Diversity of Floral Visitors in Apple Orchards: Influence on Fruit Characteristics Depends on Apple Cultivar.

Most cultivars of apple trees are highly dependent on insects for successful pollination and fruit production. In this study, we evaluated the insect diversity in apple orchards of southern Brazil and verified whether or not there is a relationship between the diversity of insect visitors and the characteristics (weight, seed number, and symmetry) of the fruits of 'Fuji' and 'Gala' apples produced by the orchards. We also evaluated the diversity of insects on flowering weeds within apple orchards and compared it with the apple flowers. Diversity of anthophilous insects was low, in general, and differed between the regions. Furthermore, regarding insect diversity, orchards were grouped by management system: organic orchards were more similar to each other than to conventional orchards. The insect diversity of weed flowers was higher than apple flowers, but insect abundance was greater on apple flowers, suggesting that weeds may increase insect diversity within apple orchards and may sustain pollinators. We found a positive effect of insect diversity on the number of seeds of 'Fuji' apples and of honeybee abundance on their weight, suggesting that honeybee management is important in the studied areas. In contrast, we found no significant effect of insect diversity and abundance on 'Gala' apple characteristics. Despite this, the analyses of the seeds of 'Gala' apples indicate that the orchards may suffer a pollination deficit, which could be overcome by improving insect pollination. These results reinforce previous findings that insect diversity is important for apple yield, but its influence varies with cultivar.

Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria.

Resilience is increasingly recognised as a key process mitigating the impact of shocks and stressors on functioning. The literature on individual and community resilience is being extended to address characteristics of resilient service delivery systems in contexts of adversity. The validity and utility of a capacity-oriented resilience framework (including absorption, adaptation and transformation) is examined with respect to the functioning of United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health systems in Lebanon and Jordan in the context of the Syrian crisis. We completed 62 semi-structured interviews (30 in Lebanon in November-December 2016, and 32 in Jordan in January 2017) with professionals at primary care, area, and country management levels. Participants reflected on changes in population health status and health service delivery during the Syrian crisis, notably with respect to the influx of refugees from Syria. Interviews were analysed through inductive thematic analysis and used to critically interrogate health systems resilience against a pro-capacities framework. We find that UNRWA systems in Lebanon and Jordan were broadly resilient, deploying diverse strategies to address health challenges and friction between host and refugee populations. Absorptive capacity was evidenced by successful accommodation of increased patient numbers across most service areas. Adaptive capacities were reflected in broadening of collaboration and reconfiguration of staff roles to enhance service delivery. Transformative capacities were demonstrated in the revision of the service packages provided. While manifest as technical capacities, these clearly drew upon solidarity and commitment linked to the political context of the Palestinian experience. The study adds to the limited literature on health system and organizational resilience and indicates that capacity-oriented framings of resilience are valuable in extracting generalizable lessons for health systems facing adversity. The proposed resilience framework promises to guide strategies for sustained care delivery in these contexts.

Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco.

BACKGROUND: Across the Africa region and beyond, the last decade has seen many countries introducing policies aimed at reducing financial barriers to obstetric care. This article provides evidence of the cost and effects of national policies focussed on improving financial access to caesarean and facility deliveries in Benin, Burkina Faso, Mali and Morocco. METHODS: The study uses a comparative case study design with mixed methods, including realist evaluation components. This article presents results across 14 different data collection tools, used in 4-6 research sites in each of the four study countries over 2011-13. The methods included: document review; interviews with key informants; analysis of secondary data; structured extraction from medical files; cross-sectional surveys of patients and staff; interviews with patients and observation of care processes. RESULTS: The article finds that the policies have contributed to continued increases in skilled birth attendance and caesarean sections and a narrowing of inequalities in all four countries, but these trends were already occurring so a shift cannot be attributed solely to the policies. It finds a significant reduction in financial burdens on households after the policy, suggesting that the financial protection objectives may have been met, at least in the short term, although none achieved total exemption of targeted costs. Policies are domestically financed and are potentially sustainable and efficient, and were relatively thoroughly implemented. Further, we find no evidence of negative effects on technical quality of care, or of unintended negative effects on untargeted services. CONCLUSIONS: We conclude that the policies were effective in meeting financial protection goals and probably health and equity goals, at sustainable cost, but that a range of measures could increase their effectiveness and equity. These include broadening the exempted package (especially for those countries which focused on caesarean sections alone), better calibrated payments, clearer information on policies, better stewardship of the local health system to deal with underlying systemic weaknesses, more robust implementation of exemptions for indigents, and paying more attention to quality of care, especially for newborns.

