A qualitative assessment of the referral system at district level in Zimbabwe: implications on efficiency and effective delivery of health services

This exploratory study describes the nature and magnitude of the problem of health referrals, health-seeking behavior, perceptions, and knowledge at the district level in Zimbabwe. Data were obtained from focus groups with 159 persons in Tsholotsho and 132 persons in Murewa; from discussions with health personnel from the 6 health centers in Murewa and the 2 rural hospitals in Tsholotsho; and from records among a systematic sample of 400 new outpatients during October 1993 and March 1994 in Murewa district. Findings indicate that 71.8% in outpatient departments at Murewa Hospital had no access to a health center. 24.3% by-passed the health center for treatment at the hospital. 3.8% were referred by health centers. The absolute number of referrals did not change during 1991-93. However, the number directly accessing services from outside the district rose. Focus group participants reported their intention to use the nearest clinic for an illness. In Tsholotsho, people initially used the village community worker/headman. If illness was perceived as serious, patients would go to a hospital. For minor illness, people used traditional herbal remedies. If illness did not change after remedies, the clinic was consulted. Some illnesses were perceived as outside the realm of medicine. Most distinguished between a health center and a hospital, but were unaware of the important, superior functions of the health center. Most did not understand the logic behind the referral system, but appreciated referrals and not the cost of hospital treatment or transportation. The community was unaware of Ward Health Teams. Many did not understand the new fee policy introduced in 1994.     

Microencapsulation of sulfur by calcium alginate

The sulfur blooms on surface of rubber compounds cause loss of the needed tack for formation of multiply articles like tires. Although insoluble sulfur can be used to mitigate this problem, it is expensive to manufacture with a complex and hazardous process. This work examines an alternative approach that involves microencapsulation of soluble sulfur in alginate-based matrix. The formulations and procedures are developed and evaluated. Alginate crosslinking time, controlled temperature change (e.g., from 10 to 36°C), and the drying method were found to be critical to achieving high encapsulation efficiencies. The higher temperature (36°C) helped with the mass transfer limited removal of CS₂ used for dissolving sulfur, and treatment of crosslinked beads with oil prior to air-drying improved sulfur encapsulation. Formulated beads had higher than 65% sulfur content (>80%, oil-free basis) with almost 90% of the beads being <150 μm. The process parameters can be adjusted to make even smaller beads.     

A model for transport of hydrogen sulfide in oil- and water-saturated porous media

In several oilfields, reservoir souring by generation of hydrogen sulfide (H₂S) occurs in secondary recovery during which seawater is injected into originally sweet reservoirs. At the production site, high concentrations of H₂S can cause severe damage to both equipment and human personnel. Proper modeling of H₂S concentration in produced fluids can be useful for decision-making during field development design. We present a model for the transport of H₂S in an oil- and water-saturated, water-wet porous medium. The different retardation mechanisms for the H₂S are described. For the adsorption of H₂S to rock, we include two distinct phases of adsorption. In addition, we introduce a functional relationship between adsorption capacity and permeability. As H₂S mixes with oil, fractions become immobile as part of the residual oil.     

Evaluation of cooking energy cost,efficiency, impact on air pollution and policy in Nigeria

This study evaluated the cooking energy costs and efficiencies, the air pollution impacts of cooking energy consumption and the impact of the energy policy in the cooking energy sector in Nigeria. Water boiling and cooking experiments using the common cooking energy sources (fuel wood, kerosene, liquefied petroleum gas (LPG) and electricity) and common food items (water, yam and beans) were carried out. Energy surveys were carried out to determine the cooking energy use patterns in the urban and rural areas. It was found that fuel wood is the least expensive cooking energy source and LPG is the most expensive. Energy use efficiencies for boiling water were estimated at 25%, 46%, 73%, 79%, 66% and 90% for fuel wood, kerosene, gas, electric immersion coil, electric heating coil and electric hot plate, respectively. Energy intensity was found to be a comparative measure of energy efficiency. The impacts of air pollution from household cooking suggested a possibility of significant air pollutants contribution to the ambient environment using any of the energy carriers considered except electricity. The cooking energy use patterns showed that fuel wood is the predominant energy source for cooking in the rural areas while kerosene is the predominant energy source in the urban areas, revealing that the energy policy in the country had made no impact in the cooking energy sector. Recommendations for improving the energy supply situation were given and for removing the barriers that prevent the implementation of the recommendations.     

Cholesteryl Ester Transfer Protein Impairs Triglyceride Clearance via Androgen Receptor in Male Mice

Elevated postprandial triacylglycerols (TAG) are an important risk factor for cardiovascular disease. Men have higher plasma TAG and impaired TAG clearance compared to women, which may contribute to sex differences in risk of cardiovascular disease. Understanding mechanisms of sex differences in TAG metabolism may yield novel therapeutic targets to prevent cardiovascular disease. Cholesteryl ester transfer protein (CETP) is a lipid shuttling protein known for its effects on high-density lipoprotein (HDL) cholesterol levels. Although mice lack CETP, we previously demonstrated that transgenic CETP expression in female mice alters TAG metabolism. The impact of CETP on TAG metabolism in males, however, is not well understood. Here, we demonstrate that CETP expression increases plasma TAG in males, especially in very-low density lipoprotein (VLDL), by impairing postprandial plasma TAG clearance compared to wild-type (WT) males. Gonadal hormones were required for CETP to impair TAG clearance, suggesting a role for sex hormones for this effect. Testosterone replacement in the setting of gonadectomy was sufficient to restore the effect of CETP on TAG. Lastly, liver androgen receptor (AR) was required for CETP to increase plasma TAG. Thus, expression of CETP in males raises plasma TAG by impairing TAG clearance via testosterone signaling to AR. Further understanding of how CETP and androgen signaling impair TAG clearance may lead to novel approaches to reduce TAG and mitigate risk of cardiovascular disease.