The Medical System in Ghana

Ghana is a developing country in West Africa with a population of about 25 million. Medical illnesses in Ghana overlap with those in developed countries, but infection, trauma, and women’s health problems are much more prominent. Medical practice in rural Africa faces extremely limited resources, a multiplicity of languages (hundreds in Ghana), and presentation of severe illnesses at later stages than seen elsewhere. Despite these limitations, Ghana has established a relatively successful national medical insurance system, and the quality of medical practice is high, at least where it is available. Ghana also has a well-established and sophisticated administrative structure for the supervision of medical education and accreditation, but it has proven very difficult to extend medical training to rural areas, where health care facilities are particularly short of personnel. Physicians are sorely needed in rural areas, but there are few because of the working conditions and financial limitations. Hospital wards and clinics are crowded; time per patient is limited. This article details some of the differences between medical practice in Ghana and that in wealthier countries and how it functions with very limited resources. It also introduces the medical education and training system in Ghana. The following article describes an attempt to establish and maintain a residency training program in General Medicine in a rural area of Ghana.     

Property Rights in Fisheries: Iceland’s Experience with ITQs

The fundamental problem of economic inefficiency in fisheries, the so-called common property problem, may be seen to be caused by inadequate or lacking property rights in the underlying natural resources. The introduction of Individual Transferable Quotas (ITQs) into fisheries represents an attempt to correct this failure. ITQs, however, are not property rights in the relevant natural resources, i.e. the fish stocks and their habitat. They are merely harvesting rights and thus far from ideal as property rights. Nevertheless, ITQs have been introduced in numerous fisheries around the world, apparently with generally, even consistently, good economic results. This paper outlines the basic theory of property rights and the strengths and weaknesses of ITQs as property rights in fisheries. The paper goes on to discuss the Icelandic ITQ system and compares its property rights value with that of the New Zealand ITQ system and the Norwegian IQ system. Finally, the paper reviews some measures of the economic outcomes of the ITQ system in Iceland.     

Rights Based Fishing: Use Rights versus Property Rights to Fish

The basic economic problem of commercial fisheries can be seen as the absence of property rights to the fish stocks. There are, however, both practical and principal obstacles to applying that solution. Instead, the preferable arrangement appears to be stock control by public agencies, combined with exclusive use rights granted, leased or sold to the fishing industry in order to achieve economic efficiency. Incentives to establish such rights can be found both in government circles and in the industry. Both have a vital role to play; plans to establish use rights such as ITQs have run aground on more than one occasion because of opposition from the industry. Use rights can be seen as a tool for government agencies to achieve economic efficiency in the industry. If desired, these gains can be distributed over a wider public through user fees of some kind. There are few examples, however, of substantial user fees, and the industry has been successful in getting such schemes abolished when they have been put into effect. The experience of Russia and, in particular, Estonia is discussed. The absence of user fees can be explained by the need to obtain support for use right schemes from the industry, and the windfall gains from gratis use rights are vehicles for this. Norway and Iceland are two countries which have put in place use rights, but they have done so in different ways. Iceland has an ITQ system while Norway has fishing concessions combined with individual vessel quotas. Some success appears to have been achieved in both countries with these systems.     

The Dispute Concerning the Delimitation of the Maritime Boundary Between Ghana and Côte d’Ivoire: Implications for the Law of the Sea

The final judgment in the maritime boundary delimitation case between Ghana and Côte d’Ivoire was delivered by an ad hoc special chamber (the Chamber) of the International Tribunal for the Law of the Sea (ITLOS) on 23 September 2017. The decision addressed important legal questions relating not only to maritime boundary delimitation but also to the balancing of various rights and interests at the provisional measures stage and international responsibility for unilateral resource exploitation activities in disputed zones pending delimitation. This article analyzes the decision of the Chamber with respect to its findings on tacit boundary agreements, delimitation methodology, and international responsibility.     

