The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina,Jordan, and South Africa (2017–2018)

IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.     

Correspondence analysis as a screening method for indicants for clinical diagnosis

In clinical diagnosis, a patient's symptoms are observed and the probabilities of various diseases are assessed. A widely used method of formalizing this approach is independent Bayes in which symptoms are assumed to be independent conditional on the disease category. Correspondence analysis provides a method for examining the dependence between symptoms and assists in the selection of a reduced set of symptoms for the application of the independent Bayes method. This approach is illustrated on two data sets concerned with patients attending Accident and Emergency departments with chest pain and acute abdominal pain, respectively.     

Independent and court-ordered forensic neuropsychological examinations: Official statement of the National Academy of Neuropsychology

Independent forensic neuropsychological examinations are performed by neuropsychologists who are hired as independent contractors by third parties to make determinations regarding neuropsychological functioning. The responsibilities of neuropsychologists when performing independent or court-ordered forensic examinations differ from those of clinical examinations. Because neuropsychological training typically occurs in clinical contexts, the transition to forensic contexts may result in uncertainty about how to negotiate the unique responsibilities of the forensic examiner role. Neuropsychologists are responsible for maintaining the highest standards of professional practice when performing independent and court-ordered forensic examinations. To reach and maintain the highest standards of practice, neuropsychologists must understand the unique relationships with retaining parties and examinees and strive to maintain true independence and objectivity. Although a true neuropsychologist-patient relationship is not considered to exist within the context of a forensic neuropsychological evaluation, neuropsychologists have ethical responsibilities to both the retaining party and the examinee.     

Paired kidney analysis of tacrolimus and cyclosporine microemulsion-based therapy in Chinese cadaveric renal transplant recipients

Few studies used paired kidneys for comparison between tacrolimus and cyclosporine in renal transplantation. Most of the published data used whole blood trough levels for drug monitoring. However, the use of limited sampling strategy and abbreviated formula to estimate the 12-h area under concentration-time curve (AUC(0-12)) allowed better prediction of drug exposure. Sixty-six first cadaveric renal transplant recipients receiving paired kidneys were randomized to receive either tacrolimus-based (n = 33) or cyclosporine microemulsion (Neoral)-based therapies (n = 33). Abbreviated AUC(0-12) was used for drug monitoring and dose titration. Mean follow-up duration was 2.8 +/- 2 years. The patient and graft survival were comparable. Fewer incidence of acute rejection was observed in tacrolimus group (15% vs. 27.3%) though the difference was not significant (P = 0.23). The absolute value and the rate of decline of creatinine clearance were both significantly better in tacrolimus-treated patients. Prevalence of hypertension, post-transplant diabetes mellitus, infection, and malignancy were similar in both groups. Prevalence of hypercholesterolemia (11/33 vs. 4/33) and gum hypertrophy (6/33 vs. 1/33) was more common in cyclosporine-treated patients (P = 0.04 in both parameters). This was the first prospective, randomized study with paired kidney analysis showing the renal function was significantly better in tacrolimus-treated patients than in cyclosporine-treated patients.     

噪声中EP信号的提取算法及研究进展

诱发电位的提取是脑电信号处理领域的前沿课题近年来 ,通过少次甚至单次试验提取诱发电位已经成为研究的主流。本文对近年来提取诱发电位的信号处理方法进行了简要的回顾 ,并分别从小波变换、神经网络、高阶累积量、独立分量分析等四个方面对算法进行了介绍     

翻转微课在小儿传染病学教学中的设计应用

目的 探讨翻转微课模式在小儿传染病学教学中的应用效果。方法 以重庆医科大学2019级五年制儿科系199名学生为研究对象,分为14组。每组选择一个靶向课程重难点的微课主题,通过翻转课堂,制作原创微课视频,作品上传至超星平台供师生评价。结课后采用问卷调查教学效果,并对2019级与2018级五年制儿科学本科生的期末考试成绩及实习阶段出科考试成绩进行比较。采用SPSS 22.0统计学软件进行t检验、Wilcoxon秩和检验、卡方检验或Fisher精确检验。结果 学生共完成14个翻转微课作品。98.47%（193/196）的学生认为这一模式有助于掌握教学重难点;93.88%（184/196）的人认为相比既往的读书报告、文献综述等,翻转微课作品原创性和作业质量更好;94.90%（186/196）的学生更愿意接受翻转微课模式。2019级学生期末考试成绩、实习阶段出科考核理论成绩及操作成绩分别为（79.32±7.53）分、（88.68±4.87）分、（84.93±7.56）分,均高于2018级的（76.06±12.01）分、（87.15±4.09）分、（82.08±9.10）分,差异有统计学意义（P<0.001）。结论 翻转微课能有效解决小儿传染病学教学中的重难点问题,激发了学生自主学习的兴趣,有助于提高学习成绩,值得推广。     

