Privatization, Corporatization, and Public-Private Partnership in the Kingdom of Saudi Arabia

There are different governmental reasons and technologies for seeking public-private partnerships throughout the developed countries. Significant motives have been to improve efficiency and risk distribution in comparison to traditional financing techniques and to lessen budget and borrowing limits. In this study, the movement toward privatization enhancing the efficiency of MoH’s hospitals has been assessed using Data Envelopment Analysis (DEA) from 1979 to 2020. Moreover, the efficiencies of the individual hospital were estimated through the DEA model, which includes: scale efficiency (SE), pure technical efficiency (PTE), and overall technical efficiency (OTE). In addition, factor affecting such efficiencies was analyzed through Tobit regression. The VRS results suggest that the numbers of hospitals benefiting from the complete corporatized phase are greater than those benefiting from the last phase (and vice versa in the case of DRS). The variance between inefficient hospitals in the less corporatized phase (2000-2020) was more prominent than in the fully corporatized phase (1988-1999). In conclusion, fully corporatized hospitals (on average) achieve relatively better overall efficiency. It is recommended that additional corporatization might be stimulated by a standardized set of performance measures, which cover both the quality criteria and economic efficiency measurements from a healthcare perspective.

Wie schreibe ich eine gute Übersichtsarbeit?

Übersichtsarbeiten stellen einen wichtigen Teil medizinischer Literatur dar und ermöglichen dem Leser innerhalb kurzer Zeit einen umfassenden Überblick über ein bestimmtes Thema zu bekommen. In der Radiologie und der Nuklearmedizin haben Übersichtsarbeiten oft einen erzählenden/narrativen Charakter und somit ein hohes Maß an Subjektivität. Diese Subjektivität ist letztlich ausschlaggebend dafür, dass narrative Übersichtsarbeiten bei der Erstellung wissenschaftlicher Leitlinien nicht berücksichtigt werden.

Ziel dieser Arbeit ist es, die Kriterien für die Erstellung einer systematischen Übersichtsarbeit zu beleuchten und den Leser so bei der Erstellung einer systematischen und strukturierten Übersichtsarbeit zu unterstützen.

The changing role of gesture in linguistic development: a developmental trajectory and a cross-cultural comparison between British and Finnish children

We studied how gesture use changes with culture, age and increased spoken language competence. A picture-naming task was presented to British (N = 80) and Finnish (N = 41) typically developing children aged 2-5 years. British children were found to gesture more than Finnish children and, in both cultures, gesture production decreased after the age of two. Two-year-olds used more deictic than iconic gestures than older children, and gestured more before the onset of speech, rather than simultaneously or after speech. The British 3- and 5-year-olds gestured significantly more when naming praxic (manipulable) items than non-praxic items. Our results support the view that gesture serves a communicative and intrapersonal function, and the relative function may change with age. Speech and language therapists and psychologists observe the development of children's gestures and make predictions on the basis of their frequency and type. To prevent drawing erroneous conclusions about children's linguistic development, it is important to understand developmental and cultural variations in gesture use.

Defining survival for patients with breast cancer with brain metastases

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Background: Brain metastases account for 100,000 to 170,000 cases per year in the U.S, the bulk being from breast and lung primaries. About 10-15% of breast cancer patients develop brain metastases and historically, their survival has been poor. Introduction of novel chemotherapeutic and biologic agents and newer radiation techniques in the past decade has led to better control of systemic disease raising the possibility of increasing incidence of brain metastases as well as better control of CNS disease. The aim of this study was to determine the survival of breast cancer patients with brain metastases in our practice in the last 10 years.

Methods: This study was a retrospective chart analysis and we analyzed the charts of 18 patients with breast cancer who had developed brain metastases. The parameters analyzed included patient age at diagnosis of breast cancer and at development of brain metastases, receptor status and various treatment modalities used to control local as well as Metastatic disease.

Results: The median survival time after adjusting for age at diagnosis of breast cancer, age at diagnosis of brain metastases and the number of brain metastases was 55 months. The time to death was analyzed using Cox proportional hazard model, adjusting for age and number of brain metastases. Age at diagnosis of breast cancer was significant with a p-value of 0.007 and the number of brain metastases was not significant with a p-value of 0.55. Using the Log Rank test, median survival for Her2neu positive patients was 71 months and for Her2neu negative patients was 58 months with a non-significant p value of 0.86. Review of treatment modalities revealed that six patients underwent surgical removal of metastases and 12 patients received WBRT. Average number of systemic treatments used was 6.7 including chemotherapeutic, biological and hormonal agents.

