Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

BACKGROUND: The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. METHODS: This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. RESULTS: Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. CONCLUSION: There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa

Impact of Aging Effect and Heat Treatment on the Tensile Properties of PLA (Poly Lactic Acid) Printed Parts

Rapid innovations in 3D printing technology have allowed highly complex parts to be manufactured quickly and easily, particularly for prototyping purposes. Fused Deposition Modeling of thermoplastic materials is one of the most commonly used techniques in three-dimensional (3D) printing. The major aim of Fused Deposition Modeling (FDM) is to design and manufacture usable parts for fields such as engineering and medicine. Therefore, it is essential to investigate the mechanical properties of such FDM processed structures. One of the most commonly used materials currently on the market is Polylactic Acid (PLA). The main purpose of this paper is to investigate the effects of aging and heat treatment on the tensile properties of PLA printed test specimens. The tensile properties of parts manufactured by the 3D printer are influenced by various parameters such as extrusion temperature, infill density, building direction, layer height, etc. A total of 96 specimens were built by altering building orientation and layer height to estimate and compare the tensile properties of the printed parts. To investigate the aging effect, 30 of 96 specimens were printed 6 months before the tensile experiment. Half of both aged and new specimens were cured in an oven at 57.5 [degrees C] for 3 hours while the other half endured no heat treatment. After the performed measurement, it can be concluded that heat treatment generally improves structural strength of the printed parts, while aging decreases it. However, these effects are highly dependent on the layer thickness and printing quality. The tensile test is conducted according to the ASTM D638 standard. The fractured samples were further characterized using an electron microscope

Zooming on the Quantum Critical Point in Nd-LSCO

Recent studies of the high-Tc superconductor La_(1.6-x)Nd_(0.4)Sr_(x)CuO_(4) (Nd-LSCO) have found a linear-T in-plane resistivity rho_(ab) and a logarithmic temperature dependence of the thermopower S / T at a hole doping p = 0.24, and a Fermi-surface reconstruction just below p = 0.24 [1, 2]. These are typical signatures of a quantum critical point (QCP). Here we report data on the c-axis resistivity rho_(c)(T) of Nd-LSCO measured as a function of temperature near this QCP, in a magnetic field large enough to entirely suppress superconductivity. Like rho_(ab), rho_(c) shows an upturn at low temperature, a signature of Fermi surface reconstruction caused by stripe order. Tracking the height of the upturn as it decreases with doping enables us to pin down the precise location of the QCP where stripe order ends, at p* = 0.235 +- 0.005. We propose that the temperature T_(rho) below which the upturn begins marks the onset of the pseudogap phase, found to be roughly twice as high as the stripe ordering temperature in this material.Comment: Submitted for the Proceedings of the M2S-IX Conference (Tokyo, September 2009

Enhancement of the Nernst effect by stripe order in a high-Tc superconductor

The Nernst effect in metals is highly sensitive to two kinds of phase transition: superconductivity and density-wave order. The large positive Nernst signal observed in hole-doped high-Tc superconductors above their transition temperature Tc has so far been attributed to fluctuating superconductivity. Here we show that in some of these materials the large Nernst signal is in fact caused by stripe order, a form of spin / charge modulation which causes a reconstruction of the Fermi surface. In LSCO doped with Nd or Eu, the onset of stripe order causes the Nernst signal to go from small and negative to large and positive, as revealed either by lowering the hole concentration across the quantum critical point in Nd-LSCO, or lowering the temperature across the ordering temperature in Eu-LSCO. In the latter case, two separate peaks are resolved, respectively associated with the onset of stripe order at high temperature and superconductivity near Tc. This sensitivity to Fermi-surface reconstruction makes the Nernst effect a promising probe of broken symmetry in high-Tc superconductors

The neurotrophin receptor, gp75, forms a complex with the receptor tyrosine kinase TrkA

The high-affinity NGF receptor is thought to be a complex of two receptors , gp75 and the tyrosine kinase TrkA, but direct biochemical evidence for such an association had been lacking. In this report, we demonstrate the existence of such a gp75-TrkA complex by a copatching technique. Gp75 on the surface of intact cells is patched with an anti-gp75 antibody and fluorescent secondary antibody, the cells are then fixed to prevent further antibody-induced redistributions, and the distribution of TrkA is probed with and anti-TrkA antibody and fluorescent secondary antibody. We utilize a baculovirus-insect cell expression of wild-type and mutated NGF receptors. TrkA and gp75 copatch in both the absence and presence of NGF. The association is specific, since gp75 does not copatch with other tyrosine kinase receptors, including TrkB, platelet-derived growth factor receptor-beta, and Torso (Tor). To determine which domains of TrkA are required for copatching, we used a series of TrkA-Tor chimeric receptors and show that the extracellular domain of TrkA is sufficient for copatching with gp75. A chimeric receptor with TrkA transmembrane and intracellular domains show partial copatching with gp75. Deletion of the intracellular domain of gp75 decreases but does not eliminate copatching. A point mutation which inactivates the TrkA kinase has no effect on copatching, indicating that this enzymatic activity is not required for association with gp75. Hence, although interactions between the gp75 and TrkA extracellular domains are sufficient for complex formation, interactions involving other receptor domains also play a role

