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Purchasing health care from the private sector:A primer for middle-income countries in the WHO European Region
Get PDFThe decision to include private health-care providers (PHPs) in state financed service delivery networks can be motivated by a number of potential benefits, such as stimulating choice and competition, harnessing the disciplines of private ownership and management and increasing capacity. By making this decision, state authorities limit their ability to influence the network's structure and providers' conduct and performance. This loss of control can generate risks to equity of access, financial protection, efficiency and quality of care – particularly if regulatory gaps enable PHPs to engage in adverse behaviours, such as inappropriate self-referrals, abuse of dual practice and patient selection. In principle, stronger regulations can mitigate these risks. However, in reality, these are often absent or inadequate in the middle-income countries of the WHO European Region. As a result, purchasing policies – including eligibility criteria, contractual specifications and monitoring arrangements – must be strong enough to ensure that PHPs have appropriate incentives and are held accountable for their conduct and performance. This report draws on experiences from Member States in the Region, including many middle income countries, to provide guidance on how to achieve these outcomes
Women's football and political propaganda in North Korea:Socialist patriotism, communist feminism, and state patriarchy
Get PDFIn 2024, the North Korean women's football team achieved a significant milestone. This study concerns how the despotic communist regime in this country exploits these sporting triumphs to promulgate its ruling ideologies. It examines political messages embedded in the North Korean newspaper coverage of women’s football. The communist state is surely a footballing powerhouse. Their production and articulation of political propaganda through sports is second to none in the world. From the reinforcement of socialism to the idolization of the political leader, the case of North Korea offers the prototype of the intersection between politics and football under authoritarian regime
Comparative Analysis of CRISPR/Cas9 Delivery Methods in Marine Teleost Cell Lines
Get PDFGene editing technologies such as CRISPR/Cas9 have revolutionized functional genomics, yet their application in marine fish cell lines remains limited by inefficient delivery. This study compares three delivery strategies-electroporation, lipid nanoparticles (LNPs), and magnetofection using gelatin-coated superparamagnetic iron oxide nanoparticles (SPIONs)-for CRISPR/Cas9-mediated editing of the ifi27l2a gene in DLB-1 and SaB-1 cell lines. We evaluated transfection and editing efficiency, intracellular Cas9 localization, and genomic stability of the target locus. Electroporation achieved up to 95% editing in SaB-1 under optimized conditions, but only 30% in DLB-1, which exhibited locus-specific genomic rearrangements. Diversa LNPs enabled intracellular delivery and moderate editing (~25%) in DLB-1 but yielded only minimal editing in SaB-1, while SPION-based magnetofection resulted in efficient uptake but no detectable editing, highlighting post-entry barriers. Confocal imaging and fluorescence correlation spectroscopy suggested that nuclear localization and Cas9 aggregation may influence editing success, highlighting the importance of intracellular trafficking in CRISPR/Cas9 delivery. Our findings demonstrate that CRISPR/Cas9 delivery efficiency is cell line-dependent and governed by intracellular trafficking and genomic integrity. These insights provide a practical framework for optimizing gene editing in marine teleosts, advancing both basic research and selective breeding in aquaculture.</p
Polygenic pathways shape white matter vulnerability to Alzheimer's disease-related pathophysiological changes
Get PDFBACKGROUND: The accumulation of amyloid-β 1-42 (Aβ 1-42) peptides and phosphorylated-Tau 181 (p-Tau 181) tangles from the preclinical stages of Alzheimer's disease (AD) has led to a biological definition of the disease. However, among Aβ 1-42-positive individuals, cognitive decline onset varies, and some never develop symptoms. Genetic influences on molecular pathways and their interactions with proteinopathy may underlie this heterogeneity. Leveraging data from a large sample of cognitively intact older adults in the European Prevention of Alzheimer Dementia (EPAD) cohort, we examined how AD-related pathophysiological changes (i.e., Aβ 1-42 and p-Tau 181), polygenic pathways and their interaction are associated with WM micro- and macrostructural properties. METHODS: We selected 803 individuals (mean age = 64.7 ± 7.3 years, 458 [57.0%] females, 275 [34.2%] APOE-ε4 carriers) with CSF-Aβ 1-42 and p-Tau 181 measurements available, full genotyping, and structural and diffusion MRI. Polygenic risk scores (PRSs) were computed using 85 AD-related genetic variants. These were mapped to their corresponding genes and, after excluding those belonging to the APOE locus, clustered by function into six pathway-specific PRSs (i.e., immune activation, signal transduction, inflammation, lipid, amyloid, and clearance pathways). Diffusion MRIs were processed through the fixel-based analysis framework to derive fiber density (FD) and fiber cross-section (FC) metrics, which were averaged within WM tracts. Linear models assessed the effects of AD-related pathophysiological changes, global and pathway-specific PRSs, and their interactions on FD and FC at both the tract and fixel levels. Models were corrected for multiple comparisons. RESULTS: P-Tau 181 was primarily associated with greater FD. The lipid pathway was associated with greater FD and FC, with these effects predominantly occurring in the left hemisphere, consistent with evidence of hemispheric dominance. The clearance pathway moderated the effect of Aβ 1-42 on FD, with a positive slope in A + compared to A- individuals. The immune activation pathway moderated the effect of p-Tau 181 on FD, with a negative slope in T + compared to T- individuals. CONCLUSIONS: Pathway-specific genetic vulnerability to AD is associated with alterations in WM tracts both directly and by moderating the effects of AD-related pathophysiological changes. AD-associated genetic risk should be integrated into the AD diagnostic framework to enable targeted screening and intervention for future preclinical trials aimed at specific biological pathways.</p
Inclusive Strategies for Children With Developmental Disabilities in Mainstream Classrooms in African Countries:A Systematic Review of Stakeholder Experiences, Attitudes, and Perspectives
Get PDFAfrican children with developmental disabilities (DD), including autism and intellectual disability, are often excluded from mainstream schools. We systematically reviewed 28 qualitative studies conducted in Africa, aiming to synthesize stakeholders' perspectives on inclusive teaching strategies for supporting children with DD in mainstream classes. Six interrelated themes were developed using thematic analysis. Teachers strived to meet learners' needs through teaching and task adaptations (Theme 1) and provide targeted support, reinforcement, and feedback (Theme 2). Teachers' inclusive pedagogies, while sometimes creating divisions, often reflected a whole-class approach (Theme 3), especially in promoting inclusive environments (Theme 4) and engaging teaching (Theme 5). Authors of reviewed studies often discussed how teachers' strategies fit in with the evidence base (Theme 6). While teachers' inclusion efforts appeared progressive, they were mostly based on Western pedagogies and challenged by limited resources and training. Training efforts based on indigenous pedagogies could improve use and outcomes of inclusive strategies.</p
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