Decentralization's impact on the health workforce: Perspectives of managers, workers and national leaders

Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralization's impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers. The main body of the paper is devoted to examining decentralization's impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1) defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2) supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3) identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best practices to improve them. Notable experiences from South Africa, Ghana, Indonesia and Mexico are shared in an annex

Telomere lengths in human oocytes, cleavage stage embryos and blastocysts

Telomeres are repeated sequences that protect the ends of chromosomes and harbour DNA-repair proteins. Telomeres shorten during each cell division in the absence of telomerase. When telomere length becomes critically short, cell senescence occurs. Telomere length therefore reflects both cellular ageing and capacity for division. We have measured telomere length in human germinal vesicle (GV) oocytes and pre-implantation embryos, by quantitative fluorescence in-situ hybridisation (Q-FISH), providing baseline data towards our hypothesis that telomere length is a marker of embryo quality. The numbers of fluorescent foci suggest that extensive clustering of telomeres occurs in mature GV stage oocytes, and in pre-implantation embryos. When calculating average telomere length by assuming that each signal presents one telomere, the calculated telomere length decreased from the oocyte to the cleavage stages, and increased between the cleavage stages and the blastocyst (11.12 vs 8.43 vs 12.22kb respectively, p<0.001). Other methods of calculation, based upon expected maximum and minimum numbers of telomeres, confirm that telomere length in blastocysts is significantly longer than cleavage stages. Individual blastomeres within an embryo showed substantial variation in calculated average telomere length. This study implies that telomere length changes according to the stage of pre-implantation embryo development

The millimetre variability of M81* -- Multi-epoch dual frequency mm-observations of the nucleus of M81

There are still many open questions as to the physical mechanisms at work in Low Luminosity AGN that accrete in the extreme sub-Eddington regime. Simultaneous multi-wavelength studies have been very successful in constraining the properties of SgrA*, the extremely sub-Eddington black hole at the centre of our Milky Way. M81*, the nucleus of the nearby spiral galaxy M81, is an ideal source to extend the insights obtained on SgrA* toward higher luminosity AGN. Here we present observations at 3 and 1 mm that were obtained within the framework of a coordinated,multi-wavelength campaign on M81*. The continuum emission from M81* was observed during three epochs with the IRAM Plateau de Bure Interferometer simultaneously at wavelengths of 3 and 1 mm. We present the first flux measurements of M81* at wavelengths around 1 mm. We find that M81* is a continuously variable source with the higher variability observed at the shorter wavelength. Also, the variability at 3 and 1 mm appears to be correlated. Like SgrA*, M81* appears to display the strongest flux density and variability in the mm-to-submm regime. There remains still some ambiguity concerning the exact location of the turnover frequency from optically thick to optically thin emission. The observed variability time scales point to an upper size limit of the emitting region of the order 25 Schwarzschild radii. The data show that M81* is indeed a system with very similar physical properties to SgrA* and an ideal bridge toward high luminosity AGN. The data obtained clearly demonstrate the usefulness and, above all, the necessity of simultaneous multi-wavelength observations of LLAGN.Comment: accepted for publication in A&

Ancient cultural landscapes in the valleys of Tormes and Corneja (Ávila)

