Public expenditure reviews for education : the Bank's experience

Public expenditure reviews (PERs) are an excellent vehicle for analyzing important sector issues in the context of the overall economic and fiscal situation. PERs should give as accurate a picture as possible of how funds to the sector are allocated and disbursed. The education sector (like other social sectors) has specific characteristics that affect the relationship between sector and macro expenditures that can skew the impact of"sector-neutral"policies. PERs should pay explicit attention to these concerns, which include : a) the different time frames for the attainment of macroeconomic and education sector goals; b) the often substantial part of education sector spending that is outside the purview and control of the Ministry of Education; c) the low ratio of nonwage to wage expenditures within the sector's recurrent budget; and e) the large and capital-intensive foreign financing component of sector funding in many low-income countries, which is often fragmented among many donors and projects. The treatment of the education sector in PERs must be analyzed in the broader context of Bank operations. This report is the first step in a broader research agenda which includes : 1) analysis of effects of adjustment operations on the sector; and 2) development of guidelines for an improved analysis of sector-specific cost and financing issues in the macroeconomic expenditure context.Curriculum&Instruction,Primary Education,National Governance,Gender and Education,Health Monitoring&Evaluation

Persistence on prostaglandin ocular hypotensive therapy: an assessment using medication possession and days covered on therapy

BACKGROUND:Prior research has demonstrated that medication persistence (continued acquisition of therapy over time) is far from optimal among patients with glaucoma. The purpose of the present study was to evaluate persistence with prostaglandin analogs among glaucoma patients in the first therapy year using a modification of a previously published technique.METHODS:This retrospective analysis of medical and pharmacy claims database included treatment-naive patients dispensed bimatoprost, latanoprost, or travoprost between 1/1/04-12/31/04. "Index agent" was defined as the first agent filled; "index date" was defined as the fill date. Follow-up continued for 358 days. Persistence measures for first therapy year were: (1) whether last fill had sufficient days supply to achieve medication possession at year's end, and (2) number of days for which the index agent was available (days covered). Associations between index agent and medication possession (logistic regression) and days covered (linear regression) were evaluated. Models were adjusted for gender, age, and previous ocular hypertension diagnosis.RESULTS:7873 patients met inclusion criteria (bimatoprost, n = 1464; latanoprost, n = 4994; travoprost, n = 1415). Medication possession was 28% and days covered was 131 when using the unadjusted (pharmacy-reported) days supply estimates and rose to 47-48% and days covered to 228-236 days when days supply was imputed. Compared to latanoprost, odds of achieving medication possession at first year's end were 26-34% lower for bimatoprost and 34-36% lower for travoprost (p [less than or equal to] 0.001 for all comparisons). Days covered in the first year were 21-29 days lower for bimatoprost and 33-42 days lower for travoprost (p [less than or equal to] 0.001 for all comparisons). Failure to refill the index agent within the initial 90 days was a strong predictor of poor persistence. CONCLUSIONS:Persistence with ocular prostaglandin therapy remains a problem. Latanoprost users had greater odds of achieving medication possession and had more days covered during the first therapy year.The results of this study were presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, April 27 to May 1, 2008, in Fort Lauderdale, Florida, USA and at the International Society for Pharmacoeconomics and Outcomes Research 13th Annual International Meeting, May 3 to May 7, 2008, in Toronto, Canada. The research was supported by Pfizer Inc, New York, New York, USA. Assistance in styling the paper for journal submission was provided by Jane G. Murphy, PhD, of Zola Associates and was funded by Pfizer Inc, New York, New York, USA. Sonali Shah, BS Pharm, RPh, MPH provided the impetus and helpful support and advice for design of this study

Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review

Gregory Reardon1, Sameer Kotak2, Gail F Schwartz3 1Informagenics, LLC, Worthington, OH, USA; The Ohio State University College of Pharmacy, Columbus, OH, USA; 2Pfizer Inc, New York, NY, USA; 3Glaucoma Consultants, Greater Baltimore Medical Center; Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA Purpose: This study summarizes findings from objective assessments of compliance (or adherence) and persistence with ocular hypotensive agents in patients with glaucoma and ocular hypertension. Design: Systematic literature review. Methods: A PubMed and reference list search was conducted across publication years 1970–2010, using these terms and variants: "compliance," the equivalent term "adherence," and "persistence" in patients with these conditions and therapies. Summaries of selected studies were stratified by measurement method (electronic monitor, prescription fills review, medical chart review). Measures of central tendency across studies were calculated for commonly-reported compliance or persistence measures. Results: Fifty-eight articles met all inclusion/exclusion criteria: measurement of compliance–electronic monitoring (seven studies reported in 14 articles), measurement of compliance/persistence–prescription records (36 studies in 38 articles), and measurement of persistence–medical chart review (six studies in six articles). From electronic monitoring, most therapy-experienced patients took medication consistently, but ≥20% met criteria for poor compliance. From prescription records, only 56% (range 37%–92%) of the days in the first therapy year could be dosed with the medication supply dispensed over this period. At 12 months from therapy start, only 31% (range 10%–68%) of new therapy users had not discontinued, and 40% (range 14%–67%) had not discontinued or changed the initial therapy. From medical chart review, only 67% (range 62%–78%) of patients remained persistent 12 months after starting therapy. Conclusions: Evidence provided by this review suggests that poor compliance and persistence has been and remains a common problem for many glaucoma patients, and is especially problematic for patients new to therapy. The direction of empirical research should shift toward a greater emphasis on understanding of root causes and identification and testing of solutions for this problem. Keywords: persistence, adherence, glaucoma, ocular hypertension, revie

