Burnout at the Frontline: The Effect of a Reproductive Health Voucher Program on Health Workers in Uganda

Background: Low job satisfaction among healthcare workers in developing countries can increase risk of burnout and have a negative effect on the quality of services. Novel financing strategies such as voucher programs, which aim to increase the utilization of services by the poor by offering physical vouchers for subsidized care, may unintentionally exacerbate burnout for health care workers by creating higher workloads. Methods: A semi-structured survey that included both closed and open-ended questions as well as a locally-adapted job satisfaction scale was used to collect information on provider perceptions of changes in job satisfaction, workload, staffing and salaries since the start of a health voucher program at facilities in fifteen districts in western Uganda. Results: Voucher providers reported feeling more rewarded and more motivated than comparison providers. While frontline workers at both sites were less satisfied than their managers overall (p Conclusions: Providers at voucher facilities may experience a more enabling work environment but job satisfaction differences between manager and frontline workers may intensify when staffing, workload and incentives are not addressed. Strategies to support staff when implementing new demand creation programs should be prioritized. Incentive strategies for staff and management guidance for facilities managers will be important components of successful voucher programs

Keys to the Mammals and Mammal Skulls of the Northern Coastal Plain of Virginia

This publication is designed to function as a tool for the identification of mammal species that occur on the Coastal Plain of northern Virginia. We provide whole-body and skull keys to the 40 species that occur in this region. Baseline data for this work were collected during several studies conducted on Fort A.P. Hill, Caroline County. The intended audience includes interested naturalists, teachers, students, field biologists, and natural resource managers

Mammals of Fort A. P. Hill, Caroline County, Virginia and Vicinity

Fort A.P. Hill (APH) is a 30,329 ha military training installation (U.S. Army) located in the upper Coastal Plain of Caroline County, Virginia. It was formed in 1941 and named in honor of Civil War Confederate Lt. General Ambrose Powell Hill. The current landscape includes a mosaic of habitats that range from old fields to hardwood forests. Forty species of mammals are known to exist on or near the installation. These include one marsupial, five insectivores, 9 chiropterans, one lagomorph, 12 rodents, 10 carnivores, and one cervid. We have studied many of the species on APH since 1997. In this paper we describe the physical environment of the area and 7 important habitats used by mammals. We also summarize the ecology and natural history of each species and provide statistical summaries of original measurements from mammals caught on the installation. The results of several recent studies on APH allow us to describe habitat affiliations and relative abundance of most of the mammals native to the mid-Atlantic region. Old fields and clearcuts support a total of 20 species, including several found predominately in this habitat. Pine stands and pine plantations support the fewest number of mammal species (17) of any habitat on the installation. Mixed pine and hardwood forests, hardwood forests, and riparian forests support the largest number of species (29-36). With the possible exception of pine plantations, the habitat mosaic found on APH provides abundant resources for mammal communities. We also include an evaluation of age and health attributes of the deer population and describe the hunting program on the base. Number of deer harvested annually 1985-2000 varied from 460 to 1765. Management activities since 1996 when the deer population exceeded carrying capacity have improved herd health. Because much of Caroline County and eastern Virginia is in extensive agriculture and the remaining hardwood forests are being clearcut, APH is becoming a valuable habitat island for the mammalian fauna of the upper Coastal Plain of Virginia and the mid-Atlantic region

A retrospective analysis of health systems in Denmark and Kaiser Permanente

<p>Abstract</p> <p>Background</p> <p>To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy.</p> <p>Methods</p> <p>Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase comparability.</p> <p>Results</p> <p>A higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100,000 individuals. KP physicians are salaried employees; in contrast, DHS primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-for-service payments, while most specialists are employed at largely public hospitals. Hospitalisation rates and lengths of stay (LOS) were lower in KP, with mean acute admission LOS of 3.9 days versus 6.0 days in the DHS, and, for stroke admissions, 4.2 days versus 23 days. Screening rates also differed: 93% of KP members with diabetes received retinal screening; only 46% of patients in the DHS with diabetes did. Per capita operating expenditures were PPP$1,951 (KP) and PPP$1,845 (DHS).</p> <p>Conclusion</p> <p>Compared to the DHS, KP had a population with more documented disease and higher operating costs, while employing fewer physicians and resources like hospital beds. Observed quality measures also appear higher in KP. However, simple comparisons between health care systems may have limited value without detailed information on mechanisms underlying differences or identifying translatable care improvement strategies. We suggest items for more in-depth analyses that could improve the interpretability of findings and help identify lessons that can be transferred.</p

Self-Management Support to People with Type 2 Diabetes - A comparative study of Kaiser Permanente and the Danish Healthcare System

