Dual Role for FHY3 in Light Input to the Clock.

The red-light regulated transcription factors FHY3 and FAR1 form a key point of light input to the plant circadian clock in positively regulating expression of genes within the central clock. However, the fhy3 mutant shows an additional red light-specific disruption of rhythmicity which is inconsistent with this role. Here we demonstrate that only fhy3 and not far1 mutants show this red specific disruption of rhythmicity. We examined the differences in rhythmic transcriptome in red versus white light and reveal differences in patterns of rhythmicity among the central clock proteins suggestive of a change in emphasis within the central mechanism of the clock, changes which underlie the red specificity of the fhy3 mutant. In particular, changes in enrichment of promoter elements were consistent with a key role for the HY5 transcription factor, a known integrator of the ratio of red to blue light in regulation of the clock. Examination of differences in the rhythmic transcriptome in the fhy3 mutant in red light identified specific disruption of the CCA1-regulated ELF3 and LUX central clock genes, while the CCA1 target TBS element, TGGGCC, was enriched among genes that became arrhythmic. Coupled with the known interaction of FHY3 but not FAR1 with CCA1 we propose that the red-specific circadian phenotype of fhy3 may involve disruption of the previously demonstrated moderation of CCA1 activity by FHY3 rather than a disruption of its own transcriptional regulatory activity. Together, this evidence suggests a conditional redundancy between FHY3 and HY5 in the integration of red and blue light input to the clock in order to enable a plasticity in response to light and optimise plant adaptation. Furthermore, our evidence also suggests changes in CCA1 activity between red and white light transcriptomes. This, together with the documented interaction of HY5 with CCA1, leads us to propose a model whereby this integration of red and blue signals may at least partly occur via direct FHY3 and HY5 interaction with CCA1 leading to moderation of CCA1 activity.

What is the financial incentive to immigrate? An analysis of salary disparities between health workers working in the Caribbean and popular destination countries.

BACKGROUND: The continuous migration of Human Resources for Health (HRH) compromises the quality of health services in the developing supplying countries. The ability to increase earnings potentially serves as a strong motivator for HRH to migrate abroad. This study adds to limited available literature on HRH salaries within the Caribbean region and establishes the wage gap between selected Caribbean and popular destination countries. METHODS: Salaries are reported for registered nurses, medical doctors and specialists. Within these cadres, experience is incorporated at three different levels. Earnings are compared using purchasing power parity (PPP) exchange rates allowing for cost of living adjusted salary differentials, awarded to different levels of work experience for the chosen health cadres in the selected Caribbean countries (Jamaica, Dominica, St Lucia and Grenada) and the three destination countries (United States, United Kingdom and Canada). RESULTS: Registered nurses in the destination countries, across all experience levels, have greater spending power compared to their Caribbean counterparts. Recently qualified registered nurses earn substantially more in the UK (86.4%), US (214.2%) and Canada (182.5% more). The highest PPP salary ($) gap amongst more experienced nurses (5-10 years) is found within the US, with a gap of 163.9%. PPP salary gaps amongst medical doctors were pronounced, with experienced cadres (10-20 years of experience) in the US earning 316.3% more than their Caribbean counterparts, whilst UK doctors (183.5%) and Canadian doctors (251.3%) also earning significantly more. Large salary differentials remained for medical specialists and consultants. US specialist salaries were 540.4% higher than their Caribbean based counterparts, whilst UK and Canadian specialists earned 95.2 and 181.6% more respectively. CONCLUSION: The PPP adjusted HRH salaries in the three destination countries are superior to those of comparable HRH working in the Caribbean countries selected. The extent of the salary gaps vary according to country and the health cadre under examination, but remain considerable even for newly qualified HRH. The financial incentive to migrate for HRH trained and working in the Caribbean region remains strong, with governments having to consider earning potential abroad when formulating policies and strategies aimed at retaining health professionals.

Determining Preferences Related to HIV Counselling and Testing Services Among High School Learners in KwaZulu-Natal: A Discrete Choice Experiment.

A key strategy of the South African national response to HIV is the scale-up of HIV counselling and testing (HCT) in the 15-49 years age group. The integrated school health policy aims to guide the roll out of youth-friendly health services including the provision of HCT in schools. Using a discrete choice experiment to examine preferences regarding the attributes of HCT service packages, this study identifies barriers to and facilitators of HCT among high school learners. Monetary considerations were found to have the strongest effect of any attribute on choice, whilst confidentiality was found to be a primary concern for learners considering HCT. Policy makers and service providers must ensure that confidentiality is maintained, and could consider using monetary incentives as a way of increasing uptake of HCT. Programmes designed to reduce social stigma and improve education and knowledge dissemination around HCT and HIV, are vital in creating demand for HCT and changing attitudes among young people.

