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To identify the genes up‐regulated by interleukin‐1 (IL‐1) in combination with oncostatin M (OSM) in chondrocytes that may be involved in mechanisms of cartilage repair and degradation. Gene microarray and real‐time polymerase chain reaction (PCR) experiments were performed using RNA from SW1353 chondrocytes and primary human articular chondrocytes. Sections prepared from murine joints, injected with adenovirus vectors overexpressing IL‐1 and/or OSM, were analyzed by immunohistochemistry for selected proteins.The combination of IL‐1 and OSM markedly up‐regulated the expression of various genes, including matrix metalloproteinases (MMPs), cytokines, chemokines, extracellular matrix components, and genes involved in signal transduction. Real‐time PCR confirmed a synergistic induction of several MMPs, activin A, pentraxin 3 (PTX‐3), and IL‐8. The in vivo findings further indicated that stimulation with IL‐1 plus OSM induced protein expression of activin A, PTX‐3, and KC (the murine homolog of IL‐8), as compared with the changes induced by individual cytokine treatment and unstimulated controls.The results confirm that the potent proinflammatory cytokine combination of IL‐1 plus OSM synergistically and coordinately up‐regulates many genes and several MMPs. Moreover, chondrocytes exhibit a potential repair response following this procatabolic stimulus such that the repair mechanisms are ultimately overwhelmed by degradative processes in the cartilage. This gene‐profiling study provides insight into the complex processes that mediate joint disease in the inflammatory arthritides through the coordinated expression of multiple genes. [ABSTRACT FROM AUTHOR]

The study investigates the association between tobacco and alcohol use, and the potential risk of impoverishment from borrowing and distress selling of assets for meeting costs of hospitalization in India. Data from the fifty-second round of the National Sample Survey, a representative survey of 120?942 households across India, were used to investigate the likelihood and the levels of borrowing and distress selling of assets to cover hospitalization expenditures among regular users of tobacco and/or alcohol, non-users from households where there was use, and non-users from households with no use. The data were analyzed by bivariate comparisons and multivariate logistic and ordinary least square regression.The study found a higher risk of borrowing/distress selling during hospitalization for individuals who use tobacco (OR 1.35, p?

Predicting the long-time, nonequilibrium dynamics of receptor-ligand interactions for structured proteins in a host fluid is a formidable task, but of great importance to predicting and analyzing cell-signaling processes and small molecule drug efficacies. Such processes take place on timescales on the order of milliseconds to seconds, so “brute-force” real-time, molecular or atomic simulations to determine absolute ligand-binding rates to receptor targets and over a statistical ensemble of systems are not currently feasible. In the current study, we implement on real protein systems a previously developed 3–5 hybrid molecular dynamics/Brownian dynamics algorithm, which takes advantage of the underlying, disparate timescales involved and overcomes the limitations of brute-force approaches. The algorithm is based on a multiple timescale analysis of the total system Hamiltonian, including all atomic and molecular structure information for the system: water, ligand, and receptor. In general, the method can account for the complex hydrodynamic, translational-orientational diffusion aspects of ligand-docking dynamics as well as predict the actual or absolute rates of ligand binding. To test some of the underlying features of the method, simulations were conducted here for an artificially constructed spherical protein “made” from the real protein insulin. Excellent comparisons of simulation calculations of the so-called grand particle friction tensor to analytical values were obtained for this system when protein charge effects were neglected. When protein charges were included, we found anomalous results caused by the alteration of the spatial, microscopic structure of water proximal to the protein surface. Protein charge effects were found to be highly significant and consistent with the recent hypothesis of Hoppert and Mayer (Am Sci 1999;87:518–525) for charged macromolecules in water, which involves the formation of a “water dense region” proximal to the charged protein surface followed by a “dilute water region.” We further studied the algorithm on a D-peptide/HIV capside protein system and demonstrated the algorithms utility to study the nonequilibrium docking dynamics in this contemporary problem. In general, protein charge effects, which alter water structural properties in an anomalous fashion proximal to the protein surface, were found to be much more important than the so-called hydrodynamic interaction effects between ligand and receptor. The diminished role of hydrodynamic interactions in protein systems allows for a much simpler overall dynamic algorithm for the nonequilibrium protein-docking process. Further studies are now underway to critically examine this simpler overall algorithm in analyzing the nonequilibrium protein-docking problem. Proteins 2003;52:339–348. © 2003 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The tremendous growth in state and federal correctional populations has focused greater attention on the needs of mentally ill and substance abusing inmates. Although an estimated 3–11% of prison inmates have co-occurring mental health (psychotic and major mood) disorders and substance abuse disorders, few treatment programs are described in the literature and there is little available information regarding effective treatment strategies for this population. The current study provides an integrative review of seven ‘dual diagnosis’ treatment programs that recently have been developed in state and federal prisons. Many of these have evolved from existing substance abuse treatment programs and approaches. Key program components include an extended assessment period, orientation/motivational activities, psychoeducational groups, cognitive–behavioral interventions such as restructuring of ‘criminal thinking errors’, self-help groups, medication monitoring, relapse prevention, and transition into institution or community-based aftercare facilities. Many programs use therapeutic community approaches that are modified to provide (a) greater individual counseling and support, (b) less confrontation, (c) smaller staff caseloads, and (d) cross-training of staff. Research is underway in three of the seven sites to examine the effectiveness of these new programs. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Explaining skills are among the most important skills educators possess. Those skills have also been researched in recent years. During the same period, another medium has additionally emerged and become a popular source of information for learners: online explanatory videos, chiefly from the online video sharing website YouTube. Their content and explaining quality remain to this day mostly unmonitored, as well is their educational impact in formal contexts such as schools or universities. In this study, a framework for explaining quality, which has emerged from surveying explaining skills in expert-novice face-to-face dialogues, was used to explore the explaining quality of such videos (36 YouTube explanatory videos on Kepler’s laws and 15 videos on Newton’s third law). The framework consists of 45 categories derived from physics education research that deal with explanation techniques. YouTube provides its own ‘quality measures’ based on surface features including ‘likes’, views, and comments for each video. The question is whether or not these measures provide valid information for educators and students if they have to decide which video to use. We compared the explaining quality with those measures. Our results suggest that there is a correlation between explaining quality and only one of these measures: the number of content-related comments. [ABSTRACT FROM AUTHOR]