El presente trabajo pretende ofrecer una visión diacrónica de la antigua ocupación humana en los valles del Tormes y del Corneja (Ávila), abarcando cronológicamente los momentos culturales incluidos entre la II Edad del Hierro y la Alta Edad Media (ss. ii a. C. - x d. C.). La información sobre los yacimientos procede tanto de prospecciones sistemáticas extensivas e intensivas, así como de algunas excavaciones arqueológicas. Se presenta así por primera vez un análisis de conjunto, diacrónico y comparativo, del poblamiento antiguo en esta zona serrana y de las dinámicas que marcaron su transformación durante la época romana y tardoantigua. Mediante el recurso a las Técnicas de Información Geográfica (TIG), se ha recopilado e incluido toda la información arqueológica relativa a los yacimientos documentados en esta zona, analizándola de forma combinada junto con aquella relativa a su contexto espacial (vías de comunicación, toponimia, recursos naturales, medio físico, etc.). Todo ello nos permite, por un lado, trazar la evolución del poblamiento en este territorio, ofreciendo una visión de largo alcance y, por otro, insertar este sector serrano en los procesos que definen este periodo en otras áreas próximas, en especial, en las vecinas tierras salmantinas y madrileñasThis paper offers a diachronic interpretation of the ancient human occupation of the Tormes and Corneja valleys (Ávila), chronologically including the cultural times between the II Iron Age to the High Middle Ages (2nd century BC - 10th century AD). The information on the deposits comes from extensive and intensive systematic surveys as well as some archaeological excavations. For the first time it is presented a diachronic and comparative analysis of the old settlement in this mountain area and of the dynamics that marked its transformation during the Roman period and Late Antiquity. By using Geographic Information Techniques (GIS), all the archaeological information related to the sites documented in this area has been compiled and analyzed together with that relating to its spatial context (ways of communication, toponymy, natural resources, physical environment, etc.). All this allows us to, on the one hand, trace the evolution of the settlement in this territory, offering a vision of long reach and, on the other hand, insert this sector serrano in the processes that define this period in other nearby areas, especially in the neighboring lands in Salamanca and Madri

Connecting the cosmic infrared background to the X-ray background

We estimate the contribution of AGNs and of their host galaxies to the infrared background. We use the luminosity function and evolution of AGNs recently determined by the hard X-ray surveys, and new Spectral Energy Distributions connecting the X-ray and the infrared emission, divided in intervals of absorption. These two ingredients allow us to determine the contribution of AGNs to the infrared background by using mostly observed quantities, with only minor assumptions. We obtain that AGN emission contributes little to the infrared background ($<$5% over most of the infrared bands), implying that the latter is dominated by star formation. However, AGN host galaxies may contribute significantly to the infrared background, and more specifically 10--20% in the 1--20$\mu$m range and $\sim$5% at $\lambda<60\mu m$. We also give the contribution of AGNs and of their host galaxies to the source number counts in various infrared bands, focusing on those which will be observed with Spitzer. We also report a significant discrepancy between the expected contribution of AGN hosts to the submm background and bright submm number counts with the observational constraints. We discuss the causes and implications of this discrepancy and the possible effects on the Spitzer far-IR bands.Comment: to appear in MNRAS, replaced with accepted version, paper shortened, results unchange

Real-time imaging of cotranscriptional splicing reveals a kinetic model that reduces noise: implications for alternative splicing regulation

A combination of several rate-limiting steps allows for efficient control of alternative splicing

The Bostrichidae of the Maltese Islands (Coleoptera)

The Bostrichidae of the Maltese Islands are reviewed. Ten species are recorded with certainty from this Archipelago, of which 6 namely, Trogoxylon impressum (Comolli, 1837), Amphicerus bimaculatus (A.G. Olivier, 1790), Heterobostrychus aequalis (Waterhouse, 1884), Sinoxylon unidentatum (Fabricius, 1801), Xyloperthella picea (A.G. Olivier, 1790) and Apate monachus Fabricius, 1775 are recorded for the first time. Two of the mentioned species (H. aequalis and S. unidentatum) are alien and recorded only on the basis of single captures and the possible establishment of these species is discussed. Earlier records of Scobicia pustulata (Fabricius, 1801) from Malta are incorrect and should be attributed to S. chevrieri (A. Villa & J.B. Villa, 1835). A zoogeographical analysis and an updated checklist of the 12 species of Bostrichidae recorded from the Maltese Islands and neighbouring Sicilian islands (Pantelleria, Linosa and Lampedusa) are also provided. Rhizopertha dominica (Fabricius, 1792) form granulipennis Lesne in Beeson & Bhatia, 1937 from Uttarakhand (northern India) was overlooked by almost all subsequent authors. Its history is summarized and the following new synonymy is established: Rhizopertha dominica (Fabricius, 1792) form granulipennis Lesne in Beeson & Bhatia, 1937 = Rhyzopertha dominica (Fabricius, 1792), syn. n. Finally, records of Amphicerus bimaculatus from Azerbaijan, of Bostrichus capucinus (Linnaeus, 1758) from Jordan and Syria, of Scobicia chevrieri from Jordan and Italy, of Xyloperthella picea from Italy, and of Apate monachus from Corsica (France) and Italy, are also provided.peer-reviewe

