All things to all people: trade-offs in pursuit of an ideal modeling tool for maternal and child health

Background

Modeling tools have potential to aid decision making for program planning and evaluation at all levels, but are still largely the domain of technical experts, consultants, and global-level staff. One model that can improve decision making for maternal and child health is the Lives Saved Tool (LiST). We examined respondents’ perceptions of LiST’s strengths and weaknesses, to identify ways in which LiST – and similar modeling tools – can adapt to be more accessible and helpful to policy makers.

Methods

We interviewed 21 purposefully sampled LiST users. First, we identified the characteristics that respondents explicitly stated, or implicitly implied, were important in a modeling tool, and then used these results to create a framework for reviewing a modeling tool. Second, we used this framework to categorize the strengths and weaknesses of LiST that respondents articulated.

Results

Two overarching qualities were important to respondents: usability and accuracy. For some users, LiST already meets these criteria: it allows for customized input parameters to increase specificity; the interface is intuitive; the assumptions and calculations are scientifically sound; and the standard metric of “additional lives saved” is understood and comparable across settings. Other respondents had different views, although their complaints were typically not that the tool is unusable or inaccurate, but that aspects of the tool could be better explained or easier to understand.

Conclusion

Government and agency staff at all levels should be empowered to use the data available to them, including the use of models to make full use of these data. For this, we need tools that meet a threshold of both accuracy, so results clarify rather than mislead, and usability, so tools can be used readily and widely, not just by select experts. With these ideals in mind, there are ways in which LiST might continue to be improved or adapted to further advance its uptake and impact.

     

Cytomegalovirus renal infection: Rare manifestation of a common post‐transplant viral infection—A case series

Cytomegalovirus is the most common viral infection in organ transplant recipients that usually affects the brain, lungs, liver, and gastrointestinal tract. Renal involvement of Cytomegalovirus (CMV) is otherwise rare. We present six cases of biopsy‐proven CMV renal infection. Five out of the six patients had detectable CMV viremia. Kidney biopsy revealed glomerulopathy in four cases and tubulointerstitial involvement in two cases. All patients exhibited decline in renal function at the onset of infection. Four out of six patients had improvement of renal function following treatment of CMV disease. To date, this is the largest case series of pure biopsy‐proven CMV renal infection described in a single center.     

Physiological responses to the Coriolis illusion: effects of head position and vision

INTRODUCTION: Changes in sympathetic outflow during Type II spatial disorientation are well documented. In this study we investigated the influences of head position and eye state (open or closed) on sympathetic activation. METHODS: There were 11 naive subjects (6 men, 5 women) who were tested in a General Aviation Trainer that accelerated at a subthreshold rate for 60 s until a constant angular velocity of 90 degrees x s(-1) was reached. Approximately 40 s later, subjects were instructed to tilt their heads along either the pitch or roll axis, stimulating a Coriolis illusion. Subjects reported the perceived intensity and duration of disorientation. Heart rate, heart rate variability, and electrodermal responses were recorded before, during, and after the period of disorientation. Each subject completed four trials, which were crossed combinations of head position and eye state. RESULTS: There were significant increases in heart rate and the electrodermal response during disorientation, but no significant change in heart rate variability. Head position had no significant effect on any physiological parameters or on the perceived intensity of disorientation; subjects reported a shorter duration of disorientation when the head was tilted into the roll versus the pitch axis. Eye state had no effect on heart rate, heart rate variability, or the intensity of disorientation, but the electrodermal response was somewhat greater, and the duration of disorientation shorter when eyes were open. CONCLUSIONS: The results suggest that head position and eye state (open or closed) do not need to be included as factors when investigating sympathetic outflow during a mild Coriolis illusion.     

Buffering the effects of violence: communication and problem‐solving skills as protective factors for adolescents exposed to violence

Although many adolescents exposed to violence evidence negative outcomes, some report few deleterious effects, indicating the presence of moderating variables. This study examined the moderating role of family communication and problem solving on positive and negative outcomes in adolescents exposed to school and neighborhood violence. Participants were 90 adolescents and their parents, who completed measures of violence exposure, psychological and behavioral functioning, and communication and problem‐solving skills. Results indicated that after controlling for demographic variables and violence exposure in the home, communication and problem‐solving skills moderated the association between school and neighborhood violence exposure and psychological distress. There was no moderation of the violence exposure‐positive outcome association. The findings suggest that family communication and problem‐solving skills might serve a protective function for adolescents, thereby decreasing psychological distress in the face of school and neighborhood violence exposure. © 2011 Wiley Periodicals, Inc.     

A phosphate-dependent shift in redox state of cerium oxide nanoparticles and its effects on catalytic properties

Cerium oxide nanoparticles (CeNPs) have shown promise as catalytic antioxidants in cell culture and animal models as both superoxide dismutase and catalase mimetics. The reactivity of the cerium (Ce) atoms at the surface of its oxide particle is critical to such therapeutic properties, yet little is known about the potential for a protein or small molecule corona to form on these materials in?vivo. Moreover Ce atoms in these active sites have the potential to interact with small molecule anions, peptides, or sugars when administered in culture or animal models. Several nanomaterials have been shown to alter or aggregate under these conditions, rendering them less useful for biomedical applications. In this work we have studied the change in catalytic properties of CeNPs when exposed to various biologically relevant conditions in?vitro. We have found that CeNPs are resistant to broad changes in pH and also not altered by incubation in cell culture medium. However to our surprise phosphate anions significantly altered the characteristics of these nanomaterials and shifted the catalytic behavior due to the binding of phosphate anions to cerium. Given the abundance of phosphate in biological systems in an inorganic form, it is likely that the action of CeNPs as a catalyst may be strongly influenced by the local concentration of phosphate in the cells and/or tissues in which it has been introduced.     

More than Freud: Clark University's Child Welfare Conference--1909

The Clarke University conferences were a seminal event in intellectual history most remembered for the lectures given by Freud on psychoanalytic theory and practice. Largely forgotten are the Child Welfare sessions that highlighted the nature/nurture debate that would foreshadow and frame social policy for the 20th century.