Multiple chemical sensitivities: stigma and social experiences

Multiple Chemical Sensitivity (MCS), an intolerance to everyday chemical and biological substances in amounts that do not bother other people, is a medically contested condition. In addition to symptoms and the ongoing difficulties of living with this condition, this hidden and stigmatized disability strongly impacts social relationships and daily life. Based on an ethnographic study, this article introduces the context of MCS in terms of cultural themes, the media, and the economic power of industries that manufacture the products that make people with MCS sick. Participants' experiences with family members and friends, in work and school settings, and with physicians exemplify the difficulties of living with MCS. I dedicate this article to Joan Ablon, my professor and mentor, whose work has always inspired my thinking and research topics.     

Perspective on architecture and assembly of membrane contact sites

Membrane contact sites (MCS) are platforms of physical contact between different organelles. They are formed through interactions involving lipids and proteins, and function in processes such as calcium and lipid exchange, metabolism and organelle biogenesis. In this article, we discuss emerging questions regarding the architecture, organisation and assembly of MCS, such as: What is the contribution of different components to the interaction between organelles? How is the specific composition of different types of membrane contacts sites established and maintained? How are proteins and lipids spatially organised at MCS and how does that influence their function? How dynamic are MCS on the molecular and ultrastructural level? We highlight current state of research and point out experimental approaches that promise to contribute to a spatiomechanistic understanding of MCS functions.     

Community Based Fisheries Management and Fisher Livelihoods: Bangladesh Case Studies

Poor fishers in Bangladesh have been disadvantaged by policies that favored powerful people leasing fishing rights. Community-based management was expected to improve fisher access, livelihoods, and the sustainability of fisheries. The impacts of community management in three floodplain waterbodies differed according to the environment and property rights. Where a set of fishers jointly held exclusive rights to a small enclosed lake they increased production by stocking fish and shared the returns. This strategy is productive but attracts competition for profits and fish consumption was unchanged. Access to capture fisheries in floodplain waterbodies enables the poor to catch diverse small fish for their consumption. Yet sustainability requires limits on fishing. Fish sanctuaries were respected, yet catches per day fell when more people from several villages increased fishing effort in a large wetland, while a tightly knit community restored the fishery in a smaller floodplain. Community organizations will need recognition of their long-term use rights to overcome future threats.

Maritime Delimitation and Fishery Cooperation in the Tonkin Gulf

In June 2004 China and Vietnam ratified both a maritime boundary agreement for the Tonkin Gulf (Beibu Gulf) and a fisheries cooperation agreement for the Gulf. These agreements end years of negotiation and debate regarding the rights of the respective states to the ocean areas and resources in the Gulf.     

Identifying 3D maximal common substructures using transputer networks

This paper describes the use of a multiprocessor system for identifying the maximal common substructure (MCS) between pairs of three-dimensional (3D) chemical structures. The system is constructed from Transputers, 32-bit RISC microprocessors produced by Inmos Ltd., linked together in a tree network. The MCS algorithm used, developed by Crandell and Smith, identifies the MCS by a breadth-first search in which individual atoms common to the structures are extended one atom at a time until no further extension of the common substructure can be obtained. Experiments using a Pascal-based simulation package demonstrate the feasibility of using a multiprocessor system to increase the speed of MCS identification. Experiments with networks of Transputers demonstrate that substantial increases in speed can be achieved in practice if, and only if, the MCS is large.     

CAT & MAUS: A novel system for true dynamic motion measurement of underlying bony structures with compensation for soft tissue movement

Optoelectronic motion capture systems are widely employed to measure the movement of human joints. However, there can be a significant discrepancy between the data obtained by a motion capture system (MCS) and the actual movement of underlying bony structures, which is attributed to soft tissue artefact. In this paper, a computer-aided tracking and motion analysis with ultrasound (CAT & MAUS) system with an augmented globally optimal registration algorithm is presented to dynamically track the underlying bony structure during movement. The augmented registration part of CAT & MAUS was validated with a high system accuracy of 80%. The Euclidean distance between the marker-based bony landmark and the bony landmark tracked by CAT & MAUS was calculated to quantify the measurement error of an MCS caused by soft tissue artefact during movement. The average Euclidean distance between the target bony landmark measured by each of the CAT & MAUS system and the MCS alone varied from 8.32 mm to 16.87 mm in gait. This indicates the discrepancy between the MCS measured bony landmark and the actual underlying bony landmark. Moreover, Procrustes analysis was applied to demonstrate that CAT & MAUS reduces the deformation of the body segment shape modeled by markers during motion. The augmented CAT & MAUS system shows its potential to dynamically detect and locate actual underlying bony landmarks, which reduces the MCS measurement error caused by soft tissue artefact during movement.     

