Abstract
If overcrowding harms health care quality, the impacts of encouraging more people to use services are not obvious. Impacts will depend on whether marginal entrants benefit and whether they ...benefit enough to offset the congestion externalities imposed on inframarginal users. We develop a general-equilibrium model that formalizes these ideas. We examine them empirically by studying JSY, a program in India that paid women to give birth in medical facilities. We find evidence that JSY increased perinatal mortality in areas with low health-system capacity, was particularly harmful in more-complex births, reduced the quality of facilities' postnatal care, and generated harmful spillovers onto other services.
The unavoidable and detrimental formation of silica scale in engineered processes necessitates the urgent development of effective, economic, and sustainable strategies for dissolved silica removal ...from water. Herein, we demonstrate a rapid, chemical-free, and selective silica removal method using electrosorption. Specifically, we confirm the feasibility of exploiting local pH dynamics at the electrodes in flow-through electrosorption, achieved through a counterintuitive cell configuration design, to induce ionization and concomitant electrosorption of dissolved silica. In addition, to improve the feasibility of silica electrosorption under high-salinity solutions, we developed a silica-selective anode by functionalizing porous activated carbon cloths with aluminum hydroxide nanoparticles (Al(OH)3–p–ACC). The modification markedly enhances silica sorption capacity (2.8 vs 1.1 mgsilica ganode –1) and reduces the specific energy consumption (13.3 vs 19.8 kWh kgsilica –1). Notably, the modified electrode retains remarkable silica sorption capacity even in the presence of high concentrations of co-occurring ions (up to 100 mM NaCl). The mechanisms underlying the superior silica removal stability and selectivity with the Al(OH)3–p–ACC electrode are also elucidated, revealing a synergistic interaction involving outer-sphere and inner-sphere complexation between dissolved silica and Al(OH)3 nanoparticles on the electrodes. Moreover, we find that effective regeneration of the electrodes may be achieved by applying a reverse potential during discharge, although complete regeneration of the modified electrodes may necessitate alternative materials or process optimization. We recommend the adoption of feedwater-specific designs for the development of future silica-selective electrodes in electrosorption capable of meeting silica removal demands across a wide range of engineered systems.
This paper studies the relationship between group size and informal risk sharing. It shows that under limited commitment with coalitional deviations, this relationship is theoretically ambiguous. It ...investigates this question empirically using data on sibship size of household heads and spouses from rural Malawi, exploiting a social norm among the main sample ethnic group to define the potential risk-sharing group. We uncover evidence of worse risk sharing of crop losses in larger potential risk-sharing groups, and rule out alternative explanations for the findings. A simple calibration exercise indicates that our empirical findings are consistent with the theory.
Synergies between surfactants and proteins are found everywhere in everyday life. Beneficial interactions are exploited in fields such as food processing, pharmaceutical production, and laundry, ...leading to better products and lower energy consumption. Nevertheless, there is still room for improvement regarding sustainability. Here, biosurfactants (BS) are an attractive alternative to petrochemical surfactants. Insights into BS-protein interactions can help replacing traditional surfactants with BS and uncover new opportunities. Here, we review recent work on proteins' interactions with BS, with focus on the self-assembly of protein:BS complexes and BS’ effects on enzymatic activity. Generally, interactions are milder than those with traditional ionic surfactants, leading to modest effects on protein structure and self-assembly, while enzymatic inhibition is generally observed above BS' critical micelle concentration. Mild interactions between proteins and BS show promise in forming functional complexes with proteins, however, further studies are required to understand and minimize the detrimental effects that do occur.
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Recent studies suggested a link between diversity of beta tubulin isotypes in microtubule structures and the regulatory roles that they play not only on microtubules' intrinsic dynamic, but also on ...the translocation characteristics of some of the molecular motors along microtubules. Remarkably, unlike porcine brain microtubules, MCF7 microtubules are structured from a different beta tubulin distribution. These types of cancer microtubules show a relatively stable and slow dynamic. In addition, the translocation parameters of some molecular motors are distinctly different along MCF7 as compared to those parameters on brain microtubules. It is known that the diversity of beta tubulin isotypes differ predominantly in the specifications and the electric charge of their carboxy-terminal tails. A key question is to identify whether the negative electrostatic charge of tubulin isotypes and, consequently, microtubules, can potentially be considered as one of the sources of functional differences in MCF7 vs. brain microtubules.
We tested this possibility experimentally by monitoring the electro-orientation of these two types of microtubules inside a uniform electric field. Through this evaluation, we quantified and compared the average normalized polarization coefficient of MCF7 vs. Porcine brain microtubules. The higher value obtained for the polarization of MCF7 microtubules, which is associated to the higher negative charge of these types of microtubules, is significant as it can further explain the slow intrinsic dynamic that has been recently reported for single MCF7 microtubules in vitro. Furthermore, it can be potentially considered as a factor that can directly impact the translocation parameters of some molecular motors along MCF7 microtubules, by altering the mutual electrostatic interactions between microtubules and molecular motors.
