The PRIME model: a management solution in academic medicine

Background: The Health Sector and the rendering of health services in South Africa have undergone substantial adjustment since the political change in 1994, filtering through to academic medicine. The managerial responsibilities of the Heads of Department at Medical Schools multiplied. In order to improve their management skills; decrease their frustration; and optimally utilize the highly skilled person-power available, this study endeavoured to establish a management model for use by experienced as well as new Heads of Department in a School of Medicine, measured against the background of good management practices. Methods: A descriptive, explanatory survey comprising a literature review, a questionnaire survey and a Delphi process was performed. The literature study covered a few aspects, including assessing the possible needs of Heads of Department, exploring factors impacting on their environment, as well as the difference between management and leadership, and the difference between various management models that may be applicable to management in an academic setting such as a Medical School. The second part of the empirical study was the Delphi process, which involved six experts from the areas of management, health management, and education. A quantitative approach with open-ended questions was followed, focusing on measurement of experts' feelings about these areas. Results: Heads of Department are appointed in the academic environment with the primary focus on their educational achievements. Throughout the process, it was demonstrated that this is still relevant and needs to be part of the appointment process of Heads of Department in a School of Medicine. It was also indicated throughout this study that there is an increasing expectation from Heads of Department to take on sole responsibility for the management of their departments. In view of these developments, it was important to consider assisting them through establishing a management model, thus empowering them to manage their departments in the future. The main findings from the questionnaire to Heads of Department, the Delphi technique, and information obtained via the literature study enabled the researcher to make a recommendation on a management model that is flexible, individualized, relevant, and adaptable for Heads of Department at the School of Medicine at the UFS. Conclusion: Resources and services are spread thin by challenges from political changes and other challenges such as the AIDS pandemic and tuberculosis. Emphasis has shifted from hospital-based care to primary health care adding another dimension to the management strategy of academic institutions. A management model, the PRIME model, was developed that is simple, flexible, allows for individuality, integration and efficiency and should be easy to implement. It adds quality to management tasks but also to lives. It embraces multi-tasking and still focuses on the key position of the leader, while allowing growth and development of new talent. It is adjustable and should be the model of choice to address the ever changing environment of health management. It is recommended that a future study be conducted evaluating the possibility of utilising the principles of the PRIME model in other Medical Schools in South Africa in order to assist them with the managerial problems they might be experiencing. South African Family Practice Vol. 50 (1) 2008: pp. 71-71

A new fossil ichneumon wasp from the Lowermost Eocene amber of Paris Basin (France), with a checklist of fossil Ichneumonoidea s.l. (Insecta : Hymenoptera : Ichneumonidae : Metopiinae)

We describe a new fossil genus and species Palaeometopius eocenicus of Ichneumonidae Metopiinae (Insecta: Hymenoptera), from the Lowermost Eocene amber of the Paris Basin. A list of the described fossil Ichneumonidae is proposed

POPULATION DYNAMICS OF THE WANDERING ALBATROSS DIOMEDEA EXULANS AT MARION ISLAND: LONGLINE FISHING AND ENVIRONMENTAL INFLUENCES

The subantarctic Prince Edward Islands (Marion and Prince Edward) support the largest breeding population of the Vulnerable wandering albatross Diomedea exulans. The number of birds breeding at Marion Island has fluctuated over the past three decades apparently as a result of both real changes in the size of the population and changes in the proportion of the population that attempts to breed in a given year. Changes in several demographic parameters that appear to be influenced by both environmental and anthropogenic effects are described. From 1994–2001, the proportion of first-time breeders in the population was positively correlated with the maximum ENSO (Ni&#241o 3) index, whereas from 1984–2000 the annual survival rates of breeding adults were negatively correlated with Japanese pelagic longline fishing effort in the southern Indian Ocean. Adult survival rates were significantly correlated with those on neighbouring Possession Island, Crozet Islands, but differed from those at South Georgia, suggesting common factors operating at an ocean-basin scale. The average survival rate of adult females was lower than that of males. Males who lost partners took 40% longer than females to find a new mate, suggesting a male-biased population. Survival rates of juvenile males and females did not differ. The age distribution of first-time breeders shifted progressively towards younger birds during the 1990s. Higher than expected survival rates of breeding adults during the late 1990s may be linked to large amounts of supplementary food being made available by the initiation of a longline fishery for Patagonian toothfish Dissostichus eleginoides close to the islands at this time. Overall, breeding success was better than recorded at other localities, indicating that breeding conditions at Marion Island were comparatively favourable. The early implementation of both international and national conservation initiatives to reduce the impact of longline fishing on this species and improve its conservation status is encouraged.Afr. J. mar. Sci. 25: 503–51

