Emerging evidence highlights the critical role of gut microbiota in childhood growth; however, the contribution of methanogenic archaea remains underexplored. In this study, we investigated the involvement of gut methanogens in linear growth impairment by analyzing their abundance, diversity, methanogenesis, and interactions with bacterial short-chain fatty acids (SCFAs) and glucagon-like peptide-1 (GLP-1) levels in stunted versus normal children. This case-control study included 42 children aged 24-59 months from Pidie, Aceh, Indonesia. Gut archaea were profiled through 16S rDNA amplicon sequencing, and mcrA gene expression was measured using quantitative Polymerase Chain Reaction. SCFAs were analyzed using gas chromatography-mass spectrometry, and GLP-1 levels were quantified using immunoassay. The microbial co-occurrence networks were also assessed. Archaeal 16S rDNA amplicon sequencing revealed a lower abundance of Methanobacteriaceae, particularly Methanobrevibacter, in stunted children, although their presence contributed to greater microbial diversity. Reduced mcrA gene expression in stunted children indicates a decrease in methanogenesis. Although not statistically significant, mcrA gene expression positively correlated with height, SCFA concentrations, and GLP-1 levels. Microbial network analysis revealed a lower density of microbial networks, indicating reduced stability and resilience in stunted children, with Methanobrevibacter playing a substantial role. Notably, Methanobrevibacter exhibited a positive association with Elusimicrobium, a rare human-associated microbe, and a negative correlation with Lachnospiraceae in normal children, indicating unique microbial interactions that may influence metabolic health. Methanogens, particularly Methanobrevibacter, may play a crucial role in shaping gut microbial ecology and supporting metabolic pathways relevant to linear growth during early childhood.
This study measured experiences of parenting stress and stressful life events in caregivers of families with a toddler who has either an autistic or non-autistic older sibling(s). Caregivers of toddlers (12-18 months old) with older autistic siblings (Sibs-autism; n = 58) and toddlers with older non-autistic siblings (Sibs-NA; n = 46) completed questionnaires assessing stress related to parenting their toddler and their exposure to stressful life events since their toddler's birth. We compared levels of parenting stress and stressful life events between caregivers of Sibs-autism and Sibs-NA and examined the association between these measures. Caregivers of Sibs-autism reported significantly higher levels of parenting stress and stressful life events relative to caregivers of Sibs-NA, with small to moderate effects. Parenting stress and stressful life events were moderately correlated. Across these groups of caregivers, parenting stress and stressful life events appear to be related, but partially distinct aspects of caregiver stress. These findings highlight the importance of assessing multiple aspects of stress to better understand how stress may influence both caregiver wellbeing and the development of children with autistic siblings. In this study, we compared the stress levels of caregivers who care for toddlers with older siblings diagnosed with autism to the stress levels of parents/guardians of toddlers with older siblings who are not diagnosed with autism. We assessed perceived parenting‐related stress and obtained reports on the number of stressful life events the parents/guardians had experienced since the toddlers in the study were born. We found that parents/guardians of toddlers with older autistic siblings reported higher levels of parenting stress and more stressful life events relative to parents of toddlers without older autistic siblings. Future work should study how to best support parents/guardians who are experiencing high levels of stress.
The 1974 discovery of Lucy in Ethiopia marked a watershed moment in paleoanthropology. While the scientific community classifies Lucy as an extinct early hominin species that predates Homo sapiens by millions of years, in Ethiopia, she has been embraced as a national matriarch-the first human and mother of humanity. This commentary analyzes how government campaigns and media coverage actively promote a humanized, scientifically inaccurate identity for Lucy. By framing her as "one of us," these narratives sacrifice scientific facts for emotional resonance and commercial appeal. This popular mischaracterization creates significant obstacles for public science education and undermines scientific literacy, raising ethical questions about the role of the state and media in science communication. Ultimately, the article advocates for a balanced approach that celebrates Lucy's immense cultural and national importance without compromising the scientific integrity of human evolutionary science.