•The normalized polarization coefficient of MCF7 is higher than porcine brain microtubules.•The difference in electrostatic charge can play a crucial role in the slow dynamic of MCF7 vs. brain microtubules.•The difference in electrostatic charge can cause different interactions between some molecular motors on MCF7 vs. brain microtubules.
Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen ...Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a "fuzzy" regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally underutilized preventive services—with measurable health gains.
Community-based group interventions are a cost-effective way of delivering programs in low-income settings. Design features may influence behaviors beyond those targeted by the intervention. This ...paper studies spillover effects of a participatory community health intervention in rural Malawi, implemented through a cluster randomized control trial, on an untargeted outcome: consumption smoothing after crop losses. While crop losses reduce consumption growth in the absence of the intervention, households in treated areas compensate for this loss and perfectly insure their consumption. We rule out better self-insurance and labor supply adjustments as drivers, indicating that informal risk sharing must have improved. Suggestive evidence shows that health improvements cannot explain the whole effect and that instead social interactions, which may have alleviated contracting frictions, had a role to play.
We study how agents respond to performance incentives according to key personality traits (conscientiousness and neuroticism) through a field experiment offering financial incentives for improving ...maternal and neonatal health outcomes to rural Indian doctors. More conscientious providers performed better--but improved less--under performance incentives. The effect of the performance incentives was also smaller for providers with higher levels of neuroticism. Our results contribute to a growing body of empirical research on heterogeneous responses to incentives and have implications for worker selection.
Breastfeeding and Child Development Fitzsimons, Emla; Vera-Hernández, Marcos
American economic journal. Applied economics,
07/2022, Letnik:
14, Številka:
3
Journal Article
Recenzirano
Odprti dostop
We show that children who are born at or just before the weekend are less likely to be breastfed, owing to poorer breastfeeding support services in hospitals at weekends. We use this variation to ...estimate the effect of breastfeeding on children's development in the first seven years of life, for a sample of births of low-educated mothers. We find large effects of breastfeeding on children's cognitive development but no effects on health or noncognitive development during the period of childhood we consider. Regarding mechanisms, we study how breastfeeding affects parental investments and the quality of the mother-child relationship. (JEL I12, I14, I18, J13, J16, J24)
IMPORTANCE: In rural India, as in many developing countries, childhood mortality remains high and the quality of health care available is low. Improving care in such settings, where most health care ...practitioners do not have formal training, requires an assessment of the practitioners’ knowledge of appropriate care and the actual care delivered (the know-do gap). OBJECTIVE: To assess the knowledge of local health care practitioners and the quality of care provided by them for childhood diarrhea and pneumonia in rural Bihar, India. DESIGN, SETTING, AND PARTICIPANTS: We conducted an observational, cross-sectional study of the knowledge and practice of 340 health care practitioners concerning the diagnosis and treatment of childhood diarrhea and pneumonia in Bihar, India, from June 29 through September 8, 2012. We used data from vignette interviews and unannounced standardized patients (SPs). MAIN OUTCOMES AND MEASURES: For SPs and vignettes, practitioner performance was measured using the numbers of key diagnostic questions asked and examinations conducted. The know-do gap was calculated by comparing fractions of practitioners asking key diagnostic questions on each method. Multivariable regressions examined the relation among diagnostic performance, prescription of potentially harmful treatments, and the practitioners’ characteristics. We also examined correct treatment recommended by practitioners with both methods. RESULTS: Practitioners asked a mean of 2.9 diagnostic questions and suggested a mean of 0.3 examinations in the diarrhea vignette; mean numbers were 1.4 and 0.8, respectively, for the pneumonia vignette. Although oral rehydration salts, the correct treatment for diarrhea, are commonly available, only 3.5% of practitioners offered them in the diarrhea vignette. With SPs, no practitioner offered the correct treatment for diarrhea, and 13.0% of practitioners offered the correct treatment for pneumonia. Diarrhea treatment has a large know-do gap; practitioners asked diagnostic questions more frequently in vignettes than for SPs. Although only 20.9% of practitioners prescribed treatments that were potentially harmful in the diarrhea vignettes, 71.9% offered them to SPs (P < .001). Unqualified practitioners were more likely to prescribe potentially harmful treatments for diarrhea (adjusted odds ratio, 5.11 95% CI, 1.24-21.13). Higher knowledge scores were associated with better performance for treating diarrhea but not pneumonia. CONCLUSIONS AND RELEVANCE: Practitioners performed poorly with vignettes and SPs, with large know-do gaps, especially for childhood diarrhea. Efforts to improve health care for major causes of childhood mortality should emphasize strategies that encourage pediatric health care practitioners to diagnose and manage these conditions correctly through better monitoring and incentives in addition to practitioner training initiatives.
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