Factors influencing job preferences of health workers providing obstetric care : results from discrete choice experiments in Malawi, Mozambique and Tanzania

BACKGROUND: Task shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. METHODS: This paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries. RESULTS: The strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management (transparent, accountable and consistent systems for staff support, supervision and appraisal). Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location (urban vs rural) had the smallest average effect on utility for job choice in all three countries. CONCLUSIONS: These findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas

Analysis of meniscal degeneration and meniscal gene expression

<p>Abstract</p> <p>Background</p> <p>Menisci play a vital role in load transmission, shock absorption and joint stability. There is increasing evidence suggesting that OA menisci may not merely be bystanders in the disease process of OA. This study sought: 1) to determine the prevalence of meniscal degeneration in OA patients, and 2) to examine gene expression in OA meniscal cells compared to normal meniscal cells.</p> <p>Methods</p> <p>Studies were approved by our human subjects Institutional Review Board. Menisci and articular cartilage were collected during joint replacement surgery for OA patients and lower limb amputation surgery for osteosarcoma patients (normal control specimens), and graded. Meniscal cells were prepared from these meniscal tissues and expanded in monolayer culture. Differential gene expression in OA meniscal cells and normal meniscal cells was examined using Affymetrix microarray and real time RT-PCR.</p> <p>Results</p> <p>The grades of meniscal degeneration correlated with the grades of articular cartilage degeneration (r = 0.672; P < 0.0001). Many of the genes classified in the biological processes of immune response, inflammatory response, biomineral formation and cell proliferation, including major histocompatibility complex, class II, DP alpha 1 (<it>HLA-DPA1</it>), integrin, beta 2 (<it>ITGB2</it>), ectonucleotide pyrophosphatase/phosphodiesterase 1 (<it>ENPP1</it>), ankylosis, progressive homolog (<it>ANKH</it>) and fibroblast growth factor 7 (<it>FGF7</it>), were expressed at significantly higher levels in OA meniscal cells compared to normal meniscal cells. Importantly, many of the genes that have been shown to be differentially expressed in other OA cell types/tissues, including ADAM metallopeptidase with thrombospondin type 1 motif 5 (<it>ADAMTS5</it>) and prostaglandin E synthase (<it>PTGES</it>), were found to be expressed at significantly higher levels in OA meniscal cells. This consistency suggests that many of the genes detected in our study are disease-specific.</p> <p>Conclusion</p> <p>Our findings suggest that OA is a whole joint disease. Meniscal cells may play an active role in the development of OA. Investigation of the gene expression profiles of OA meniscal cells may reveal new therapeutic targets for OA therapy and also may uncover novel disease markers for early diagnosis of OA.</p

Membranes with the Same Ion Channel Populations but Different Excitabilities

Electrical signaling allows communication within and between different tissues and is necessary for the survival of multicellular organisms. The ionic transport that underlies transmembrane currents in cells is mediated by transporters and channels. Fast ionic transport through channels is typically modeled with a conductance-based formulation that describes current in terms of electrical drift without diffusion. In contrast, currents written in terms of drift and diffusion are not as widely used in the literature in spite of being more realistic and capable of displaying experimentally observable phenomena that conductance-based models cannot reproduce (e.g. rectification). The two formulations are mathematically related: conductance-based currents are linear approximations of drift-diffusion currents. However, conductance-based models of membrane potential are not first-order approximations of drift-diffusion models. Bifurcation analysis and numerical simulations show that the two approaches predict qualitatively and quantitatively different behaviors in the dynamics of membrane potential. For instance, two neuronal membrane models with identical populations of ion channels, one written with conductance-based currents, the other with drift-diffusion currents, undergo transitions into and out of repetitive oscillations through different mechanisms and for different levels of stimulation. These differences in excitability are observed in response to excitatory synaptic input, and across different levels of ion channel expression. In general, the electrophysiological profiles of membranes modeled with drift-diffusion and conductance-based models having identical ion channel populations are different, potentially causing the input-output and computational properties of networks constructed with these models to be different as well. The drift-diffusion formulation is thus proposed as a theoretical improvement over conductance-based models that may lead to more accurate predictions and interpretations of experimental data at the single cell and network levels

The Sovereignty Deficit of Modern Constitutions

The aim of this essay is to examine the place of the people in the constitutions of democratic nations. While the meaning of democracy and the degree to which it is achieved vary within the family of nations considered democratic, the idea common to all is that the people are self-governing. In its origins, the idea is tied to liberty: not to be self-governing is to be subject to the will of another and so not to be free. What constitutes self-government is open to interpretation, although this is not the place to examine the possible meanings. Nor is this the place to set out the history of the idea or to show how it became central to modern constitutions, except to note the number of nations qualifying as democratic has steadily increased in recent years to just under a half of the total. It seems reasonable to assume that a democratic nation, a self-governing people, would want to make sure that the constitution, the basic of government and of relations between the people and government, provide for and protect self-government and hence democracy. © The Author 2013

The Sovereignty Deficit of Modern Constitutions

The aim of this essay is to examine the place of the people in the constitutions of democratic nations. While the meaning of democracy and the degree to which it is achieved vary within the family of nations considered democratic, the idea common to all is that the people are self-governing. In its origins, the idea is tied to liberty: not to be self-governing is to be subject to the will of another and so not to be free. What constitutes self-government is open to interpretation, although this is not the place to examine the possible meanings. Nor is this the place to set out the history of the idea or to show how it became central to modern constitutions, except to note the number of nations qualifying as democratic has steadily increased in recent years to just under a half of the total. It seems reasonable to assume that a democratic nation, a self-governing people, would want to make sure that the constitution, the basic of government and of relations between the people and government, provide for and protect self-government and hence democracy. © The Author 2013

Law and Informal Practices: The Post-Communist Experience

Law and Informal Practices is a work in socio-legal studies, examining the functions and effectiveness of law in the countries of the former Soviet Union. As the transition away from communism enters its second decade, the countries involved are confronted by an apparent failure of law. Understanding the newly formed social order in which law is powerless is a challenge to the assumptions of western jurisprudence. The contributors to this book take up that challenge. Using the framework of contemporary theory, ten specialists in different aspects of social science analyse the status of post-communist law from a variety of perspectives. Their emphasis is on the interplay between law and social norms, informal practices, and human values. Their work contributes to several of the wider ongoing debates in socio-legal studies: on the rule of law and its role in maintaining social order; on the interaction between law and social norms, relation between legitimacy and legality; and on the relative merits of solving problems by informal means such as networking or the use of intermediaries rather than by formal, institutionalised processes. At the same time, the book is intended to meet the needs of those interested not just in law but in the post-communist region. Blending theory with case studies, each contributor focuses on a single sector, such as the political system, worker-management relations, human rights, the machinery by which law is made and implemented, or the cultural and historical background of the societies under consideration. The majority of the chapters draw directly upon the authors' own experience and empirical research. Contributors to this volume - Professor Denis Galligan (Centre for Socio-Legal Studies, Oxford University): Dr. Marina Kurkchiyan (Centre for Socio-Legal Studies, Oxford University): Professor William Butler (School of Oriental and African Studies): Professor Neil MacFarlane (St. Anthony's College, Oxford University): Professor James L. Gibson (Washington University, St. Louis, Missouri): Dr. Sarah Ashwin (London School of Economics): Dr. Marat Shterin (London School of Economics): Dr. Frederique Dahan (European Bank for Reconstruction and Development): Dr. Scott Newton (School of Oriental and African Studies): Dr. Tom Ginsburg (University of Illinois, Champagne-Urbana, Illinois)