BACKGROUND: Self-management support is considered to be an essential part of diabetes care. However, the implementation of self-management support within healthcare settings has appeared to be challenging and there is increased interest in “real world” best practice examples to guide policy efforts. In order to explore how different approaches to diabetes care and differences in management structure influence the provision of SMS we selected two healthcare systems that have shown to be comparable in terms of budget, benefits and entitlements. We compared the extent of SMS provided and the self-management behaviors of people living with diabetes in Kaiser Permanente (KP) and the Danish Healthcare System (DHS). METHODS: Self-administered questionnaires were used to collect data from a random sample of 2,536 individuals with DM from KP and the DHS in 2006–2007 to compare the level of SMS provided in the two systems and identify disparities associated with educational attainment. The response rates were 75 % in the DHS and 56 % in KP. After adjusting for gender, age, educational level, and HbA1c level, multiple linear regression analyses determined the level of SMS provided and identified disparities associated with educational attainment. RESULTS: Receipt of SMS varied substantially between the two systems. More people with diabetes in KP reported receiving all types of SMS and use of SMS tools compared to the DHS (p < .0001). Less than half of all respondents reported taking diabetes medication as prescribed and following national guidelines for exercise. CONCLUSIONS: Despite better SMS support in KP compared to the DHS, self-management remains an under-supported area of care for people receiving care for diabetes in the two health systems. Our study thereby suggests opportunity for improvements especially within the Danish healthcare system and systems adopting similar SMS support strategies

Fluctuations in auxin levels depend upon synchronicity of cell divisions in a one-dimensional model of auxin transport

Auxin is a well-studied plant hormone, the spatial distribution of which remains incompletely understood. Here, we investigate the effects of cell growth and divisions on the dynamics of auxin patterning, using a combination of mathematical modelling and experimental observations. In contrast to most prior work, models are not designed or tuned with the aim to produce a specific auxin pattern. Instead, we use well-established techniques from dynamical systems theory to uncover and classify ranges of auxin patterns as exhaustively as possible as parameters are varied. Previous work using these techniques has shown how a multitude of stable auxin patterns may coexist, each attainable from a specific ensemble of initial conditions. When a key parameter spans a range of values, these steady patterns form a geometric curve with successive folds, often nicknamed a snaking diagram. As we introduce growth and cell division into a one-dimensional model of auxin distribution, we observe new behaviour which can be explained in terms of this diagram. Cell growth changes the shape of the snaking diagram, and this corresponds in turn to deformations in the patterns of auxin distribution. As divisions occur this can lead to abrupt creation or annihilation of auxin peaks. We term this phenomenon ‘snake-jumping’. Under rhythmic cell divisions, we show how this can lead to stable oscillations of auxin. We also show that this requires a high level of synchronisation between cell divisions. Using 18 hour time-lapse imaging of the auxin reporter DII:Venus in roots of Arabidopsis thaliana, we show auxin fluctuates greatly, both in terms of amplitude and periodicity, consistent with the snake-jumping events observed with non-synchronised cell divisions. Periodic signals downstream of the auxin signalling pathway have previously been recorded in plant roots. The present work shows that auxin alone is unlikely to play the role of a pacemaker in this context

Portfolio Vol. I N 2

Wiley, Thomas R. In the Cathedral, Mexico City . Picture. 2. Whitehead, Richard Jr. Izzy was a Lady, After All . Prose. 3. Beckham, Adela. Rain on a March morning . Poem. 6. Beckham, Adela. Heaven . Poem. 6. Deane, Dorothy. Temptation . Poem. 6. Kellogg, Elizabeth. Gruess Dich Gott . Prose. 7. Nadel, Norman. The Duchess . Poem. 8. Dick, Pewilla. The Sligo Fisherman . Prose. 9. Deane, Dorothy. Against the Winter . Poem 12. Flory, Doris Jean. A problem . Poem 12. Travis, Paul Bough. My First View of the Congo Forest . Picture. 13. Bellows, George. Stag at Sharkey\u27s . Picture. 13. B.C.W. Aspiration . Poem. 14. Stewart, John. On Record . Prose 14. Sweitzer, Harry J. Playing Around . Prose. 15. Ellsberg, Edward. Book Parade: Hell on Ice . Prose. 15. B.C.W. End of Winter . Poem. 16. Wiley, Thomas R. End of Winter . Picture. 16. Deeter, Robert. Television, How, Where, and When . Prose. 17. Brush, Jane. Love A La Mode . Poem. 20. Brush, Jane. Radio! . Poem. 20. Brush, Jane. Backward Glance . Poem. 20. Brush, Jane. Homo Paradoxus . Poem. 20. Brush, Jane. The Sardonic Slant . Poem. 20. Brush, Jane. Baths . Prose. 20. Wilson, Gordon. Brushword . Cartoon. 20