Dual practice in the health sector: review of the evidence

This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public–private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular. To compensate for unrealistically low salaries, health workers rely on individual coping strategies. Many clinicians combine salaried, public-sector clinical work with a fee-for-service private clientele. This dual practice is often a means by which health workers try to meet their survival needs, reflecting the inability of health ministries to ensure adequate salaries and working conditions. Dual practice may be considered present in most countries, if not all. Nevertheless, there is surprisingly little hard evidence about the extent to which health workers resort to dual practice, about the balance of economic and other motives for doing so, or about the consequences for the proper use of the scarce public resources dedicated to health. In this paper dual practice is approached from six different perspectives: (1) conceptual, regarding what is meant by dual practice; (2) descriptive, trying to develop a typology of dual practices; (3) quantitative, trying to determine its prevalence; (4) impact on personal income, the health care system and health status; (5) qualitative, looking at the reasons why practitioners so frequently remain in public practice while also working in the private sector and at contextual, personal life, institutional and professional factors that make it easier or more difficult to have dual practices; and (6) possible interventions to deal with dual practice

Cholesterol and Lipoprotein Dynamics in a Hibernating Mammal

Hibernating mammals cease feeding during the winter and rely primarily on stored lipids to fuel alternating periods of torpor and arousal. How hibernators manage large fluxes of lipids and sterols over the annual hibernation cycle is poorly understood. The aim of this study was to investigate lipid and cholesterol transport and storage in ground squirrels studied in spring, summer, and several hibernation states. Cholesterol levels in total plasma, HDL and LDL particles were elevated in hibernators compared with spring or summer squirrels. Hibernation increased plasma apolipoprotein A-I expression and HDL particle size. Expression of cholesterol 7 alpha-hydroxylase was 13-fold lower in hibernators than in active season squirrels. Plasma triglycerides were reduced by fasting in spring but not summer squirrels. In hibernators plasma β-hydroxybutyrate was elevated during torpor whereas triglycerides were low relative to normothermic states. We conclude that the switch to a lipid-based metabolism during winter, coupled with reduced capacity to excrete cholesterol creates a closed system in which efficient use of lipoproteins is essential for survival

Electrophoresis of the hemoglobin of three animals in the hibernating and non-hibernating state

1. 1. The phenomenon of the red blood cells of the woodchuck (Marmota monax) being resistant to lysis by the cyanmethemoglobin procedure for hemoglobin was observed during the pre-hibernation period. 2. 2. Electrophoresis was performed on the hemoglobin obtained from these cells in order to determine if a different type of hemoglobin was present during the hibernating period as compared to the non-hibernating period. There was no difference. 3. 3. Hemoglobin samples were also obtained from the little brown bat (Myotis lucifigus) and the golden mantle ground squirrel (Citellus lateralis) during the hibernating period and the non-hibernating period for comparative purposes. All samples were compared to human hemoglobin. 4. 4. There was no difference between the hibernating and non-hibernating pattern . © 1973

The dynamics of clinical dietetics

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RSat Flight Qualification and Test Results for Manipulable Robotic Appendages Installed on 3U CubeSat Platform

The United States Naval Academy (USNA) is developing a system utilizing two 3U Cube Satellites to deliver diagnostic and basic repair services to on-orbit spacecraft. The Autonomous On-orbit Diagnostic System (AMODS) is comprised of 1) a CubeSat with robotic arms (RSat) with the ability to maneuver around a satellite providing images and other diagnostic information to ground-based engineers; and 2) the BRICSat spacecraft which acts as a “space tug” for RSat and houses the attitude control systems and maneuvering thrusters. Both RSat and BRICSat offer new technologies bringing tremendous flexibility and innovative opportunity to the CubeSat platform while providing cost- effective diagnostic services to on-orbit spacecraft. This paper focuses on the RSat platform, outlining the basic structure of the robotic arms and the concept of operations for the late 2017 launch of RSat-P (prototype) through the NASA Launch Initiative. The paper continues with a discussion of the results of ground tests validating the robotic arm mechanism and the RSat motors. The paper concludes with a description of the on-orbit test of the arms’ motors schedule for early 2017

Decrease in use of manual vacuum aspiration in postabortion care in Malawi: A cross-sectional study from three public hospitals, 2008-2012

Objectives: To investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008–2012. Methods: A retrospective cross-sectional study was done at the referral hospital Queen Elisabeth Central Hospital, and the two district hospitals of Chiradzulu and Mangochi. The data were collected simultaneously at the three sites from Feb-March 2013. All records available for women admitted to the gynaecological ward from 2008-2012 were reviewed. Women who had undergone surgical uterine evacuation after incomplete abortion were included and the use of manual vacuum aspiration versus sharp curettage was analysed. Results: Altogether, 5121 women were included. One third (34.2%) of first trimester abortions were treated with manual vacuum aspiration, while all others were treated with sharp curettage. There were significant differences between the hospitals and between years. Overall there was an increase in the use of manual vacuum aspiration from 2008 (19.7%) to 2009 (31.0%), with a rapid decline after 2010 (28.5%) ending at only 4.9% in 2012. Conversely there was an increase in use of sharp curettage in all hospitals from 2010 to 2012. Conclusion: Use of manual vacuum aspiration as part of the postabortion care in Malawi is rather low, and decreased from 2010 to 2012, while the use of sharp curettage became more frequent. This is in contrast with current international guidelines

Immunization with native surface protein NcSRS2 induces a Th2 immune response and reduces congenital Neospora caninum transmission in mice

NcSRS2, a tachyzoite surface protein of Neospora caninum, is an immunodominant protein with respect to induction of antibody production and has a role in attachment and invasion of host cells. Native NcSRS2 was isolated from whole tachyzoite lysate antigen by affinity chromatography using NcSRS2 specific monoclonal antibody and used to immunize BALB/c mice in a congenital transmission study. NcSRS2 was a highly conserved protein as indicated by comparison of deduced amino acid sequence obtained from NcSRS2 gene sequences of 10 geographically distinct N. caninum isolates. Mice immunized with purified native NcSRS2 produced antigen-specific antibody, primarily of IgG 1 subtype. Following challenge during gestation with 10(7) tachyzoites, immunized mice had a statistically significant decreased frequency of congenital transmission compared to non-immunized mice (P <= 0.05) or mice inoculated with adjuvant alone (P <= 0.01). Decreased congenital transmission among immunized mice correlated with a predominately Th2 immune response compared to non-immunized mice as indicated by an increased ratio of interleukin 4 (IL-4) to interferon gamma (IFN-gamma) secretion from antigen-stimulated splenocytes. The results provide a rationale for NcSRS2 as a candidate subunit vaccine antigen for reduction of N. caninum congenital transmission. Furthermore, the studies suggest that a Th2 immune response, if directed against an appropriate antigen, may induce protection against N. caninum congenital infection in mice. (c) 2005 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved