•In Myanmar, between 2005 and 2010, average real expenditures did not rise.•Nevertheless, both poverty incidence and inequality declined significantly.•A major natural disaster, Tropical Cyclone ...Nargis, occurred in 2008.•The paper develops a method for isolating the impact of the cyclone.•The cyclone reduced between-region inequality but increased it within-regions.•The between-region effect dominated, so the net effect was to reduce inequality.
According to national household survey data for Myanmar, spanning the five-year interval 2005–2010, average real household consumption expenditures remained stagnant, but measured poverty incidence and inequality both declined significantly. The distribution of the economic pie shifted in favor of the poor while the overall size of the pie barely changed. This paper examines the possibility that the hitherto unexplained reduction in measured inequality was caused, at least partly, by a natural disaster, Tropical Cyclone Nargis, which devastated parts of Myanmar in May 2008. This hypothesis is supported by a recent historical study which argues that, globally, large reductions in inequality normally occur only through either man-made or natural disasters. The paper develops a method, based on regression analysis of household level data, for isolating the impact of an exogenous natural event like a cyclone. The estimated regression model is used to simulate a counterfactual distribution of expenditures in which, hypothetically, the cyclone did not occur. The estimated impact of the cyclone is the difference between the observed outcome, in which the cyclone happened, and this simulated, counterfactual outcome in which it did not. The findings indicate that the cyclone reduced inequality between regions of Myanmar, because the negatively affected regions were on average better-off than the unaffected regions, both before and after the cyclone. Within the affected regions the negative impact of the cyclone was largest in absolute terms among richer households, but as a proportion of household expenditures, these negative effects were larger among the poorer households. The cyclone therefore increased economic inequality within the affected regions. Overall measured inequality declined because the between-region reduction exceeded the within-region increase.
We study the determinants of changes in the distribution of household expenditures in Myanmar, using a large, nationwide panel household survey data set covering 2005 and 2010, the only panel ...household survey data currently existing for Myanmar. There was no statistically significant change in mean real consumption expenditures between these years, but the distribution of that consumption across households became significantly less unequal. The sources of this large decline in measured inequality have not been systematically investigated. The paper attempts that investigation by using the above data and applying regression‐based inequality decomposition methods developed by Fields and its subsequent extension by Yun.
The results using Fields’ approach indicate that region‐specific variables, occupational changes, and education were the main factors contributing to the narrowing of expenditure inequality but that road development expenditures had the opposite effect. On the methodology of decomposition, we argue first that the Yun extension of Fields’ approach promises enhanced policy relevance, by distinguishing between changes in household characteristics and changes in their impact on expenditures. Second, we show that the decomposition described by Yun entails arbitrary sequencing of the distributions being compared, substantially influencing the decomposition obtained. We explain the underlying reason for this problem and demonstrate a simple solution.
Oceanographic remote sensing, which is based on the sensitivity of reflected signals from the Global Navigation Satellite Systems (GNSS), so-called GNSS-Reflectometry (GNSS-R), is very useful for the ...observation of ocean wind speed. Wind speed estimation over the ocean is the core factor in maritime transportation management and the study of climate change. The main concept of the GNSS-R technique is using the different times between the reflected and the direct signals to measure the wind speed and wind direction. Accordingly, this research proposes a novel technique for wind speed estimation involving the integration of an artificial neural network and the particle filter based on a theoretical model. Moreover, particle swarm optimization was applied to find the optimal weight and bias of the artificial neural network, in order to improve the accuracy of the estimation result. The observation dataset of the reflected signal information from BeiDou Geostationary Earth Orbit (GEO) satellite number 4 was used as an input for the estimation model. The data consisted of two phases with
and
components. Two periods of BeiDou data were selected, the first period was from 3 to 8 August 2013 and the second period was from 12 to 14 August 2013, which corresponded to events from the typhoon Utor. The in situ wind speed measurement collected from the buoy station was used to validate the results. A coastal experiment was conducted at the Yangjiang site located in the South China Sea. The results show the ability of the proposed technique to estimate wind speed with a root mean square error of approximately 1.9 m/s.
Globally, cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes are the four major non-communicable diseases (NCDs) contributing to more than 80% of mortality and morbidity due ...to NCDs. In Myanmar, the proportional mortality rate due to NCDs increased from 46.9% in 2000 to 68% in 2017. However, the trends and patterns of four major NCDs or their hospital admissions are not known. In this regard, we aimed to assess the trends and profile of admissions with four major NCDs using final diagnosis coded in International Classification of Diseases-2010 version (ICD-10) from medical record data of the large tertiary hospitals in different regions of Myanmar.
Of the 774,970 total admissions in the study hospitals, the median and interquartile range (IQR) age was 39 (25-55) years and 51.6% were males. Over a 6-year period, there was not only 2.2-fold increase in the number of admissions due to any of four major NCDs but also their proportion increased significantly from 18.8% in 2012 to 25.4% in 2017 (chi-square for trend,
value < 0.001). The number of admissions due to cancers, cardiovascular diseases, and chronic respiratory diseases also showed linear increasing trends at the rate of 1741 (95% CI 766 to 2715), 1797 (95% CI 345 to 3249), and 597 (95% CI 530 to 612) per year, respectively. Though the admissions with diabetes increased over the years, the rate of increase of 284 (95% CI - 60 to 628) per year was not statistically significant. Among cancer admissions, colorectal (13.1%), breast (13.0%), and lung (11.0%) cancers were the commonest. Stroke (30.6%) and ischemic heart disease (21.9%) admissions were the highest among the cardiovascular diseases. Chronic obstructive pulmonary disease (35.5%) and type 2 diabetes (53.9%) were commonest among chronic respiratory diseases and diabetes, respectively.
