Public hospital costs and quality in the Dominican Republic

Measuring costs in public hospitals in developing countries is hampered by the lack of an appropriate costing system, or of any systematic cost accounting. Invoices for goods and services, prices for inputs, and patient records are generally absent. As a result, cost measures have historically been based on budget figures - the only available financial data. But budget allocations bear little relationship to the resources actually required to provide services to hospital patients. The patient-based methodology described by the authors circumvents this problem by measuring actual hospital resources allocated to patients. Their study was conducted in a single Dominican hospital during a one week period in April 1989. Their approach documents and gives prices for goods, services, and personnel time provided by the hospital to emergency patients, inpatients, and outpatients. They used the following to measure quality and efficiency: (a) the qualifications and relative costs of medical manpower delivering services; (b) the extent and nature of shortages; (c) comparisons of physician orders and actual services provided; and (d) (for selected diagnoses) the specifics of clinical practices in the hospital, compared with accepted clinical norms for the Dominican Republic. They found that average and total costs of services understate the true costs - because of shortages, inappropriate and underused personnel, and nonfunctioning equipment. Quality of care measures suggest low quality and poor efficiency. Norms of medical practice were not followed in more than 80 percent of the cases examined. Rates of completion for diagnostic tests were below 50 percent for outpatient services and between 60 and 70 percent for inpatient and emergency services. The study registered significant monthly savings of $641 for noncompletion of tests and$824 for nonavailability of drugs. Policy recommendations of the authors center on the need to reform the organization and delivery of health care as well as physician payment practices - and to giving more authority to hospital administrators. To make Dominican hospitals more efficient, there must be greater authority and accountability for hospital directors and better incentives for improving medical and management performance. Quality assurance needs great improvement if the Dominican system is to ensure a basic standard of care.Health Monitoring&Evaluation,Health Systems Development&Reform,Business Environment,Business in Development,Health Economics&Finance

Combustion and performance characteristics of air-fuel mixtures ignited by means of photo-thermal ignition of Nano-Energetic Materials

Abstract This work presents an experimental investigation to determine the performance and characteristics of the combustion process triggered by a new ignition system based on photo-thermal effect, observed when nano-Energetic Materials are exposed to a flash light. The resulting combustion process has been compared with the one obtained using the spark-plug traditionally used in spark ignition engines. Results showed that the photo-thermal ignition determines higher combustion pressure gradient, peak pressure, total heat released, fuel combustion efficiency, and a shorter ignition delay and combustion duration compared with the spark ignition, for all the tested fuels and air-fuel ratios

Passive Tracer Dynamics in 4 Point-Vortex Flow

The advection of passive tracers in a system of 4 identical point vortices is studied when the motion of the vortices is chaotic. The phenomenon of vortex-pairing has been observed and statistics of the pairing time is computed. The distribution exhibits a power-law tail with exponent $\sim 3.6$ implying finite average pairing time. This exponents is in agreement with its computed analytical estimate of 3.5. Tracer motion is studied for a chosen initial condition of the vortex system. Accessible phase space is investigated. The size of the cores around the vortices is well approximated by the minimum inter-vortex distance and stickiness to these cores is observed. We investigate the origin of stickiness which we link to the phenomenon of vortex pairing and jumps of tracers between cores. Motion within the core is considered and fluctuations are shown to scale with tracer-vortex distance $r$ as $r^{6}$. No outward or inward diffusion of tracers are observed. This investigation allows the separation of the accessible phase space in four distinct regions, each with its own specific properties: the region within the cores, the reunion of the periphery of all cores, the region where vortex motion is restricted and finally the far-field region. We speculate that the stickiness to the cores induced by vortex-pairings influences the long-time behavior of tracers and their anomalous diffusion.Comment: 18 pages, 15 figure

Early mandibular canine-lateral incisor transposition: case report

Purpose. The main aim of the present study is to present a case of mandibular transposition between lateral incisor and canine in a paediatric patient. Materials and methods. A fixed multibracket orthodontic treatment was performed by means of a modified welded arch as to correct the transposition and obtaining a class I functional and symmetrical occlusion, also thanks to the early diagnosis of the eruption anomaly. Results. Our case report shows that a satisfactory treatment of mandibular transpositions is obtained when detected at an early stage of the tooth development. Conclusions. The main treatment options to be taken into consideration in case of a mandibular transposition are two: correcting the transposition or aligning it leaving the dental elements in their transposed order; in both cases, the followups show a stable condition, maintained without relapses. Several factors, such as age of the patient, occlusion, aesthetics, patient’s collaboration, periodontal support and duration of treatment have to be considered as to prevent potential damage to dental elements and support appliances. The choice between the two treatment approaches for mandibular lateral incisor/canine transpositions mainly depends on the time the anomaly is detected

On the vanishing viscosity limit in a disk

We say that the solution u to the Navier-Stokes equations converges to a solution v to the Euler equations in the vanishing viscosity limit if u converges to v in the energy norm uniformly over a finite time interval. Working specifically in the unit disk, we show that a necessary and sufficient condition for the vanishing viscosity limit to hold is the vanishing with the viscosity of the time-space average of the energy of u in a boundary layer of width proportional to the viscosity due to modes (eigenfunctions of the Stokes operator) whose frequencies in the radial or the tangential direction lie between L and M. Here, L must be of order less than 1/(viscosity) and M must be of order greater than 1/(viscosity)

