Experience with chronic haemodialysis in Johannesburg

Since 1966 the treatment for patients with end-stage renal disease in Johannesburg has primarily been renal transplantation. This has required an adequate programme of regular dialysis. All patients were treated at the central hospital or at two small satellite units. A total of 158 patients, mean age 34,2 years (88 males) have been dialysed. The mean duration on dialysis prior to transplantation was 5,6 months (range 1 week - 23 months). The commonest cause of renal failure in males was chronic glomerulonephritis (63%), whereas in females it was analgesic nephropathy (39%). Twenty-seven patients (17%) died while on dialysis, including 6 who had had unsuccessful transplantations. Renal osteodystrophy was diagnosed in 30% of the patients. Hepatitis has been endemic among both patients and staff. Nephrectomies were done in 106 patients. Ten patients had operations for peptic ulcer and 5 parathyroidectomies were performed. The number of patients unsuccessfully transplanted, or who died, was less than the number of new patients requiring treatment. In addition, an increasing proportion of patients have become 'relatively untransplaotable'. This has led to overloading of facilities.S. Afr. Med. J., 48, 1821 (1974

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

A systematic review conducted by Sanjay Basu and colleagues reevaluates the evidence relating to comparative performance of public versus private sector healthcare delivery in low- and middle-income countries

The Use and Abuse of Reinsurance in Medical Schemes

An investigation by the regulatory authorities into the use of reinsurance by medical schemes indicated clear problems with reinsurance agreements and cases where the contracts were resulting in substantial losses for members of schemes. It was shown that a number of cases reinsurance had become a conduit for systematically removing surplus from medical schemes. Thus undermining the security of members of those schemes. This paper summarises the key features of the investigation into the use of reinsurance by medical schemes over the period 1996 to 1999. The paper then outlines the actions taken by the regulatory authorities. The specific areas of abuse are described and the conduct of trustees, brokers, administrators and insurance companies is discussed. This leads to the question of the professional responsibilities of actuaries in the design and implementation of these arrangements. KEYWORDS: Medical schemes; reinsurance; regulation; professionalism, trustee responsibility South African Actuarial Journal: 2001 1: 95-11

A heatwave of accretion energy traced by masers in the G358-MM1 high-mass protostar

High-mass stars are thought to accumulate much of their mass via short, infrequent bursts of disk-aided accretion. Such accretion events are rare and difficult to observe directly but are known to drive enhanced maser emission. In this Letter we report high-resolution, multi-epoch methanol maser observations toward G358.93-0.03, which reveal an interesting phenomenon: the subluminal propagation of a thermal radiation ‘heatwave’ emanating from an accreting high-mass protostar. The extreme transformation of the maser emission implies a sudden intensification of thermal infrared radiation from within the inner (40-mas, 270-au) region. Subsequently, methanol masers trace the radial passage of thermal radiation through the environment at ≥4% of the speed of light. Such a high translocation rate contrasts with the ≤10 km s-1 physical gas motions of methanol masers typically observed using very-long-baseline interferometry (VLBI). The observed scenario can readily be attributed to an accretion event in the high-mass protostar G358.93-0.03-MM1. While being the third case in its class, G358.93-0.03-MM1 exhibits unique attributes hinting at a possible ‘zoo’ of accretion burst types. These results promote the advantages of maser observations in understanding high-mass-star formation, both through single-dish maser monitoring campaigns and via their international cooperation as VLBI arrays