Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria

The posting and transfer of health workers and managers receives little policy and research attention in global health. In Nigeria, there is no national policy on posting and transfer in the health sector. We sought to examine how the posting and transfer of frontline primary health care (PHC) workers is conducted in four states (Lagos, Benue, Nasarawa and Kaduna) across Nigeria, where public sector PHC facilities are usually the only form of formal health care service providers available in many communities. We conducted in‐depth interviews with PHC workers and managers, and group discussions with community health committee members. The results revealed three mechanisms by which PHC managers conduct posting and transfer: (1) periodically moving PHC workers around as a routine exercise aimed at enhancing their professional experience and preventing them from being corrupted; (2) as a tool for improving health service delivery by assigning high‐performing PHC workers to PHC facilities perceived to be in need, or posting PHC workers nearer their place of residence; and (3) as a response to requests for punishment or favour from PHC workers, political office holders, global health agencies and community health committees. Given that posting and transfer is conducted by discretion, with multiple influences and sometimes competing interests, we identified practices that may lead to unfair treatment and inequities in the distribution of PHC workers. The posting and transfer of PHC workers therefore requires policy measures to codify what is right about existing informal practices and to avert their negative potential. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd     

Welding methods for joining thermoplastic polymers for the hermetic enclosure of medical devices

New high performance polymers have been developed that challenge traditional encapsulation materials for permanent active medical implants. The gold standard for hermetic encapsulation for implants is a titanium enclosure which is sealed using laser welding. Polymers may be an alternative encapsulation material. Although many polymers are biocompatible, and permeability of polymers may be reduced to acceptable levels, the ability to create a hermetic join with an extended life remains the barrier to widespread acceptance of polymers for this application. This article provides an overview of the current techniques used for direct bonding of polymers, with a focus on thermoplastics. Thermal bonding methods are feasible, but some take too long and/or require two stage processing. Some methods are not suitable because of excessive heat load which may be delivered to sensitive components within the capsule. Laser welding is presented as the method of choice; however the establishment of suitable laser process parameters will require significant research.     

Screening patients with sensorineural hearing loss for vestibular schwannoma using a Bayesian classifier

Objectives: Selecting patients with asymmetrical sensorineural hearing loss for further investigation continues to pose clinical and medicolegal challenges, given the disparity between the number of symptomatic patients, and the low incidence of vestibular schwannoma as the underlying cause. We developed and validated a diagnostic model using a generalisation of neural networks, for detecting vestibular schwannomas from clinical and audiological data, and compared its performance with six previously published clinical and audiological decision‐support screening protocols. Design: Probabilistic complex data classification using a neural network generalization. Settings: Tertiary referral lateral skull base and a computational neuroscience unit. Participants: Clinical and audiometric details of 129 patients with, and as many age and sex‐matched patients without vestibular schwannomas, as determined with magnetic resonance imaging. Main outcome measures: The ability to diagnose a patient as having or not having vestibular schwannoma. Results: A Gaussian Process Ordinal Regression Classifier was trained and cross‐validated to classify cases as ‘with’ or ‘without’ vestibular schwannoma, and its diagnostic performance was assessed using receiver operator characteristic plots. It proved possible to pre‐select sensitivity and specificity, with an area under the curve of 0.8025. At 95% sensitivity, the trained system had a specificity of 56%, 30% better than audiological protocols with closest sensitivities. The sensitivities of previously‐published audiological protocols ranged between 82–97%, and their specificities ranged between 15–61%. Discussion: The Gaussian Process ORdinal Regression Classifier increased the flexibility and specificity of the screening process for vestibular schwannoma when applied to a sample of matched patients with and without this condition. If applied prospectively, it could reduce the number of ‘normal’ magnetic resonance (MR) scans by as much as 30% without reducing detection sensitivity. Performance can be further improed through incorporating additional data domains. Current findings need to be reproduced using a larger dataset.     

PI3K-Akt Signaling in the Basolateral Amygdala Facilitates Traumatic Stress Enhancements in Fear Memory

BackgroundA core symptom of posttraumatic stress disorder is persistent fear memory, which can be defined as fear memory that is resistant to updating, inhibition, or extinction. posttraumatic stress disorder emerges after traumatic stress exposure, but neurobiological mechanisms via which traumatic stress leads to persistent fear memory are not well defined. Akt signaling within the amygdala (Amy) is enhanced with traumatic stress, and phosphatidylinositol kinase 3 (PI3K) activation of Akt within the basolateral Amy (BLA) has been implicated as critical to fear memory formation. These findings raise the possibility that traumatic stress enhances PI3K→Akt signaling in the BLA, which leads to persistent fear memory.MethodsTo test this hypothesis, rats were exposed to traumatic stress using the single prolonged stress model, and changes in Akt phosphorylation were assayed in the Amy at 0 and 30 minutes after fear conditioning (FC). In a separate experiment, we inhibited PI3K→Akt signaling in the BLA prior to FC and observed the effect this had on acquisition, expression, and extinction of FC in stressed and control rats.ResultsEnhanced Akt phosphorylation in the Amy at both time points was observed in stressed rats, but not in control rats. PI3K→Akt inhibition in the BLA had no effect on freezing in control rats but decreased freezing during extinction training and testing in stressed rats.ConclusionThese findings suggest that PI3K→Akt signaling in the BLA could be a mechanism via which traumatic stress leads to fear memory that is resistant to extinction.