Detrimental Effects of Non-Functional Spermatozoa on the Freezability of Functional Spermatozoa from Boar Ejaculate

In the present study, the impact of non-functional spermatozoa on the cryopreservation success of functional boar spermatozoa was evaluated. Fifteen sperm-rich ejaculate fractions collected from five fertile boars were frozen with different proportions of induced non-functional sperm (0 –native semen sample-, 25, 50 and 75% non-functional spermatozoa). After thawing, the recovery of motile and viable spermatozoa was assessed, and the functional of the spermatozoa was evaluated from plasma membrane fluidity and intracellular reactive oxygen species (ROS) generation upon exposure to capacitation conditions. In addition, the lipid peroxidation of the plasma membrane was assessed by the indirect measurement of malondialdehyde (MDA) generation. The normalized (with respect to a native semen sample) sperm motility (assessed by CASA) and viability (cytometrically assessed after staining with Hoechst 33342, propidium iodide and fluorescein-conjugated peanut agglutinin) decreased (p<0.01) as the proportion of functional spermatozoa in the semen samples before freezing decreased, irrespective of the semen donor. However, the magnitude of the effect differed (p<0.01) among boars. Moreover, semen samples with the largest non-functional sperm subpopulation before freezing showed the highest (p<0.01) levels of MDA after thawing. The thawed viable spermatozoa of semen samples with a high proportion of non-functional spermatozoa before freezing were also functionally different from those of samples with a low proportion of non-functional spermatozoa. These differences consisted of higher (p<0.01) levels of intracellular ROS generation (assessed with 5-(and-6) chloromethyl-20,70-dichlorodihydrofluorescein diacetate acetyl ester; CM-H2DCFDA) and increased (p<0.01) membrane fluidity (assessed with Merocyanine 540). These findings indicate that non-functional spermatozoa in the semen samples before freezing negatively influence the freezability of functional spermatozoa

Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis

Background Ultrasound (US) has largely replaced contrast venography as the definitive diagnostic test for deep vein thrombosis (DVT). We aimed to derive a definitive estimate of the diagnostic accuracy of US for clinically suspected DVT and identify study-level factors that might predict accuracy. Methods We undertook a systematic review, meta-analysis and meta-regression of diagnostic cohort studies that compared US to contrast venography in patients with suspected DVT. We searched Medline, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Reviews of Effectiveness, the ACP Journal Club, and citation lists (1966 to April 2004). Random effects meta-analysis was used to derive pooled estimates of sensitivity and specificity. Random effects meta-regression was used to identify study-level covariates that predicted diagnostic performance. Results We identified 100 cohorts comparing US to venography in patients with suspected DVT. Overall sensitivity for proximal DVT (95% confidence interval) was 94.2% (93.2 to 95.0), for distal DVT was 63.5% (59.8 to 67.0), and specificity was 93.8% (93.1 to 94.4). Duplex US had pooled sensitivity of 96.5% (95.1 to 97.6) for proximal DVT, 71.2% (64.6 to 77.2) for distal DVT and specificity of 94.0% (92.8 to 95.1). Triplex US had pooled sensitivity of 96.4% (94.4 to 97.1%) for proximal DVT, 75.2% (67.7 to 81.6) for distal DVT and specificity of 94.3% (92.5 to 95.8). Compression US alone had pooled sensitivity of 93.8 % (92.0 to 95.3%) for proximal DVT, 56.8% (49.0 to 66.4) for distal DVT and specificity of 97.8% (97.0 to 98.4). Sensitivity was higher in more recently published studies and in cohorts with higher prevalence of DVT and more proximal DVT, and was lower in cohorts that reported interpretation by a radiologist. Specificity was higher in cohorts that excluded patients with previous DVT. No studies were identified that compared repeat US to venography in all patients. Repeat US appears to have a positive yield of 1.3%, with 89% of these being confirmed by venography. Conclusion Combined colour-doppler US techniques have optimal sensitivity, while compression US has optimal specificity for DVT. However, all estimates are subject to substantial unexplained heterogeneity. The role of repeat scanning is very uncertain and based upon limited data

The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work