Model-based cell number quantification using online single-oxygen sensor data for tissue engineering perfusion bioreactors.

Online and non-invasive quantification of critical tissue engineering (TE) construct quality attributes in TE bioreactors is indispensable for the cost-effective up-scaling and automation of cellular construct manufacturing. However, appropriate monitoring techniques for cellular constructs in bioreactors are still lacking. This study presents a generic and robust approach to determine cell number and metabolic activity of cell-based TE constructs in perfusion bioreactors based on single oxygen sensor data in dynamic perfusion conditions. A data-based mechanistic modeling technique was used that is able to correlate the number of cells within the scaffold (R(2) = 0.80) and the metabolic activity of the cells (R(2) = 0.82) to the dynamics of the oxygen response to step changes in the perfusion rate. This generic non-destructive measurement technique is effective for a large range of cells, from as low as 1.0 × 10(5) cells to potentially multiple millions of cells, and can open-up new possibilities for effective bioprocess monitoring.

[The unfinished agenda for child survival: what role for the integrated management of childhood illness?]. / La bataille inachevée pour la survie de l'enfant: quel rôle pour la prise en charge intégrée des maladies de l'enfant?

The endorsement by the United Nations General Assembly of the Millennium Development Goals (MDG) and the growing acknowledgment by the international community that child survival is an unfinished agenda created a new momentum for rapid scaling up of effective child health interventions. In this review, the authors discuss the environment in which child health programs are being implemented and the potential role of the integrated management of childhood illness (IMCI) strategy in country efforts to achieve the MDGs. The discussion is based on the conclusions of a multi-country analytic review of the IMCI strategy conducted jointly by DFID, UNICEF, USAID, and WHO as well as the results of another multi-country evaluation coordinated by the WHO on IMCI costs, effectiveness, and impact. The article concludes on the need to increase child health investments and on the potential importance of IMCI in improving child survival. However, the MDGs may not be reached if IMCI is not implemented in conjunction with other strategies to reduce mortality during the first days of life and to strengthen the health system. The authors also stress the need to increase research on mechanisms to scale up delivery of existing public health interventions.

Integrated management of childhood illness: a summary of first experiences.

The strategy of Integrated Management of Childhood Illness (IMCI) aims to reduce child mortality and morbidity in developing countries by combining improved management of common childhood illnesses with proper nutrition and immunization. The strategy includes interventions to improve the skills of health workers, the health system, and family and community practices. This article describes the experience of the first countries to adopt and implement the IMCI interventions, the clinical guidelines dealing with the major causes of morbidity and mortality in children, and the training package on these guidelines for health workers in first-level health facilities. The most relevant lessons learned and how these lessons have served as a basis for developing a broader IMCI strategy are described.

PIP: This article delineates the experience of the first countries to adopt and implement the Integrated Management of Childhood Illness (IMCI) strategy in reducing child mortality and morbidity through the combination of improved management of common childhood illnesses and proper nutrition and immunization. The strategy includes intervention schemes involving improving the skills of health workers, the health systems, and the family and community practices. IMCI implementation proceeds in three phases. The first phase involves activities for the introduction of IMCI, in which clinical guidelines involving the review of child health policies and reorganization of services and interventions are discussed. The second phase is the initial implementation, in which each country adapts the generic IMCI clinical guidelines to suit its own epidemiological and cultural characteristics and begins implementing them in a limited number of districts. The third phase involves expanding of IMCI through increasing access to its programs and broadening the range of its interventions. In this phase, problems identified during the early implementation are addressed, priorities are identified, and strategies for expanding access while maintaining quality are developed. The introduction of the IMCI strategy helped develop and update national policies in the management of sick children. The implementation of IMCI brings together a broader range of programs and national medical expertise relating to child health. The program serves as a catalyst for the identification of substantial weaknesses in public health systems.

Linking the integrated management of childhood illness (IMCI) and health information system (HIS) classifications: issues and options.

Differences in the terms used to classify diseases in the Integrated Management of Childhood Illness (IMCI) guidelines and for health information system (HIS) disease surveillance could easily create confusion among health care workers. If the equivalent terms in the two classifications are not clear to health workers who are following the guidelines, they may have problems in performing the dual activities of case management and disease surveillance. These difficulties could adversely affect an individual's performance as well as the overall effectiveness of the IMCI strategy or HIS surveillance, or both. We interviewed key informants to determine the effect of these differences between the IMCI and HIS classifications on the countries that were implementing the IMCI guidelines. Four general approaches for addressing the problem were identified: translating the IMCI classifications into HIS classifications; changing the HIS list to include the IMCI classifications; using both the IMCI and HIS classification systems at the time of consultations; and doing nothing. No single approach can satisfy the needs of all countries. However, if the short-term or medium-term goal of IMCI planners is to find a solution that will reduce the problem for health workers and is also easy to implement, the approach most likely to succeed is translation of IMCI classifications into HIS classifications. Where feasible, a modification of the health information system to include the IMCI classifications may also be considered.

