A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia.

BACKGROUND: Any health care system that strives to deliver good health and well-being to its population relies on a trained workforce. The aim of this study was to enumerate surgical provider density, describe operative productivity and assess the association between key surgical system characteristics and surgical provider productivity in Liberia. METHODS: A nationwide survey of operation theatre logbooks, available human resources and facility infrastructure was conducted in 2018. Surgical providers were counted, and their productivity was calculated based on operative numbers and full-time equivalent positions. RESULTS: A total of 286 surgical providers were counted, of whom 67 were accredited specialists. This translated into a national density of 1.6 specialist providers per 100,000 population. Non-specialist physicians performed 58.3 percent (3607 of 6188) of all operations. Overall, surgical providers performed a median of 1.0 (IQR 0.5-2.7) operation per week, and there were large disparities in operative productivity within the workforce. Most operations (5483 of 6188) were categorized as essential, and each surgical provider performed a median of 2.0 (IQR 1.0-5.0) different types of essential procedures. Surgical providers who performed 7-14 different types of essential procedures were more than eight times as productive as providers who performed 0-1 essential procedure (operative productivity ratio = 8.66, 95% CI 6.27-11.97, P < 0.001). CONCLUSION: The Liberian health care system struggles with an alarming combination of few surgical providers and low provider productivity. Disaggregated data can provide a high-resolution picture of local challenges that can lead to local solutions.

The tissue polarity gene nemo carries out multiple roles in patterning during Drosophila development.

Drosophila nemo was first identified as a gene required for tissue polarity during ommatidial development. We have extended the analysis of nemo and found that it participates in multiple developmental processes. It is required during wing development for wing shape and vein patterning. We observe genetic interactions between nemo and mutations in the Notch, Wingless, Frizzled and Decapentaplegic pathways. Our data support the findings from other organisms that Nemo proteins act as negative regulators of Wingless signaling. nemo mutations cause polarity defects in the adult wing and overexpression of nemo leads to abdominal polarity defects. The expression of nemo during embryogenesis is dynamic and dsRNA inhibition and ectopic expression studies indicate that nemo is essential during embryogenesis.

Redesigning geriatric healthcare: how cross-functional teams and process improvement provide a competitive advantage.

This study examines the consequences of adding a geriatric subacute unit to the traditional health care mix offered by a nonprofit hospital. Historically, geriatric health care offerings have been limited to either acute care units or long-term care facilities. The study's findings demonstrate that the addition of a subacute unit that is operated by an interdisciplinary team is a competitively rational move for two reasons. First, it provides a continuum of care that integrates services and departments, thereby reducing costs. Second, it provides a supportive environment for patients and their families. As a consequence patients have a higher probability of returning home than patients who are assigned to more traditional modes of care.

Physical characteristics of patients with herniated intervertebral lumbar discs.

In an attempt to determine whether certain physical characteristics discriminated between people with and without herniated intervertebral lumbar discs, volunteers (N = 40) who were diagnosed as having a herniated lumbar disc were compared to control subjects (N = 40) who had been randomly selected and matched by age and sex. All subjects completed a questionnaire to determine the history of their back injury and a description of their exercise behavior patterns. Body composition was estimated by hydrostatic weighing. Maximum oxygen consumption was predicted using the Astrand-Ryhming nomogram. Strength scores were determined from a battery of cable tensiometer tests. Dependent variables were analyzed using a multiple analysis of variance (MANOVA). Using discriminant analysis, as a post hoc test, predicted maximum oxygen consumption was shown to account for the difference between the groups (P less than .002). The control subjects' values were higher than the patients' values. Subjects' exercise history indicated no differences between the groups relative to the time period preceding the onset of injury (P greater than .05). The exercise activity of patients was significantly reduced after injury (P less than .001). An average of 87 days elapsed between the onset of injury to the date of fitness testing.