Objective:To determine the effect of management before and during transplantation on the quality of donated organs.Improvement of preservation methods in cases involving brain death will lead to more effective organ p...Objective:To determine the effect of management before and during transplantation on the quality of donated organs.Improvement of preservation methods in cases involving brain death will lead to more effective organ procurement.Methods:Data were collected from the 226 brain death cases enrolled in the 12-month study period.All cases,patients with a Glasgow Coma Scale(GCS)score of 3 points,appropriate age,and having medical indications for organ donation,were considered to confirm the criteria of brain death.Transplant outcome data were obtained from the transplant centers.Results:The age of the deceased ranged between 1 year and 68 years,with a mean±SD of 39.54±17.28 years.There was no significant difference between the quality of organs regarding blood group and cause of brain death(P>0.05).However,there was a significant difference in the quality of organs regarding age,body mass index(BMI),and gender.There was a significant difference between the level of urea at admission time and procurement time(P<0.001),as well as between creatinine level at admission time and procurement time(P<0.001).There was also a significant difference between aspartate aminotransferase(AST)at admission time and procurement time(P<0.001),and between alanine aminotransferase(ALT)at admission time and procurement time(P<0.001).Conclusions:Transplant outcomes using older donor livers and kidneys were comparable to those using younger or male donors.These findings provide further evidence that decision-making about organ quality is influenced by age and gender and emphasize the importance of transparency in organ acceptance practices.展开更多
<p> <span style="font-family:Verdana;">Under the Nigerian privatisation programme, the issues of risk allocation and mitigation were never always properly handled. Historically, there had always ...<p> <span style="font-family:Verdana;">Under the Nigerian privatisation programme, the issues of risk allocation and mitigation were never always properly handled. Historically, there had always been a tendency to dump all the project risks on the private sector partner without properly evaluating whether it was capable of managing them. Extant literature has shown that where the comparative advantages of parties to handle risks are not properly taken into consideration, the allocation of risk is unbalanced and the tendency for the project to run into difficulties and/or fail increases. This paper looks at the electric power sector privatisation, distilling how key project risks were handled under the exercise. This should be a good pointer as to whether the privatisation exercise wo</span><span style="font-family:Verdana;">u</span><span style="font-family:Verdana;">ld be a success in the long run.</span><span></span> </p>展开更多
Background:As part of the WHO End TB strategy,national tuberculosis(TB)programs increasingly aim to engage all private and public TB care providers.Engagement of communities,civil society organizations and public and ...Background:As part of the WHO End TB strategy,national tuberculosis(TB)programs increasingly aim to engage all private and public TB care providers.Engagement of communities,civil society organizations and public and private care provider is the second pillar of the End TB strategy.In Myanmar,this entails the public-public and public-private mix(PPM)approach.The public-public mix refers to public hospital TB services,with reporting to the national TB program(NTP).The public-private mix refers to private general practitioners providing TB services including TB diagnosis,treatment and reporting to NTP.The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time.Methods:Using 2007-2014 aggregated program data,we collected information from NTP and non-NTP actors on 1)the number of TB cases detected and their relative contribution to the national case load;2)the type of TB cases detected;3)their treatment outcomes.Results:The total number of TB cases detected per year nationally increased from 133,547 in 2007 to 142,587 in 2014.The contribution of private practitioners increased from 11%in 2007 to 18%in 2014,and from 1.8%to 4.6%for public hospitals.The NTP contribution decreased from 87%in 2007 to 77%in 2014.A similar pattern was seen in the number of new smear(+)TB cases(31%of all TB cases)and retreatment cases,which represented 7.8%of all TB cases.For new smear(+)TB cases,adverse outcomes were more common in public hospitals,with more patients dying,lost to follow up or not having their treatment outcome evaluated.Patients treated by private practitioners were more frequently lost to follow up(8%).Adverse treatment outcomes in retreatment cases were particularly common(59%)in public hospitals for various reasons,predominantly due to patients dying(26%)or not being evaluated(10%).In private clinics,treatment failure tended to be more common(8%).Conclusions:The contribution of non-NTP actors to TB detection at the national level increased over time,with the largest contribution by private practitioners involved in PPM.Treatment outcomes were fair.Our findings confirm the role of PPM in national TB programs.To achieve the End TB targets,further expansion of PPM to engage all public and private medical facilities should be targeted.展开更多