Lucy is a NASA Discovery-class mission to send a highly capable and robust spacecraft to investigate primitive bodies near both the L4 and L5 Lagrange points with Jupiter; the Jupiter Trojan asteroids. This heretofore unexplored population of planetesimals from the outer planetary system holds vital clues to deciphering the history of the Solar System. Due to an unusual and fortuitous orbital configuration, Lucy will perform a comprehensive investigation that visits eight Trojans, including all the recognized taxonomic classes, a collisional family member and a near equal-mass binary. It will visit objects with diameters ranging from roughly 1 to 100 km. In particular, Lucy will perform flybys of (3548) Eurybates and its satellite Queta (L4, C-type), (15094) Polymele and its currently unnamed satellite (L4, P-type), (11351) Leucus (L4, D-type), (21900) Orus (L4, D-type), and the (617) Patroclus-Menoetius binary (L5, P-types). This diverse array of targets will supply invaluable constraints on the formation and early dynamical evolution of the giant planets. In addition, Lucy will visit two main-belt asteroids, (152830) Dinkinesh and (52246) Donaldjohanson, in order to practice its encounters. Lucy's payload suite consists of a color camera and infrared imaging spectrometer, a high resolution panchromatic imager, and a thermal infrared spectrometer. Additionally, two spacecraft subsystems will also contribute to the science investigations: the terminal tracking cameras will supplement imaging during closest approach and the telecommunication subsystem will be used to measure the mass of the Trojans. Lucy launched on October 16, 2021 and will have encounters with the Trojans from August 2027 until March 2033.
The rates of forceps-assisted vaginal deliveries in the management of the second stage of labor are decreasing. This decline is mirrored by fewer learning opportunities for resident trainees in obstetrics. Previous studies have demonstrated an increase in the skill and confidence of trainees in performing forceps-assisted vaginal delivery with simulation. The optimum timing and frequency of simulation sessions to improve skill retention are currently unknown. This study aimed to test the effects of clustered vs spaced training sessions to teach trainees forceps-assisted vaginal delivery to determine whether spaced training sessions would lead to superior retention of skill. A commercially available pelvic trainer (Lucy's Mum; MODEL-med International, Cheltenham, Australia) was used, and Objective Structured Assessment of Technical Skills scores were measured at >1 month after the intervention. This was a randomized controlled trial of clustered vs spaced forceps-assisted vaginal delivery simulation sessions. This study included 35 participants, giving 80% power to detect a difference in the Objective Structured Assessment of Technical Skills score of 6. Trainees and obstetrical providers who did not independently perform forceps-assisted vaginal delivery were randomized in blocks to a single learning session (clustered: 30 minutes of hands-on teaching with a model [n=17]) or 3 individual learning sessions (spaced: 10 minutes each [n=18]) spaced 1 week apart. Participants completed an online module introducing forceps-assisted vaginal delivery and completed skillset questionnaires before and after the simulation. A chest-mounted GoPro camera (GoPro, Inc, San Mateo, CA) was used to capture the first-person point-of-view technique to blind expert adjudicators to the participants' identities. Blinded footage was used to grade the average Objective Structured Assessment of Technical Skills scores. Both clustered and spaced simulation training led to improved forceps-assisted vaginal delivery Objective Structured Assessment of Technical Skills scores after the intervention (+4.8 vs +5.9, respectively, from baseline). However, the median change was not different between randomization groups (Wilcoxon rank-sum test, P=.78). Both simulation groups had higher confidence to apply forceps, perform safety checks, and independently/safely perform forceps-assisted vaginal delivery (t test, P<.05). This study described the novel use of a point-of-care video and simulator application to improve forceps-assisted vaginal delivery simulation training. Objective Structured Assessment of Technical Skills scores and provider self-assessment of training improved, regardless of clustered vs spaced simulation sessions. El resumen está disponible en Español al final del artículo.
