New Directions in Philosophy of Medicine

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research

Penggunaan Abu Batu Bara Pltu Mpanau sebagai Bahan Stabilisasi Tanah Lempung

Penelitian ini bertujuan memeriksa pengaruh stabilisasi tanah lempung menggunakan bahanstabilisasi Abu batu bara dan semen. Abu batu bara yang digunakan adalah abu bara hasilpembakaran dari PLTU Mpanau Kecamatan Tawaeli Kota Palu yang lolos saringan No.200, tanahlempung yang diuji memiliki indeks plastisitas lebih besar dari 20. Sifat yang diperiksa adalah:Perubahan batas cair, kepadatan maksimum dan nilai CBR. Proporsi rancangan campuran terdiridari abu batu bara adalah 10% dan 20% semen sebesar 4% dan 8% masing-masing terhadapberat kering tanah lempung,.Hasil penelitian menunjukkan bahwa campuran abu batu bara dansemen mampu menurunkan nilai indeks plastisitas tanah lempung dari 27,33% menjadi 10,37 %,meningkatkan nilai CBR tanah dari 4,46% menjadi 13,8% untuk CBR rendaman dan dari 5,6%menjadi 15,5% untuk CBR tanpa rendama

Scholarly Communications Journal Club Syllabus

This Medical Library Association Journal Club was conducted at the Health Sciences Library and Informatics Center at the University of New Mexico from August 2015 - May 2016. Ten topics within scholarly communications were studied, including an introduction and background to scholarly communications, academic publishing and the role of publishers, digital curation and preservation, copyright, open access and the role of peer review, scholarly communication in libraries, scholarly impact and metrics, and open educational resources (OERs). The readings for each topic are included, many of which are open access publications

The use of video vignettes to measure health worker knowledge. Evidence from Burkina Faso

The quality of care is a crucial determinant of good health outcomes, but is difficult to measure. Survey vignettes are a standard approach to measuring medical knowledge among health care providers. Given that written vignettes or knowledge tests may be too removed from clinical practice, particularly where “learning by doing” may be an important form of training, we developed a new type of provider vignette. It uses videos presenting a patient visiting the clinic with maternal/early childhood symptoms. We tested these video vignettes with current and future (students) health professionals in Burkina Faso. Participants indicated that the cases used were interesting, understandable and common. Their performance was consistent with expectations. Participants with greater training (medical doctors vs. nurses and midwives) and experience (health professionals vs. students) performed better. The video vignettes can easily be embedded in computers, tablets and smart phones; they are a convenient tool to measure provider knowledge; and they are cost-effective instruction and testing tools

Does enrollment status in community-based insurance lead to poorer quality of care? Evidence from Burkina Faso

Introduction: In 2004, a community-based health insurance (CBI) scheme was introduced in Nouna health district, Burkina Faso, with the objective of improving financial access to high quality health services. We investigate the role of CBI enrollment in the quality of care provided at primary-care facilities in Nouna district, and measure differences in objective and perceived quality of care and patient satisfaction between enrolled and non-enrolled populations who visit the facilities. Methods: We interviewed a systematic random sample of 398 patients after their visit to one of the thirteen primary-care facilities contracted with the scheme; 34% (n = 135) of the patients were currently enrolled in the CBI scheme. We assessed objective quality of care as consultation, diagnostic and counselling tasks performed by providers during outpatient visits, perceived quality of care as patient evaluations of the structures and processes of service delivery, and overall patient satisfaction. Two-sample t-tests were performed for group comparison and ordinal logistic regression (OLR) analysis was used to estimate the association between CBI enrollment and overall patient satisfaction. Results: Objective quality of care evaluations show that CBI enrollees received substantially less comprehensive care for outpatient services than non-enrollees. In contrast, CBI enrollment was positively associated with overall patient satisfaction (aOR = 1.51, p = 0.014), controlling for potential confounders such as patient socio-economic status, illness symptoms, history of illness and characteristics of care received. Conclusions: CBI patients perceived better quality of care, while objectively receiving worse quality of care, compared to patients who were not enrolled in CBI. Systematic differences in quality of care expectations between CBI enrollees and non-enrollees may explain this finding. One factor influencing quality of care may be the type of provider payment used by the CBI scheme, which has been identified as a leading factor in reducing provider motivation to deliver high quality care to CBI enrollees in previous studies. Based on this study, it is unlikely that perceived quality of care and patient satisfaction explain the low CBI enrollment rates in this community

