Engaging for-profit providers in TB control: lessons learnt from initiatives in South Asia.

There has been a huge expansion in the private health-care sector over the past two decades, particularly in South Asia, resulting in over 80% of patients seeking care from private health providers. Despite concerns about the quality and equity of private sector service provision, most government public health bodies recognize that the private sector reaches individuals that public institutions cannot cater to, thereby being important in moving closer to universal health coverage. Numerous initiatives have been launched and are being planned to involve private practitioners in effectively diagnosing, reporting and managing infectious diseases such as tuberculosis. However, there is a notable dearth of papers discussing which elements of private sector engagement strategies are more or less successful and the ethical issues that arise when engagement strategies are operationalized. This article brings together the authors' experiences of working on projects to engage private allopathic health providers in Pakistan, Bangladesh and India for improved tuberculosis control. Motivations of and strategies required to engage private allopathic heath providers, specifically doctors, diagnostic laboratories and pharmacies, and some of the ethical issues that arise when designing programmes for engagement are discussed

Determination of the Gyrotropic Characteristics of Hexaferrite Ceramics From 75 to 600 GHz

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Treatment of fibrolamellar hepatoma with partial or total hepatectomy and transplantation of the liver

Fourteen patients with fibrolamellar hepatoma were treated with radical excision. In eight, a subtotal hepatic resection was performed from 16 months to more than 16 years ago. None of the patients have died and recurrences have been seen in only one patient. Six other patients had total hepatectomy and hepatic replacement. Two of these six patients have died of metastases and a third is living with recurrent tumor. This experience has justified the continuing use of quite aggressive extirpative procedures for the treatment of fibrolamellar hepatoma

Candida carriage in the alimentary tract of liver transplant candidates

Thirty randomly selected patients with advanced chronic liver disease, which had been evaluated for possible liver transplantation, were sampled endoscopically at 7 alimentary tract locations to assess the frequency and amount of Candida carriage. Eightyone percent (127/156) of the samples obtained contained Candida and 53% (82/156) yielded high counts (> 300 CFU/ml). The most predominant Candida species isolated at each site was Candida albicana, which accounted for 103 (64%) of the 160 fungal isolates. The other Candida species isolated included C tropicalis 30 (19%), C krusei 16 (10%), and C glabrata 11 (7%), Although the number of sites at which yeast was present and the quantities of yeast at each site varied widely among the patients studied, 100% of the patients had Candida in at least one site of the gastrointestinal tract. Eighty-six percent (24/28) of the duodenal aspirates contained Candida and 50% (14/28) of the duodenal samples contained greater than 300 CFU/ml. A positive culture from the stomach was a reliable predictor of the presence of Candida in the duodenum (P=0.0001), but a positive culture at no other site readily predicted the presence of Candida at yet another site. Importantly, there was no correlation between the presence or absence of Candida in either oral or rectal swabs and colonization at other anatomic sites within the gastrointestinal tract, These findings are important in liver transplantation, particularly in those cases in which the bowel has been opened to create a choledochojejunostomy anastomosis. The operative attempts to reduce gastrointestinal fungal carriage using oral antifungal agents may be justified before liver transplantation in an effort to lower the risk of posttransplantation fungal infections, particularly in those patients expected to have a Roux-en-Y choledochojejunostomy biliary reconstruction. © 1994 by Williams and Wilkins

Three Notions of Dynamicness in Language

We distinguish three ways that a theory of linguistic meaning and communication might be considered dynamic in character. We provide some examples of systems which are dynamic in some of these senses but not others. We suggest that separating these notions can help to clarify what is at issue in particular debates about dynamic versus static approaches within natural language semantics and pragmatics

On the Dynamics of Conversation

There is a longstanding debate in the literature about static versus dynamic approaches to meaning and conversation. A formal result due to van Benthem (1986, 1996) is often thought to be important for understanding what, conceptually speaking, is at issue in the debate. We introduce the concept of a conversation system, and we use it to clarify the import of van Benthem’s result. We then distinguish two classes of conversation systems, corresponding to two concepts of staticness. The first class, the strongly static conversation systems, corresponds to a generalization of the class of systems that van Benthem’s result concerns. The second class, the weakly static conversation systems, corresponds to a broader class, one permitting a certain commonly recognized form of context sensitivity. In the vein of van Benthem’s result, we supply representation theorems which independently characterize these two varieties of conversation system. We observe that some canonically dynamic semantic systems correspond to weakly static conversation systems. We close by discussing some hazards that arise in trying to bring our formal results to bear on natural language phenomena, and on the debate about whether the compositional semantics for natural language should take a dynamic shape