Family medicine in Tanzania: Seize the moment

In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC. The paper reviews how PHC is understood, the context of family medicine in sub-Saharan Africa and makes a case for how family medicine can assist in addressing the current burden of disease in Tanzania

Bridging the gap: exploring the attitudes and beliefs of nurses and patients about coexisting traditional and biomedical healthcare systems in a rural setting in KwaZulu-Natal

Objectives: Health care in South Africa takes place within a diverse cultural context and includes perceptions about health that strongly link to cultural beliefs and values. Biomedical healthcare professionals, particularly nurses, are exposed to and expected to cope with cultural challenges on a daily basis, with little or no training on how to do so. In this paper, we explore nurse and patient attitudes to and beliefs about how the systems of health care coexist, what issues this raises and how nurses and patients address these issues in their daily practice.Design: The study employed an exploratory, qualitative research design.Setting and subjects: Four in-depth focus group discussions were conducted with nurses and patients at a deep rural, district hospital in northern KwaZulu-Natal. Participants were selected based on their availability and willingness to contribute to the discussion.Results: Traditional and biomedical healthcare systems coexist and are used simultaneously with the healthcare- seeking pattern of patients traversing multiple systems of care. Currently, patients and nurses have developed strategies to address this by steering a pragmatic course to minimise risks, and by doing so, bridging the gap between the two healthcare mediums.Conclusion: Further research is required to understand which illnesses are primarily seen as traditional, how this gap can be effectively addressed, and how different healthcare co-delivery models can best be utilised and evaluated.Keywords: health worker, traditional health care, biomedical health care, cultur

Monolithic Pixel Sensors in Deep-Submicron SOI Technology

Monolithic pixel sensors for charged particle detection and imaging applications have been designed and fabricated using commercially available, deep-submicron Silicon-On-Insulator (SOI) processes, which insulate a thin layer of integrated full CMOS electronics from a high-resistivity substrate by means of a buried oxide. The substrate is contacted from the electronics layer through vias etched in the buried oxide, allowing pixel implanting and reverse biasing. This paper summarizes the performances achieved with a first prototype manufactured in the OKI 0.15 micrometer FD-SOI process, featuring analog and digital pixels on a 10 micrometer pitch. The design and preliminary results on the analog section of a second prototype manufactured in the OKI 0.20 micrometer FD-SOI process are briefly discussed.Comment: Proceedings of the PIXEL 2008 International Workshop, FNAL, Batavia, IL, 23-26 September 2008. Submitted to JINST - Journal of Instrumentatio

High-sensitivity cardiac troponin T and copeptin assays to improve diagnostic accuracy of exercise stress test in patients with suspected coronary artery disease

Background: The average diagnostic sensitivity of exercise stress tests (ESTs) is lower than that of other non-invasive cardiac stress tests. The aim of the study was to examine whether high-sensitivity cardiac troponin T (hs-cTnT) or copeptin concentrations rise in response to inducible myocardial ischaemia and may improve the diagnostic accuracy of ESTs. Methods and results: An EST was performed stepwise on a bicycle ergometer by 383 consecutive patients with suspected or progression of coronary artery disease (CAD). In addition venous blood samples for measurement of hs-cTnT and copeptin were collected prior to EST, at peak exercise, and 4 h after EST. Coronary angiography was assessed for all patients. Patients with significant CAD (n=224) were more likely to be male and older compared to patients with non-significant CAD (n=169). Positive EST was documented in 125 (55.8%) patients with significant CAD and in 69 (43.4%) patients with non-significant CAD. Copeptin and hs-cTnT concentrations at baseline were higher in patients with significant CAD (copeptin: 10.8 pmol/l (interquartile range (IQR) 8.1–15.6) vs 9.4 pmol/l (IQR 7.1–13.9); p=0.04; hs-cTnT: 3.0 ng/l (IQR <3.0–5.4) vs <3.0 ng/l (IQR <3.0); p=0.006). Hs-cTnT improved sensitivity (61.6% vs 55.8%), specificity (67.7% vs 56.6%) and the positive predictive value (PPV) (72.3% vs 64.4%) and negative (55.2% vs 47.6%) predictive value (NPV) of EST. Copeptin could not improve sensitivity (55.4% vs 55.8%) and reduced specificity, PPV and NPV. Conclusions: The measurement of hs-cTnT during EST improves sensitivity, specificity, and positive and negative predictive values. In contrast, measurement of copeptin does not improve diagnostic sensitivity and reduces specificity

Antiretroviral initiation of pregnant women and antenatal care booking practices in eThekwini District, KwaZulu-Natal, South Africa