The free delivery and caesarean policy in Morocco: how much do households still pay?

BACKGROUND: The Free Deliveries and Caesarean Policy (FDCP) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile. METHODS: Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units. RESULTS: Households reported spending a median of US$ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries (P < 0.0001). The median cost was US$45 for a uncomplicated delivery, US$50 for a complicated delivery and US$65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty-eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites. CONCLUSION: The policy has been largely but not fully effective in removing financial barriers for delivery care in Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes.

Costs and cost-effectiveness of community health workers: evidence from a literature review

This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.

Comparative study of the floral biology and of the response of productivity to insect visitation in two rapeseed cultivars (Brassica napus L.) in Rio Grande do Sul / Estudo comparativo da biologia floral e da resposta da produtividade à visita por insetos em duas cultivares de canola (Brassica napus L.) no Rio Grande do Sul

Planning the artificial pollination of agricultural crops requires knowledge of the floral biology and reproductive system of the crop in question. Many studies have shown that rapeseed (Brassica napus Linnaeus) is self-compatible and self-pollinated, but its productivity may be increased by insect visitation. In the present study, the floral biology and the response of productivity to insect visitation of two rapeseed cultivars (Hyola 420 and Hyola 61) were analyzed and compared in three regions of Rio Grande do Sul, Brazil. The rapeseed flowers presented three stages during anthesis, with the time periods varying between the cultivars. Both cultivars are self-compatible, but free visitation of insects increased productivity by 17% in the Hyola 420 cultivar and by approximately 30% in the Hyola 61 cultivar. Therefore, it is concluded that the cultivar Hyola 61 is more dependent on insect pollination than Hyola 420.

O planejamento de polinização dirigida nas culturas agrícolas requer o conhecimento da biologia floral e do sistema reprodutivo da cultura em questão. Muitos estudos mostram que a canola (Brassica napus Linnaeus) é auto compatível e auto polinizada, no entanto, sua produtividade pode ser aumentada pela visita por insetos. Nesse estudo, a biologia floral e a resposta da produtividade à visita por insetos de duas cultivares de canola (Hyola 420 e Hyola 61) foram analisadas e comparadas em três regiões do Rio Grande do Sul, Brasil. As flores de canola apresentaram três fases durante a antese, havendo variação no período de tempo de acordo com a cultivar. Ambas as cultivares são auto compatíveis, mas a livre visita por insetos aumentou a produtividade em 17% na cultivar Hyola 420 e cerca de 30% na cultivar Hyola 61. Dessa maneira, concluímos que a cultivar Hyola 61 é mais dependente da polinização entomófila que a Hyola 420.

Comparative study of the floral biology and of the response of productivity to insect visitation in two rapeseed cultivars (Brassica napus L.) in Rio Grande do Sul.

Planning the artificial pollination of agricultural crops requires knowledge of the floral biology and reproductive system of the crop in question. Many studies have shown that rapeseed (Brassica napus Linnaeus) is self-compatible and self-pollinated, but its productivity may be increased by insect visitation. In the present study, the floral biology and the response of productivity to insect visitation of two rapeseed cultivars (Hyola 420 and Hyola 61) were analyzed and compared in three regions of Rio Grande do Sul, Brazil. The rapeseed flowers presented three stages during anthesis, with the time periods varying between the cultivars. Both cultivars are self-compatible, but free visitation of insects increased productivity by 17% in the Hyola 420 cultivar and by approximately 30% in the Hyola 61 cultivar. Therefore, it is concluded that the cultivar Hyola 61 is more dependent on insect pollination than Hyola 420.

