Creation and implementation of an emergency medicine education and training program in Turkey: An effective educational intervention to address the practitioner gap

Background The specialty of Emergency Medicine has enjoyed recognition for nearly 20 years in Turkey. However, the majority of underserved and rural Turkish emergency departments are staffed by general practitioners who lack formal training in the specialty and have few opportunities to increase emergency medicine-specific knowledge and skills. Methods To address this “practitioner gap,” the authors developed a four-phase comprehensive emergency medicine education and training program for general practitioners practicing in government hospitals in Turkey. Results From April 2006 until June 2009, 42 courses were taught by 62 trainers across seven regions in Turkey. A total of 2,262 physicians were trained. The mean course pre-test score for all regions was 42.3 (95% CI 39.8 to 44.7). The mean course post-test score was 70.1 (95% CI 67.2 to 72.9). The difference between the mean scores was 27.8 (95% CI 25.3 to 30.4, P \u3c0.0001), reflecting an improvement of 65.7%. Conclusions A partnership between an academic emergency medicine department and an emergency medicine society to implement country-wide training of physicians practicing in public emergency departments can serve as a successful model for capacity-building global emergency medicine endeavors

The private sector as a provider of family planning services in Egypt: Challenges and opportunities [Arabic]

[In Arabic] The recent increase in Egypt’s fertility rate, following decades of progress in lowering fertility levels, highlights the need for renewed attention to the country’s family planning program. The Ministry of Health is currently the largest provider of family planning in Egypt, serving a diverse population of women, many of whom may not need the free public service. Expanding the role of the private sector in the provision of family planning services and supplies holds great potential to more effectively meet the current and future family planning needs of millions of Egyptian women. This brief examines the role of the private sector in providing FP services and identifies challenges that are hindering the private sector from playing a more effective role in FP service delivery. In conclusion, this brief offers recommendations on how to strengthen the role of the private sector in providing FP to meet the needs of 16 million women with a demand for family planning

The private sector as a provider of family planning services in Egypt: Challenges and opportunities

The recent increase in Egypt’s fertility rate, following decades of progress in lowering fertility levels, highlights the need for renewed attention to the country’s family planning program. The Ministry of Health is currently the largest provider of family planning in Egypt, serving a diverse population of women, many of whom may not need the free public service. Expanding the role of the private sector in the provision of family planning services and supplies holds great potential to more effectively meet the current and future family planning needs of millions of Egyptian women. This brief examines the role of the private sector in providing FP services and identifies challenges that are hindering the private sector from playing a more effective role in FP service delivery. In conclusion, this brief offers recommendations on how to strengthen the role of the private sector in providing FP to meet the needs of 16 million women with a demand for family planning

Situational analysis of the private sector in the delivery of family planning services in Egypt: Current status and potential for increased involvement

The recent increase in Egypt’s total fertility rate, along with stalling contraceptive rates and persistent unmet need for family planning (FP), highlights a need to explore new venues for providing FP services. The specific objectives of this study are to determine the size, scope, and scale of private-sector FP providers (private physicians, nongovernmental organization clinics, and private pharmacies); examine the policy and regulatory environment for private provision of FP products and services; and assess business, financing, and training needs of the private health sector and the potential for expanding its role in FP service provision. To improve current trends in contraceptive uptake and provide expanded service delivery and contraceptive options for Egyptian couples, the report proposes a number of recommendations. These could strengthen the role of the private sector as it complements the government’s current and planned efforts to meet population demand for contraception

Science and Film-making

The essay reviews the literature, mostly historical, on the relationship between science and film-making, with a focus on the science documentary. It then discusses the circumstances of the emergence of the wildlife making-of documentary genre. The thesis examined here is that since the early days of cinema, film-making has evolved from being subordinate to science, to being an equal partner in the production of knowledge, controlled by non-scientists

Bubbling and bistability in two parameter discrete systems

We present a graphical analysis of the mechanisms underlying the occurrences of bubbling sequences and bistability regions in the bifurcation scenario of a special class of one dimensional two parameter maps. The main result of the analysis is that whether it is bubbling or bistability is decided by the sign of the third derivative at the inflection point of the map function.Comment: LaTeX v2.09, 14 pages with 4 PNG figure

Extracellular ATP released by osteoblasts is a key local inhibitor of bone mineralisation