Monte Carlo Vadose Zone Model for Soil Remedial Criteria

Many vadose zone models are available for environmental remediation, but few offer the procedures for verifying model predictions with field data and for dealing with uncertainties associated with model input parameters. This article presents a modified model combining a one-dimensional vadose-zone transport model and a simple groundwater mixing model with a function of Monte Carlo simulation (MCS). The modified model is applied to determine soil remedial concentrations for methyl tertiary butyl ether (MTBE). The modified model generates a distribution of MTBE ground-water concentrations at the point of compliance. This distribution can be used to estimate the risk of exceeding groundwater quality standard given soil remedial concentrations. In a case study, soil remedial concentration for MTBE is established to be 5?µg/kg, with a 95% and 10?µg/kg with a 50% probability that groundwater concentration will not exceed the water quality objective of 13?µg/L. Furthermore, this study uses MCS to investigate uncertainties of model input parameter hydraulic conductivity (K). One set of data (K1) is based on the results of hydraulic conductivity laboratory tests, and the other (K2) is based on the results of slug tests conducted in the field. As expected, the laboratory data show smaller K values than the field data. The comparison of the MCS results obtained from the two sets of K data indicates that the MTBE groundwater concentrations calculated based on K1 are generally 160 to 625% greater than those calculated based on K2 at the same percentiles of the MCS distribution. A higher soil remedial concentration of9jig/kg is then calculated based on the MCS results from K2 at 95%ile and 19?µg/kg at 50%ile.     

Alcoholism in Ghana—A socio-cultural exploration

A vast literature has accumulated in recent years, examining the disease concept of alcoholism, and analyzing the interaction of biomedicine with indigenous healing systems in colonial and post-colonial societies. Social scientists have consistently emphasized the social context of alcoholism, although their works have been largely ignored. This article engages the literature on the social history of medicine in Africa, and works on alcohol use in non-Western societies, in an attempt to offer an understanding of alcoholism in Ghana rooted in Ghanaian cultures and history. It explores how alcohol's established ties with spirituality influences Ghanaian perceptions of alcoholism. Based on interviews, highlife music, popular literature, and the few written works on alcohol use in Ghana, the article examines the social construction of the alcoholic in independent Ghana.Research for this article was made possible by a 1991–92 research grant from the African Development Foundation. An earlier version of this article was presented at a seminar organized by the Social Medicine Department, Harvard Medical School, April 1994. The article has benefitted from suggestions made at this seminar. The clarity of this article has been enhanced by the comments of the anonymous reviewers forCulture, Medicine and Psychiatry.     

Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya

Background

Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited.

Methodology/Principal Findings

We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities.

Conclusions/Significance

The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility.     

A study on the correlation between plan complexity and gamma index analysis in patient specific quality assurance of volumetric modulated arc therapy

Aim

To evaluate the new Octavius 4D system for patient specific quality assurance and to study the correlation between plan complexity and gamma index analysis in patient specific quality assurance of VMAT using the Octavius 4D system.

Background

McNiven (2010) proposed a study to evaluate the utility of a complexity metric, the Modulation Complexity Score, to evaluate the relationship of the metric with deliverability in IMRT.

Materials and methods

Evaluation of the Octavius 4D system was carried out by gamma evaluation of user defined MLC created patterns and AAPM TG 119 benchmark plans. The relationship between plan complexity expressed as Modulation Complexity Score (MCS) and the gamma index analysis was established by a planar and volumetric gamma analysis of 106 clinically approved VMAT patient plans of different sites.