Health Worker Preferences for Community-Based Health Insurance Payment Mechanisms: A Discrete Choice Experiment

Background: In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods: A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results: Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)). Conclusions: Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid

Very fast chilling modifies the structure of muscle fibres in hot-boned beef loin

The aim of this study was to gain a better understanding of the tenderisation mechanism associated with very fast chilling (VFC) of beef muscle. Hot-boned striploins from 36 carcasses were allocated to a treatment (control, delayed or immediate chilling below 0 °C), and each striploin was divided into three equal portions and allocated to a time post-mortem (2, 5 or 14 d). Immediate chilling resulted in lower peak force values at 2 d post-mortem and lower particle size after 5 d post-mortem. Both chilling treatments significantly improved the WHC by reducing drip loss and cooking loss. Sarcomere lengths were not affected by chilling treatments, although fragmentation and cleavage of muscle fibres were evident along the fibre length, possibly contributing to the reduction in peak force values at 2 d post-mortem. Both delayed and immediate chilling resulted in a higher pH at 4 and 24 h post-mortem, and colour parameters were modified. These results suggest that VFC has potential for accelerating tenderisation early post-mortem by a combination of biochemical and biophysical effects

Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon

Background: Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. Methods: To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Results: Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, P < 0.001) and improved health facility infrastructure (aOR= 3.54, 95% CI: 2.73-4.58) respectively were the attributes with the largest effect sizes. Among medical doctors and nurse aides, a rural retention bonus of 75% of base salary was the attribute with the largest effect size (medical doctors aOR= 5.60, 95% CI: 4.12-7.61, P < 0.001; nurse aides aOR= 4.29, 95% CI: 3.11-5.93, P < 0.001). On the other hand, improved health facility infrastructure (aOR= 3.56, 95% CI: 2.75-4.60, P < 0.001), was the attribute with the largest effect size among the state registered nurses surveyed. Willingness-to-Pay (WTP) estimates were generated for each health worker cadre for all the attributes. Preference impact measurements were also estimated to identify combination of incentives that health workers would find most attractive. Conclusion: Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policy- makers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health

Hyperspectral terahertz microscopy via nonlinear ghost-imaging

Ghost-imaging, based on single-pixel detection and multiple pattern illumination, is a crucial investigation tool in difficult-to-access wavelength regions. In the terahertz domain, where high-resolution imagers are mostly unavailable, Ghost-imaging is an optimal approach to embed the temporal dimension, creating a ‘hyperspectral’ imager. In this framework high-resolution is mostly out-of-reach. Hence, it is particularly critical to developing practical approaches for microscopy. Here we experimentally demonstrate Time-Resolved Nonlinear Ghost-Imaging, a technique based on near-field, optical-to-terahertz nonlinear conversion and detection of illumination patterns. We show how space-time coupling affects near-field time-domain imaging and we develop a complete methodology that overcomes fundamental systematic reconstruction issues. Our theoretical-experimental platform enables high-fidelity subwavelength imaging and carries relaxed constrains on the nonlinear generation crystal thickness. Our work establishes a rigorous framework to reconstruct hyperspectral images of complex samples inaccessible through standard fixed-time methods

Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi

Background: In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component. Design: The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure ‘equitable access to healthcare services’ at the community level and ‘healthcare quality’ at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time. To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements. Discussion Combining a traditional quasi-experimental controlled pre- and post-test design with an explanatory mixed methods model permits an additional assessment of organizational and behavioral changes affecting complex processes. Through this impact evaluation approach, our design will not only create robust evidence measures for the outcome of interest, but also generate insights on how and why the investigated interventions produce certain intended and unintended effects and allows for a more in-depth evaluation approach