67 research outputs found
The Effect of Maternal Tetanus Immunization on Children’s Schooling Attainment in Matlab, Bangladesh: Follow-up of a Randomized Trial
We investigate the effects of ante-natal maternal vaccination against tetanus on the schooling attained by children in Bangladesh. Maternal vaccination prevents the child from acquiring tetanus at birth through blood infection and substantially reduces infant mortality and may prevent impairment in children who would otherwise acquire tetanus but survive. We follow up on a 1974 randomized trial of maternal tetanus toxoid, looking at outcomes for children born in the period 1975-1979. We find significant schooling gains from maternal tetanus vaccination for children whose parents had no schooling, showing a large impact on a small number of children.Vaccination, tetanus, schooling, education, Bangladesh
"Põe o pé na terra fria": (re)construções lúdicas da 'cultura popular' em Curitiba
Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e CiĂŞncias Humanas, Programa de PĂłs-Graduação em Antropologia Social, FlorianĂłpolis, 2016.Cultura popular brasileira e seus brinquedos sĂŁo categorias que vem sendo investigadas por artistas e pesquisadores dentro e fora do meio acadĂŞmico. Neste contexto, algumas expressões da cultura popular sĂŁo deslocadas e traduzidas para novas paisagens em que os brinquedos populares sĂŁo reconstruĂdos. Ao traçar a (re)construção de certas práticas lĂşdicas recontextualizadas, este trabalho busca refletir sobre como a categoria cultura popular vem sendo entendida e traduzida por um grupo de artistas e pesquisadores da cidade de Curitiba e como os sujeitos brincantes vem incorporando seus 'modos de fazer' caracterĂsticos. AtravĂ©s da etnografia realizada, este trabalho pretende abordar questões sobre como práticas brincantes sĂŁo enquadradas, articuladas, transmitidas, reconstruĂdas e transformadas em outros contextos, de paisagens e significações tĂŁo distintas que trazem em seu ato tensões e conflitos para alĂ©m da brincadeira.Abstract : Brazilian popular culture and their plays are categories that have been investigated by artists and researchers in and outside Academy. Around this context, some expressions of popular culture are displaced and translated into new landscapes in which the plays are reconstructed. From some examples about (re)construction of playful recontextualizad practices, this work reflects on how the popular culture category has been understood and translated by a group of artists and researchers from Curitiba and how the players incorporate their characteristic way to do it. Through ethnography, this work intends to hold questions about how plays are framed, linked, transmitted and rebuilt in other contexts, of different landscapes and meanings that take tensions and conflicts beyond play
Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis
AbstractVaccination coverage rates often mask wide variation in access, uptake, and cost of providing vaccination. Financial incentives have been effective at creating demand for social services in a variety of settings. Using methods of extended cost-effectiveness analysis, we compare the health and economic implications of three different vaccine delivery strategies for measles vaccination in Ethiopia: i) routine immunization, ii) routine immunization with financial incentives, and iii) mass campaigns, known as supplemental immunization activities (SIAs). We examine annual birth cohorts of almost 3,000,000 births over a ten year period, exploring variation in these outcomes based on economic status to understand how various options may improve equity. SIAs naturally achieve higher levels of vaccine coverage, but at higher costs. Routine immunization combined with financial incentives bolsters demand among more economically vulnerable households. The relative appeal of routine immunization with financial incentives and SIAs will depend on the policy environment, including short-term financial limitations, time horizons, and the types of outcomes that are desired. While the impact of financial incentives has been more thoroughly studied in other policy arenas, such as education, consideration of this approach alongside standard vaccination models such as SIAs is timely given the dialog around measles eradication
Understanding and valuing the broader health system benefits of Uganda’s national Human Resources for Health Information System investment
Background\ud
To address the need for timely and comprehensive human resources for health (HRH) information, governments and organizations have been actively investing in electronic health information interventions, including in low-resource settings. The economics of human resources information systems (HRISs) in low-resource settings are not well understood, however, and warrant investigation and validation.\ud
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Case description\ud
