Can the Midwives Service Scheme (MSS) present an effective and health systems strengthening response to the shortages in human resources for maternal health services in Nigeria?

The flagship Midwives Service Scheme (MSS) was introduced in 2009 as the first large-scale intervention to address rural retention of midwives in Nigeria. This was a multi-component intervention including financial incentives to midwives, provision of accommodation and systems level support, aiming to improve human resource capacity to provide quality services. This study explores how effectively the scheme’s design and implementation drew on the health system’s context, resources, needs and population preferences, and how it contributed to strengthening health systems at all levels. To meet the objectives, 87 in-depth interviews and eight focus group discussions with policymakers, implementers, midwives and community members were conducted in two Nigerian states and at the federal level. Drawing on a systems-thinking approach, the study developed a new framework examining the fit of the intervention with the local health system’s context considering: i) leadership and commitment ii) policy and financing context iii) human resource management capacity, and iv) stakeholder participation. The framework informed the framing of the study and guided data collection; however, themes were identified and synthesised inductively. The broad principles and features of the scheme were widely supported by program managers and policy-makers across the three health systems levels (local, state, federal). However, its design was based on federal level program managers’ knowledge of maternal health and health worker issues, and limited recognition of the decentralised nature of the health system. Implementation was hampered by inadequate management and logistical capacity to deal with the complex design, poor absorptive capacity of states for the posted midwives, failure to provide continued supervision, and welfare issues that affected the midwives. The MSS was successful in attracting midwives including those employed in the private sector due to the promised pay package and capacity building opportunities offered under it. Several factors affected motivation of midwives and impacted on midwife retention. These include low and unpaid salaries and incentives, housing difficulties and distance of housing from the facility, and travel costs and hardships incurred from commuting to the facility. Unmet career development priorities were an additional source of demotivation. The findings point to poor retention of midwives in both states. Retention was better among retired midwives compared to other categories. Younger midwives were more mobile and exited the scheme mainly to the private sector. The MSS had the potential to bring about system-wide changes; however, weak implementation severely hampered its achievement of the intended outcomes and dampened the expectations of significant improvements in the health systems. The findings underscore the importance of reflecting overall health systems structures and processes and local contextual factors, including local health workers’ preferences in designing effective human resource retention schemes. The scheme is potentially replicable as a bundled package of interventions to improve access to skilled workers in rural communities in LMICs. Since decentralisation critically modifies the decision-making space, an inclusive process where sub-national actors participate in choosing policy options should be a prerequisite

Evaluation of Stoichiometry, Stability Constants and Gibbs Free Energies of Acetaminophen-Zn (II) complex at Different Temperatures

Acetaminophen also known as paracetamol, is a drug used in the treatment of pain and fever. It is essentially used for the relief of mild to moderate pain. The presence of phenol and carbonyl oxygen atom enables acetaminophen to behave as a bidentate ligand. The stoichiometry, stability constants and Gibbs free energies of acetaminophen-Zn (II) were determined colorimetrically at 25 and 40 oC using continuous variation and mole  ratio methods. The formation of Zn (II) complex with acetaminophen was studied colorimetrically at an absorption maximum of 630 nm at different temperatures. The data showed that Zn (II) and acetaminophen combine in the molar ratio of 1:1 at pH 7.4 with ionic strength maintained using 0.1M KNO3. Calculated stability constants values were 2.70 x 103 and 2.20 x 103 using continuous variation method and 7.21 x 103 and 7.21 x 103 using mole ratio methods at 25 and 40 oC respectively. Calculated ΔGƟ for the complex were - 1.96 x 104 and -1.98 x 104 J using continuous variation method and -2.2 x 104 J and - 2.31 x 104 J using mole ratio method at 25 and 40 oC respectively. The stability constant and Gibbs free energy results suggested that acetaminophen used in the study is a good chelating agent and can be an efficient antidote in the therapy of Zn (II) overload or poisoning. Keywords: Acetaminophen, Zinc, complex, stability constant, Gibbs free energy

Comparative anti-ulcerogenic activities of the leaf, seed and stem bark hydromethanolic extracts of Picralima nitida in rats