Incremental cost-effectiveness of improving treatment results among migrant tuberculosis patients in Shanghai.

SETTING: Two projects were introduced in October 2007 to improve treatment completion among rural-to-urban migrant tuberculosis (TB) patients in Shanghai. The Communicable Disease Research Consortium (COMDIS) project provided financial incentives to poor patients, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) project provided incentives to all patients and increased staff time. OBJECTIVE: To assess the incremental cost-effectiveness of these two projects. METHODS: Case study. Costs were assessed from a societal perspective. The primary measure of effectiveness was the treatment completion rate. The incremental cost-effectiveness ratio was calculated as the additional cost of the intervention divided by the additional percentage of patients completing treatment compared to controls. RESULTS: Post intervention, the treatment completion rates in the COMDIS and Global Fund projects were respectively 89% and 88%, 17% and 16% higher than in the control district (76%). For one additional per cent of patients to complete treatment, the additional cost of the COMDIS intervention was US$1891, 91% lower than that of the Global Fund intervention (US$21,904). CONCLUSION: The intervention that addressed the financial barriers of poor patients was more cost-effective than the comprehensive intervention that provided assistance to both patients and providers. Further study is needed to understand the process of interventions prior to wider scale-up.

Apis mellifera (Hymenoptera: Apidae) as a potential Brassica napus pollinator (cv. Hyola 432) (Brassicaceae), in Southern Brazil.

Brassica napus Linnaeus is considered a self-compatible crop; however, studies show that bee foraging elevates their seed production. Considering bee food shortages during the winter season and that the canola is a winter crop, this study aimed to evaluate the foraging behaviour of Apis mellifera Linnaeus, 1758 regarding those flowers, and to verify if it presents adequate behaviour for successfully pollinating this crop in Rio Grande do Sul State. The study was carried out in a canola field, in Southern Brazil. The anthesis stages were morphologically characterised and then related to stigma receptivity and pollen grain viability. Similarly, the behaviour of A. mellifera individuals on flowers was followed, considering the number of flowers visited per plant, the amount of time spent on the flowers, touched structures, and collected resources. Floral fidelity was inferred by analysing the pollen load of bees collected on flowers. The bees visited from 1-7 flowers/plant (x = 2.02; sd = 1.16), the time spent on the flowers varied between 1-43 seconds (x = 3.29; sd = 2.36) and, when seeking nectar and pollen, they invariably touched anthers and stigmas. The pollen load presented 100% of B. napus pollen. The bees' attendance to a small number of flowers/plants, their short permanence on flowers, their contact with anthers and stigma and the integral floral constancy allows their consideration as potential B. napus pollinators.

Achieving sustainability, quality and access: lessons from the world's largest revolving drug fund in Khartoum.

Ensuring a reliable and affordable supply of essential drugs to health facilities is one of the main challenges facing developing countries. This paper describes the revolving drug fund in Khartoum, which was set up in 1989 to improve access to high quality drugs across the State. An evaluation in 2004 showed that the fund has successfully managed a number of threats to its financial sustainability and has expanded its network of facilities, its range of products and its financial assets. It now supplies essential drugs to 3 million out of the 5 million population of Khartoum each year, at prices between 40% and 100% less than alternative sources. However, results illustrated the tension between achieving an efficient cost-recovery system and access for the poorest.

Achieving sustainability, quality and access: lessons from the world's largest revolving drug fund in Khartoum

Ensuring a reliable and affordable supply of essential drugs to health facilities is one of the main challenges facing developing countries. This paper describes the revolving drug fund in Khartoum, which was set up in 1989 to improve access to high quality drugs across the State. An evaluation in 2004 showed that the fund has successfully managed a number of threats to its financial sustainability and has expanded its network of facilities, its range of products and its financial assets. It now supplies essential drugs to 3 million out of the 5 million population of Khartoum each year, at prices between 40% and 100% less than alternative sources. However, results illustrated the tension between achieving an efficient cost-recovery system and access for the poorest

Tuberculosis patient adherence to direct observation: results of a social study in Pakistan.