疾控人员职业倦怠潜在剖面分析及与工作特征的关系

目的 通过对疾控(CDC)人员职业倦怠进行潜在剖面分析识别不同的职业倦怠类别,探讨工作特征各维度与职业倦怠类别间的独立效应。 方法 采用中文版职业倦怠量表(MBI-GS)、工作特征量表和自编一般资料调查表对943名疾控人员进行调查。使用潜在剖面分析方法识别疾控人员职业倦怠潜在类别,多分类Logistic回归分析探讨工作特征各维度与不同职业倦怠类别间的独立效应。 结果 疾控人员职业倦怠存在3种类别:低倦怠型(Ⅰ,54.7%)、高倦怠型(Ⅱ,24.1%)和成就感低落型(Ⅲ,21.2%)。高工作反馈、高工作意义是个体进入高倦怠型组的独立保护因素(OR=0.561;OR=0.612),高工作负荷、高工作对个体控制及情绪表达的要求是个体进入高倦怠型组的独立风险因素(OR=1.693;OR=1.770);高工作自主性是个体进入成就感低落型组的独立风险因素(OR=1.810),高工作对个体控制及情绪表达的要求是个体进入成就感低落型组的独立保护因素(OR=0.582)。 结论 疾控人员可区分出3种潜在职业倦怠类别,工作特征不同维度与潜在职业倦怠类别间存在独立效应。     

Potentiation and restitution of heart muscle contraction in rats adapted to exercise

The original amplitude of contraction of strips of myocardium determined the inotropic response to paired stimulation. The higher the initial amplitude, the lower the degree of potentiation and the higher the degree of restitution of contraction. For equal amplitude, the degree of potentiation of myocardial contraction of exercise-adapted rats was greater and the degree of restitution smaller than in the control. These changes probably reflect changes in the ion transport system of the myocardial cells.Presented by Academician of the Academy of Medical Sciences of the USSR A. M. Chernukh.Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 82, No. 7, pp. 780–782, July, 1976.     

一种用ICA去除瞬态诱发耳声发射伪迹的新方法

如何去除伪迹是瞬态诱发耳声发射检测中一个关键的问题。本研究提出了一种用ICA去除伪迹的新方法。首先用四组线性增长的刺激声在耳道内录音 ,得到的波形是瞬态诱发耳声发射和伪迹的混叠。因为伪迹和瞬态诱发耳声发射是统计独立的 ,而且伪迹随刺激声的变化线性增长 ,而瞬态诱发耳声发射随刺激声的变化非线性增长 ,逐渐趋于饱和 ,所以它们在混叠信号中具有不同的混叠系数。用ICA算法可以将各独立分量及混叠矩阵估计出来 ,伪迹是其中的一个独立分量。然后将伪迹的波形置零后再进行一次混叠 ,便达到了去除伪迹的目的。最后通过与传统的DNLR方法比较 ,证明这种方法是有效的     

Characterisation of electrocardiogram signals based on blind source separation

Blind source separation assumes that the acquired signal is composed of a weighted sum of a number of basic components corresponding to a number of limited sources. This work poses the problem of ECG signal diagnosis in the form of a blind source separation problem. In particular, a large number of ECG signals undergo two of the most commonly used blind source separation techniques, namely, principal component analysis (PCA) and independent component analysis (ICA), so that the basic components underlying this complex signal can be identified. Given that such techniques are sensitive to signal shift, a simple transformation is used that computes the magnitude of the Fourier transformation of ECG signals. This allows the phase components corresponding to such shifts to be removed. Using the magnitude of the projection of a given ECG signal onto these basic components as features, it was shown that accurate arrhythmia detection and classification were possible. The proposed strategies were applied to a large number of independent 3s intervals of ECG signals consisting of 320 training samples and 160 test samples from the MIT-BIH database. The samples equally represent five different ECG signal types, including normal, ventricular couplet, ventricular tachycardia, ventricular bigeminy and ventricular fibrillation. The intervals analysed were windowed using either a rectangular or a Hamming window. The methods demonstrated a detection rate of sensitivity 98% at specificity of 100% using nearest neighbour classification of features from ICA and a rectangular window. Lower classification rates were obtained using the same classifier with features from either PCA or ICA and a rectangular window. The results demonstrate the potential of the new method for clinical use.