How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa.

Shortages of essential medicines are a daily occurrence in many of South Africa (SA)'s public health facilities. This study focuses on the responses of healthcare workers to stock-outs, investigating how actors at the 'front line' of public health delivery understand, experience and respond to shortages of essential medicines and equipment in their facilities. Findings are based on focus groups, observations and interviews with healthcare workers and patients at healthcare facilities in the Eastern Cape Province of SA, conducted as part of the Mzantsi Wakho study. The research revealed a discrepancy between 'informal' definitions of stock-outs and their reporting through formal stock-out management channels. Front-line healthcare workers had designed their own systems for classifying the severity of stock-outs, based on the product in question, and on their potential to access stocks from other facilities. Beyond formal systems of procurement and supply, healthcare workers had established vast networks of alternative communication and action, often using personal resources to procure medical supplies. Stock-outs were only reported when informal methods of stock-sharing did not secure top-up supplies. These findings have implications for understanding the frequency and severity of stock-outs, and for taking action to prevent and manage stock-outs effectively.

A national audit of gonorrhoea management.

A national audit of gonorrhoea clinic policy and case management was carried out by postal survey on behalf of the National Audit Group of the British Association for Sexual Health and HIV. Ninety-three clinics out of a total of 278 (33%) and 1324 cases were included. The results showed that both the auditable outcome measures listed in the National Guideline for the Management of Gonorrhoea in Adults and the evidence-based outcome standards recently published by Low et al. were broadly being met.

Modulation of morphine-induced Fos-immunoreactivity by the cannabinoid receptor antagonist SR 141716.

A growing body of evidence suggests the existence of a functional interaction between opioid and cannabinoid systems. The present study further investigated this functional interaction by examining the combined effects of morphine and the cannabinoid receptor antagonist SR 141716 on Fos-immunoreactivity (Fos-IR), a marker for neural activation. Male albino Wistar rats were treated with SR 141716 (3 mg/kg, intraperitoneally), morphine HCl (10 mg/kg, subcutaneously), vehicle, or SR 141716 and morphine combined (n = 6 per group). Rats were injected with morphine or its vehicle 30-min after administration of SR 141716 or its vehicle and perfused 3 h later. Locomotor activity and body temperature were both increased in the morphine-treated group and SR 141716 significantly inhibited these effects. Morphine increased Fos-IR in several brain regions including the caudate-putamen (CPu), cortex (cingulate, insular and piriform), nucleus accumbens (NAS) shell, lateral septum (LS), bed nucleus of the stria terminalis (BNST), median preoptic nucleus (MnPO), medial preoptic nucleus (MPO), hypothalamus (paraventricular, dorsomedial and ventromedial), paraventricular thalamic nucleus (PV), amygdala (central and basolateral nuclei), dorsolateral periaqueductal gray, ventral tegmental area (VTA), and Edinger-Westphal nucleus. SR 141716 alone increased Fos-IR in the cortex (cingulate, insular and piriform), NAS (shell), LS, BNST, hypothalamus (paraventricular, dorsomedial and ventromedial), PV, amygdala (central, basolateral and medial nuclei), VTA, and Edinger-Westphal nucleus. SR 141716 attenuated morphine-induced Fos-IR in several regions including the CPu, cortex, NAS (shell), LS, MnPO, MPO, paraventricular and dorsomedial hypothalamus, PV, basolateral amygdala, VTA, and Edinger-Westphal nucleus (EW). These results provide further support for functional interplay between the cannabinoid and opioid systems. Possible behavioural and physiological implications of the interactive effects of SR 141716 on morphine-induced Fos-IR are discussed.

Shuttling behavior and intracranial self-stimulation reward: behavioral changes as a function of intensity and independence of on/off times.

The correlation between "on" time and "off" time in intracranial self-stimulation shuttling behavior under continuous reinforcement was examined. The results showed that if a tendency for positive trend in the data was accounted for, no consistent correlation could be found between within-trial on time and the succeeding or preceding off time either as a function of intensity or number of trials. However, mean on and off times showed a significant positive correlation at low to moderate intensities. Total charge, total time, and proportion of time on remain relatively constant over a series of trials despite significant changes in on time, off time, and crossing rate. The results indicate the importance of selecting suitable measures in the study of shuttling behavior.

Effectiveness of training in negative thought reduction and positive thought increment in reducing thought-produced distress.

Subjects (N = 86) completed scales designed to measure distress caused by thoughts, distress caused by day-to-day experiences, positive affect caused by thoughts, positive affect caused by day-to-day experiences, anxiety, stress, depressive cognitions, well-being, and psychological health. Subjects who reported high distress as a result of one or more items on the Thought-Related Distress subscale were asked to nominate three specific thoughts related to one of the distress-producing thought categories. These subjects were randomly placed in one of the five training groups. One group was trained to reduce negative thoughts (NTR), the second group was trained to replace negative thoughts with positive thoughts (PTI), the third group was given training in both procedures, the fourth group was given a placebo treatment, and the fifth group was not given any treatment. NTR, PTI, and the combination of both were effective in reducing the distress caused by the specific thoughts. There was a significant reduction in the distress caused by specific thoughts in the NTR and combined-treatment groups. Training produced no significant changes in overall negative and positive affect caused by thoughts and day-to-day experiences or in anxiety, stress, depressive cognitions, well-being, and general health.

Managing change in health care institutions. The Austin experience 1973-1983.