A randomized controlled trial was carried out in Pakistan in 1999 to establish the effectiveness of the direct observation component of DOTS programmes. It found no significant differences in cure rates for patients directly observed by health facility workers, community health workers or by family members, as compared with the control group who had self-administered treatment. This paper reports on the social studies which were carried out during and after this trial, to explain these results. They consisted of a survey of all patients (64% response rate); in-depth interviews with a smaller sample of different types of patients; and focus group discussions with patients and providers. One finding was that of the 32 in-depth interview patients, 13 (mainly from the health facility observation group) failed to comply with their allocated DOT approach during the trial, citing the inconvenience of the method of observation. Another finding was that while patients found the overall TB care approach efficient and economical in general, they faced numerous barriers to regular attendance for the direct observation of drug-taking (most especially, time, travel costs, ill health and need to pursue their occupation). This may be one of the reasons why there was no overall benefit from direct observation in the trial. Provider attitudes were also poor: health facility workers expressed cynical and uncaring views; community health workers were more positive, but still arranged direct observation to suit their, rather than patients', schedules. The article concludes that direct observation, if used, should be flexible and convenient, whether at a health facility close to the patient's home or in the community. The emphasis should shift in practice from tablet watching towards treatment support, together with education and other adherence measures.

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the highest cure rates (67%), with a cost per case only slightly higher than the self-administered group (172 dollars per case cured). This approach should be investigated further, along with other approaches to improving patient compliance.

Simplified antiviral prophylaxis with or and without artificial feeding to reduce mother-to-child transmission of HIV in low and middle income countries: modelling positive and negative impact on child survival.

BACKGROUND: Antiviral prophylaxis is recommended for HIV positive mothers to prevent mother-to-child transmission of HIV. To date UNAIDS and WHO policy has been based on a study in Thailand which showed a reduction in transmission by half with short course AZT (Zidovudine) treatment together with artificial feeding. We modelled the possible positive and negative effects on child deaths in low and middle resource developing country settings of two interventions to reduce mother to child transmission (MTCT) of HIV: antenatal testing, short-course antivirals (zidovudine or nevirapine), firstly with and then without artificial feeding. MATERIAL AND METHODS: Estimates are made of child lives likely to be saved by the programme by age ten years, balanced against increases in deaths due to more uninfected mothers choosing to use artificial feeds where these are part of the intervention. Mid-point values for variables affecting the balance of mortality gains and losses are taken from recent published data for low and middle income developing countries and a sensitivity analysis is undertaken. RESULTS: In low income settings the use of antivirals alone would result in an estimated gain in child survival of around 0.36%, representing 360 deaths avoided from a birth cohort of 100,000 by age 10 years. Adding artificial feeding could reduce the gain to 0.03% (30 deaths avoided). In middle income settings the gain from antivirals alone would be 0.26% but as 'spill-over' of artificial feeding to uninfected women was more likely it could result in a net increase of child deaths of up to 1.08% (1,080 additional deaths). A sensitivity analysis emphasised this potential for regimens using artificial feeding if progamme participation was low, and under most circumstances in middle income settings. CONCLUSIONS: HIV testing and use of antivirals by infected mothers, if well implemented, will be effective at a population level in reducing MTCT. However the addition of artificial feeding is potentially be a high risk strategy, especially in middle income countries.

Health economics in low income countries: adapting to the reality of the unofficial economy.

There is some evidence in established market economies that health economics is having a positive impact on policy. Although many of the underlying assumptions can be questioned, the predictions made are broadly applicable to a range of relatively wealthy industrialised economies. In low and middle income countries these assumptions are often less applicable. In particular, assumptions about the regulation and functioning of public and private sector activities often fail to account for the operation of the unofficial health care sector. This paper illustrates how unofficial markets might operate in the context of the health care sector in a developing economy. In particular it examines how the motives of practitioners may be influenced by a lack of regulation and under-funding which in turn contribute to the presence of unofficial activities. Unofficial market activities could influence and distort the impact of policies commonly being pursued in many countries. Further research is required into the functioning of these markets in order to align the assumptions of policy with the reality of the developing health care sector.

Informal payments in transitional economies: implications for health sector reform.