文摘Objective:To determine the effect of management before and during transplantation on the quality of donated organs.Improvement of preservation methods in cases involving brain death will lead to more effective organ procurement.Methods:Data were collected from the 226 brain death cases enrolled in the 12-month study period.All cases,patients with a Glasgow Coma Scale(GCS)score of 3 points,appropriate age,and having medical indications for organ donation,were considered to confirm the criteria of brain death.Transplant outcome data were obtained from the transplant centers.Results:The age of the deceased ranged between 1 year and 68 years,with a mean±SD of 39.54±17.28 years.There was no significant difference between the quality of organs regarding blood group and cause of brain death(P>0.05).However,there was a significant difference in the quality of organs regarding age,body mass index(BMI),and gender.There was a significant difference between the level of urea at admission time and procurement time(P<0.001),as well as between creatinine level at admission time and procurement time(P<0.001).There was also a significant difference between aspartate aminotransferase(AST)at admission time and procurement time(P<0.001),and between alanine aminotransferase(ALT)at admission time and procurement time(P<0.001).Conclusions:Transplant outcomes using older donor livers and kidneys were comparable to those using younger or male donors.These findings provide further evidence that decision-making about organ quality is influenced by age and gender and emphasize the importance of transparency in organ acceptance practices.
文摘<p> <span style="font-family:Verdana;">Under the Nigerian privatisation programme, the issues of risk allocation and mitigation were never always properly handled. Historically, there had always been a tendency to dump all the project risks on the private sector partner without properly evaluating whether it was capable of managing them. Extant literature has shown that where the comparative advantages of parties to handle risks are not properly taken into consideration, the allocation of risk is unbalanced and the tendency for the project to run into difficulties and/or fail increases. This paper looks at the electric power sector privatisation, distilling how key project risks were handled under the exercise. This should be a good pointer as to whether the privatisation exercise wo</span><span style="font-family:Verdana;">u</span><span style="font-family:Verdana;">ld be a success in the long run.</span><span></span> </p>
基金The program was funded by WHO/TDR Impact grant to two TDR alumni from DMR.The funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Background:As part of the WHO End TB strategy,national tuberculosis(TB)programs increasingly aim to engage all private and public TB care providers.Engagement of communities,civil society organizations and public and private care provider is the second pillar of the End TB strategy.In Myanmar,this entails the public-public and public-private mix(PPM)approach.The public-public mix refers to public hospital TB services,with reporting to the national TB program(NTP).The public-private mix refers to private general practitioners providing TB services including TB diagnosis,treatment and reporting to NTP.The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time.Methods:Using 2007-2014 aggregated program data,we collected information from NTP and non-NTP actors on 1)the number of TB cases detected and their relative contribution to the national case load;2)the type of TB cases detected;3)their treatment outcomes.Results:The total number of TB cases detected per year nationally increased from 133,547 in 2007 to 142,587 in 2014.The contribution of private practitioners increased from 11%in 2007 to 18%in 2014,and from 1.8%to 4.6%for public hospitals.The NTP contribution decreased from 87%in 2007 to 77%in 2014.A similar pattern was seen in the number of new smear(+)TB cases(31%of all TB cases)and retreatment cases,which represented 7.8%of all TB cases.For new smear(+)TB cases,adverse outcomes were more common in public hospitals,with more patients dying,lost to follow up or not having their treatment outcome evaluated.Patients treated by private practitioners were more frequently lost to follow up(8%).Adverse treatment outcomes in retreatment cases were particularly common(59%)in public hospitals for various reasons,predominantly due to patients dying(26%)or not being evaluated(10%).In private clinics,treatment failure tended to be more common(8%).Conclusions:The contribution of non-NTP actors to TB detection at the national level increased over time,with the largest contribution by private practitioners involved in PPM.Treatment outcomes were fair.Our findings confirm the role of PPM in national TB programs.To achieve the End TB targets,further expansion of PPM to engage all public and private medical facilities should be targeted.
