High-resolution Functional Magnetic Resonance Imaging Reveals Configural Processing of Cars in Right Anterior Fusiform Face Area of Car Experts.

Visual object expertise correlates with neural selectivity in the fusiform face area (FFA). Although behavioral studies suggest that visual expertise is associated with increased use of holistic and configural information, little is known about the nature of the supporting neural representations. Using high-resolution 7-T functional magnetic resonance imaging, we recorded the multivoxel activation patterns elicited by whole cars, configurally disrupted cars, and car parts in individuals with a wide range of car expertise. A probabilistic support vector machine classifier was trained to differentiate activation patterns elicited by whole car images from activation patterns elicited by misconfigured car images. The classifier was then used to classify new combined activation patterns that were created by averaging activation patterns elicited by individually presented top and bottom car parts. In line with the idea that the configuration of parts is critical to expert visual perception, car expertise was negatively associated with the probability of a combined activation pattern being classified as a whole car in the right anterior FFA, a region critical to vision for categories of expertise. Thus, just as found for faces in normal observers, the neural representation of cars in right anterior FFA is more holistic for car experts than car novices, consistent with common mechanisms of neural selectivity for faces and other objects of expertise in this area.

Reliability of composite-task measurements of holistic face processing.

There is growing interest in the study of individual differences in face recognition, including one of its hallmarks, holistic processing, which can be defined as a failure of selective attention to parts. These efforts demand that researchers be aware of, and try to maximize, the reliability of their measurements. Here we report on the reliability of measurements using the composite task (complete design), a measure of holistic processing that has been shown to have relatively good validity. Several studies have used the composite task to investigate individual differences, yet only one study has discussed its reliability. We investigate the reliability of composite-task measurements in eight data sets from five different samples of subjects. In general, we found reliability to be fairly low, but there was substantial variability across experiments. Researchers should keep in mind that reliability is a property of measurements, not of a task, and think about the ways in which measurements in a particular task may be improved before embarking on individual differences research.

Non-specific effects of diphtheria-tetanus-pertussis and measles vaccinations? An analysis of surveillance data from Navrongo, Ghana.

OBJECTIVES: Studies from low-income countries have suggested that routine vaccinations may have non-specific effects on child mortality; measles vaccine (MV) is associated with lower mortality and diphtheria-tetanus-pertussis (DTP) with relatively higher mortality. We used data from Navrongo, Ghana, to examine the impact of vaccinations on child mortality. METHODS: Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow-up. Within the placebo group, we compared the mortality over the first 4 months and the full 2 years of follow-up for different vaccination status groups with different likelihoods of additional vaccinations during follow-up. The frequency of additional vaccinations was assessed among children whose vaccination card was seen at 12 and 24 months of follow-up. RESULTS: Among children with a vaccination card, more than 75% received missing DTP or MV during the first 12 months of follow-up, whereas only 25% received these vaccines among children with no vaccination card at enrollment. Children without a card at enrollment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated. The small group of children with DTP3-4 but no MV at enrollment had lower mortality than children without a card and had the same mortality as fully vaccinated children. In contrast, children with 1-2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [MRR = 1.65 (0.95, 2.87)]; compared with the fully vaccinated children, they had significantly higher mortality after 4 months [MRR = 2.38 (1.07, 5.30)] and after 2 years [MRR = 2.41 (1.41, 4.15)]. Children with 0-2 DTP doses at enrollment had higher mortality after 4 months (MRR = 1.67 (0.82, 3.43) and after 2 years [MRR = 1.85 (1.16, 2.95)] than children who had all three doses of DTP at enrollment. CONCLUSIONS: As hypothesised, DTP vaccination was associated with higher child mortality than measles vaccination. To optimise vaccination policies, routine vaccinations need to be evaluated in randomised trials measuring the impact on survival.

HIV treatment and care systems: the way forward.

This article summarizes the conclusions and recommendations from the articles in this supplement. It presents a call for greater clarity of thinking related to projections of future need for HIV treatment and care. The demands placed on HIV treatment and care services will increase for the foreseeable future while the resources available for this are likely to remain constant or to decline. This highlights the need for realistic budgeting by national governments. The key strategies that should be employed to sustain HIV treatment and care programmes in high HIV-prevalence low and middle-income countries over the coming decade include further decentralization, task shifting, and integration of HIV services with other chronic disease treatment services. At the same time, greater attention will need to be given to the provision of mental healthcare for those living with HIV; to the specific treatment needs of children, adolescents, pregnant women and older people; and to the standard collection of validated indicators of treatment outcomes within national programmes. For the considerable gains that have been achieved to be sustained, funders--both internal and external to the country concerned--need to prioritize investment in operations research to maximise the efficiency of their other investments in HIV treatment and care services.

What are the essential components of HIV treatment and care services in low and middle-income countries: an overview by settings and levels of the health system?

