution in the community population, with poorer patients underrepresented among inpatients. The wealth distribution of pediatric inpatients (p = 0.2242) did not significantly differ from the population at large. The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.\u

Harman and Lorandos’ False Critique of Meier et al.’s Family Court Study

Jennifer Harman and Demosthenes Lorandos purport to have identified numerous methodological flaws in our 2019 study of family court outcomes in cases involving abuse and alienation allegations (“FCO study”; Meier et al., 2019). At least half of the supposed flaws they itemized relate to one claim - that they were unable to access our methods and data. They treat the claimed lack of public access as evidence that our study is unreliable, while speculating about other potential flaws. Yet we note - and they acknowledge - that most of the methodological information they sought was in fact available before publication of their article. This article responds to and refutes Harman and Lorandos’ exaggerated and unfounded condemnation of our study. In addition to pointing out that the claimed lack of information would not be a methodological flaw even if true, we explain that their other criticisms are speculative, incorrect, or insignificant. We appreciate this opportunity to clarify that the important findings of the FCO study are valid and should be taken seriously by the courts and those interested in the fairness and safety of custody decisions when there are allegations of abuse and alienation

Child Custody Outcomes in Cases Involving Parental Alienation and Abuse Allegations

Arguably the most troubling aspect of justice system response to intimate partner violence is custody courts\u27 failure to protect children when mothers allege the father is abusive. Family courts\u27 errors in assessing adult and child abuse, and punitive responses to abuse allegations, have been widely documented. A significant contributor to these errors is the pseudo-scientific theory of parental alienation (PA). Originally termed parental alienation syndrome (PAS), the theory suggests that when mothers allege that a child is not safe with the father, they are doing so illegitimately, to alienate the child from the father. PA labeling often results in dismissal of women\u27s and children\u27s reports of abuse, and sometimes trumps even expert child abuse evaluations. PAS was explicitly based on negative stereotypes of mothers and has been widely discredited. The term parental alienation – while treated as distinct - is still widely used in ways that are virtually identical to PAS. Nonetheless, because PA is nominally gender neutral (and not called a scientific syndrome), it continues to have substantial credibility in court. The first goal of this project was to ascertain whether empirical evidence indicates that parental alienation is, like PAS, gender-biased in practice and outcome. Second, the study sought to explore outcomes in custody/abuse litigation by gender and by differing types of abuse. Analysis of over 2000 court opinions confirms that courts are skeptical of mothers’ claims of abuse by fathers; this skepticism is greatest when mothers claim child abuse. The findings also confirm that fathers’ cross-claims of parental alienation increase (virtually doubling) courts’ rejection of mothers’ abuse claims, and mothers’ losses of custody to the father accused of abuse. In comparing court responses when fathers accuse mothers of abuse, a significant gender difference is identified. Finally, the findings indicate that where Guardians Ad Litem or custody evaluators are appointed, unfavorable outcomes for mothers and gender differences are increased. The study relies solely on electronically available published opinions in child custody cases. It has produced an invaluable database identifying 10 years of published cases involving alienation, abuse and custody, while coding parties’ claims and defenses, outcomes, and other key factors by gender and parental status

The trouble with Harman and Lorandos’s attempted refutation of the Meier et al. Family court study

Harman and Lorandos assert that they have produced a study analyzing custody cases involving alienation allegations, which “disconfirms” the findings from our study of family court out- comes in cases involving abuse and alienation. In addition to pointing out the authors’ misrepresentation and mis-reporting of some of their findings, this Response details a series of profound flaws in their study’s design, dataset construction and variable coding, interpretations and analytic approach, as well as a series of statistical errors. The statistical analyses demonstrate that Harman and Lorandos’s five findings of a gender bias in favor of fathers are not supported by their data; the only statistically significant findings that persist after re-analysis of the correct data are consistent with the Meier et al. study. These pervasive design and methodological errors undermine both the appearance and assertion of rigor in their approach; these problems and the foundational differences in their dataset from our own disqualify their study from serving as any kind of credible test or disconfirmation of our study

Assessing cementation in the El Capitan Reef Complex and Lincolnshire Limestone using ^(13)C-^(18)O bond abundances in carbonates

The Permian El Capitan and Jurassic Lincolnshire limestones have been intensely studied for their stratigraphy, depositional setting and paleoecology. Nevertheless, the diagenetic development of these two units remains controversial, particularly with regard to diagenetic carbonate formation. Calcite cement phases have previously been characterized via δ^(18)O and δ^(13)C in order to determine precipitation temperatures and carbon sources, however, these results have lead to conflicting hypotheses

Equity of inpatient health care in rural Tanzania: a population- and facility-based survey

