Hb Vila Real [beta36(C2)Pro®His] in Italy: characterization of the amino acid substitution and the DNA mutation

A rare high oxygen affinity hemoglobin variant was identified in a 22-year-old male patient from Napoli (Naples, Italy) affected by erythrocytosis. A detailed structural characterization of the variant hemoglobin was carried out, both at the protein and DNA levels essentially by mass spectrometric procedures and allele-specific amplification techniques. The amino acid substitution was determined by liquid chromatography tandem mass spectrometric analysis of the tryptic digest as β36(C2)Pro → His; the corresponding DNA mutation was identified as C → A at the second position of codon 36 of the β chain (CCT → CAT). These variations identified the presence of Hb Vila Real, described only once before in a Portuguese woman. Haplotype analysis of DNA polymorphisms showed that the β-globin gene of Hb Vila Real was associated with haplotype I

Research training needs in Peruvian national TB/HIV programs

<p>Abstract</p> <p>Background</p> <p>There are few published reports of <it>research training </it>needs assessments and research training programs. In an effort to expand this nascent field of study and to bridge the gap between research and practice, we sought to systematically assess the research training needs of health care professionals working at Peruvian governmental institutions leading HIV and tuberculosis (TB) control and among senior stakeholders in the field.</p> <p>Methods</p> <p>Six institutional workshops were conducted with the participation of 161 mid-level health professionals from agencies involved in national HIV and TB control. At each workshop informants completed a structured questionnaire and participated in small and large group discussions. Additional data and institutional commitment was obtained through in-depth interviews from 32 senior managers and researchers from the Ministry of Health, academia and NGOs.</p> <p>Results</p> <p>Participants exhibited an overwhelming receptivity for additional research training, observing a gap between current levels of research training and their perceived importance. Specialized skills in obtaining funding, developing research protocols, particularly in operational, behavioral and prevention research were considered in greatest need. Beyond research training, participants identified broader social, economic and political factors as influential in infectious disease control.</p> <p>Conclusions</p> <p>The needs assessment suggests that future training should focus on operational research techniques, rather than on clinical skill building or program implementation only. Strengthening health systems not only requires additional research training, but also adequate financial resources to implement research findings.</p

A filled duration illusion in music: Effects of metrical subdivision on the perception and production of beat tempo.

This study replicates and extends previous findings suggesting that metrical subdivision slows the perceived beat tempo (Repp, 2008). Here, musically trained participants produced the subdivisions themselves and were found to speed up, thus compensating for the perceived slowing. This was shown in a synchronization-continuation paradigm (Experiment 1) and in a reproduction task (Experiment 2a). Participants also judged the tempo of a subdivided sequence as being slower than that of a preceding simple beat sequence (Experiment 2b). Experiment 2 also included nonmusician participants, with similar results. Tempo measurements of famous pianists’ recordings of two variation movements from Beethoven sonatas revealed a strong tendency to play the first variation (subdivided beats) faster than the theme (mostly simple beats). A similar tendency was found in musicians’ laboratory performances of a simple theme and variations, despite instruc-tions to keep the tempo constant (Experiment 3a). When playing melodic sequences in which only one of three beats per measure was subdivided, musicians tended to play these beats faster and to perceive them as longer than adjacent beats, and they played the whole sequence faster than a sequence without any subdivisions (Experiments 3b and 3c). The results amply demonstrate a filled duration illusion in rhythm perception and music performance: Intervals containing events seem longer than empty intervals and thus must be shortened to be perceived as equal in duration

Do Changes in the Pace of Events Affect One-Off Judgments of Duration?

Five experiments examined whether changes in the pace of external events influence people’s judgments of duration. In Experiments 1a–1c, participants heard pieces of music whose tempo accelerated, decelerated, or remained constant. In Experiment 2, participants completed a visuo-motor task in which the rate of stimulus presentation accelerated, decelerated, or remained constant. In Experiment 3, participants completed a reading task in which facts appeared on-screen at accelerating, decelerating, or constant rates. In all experiments, the physical duration of the to-be-judged interval was the same across conditions. We found no significant effects of temporal structure on duration judgments in any of the experiments, either when participants knew that a time estimate would be required (prospective judgments) or when they did not (retrospective judgments). These results provide a starting point for the investigation of how temporal structure affects one-off judgments of duration like those typically made in natural settings

Institutional influence: The role of international donors in shaping development goals, implementation and effectiveness