Background: Picralima nitida (Stapf) commonly called akuamma belongs to the family apocynaceae found mostly in forest areas of Africa. It is a shrub or a deciduous tree that can grow up to 35 meters in height. It has a cylindrical trunk measuring about 60 cm in diameter with white latex in its parts. The bark of the trunk is fragile and is greyish brown or black in colour.Methods: The acute oral toxicity test was done using up and down method. The anti-ulcerogenic activities of the leaf, seed and stem bark extracts were evaluated using ethanol-induced ulceration model in rats.Results: There were no signs of morbidity and mortality in rats following oral acute toxicity test. The extracts produced a significant (p<0.05) dose dependent reduction in the number of ulcers and ulcer scores reducing them from 14.00±2.82 and to 56.00±4.55 to as low as 2.00±1.21 and 8.45±1.24 respectively. The ulcer preventive index was also increased by P. nitida extracts in a dose dependent manner with the (Picralima nitida leaf extract) PNLE at the dose of 400 mg/kg causing up to 76.13% inhibition of ulcers in the rats.Conclusions: Picralima nitida extracts demonstrated significant anti-ulcerogenic activities in ethanol-induced gastric ulcerations in rats

Fields in Dispersive Media

It is not just the case that matter affects the propagation of light—or more specifically electromagnetic (EM) radiation—it is also the case that light affects the matter through which it propagates. Conversely, this affects the propagation of light through the medium, but in a much more specific way; this effect is a function of the properties of both the material and the incident EM radiation. We will additionally discuss the effects of dispersion in confined (bounded) media, i.e., where the dispersion is a function of the arrangement of certain materials and unbounded media where EM radiation is free to propagate undisturbed. This will be important when we discuss the propagation electric field signals of such media as well

Effect of Globalization on Nigerian Financial Sector

The study examined the effect of globalization on the Nigerian financial sector and to ascertain the contribution of globalization on the Nigerian stock exchange and commercial banks. Assets of the Nigerian stock exchange and commercial banks were used as performance indicators. The data used are Nigerian yearly data from 1983 to 2014; the data were analyzed using descriptive statistics, ordinary least square statistical technique, Johannes’s co-integration and error correction mechanism. We used Augmented Dickey-fuller statistics test for stationary. We proxy globalization with degree of openness measured by total trade divided by gross domestic product, foreign direct investment flows, Real Gross Domestic Product, external debt flows, nominal exchange rate and gross capital formation. Two null hypotheses were formulated and were tested. They were rejected based on overall significant of models using F statistics at 5 percent level of significance. The result of our estimate based on overall significant of models using F statistics at 5 percent level of significance shows that Nigerian financial sector as a whole has benefited from globalization. Some of the globalization proxy variables take out a priori signs while some did not. However, the foreign direct investment flows and Real Gross Domestic Product affected the performance of the Nigeria Stock Exchange and commercial banks positively while degree of openness, external debt flows, nominal exchange rate and gross capital formation affected the Nigeria stock exchange and Commercial Banks negatively. This shows that Nigerian foreign trade is low. External debt flow has a negative effect on the Nigerian stock Exchange and positive on commercial banks. Nigeria should discourage external loans. Gross capital formation and external debt flows affected the Nigeria stock exchange negatively. We therefore recommend that the recent re-capitalization and debt recovery exercise and monitoring macroeconomic stability be encouraged to gain confidence by investors in the financial sector.

Evaluation of Stoichiometry, Stability Constants and Gibbs Free Energies of Acetaminophen-Zn (II) complex at Different Temperatures