Abstract Objective To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire. Methods Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey. Results Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p < 0.0001), obstetric inpatients (p < 0.0001), other inpatients (p < 0.0001), and fee-exempt inpatients (p < 0.001) were significantly different than the wealth distribution in the community population, with poorer patients underrepresented among inpatients. The wealth distribution of pediatric inpatients (p = 0.2242) did not significantly differ from the population at large. Conclusion The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.http://deepblue.lib.umich.edu/bitstream/2027.42/112633/1/12939_2011_Article_251.pd

A feasibility study of a cross-diagnostic, CBT-based psychological intervention for acute mental health inpatients: Results, challenges, and methodological implications

ObjectivesAcute psychiatric inpatient wards are characterised by minimal provision of therapeutic activities and high readmission rates. Implementation of a comprehensive inpatient psychological intervention service has been recommended to overcome these problems, however whether this is feasible or effective remains unclear.MethodsThis non-randomised parallel cluster feasibility trial examined the feasibility of delivering and evaluating cross-diagnostic psychologically informed acute psychiatric care (the E-Acute Psychological Inpatient Therapy Service; EDAPTS), and gathered preliminary clinical outcome data. Patients able to consent and complete questionnaires were recruited from two adult acute wards (i.e. clusters) and received either EDAPTS plus TAU or TAU.ResultsBetween October 2015 and 2016, 96 inpatients were recruited. Findings suggested there were good data completion rates for several clinical outcomes, that several EDAPTS components were successfully delivered and that some initial effects appeared to favour the intervention, depending on outcome. However difficulties relating to the recruitment process were also identified, as well as problems relating to adequate delivery of group therapies, participant engagement in some intervention components, and data-completion at follow-up.ConclusionThese issues, and the feasibility of randomisation and rater-blinding, have important implications for the design of future trials. Overall, this study provides an important insight into the challenges and complexities of developing and evaluating a comprehensive psychological intervention service in an acute psychiatric setting

Attributing scientific and technical progress: the case of holography

Holography, the three-dimensional imaging technology, was portrayed widely as a paradigm of progress during its decade of explosive expansion 1964–73, and during its subsequent consolidation for commercial and artistic uses up to the mid 1980s. An unusually seductive and prolific subject, holography successively spawned scientific insights, putative applications and new constituencies of practitioners and consumers. Waves of forecasts, associated with different sponsors and user communities, cast holography as a field on the verge of success—but with the dimensions of success repeatedly refashioned. This retargeting of the subject represented a degree of cynical marketeering, but was underpinned by implicit confidence in philosophical positivism and faith in technological progressivism. Each of its communities defined success in terms of expansion, and anticipated continual progressive increase. This paper discusses the contrasting definitions of progress in holography, and how they were fashioned in changing contexts. Focusing equally on reputed ‘failures’ of some aspects of the subject, it explores the varied attributes by which success and failure were linked with progress by different technical communities. This important case illuminates the peculiar post-World War II environment that melded the military, commercial and popular engagement with scientific and technological subjects, and the competing criteria by which they assessed the products of science

Enzyme Replacement Therapy for Mucopolysaccharidosis IIID using Recombinant Human α-N-Acetylglucosamine-6-Sulfatase in Neonatal Mice

There is currently no cure or effective treatment available for mucopolysaccharidosis type IIID (MPS IIID, Sanfilippo syndrome type D), a lysosomal storage disorder (LSD) caused by the deficiency of α-N-acetylglucosamine-6-sulfatase (GNS). The clinical symptoms of MPS IIID, like other subtypes of Sanfilippo syndrome, are largely localized to the central nervous system (CNS), and any treatments aiming to ameliorate or reverse the catastrophic and fatal neurologic decline caused by this disease need to be delivered across the blood–brain barrier. Here, we report a proof-of-concept enzyme replacement therapy (ERT) for MPS IIID using recombinant human α-N-acetylglucosamine-6-sulfatase (rhGNS) via intracerebroventricular (ICV) delivery in a neonatal MPS IIID mouse model. We overexpressed and purified rhGNS from CHO cells with a specific activity of 3.9 × 10⁴ units/mg protein and a maximal enzymatic activity at lysosomal pH (pH 5.6), which was stable for over one month at 4 °C in artificial cerebrospinal fluid (CSF). We demonstrated that rhGNS was taken up by MPS IIID patient fibroblasts via the mannose 6-phosphate (M6P) receptor and reduced intracellular glycosaminoglycans to normal levels. The delivery of 5 μg of rhGNS into the lateral cerebral ventricle of neonatal MPS IIID mice resulted in normalization of the enzymatic activity in brain tissues; rhGNS was found to be enriched in lysosomes in MPS IIID-treated mice relative to the control. Furthermore, a single dose of rhGNS was able to reduce the accumulated heparan sulfate and β-hexosaminidase. Our results demonstrate that rhGNS delivered into CSF is a potential therapeutic option for MPS IIID that is worthy of further development