The lung in progressive systemic sclerosis (scleroderma)

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Reconstructing Tuberculosis Services after Major Conflict: Experiences and Lessons Learned in East Timor

BACKGROUND: Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the National Tuberculosis Control Program was established, with a local non-government organisation as the lead agency. Within a few months, the TB program was operational in all districts. METHODS AND FINDINGS: Using the East Timor TB program as a case study, we have examined the enabling factors for the implementation of this type of communicable disease control program in a post-conflict setting. Stakeholder analysis was undertaken, and semi-structured interviews were conducted in 2003 with 24 key local and international stakeholders. Coordination, cooperation, and collaboration were identified as major contributors to the success of the TB program. The existing local structure and experience of the local non-government organisation, the commitment among local personnel and international advisors to establishing an effective program, and the willingness of international advisers and local counterparts to be flexible in their approach were also important factors. This success was achieved despite major impediments, including mass population displacement, lack of infrastructure, and the competing interests of organisations working in the health sector. CONCLUSIONS: Five years after the conflict, the TB program continues to operate in all districts with high notification rates, although the lack of a feeling of ownership by government health workers remains a challenge. Lessons learned in East Timor may be applicable to other post-conflict settings where TB is highly prevalent, and may have relevance to other disease control programs

Parameterized Approximation Schemes using Graph Widths

Combining the techniques of approximation algorithms and parameterized complexity has long been considered a promising research area, but relatively few results are currently known. In this paper we study the parameterized approximability of a number of problems which are known to be hard to solve exactly when parameterized by treewidth or clique-width. Our main contribution is to present a natural randomized rounding technique that extends well-known ideas and can be used for both of these widths. Applying this very generic technique we obtain approximation schemes for a number of problems, evading both polynomial-time inapproximability and parameterized intractability bounds

Changing the malaria treatment protocol policy in Timor-Leste: an examination of context, process, and actors’ involvement

In 2007 Timor-Leste, a malaria endemic country, changed its Malaria Treatment Protocol for uncomplicated falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. The change in treatment policy was based on the rise in morbidity due to malaria and perception of increasing drug resistance. Despite a lack of nationally available evidence on drug resistance, the Ministry of Health decided to change the protocol. The policy process leading to this change was examined through a qualitative study on how the country developed its revised treatment protocol for malaria. This process involved many actors and was led by the Timor-Leste Ministry of Health and the WHO country office. This paper examines the challenges and opportunities identified during this period of treatment protocol change

Increasing the use of evidence in health policy: practice and views of policy makers and researchers

Background: Better communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy. Methods: Separate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company. Results: Thirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research. Conclusion: Policy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy. © 2009 Campbell et al; licensee BioMed Central Ltd

Parameterized Inapproximability of Target Set Selection and Generalizations

In this paper, we consider the Target Set Selection problem: given a graph and a threshold value $thr(v)$ for any vertex $v$ of the graph, find a minimum size vertex-subset to "activate" s.t. all the vertices of the graph are activated at the end of the propagation process. A vertex $v$ is activated during the propagation process if at least $thr(v)$ of its neighbors are activated. This problem models several practical issues like faults in distributed networks or word-to-mouth recommendations in social networks. We show that for any functions $f$ and $\rho$ this problem cannot be approximated within a factor of $\rho(k)$ in $f(k) \cdot n^{O(1)}$ time, unless FPT = W[P], even for restricted thresholds (namely constant and majority thresholds). We also study the cardinality constraint maximization and minimization versions of the problem for which we prove similar hardness results

The tumor-associated antigen RHAMM (HMMR/CD168) is expressed by monocyte-derived dendritic cells and presented to T cells

We formerly demonstrated that vaccination with Wilms' tumor 1 (WT1)-loaded autologous monocyte-derived dendritic cells (mo-DCs) can be a well-tolerated effective treatment in acute myeloid leukemia (AML) patients. Here, we investigated whether we could introduce the receptor for hyaluronic acid-mediated motility (RHAMM/HMMR/CD168), another clinically relevant tumor-associated antigen, into these mo-DCs through mRNA electroporation and elicit RHAMM-specific immune responses. While RHAMM mRNA electroporation significantly increased RHAMM protein expression by mo-DCs, our data indicate that classical mo-DCs already express and present RHAMM at sufficient levels to activate RHAMM-specific T cells, regardless of electroporation. Moreover, we found that RHAMM-specific T cells are present at vaccination sites in AML patients. Our findings implicate that we and others who are using classical mo-DCs for cancer immunotherapy are already vaccinating against RHAMM

Malaria control in Timor-Leste during a period of political instability: what lessons can be learned?

<p>Abstract</p> <p>Background</p> <p>Malaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration.</p> <p>Objectives</p> <p>To examine the impact of political upheaval and population displacement in Timor-Leste (2006) on malaria in the country.</p> <p>Method</p> <p>Case study approach drawing on both qualitative and quantitative methods including document reviews, in-depth interviews, focus group discussions, site visits and analysis of routinely collected data.</p> <p>Findings</p> <p>The conflict had its most profound impact on Dili, the capital city, in which tens of thousands of people were displaced from their homes. The conflict interrupted routine malaria service programs and training, but did not lead to an increase in malaria incidence. Interventions covering treatment, insecticide treated nets (ITN) distribution, vector control, surveillance and health promotion were promptly organized for internally displaced people (IDPs) and routine health services were maintained. Vector control interventions were focused on IDP camps in the city rather than on the whole community. The crisis contributed to policy change with the introduction of Rapid Diagnostic Tests and artemether-lumefantrine for treatment.</p> <p>Conclusions</p> <p>Although the political crisis affected malaria programs there were no outbreaks of malaria. Emergency responses were quickly organized and beneficial long term changes in treatment and diagnosis were facilitated.</p