Acetaminophen also known as paracetamol, is a drug used in the treatment of pain and fever. It is essentially used for the relief of mild to moderate pain. The presence of phenol and carbonyl oxygen atom enables acetaminophen to behave as a bidentate ligand. The stoichiometry, stability constants and Gibbs free energies of acetaminophen-Zn (II) were determined colorimetrically at 25 and 40 oC using continuous variation and mole ratio methods. The formation of Zn (II) complex with acetaminophen was studied colorimetrically at an absorption maximum of 630 nm at different temperatures. The data showed that Zn (II) and acetaminophen combine in the molar ratio of 1:1 at pH 7.4 with ionic strength maintained using 0.1M KNO3. Calculated stability constants values were 2.70 x 103 and 2.20 x 103 using continuous variation method and 7.21 x 103 and 7.21 x 103 using mole ratio methods at 25 and 40 oC respectively. Calculated 06G\u19f for the complex were - 1.96 x 104 and -1.98 x 104 J using continuous variation method and -2.2 x 104 J and - 2.31 x 104 J using mole ratio method at 25 and 40 oC respectively. The stability constant and Gibbs free energy results suggested that acetaminophen used in the study is a good chelating agent and can be an efficient antidote in the therapy of Zn (II) overload or poisoning

Donor origin of circulating endothelial progenitors after allogeneic bone marrow transplantation

AbstractEndothelial cell precursors circulate in blood and express antigens found on hematopoietic stem cells, suggesting that such precursors might be subject to transplantation. To investigate, we obtained adherence-depleted peripheral blood mononuclear cells from 3 individuals who had received a sex-mismatched allogeneic bone marrow transplant (BMT) and cultured the cells on fibronectin-coated plates with endothelial growth factors. The phenotype of the spindle-shaped cells that emerged in culture was characterized by immunofluorescent staining, and the origin of the cells was determined using a polymerase chain reaction (PCR)-based assay for polymorphic short tandem repeats (STRs). The cells manifested a number of endothelial characteristics-such as von Wlllebrand factor, CD31, and Flk-1/KDR expression; Bandeiraea simplicifolia lectin 1 binding; and acetylated low-density lipoprotein uptake-but lacked expression of certain markers of activation or differentiation, including intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and the epitope for the anti-endothelial cell antibody P1H12. For each patient and at all time points studied (ranging from 5 to 52 months after transplantation), STR-PCR analysis showed that cultured cells and nucleated blood cells came exclusively from the bone marrow donor. These results demonstrate that circulating endothelial progenitors are both transplantable and capable of long-term repopulation of human allogeneic BMT recipients.Biol Blood Marrow Transplant 2000;6(3A):301-8

Phase III Randomized Trial of Chemotherapy With or Without Bevacizumab in Patients With Recurrent or Metastatic Head and Neck Cancer.

PURPOSE: We evaluated the addition of bevacizumab, a humanized monoclonal antibody that targets vascular endothelial growth factor, to platinum-based chemotherapy in recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Patients with chemotherapy-naïve (or with prior platinum as part of multimodal therapy completed ≥ 4 months earlier) recurrent or metastatic SCCHN were randomly assigned to receive a platinum-based chemotherapy doublet with or without bevacizumab 15 mg/kg given intravenously every 3 weeks until disease progression. Chemotherapy could be discontinued after six cycles if a maximum response was achieved. RESULTS: The study randomly assigned 403 patients. Median overall survival (OS) was 12.6 months with bevacizumab plus chemotherapy (BC) and 11.0 months with chemotherapy alone (hazard ratio, 0.87; 95% CI, 0.70 to 1.09; P = .22). At 2, 3, and 4 years, the OS rates were 25.2% v 18.1%, 16.4% v 10.0%, and 11.8% v 6.4% for BC versus chemotherapy, respectively. In an analysis of 365 eligible patients who started treatment, the hazard ratio was 0.82 (95% CI, 0.65 to 1.04; P = .10), with a median OS of 14.2 months on BC v 11.1 months on chemotherapy. Median progression-free survival with BC was 6.0 months v 4.3 months with chemotherapy (P = .0014). Overall response rates were 35.5% with BC and 24.5% with chemotherapy (P = .016). There was increased toxicity, including a higher rate of treatment-related grade 3 to 5 bleeding events (6.7% v 0.5%; P \u3c .001) and treatment-related deaths (9.3% v 3.5%; P = .022) with BC versus chemotherapy. CONCLUSION: The addition of bevacizumab to chemotherapy did not improve OS but improved the response rate and progression-free survival with increased toxicities. These results encourage biomarker-driven studies of angiogenesis inhibitors with better toxicity profiles in select patients with SCCHN