Candidemia, a bloodstream infection caused by Candida spp., is a common cause of health care-associated bloodstream infections in the United States. Candidemia is associated with substantial health care costs, morbidity, and mortality. 2017-2021. CDC's Emerging Infections Program (EIP), a collaboration among CDC, state health departments, and academic partners, was used to conduct active, population-based laboratory surveillance for candidemia at city or county sites located in 10 states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee), representing a combined population of approximately 21.5 million persons, or 7% of the U.S. population in 2019. Connecticut began reporting cases on January 1, 2019, and conducts statewide surveillance. Although candidemia is not a nationally notifiable condition, cases of Candida auris infection are nationally notifiable, and cases of candidemia caused by C. auris could be included in both national case counts and EIP surveillance. A culture-confirmed candidemia case is defined as a positive blood culture for any Candida sp. from a resident in the surveillance catchment area. Subsequent positive blood cultures for Candida within 30 days of the initial positive culture (index date) in the same patient are considered part of the same case. Clinical laboratories serving each catchment area report candidemia cases, and trained surveillance officers abstract information from medical charts for all cases. Corresponding isolates are sent to CDC for species confirmation and antifungal susceptibility testing. A total of 7,381 candidemia cases were identified during the surveillance period (2017-2021). The overall incidence was 7.4 cases per 100,000 population. Across age groups, sexes, racial and ethnic groups, and surveillance sites, incidence was generally stable or increased slightly from 2017 to 2021, with the lowest overall incidence in 2019 (6.8) and the highest in 2021 (7.9). In 2021, candidemia incidence was highest in patients aged ≥65 years (22.7) and infants (aged <1 year) (8.0). Incidence was higher in males (8.7) compared with females (7.0) and higher in non-Hispanic Black or African American (Black) patients (12.8) compared with non-Black patients (5.6). Incidence was highest in Maryland (14.5), followed by Tennessee (10.1) and Georgia (10.0); incidence was lowest in Oregon (4.8). Increases occurred in the percentage of cases classified as health care onset (52.2% in 2017 to 58.0% in 2021). Overall, among 7,381 cases (in 6,235 patients), 63.7% occurred in patients who had a central venous catheter, 80.7% involved recent systemic antibiotic receipt, and 9.0% occurred in patients who had a history of injection drug use. The percentage of cases with a positive SARS-CoV-2 test during the 90 days before or after the index date increased from 10.4% in 2020 to 17.7% in 2021. From 2017 to 2021, the percentage of cases involving an intensive care unit stay before the index date increased from 38.3% to 44.9%. Echinocandins (e.g., micafungin) were used as treatment in 49.8% of cases, and azoles were used in 47.7%. The all-cause in-hospital mortality rate was 32.6%; this increased from 26.8% in 2019 to 36.1% in 2021. Overall, Candida albicans accounted for 37.1% of cases, followed by Candida glabrata (30.4%) and Candida parapsilosis (13.5%); however, C. glabrata was the most frequent species in California (38.4%) and Maryland (32.9%). Candida auris infections accounted for 0.4% of cases. Among 6,576 Candida isolates for which interpretive breakpoints exist and isolates were available for testing, 5.6% were fluconazole resistant, and <1% were echinocandin resistant. Antifungal resistance was stable for all antifungals tested across years. Candidemia remains an important health care-associated infection. The disproportionate incidence among older adults, males, and Black patients is consistent with previous reports, and the overall incidence of candidemia has not changed substantially compared with previous EIP findings based on data collected during 2012-2016 (8.7 per 100,000 population). The higher mortality rate associated with candidemia during 2020-2021 likely reflects consequences of the COVID-19 pandemic, including strained health care systems and an increased population of patients who were susceptible to candidemia because of COVID-19-related critical illness. Strict implementation of measures to prevent health care-associated bloodstream infections is important to help prevent candidemia cases. Health care officials and providers should be vigilant for candidemia as a complication of critical illness. Continued surveillance is needed to monitor for emerging populations at risk for candidemia and changes in antifungal resistance patterns, which can help guide antifungal treatment selection.
The legacy of J. Marion Sims as the "father of gynecology" has become widely controversial among medical professionals and lay public because of ethical concerns surrounding the development of his surgical techniques and his exploitation of enslaved women for his experiments. Notably, in April 2018, the City of New York relocated a commemorative statue of Sims from Central Park following an art commission's investigation of his controversial practices. The relocation was viewed by many as a public acknowledgement of the contributions of Anarcha, Betsey, Lucy, and the other enslaved women to the advancement of gynecologic surgery. However, despite the increased public awareness of the women's sacrifices in recent years medical literature has not kept pace. We compared the portrayal of Sims and these enslaved women within current gynecology textbooks, prior editions, and historical medical literature. We found that gynecologic textbooks more often mention J. Marion Sims by name (74%) compared to the enslaved women he experimented on (24%). Neither current gynecologic surgery textbooks nor primary historical sources contain significant references to these women, meaning much of their story has been lost to history. While there has been increased public knowledge of the sacrifices of Anarcha, Betsey, and Lucy and other enslaved women, lay recognition is not enough. Full acknowledgment of their contributions necessitates crediting their roles in Sims' experiments and stating their names in medical literature.