Since the collapse of the Soviet Union increasing evidence is emerging of informal payments by patients for health care services that are officially free. There is little information, however, on the characteristics of these payments and the effect that they have on health care reform initiatives. This paper examines these issues and concludes that the endemic and complex nature of such payments suggests that a range of policy tools are necessary to address the negative features of informal payments in those countries undergoing transition.

Decreased bone mineralization in children with phenylketonuria under treatment.

Children with phenylketonuria (PKU) obtain a great deal of their protein and mineral intakes from synthetic elemental formulae devoid of phenylalanine. To assess the effect of such diets and/or the disease on bone mineralization, children with PKU were compared to normal children for many parameters of mineral homeostasis and bone mineralization. A total of 11 children with PKU of mean age 10.9 +/- 4.2 years were compared to a large group of normal control children mean age 11.4 +/- 4.2, and an age and sex matched subset (n = 11). Children with PKU had lower serum calcium (9.1 +/- 0.9 vs 10.4 +/- 1.9 mg/dl P < 0.01) amd magnesium (1.67 +/- 1.4 vs 2.07 +/- 0.16 mg/ dl, P < 0.001) but normal values for phosphorus, zinc, and copper. The percentage tubular reabsorption of phosphorus was increased in PKU (93 +/- 3% vs 88 +/- 6%, P < 0.05) suggesting a lower phosphorus intake and/or absorption. Serum 25-hydroxyvitamin D, parathyroid hormone and 1,25 dihydroxyvitamin D were similar in PKU and control children. Serum albumin and lean body mass by dual energy X-ray absorption were not different suggesting that protein intake was adequate. In the 11 pairs, a decreased bone mineral density was seen for the lumbar spine (0.61 +/- 0.15 vs 0.72 +/- 0.24 P < 0.05), and lower extremities (1.56 +/- 0.30 vs 1.87 +/- 0.56 P < 0.05) by paired t-test. Compared to the total controls and the paired controls, decreases were seen in markers of bone formation; bone alkaline phosphatase, (72 +/- 30 vs 126 +/- 43 P < 0.001), osteocalcin (10.7 +/- 3.4 vs 13.1 +/- 2.0 P < 0.05) and procollagen type I carboxyterminal propeptide. No differences were seen in the bone resorption markers tartrate resistant acid phosphatase and urine Ca/Cr. The changes noted could not be related after age correction to serum phenylalanine levels, protein intake, or mineral intakes. It is unclear whether deficits in bone mineralization relate to the disease process itself or its treatment.

'Doi moi' and health: the effect of economic reforms on the health system in Vietnam.

The article examines changes which have taken place in the health system in Vietnam as a result of the economic reform process dating back to the late 1980s. With the liberalization of the economy have come not only growth for many, and increased choice, but also increased income and regional disparities and the problem of access to social services for those households which are less successful in the market economy. While state official policy emphasizes equity and free access to services for the poor, health costs for patients have risen substantially in the form of official and unofficial payments to staff and payments for drugs. The public sector faces an unprecedented challenge in the form of dramatic decreases in the utilization of public facilities; a shift towards self-prescription and, to a lesser extent, private practice by public employees; and, increasing reliance on foreign donors for support to preventive programmes. The article makes some recommendations on priorities for health policy in Vietnam to face these challenges.

[From drawing and photograph to printed illustration; engravers, lithographers and printers in action for the Nederlandsch Tijdschrift voor Geneeskunde to 1920]. / Van tekening en foto tot gedrukte illustratie; graveurs, lithografen en drukkers werkzaam voor het Nederlandsch Tijdschrift voor Geneeskunde tot 1920.

From 1857 to 1920 a number of engravers and lithographers supplied the Nederlandsch Tijdschrift voor Geneeskunde with illustrations. Two lithographers may be regarded as regular contributors to the Journal. They were A.J. Wendel of Leiden, who from 1859 to 1875 was active as house lithographer, and the Amsterdam lithographer C. Mooy from 1883 to 1910. The new techniques of mechanical reproduction of photographs in printing slowly but surely replaced the lithos and wood engravings.