OBJECTIVES: To review and summarize the essential components of HIV treatment and care services in low and middle-income countries (LMICs). METHODS: Literature review and reflection on programmatic experience. FINDINGS: There is increasing recognition that the essential 'package' of HIV care must include early identification of HIV-positive people in need of care, appropriate initial and continued counselling, assessment of HIV disease stage, treatment with HAART for those who need it, monitoring while on treatment for efficacy, adherence and side-effects, detection and management of other complications of HIV infection, provision of sexual and reproductive health services as well as careful record-keeping. The impressive scale-up of HIV treatment and care services has required decentralization of service provision linked to task-shifting. But the future holds even greater challenges, as the number of people in need of HIV care continues to rise at a time when many traditional donors and governments in the most-affected regions have reduced budgets. CONCLUSION: In the long-term, the increased demand for HIV-care services can only be satisfied through increased decentralisation to peripheral health units, with the role of each type of unit being appropriate to the human and material resources available to it.HIV-care services can also naturally integrate with the care of chronic noncommunicable diseases and with closely related services like mother and child health, and thus should promote a shift from vertical to integrated programming. Staff training and support around a set of evidence-based policies and guidelines and a reliable supply of essential medicines and supplies are further essential components for a successful programme.

Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial.

BACKGROUND: The World Health Organization recommends vitamin A supplementation (VAS) at vaccination contacts after 6 mo of age to reduce mortality. However, it is unknown whether the effect of VAS is independent of vaccinations. One of the original VAS trials from Ghana had collected vaccination information. OBJECTIVE: We reanalyzed the data to explore the hypothesis that VAS reduces mortality in children who had bacille Calmette-Guérin or measles vaccine as their most recent vaccine but increased mortality when diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccine. On the basis of previous studies, we expected the effects to be strongest in girls. DESIGN: At enrollment, children aged 6-90 mo were randomly assigned to receive VAS or placebo every 4 mo for 2 y. Vaccination status was assessed at enrollment and after 1 and 2 y by reviewing the children's health cards. Lack of a health card was presumed to mean that the child had not been vaccinated. RESULTS: VAS had a beneficial effect only in children with no record of vaccination at enrollment (n = 5066); the mortality rate ratio (MRR) was 0.64 (95% CI: 0.47, 0.88) compared with 0.95 (95% CI: 0.72, 1.26) in children with one or more vaccinations (n = 6656). Among vaccinated children, the effect of VAS differed between boys (MRR: 0.74; 95% CI: 0.51, 1.08) and girls (MRR: 1.18; 95% CI: 0.84, 1.67) (P = 0.046 for interaction). VAS had a negative effect in measles-vaccinated girls who were missing one or more doses of DTP at enrollment, a group who often received DTP during follow-up (MRR: 2.60; 95% CI: 1.41, 4.80). CONCLUSIONS: The effect of VAS differed by vaccination status. This is potentially problematic because VAS is provided at vaccination contacts.

Aborting and suspending pregnancy in rural Tanzania: an ethnography of young people's beliefs and practices.

The World Health Organization estimates that 3.1 percent of East African women aged 15-44 have undergone unsafe abortions. This study presents findings regarding abortion practices and beliefs among adolescents and young adults in Tanzania, where abortion is illegal. From 1999 to 2002, six researchers carried out participant observation in nine villages and conducted group discussions and interviews in three others. Most informants opposed abortion as illegal, immoral, dangerous, or unacceptable without the man's consent, and many reported that ancestral spirits killed women who aborted clan descendants. Nonetheless, abortion was widely, if infrequently, attempted, by ingestion of laundry detergent, chloroquine, ashes, and specific herbs. Most women who attempted abortion were young, single, and desperate. Some succeeded, but they experienced opposition from sexual partners, sexual exploitation by practitioners, serious health problems, social ostracism, and quasi-legal sanctions. Many informants reported the belief that inopportune pregnancies could be suspended for months or years using traditional medicine. We conclude that improved reproductive health education and services are urgently needed in rural Tanzania.

'The man who believed he had AIDS was cured': AIDS and sexually-transmitted infection treatment-seeking behaviour in rural Mwanza, Tanzania.

Most people living with AIDS in sub-Saharan Africa have had neither a biomedical diagnosis nor antiretroviral medication, leading to the question of how individuals understand and treat AIDS. This study examined general illness, sexually-transmitted infection (STI) and AIDS treatment-seeking behaviour in rural Mwanza, Tanzania. From 1999-2002, participant observation was carried out in nine villages for a total of 158 person-weeks. Treatments were pluralistic and opportunistic, usually beginning with home remedies (western or traditional), followed by visits to traditional healers (THs) and/or health facilities (HFs). THs were sometimes preferred over HFs because of familiarity, trust, accessibility, expense, payment plans, and the perceived cause, nature and severity of the illness, e.g. only THs were believed to successfully treat bewitchment. Some people, particularly young girls, delayed or avoided seeking treatment for STIs for fear of stigma. Most STIs were attributed to natural causes, but AIDS was sometimes attributed to witchcraft. Locally available biomedical care of people with AIDS-like symptoms consisted of basic treatment of opportunistic infections. Most such individuals repeatedly visited THs and HFs, but many stopped attending HFs because they came to believe they could not be cured there. Some THs claimed to cure witchcraft-induced, AIDS-like illnesses. There is an urgent need for improved biomedical services, and TH interventions could be important in future HIV/AIDS education and care.