The emergence of HIV in rural India has the potential to heighten gender inequity in a context where women already suffer significant health disparities. Recent Indian health policies provide new opportunities to identify and implement gender-equitable rural HIV services. In this review, we adapt Mosley and Chens conceptual framework of health to outline determinants for HIV health services utilization and outcomes. Examining the framework through a gender lens, we conduct a comprehensive literature review for gender-related gaps in HIV clinical services in rural India, focusing on patient access and outcomes, provider practices, and institutional partnerships. Contextualizing findings from rural India in the broader international literature, we describe potential strategies for gender-equitable HIV services in rural India, as responses to the following three questions: (1) What gender-specific patient needs should be addressed for gender-equitable HIV testing and care? (2) What do health care providers need to deliver HIV services with gender equity? (3) How should institutions enforce and sustain gender-equitable HIV services? Data at this early stage indicate substantial gender-related differences in HIV services in rural India, reflecting prevailing gender norms. Strategies including gender-specific HIV testing and care services would directly address current gender-specific patient needs. Rural care providers urgently need training in gender sensitivity and HIV-related communication and clinical skills. To enforce and sustain gender equity, multi-sectoral institutions must establish gender-equitable medical workplaces, interdisciplinary HIV services partnerships, and oversight methods, including analysis of gender-disaggregated data. A gender-equitable approach to rural Indias rapidly evolving HIV services programmes could serve as a foundation for gender equity in the overall health care system. [ABSTRACT FROM AUTHOR]

This paper analyses the effect of wealth status on care-seeking patterns and health expenditures in Afghanistan, based on a national household survey conducted within public health facility catchment areas. We found high rates of reported care-seeking, with more than 90% of those ill seeking care. Sick individuals from all wealth quintiles had high rates of care-seeking, although those in the wealthiest quintile were more likely to seek care than those from the poorest (odds ratio 2.2; 95% CI 1.6, 3.0). The nearest clinic providing the governments Basic Package of Health Services (BPHS) was the most commonly sought first provider (53% overall), especially for relatively poor households (62% in poorest vs. 42% in least poor quintile, P P < 0.0001). Financing care through selling assets/land (‘severe distress’ financing) was less common (10% overall) and did not differ by wealth status. These findings indicate that BPHS facilities are being used by the poor who live close to them, but further research is needed to assess utilization among populations in more remote areas. The high out-of-pocket health expenditures, particularly for private sector services, highlight the need to develop financial protection mechanisms in Afghanistan. [ABSTRACT FROM AUTHOR]

: Objective To identify factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan. : Design Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. : Setting Primary health care facilities in every province of Afghanistan. : Main outcome measures Composite scale measuring the quality of clinical processes in four areas: patient histories, physical examinations, communication and time spent with patient. : Results No difference in service quality was observed between male and female providers or between male and female patients, but when both the provider and patient were female quality was much higher. Overall, the quality of care at non-governmental organization and government-managed health facilities did not differ, but the poor received higher quality care at non-governmental facilities than at government facilities. Doctors provided higher quality care than lower level providers. Provision of six or more supervisory visits in the last 6 months was associated with higher service quality. Training doctors in integrated management of childhood illness was not associated with quality, but when lower level health workers received such training the quality of patient–provider communication was higher. Other recurrent inputs and geographic remoteness are not associated with the quality of care provided. : Conclusions The governments strategy to form partnerships with non-governmental organizations has led to higher quality of care provided to the poor. This represents a promising start in the reconstruction of Afghanistans health system and provides useful evidence to other countries striving to increase access to quality care for the poor. [ABSTRACT FROM AUTHOR]

: Objective To identify factors associated with client perceptions of the quality of primary care services in Afghanistan. : Design Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. : Setting Primary health care facilities in every province of Afghanistan. : Main outcome measure Numerical scale of client perceptions of service quality. : Results Clients report relatively high levels of perceived quality in Afghanistan. Most of the variation that is explained relates specifically to the patients interaction with the health worker and not to other health facility characteristics, such as cleanliness, infrastructure, service capacity and the presence of equipment or drugs. The strongest determinants of client-perceived quality identified are health worker thoroughness in taking patient histories, conducting physical examinations and communicating with patients. Being seen by a doctor and being from a household in the poorest quintile are also associated with higher perceived quality. For female patients, being seen by a female provider is associated with higher perceived quality, while for male patients time and money spent for travel to the health facility are negatively associated with perceived quality. : Conclusions Clinical quality and client perceived quality appear to be mutually reinforcing, and efforts to improve health worker performance in taking histories, conducting exams and communicating with patients are likely to increase client perceived quality in this setting. Client perceptions of service quality assume additional importance in Afghanistan, where the perceived legitimacy of the government may depend partially on its ability to convince the population that it can deliver essential health services. [ABSTRACT FROM AUTHOR]