Results

Average volumetric 3D global gamma evaluation (3 mm/3%) results for the evaluation plans was 97.41% for 6 MV X-rays and 98.30% for 15 MV X-rays. Average MCS values for the head and neck, pelvic and thoracic plans were 0.2224, 0.3615 and 0.1874. Average volumetric 3D global gamma analysis (3 mm/3%) results for the head and neck, pelvic and thoracic VMAT plans were 95.45%, 97.51% and 96.98%, respectively. Out of 90 correlation analyses between the MCS and gamma passing rate, only 3 had the r value greater than 0.5.

Conclusions

The Octavius 4D system is a suitable device for patient specific pretreatment QA. Global and local gamma analysis results showed a weak correlation with the MCS.     

Omentopexy enhances graft function in myocardial cell sheet transplantation

Myocardial cell sheets (MCS) are a potentially valuable tool for tissue engineering aimed at heart regeneration. Several methods have recently been established for the fabrication of MCS. However, the lack of a sufficient blood supply has inhibited functional recovery of the MCS. To address this challenge, we combined MCS transplantation with omentopexy (OP), which utilizes omental tissue as a surgical flap. Rats were divided into five groups: sham, myocardial infarction (MI), MCS transplantation, OP, and MCS + OP. Histologic analysis revealed that MCS + OP drastically reversed MI-induced cardiac remodeling. Echocardiography revealed that MCS increased cardiac function, while OP had a synergistic beneficial effect with MCS transplantation. Immunofluorescence imaging showed that OP increased the survival of transplanted cardiomyocytes, and increased the blood supply through enhancement of angiogenesis and migration of small arteries into the MCS. Taken together, we concluded that OP is a promising strategy for the enhancement of graft function in MCS transplantation.     

Gene Identification and Functional Analysis of Methylcitrate Synthase in Citric Acid-Producing Aspergillus niger WU-2223L

Methylcitrate synthase (EC 2.3.3.5; MCS) is a key enzyme of the methylcitric acid cycle localized in the mitochondria of eukaryotic cells and related to propionic acid metabolism. In this study, cloning of the gene mcsA encoding MCS and heterologous expression of it in Escherichia coli were performed for functional analysis of the MCS of citric acid-producing Aspergillus niger WU-2223L. Only one copy of mcsA (1,495 bp) exists in the A. niger WU-2223L chromosome. It encodes a 51-kDa polypeptide consisting of 465 amino acids containing mitochondrial targeting signal peptides. Purified recombinant MCS showed not only MCS activity (27.6 U/mg) but also citrate synthase (EC 2.3.3.1; CS) activity (26.8 U/mg). For functional analysis of MCS, mcsA disruptant strain DMCS-1, derived from A. niger WU-2223L, was constructed. Although A. niger WU-2223L showed growth on propionate as sole carbon source, DMCS-1 showed no growth. These results suggest that MCS is an essential enzyme in propionic acid metabolism, and that the methylcitric acid cycle operates functionally in A. niger WU-2223L. To determine whether MCS makes a contribution to citric acid production, citric acid production tests on DMCS-1 were performed. The amount of citric acid produced from glucose consumed by DMCS-1 in citric acid production medium over 12 d of cultivation was on the same level to that by WU-2223L. Thus it was found that MCS made no contribution to citric acid production from glucose in A. niger WU-2223L, although MCS showed CS activity.     

The cost to government of maintaining a commercially unviable fishery: The case of newfoundland 1981/82 to 1990/91

The commercial fishery for northern cod off Newfoundland has been closed since 1992. Since then, the recreational “food fishery”; has also been closed, as have the fisheries for many additional cod and other groundfish stocks. The Newfoundland fisheries had been commercially unviable for many years before the closures. This article records the federal and provincial governments’ financial outlays (expenditures, transfer payments to individuals, subsidies, net equity purchases, and net loans) on the fishery during the decade following 1981. Special emphasis is placed on the cost of the financial restructuring of the industry in the mid‐1980s, net unemployment insurance payments, and social overhead capital expenditures.