PIP: An interview was conducted among key informants to determine the effect of the differences between the Integrated Management of Childhood Illness (IMCI) and health information system (HIS) classifications on countries that were implementing the IMCI guidelines. Differences in the terms used to classify diseases in the IMCI guidelines and for the HIS disease surveillance could easily create confusion among health care workers. If the equivalent terms in the two classifications are not clear to health workers who are following the guidelines, they may have problems in performing the dual activities of case management and disease surveillance. These difficulties could adversely affect an individual's performance as well as the overall effectiveness of the IMCI strategy or HIS surveillance or both. Four general approaches for addressing the problem were identified: 1) translating the IMCI classifications into HIS classifications; 2) changing the HIS list to include the IMCI classifications; 3) using both the IMCI and HIS classification systems at the time of consultations; 4) doing nothing. No single approach can satisfy the needs of all countries. However, if the short-term or medium-term goal of IMCI planners is to find a solution that will reduce the problem for health workers and would also be easy to implement, then the method most feasible is the translation of IMCI classifications into HIS classifications. A modification of the HIS to include the IMCI classifications may also be considered.

Diarrhoeal disease morbidity and home treatment practices in Egypt.

Diarrhoeal disease is a major cause of death in children in the developing world. In developing countries a quarter of infant and childhood mortality is related to diarrhoea. The World Health Organization started the Diarrhoeal Disease Control Programme (CDD) in 1980 with the objective to decrease diarrhoeal mortality and morbidity among young children in developing countries. The aim of this study was to measure the prevalence and incidence of diarrhoeal diseases among young children and to assess the quality of home case management of diarrhoeal cases. Particular emphasis was put on the assessment of drug use during diarrhoea. The survey included also the assessment of breast feeding practices. Geographically the survey was limited to two governorates, Dakahlia and Gharbia, in lower Egypt, which have the largest population (7.12 million) and were thought to be representative of lower Egypt. The total sample size was 11032. Seasonally adjusted diarrhoea incidence was 3.6 episodes per child under five years of age per year. This means a minimum estimate of 30 million cases annually in Egypt. Although the majority of the caretakers knew of Oral Rehydration Salts (ORS), only 22% of cases with diarrhoea in the last 24 h received ORS. 54% of cases had received drugs, and many of the children with diarrhoea received more than one drug. The source of drug prescription was most often a private doctor and the use of drugs was common among government doctors and health workers. The high proportion of cases treated with drugs, other than ORS, is the major problem in diarrhoeal home case management in Egypt. The message of ORS has penetrated into the general population well, but the practices of health professionals have not changed. To improve the situation further, training of health workers in correct case management is needed. Paediatric forms of symptomatic antidiarrhoeal drugs should also be withdrawn from the market.

PIP: In August 1992, interviews were conducted with 9711 caretakers, usually mothers, living in Kakahlia and Gharbia governorates, Egypt, so researchers could determine the prevalence and incidence of diarrheal diseases among 11,032 children aged under 5 years and examine the quality of home treatment practices among 958 children who had had diarrhea in the previous 24 hours. The point prevalence of diarrhea for the previous 24 hours was 8.7% (958 children). 4.1% of these diarrhea cases had had persistent diarrhea (14 days in duration). 3.8% had had blood in the stool. Only 2 of the 36 children with blood in the stool had received an antibiotic or an antiparasitic drug. 21.9% had received oral rehydration solution (ORS). 77.1% of their caretakers prepared ORS correctly. The mean quantity of ORS was 351 ml/child, probably too little for effective rehydration. 95.8% of caretakers of all cases of diarrhea in the last 24 hours were familiar with ORS. The 2-week diarrheal incidence rate was 20.4%. The seasonally adjusted incidence rate was 3.6 episodes/child/year. Rural areas had higher incidence and prevalence rates than urban areas (2-weeks incidence, 22.7% vs. 16.9%; point prevalence, 10% vs. 6.6%). 96.3% of lactating mothers continued to breast feed during their child's diarrhea episode. 69.8% of diarrhea cases receiving solid or semi-solid foods before the illness received the same amount during the diarrhea episode. Only 24.4% of cases who received fluids other than breast milk before diarrhea received more fluids during diarrhea. 54.2% of all cases were given at least one drug during the diarrhea episode; more than 50% of these were given more than one drug. 17.6% received ORS and drugs. Only 5% received ORS alone. A private physician and a government physician or health worker, respectively, prescribed a drug for 50% and 23.3% of cases who were given drugs. A pharmacy provided 90.4% of the drugs. The continued breast feeding rate (i.e., any breast feeding in last 24 hours) was 78.2% among children aged 12-15 months and 48.9% among those aged 20-23 months. Training of health workers in correct case management is needed.

The value of maternal height as a risk factor of dystocia: a meta-analysis.

Ten publications and studies on the relation between maternal height and the risk of dystocia due to cephalopelvic disproportion (CPD) are analysed. The rate of Caesarean sections was chosen as the CPD indicator. When maternal height is presented in percentiles, curves can be superimposed, and sensitivities and specificities of the various studies may be analysed together. One biased study was excluded; the remaining 9 were pooled and regression lines calculated for sensitivity (Se) and specificity (Sp) of the entire set of points. The resulting model, i.e. Se = 10.9 + 1.99 Y and Sp = 99.9 - 0.99 Y, permits easy calculation of the expected sensitivity and specificity for each percentile Y. When the frequency of Caesarean section due to CPD is known, positive and negative predictive values can also be calculated. The proposed formulas can also be used to determine confidence intervals. The findings in terms of the sensitivity and specificity of low maternal height as a risk factor for dystocia indicate that 1 out of 5 pregnant women would have to be referred for further investigation to identify half of the cases of mechanical dystocia necessitating Caesarean section. The predictive value for a Caesarean rate of 2% (a value often seen in developing countries) for this 20th percentile would be only 5%. Practical ways of choosing a reference criterion are suggested. A two-track strategy (antenatal check-ups and community monitoring) is proposed.