Conclusions: In our practice, the overall survival of breast cancer patients with brain metastases was found to be 55 months after adjusting for age at diagnosis of breast cancer, age at diagnosis of brain metastases and number of brain metastases. Overall survival did not vary significantly with the number of brain metastases and Her2neu receptor status.

Dengue infection in patients presenting with neurological manifestations in a dengue endemic population

The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.

Estrogenic potency of chemicals detected in sewage treatment plant effluents as determined by in vivo assays with Japanese medaka (Oryzias latipes)

Gonadal intersex and high prevalences of the female phenotype have been observed in fish populations in urbanized areas. Environmental estrogens discharged in sewage treatment plant effluents may be responsible for feminization of fish but many compounds with the potential to induce these responses occur in effluents, including natural and synthetic estrogen hormones, degradation products of alkylphenol ethoxylate surfactants, and plasticizers. In this study, the estrogen hormones 17 alpha-ethinylestradiol, 17 beta-estradiol, estrone, and estriol induced intersex (i.e., testis-ova) and altered sex in Japanese medaka (Oryzias latipes) when these fish were exposed to nanogram per liter concentrations of test compounds from hatch to approximately 100 d after hatch. A mix of nonylphenol mono- and diethoxylate induced a weak response and a mix of nonylphenol mono- and diethoxycarboxylate did not give a response in this assay at microgram per liter concentrations, indicating that these degradation products of nonylphenol ethoxylates have little or no estrogenic activity in fish. Bisphenol A induced testis-ova in medaka exposed to a concentration of 10 micrograms/L, but diethylhexyl phthalate did not induce a response. Results with the medaka assay were consistent with estrogenic responses in the yeast estrogen screening assay. Analyses of monitoring data reported in the literature indicate that concentrations of estrogen hormones detected in the final effluents of sewage treatment plants are generally greater than the lowest-observed-effect levels for alterations to gonadal development in medaka.

Frequent detection of HIV-1 in the gastric aspirates of neonates born to HIV-infected mothers

OBJECTIVE

To evaluate the frequency and correlates of oral route exposure of infants born to HIV-1-infected women.

METHODS

A multicenter study was performed within the prospective French Perinatal Cohort Study of mother-to-child HIV transmission. Oropharyngeal and gastric aspirates from 122 neonates were studied by reverse transcriptase (RT) polymerase chain reaction (PCR) for the presence of HIV-1, as well as for standard microbiology (Gram staining and culture).

RESULTS

Aspirates from 101 neonates were analyzed by RT-PCR; 28% of these were positive for HIV RNA. Another 21 aspirates could not be tested because of PCR inhibition. The median concentration of HIV RNA in the positive aspirates was 126 copies/ml (range: 8-1270). Detection of HIV-1 in the aspirate was significantly related to high maternal plasma-viral load, presence of blood in the aspirate, positive Gram stain or culture, episiotomy or perineal lesions, and sexually transmitted infections during the pregnancy. Most of the mothers received zidovudine prophylaxis during pregnancy and delivery. Among the six infants who were infected with HIV, three had positive aspirates. Of the three assumed to have acquired the infection intrapartum, only one had an HIV RNA-positive aspirate.

CONCLUSION

Exposure of the fetus to HIV via the oral route occurs frequently, even in the presence of zidovudine prophylaxis, and is likely to be one of the mechanisms of intrapartum transmission, but not the only one.

Rubella susceptibility in Jamaican women, 1996

The 1995 rubella outbreak in Jamaica indicated a need to survey the susceptibility rate in Jamaican antenatal women at risk. In this 1996 study, 389 women in the reproductive age group were investigated for rubella antibodies. In the public sector urban group (A), rubella susceptibility was 20.2%, while in a private sector urban clinic (B) practising routine rubella surveillance and recommending postpartum immunization in seronegatives, the susceptibility rate was 13.8%. The latter rate was significantly lower than that in the rural group (C) (35.9%; p < 0.001). The overall susceptibility rate was 21.3%. Rubella susceptibility has improved overall in women of childbearing age compared with levels in the prevaccine year of 1968. A significant thrust in rubella prevention will still be required before the next rubella epidemic in order to reduce the risk of congenital rubella syndrome.

