Measurement of Epstein-Barr virus DNA load using a novel quantification standard containing two EBV DNA targets and SYBR Green I dye

BACKGROUND Reactivation of Epstein-Barr virus (EBV) infection may cause serious, life-threatening complications in immunocompromised individuals. EBV DNA is often detected in EBV-associated disease states, with viral load believed to be a reflection of virus activity. Two separate real-time quantitative polymerase chain reaction (QPCR) assays using SYBR Green I dye and a single quantification standard containing two EBV genes, Epstein-Barr nuclear antigen-1 (EBNA-1) and BamHI fragment H rightward open reading frame-1 (BHRF-1), were developed to detect and measure absolute EBV DNA load in patients with various EBV-associated diseases. EBV DNA loads and viral capsid antigen (VCA) IgG antibody titres were also quantified on a population sample. RESULTS EBV DNA was measurable in ethylenediaminetetraacetic acid (EDTA) whole blood, peripheral blood mononuclear cells (PBMCs), plasma and cerebrospinal fluid (CSF) samples. EBV DNA loads were detectable from 8.0 × 10² to 1.3 × 10⁸ copies/ml in post-transplant lymphoproliferative disease (n = 5), 1.5 × 10³ to 2.0 × 10⁵ copies/ml in infectious mononucleosis (n = 7), 7.5 × 10⁴ to 1.1 × 10⁵ copies/ml in EBV-associated haemophagocytic syndrome (n = 1), 2.0 × 10² to 5.6 × 10³ copies/ml in HIV-infected patients (n = 12), and 2.0 × 10² to 9.1 × 10⁴ copies/ml in the population sample (n = 218). EBNA-1 and BHRF-1 DNA were detected in 11.0% and 21.6% of the population sample respectively. There was a modest correlation between VCA IgG antibody titre and BHRF-1 DNA load (rho = 0.13, p = 0.05) but not EBNA-1 DNA load (rho = 0.11, p = 0.11). CONCLUSION Two sensitive and specific real-time PCR assays using SYBR Green I dye and a single quantification standard containing two EBV DNA targets, were developed for the detection and measurement of EBV DNA load in a variety of clinical samples. These assays have application in the investigation of EBV-related illnesses in immunocompromised individuals.The Ausimmune Study is funded by the National Multiple Sclerosis Society of the USA, the National Health & Medical Research Council (Project Grant 316901) and Multiple Sclerosis Research Australia

Patient, carer and public involvement in major system change in acute stroke services: The construction of value

BACKGROUND: Patient and public involvement is required where changes to care provided by the UK National Health Service are proposed. Yet involvement is characterized by ambiguity about its rationales, methods and impact. AIMS: To understand how patients and carers were involved in major system changes (MSCs) to the delivery of acute stroke care in 2 English cities, and what kinds of effects involvement was thought to produce. METHODS: Analysis of documents from both MSC projects, and retrospective in-depth interviews with 45 purposively selected individuals (providers, commissioners, third-sector employees) involved in the MSC. RESULTS: Involvement was enacted through consultation exercises; lay membership of governance structures; and elicitation of patient perspectives. Interviewees' views of involvement in these MSCs varied, reflecting different views of involvement per se, and of implicit quality criteria. The value of involvement lay not in its contribution to acute service redesign but in its facilitation of the changes developed by professionals. We propose 3 conceptual categories-agitation management, verification and substantiation-to identify types of process through which involvement was seen to facilitate system change. DISCUSSION: Involvement was seen to have strategic and intrinsic value. Its strategic value lay in facilitating the implementation of a model of care that aimed to deliver evidence-based care to all; its intrinsic value was in the idea of citizen participation in change processes as an end in its own right. The concept of value, rather than impact, may provide greater traction in analyses of contemporary involvement practices

Citizen Engagement in Nigeria’s Public Policy Process: A Comparative Analysis of State and Non-State Actors’ Perspectives

This paper presents a comparative analysis of state and non-state actors' perspectives on citizen engagement in the public policy process in Nigeria. It addresses a critical question: are citizens actively engaged in shaping policy, or does their participation remain largely tokenistic, as characterised by Arnstein’s (1969) concept of "illusory" involvement? Employing a cross-sectional survey design with stratified and simple random sampling techniques, data were collected from 1,614 respondents across both state and non-state sectors. Descriptive analysis, using percentages and graphical presentations, reveals that while Nigeria has moved beyond the zone of non-participation associated with its historical period of military rule, citizen engagement predominantly remains within the zone of tokenism, marked by information sharing, consultation, and placation. Respondents widely perceived low levels of trust in government, poor performance, persistent corruption, and limited transparency and accountability as key barriers to deeper engagement. Nevertheless, anecdotal evidence suggests an emerging shift toward partnership models of engagement, aligning with the higher rungs of Arnstein’s Ladder of Citizen Participation. The study recommends the adoption and institutionalisation of strategies for constructive engagement to broaden and deepen citizen participation in Nigeria’s public policy processes. Keywords: Citizen engagement, citizen participation, drivers of citizen engagement, public policy process, state actors, non-state actors, and ladder of citizen participation. DOI: 10.7176/PPAR/15-3-01 Publication date: July 30th 202