This article is written by Ian Price who was engaged as a consultant by the Austin Hospital in 1973 to conduct an organisation study. The result of his work was to establish a divisional organisation which integrated the University of Melbourne into the hospital management structure. His work set in train an extensive organisational development program which has become widely known and regarded in the hospital field. After an absence of nine years Ian Price has taken up an appointment with the Austin an Executive Assistant to the General Manager. This article summarises the process which he adopted and the rationale for the changes which were implemented. The article also presents a brief resume of these changes ten years on.

Depression in early adolescence: relation to externalising and internalising behaviour.

The relationship between depression, on the one hand, and externalising and internalising behaviour, on the other, in 151 adolescents (79 boys and 72 girls) was examined with respect to the possible moderating role of sex-role stereotyping. The Reynolds Adolescent Depression Scale, the Achenbach Teacher Report Form, and the Australian Sex-Role Scale were used to assess the hypothesis that adolescents adapt to the experience of depression in gender-appropriate ways. A regression analysis indicated that the pattern of relationships was different for boys and girls. The hypothesis was supported for boys and externalising behaviour but not for girls and internalising behaviour.

Optical properties of low vision telescopes.

Angular magnification, resolving power, astigmatism, field of view, eye relief, and light transmittance of 157 low power telescopes comprising 25 models from seven manufacturers were measured. Roof-prism Keplerian telescopes provided about one-half the resolution, 30% lower transmittance, and more objectionable image flare than Galilean designs. The roof-prism was responsible for producing overlapping doubled images that appeared astigmatic-like. The prism further compromised rotational symmetry by deviating the image in a direction along the roof edge. The Keplerian telescopes, however, had about twice the field of view of the Galilean telescopes. Notably, several Keplerian telescope models from different suppliers were found to be optically identical, although they varied 50-100% in price.

Effects of transdermal nicotine on learning, memory, verbal fluency, concentration, and general health in a healthy sample at risk for dementia.

Nicotinic receptor loss has been implicated in the pathogenesis of Alzheimer's disease. The present study investigated the effects of chronic low-dose transdermal nicotine in a cohort of nondemented, healthy volunteers (mean age 63 years). The majority of subjects (85%) had a first-degree relation with dementia. Subjects were tested using a before, during, and after design on a battery of tests known to be sensitive to early cognitive decline. A mixed pattern of results was seen, with significant changes occurring with verbal learning, object learning, delayed recall, and word retrieval. Nicotine had no effect on measures of concentration or psychomotor speed. The effects were most noticeable in subjects at the lower end of baseline test performance on the tasks used. The results are discussed with reference to the relationship between strategic nicotinic receptor loss and measurable psychometric change. The potential therapeutic role of nicotinic agonists in preclinical "at risk" individuals is supported by the results of this study.

The protease and gag gene products of the human immunodeficiency virus: authentic cleavage and post-translational modification in an insect cell expression system.

Three recombinant baculoviruses which are capable of expressing human immunodeficiency virus (HIV) protease, p55gag, and both products simultaneously in insect cell culture have been constructed. Upon co-infection of cells with the protease and p55gag-expressing viruses, authentic processing of the gag precursor is observed to take place. This processing could be reproduced in vitro using mixtures of cellular lysates containing the expressed proteins. When expressed alone, uncleaved p55gag precursor appears to form retroviral core-like particles within the cytoplasm of infected cells. Metabolic labeling studies of the baculovirus-expressed gag products have demonstrated that p17 is myristylated at its amino terminus, and that p24 is phosphorylated. In these respects, the insect cell system is evidently capable of carrying out post-translational processing resembling that which occurs in authentic HIV-1 replication.

Amperozide influences feeding independently of 5-HT2A receptor antagonism.

Amperozide has been biochemically classified as a selective 5-HT2A (serotonin type 2A) receptor antagonist. However, research on the behavioral effects of amperozide suggests the possibility of other mechanisms. The present study in the male rat is an investigation of the effect of amperozide on feeding, a behavior which can be inhibited by 5-HT2A agonists such as 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI). Experiments revealed that amperozide acted to inhibit feeding behavior both when administered alone and when administered in combination with DOI. These results are inconsistent with 5-HT2A receptor antagonism by amperozide. Further experiments suggested that amperozide may be acting via alpha 2-adrenergic or 5-HT1A receptors to inhibit feeding. These studies imply that amperozide's selective 5-HT2A antagonistic activity is behaviorally specific.

A measurement of the cosmological mass density from clustering in the 2dF Galaxy Redshift Survey.

The large-scale structure in the distribution of galaxies is thought to arise from the gravitational instability of small fluctuations in the initial density field of the Universe. A key test of this hypothesis is that forming superclusters of galaxies should generate a systematic infall of other galaxies. This would be evident in the pattern of recessional velocities, causing an anisotropy in the inferred spatial clustering of galaxies. Here we report a precise measurement of this clustering, using the redshifts of more than 141,000 galaxies from the two-degree-field (2dF) galaxy redshift survey. We determine the parameter beta = Omega0.6/b = 0.43 +/- 0.07, where Omega is the total mass-density parameter of the Universe and b is a measure of the 'bias' of the luminous galaxies in the survey. (Bias is the difference between the clustering of visible galaxies and of the total mass, most of which is dark.) Combined with the anisotropy of the cosmic microwave background, our results favour a low-density Universe with Omega approximately 0.3.