Is there a financial incentive to immigrate? Examining of the health worker salary gap between India and popular destination countries.

BACKGROUND: International migration is one of the factors resulting in the shortage of Human Resources for Health (HRH) in India. Literature suggests that migration is fuelled by the prospect of higher salaries available abroad. The extent of these salary differentials are unknown, and this study seeks to examine the salaries of selected HRH in India and four popular destination countries (United States of America, United Kingdom, Canada and the United Arab Emirates), whilst accounting for the in-country cost of living. This study will therefore determine truer financial incentives for Indian HRH to migrate abroad. METHODS: A purchasing power parity (PPP) ratio is employed to equalise the international price of buying a representative basket of commonly bought goods (including food, entertainment, fuel and utilities). Using the PPP index, real differences in salaries are directly compared for selected work categories and different levels of work experience in the four respective countries. RESULTS: Nurses in the USA can earn up to 82.7% more than their Indian counterparts. Nurses in Canada and the UAE reveal more modest salary differentials, yet still significant better off by up to 28 and 20% respectively. Only nurses in the UK are potentially materially worse off than nurses working in India. We observe significant potential PPP gains of up to 57.4, 99.1 and 94.4% for medical doctors in the USA, Canada and the UAE respectively. Medical specialists potentially experience the greatest income disparities with anaesthetists potentially earning up to 600% more than their counterparts in India. Radiologists operating in the UK and general surgeons working in the USA can potentially earn more than double that of their counterparts working in India. We observe more modest positive or negligible PPP gains in other selected countries for health specialists. CONCLUSION: Even when considering the differences in the cost of living, the financial incentive for selected cadres of Indian HRH to seek work abroad remains strong. The migration of Indian HRH to countries offering superior salaries makes it difficult for India to retain experienced health personal and compromises government efforts to render health care more accessible across the country.

Designing Human Immunodeficiency Virus Counselling and Testing Services to Maximize Uptake Among High School Learners in South Africa: What Matters?

BACKGROUND: Increasing human immunodeficiency virus (HIV) testing in South Africa is vital for the HIV response. Targeting young people is important as they become sexually active and because HIV risk rapidly increases as youth enter their 20s. This study aims to increase the understanding of high school learners' preferences regarding the characteristics of HIV testing service delivery models and to inform policy makers and implementers regarding potential barriers to and facilitators of HIV testing. METHODS: An attitudinal survey was used to examine HIV testing preferences among 248 high school learners in KwaZulu-Natal. Statistical tests were used to identify the most favored characteristics of testing service delivery models and examine key differences in preferences based on demographic characteristics and testing history. RESULTS: Most learners were found to prefer testing offered at a clinic on a Saturday (43%), using a finger prick test (59%), conducted by a doctor (61%) who also provides individual counselling (60%). Shorter testing times were preferred, as well as a monetary incentive to cover any associated expenses. Time, location, the type of test, and who conducts the test were most important. However, stratified analysis suggests that preferences diverge, particularly around gender, grade, but also sexual history and previous testing experience. CONCLUSIONS: Human immunodeficiency virus testing services can be improved in line with preferences, but there is no single optimal design that caters to the preferences of all learners. It is unlikely that a "one-size-fits-all" approach will be effective to reach HIV testing targets. A range of options may be required to maximize coverage.

FHY3 and FAR1 Act Downstream of Light Stable Phytochromes.

FHY3 and FAR1 are positively acting transcription factors that directly regulate expression of a number of target genes in Arabidopsis thaliana. Here, we looked at the regulation of one specific target gene, ELF4. We demonstrate that the action of FHY3 and FAR1 in upregulation of ELF4 is light dependent. Furthermore, although FHY3 and FAR1 have been exclusively characterized as components of the phytochrome A signaling pathway because of their importance in regulating expression of phyA nuclear importers, we show that, as transcription factors in their own right, FHY3 and FAR1 act downstream of light stable phytochromes, phyB, phyD, and phyE. We demonstrate that light stable phytochrome acts in a red/far-red reversible manner to regulate the level of FHY3 protein. We also observed that ELF4 shows specific FHY3 and FAR1-mediated light induction in the evening and we show that regulation by light stable phytochromes at this time is important as it allows the plant to maintain normal ELF4 expression beyond dusk when the day length shortens, something which would not be possible through light labile phytochrome action. Without FHY3 and FAR1, ELF4 expression falls rapidly at dusk and in short days this results in an early drop in ELF4 expression, accompanied by a de-repression of an ELF4 target gene later in the night. Our results, therefore, demonstrate an important role for FHY3 and FAR1 as mediators of light stable phytochrome signaling.

