Determinants of local responsiveness of FMNCS in mainland China

Recent regulations, associated with China’s accession to the World Trade Organisation (WTO), specifically Decree 113 and Decree 114, have largely changed the situation for foreign multinational construction companies (FMNCs) operating in mainland China. A field investigation has identified that local responsiveness is critical for FMNCs to survive and develop in the complicated and uncertain Chinese construction industry. Government policy, China-specific construction industrial factors and increasing competition intensity imposed by local competitors are recognized as the major determinants driving local responsiveness of FMNCs. This study has also examined that localisation of internal resources, establishment of local networks and cooperation or strategic alliances with local contractors and design institutes are the key local adaptation strategies for FMNCs operating in mainland China

The General Primordial Cosmic Perturbation

We consider the most general primordial cosmological perturbation in a universe filled with photons, baryons, neutrinos, and a hypothetical cold dark matter (CDM) component within the framework of linearized perturbation theory. We give a careful discussion of the different allowed modes, distinguishing modes which are regular at early times, singular at early times, or pure gauge. As well as the familiar growing and decaying adiabatic modes and the baryonic and CDM isocurvature modes we identify two {\it neutrino isocurvature} modes which do not seem to have been discussed before. In the first, the ratio of neutrinos to photons varies spatially but the net density perturbation vanishes. In the second the photon-baryon plasma and the neutrino fluid have a spatially varying relative bulk velocity, balanced so that the net momentum density vanishes. Possible mechanisms which could generate the two neutrino isocurvature modes are discussed. If one allows the most general regular primordial perturbation, all quadratic correlators of observables such as the microwave background anisotropy and matter perturbations are completely determined by a $5\times 5,$ real, symmetric matrix-valued function of co-moving wavenumber. In a companion paper we examine prospects for detecting or constraining the amplitudes of the most general allowed regular perturbations using present and future CMB data.Comment: 18 pages, 2 Postscript figures, uses revtex. Revised 2-2000 Minor errors corrected and some references adde

Features: Community engagement for biobanking research: perspectives from Africa

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The implications of Methylphenidate use by healthy medical students and doctors in South Africa

Background: The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown. Discussion: The implication of the use of Methylphenidate by medical students and doctors has not been fully explored. This article considers the impact of this use on the traditional role of medicine, society, the patient and suggests a way forward. We discuss the salient philosophy surrounding the use of cognitive enhancement. We query whether there are cognitive benefits to the use of Methylphenidate in healthy students and doctors and whether these benefits would outweigh the risks in taking the medication. Could these benefits lead to tangible outcomes for society and could the off label-use of Methylphenidate potentially undermine the medical profession and the treatment of patients? If cognitive benefits are proven then doctors may be coerced explicitly or implicitly to use the drug which may undermine their autonomy. The increased appeal of cognitive enhancement challenges the traditional role of medicine in society, and calls into question the role of a virtuous life as a contributing factor for achievement. In countries with vast economic disparity such as South Africa an enhancement of personal utility that can be bought may lead to greater inequities. Summary: Under the status quo the distribution of methylphenidate is unjust. Regulatory governmental policy must seek to remedy this while minimising the potential for competitive advantage for the enhanced. Public debate on the use of cognitive enhancement is long overdue and must be stimulated. The use of Methylphenidate for cognitive enhancement is philosophically defendable if long-term research can prove that the risks are negligible and the outcomes tangible

Prevalence of anaemia in pregnancy in a regional health facility in South Africa

Background. Anaemia is a major global health problem affecting an estimated 42% of pregnant women worldwide. There is a paucity of South African (SA) data on anaemia in pregnancy, despite the fact that parasitic infections are endemic and the nutritional status of sections of the population is poor.Objective. To determine the prevalence of anaemia among antenatal attendees in a regional hospital in Durban, SA.Methods. This was a cross-sectional prospective study in a regional health facility in an urban setting serving a population of low socioeconomic status. Venous blood samples to perform a full blood count were obtained from antenatal attendees at their first clinic visit.Results. Two thousand pregnant women were studied; the mean (standard deviation) age and gestational age at booking was 27.6 (7.6) years and 21.7 (7.1) weeks, respectively. Eight hundred and fifty-four (42.7%) were anaemic (haemoglobin (Hb) levels <11 g/dL). The majority (81.4%) were mildly anaemic. There were five (0.6%) cases of severe anaemia (Hb <7 g/dL). The prevalence of anaemia was significantly higher in HIV-positive compared with HIV-negative pregnant women (71.3% v. 28.7%; p<0.0001). The common morphology was normochromic normocytic (n=588, 68.9%).Conclusion. The prevalence of anaemia was 42.7%. In the majority (81.4%) the anaemia was mild and normocytic and normochromic (68.9%). Anaemia is a common problem among antenatal attendees in an SA urban population

Technical efficiency and productivity of public district hospitals in KwaZulu-Natal province, South Africa

Background: District hospitals (DHs) constitute a significant proportion of public hospitals and consume a more substantial percentage of the government’s total hospital budget. With the level of resources disbursed to DHs, it is essential to ensure efficient allocation and utilization. Hence, this study set out to assess the technical efficiency and productivity of public DHs in KwaZulu-Natal province, South Africa. Methods: Data envelopment analysis (DEA) and Malmquist total factor productivity (MTFP) were used to assess technical efficiency, identify adjustments required to make inefficient facilities more efficient, and determine overall productivity growth. Input data such as medical personnel and output information such as outpatient visits were retrieved from the databases of the district health information system (DHIS), and personnel salary systems (PERSAL) for three consecutive financial years (2014/15, 2015/16 and 2016/17). A total of 38 district hospitals were included in the study. Results: The proportion of technically efficient facilities according to constant return to scale (CRS) were 12 (31.6%), 16 (42.1%) and 14 (36.8%) in 2014/15, 2015/16 and 2016/17, respectively, while according to the variable return to scale (VRS) technically efficient facilities were 22 (57.9%), 19 (50.0) and 21 (55.2%), respectively, for the three consecutive years. On average, the total productivity of DHs increased by 4.8 percent over the three years, which is attributed majorly to technical growth of 6.9 percent. Conclusion: This study showed that a significant proportion of the district hospitals were technically inefficiency. Also, steps that could enable more efficient use of healthcare resources to yield optimal health service delivery were recommended