Nernst and Seebeck Coefficients of the Cuprate SuperconductorYBa2_2Cu3_3O6.67_{6.67}: A Study of Fermi Surface Reconstruction

The Seebeck and Nernst coefficients $S$ and $\nu$ of the cuprate superconductor YBa$_2$Cu$_3$O$_y$ (YBCO) were measured in a single crystal with doping $p = 0.12$ in magnetic fields up to H = 28 T. Down to T=9 K, $\nu$ becomes independent of field by $H \simeq 30$ T, showing that superconducting fluctuations have become negligible. In this field-induced normal state, $S/T$ and $\nu/T$ are both large and negative in the $T \to 0$ limit, with the magnitude and sign of $S/T$ consistent with the small electron-like Fermi surface pocket detected previously by quantum oscillations and the Hall effect. The change of sign in $S(T)$ at $T \simeq 50$ K is remarkably similar to that observed in La$_{2-x}$Ba$_x$CuO$_4$, La$_{2-x-y}$Nd$_y$Sr$_x$CuO$_4$ and La$_{2-x-y}$Eu$_y$Sr$_x$CuO$_4$, where it is clearly associated with the onset of stripe order. We propose that a similar density-wave mechanism causes the Fermi surface reconstruction in YBCO.Comment: Final version accepted for publication in Phys. Rev. Lett. New title, shorter abstract, minor revision of text and added reference

Lifshitz critical point in the cuprate superconductor YBa2Cu3Oy from high-field Hall effect measurements

The Hall coefficient R_H of the cuprate superconductor YBa2Cu3Oy was measured in magnetic fields up to 60 T for a hole concentration p from 0.078 to 0.152, in the underdoped regime. In fields large enough to suppress superconductivity, R_H(T) is seen to go from positive at high temperature to negative at low temperature, for p > 0.08. This change of sign is attributed to the emergence of an electron pocket in the Fermi surface at low temperature. At p < 0.08, the normal-state R_H(T) remains positive at all temperatures, increasing monotonically as T \to 0. We attribute the change of behaviour across p = 0.08 to a Lifshitz transition, namely a change in Fermi-surface topology occurring at a critical concentration p_L = 0.08, where the electron pocket vanishes. The loss of the high-mobility electron pocket across p_L coincides with a ten-fold drop in the conductivity at low temperature, revealed in measurements of the electrical resistivity $\rho$ at high fields, showing that the so-called metal-insulator crossover of cuprates is in fact driven by a Lifshitz transition. It also coincides with a jump in the in-plane anisotropy of $\rho$, showing that without its electron pocket the Fermi surface must have strong two-fold in-plane anisotropy. These findings are consistent with a Fermi-surface reconstruction caused by a unidirectional spin-density wave or stripe order.Comment: 16 pages, 13 figures, see associated Viewpoint: M. Vojta, Physics 4, 12 (2011

Broken rotational symmetry in the pseudogap phase of a high-Tc superconductor

The nature of the pseudogap phase is a central problem in the quest to understand high-Tc cuprate superconductors. A fundamental question is what symmetries are broken when that phase sets in below a temperature T*. There is evidence from both polarized neutron diffraction and polar Kerr effect measurements that time- reversal symmetry is broken, but at temperatures that differ significantly. Broken rotational symmetry was detected by both resistivity and inelastic neutron scattering at low doping and by scanning tunnelling spectroscopy at low temperature, but with no clear connection to T*. Here we report the observation of a large in-plane anisotropy of the Nernst effect in YBa2Cu3Oy that sets in precisely at T*, throughout the doping phase diagram. We show that the CuO chains of the orthorhombic lattice are not responsible for this anisotropy, which is therefore an intrinsic property of the CuO2 planes. We conclude that the pseudogap phase is an electronic state which strongly breaks four-fold rotational symmetry. This narrows the range of possible states considerably, pointing to stripe or nematic orders.Comment: Published version. Journal reference and DOI adde