Analysis of Videotape Evidence in Police Misconduct Cases

Many evidentiary issues arise with respect to the admission of videotape evidence and computer generated simulations at trial, and the authors of this Article address these issues as they arise in police misconduct cases. Professor Schwartz provides insight into and analysis of the evidentiary principles that govern the use of video and computer simulation evidence at trial in cases where police misconduct is at issue. His discussion first addresses the issues that concern the admissibility of videotape evidence, then discusses the role of a videotape on summary judgment, and lastly, analyzes evidentiary issues with respect to computer generated simulations

Enhancement of human natural killer cells by interferon requires RNA and protein synthesis

An enriched population of human natural killer (NK) cells was obtained by density gradient centrifugation. The cytotoxic activity of these cells was enhanced by pretreatment with human leukocyte interferon (IF), and the metabolic requirements of this enhancement were examined. Augmentation of NK activity was initiated in a rapid, temperature-independent manner, requiring only a 10- to 15-min exposure to IF, and occurred at either 4 or 37[deg]C. Increased activity of the IF-treated NK effector cells was consistently observed after only 30 min of contact with target cells. Augmentation was inhibited by prior treatment of NK effector cells with actinomycin D (AD), but treatment with AD after 1 hr of IF treatment did not inhibit the IF-mediated increase in cytotoxicity, suggesting that the RNA species required for enhancement are synthesized within 1 hr of cell-IF interaction. Protein synthesis was required for at least 1 hr following cell-IF interaction, as shown by the ability of emetine and puromycin treatments to abrogate increased NK cell activity. Binding of IF to cells was independent of protein synthesis. IF-induced enhancement was unaffected by incubation of effector cells with mitomycin C either before or after IF treatment, indicating that IF acts primarily upon a population of preexisting cells of lower NK activity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23787/1/0000025.pd

Association between CD14 gene polymorphisms and disease phenotype in sarcoidosis

SummaryAlthough the etiology of sarcoidosis is unknown, genetic susceptibility has been demonstrated. Granuloma formation is a key feature in the pathophysiology of sarcoidosis and Crohn’s Disease, raising the possibility that these diseases share common pathogenetic pathways. An association between sarcoidosis and the protein “CD14”, a molecule that is part of the lipopolysaccharide (LPS) cell surface receptor complex, has been suggested.In the current study we evaluated the CD14 gene promoter 159 C→T polymorphic site and soluble CD14 levels in a cohort of 74 sarcoidosis patients compared to 85 healthy controls. We further sought to identify correlations between clinical phenotype, specific genotypes and soluble CD14 levels.We found the TT genotype to be more prevalent in the sarcoidosis patient group than in controls (p=0.03). Serum levels of soluble CD14 were higher in the sarcoidosis patients (p=0.001). Within the patient cohort, CC homozygous patients presented at an older age with milder disease as assessed with the SAC score, longer time to diagnosis, and less impairment of pulmonary function tests.Our study suggests a role of CD14 in the pathogenesis of sarcoidosis, and a clinical phenotype-genotype association. Further mechanistic and epidemiologic studies are needed in order to establish the specific role of CD14 in the etiology, pathogenesis and clinical phenotype of sarcoidosis

International vision requirements for driver licensing and disability pensions: using a milestone approach in characterization of progressive eye disease

OBJECTIVE: Low vision that causes forfeiture of driver's licenses and collection of disability pension benefits can lead to negative psychosocial and economic consequences. The purpose of this study was to review the requirements for holding a driver's license and rules for obtaining a disability pension due to low vision. Results highlight the possibility of using a milestone approach to describe progressive eye disease. METHODS: Government and research reports, websites, and journal articles were evaluated to review rules and requirements in Germany, Spain, Italy, France, the UK, and the US. RESULTS: Visual acuity limits are present in all driver's license regulations. In most countries, the visual acuity limit is 0.5. Visual field limits are included in some driver's license regulations. In Europe, binocular visual field requirements typically follow the European Union standard of ≥120°. In the US, the visual field requirements are typically between 110° and 140°. Some countries distinguish between being partially sighted and blind in the definition of legal blindness, and in others there is only one limit. CONCLUSIONS: Loss of driving privileges could be used as a milestone to monitor progressive eye disease. Forfeiture could be standardized as a best-corrected visual acuity of <0.5 or visual field of <120°, which is consistent in most countries. However, requirements to receive disability pensions were too variable to standardize as milestones in progressive eye disease. Implementation of the World Health Organization criteria for low vision and blindness would help to establish better comparability between countries

Lifetime risk of symptomatic knee osteoarthritis

Objective—To estimate the lifetime risk of symptomatic knee osteoarthritis (OA), overall and stratified by sex, race, education, history of knee injury, and body mass index (BMI). Methods—The lifetime risk of symptomatic OA in at least 1 knee was estimated from logistic regression models with generalized estimating equations among 3,068 participants of the Johnston County Osteoarthritis Project, a longitudinal study of black and white women and men age ≥45 years living in rural North Carolina. Radiographic, sociodemographic, and symptomatic knee data measured at baseline (1990–1997) and first followup (1999–2003) were analyzed. Results—The lifetime risk of symptomatic knee OA was 44.7% (95% confidence interval [95% CI] 40.0–49.3%). Cohort members with history of a knee injury had a lifetime risk of 56.8% (95% CI 48.4–65.2%). Lifetime risk rose with increasing BMI, with a risk of 2 in 3 among those who were obese. Conclusion—Nearly half of the adults in Johnston County will develop symptomatic knee OA by age 85 years, with lifetime risk highest among obese persons. These current high risks in Johnston County may suggest similar risks in the general US population, especially given the increase in 2 major risk factors for knee OA, aging, and obesity. This underscores the immediate need for greater use of clinical and public health interventions, especially those that address weight loss and self-management, to reduce the impact of having knee OA