This case study describes Uganda’s Human Resources for Health Information System (HRHIS), implemented with support from the US Agency for International Development, and documents perceptions of its impact on the health labour market against the backdrop of the costs of implementation. Through interviews with end users and implementers in six different settings, we document pre-implementation data challenges and consider how the HRHIS has been perceived to affect human resources decision-making and the healthcare employment environment.\ud
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Discussion and evaluation\ud
This multisite case study documented a range of perceived benefits of Uganda’s HRHIS through interviews with end users that sought to capture the baseline (or pre-implementation) state of affairs, the perceived impact of the HRHIS and the monetary value associated with each benefit. In general, the system appears to be strengthening both demand for health workers (through improved awareness of staffing patterns) and supply (by improving licensing, recruitment and competency of the health workforce). This heightened ability to identify high-value employees makes the health sector more competitive for high-quality workers, and this elevation of the health workforce also has broader implications for health system performance and population health.\ud
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Conclusions\ud
Overall, it is clear that HRHIS end users in Uganda perceived the system to have significantly improved day-to-day operations as well as longer term institutional mandates. A more efficient and responsive approach to HRH allows the health sector to recruit the best candidates, train employees in needed skills and deploy trained personnel to facilities where there is real demand. This cascade of benefits can extend the impact and rewards of working in the health sector, which elevates the health system as a whole
Organizational and Environmental Context for Including Advanced Practice Providers in UPMC Hospitalist Models
This study qualitatively examines the environmental and organizational context driving the implementation of advanced practice providers (APPs) in hospital medicine at UPMC. We utilized a comparison case study methodology, including field observation and semi-structured interviews at two hospital medicine programs. We identified three distinct models of APPs in hospital medicine, including the Team Approach, Divide and Conquer, and a Hybrid model, and linked the evolution of these models to contextual factors. Our findings present unique insight into the roles of APPs on UPMC hospital medicine teams. We show that environmental pressures, organizational initiatives, and clinician experience can influence APP roles
Breakdown in the Organ Donation Process and Its Effect on Organ Availability
Background. This study examines the effect of breakdown in the organ donation process on the availability of transplantable organs. A process breakdown is defined as a deviation from the organ donation protocol that may jeopardize organ recovery. Methods. A retrospective analysis of donation-eligible decedents was conducted using data from an independent organ procurement organization. Adjusted effect of process breakdown on organs transplanted from an eligible decedent was examined using multivariable zero-inflated Poisson regression. Results. An eligible decedent is four times more likely to become an organ donor when there is no process breakdown (adjusted OR: 4.01; 95% CI: 1.6838, 9.6414; < 0.01) even after controlling for the decedent's age, gender, race, and whether or not a decedent had joined the state donor registry. However once the eligible decedent becomes a donor, whether or not there was a process breakdown does not affect the number of transplantable organs yielded. Overall, for every process breakdown occurring in the care of an eligible decedent, one less organ is available for transplant. Decedent's age is a strong predictor of likelihood of donation and the number of organs transplanted from a donor. Conclusion. Eliminating breakdowns in the donation process can potentially increase the number of organs available for transplant but some organs will still be lost
Breakdown in the Organ Donation Process and Its Effect on Organ Availability
Background. This study examines the effect of breakdown in the organ donation process on the availability of transplantable organs. A process breakdown is defined as a deviation from the organ donation protocol that may jeopardize organ recovery. Methods. A retrospective analysis of donation-eligible decedents was conducted using data from an independent organ procurement organization. Adjusted effect of process breakdown on organs transplanted from an eligible decedent was examined using multivariable zero-inflated Poisson regression. Results. An eligible decedent is four times more likely to become an organ donor when there is no process breakdown (adjusted OR: 4.01; 95% CI: 1.6838, 9.6414; P<0.01) even after controlling for the decedent’s age, gender, race, and whether or not a decedent had joined the state donor registry. However once the eligible decedent becomes a donor, whether or not there was a process breakdown does not affect the number of transplantable organs yielded. Overall, for every process breakdown occurring in the care of an eligible decedent, one less organ is available for transplant. Decedent’s age is a strong predictor of likelihood of donation and the number of organs transplanted from a donor. Conclusion. Eliminating breakdowns in the donation process can potentially increase the number of organs available for transplant but some organs will still be lost