Food items consumed by students attending schools in different socio-economic areas in Cape Town, South Africa

Objective: We investigated the food consumption patterns of adolescent students at schools. Our findings are intended to reveal the overall nutritional quality of foods eaten by students at school, including foods brought to school and foods purchased at school. Methods: A questionnaire was completed by 476 students, mostly from grades 7 and 10, from 14 schools in Cape Town, South Africa. The schools were representative of the various ethnic groups and socioeconomic strata of the population. The questionnaire requested information on eating habits at school, foods brought to school and food purchases, and breakfast consumption before school. We also tested whether students knew which foods are healthy and which are less healthy choices. Results: The students were mostly 12 to 16 y of age (mean age 14.5 y). The large majority had breakfast before school (77.8%) and ate at school (79.7%). Food was brought to school by 41% to 56%, whereas 69.3% purchased food at school, mainly at the school store (tuck shop). Predefined “unhealthy” foods brought to school outnumbered “healthy” ones by 2 to 1. Among students who purchased food at school, 70.0% purchased no healthy items, whereas 73.2% purchased two or more unhealthy items. With six foods 84% of students correctly stated whether they were healthy or unhealthy; however, with cola drinks, samoosas (deep-fried pastry with spicy filling), and pies, only 47% to 61% knew that these were less healthy choices. Students’ scores on this question were unrelated to whether they purchased healthy or unhealthy foods. Students who attended schools of high socioeconomic status were twice as likely to bring food to school (64.7% versus 31.0%, P < 0.001), scored higher marks on the quiz of healthy versus unhealthy foods (P < 0.01), but were no more likely to purchase healthy food. Conclusions: The large majority of food eaten by adolescent students in Cape Town is classified as being unhealthy choices. This applies to foods brought to school and food purchases. Consideration needs to be given to policy measures to improve this situation and to improve education of students and their parents

Identification of the Synthetic Cannabinoid R()WIN55,212-2 as a Novel Regulator of IFN Regulatory Factor 3 Activation and IFN- Expression

Beta Interferons (IFN-βs) represent one of the first line treatments for relapsing remitting multiple sclerosis (RRMS), slowing disease progression whilst reducing the frequency of relapses. Despite this, more effective, well tolerated therapeutic strategies are needed. Cannabinoids palliate experimental autoimmune encephalomyelitis (EAE) symptoms and have therapeutic potential in MS patients although the precise molecular mechanism for these effects is not understood. Toll-like receptor (TLR) signaling controls innate immune responses and TLRs are implicated in MS. Here we demonstrate that the synthetic cannabinoid R(+)WIN55,212-2 is a novel regulator of TLR3 and TLR4 signaling by inhibiting the pro-inflammatory signaling axis triggered by TLR3 and TLR4 whilst selectively augmenting TLR3-induced activation of IFN regulatory factor 3 (IRF3) and expression of IFN-β. We present evidence that R(+)WIN55,212-2 strongly promotes the nuclear localization of IRF3. The potentiation of IFN-β expression by R(+)WIN55,212-2 is critical for manifesting its protective effects in the murine MS model EAE as evidenced by its reduced therapeutic efficacy in the presence of an anti-IFN-β antibody. R(+)WIN55,212-2 also induces IFN-β expression in MS patient peripheral blood mononuclear cells (PBMCs), whilst downregulating inflammatory signaling in these cells. These findings identify R(+)WIN55,212-2 as a novel regulator of TLR3 signaling to IRF3 activation and IFN-β expression and highlights a new mechanism that may be open to exploitation in the development of new therapeutics for the treatment of MS

Identification of the Synthetic Cannabinoid R()WIN55,212-2 as a Novel Regulator of IFN Regulatory Factor 3 Activation and IFN- Expression

