USING LAND EQUITY TO PROVIDE A RETIREMENT INCOME

Many retiring farmers will need to use their land equity to provide a retirement income. Based on a present value analysis, retiring farmers may either decide to sell or lease their land. The analysis is needed because taxes, liability issues, and goals of the farmer complicate the decision.retirement, land equity, Consumer/Household Economics, Land Economics/Use,

Costs, payments and incentives in family planning programs

A variety of monetary policies regarding contraception exists around the world. These range from high user charges in some countries, to free contraceptives in many, to incentives and disincentives in others. This paper examines these policies, focuses on charges and payments as they existed in early 1988, looks at the consistency of monetary policies within countries, and considers the ethical issues raised by each kind of incentive.Health Monitoring&Evaluation,Adolescent Health,Reproductive Health,Economic Theory&Research,Pharmaceuticals&Pharmacoeconomics

Scedosporium prolificans Septic Arthritis

Scedosporium prolificans is an emerging fungal pathogen that can cause significant morbidity, and even mortality, in both immunocompromised and immunocompetent patients. Approximately 10% of patients affected by this rare fungal pathogen present with septic osteomyelitis or arthritis. Overall, the rate of mortality is close to 50%, and several patients with orthopedic infections have required amputations.1 Our patient is a 59-year-old woman, with a history of rheumatoid arthritis requiring immunosuppressants, who presented with a 5-month history of right wrist pain and swelling. She described an oscillating course of swelling, erythema, and pain involving the dorsal aspect of her wrist that did not show sustained response to antibiotics or a radiocarpal joint steroid injection given by other providers. On initial examination, she was afebrile with dorsal wrist swelling. There was no erythema, but wrist mobility was limited. She had tenderness throughout the wrist, but no fluctuance or drainage. All initial laboratory work was normal. Right wrist X-ray showed severe osteopenia with some mild evidence of cortical erosion. Despite the normal laboratory values, her presenting findings of swelling, radiographic erosions, and immunocompromised state prompted concern for atypical septic arthritis. The patient subsequently underwent wrist exploration for tissue and culture harvest. In addition to extensive wrist synovectomy, the proximal pole of the scaphoid, lunate, triquetrum, capitate, hamate, and metacarpal bases all showed evidence of necrosis that required debridement. One week later, her fluid aspirate and bone cultures unexpectedly grew an unidentified fungal species, and she was taken back to the operating room for further debridement and placement of a voriconazole-impregnated cement spacer. The culture grew pan-resistant Scedosporium prolificans, and based on recommendations from Rheumatology and Infectious Disease, the patient was started on a 6-week course of intravenous micafungin, and immunosuppressive medications were stopped. She returned to the operating room for debridement and serial treatments with polyhexamethylene biguanide (PHMB) irrigation until intraoperative tissue cultures showed no growth. PHMB is an antiseptic medication that has been described as a local adjunct to the treatment of resistant fungal infections.2–4 After successful eradication of her infection, she underwent wrist reconstruction and fusion with a double-barrel free fibula osteocutaneous flap. She is now 18 months out from her reconstruction, has healed uneventfully, and has a functional, painless upper extremity

Implementing a structured triage system at a community health centre using Kaizen

Background: More than 100 unbooked patients present daily to the Mitchell’s Plain Community Health Centre (MPCHC), and are triaged by a doctor, with the assistance of a staff nurse. The quality of the triage assessments has been found to be variable, with patients often being deferred without their vital signs being recorded. This leads to frustration, and a resultant increased workload for doctors; management is concerned with the medicolegal risk of deferring patients who have not been triaged in accordance with the guidelines; and patients are unhappy with the quality of service they receive. Aim: We set out to standardise the triage process and to manage unbooked patients presenting to the community health centre (CHC) in a manner that is medico-legally safe, cost efficient and patient friendly, using the Kaizen method. Methods: The principles of Kaizen were used to observe and identify inefficiencies in the existing triage process at the MPCHC. Findings were analysed and interventions introduced to improve outcomes. The new processes were, in turn, validated and standardised. Results: The majority of patients presenting to Triage were those needing reissuing of prescriptions for their chronic medication, and this prevented practitioners from timeously attending to other patients waiting to be seen. Reorganising of the process was needed; it was necessary to separate the patients needing triage from those requiring only prescriptions to be reissued. After the intervention, triage was performed by a staff nurse only, using the Cape Triage Score (CTS) method. Subsequent to the implementation of interventions, no patients have been deferred, and all patients are now assessed according to a standardised protocol. The reasons for patients requiring reissuing of prescriptions were numerous, and implementing countermeasures to the main causes thereof decreased the number of reissues by 50%. Conclusion: The Kaizen method can be used to improve the triage process for unbooked patients at the MPCHC, thereby improving the quality of services delivered to these patients. As the needs of the various CHCs differ quite widely across the service platform, the model needs to be adapted to suit local conditions

Hybrid Atom--Photon Quantum Gate in a Superconducting Microwave Resonator

We propose a novel hybrid quantum gate between an atom and a microwave photon in a superconducting coplanar waveguide cavity by exploiting the strong resonant microwave coupling between adjacent Rydberg states. Using experimentally achievable parameters gate fidelities $> 0.99$ are possible on sub-$\mu$s timescales for waveguide temperatures below 40 mK. This provides a mechanism for generating entanglement between two disparate quantum systems and represents an important step in the creation of a hybrid quantum interface applicable for both quantum simulation and quantum information processing.Comment: 4 pages, 4 figure

Implementation and evaluation of a weight-reduction programme for diabetic patients at a primary health care facility in the Western Cape: a pilot study

Background: Diabetes is a common non-communicable disease and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, and self-management of diabetes, and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for diabetes state that carbohydrates should comprise 45–60% of the total nutritional intake and that lowcarbohydrate or high-protein diets offer no long-term success over healthy eating plans. Recent studies suggest that there may be merit in using low-carbohydrate diets in diabetic patients for weight reduction and improved cardiovascular markers. This study aimed to implement and evaluate a pilot programme for weight loss in diabetes mellitus type 2 patients by comparing a low-carbohydrate diet with the conventional low-fat diet.Methods: The study design was that of a two-group parallel design, with one group following a low-fat diet and the other a lowcarbohydrate diet. Diabetic patients attending the Mitchell’s Plain Community Health Centre in Cape Town were recruited, with 10 participants in each group. Both groups received similar advice on exercise and behaviour change. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded at baseline and again after 12 weeks.Results: There were reductions in weight (1.85 kg vs. 0.1 kg gain) and HbA1c (1.72 vs. 0.32) in the low-carbohydrate diet group when compared with the low-fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group.Conclusion: Low-carbohydrate diets may be effective in promoting weight loss and improving glucose control in diabetic patients. Implementation of this programme would require a paradigm shift for staff and further studies to assess its acceptability for patients.Keywords: diabetes, implementation, low-carbohydrate diet, primary health care, weight los