Background: The introduction of antiretroviral therapy (ART) in South Africa began as part of the prevention of mother-to-child transmission programme. For significant reduction of vertical transmission, early antenatal care booking and ART initiation are necessary. Aim: This study aimed to evaluate ART initiation and booking practices of women attending antenatal care in eThekwini district during financial years (FY) 2010/2011 and 2013/2014. Methods: An observational study used a retrospective chart review at four eThekwini district community health centres (CHC). From these CHCs, records of women that initiated ART in FY10/11 and FY13/14 were reviewed and compared for ART initiation delays and booking practices. Results: A total of 2749 pregnant women who attended antenatal care (ANC) at the study sites were found eligible for ART; of these, 49% (n = 1334) attended ANC in FY10/11 while 51% (n = 1414) attended in FY13/14. In FY10/11, 46% (n = 610) and 60 % (n = 855) of the women were initiated on ART during pregnancy. The mean gestational age at booking for FY10/11 was 20.88 (standard deviation [s.d.] = 5.6) and 18.40 (s.d. = 6.2) in FY13/14. The mean gestational age at ART initiation for women who initiated ART in FY10/11 was 26.30 (s.d. = 6.02) and in FY13/14 it was 19.06 (s.d. = 6.86). Conclusion: In FY13/14 ART initiations occurred within 4 days after booking. ANC booking before 20 weeks was found to have improved between the two years from 39% to 58%;however, on average, in both years women booked during the second trimester

A Study of e+e- -> H0A0 Production and the Constraint on Dark Matter Density

This paper reports the results of a study of the e+e- -> H0A0 process at 1 TeV performed on fully simulated and reconstructed events. The estimated accuracies on the heavy Higgs boson masses, widths and decay branching fractions are discussed in relation to the study of Supersymmetric Dark Matter.Comment: 5 pages, 4 figures, submitted to Phys. Rev.

Theoretical study of dark resonances in micro-metric thin cells

We investigate theoretically dark resonance spectroscopy for a dilute atomic vapor confined in a thin (micro-metric) cell. We identify the physical parameters characterizing the spectra and study their influence. We focus on a Hanle-type situation, with an optical irradiation under normal incidence and resonant with the atomic transition. The dark resonance spectrum is predicted to combine broad wings with a sharp maximum at line-center, that can be singled out when detecting a derivative of the dark resonance spectrum. This narrow signal derivative, shown to broaden only sub-linearly with the cell length, is a signature of the contribution of atoms slow enough to fly between the cell windows in a time as long as the characteristic ground state optical pumping time. We suggest that this dark resonance spectroscopy in micro-metric thin cells could be a suitable tool for probing the effective velocity distribution in the thin cell arising from the atomic desorption processes, and notably to identify the limiting factors affecting desorption under a grazing incidence.Comment: 12 pages, 11 figures theoretical articl

Second tectofugal pathway in a songbird (Taeniopygia guttata) revisited: Tectal and lateral pontine projections to the posterior thalamus, thence to the intermediate nidopallium

Birds are almost always said to have two visual pathways from the retina to the telencephalon: thalamofugal terminating in the Wulst, and tectofugal terminating in the entopallium. Often ignored is a second tectofugal pathway that terminates in the nidopallium medial to and separate from the entopallium (e.g., Gamlin and Cohen [1986] J Comp Neurol 250:296–310). Using standard tract‐tracing and electroanatomical techniques, we extend earlier evidence of a second tectofugal pathway in songbirds (Wild [1994] J Comp Neurol 349:512–535), by showing that visual projections to nucleus uvaeformis (Uva) of the posterior thalamus in zebra finches extend farther rostrally than to Uva, as generally recognized in the context of the song control system. Projections to “rUva” resulted from injections of biotinylated dextran amine into the lateral pontine nucleus (PL), and led to extensive retrograde labeling of tectal neurons, predominantly in layer 13. Injections in rUva also resulted in extensive retrograde labeling of predominantly layer 13 tectal neurons, retrograde labeling of PL neurons, and anterograde labeling of PL. It thus appears that some tectal neurons could project to rUva and PL via branched axons. Ascending projections of rUva terminated throughout a visually responsive region of the intermediate nidopallium (NI) lying between the nucleus interface medially and the entopallium laterally. Lastly, as shown by Clarke in pigeons ([1977] J Comp Neurol 174:535–552), we found that PL projects to caudal cerebellar folia. J. Comp. Neurol. 524:963–985, 2016. © 2015 Wiley Periodicals, Inc