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Introduction To provide a qualitative perspective on the changes that occurred after newly placed OB/GYNs began working at district hospitals in Ashanti, Ghana. Methods Structured interviews of healthcare professionals were conducted at eight district hospitals located throughout the Ashanti district of Ghana, four with and four without a full-time OB/GYN on staff. Individuals interviewed include: medical superintendents, medical officers, district hospital administrators, OB/GYNs (where applicable), and nurse-midwives. Interviews were transcribed verbatim and content analysis was performed to identify common themes. Characteristics quotes were identified to illustrate principal interview themes. Quotes were verified in context by researchers for accuracy. Results Interviews with providers revealed four areas most impacted by an OB/GYN’s leadership and expertise at district hospitals: patient referral patterns, obstetric protocol and training, facility management and organization, and hospital reputation. Discussion OB/GYNs are uniquely positioned to add clinical capacity and care quality to established maternal care teams at district hospitals–empowering district hospitals as reliable care centers throughout rural Ghana for women’s health. Coordinated efforts between government, donors and OBGYN training institutions to provide complete obstetric teams is the next step to achieve the global goal of eliminating preventable maternal mortality by 2030.

In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters. Other costing approaches use somewhat arbitrary allocations that provide little transparency into the actual clinical processes used to treat medical conditions. TDABC has been successfully applied in European and US health-care settings to facilitate process improvements and new reimbursement approaches, but it has not been used in resource-limited settings. We aimed to optimise TDABC for use in a resource-limited setting to provide accurate procedure and service costs, reliably predict financing needs, inform quality improvement initiatives, and maximise efficiency. A multidisciplinary team used TDABC to map clinical processes for obstetric care (vaginal and caesarean deliveries, from triage to post-partum discharge) and breast cancer care (diagnosis, chemotherapy, surgery, and support services, such as pharmacy, radiology, laboratory, and counselling) at Hôpital Universitaire de Mirebalais (HUM) in Haiti. The team estimated the direct costs of personnel, equipment, and facilities used in patient care based on the amount of time each of these resources was used. We calculated inpatient personnel costs by allocating provider costs per staffed bed, and assigned indirect costs (administration, facility maintenance and operations, education, procurement and warehouse, bloodbank, and morgue) to various subgroups of the patient population. This study was approved by the Partners in Health/Zanmi Lasante Research Committee. The direct cost of an uncomplicated vaginal delivery at HUM was US$62 and the direct cost of a caesarean delivery was US$249. The direct costs of breast cancer care (including diagnostics, chemotherapy, and mastectomy) totalled US$1393. A mastectomy, including post-anaesthesia recovery and inpatient stay, totalled US$282 in direct costs. Indirect costs comprised 26–38% of total costs, and salaries were the largest percentage of total costs (51–72%). Accurate costing of health services is vital for financial officers and funders. TDABC showed opportunities at HUM to optimise use of resources and reduce costs—for instance, by streamlining sterilisation procedures and redistributing certain tasks to improve teamwork. TDABC has also improved budget forecasting and informed financing decisions. HUM leadership recognised its value to improve health-care delivery and expand access in low-resource settings. Boston Children's Hospital, Harvard Business School, and Partners in Health.

INTRODUCTION Vervets are non‐human primates that share high genetic homology with humans and develop amyloid beta (Aβ) pathology with aging. We expand current knowledge by examining Aβ pathology, aging, cognition, and biomarker proteomics. METHODS Amyloid immunoreactivity in the frontal cortex and temporal cortex/hippocampal regions from archived vervet brain samples ranging from young adulthood to old age was quantified. We also obtained cognitive scores, plasma samples, and cerebrospinal fluid (CSF) samples in additional animals. Plasma and CSF proteins were quantified with platforms utilizing human antibodies. RESULTS We found age‐related increases in Aβ deposition in both brain regions. Bioinformatic analyses assessed associations between biomarkers and age, sex, cognition, and CSF Aβ levels, revealing changes in proteins related to immune‐related inflammation, metabolism, and cellular processes. DISCUSSION Vervets are an effective model of aging and early‐stage Alzheimer's disease, and we provide translational biomarker data that both align with previous results in humans and provide a basis for future investigations. Highlights We found changes in immune and metabolic plasma biomarkers associated with age and cognition. Cerebrospinal fluid (CSF) biomarkers revealed changes in cell signaling indicative of adaptative processes. TNFRSF19 (TROY) and Artemin co‐localize with Alzheimer's disease pathology. Vervets are a relevant model for translational studies of early‐stage Alzheimer's disease.

Almost every year, Institute for Healthcare Improvement president and CEO Donald Berwick, MD, gives a lecture about quality improvement to first-year medical school students at Harvard. Looking at healthcare with the tools of quality improvement is like putting on a new pair of eyeglasses. Indeed, the author is often struck by how accessible and commonsensical many of the processes that lead to better patient care really are. Years of psychological and behavioral research have proven that people are fallible. Research published in the New England Journal of Medicine suggests that implementation of the checklist can reduce inpatient complications and prevent deaths. Notably, the Surgical Safety Checklist is a one-page document with 19 steps -- an inexpensive intervention that is readily adoptable -- that has amazing potential to save lives. Meanwhile, getting intensive care patients out of bed and walking is another area that has been ripe for innovation.

The class, taught by dance instructor Gigi Tanghe, and fellow hip- hopper Nicole Shames, typically begins with a new dance routine or a quick review of the most recent dance routine. Recently, the class worked on a dance routine to the hit song Yeah! by Usher.

\"A lot of people are souping up their cars because it's a fad now,\" said Devin Ganesh, a senior at Atlantic Community High. The movie The Fast and the Furious and its sequel, 2 Fast 2 Furious, are the best expressions of the adrenaline rush and power behind these extreme cars.

\"The IB program, being an international program, has a world literature menu of works to use,\" said Senior English IB teacher Carolyn Timberlake. \"These novels are from almost any country in the world. The rule of choosing novels for world literature is that the work must be originally written in another language.\"

What made [Franz Liszt] a legend was the series of gimmicks that defined his performances: He played technically difficult and showy pieces, and orchestrated on piano. Every rock star has a gimmick; whether it is the mushroom haircuts of the Beatles or the guitar smashing of Pete Townshend.

The nights before my birthday were tough. I tossed and turned, dreading my birthday because it would mean I was 18, a legal adult, and in many respects ... old. But in a tiny corner of my head, a voice was excitedly counting down the seconds. After all, 18 means freedom.