User-centered design and evaluation of RxMAGIC: A Prescription Management And General Inventory Control system for free clinic dispensaries
Medication management is a complex and expensive multistage process that covers the prescribing and ordering, order communication, dispensing, administering, and monitoring and use of prescription medications. While challenges in medication management are ubiquitous across all settings, they can be particularly exacerbated in a free clinic that serves a medically vulnerable population. These patients suffer from financial constraints, poor health literacy, multiple chronic conditions, and medication non-adherence. Clinical pharmacists play an integral role in the provision of healthcare services to these patients and could benefit from the use of medication management information technology (MMIT) to provide efficiencies in the tracking, provision, and use of medications. While MMITs exist, they are not designed to support the unique needs of pharmacists in these settings
Qualitative study of the impact of an authentic electronic portfolio in undergraduate medical education
Background
Portfolios are increasingly used in undergraduate and postgraduate medical education. Four medical schools have collaborated with an established NHS electronic portfolio provider to develop and implement an authentic professional electronic portfolio for undergraduate students. We hypothesized that using an authentic portfolio would have significant advantages for students, particularly in familiarizing them with the tool many will continue to use for years after graduation. This paper describes the early evaluation of this undergraduate portfolio at two participating medical schools.
Methods
To gather data, a questionnaire survey with extensive free text comments was used at School 1, and three focus groups were held at School 2. This paper reports thematic analysis of students’ opinions expressed in the free text comments and focus groups.
Results
Five main themes, common across both schools were identified. These concerned the purpose, use and acceptability of the portfolio, advantages of and barriers to the use of the portfolio, and the impacts on both learning and professional identity.
Conclusions
An authentic portfolio mitigated some of the negative aspects of using a portfolio, and had a positive effect on students’ perception of themselves as becoming past of the profession. However, significant barriers to portfolio use remained, including a lack of understanding of the purpose of a portfolio and a perceived damaging effect on feedback
Immune signatures predict development of autoimmune toxicity in patients with cancer treated with immune checkpoint inhibitors.
BACKGROUND
Immune checkpoint inhibitors (ICIs) are among the most promising treatment options for melanoma and non-small cell lung cancer (NSCLC). While ICIs can induce effective anti-tumor responses, they may also drive serious immune-related adverse events (irAEs). Identifying biomarkers to predict which patients will suffer from irAEs would enable more accurate clinical risk-benefit analysis for ICI treatment and may also shed light on common or distinct mechanisms underpinning treatment success and irAEs.
METHODS
In this prospective multi-center study, we combined a multi-omics approach including unbiased single-cell profiling of over 300 peripheral blood mononuclear cell (PBMC) samples and high-throughput proteomics analysis of over 500 serum samples to characterize the systemic immune compartment of patients with melanoma or NSCLC before and during treatment with ICIs.
FINDINGS
When we combined the parameters obtained from the multi-omics profiling of patient blood and serum, we identified potential predictive biomarkers for ICI-induced irAEs. Specifically, an early increase in CXCL9/CXCL10/CXCL11 and interferon-Îł (IFN-Îł) 1 to 2Â weeks after the start of therapy are likely indicators of heightened risk of developing irAEs. In addition, an early expansion of Ki-67+ regulatory TÂ cells (Tregs) and Ki-67+ CD8+ TÂ cells is also likely to be associated with increased risk of irAEs.
CONCLUSIONS
We suggest that the combination of these cellular and proteomic biomarkers may help to predict which patients are likely to benefit most from ICI therapy and those requiring intensive monitoring for irAEs.
FUNDING
This work was primarily funded by the European Research Council, the Swiss National Science Foundation, the Swiss Cancer League, and the Forschungsförderung of the Kantonsspital St. Gallen
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