There was a disproportionate increase in NCD admissions which requires tertiary health facilities to increase their infrastructure and trained workforce to cater to such admissions. The primary health care facilities have to be strengthened for prevention, early detection, and efficient management of NCDs to prevent life-threatening complications requiring hospitalization.
Objective
This study aims to examine the ability of optical coherence tomography (OCT) to differentiate ex vivo epithelial structure of benign disorders, dysplastic, and oral squamous cell carcinoma ...(OSCC) in comparison with the structure of normal marginal mucosa of oral biopsies. As a secondary objective, we examined the inter- and intra-observer variations of OCT measurements of two calibrated assessors.
Materials and methods
Oral biopsies (
n
= 44) were scanned using the swept source OCT (SSOCT) and grouped by pathology diagnosis to benign, dysplasia or carcinoma. Two trained and calibrated assessors scored on the five OCT variables: thickness of keratin layer (KL), epithelial layer (EL), homogeneity of lamina propria (LP), basement membrane integrity (BMI), and the degree of reflection of the epithelial layer (Ep Re). Chi-square tests and Fischer’s exact method were used to compare the data.
Results
The OCT images showed breached BM status in all the OSCC samples (100%). Epithelial reflection was noted to be hyper-reflective in all the OSCC and oral dysplasia samples (100%). An increase in KL in 66.67% of the OSCC and 100% of the oral dysplasia samples was found. EL was increased in all the OSCC samples (100%) and 85.72% of the oral dysplasias. Kappa values showed that there was very good agreement (over 0.7) when scoring individual parameters between the two assessors.
Conclusion
The study showed that the BM status was a key parameter in the detection of SCC and for differentiating SCC from oral dysplasia or benign disorders.
Clinical relevance
OCT is a non-invasive and non-radioactive adjunct diagnostic tool that can provide immediate results on the structure of oral mucosa. The BM status measured ex vivo was a key parameter in the detection of SCC and for differentiating SCC from oral dysplasia or benign disorders.
Pay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found ...to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs).
Building on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition). It was not possible to blind organizations, therapists, or all research staff to condition assignment. All treatment organizations and their therapists received a multifaceted implementation strategy. In addition to those IAU strategies, therapists in the IAU+P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions found to be associated with significantly improved patient outcomes (target A-CRA). Incremental cost-effectiveness ratios (ICERs), which represent the difference between the two conditions in average cost per treatment organization divided by the corresponding average difference in effectiveness per organization, and quality-adjusted life years (QALYs) were the primary outcomes.
At trial completion, 15 organizations were randomized to the IAU condition and 14 organizations were randomized to the IAU+P4P condition. Data from all 29 organizations were analyzed. Cluster-level analyses suggested the P4P strategy led to significantly higher average total costs compared to the IAU control condition, yet this average increase of 5% resulted in a 116% increase in the average number of months therapists demonstrated competence in treatment delivery (ICER = $333), a 325% increase in the average number of patients who received the targeted dosage of treatment (ICER = $453), and a 325% increase in the number of days of abstinence per patient in treatment (ICER = $8.134). Further supporting P4P as a cost-effective implementation strategy, the cost per QALY was only $8681 (95% confidence interval $1191-$16,171).
This study provides experimental evidence supporting P4P as a cost-effective implementation strategy.
NCT01016704 .
Background
Bariatric surgery has gained reputation for its metabolic effect and is increasingly being performed to treat type 2 diabetes mellitus (T2DM). However, there is still a gray area regarding ...the choice of surgical procedure according to patient characteristics due to inadequate evidences, so far. We aim to compare the efficacy of two most commonly performed bariatric/metabolic surgeries, sleeve gastrectomy (SG) and gastric bypass (GB) with regard to remission of T2DM after surgery.
Methods
Outcomes of 579 (349 female and 230 male) patients who had undergone SG (109) or GB (470) for the treatment of T2DM with 1-year follow-up were assessed. The remission of T2DM after SG or GB surgery was evaluated in matched groups using the ABCD scoring system. The ABCD score is composed of the age, BMI, C-peptide levels and duration of T2DM (years).
Results
The weight loss of the SG patient at 1 year after surgery was similar to the GB patients 26.3 (1.1) vs. 32.6 (1.2) %;
p
= 0.258. The mean BMI decreased from 35.7 (7.2) to 28.3 (3.7) Kg/m
2
in SG patients at 1 year after surgery and decreased from 36.9 (7.2) to 26.7 (4.5) Kg/m
2
in the GB patients. The mean HbA1c decreased from 8.8 to 6.1 % of the SG group and from 8.6 to 5.9 % of the GB group. Sixty-one (56.0 %) patients of the SG group and 300 (63.8 %) of the GB group achieved complete remission of T2DM (HbA1c < 6.0 %) at 1 year after surgery without statistical difference. However, GB exhibited significantly better glycemic control than the SG surgery in groups stratified by different ABCD score. At 5 year after surgery, GB had a better remission of T2DM than SG (53.1 vs. 35.3 %;
p
= 0.055).
Conclusions
In conclusion, although both SG and GB are effective metabolic surgery, GB carries a higher power on T2DM remission than SG. ABCD score is useful in T2DM patient classification and selection for different procedures.
Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of ...diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index BMI >35 kg/m²). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m². Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.
PDF