Previous studies have shown that exogenous ATP (>1µM) prevents bone formation in vitro by blocking mineralisation of the collagenous matrix. This effect is thought to be mediated via both P2 receptor-dependent pathways and a receptor-independent mechanism (hydrolysis of ATP to produce the mineralisation inhibitor pyrophosphate, PPi). Osteoblasts are also known to release ATP constitutively. To determine whether this endogenous ATP might exert significant biological effects, bone-forming primary rat osteoblasts were cultured with 0.5-2.5U/ml apyrase (which sequentially hydrolyses ATP to ADP to AMP + 2Pi). Addition of 0.5U/ml apyrase to osteoblast culture medium degraded extracellular ATP to <1% of control levels within 2 minutes; continuous exposure to apyrase maintained this inhibition for up to 14 days. Apyrase treatment for the first 72 hours of culture caused small decreases (≤25%) in osteoblast number, suggesting a role for endogenous ATP in stimulating cell proliferation. Continuous apyrase treatment for 14 days (≥0.5U/ml) increased mineralisation of bone nodules by up to 3-fold. Increases in bone mineralisation were also seen when osteoblasts were cultured with the ATP release inhibitors, NEM and brefeldin A, as well as with P2X1 and P2X7 receptor antagonists. Apyrase decreased alkaline phosphatase (TNAP) activity by up to 60%, whilst increasing the activity of the PPi-generating ecto-nucleotide pyrophosphatase/phosphodiesterases (NPPs) up to 2.7-fold. Both collagen production and adipocyte formation were unaffected. These data suggest that nucleotides released by osteoblasts in bone could act locally, via multiple mechanisms, to limit mineralisation

Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya

<p>Abtsract</p> <p>Background</p> <p>Alternatives to the traditional 'supply-side' approach to financing service delivery are being explored. These strategies are termed results-based finance, demand-side health financing or output-based aid which includes a range of interventions that channel government or donor subsidies to the user rather than the provider. Initial pilot assessments of reproductive health voucher programs suggest that, they can increase access and use, reducing inequities and enhancing program efficiency and service quality. However, there is a paucity of evidence describing how the programs function in different settings, for various reproductive health services. Population Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the 'voucher and accreditation' approaches to improving the reproductive health of low income women in Kenya.</p> <p>Methods/Design</p> <p>A quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status and reducing inequities at the population level; and assessing the effect of vouchers on increasing access to, and quality of, and reducing inequities in the use of selected reproductive health services. The study comprises of four populations: facilities, providers, women of reproductive health age using facilities and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in samples of health facilities - public, private and faith-based in: three districts; Kisumu, Kiambu, Kitui and two informal settlements in Nairobi which are accredited to provide maternal and newborn health and family planning services to women holding vouchers for the services; and compared with a matched sample of non-accredited facilities. Health facility assessments (HFA) will be conducted at two stages to track temporal changes in quality of care and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3000 respondents will also be carried out in areas where vouchers are distributed and similar locations where vouchers are not distributed.</p

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh

<p>Abstract</p> <p>Background</p> <p>Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed "Demand-Side Financing" or "Output-Based Aid", includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services.</p> <p>Methods/Design</p> <p>Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to address the lack of evidence around the pros and cons of 'voucher and accreditation' approaches to improving the reproductive health of low income women in five developing countries. In Bangladesh, the activities will be conducted in 11 accredited health facilities where Demand Side Financing program is being implemented and compared with populations drawn from areas served by similar non-accredited facilities. Facility inventories, client exit interviews and service provider interviews will be used to collect comparable data across each facility for assessing readiness and quality of care. In-depth interviews with key stakeholders will be conducted to gain a deeper understanding about the program. A population-based survey will also be carried out in two types of locations: areas where vouchers are distributed and similar locations where vouchers are not distributed.</p> <p>Discussion</p> <p>This is a quasi-experimental study which will investigate the impact of the voucher approach on improving maternal health behaviors and status and reducing inequities at the population level. We expect a significant increase in the utilization of maternal health care services by the accredited health facilities in the experimental areas compared to the control areas as a direct result of the interventions. If the voucher scheme in Bangladesh is found effective, it may help other countries to adopt this approach for improving utilization of maternity care services for reducing maternal mortality.</p

The achievement of food and nutrition security in South Asia is deeply gendered

Women form an integral part of the agricultural sector, and in much of South Asia women make up a majority of the agricultural workforce, often compelled to work in order to meet their families’ basic needs. While their contributions are recognised as central to the food and nutrition security of households and communities, their work is not recognized or supported adequately by public policy and social institutions. Women continue to face inequality across key development indicators including health, education, and nutrition; discriminatory laws; and high levels of precarity in terms of income, employment conditions, safety and wellbeing. Social structures that promote gender inequality and inhibit the agency of women contribute to the South Asian enigma – the persistence of undernutrition despite economic growth – and must be addressed to achieve food and nutrition security