Ectopic eruption of the first permanent molar in the maxilla: Cephalometric features of 13 pediatric patients

Ectopic eruption of the first permanent molar in the maxilla, generally characterized by the wrong axial positioning during eruption, is reported to occur in about 2–6% of children. Its incidence is surely under-estimated as it frequently remains undiagnosed and, additionally, becomes irreversible, resulting in posterior crowding in such cases. This retrospective study aims to investigate the cephalometric features of patients affected by ectopic eruption of the maxillary first molar in comparison to a control group of patients. From a total of 1935 subjects, 13 patients were enrolled in the study group, while 26 patients were randomly selected as a control group. Lateral cephalometric teleradiographs obtained at the time of diagnosis were used to measure cephalometric values between study patients and controls. The prevalence of ectopic eruption of the first maxillary permanent molar in our patients was 1.14%. The mandibular angle (SN-GoMe) was found to be significantly greater in the study group than in control. The same statistical trend was observed for the inter-maxillary angle (SnaSnp-GoMe); also, the distance Sna-Me was greater in the study group. Differences between groups were statistically significant for the following distances: Snp-Sna, Ba-S and SOR-Sna, which were found to be, overall, greater in the study group. Ectopic eruption of the first permanent molar in the maxilla seems to be associated with morphogenetic characteristics of patients, mainly with a dolichocephalic pattern

Immunohistochemical localization of NPY, VIP and 5-HT in the thyroid gland of the lizard, Podarcis sicula.

The thyroid gland of the lizard Podarcis sicula was immunohistochemically studied in adult male specimens using specific antibodies against NPY, VIP and 5-HT and the avidin-biotin peroxidase complex (ABC) procedure to localize the three peptides. Fine beaded VIP-immunoreactive nerve fibers ran between the follicles, and VIP-immunoreactivity was evenly distributed in the apical cytoplasm of follicular cells. NPY-immunoreactive fibers were found around the follicles, and, in the cells, immunoreactivity was localizated only in the cellular apices. Immunoreactivity to 5-HT was observed in the colloid, with a concentration in the follicular lumen exceeding that in the follicular cells. In fact, most follicles showed immunoreactivity in the cytoplasmic bridges formed between the apical portion of the follicular cells and the colloid

Alkyphenol exposure alters steroidogenesis in male lizard podarcis siculus

Background: Nonylphenol (NP) and Octylphenol (OP) are persistent and non-biodegradable environmental contaminants classified as endocrine disruptor chemicals (EDCs). These compounds are widely used in several industrial applications and present estrogen-like properties, which have extensively been studied in aquatic organisms. The present study aimed to verify the interference of these compounds alone, and in mixture, on the reproductive cycle of the male terrestrial vertebrate Podarcis siculus, focusing mainly on the steroidogenesis process. Methods: Male lizards have been treated with different injections of both NP and OP alone and in mixture, and evaluation has been carried out using a histological approach. Results: Results obtained showed that both substances are able to alter both testis histology and localization of key steroidogenic enzymes, such as 3β-hydroxysteroid dehydrogenase (3β-HSD), 17β-hydroxysteroid dehydrogenase (17β-HSD) and P450 aromatase. Moreover, OP exerts a preponderant effect, and the P450 aromatase represents the major target of both chemicals. Conclusions: In conclusion, NP and OP inhibit steroidogenesis, which in turn may reduce the reproductive capacity of the specimens

Nonylphenol induces proliferation of prostate epithelial cell line (PNT1a)

Nonylphenol (NP) belongs to Endocrine Disrupting Chemicals (EDCs) with xenoestrogenic activity, called xenoestrogens, abundantly present in the environment. NP is widely used as surfactants in industrial and agricultural applications and in plastic formulations. Its xenoestrogenic activity was demonstrated both in vitro and in vivo. However, there are only few studies on the NP effects on prostate cell lines. Estrogens play an important role in development and growth of the prostate and may cause some pathologies, including cancer. Since NP mimics endogenous estrogens, it could have a negative influence on prostate physiology. In this study we examined the effects of NP and 17β-estradiol (E2) on the proliferation of non tumorigenic prostate epithelial cell line (PNT1A) and their interaction with estrogen receptors. These effects were also studied in presence of selective estrogen receptor antagonist ICI182,780. We found that both NP and E2 stimulate PNT1A proliferation in a dose-dependent manner, but the NP effects were lower than E2. Immunofluorescence and western blot analyses revealed that both NP and E2 induce cytoplasm-nucleus translocation of ERα. The nuclear localization of ERα by E2 was already shown after 2h of treatment and only after 6h by NP. The inhibition of these effects by adding ICI182,780 was shown. Surprisingly, NP and E2 didn’t affect the localization of ERβ. These results suggest that NP stimulates PNT1A proliferation probably through the interaction with ERα that in turn is involved in the activation of some prostate cell cycle key regulators