A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa.

BACKGROUND: Youth in South Africa have been identified as a high-risk group for contracting HIV. In response, the South African Integrated School Health Policy (ISHP) has been developed with the aim of guiding the provision of comprehensive healthcare services within South African schools. Accordingly, the scale-up of HIV counselling and testing (HCT) in high schools is a priority. This study examines the factors affecting the utilisation of HCT services amongst learners in high schools in the KwaZulu-Natal province of South Africa. METHODS: Focus group discussions were conducted in 12 rural schools in the Vulindlela sub-district of uMgungundlovu in KwaZulu-Natal. A total of 158 randomly selected learners took part, aged 16 years and older from grades 10, 11 and 12. Qualitative analysis was conducted using the framework approach, providing a systematic structure allowing for a priori and emergent codes, with social cognitive theory as a theoretical framework. RESULTS: The stigma and discrimination attached to testing, along with the inherent fear of a positive result were the biggest barriers to HCT uptake. Fear and the subsequent negative beliefs around HCT were borne out of insufficient knowledge. These fears were exacerbated by the perceived or real attitudes of peers, partners and family towards HIV. The prospect of a positive result and the possible resultant societal backlash hinders high and regular uptake of HCT. Stigma and discrimination remain the foremost barriers to HIV testing despite the presence of localised and convenient testing. Interventions aimed at addressing these challenges could increase the demand for HIV testing amongst adolescents. CONCLUSIONS: Increasing education about the importance of HCT and creating awareness about available HCT services will not be enough to increase uptake in schools in South Africa. Efforts to decrease stigma around HIV and HCT by integrating testing into general and sexual reproductive health services offered to youth, and normalising the epidemic within the community could go some way to allaying the fears shrouding testing, if such services are designed with the specific needs of youth in mind. This paper adds to the body of literature informing the design of policy in South Africa aimed at integrating HCT into school health services.

Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa.

Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO, South Africa has embarked on an ambitious VMMC programme. However, South Africa still falls short of meeting VMMC targets, particularly in KwaZulu-Natal, the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection, led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas), which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial, as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction, as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys.

Barriers and Facilitators to the Uptake of Voluntary Medical Male Circumcision (VMMC) among Adolescent Boys in KwaZulu-Natal; South Africa

Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO; South Africa has embarked on an ambitious VMMC programme. However; South Africa still falls short of meeting VMMC targets; particularly in KwaZulu-Natal; the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection; led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas); which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial; as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction; as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys

Is there really a pot of gold at the end of the rainbow? Has the Occupational Specific Dispensation, as a mechanism to attract and retain health workers in South Africa, leveled the playing field?

BACKGROUND: South Africa is experiencing a critical shortage of human resources for health (HRH) at a time when the population and the burden of ill-health, primarily due to HIV, AIDS and TB, are on the increase. This shortage is particularly severe within the nursing profession, which has witnessed significant emigration due to poor domestic working conditions and remuneration. Salaries and other benefits are an obvious pull factor towards foreign countries, given the often extreme international wage differentials. The introduction of the Occupation Specific Dispensation (OSD) in 2007 sought to improve the public services' ability to attract and retain employees thereby reducing incentives to emigrate. METHODS: Using a representative basket of commonly bought goods (including food, entertainment, fuel and utilities), a purchasing power parity (PPP) ratio is an exchange rate between two currencies that equalises the international price of buying that basket. Our study makes comparisons, using such a PPP index, and allows the identification of real differences in salaries for our selected countries (South Africa, United States, United Kingdom, Canada, Australia and Saudi Arabia) for the same HRH professions. If PPP adjusted earnings are indeed different then this indicates an economic incentive to emigrate. RESULTS: Salaries of most South African HRH, particularly registered nurses, are dwarfed by their international counterparts (notably United States, Canada and Saudi Arabia), although the OSD has gone some way to reduce that disparity. All selected foreign countries generally offer higher salaries on a PPP adjusted basis. The United Kingdom ($43202) and Australia ($38622), in the category of Medical Officer, are the only two examples where the PPP adjustment brings the salary below what is being offered in South Africa ($50013 post OSD). The PPP adjusted salary differences between registered nurses is very slight for South Africa ($18884 post OSD), Australia ($21784) and the United Kingdom ($20487). All other foreign countries show large salary advantages across the HRH categories examined. CONCLUSION: Whilst South African salaries remain lower than their foreign counterparts by and large, the introduction and implementation of the OSD has made significant progress in reducing the gap between salaries of HRH in South Africa (SA) and the rest of the world. Given that the OSD has narrowed the gap between SA and overseas salaries whilst in the context of continued out migration of SA HRH, further research into push factors effecting migration needs to be undertaken.