'She was bewitched and caught an illness similar to AIDS': AIDS and sexually transmitted infection causation beliefs in rural northern Tanzania.

HIV/AIDS programmes and interventions are more likely to succeed if they engage with local people's beliefs about AIDS causation. This study examined beliefs about general illness, sexually-transmitted infection (STI) and AIDS aetiology in rural Mwanza, Tanzania. From 1999-2002, participant observation was carried out in nine villages for a total of 158 person-weeks. Beliefs about general illness causation included God's will, chance, natural/biological, ancestral spirits, and witchcraft. STIs were generally attributed to natural causes, but beliefs about AIDS causation were more complex. Few villagers had heard of HIV, but most had heard of AIDS and understood that AIDS could be contracted through sex. A small proportion of villagers knew that such an infected person might appear healthy, but they generally believed the asymptomatic period to last only a few months after exposure; if healthy beyond that, the person was not believed to have been infected. Many people in all villages reported belief in both a 'real' (natural) AIDS, which leads to certain death, and a similar illness caused by witchcraft, which can be cured using traditional medicine. Punishment of accused witches occurs officially and informally, and this may increase with increasing AIDS deaths. There is an urgent need for culturally appropriate interventions to address HIV/AIDS causation beliefs in the region.

Absolute pitch: music and beyond.

"Perfect pitch," known in the scientific literature as "absolute pitch" (AP), is a rare phenomenon that has fascinated musicians and scientists alike for over a century. There has been a great deal of conflict in the literature between advocates of the two main theories on the etiology of AP: some believe that AP is learned early in life through intensive musical training, whereas others believe AP to be largely innate. Both theories are alike, however, in considering AP to be exclusively a musical phenomenon. We propose a paradigm shift by presenting here a new model of AP, one that is predicated on two principles: (1) that AP may be relatively independent of musical experience; and (2) that there are different types of AP, each of which can be ascribed to discrete neurobiological mechanisms. We also review data from a diverse series of experiments that were designed to test explicitly both the predictions of our model and a series of historical myths about AP. In each case, the data strongly support our model. We conclude with a general discussion on the nature of AP, the relevance of these findings for other areas of research, and future directions of study.

Key elements for successful integrated health information systems: lessons from the States.

The Genetic Services Branch, Maternal and Child Health Bureau of the Health Services and Resources Administration has provided funding to state health departments to integrate their newborn dried blood-spot screening programs with other early child health information systems since 1999. In 2001, All Kids Count conducted site visits to these grantees to identify and describe best practices in planning, developing, and implementing their integration projects. The site visits were organized around 9 key elements considered critical to the success of an information systems integration project: leadership, project governance, project management, stakeholder involvement, organizational and technical strategy, technical support and coordination, financial support and management, policy support and evaluation. Best practices for each of the key elements and 5 lessons learned were documented in Integration of Newborn Screening and Genetic Service Systems with Other Maternal & Child Health Systems: A Sourcebook for Planning and Development. The lessons learned are overarching conclusions that agencies should consider when planning and implementing integrated information systems. This article briefly describes the key elements, their best practices as implemented by states, and the lessons learned.

Recommendations for vitamin A supplementation.

In all populations where vitamin A deficiency is an important public health problem, prophylactic vitamin A supplements should be given to all infants and young children (0-59 mo), pregnant women and postpartum women within 6 wk after delivery. The efficacy of vitamin A supplementation of young children is one of the best-proven, safest and most cost-effective interventions in international public health. The International Vitamin A Consultative Group (IVACG) also recommends that three 50,000-international unit (IU) doses of vitamin A should be given at the same time as infant vaccines during the first 6 mo of life. Recent kinetic studies have indicated that this regimen will be safe and is necessary to maintain the infant's vitamin A stores, even when the mother is also given 400,000 IU within the first 6 wk after delivery. IVACG will make a decision on whether to recommend prophylactic supplementation of all women of childbearing age when the results of two large trials in Ghana and Bangladesh are available. Active corneal xerophthalmia is always a medical emergency that should be treated with immediate high-dose vitamin A. High-dose vitamin A treatment is also recommended for infants and young children with xerophthalmia, severe malnutrition or measles. Low-dose vitamin A treatment is recommended for women with night blindness and/or Bitot's spots. Given the evidence of the cost-effectiveness of vitamin A supplementation, it is essential that effective vitamin A supplementation programs are made universally available to all populations where vitamin A deficiency is an important public health problem.