American journal of orthodontics最新文献

Global declines in donor funding present a substantial threat to development financing in low- and middle-income countries. In Nigeria, the resources required to achieve states' health goals surpass existing government budgets and available donor funding, a shortfall that incentivizes efforts to expand nondonor sources of financing, including public-driven cofinancing models. The Challenge Initiative (TCI) in Nigeria implements a demand-led model wherein 13 state governments requested technical support from TCI to adapt and scale up high-impact family planning and reproductive health (FP/RH) interventions. TCI provides a blend of technical coaching and financial support through the Challenge Fund, a mechanism designed to incentivize domestic funding for FP programming. To qualify as a recipient, states must demonstrate political will, financial commitment, and potential for impact at scale. However, state financial commitments alone are insufficient to guarantee the successful implementation of health scale-up initiatives. For this reason, the TCI Nigeria cofinancing strategy builds positive relations among key actors (donors, implementers, and government) and improves accountability in FP/RH financing. Although there are several donor-led cofinancing primary health care initiatives in Nigeria, such as the Saving One Million Lives Performance for Results project and Basic Healthcare Provision Fund, little is known about the role of government in driving the process specifically for improving domestic FP/RH financing. In Nigeria, state governments, in collaboration with TCI, developed a cofinancing model that helps states meet their FP/RH financing commitments. To promote effectiveness and sustainability, this model operates within an existing state structure, the State Annual Operation Plan. TCI's cofinancing model motivates continuous improvement in state governments' fiscal capacity, using a framework to measure, track, and reward financial and nonfinancial state commitments. Although the model is not a replacement for existing program tracking and monitoring tools, it helps subnational governments better harness their resources to accelerate improvement in FP/RH outcomes.

Purpose: The activities of a coordinating center pharmacy (CCP) supporting a multicenter, international clinical trial are described.

Summary: Serving in a research support role comparable to that of a commercial clinical trial supply company, a CCP within the Johns Hopkins Hospital Investigational Drug Service (JHH IDS) uses its management expertise and infrastructure to support multicenter trials, such as the recently completed Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage, Phase III (CLEAR III) trial. The role of the CCP staff in supporting the CLEAR III trial was overall investigational product (IP) management through coordination of IP-related operations to ensure high-quality care for study participants at study sites in the United States and abroad. For the CLEAR III trial, the CCP coordinated IP supply activities; provided education to site pharmacists; developed study-specific documents, including pharmacy manuals; communicated with trial stakeholders, including third-party IP distributors; monitored treatment assignments; and performed quality assurance monitoring to ensure compliance with institutional, state, federal, and international regulations regarding IP procurement and storage. Acting as a CCP for a multicenter international study poses a number of operational challenges while providing opportunities for the CCP to contribute to research of global importance and enrich the skill sets of its personnel.

Conclusion: The development and implementation of the CCP at JHH IDS for the CLEAR III trial included several responsibilities, such as IP supply management, communication, and database, regulatory, and finance management.

The purpose of this study was to examine agitated behaviors of people with dementia relative to time and activity variables. This descriptive study involved a sample of 420 units of 30-minute time periods collected in a long-term care setting. The highest agitation scores occurred during the evening (F = 3.93, p = 0.009). Agitation scores were significantly higher when the same level of activity was sustained for 1.5 hours or longer (p = 0.000). This study suggests that future examination is needed of an intervention to control activity schedules so that there is a balance between sensory-stimulating and sensory-calming activities.

LA7 rat mammary tumor cells stimulate the proliferation, in culture, of three normal epithelial cell types, namely mouse mammary, rat mammary, and mouse thymic cells. Gap-junctional communication between LA7 feeders and mouse mammary cells was demonstrated by microinjection of lucifer yellow, which traveled from LA7 to the surrounding mouse mammary cells. The amount of 3H-uridine exchange between feeder and recipient mouse mammary, rat mammary, and mouse thymus cells correlated with the growth rate induced by the feeders. Cells of the Madin Darby canine kidney (MDCK) line, which do not appreciably stimulate mouse mammary cell growth when used as feeder cells, also exchange little 3H-uridine with them. Expression of connexins Cx43, 32, and 26 was studied in all these cell lines and strains by immunocytochemistry. Mouse mammary cells expressed Cx26, and a few mouse thymic cells expressed Cx32. LA7, mouse mammary, mouse thymic, and rat mammary cells all expressed easily detectable amounts of the gap-junction protein Cx43, in contrast to MDCK cells, which expressed only a hint of the protein. These results suggest that gap junctions composed of Cx43 are those by which the normal epithelial cells communicate with the LA feeders. Thus, the ability of feeder cells to stimulate proliferation in recipients correlates with the expression of Cx43 in both members of the feeder/recipient pair and the capacity to form functional gap junctions between these cells.