Nonketotic hyperglycinemia due to deficient glycine cleavage enzyme activity causes a severe neonatal epileptic encephalopathy. Current therapies based on mitigating glycine excess have only limited impact. An animal model with postnatal phenotyping is needed to explore new therapeutic approaches. We developed a Gldc p.Ala394Val mutant model and bred it to congenic status in 2 colonies on C57Bl/6J (B6) and J129X1/SvJ (J129) backgrounds. Mutant mice had reduced P-protein and enzyme activity indicating a hypomorphic mutant. Glycine levels were increased in blood and brain regions, exacerbated by dietary glycine, with higher levels in female than male J129 mice. Birth defects were more prevalent in mutant B6 than J129 mice, and hydrocephalus was more frequent in B6 (40%) compared to J129 (none). The hydrocephalus rate was increased by postnatal glycine challenge in B6 mice, more so when delivered from the first neonatal week than from the fourth. Mutant mice had reduced weight gain following weaning until the eighth postnatal week, which was exacerbated by glycine loading. The electrographic spike rate was increased in mutant mice following glycine loading, but no seizures were observed. The alpha/delta band intensity ratio was decreased in the left cortex in female J129 mice, which were less active in an open field test and explored less in a Y-maze, suggesting an encephalopathic effect. Mutant mice showed no evidence of memory dysfunction. This partial recapitulation of human symptoms and biochemistry will facilitate the evaluation of new therapeutic approaches with an early postnatal time window likely most effective. A mouse model of nonketotic hyperglycinemia is described that shows postnatal abnormalities in glycine levels, neural tube defects, body weight, electroencephalographic recordings, and in activity in young mice making it amenable for the evaluation of novel treatment interventions. Study concept and design: JVH, MHM, NB, KNMAnimal study data: MAS, HJ, NB, MHM, JC, CBBiochemical and genetic studies: MAS, RAVH, MWFStatistical analysis: NB, JVHFirst draft writing: JVH, NB, MHMCritical rewriting: MAS, NB, MHM, TAB, JC, MWF, KNM, JVHFinal responsibility, guarantor, and communicating author: JVH. The University of Colorado (JVH, MS, KNM, HJ) has the intention to file Intellectual property protection for certain biochemical treatments of NKH. Otherwise, the authors have stated that they had no interests that might be perceived as posing a conflict or bias to this subject matter. Financial support is acknowledged form the NKH Crusaders, Brodyn's Friends, Nora Jane Almany Foundation, the Dickens Family Foundation, the Lucas John Foundation, Les Petits Bourdons, Joseph's Fund, the Barnett Family, Maud & Vic Foundation, Lucy's BEElievers fund, Hope for NKH, Madi's Mission NKH fund, and from Dr. and Ms. Shaw, and the University of Colorado Foundation NKH research fund. The study was supported by a grant (CNS-X-19-103) from the University of Colorado School of Medicine and the Colorado Clinical Translational Science Institute, which is supported by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535. Contents are the authors' sole responsibility and do not necessarily represent official NIH views. All funding sources had no role in the design or execution of the study, the interpretation of data, or the writing of the study. Mouse studies were carried out with approval from the Institutional Animal Care and Use Committee of the University of Colorado Anschutz Medical Campus (IACUC# 00413). The data that support the findings of this study are available from the corresponding author upon reasonable request.
Fifty years after her discovery, the 3.2-million-year-old fossil still reigns as mother of us all. But she now has rivals.