HIV-1 RNA detection in plasma for the diagnosis of infection in neonates. The French Pediatric HIV Infection Study Group

The objective of this study was to assess the frequency of detection of HIV-1 RNA in plasma of neonates born to HIV-1-seropositive mothers and to determine the diagnostic value of this method in the neonatal period. The study involved 96 infants among those enrolled in the French National Prospective Study. HIV-1 RNA was detected in the first 10 days of life by nucleic acid sequence-based amplification (NASBA) in 12 of 48 plasma samples of infected infants and in 39 of 39 of the second samples taken before the age of 3 months. On the same samples, peripheral blood mononuclear cell (PBMC) DNA polymerase chain reaction (PCR) or viral culture that had been routinely performed were found to be positive in 11 of 48 samples taken in the first 10 days of life and 39 of 39 second samples. For the noninfected infants, HIV-1 RNA was never detected in the 48 samples taken in the first 10 days of life and was detected in one of the 48 samples taken before the age of 3 months. HIV-1 RNA detection in plasma by NASBA has sensitivity and specificity equal to those of DNA PCR and culture on PBMC for the diagnosis of infection in infants with the clade B virus. This standardized method gives rapid results on a small volume of plasma and seems well suited for diagnosis on a large scale.

Stem cell factor binding to retrovirus primer binding site silencers

Using modified nuclear lysis and binding conditions, we have examined the binding of an embryonal carcinoma (EC) cell factor, binding factor A, to a stem cell-specific silencer which acts at the DNA level and overlaps the Moloney murine leukemia virus (M-MuLV) proline primer binding site (PBS). Following our protocol, we found that in vitro binding of factor A correlated with the in vivo activity of the M-MuLV silencer. Factor A bound specifically to the wild-type silencer element at room temperature and 30 degrees C, but not at 4 degrees C, and bound 10-fold better to the full-length silencer than to a minimal silencer core element. The factor was enriched in nuclear compared with cytosolic extracts and in undifferentiated EC cells compared with differentiated cells in which the silencer is nonfunctional. Salt and ion requirements for factor A binding were investigated, and partial purification steps indicated the factor to be a heparin-Sepharose-binding moiety of greater than 100 kDa. To examine possible relationships between silencer and PBS activities, sequences representing phenylalanine, isoleucine, lysine-1,2, lysine-3, methionine, and tryptophan PBS DNA fragments were tested in vivo for stem cell-specific repression of M-MuLV expression and in vitro in DNA binding assays. Of these PBS elements, only the lysine-1,2 PBS DNA fragment showed consistently high levels of repression. Interestingly, the lysine-1,2 PBS DNA fragment also formed a complex with an EC cell factor with characteristics similar to those of factor A. However, the two factors did not cross-compete in binding studies, suggesting that they may be different but related factors. Our results suggest that expression of Mason-Pfizer monkey virus, visna virus, and spumavirus, which use the lysine-1,2 PBS, may be inhibited in undifferentiated stem cells.

Heroin addiction and sex hormones in males

To investigate the effects of illicit heroin abuse on the endocrine system a study was carried out in North West Frontier Province (NWFP) where heroin addiction is prevalent. Sixty-eight subjects were included in this study. Thirty-three were untreated heroin addicts visiting "drug abuse treatment centres" in Peshawar and 35 age matched normal males. Urine samples of all addicts showed the presence of morphine. The serum concentrations of testosterone (T) in addicts was 228 ng/ml, leutinizing hormone (LH) 10.7 mlU/ml and folical stimulating hormone (FSH) 4.9 mlU/ml whereas the corresponding values for control males were T 630 ng/ml, LH 14.3 mlU/ml and FSH mlU/ml, respectively. Heroin exerts a depletion effect on T and FSH levels in more or less all the groups studied irrespective of age, amount of heroin intake per day and period of contact with heroin. LH levels remained affected and are within clinically accepted normal range.