Doctoral dissertationPrevious research on development assistance highlights the importance of the recipient country implementing environment in mediating the impact of aid; however, little is known about the donor side of the donor-recipient relationship. This dissertation fills this gap in understanding by characterizing and assessing the role of this powerful yet neglected set of stakeholders and their influence on aid goals, implementation and effectiveness. It investigates: what are the salient dimensions along which donors differ, how these differences influence health coverage and outcomes, and what features of the domestic policy process shape which approaches donors pursue. I examine these questions using mixed methods: analyses of Congressional hearings, a comparative case study of international donors in the health sector in Peru, and quantitative analyses of the cross-national Development Assistance for Health dataset. This body of work offers three key insights for development assistance, related to recipient country ownership, donor type and goal alignment. First, the most prominent difference across donors was the extent to which they formally involved recipient country public, private and civil society sectors in problem identification, resource administration, program design, implementation and governance. The Peruvian context revealed three ownership patterns: ‘doctor knows best’, ‘empowered patient’ and ‘it takes a village’ models, highlighting the dominance of foreign actors and the central government in development activities. The cross-national data support wide variation in donor perception of the capability and roles of recipient country actors, indicating very low levels, infrequent and inconsistent allocation of budget support financing, in which funds are channeled directly through recipient institutions. Second, rather than observing systematic differences between bilateral and multilateral donors, there was greater variation among rather than across donor types. Actors along the aid implementation chain identified multiple entities to whom they were accountable. Third, although there existed considerable goal alignment among stakeholders within donor countries and between donors and recipients, there was little harmonization or coherence across these very wide sets of goals. Taken together, these findings highlight the unrealized potential to substantially expand the formal involvement of recipient country actors, and the need to prioritize among broad sets of foreign assistance and development goals.This research was funded in part by a Thomas Francis, Jr. Global Health Fellowship

Toward greater inclusion: lessons from Peru in confronting challenges of multi-sector collaboration Hacia una mayor inclusión: enseñanzas del Perú para afrontar los retos de la colaboración multisectorial

Despite widespread enthusiasm for broader participation in health policy and programming, little is known about the ways in which multi-sector groups address the challenges that arise in pursuing this goal. Based on the experience of Peru's National Multi-sector Health Coordinating Body (CONAMUSA), this article characterizes these challenges and identifies organizational strategies the group has adopted to overcome them. Comprising nine government ministries, nongovernmental organizations, academia, religious institutions, and international cooperation agencies, CONAMUSA has faced three principal challenges: 1) selecting representatives, 2) balancing membership and leadership across sectors, and 3) negotiating role transition and conflict. In response, the group has instituted a rotation system for formal leadership responsibiliti es, and professionalized management functions; created electoral systems for civil society; and developed conflict of interest guidelines. This case study offers lessons for other countries trying to configure multi-sector groups, and for donors who mandate their creation, tempering unbridled idealism toward inclusive participation with a dose of healthy realism and practical adaptation.<br>A pesar del entusiasmo generalizado por la mayor participación en las políticas y programas sanitarios, poco se sabe sobre las formas de afrontar los retos que se plantean en la consecución de este objetivo por parte de los grupos multisectoriales. Este artículo parte de la experiencia de la Coordinadora Nacional Multisectorial en Salud del Perú (CONAMUSA) para caracterizar dichos retos e identificar las estrategias de organización que ha adoptado el grupo a fin de superarlos. CONAMUSA, formada por nueve ministerios del gobierno, organizaciones no gubernamentales, instituciones académicas, organizaciones religiosas y agencias de cooperación internacional, se ha enfrentado con tres retos fundamentales: 1) elegir a los representantes, 2) encontrar el equilibrio entre la representación de los miembros y el liderazgo en los distintos sectores y 3) negociar el cambio de roles y los conflictos. Para responder a estos retos el grupo ha establecido un sistema rotatorio para las responsabilidades formales de liderazgo y ha profesionalizado las funciones de gestión, se han creado sistemas electorales para la sociedad civil y se han elaborado pautas para los conflictos de intereses. Este estudio de casos aporta lecciones para otros países que estén tratando de configurar grupos multisectoriales, así como para los organismos de ayuda que dirigen su creación, suavizando los idealismos extremos con una dosis de realismo saludable y de adaptación práctica para lograr una participación inclusiva

Hepatocellular carcinoma and non-alcoholic fatty liver disease: a dangerous liaison

e1299-Hepatocellular carcinoma and non-alcoholic fatty liver disease-a dangerous liaisonLiver cancer is one of the most frequent malignancies in the world, and its incidence rates are on the rise. Due to the global epidemic of metabolic syndrome, the incidence of hepatocellular carcinoma (HCC) secondary to non-alcoholic fatty liver disease (NAFLD) is increasing, contrary to viral forms. Characteristically NAFLD-related HCCs tend to occur at the earlier stages of liver disease, while often the diagnosis of neoplasia occurs later. They also affect an averagely older population, generally with a significantly higher number of co-morbidities. For these reasons, curative treatments are seldom applicable. Therefore, this work aims to illustrate the current state of knowledge on the NAFLD-related HCC and to underline the known pathogenetic mechanisms