The avowed atheist, evolutionary naturalist and mathematician William Kingdon Clifford is often remembered for his essay, "The Ethics of Belief," in which he opposed organized religion in any form. As a mathematician, Clifford was an early advocate of non-Euclidean geometry in England. Combining William Rowan Hamilton's work on quaternions with Hermann Grassmann's theory of linear extension, he invented an original system of geometric algebra. Breaking with conservative traditionalism in his philosophical and mathematical work, Clifford's marriage to the children's writer, novelist, and dramatist Lucy Lane was a relatively conventional, if brief, Victorian marriage. After his untimely death from consumption in 1879, Lucy outlived her husband by fifty years. Raising their two daughters and supporting herself after his passing, Lucy refashioned Clifford's posthumous reputation to temper his philosophical radicalism. Her collaboration with Clifford's publisher and editor reveal Lucy's concern that Clifford not be remembered as someone ruled by passion in his mathematical work. Her efforts to expunge writings suggestive of William's weakness, excitability, or inconstancy from the public record demonstrates her desire to craft an image of her husband in alignment with gendered expectations of masculinity. This paper argues that Lucy fashioning of William's memory conformed, rather than departed from, normative parameters of gender as defined by Victorian society.
Gut microbiota is pivotal in maintaining children's health and well-being. The ingestion of enteric pathogens and dysbiosis lead to Environmental Enteric Dysfunction (EED), which is essential in stunting pathogenesis. The roles of gut microbiome and enteric infections have not been explored comprehensively in relation to childhood stunting in Indonesia. This study aimed to determine the correlation between gut microbiota composition, enteric infections, and growth biomarker, Insulin-like Growth Factor 1 (IGF-1), in stunted children from Pidie, Aceh, Indonesia. This study was a case-control study involving 42 subjects aged 24 to 59 months, comprising 21 stunted children for the case and 21 normal children for the control group. The IGF-1 serum level was quantified using ELISA. The gut microbiome profiling was conducted using 16S rDNA amplicon sequencing. The expression of enteric pathogens virulence genes was determined using quantitative PCR (qPCR) assay. The correlations of observed variables were analysed using suitable statistical analyses. The result showed that the IGF-1 sera levels in stunted were lower than those in normal children (p ≤ 0.001). The abundance of Firmicutes (50%) was higher than Bacteroidetes (34%) in stunted children. The gut microbiome profile of stunted children showed enriched genera such as Blautia, Dorea, Collinsella, Streptococcus, Clostridium sensu stricto 13, Asteroleplasma and Anaerostipes. Meanwhile the depleted genera comprised Prevotella, Lactococcus, Butyrivibrio, Muribaculaceae, Alloprevotella, Akkermansia, Enterococcus, Terrisporobacter and Turicibacter. The abundance of water biological contaminants such as Aeromonas, Stappiaceae, and Synechococcus was also higher in stunted children compared to normal children. The virulence genes expression of Enteroaggregative Escherichia coli (aaiC), Enterotoxigenic E. coli (estA), Enteropathogenic E. coli (eaeA), Shigella/Enteroinvasive E. coli (ipaH3) and Salmonella enterica (ompC) in stunted was higher than in normal children (p ≤ 0.001), which negatively correlated to height and level of IGF-1. The present study showed the distinctive gut microbiome profile of stunted and normal children from Pidie, Aceh, Indonesia. The gut microbiota of stunted children revealed dysbiosis, comprised several pro-inflammatory, metabolic abnormalities and high-fat/low-fiber diet-related taxa, and expressed virulence genes of enteric pathogens. These findings provide evidence that it is imperative to restore dysbiosis and preserve the balance of gut microbiota to support linear growth in children.
Background: The packaging and marketing of nicotine gums, lozenges, and pouches can influence users' perceptions about which products are evidence-based for tobacco cessation and which are designed for nicotine maintenance-which could keep people nicotine dependent. Lucy, a company that produces flavored nicotine gums, lozenges, and pouches, could cause confusion by mimicking the packaging of traditional chewing gum and using similar marketing for its approved smoking cessation products and non-approved products. Methods: This commentary describes Lucy's marketing practices that could prolong nicotine dependence rather than aid cessation. Results: Lucy's marketing as "FDA approved for smoking cessation" (true for the lozenges but not the gum or pouches) and "PMTA [Premarket Tobacco Product Application] accepted" could create a false narrative of regulatory acceptance. Its scientific conference presentations could imply that it is endorsed by the scientific community. Its colorful pack design, emphasizing flavors and minimizing nicotine warnings, may attract youth and non-nicotine-users to initiate nicotine use. Conclusion: Lucy's promotion of its products as safe alternatives to other forms of tobacco, its packaging that recalls innocuous chewing gum, and its use of social media to advertise its products should be explored by researchers and considered by policymakers for potential population-level health effects.
