| 1. |
- Bukachi, Salome A, et al.
(författare)
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Healthcare priority setting in Kenya : a gap analysis applying the accountability for reasonableness framework
- 2014
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 29:4, s. 342-361
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Tidskriftsartikel (refereegranskat)abstract
- In resource-poor settings, the accountability for reasonableness (A4R) has been identified as an important advance in priority setting that helps to operationalize fair priority setting in specific contexts. The four conditions of A4R are backed by theory, not evidence, that conformance with them improves the priority setting decisions. This paper describes the healthcare priority setting processes in Malindi district, Kenya, prior to the implementation of A4R in 2008 and evaluates the process for its conformance with the conditions for A4R. In-depth interviews and focus group discussions with key players in the Malindi district health system and a review of key policy documents and national guidelines show that the priority setting process in the district relies heavily on guidelines from the national level, making it more of a vertical, top-down orientation. Multilateral and donor agencies, national government, budgetary requirements, traditions and local culture influence the process. The four conditions of A4R are present within the priority setting process, albeit to varying degrees and referred to by different terms. There exists an opportunity for A4R to provide a guiding approach within which its four conditions can be strengthened and assessed to establish whether conformance helps improve on the priority setting process.
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| 2. |
- Byskov, Jens, et al.
(författare)
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Accountable priority setting for trust in health systems : the need for research into a new approach for strengthening sustainable health action in developing countries
- 2009
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Ingår i: Health Research Policy and Systems. - : BioMed Central. - 1478-4505. ; 7, s. 23-
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Tidskriftsartikel (refereegranskat)abstract
- Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research framework to examine the potential of AFR to support sustainable improvements to health systems performance. This paper reports on the project design and progress and argues that there is a high need for research into legitimate and fair priority setting to improve the knowledge base for achieving sustainable improvements in health outcomes.
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| 3. |
- Hjälm, Göran, et al.
(författare)
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Cloning and sequencing of human gp330, a Ca2+ -binding receptor with potential intracellular signaling properties
- 1996
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Ingår i: European Journal of Biochemistry. - : Wiley. - 0014-2956 .- 1432-1033. ; 239:1, s. 132-137
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Tidskriftsartikel (refereegranskat)abstract
- We present here the complete primary structure of human gp330, the human variant of the principal kidney autoantigen causing Heymann membranous glomerulonephritis in rats. The deduced 4655 amino acid residues give a calculated molecular mass of 519636 Da for the mature protein and consists of a probable 25-amino-acid N-terminal signal peptide sequence, an extracellular region of 4398 amino acids, a single transmembrane-spanning domain of 23 amino acids, and an intracellular C-terminal region of 209 amino acid residues. Three types of cysteine-rich repeats characteristic of the low density lipoprotein receptor (LDLR) superfamily are present in human gp330. In the extracellular region, there are a total of 36 LDLR ligand-binding repeats, comprising four distinct domains, 16 growth factor repeats separated by eight YWTD spacer regions, and one epidermal growth factor-like repeat. No consensus cleavage sequence for the processing endoprotease furin is detected in human gp330. The intracellular tail contains not only two copies of the F(X)NPXY coated-pit mediated internalization signal characteristic of LDLR superfamily members, but also intriguing and potentially functional motifs including several Src-homology 3 recognition motifs, one Src-homology 2 recognition motif for the p85 regulatory subunit of phosphatidylinositol 3-kinase, and additional sites for protein kinase C, casein kinase II and cAMP-/cGMP-dependent protein kinase. There is approximately 77% amino acid identity between human and rat gp330 with minor differences between the extracellular and intracellular regions. Recently gp330 has been implicated in Ca2+ regulation in the parathyroid, the placenta, and the renal tubule, but its overall physiological and pathological role still remains uncertain.
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| 4. |
- Onyango, Isaac G.
(författare)
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Intracellular components involved in parathyroid sensing of extracellular calcium
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Parathyroid glands are the primary regulator of extracellular calcium ([Ca2+]e). Ca2+ plays a key role in many fundamental biological processes and is also an essential structural component of the skeleton. The parathyroid chief cells detect small changes in [Ca2+]e and respond by altering the secretion of parathyroid hormone (PTH). This thesis details studies towards the identification of intracellular components involved in the parathyroid sensing mechanism of [Ca2+]e.Src family members c-Src, c-Yes, Fyn, Lyn, Lck and PKC isozymes (α, βI, βII, ε, ζ and ι) were found to be expressed in bovine parathyroid cells. Increase in [Ca2+]e to 3.0 mM caused activation of c-Src and c-Yes that was maximal at 5 min of incubation of the parathyroid cells. This activation was still evident after 30 min. Parathyroid caveolin along with 62, 38, 36, and 32 kDa proteins were found to be phosphorylated in high [Ca2+]e. Inhibition of Src kinases blocked tyrosine phosphorylation of caveolin and the 38 kDa protein and uncoupled the inhibition of PTH secretion seen at high [Ca2+]e. ERK was found to be strongly activated at 3 mM and also, but more weakly at 0.5 mM compared to at 1.25 mM [Ca2+]e. Inhibition of ERK blocked PTH secretion at low [Ca2+]e.Increase of [Ca2+]e to 3.0 mM also elicited translocation of PKCβI, -ε, -ζ and -ι to the cell periphery. In contrast, at 0.5 mM [Ca2+]e PKCα was translocated to the cell periphery and PI 3-kinase was found to be activated. Inhibition of PI 3-kinase activity blocked the dissociation of the cortical actin ring of parathymid cells evident at low [Ca2+]e and inhibited the subcellular translocation of PKCε, -ζ, and -ι in cells exposed to high [Ca2+]e. Moreover, the secretion of PTH induced at low [Ca2+]e was blocked by inhibition of PI 3-kinase. These results suggestthat c-Src, c-Yes, ERK, PI 3-kinase and several PKC isozymes are involved in the mechanism that couples the [Ca2+]e stimulus to secretion in the parathyroid cell.
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| 5. |
- Sumaila, U. Rashid, et al.
(författare)
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WTO must ban harmful fisheries subsidies
- 2021
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 374:6567, s. 544-544
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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