Beta Interferons (IFN-βs) represent one of the first line treatments for relapsing remitting multiple sclerosis (RRMS), slowing disease progression whilst reducing the frequency of relapses. Despite this, more effective, well tolerated therapeutic strategies are needed. Cannabinoids palliate experimental autoimmune encephalomyelitis (EAE) symptoms and have therapeutic potential in MS patients although the precise molecular mechanism for these effects is not understood. Toll-like receptor (TLR) signaling controls innate immune responses and TLRs are implicated in MS. Here we demonstrate that the synthetic cannabinoid R(+)WIN55,212-2 is a novel regulator of TLR3 and TLR4 signaling by inhibiting the pro-inflammatory signaling axis triggered by TLR3 and TLR4 whilst selectively augmenting TLR3-induced activation of IFN regulatory factor 3 (IRF3) and expression of IFN-β. We present evidence that R(+)WIN55,212-2 strongly promotes the nuclear localization of IRF3. The potentiation of IFN-β expression by R(+)WIN55,212-2 is critical for manifesting its protective effects in the murine MS model EAE as evidenced by its reduced therapeutic efficacy in the presence of an anti-IFN-β antibody. R(+)WIN55,212-2 also induces IFN-β expression in MS patient peripheral blood mononuclear cells (PBMCs), whilst downregulating inflammatory signaling in these cells. These findings identify R(+)WIN55,212-2 as a novel regulator of TLR3 signaling to IRF3 activation and IFN-β expression and highlights a new mechanism that may be open to exploitation in the development of new therapeutics for the treatment of MS

Determination of glomerular filtration rate with radionuclide renography and direct urinary activity quantitation

Objective. The direct urinary activity quantitation method is quick (approximately 40 minutes), requires only a single blood sample, is performed as part of standard renal scanning and shows high accuracy compared With 24hour creatinine clearance. The purpose was to evaluate the practical application and accuracy of this technique at our clinic. Design. Direct urinary activity quantitation was done in patients scheduled for routine radionuclide renography and compared to standard multiple-blood-sample techniques by means of Cr-51-EDTA and Tc-99m-DTPA.Setting. Academic Medical Complex, Department of Nuclear Medicine, Universitas Hospital, Bloemfontein.Participants. Fifteen patients scheduled for routine radionuclide renography (glomerular filtration rate (GFR) determination) were voluntarily enrolled in the study. The GFRs of selected patients varied over a wide range. Possible obstructive uropathy was excluded.Main outcome measures. GFRs obtained by the direct urinary method were compared with GFRs determined by multisample Cr-51-EDTA and Tc-99m DTPA.Results. GFRs from the direct urinary method compared with multisample Tc-99m-DTPA showed differences from -19,85 to 22,95 ml/min with a mean of 0,2 (+- 12,25) ml/min (r = 0,93). When compared with multisample Cr-51 EDTA, differences ranged from -34,35 to 21,05 ml/min with a mean of -4,25 (+- 16,08) ml/min (r =0,90).Conclusion. The direct urinary activity technique is easily applied and highly accurate compared with previous standardised multisample radionuclide techniques for determination of GFR

The National Food Consumption Survey (NFCS): South Africa, 1999

Objective: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1-9 years old), as well as factors that influence their dietary intake. Design: This was a cross-sectional survey of a nationally representative sample of all children aged 1-9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. Subjects: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. Methods: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. Results: At the national level, stunting (height-for-age below minus two standard deviations (&lt; -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age &lt; -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1-3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. Conclusion: The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa. © The Authors 2005.Conference Pape

Making Sense of Family Deaths in Urban Senegal: Diversities, Contexts, and Comparisons

Despite calls for cross-cultural research, Minority world perspectives still dominate death and bereavement studies, emphasizing individualized emotions and neglecting contextual diversities. In research concerned with contemporary African societies, on the other hand, death and loss are generally subsumed within concerns about AIDS or poverty, with little attention paid to the emotional and personal significance of a death. Here, we draw on interactionist sociology to present major themes from a qualitative study of family deaths in urban Senegal, theoretically framed through the duality of meanings-in-context. Such themes included family and community as support and motivation; religious beliefs and practices as frameworks for solace and (regulatory) meaning; and material circumstances as these are intrinsically bound up with emotions. Although we identify the experience of (embodied, emotional) pain as a common response across Minority and Majority worlds, we also explore significant divergencies, varying according to localized contexts and broader power dynamics