The female bony pelvis has to fulfil opposing functions: it has to be sufficiently closed to support the pelvic viscera in the upright position, while remaining sufficiently open to allow vaginal delivery. We aim to give an evolutionary perspective and the possible evolution of the bony pelvis from Lucy to the modern female with the implications in terms of genital prolapse. Thirteen pelvimetric measurements were performed on 178 bony pelves: 1 fossil pelvis from Australopithecus Lucy, 128 female Caucasian modern adult pelves and 49 female Catarrhine pelves (29 gorillas and 20 chimpanzees). Lucy's pelvis shape was the most transversely oval, short and broad, termed platypelloid. Modern female pelves were transversely oval only at the inlet. A protruding ischial spine, fairly small ischial tuberosities and a sacral concavity made Lucy closer to Homo sapiens and less like the great apes. In the last group, pelvic planes were anteroposteriorly oval, except in the gorilla, where the outlet was round or slightly transversely oval. The subpubic angle was narrowest in Lucy, whereas it was greater than 90° in the great apes. The female pelvis is involved in both visceral support and parturition and represents a compromise. The narrower pelvis of Australopithecus Lucy provided protection against genital prolapse, but resulted in complex obstetrical mechanics. From an evolutionary perspective, the pelvis of Homo sapiens became modified to make parturition easier, but increased the risk of genital prolapse: the ilia became wide open laterally and the sacrum broadened with a shorter distance between the sacroiliac and coxofemoral joints.
暂无摘要（点击查看详情）
After a short introduction of the meeting by the President 2015, Wilco Peul, the opening lecture was delivered by Bart Koes, who dealt with Health Technology Assessment and Guidelines. Then, it was the turn of Carmen Vleggert to show whether there was any Evidence for the Use of Implants in Spinal Stenosis. The final presentation of this session was delivered by Björn Strömqvist who dealt with Surgery for Lumbar Disc Herniation, patients' selection and outcomes. Developing the subject of "Do Not's", Jeremy Fairbank described the UK experience for Low Back Pain. Yves Coppens then took over and further elaborated on "Lucy's legacy". Prof. Coppens recalled that Lucy is a partial skeleton of a pre-human found in Ethiopia among other remains. Prof. Alan Crockard offered what he called "a whimsical view" of his practice of Craniocervical Surgery. Wafa Skalli was asked to speak about Finite Element Analysis of the Spine and Arts et Métiers Paris Tech where there is a long tradition of close collaboration between engineers and clinicians. Rune Hedlund, who will serve as 2016 Symposium President, further elaborated on Scoliosis with a focus on Unsolved Issues in Adolescent Idiopathic Scoliosis Treatment.
Man, rabbit, guinea-pig erythrocytes treated "in vitro" with high doses of cholecalcipherol or alpha-tocopherol release K+ and haemoglobin and show ultrastructural damages. These damages consist in a change of the red cells profile as well as in the desappearance of the glycocalix, in alterations of the membrane and of the cortical cytoplasm structure. These ultrastructural alterations are of a different degree, depending on the animal species; they partly resemble the erythrocyte changes induced by retinol. Our results are in partial agreement with the Dingle and Lucy's hypothesis on the common action of liposoluble vitamines on the erythrocyte membrane.
This article argues that the novel Disgrace points toward a politics of illegiblity and opacity that aligns more readily with anti-identitarian queer theory instead of rights- and recognition-based human rights discourses. Through an extended consideration of the relation between national allegory, history, and legibility, I argue that the novel sustains two interpretations of the category of lesbian-first, the national allegorical reading that erases her rights of lesbian desire in the transmission of racialized and sexual historical debts and second, Lucy's refusal of legibility as a lesbian in the national narrative and legal structures.
暂无摘要（点击查看详情）
Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to influence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual&s acceptance and use of ICTs: usefulness and ease of use. Recommendations are made with regard to how ICTs can be used more effectively to improve health systems at fi ve rural healthcare centres where questionnaire and interview data were collected: St. Lucy&s Hospital, Nessie Knight Hospital, the Tsilitwa Clinic, the Madzikane Ka-Zulu Memorial Hospital and the Nelson Mandela General Hospital.
暂无摘要（点击查看详情）