The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England

BACKGROUND: The economic implications of major system change are an important component of the decision to implement health service reconfigurations. Little is known about how best to report the results of economic evaluations of major system change to inform decision-makers. Reconfiguration of acute stroke care in two metropolitan areas in England, namely London and Greater Manchester (GM), was used to analyse the economic implications of two different implementation strategies for major system change. METHODS: A decision analytic model was used to calculate difference-in-differences in costs and outcomes before and after the implementation of two major system change strategies in stroke care in London and GM. Values in the model were based on patient level data from Hospital Episode Statistics, linked mortality data from the Office of National Statistics and data from two national stroke audits. Results were presented as net monetary benefit (NMB) and using Programme Budgeting and Marginal Analysis (PBMA) to assess the costs and benefits of a hypothetical typical region in England with approximately 4000 strokes a year. RESULTS: In London, after 90 days, there were nine fewer deaths per 1000 patients compared to the rest of England (95% CI -24 to 6) at an additional cost of £770,027 per 1000 stroke patients admitted. There were two additional deaths (95% CI -19 to 23) in GM, with a total costs saving of £156,118 per 1000 patients compared to the rest of England. At a £30,000 willingness to pay the NMB was higher in London and GM than the rest of England over the same time period. The results of the PBMA suggest that a GM style reconfiguration could result in a total greater health benefit to a region. Implementation costs were £136 per patient in London and £75 in GM. CONCLUSIONS: The implementation of major system change in acute stroke care may result in a net health benefit to a region, even one functioning within a fixed budget. The choice of what model of stroke reconfiguration to implement may depend on the relative importance of clinical versus cost outcomes

Scope of Citizen Engagement in Public Policy Making, Implementation, and Reforms in Nigeria: A Non-State Actors’ Perspective

The scope and depth of citizen engagement in public policymaking, implementation and reforms are crucial in determining governance outcomes, as wider and deeper engagements produce more beneficial outcomes. This article focuses on an analysis of Nigeria’s experience with the scope and depth of citizen engagement from the perspective of non-state actors.  Methodologically, this study used a cross-sectional sample survey design comprising a sample size of 1,021 non-state actors of different sub-groups selected across the six geopolitical zones of Nigeria. Data were analysed with descriptive statistical tools and are presented using tabular and graphic methods. Findings, among others, reveal that the scope and depth of citizen engagement, though showing signs of improvement after a long period of military rule, are still not wide and deep enough to be transformative and that certain drivers of engagement are not high enough to engender more participation by the citizens. The non-state actors themselves attribute the problem to the erroneous view by the state actors that the public is not sufficiently well informed to take part in deeper engagements because of the complex nature of governance. Yet, inclusiveness is key to building a public service that can deliver effective and efficient services. Keywords: Citizen Engagement, public policy making and implementation, public sector reforms, non-state actors, inclusive policymaking process. DOI: 10.7176/PPAR/15-2-03 Publication date: May 30th 202

New Technologies: Catalysts for Business Models and Finance Function

To bridge performance gap, improve operational efficiency, enhance competitive advantage and secure corporate assets, business entities have continued to embrace new technologies with profound positive impact on their bottom-line.As new technologies replace humans through automation in the emerging business models, the demand for professionals, including chartered accountants, who are not IT-savvy is fast declining, taking with it, wages, salaries and a high percent of income taxes. These problems are compounded by the huge costs of technology acquisition and inevitable investment inhuman capacity building in the face of increasingly mobile staff.Using secondary information, the study observed that many professional accountants dread the transition from manual to automation as it would eliminate repetitive finance-related jobs in the midst of high unemployment rate in the country, dissuade new entrants into the accounting profession and alter the human side of enterprise.It therefore recommends that the training curricula of professional accountancy organisations should be rejigged and skewed towards technology while existing professional accountants should hone their IT skills to leverage technology to deliver value online, real time to their diverse stakeholders. Keywords: Technology, Internet of things, automation, business models, artificial intelligence, robotics, machine learning, finance function

AIG Board of Directors Minutes 5/8/2008

A meeting of the Board of Directors of American International Group, Inc., was held by telephone conference call on May 8, 2008 at 9:00 A.M., pursuant to notice duly given to each of the Directors in accordance with the By-Laws

AIG 2008 424B Filing dated May 14, 2008 (to Prospectus dated July 13, 2007)

Prospectus Supplement for American International Group, Inc. (To Prospectus Dated July 13, 2007

How organisations contribute to improving the quality of healthcare

Naomi Fulop and Angus Ramsay argue that we should focus more on how organisations and organisational leaders can contribute to improving the quality of healthcare