Two-tier charging in Maputo Central Hospital: Costs, revenues and effects on equity of access to hospital services

<p>Abstract</p> <p>Background</p> <p>Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations.</p> <p>Methods</p> <p>A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures.</p> <p>Results</p> <p>The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital.</p> <p>Discussion</p> <p>While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around.</p> <p>Conclusion</p> <p>We conclude that the observed lack of transparency may create scope for an inequitable cross subsidy of private customers by public resources.</p

High Velocity Impact and Blast Loading of Composite Sandwich Panels with Novel Carbon and Glass Construction

This research investigates whether the layup order of the carbon-fibre/glass-fibre skins in hybrid composite sandwich panels has an effect on impact response. Composite sandwich panels with carbon-fibre/glass-fibre hybrid skins were subjected to impact at velocities of 75 ± 3 and 90 ± 3 m s−1. Measurements of the sandwich panels were made using high-speed 3D digital image correlation (DIC), and post-impact damage was assessed by sectioning the sandwich panels. It was concluded that the introduction of glass-fibre layers into carbon-fibre laminate skins reduces brittle failure compared to a sandwich panel with carbon-fibre reinforced polymer skins alone. Furthermore, if the impact surface is known, it would be beneficial to select an asymmetrical panel such as Hybrid-(GCFGC) utilising glass-fibre layers in compression and carbon-fibre layers in tension. This hybrid sandwich panel achieves a specific deflection of 0.322 mm kg−1 m2 and specific strain of 0.077% kg−1 m2 under an impact velocity of 75 ± 3 m s−1. However, if the impact surface is not known, selection of a panel with a symmetric yet more dispersed hybridisation would be effective. By distributing the different fibre layers more evenly within the skin, less surface and core damage is achieved. The distributed hybrid investigated in this research, Hybrid-(GCGFGCG), achieved a specific deflection of 0.394 mm kg−1 m2 and specific strain of 0.085% kg−1 m2 under an impact velocity of 75 ± 3 m s−1. Blast loading was performed on a large scale version of Hybrid-(GCFGC) and it exhibited a maximum deflection of 75 mm following a similar deflection profile to those observed for the impact experiments

Polo kinase recruitment via the constitutive centromere-associated network at the kinetochore elevates centromeric RNA

The kinetochore, a multi-protein complex assembled on centromeres, is essential to segregate chromosomes during cell division. Deficiencies in kinetochore function can lead to chromosomal instability and aneuploidy-a hallmark of cancer cells. Kinetochore function is controlled by recruitment of regulatory proteins, many of which have been documented, however their function often remains uncharacterized and many are yet to be identified. To identify candidates of kinetochore regulation we used a proteome-wide protein association strategy in budding yeast and detected many proteins that are involved in post-translational modifications such as kinases, phosphatases and histone modifiers. We focused on the Polo-like kinase, Cdc5, and interrogated which cellular components were sensitive to constitutive Cdc5 localization. The kinetochore is particularly sensitive to constitutive Cdc5 kinase activity. Targeting Cdc5 to different kinetochore subcomplexes produced diverse phenotypes, consistent with multiple distinct functions at the kinetochore. We show that targeting Cdc5 to the inner kinetochore, the constitutive centromere-associated network (CCAN), increases the levels of centromeric RNA via an SPT4 dependent mechanism

Spt6 is a maintenance factor for centromeric CENP-A

Replication and transcription of genomic DNA requires partial disassembly of nucleosomes to allow progression of polymerases. This presents both an opportunity to remodel the underlying chromatin and a danger of losing epigenetic information. Centromeric transcription is required for stable incorporation of the centromere-specific histone dCENP-A in M/G1 phase, which depends on the eviction of previously deposited H3/H3.3-placeholder nucleosomes. Here we demonstrate that the histone chaperone and transcription elongation factor Spt6 spatially and temporarily coincides with centromeric transcription and prevents the loss of old CENP-A nucleosomes in both Drosophila and human cells. Spt6 binds directly to dCENP-A and dCENP-A mutants carrying phosphomimetic residues alleviate this association. Retention of phosphomimetic dCENP-A mutants is reduced relative to wildtype, while non-phosphorylatable dCENP-A retention is increased and accumulates at the centromere. We conclude that Spt6 acts as a conserved CENP-A maintenance factor that ensures long-term stability of epigenetic centromere identity during transcription-mediated chromatin remodeling

The ALICE Transition Radiation Detector: Construction, operation, and performance

The Transition Radiation Detector (TRD) was designed and built to enhance the capabilities of the ALICE detector at the Large Hadron Collider (LHC). While aimed at providing electron identification and triggering, the TRD also contributes significantly to the track reconstruction and calibration in the central barrel of ALICE. In this paper the design, construction, operation, and performance of this detector are discussed. A pion rejection factor of up to 410 is achieved at a momentum of 1 GeV/c in p-Pb collisions and the resolution at high transverse momentum improves by about 40% when including the TRD information in track reconstruction. The triggering capability is demonstrated both for jet, light nuclei, and electron selection. (c) 2017 CERN for the benefit of the Authors. Published by Elsevier B.V

the adoption of climate smart agriculture the role of information and insurance under climate change

Climate change adds to the existing challenges in improving crop productivity and welfare for smallholder agricultural households by affecting the mean and variability of weather conditions and the frequency of extreme weather events. In the face of such growing uncertainty, agricultural practices of small landholders need to be adapted to better manage the changing risk structures. Since government risk management programs may complement or substitute for farmer adaptation, this chapter examines how a range of institutional interventions might assist, obstruct, channel, or change smallholder agricultural adaptation to climate change. Taken together, our results underscore the importance of the informational role of the agriculture extension, suggest that insurance can lead to significant changes in farmer planting and land management decisions, and show how information about changing conditions and insurance can be complimentary in driving changes in farmer behavior