Community health insurance (CHI) aims to provide financial protection and facilitate health care access among poor rural populations. Given common operational challenges that hamper the full ...development of the scheme, there is need to undertake systematic feasibility studies. These are scarce in the literature and usually they do not provide a comprehensive analysis of the local context.
The present research intends to adopt a mixed–methods approach to assess ex-ante the feasibility of CHI. In particular, eight preconditions are proposed to inform the viability of introducing the micro insurance. A case study located in rural northern Uganda is presented to test the effectiveness of the mixed–methods procedure for the feasibility purpose. A household survey covering 180 households, 8 structured focus group discussions, and 40 key informant interviews were performed between October and December 2016 in order to provide a complete and integrated analysis of the feasibility preconditions. Through the data collected at the household level, the population health seeking behaviours and the potential insurance design were examined; econometric analyses were carried out to investigate the perception of health as a priority need and the willingness to pay for the scheme. The latter component, in particular, was analysed through a contingent valuation method.
The results validated the relevant feasibility preconditions. Econometric estimates demonstrated that awareness of catastrophic health expenditures and the distance to the hospital play a critical influence on household priorities and willingness to pay. Willingness is also significantly affected by socio–economic status and basic knowledge of insurance principles. Overall, the mixed-methods investigation showed that a comprehensive feasibility analysis can shape a viable CHI model to be implemented in the local context.
•Eight local conditions are necessary for a viable CHI scheme.•Health care is a priority due to catastrophic expenditures and hospital distance.•CHI should be arranged to reduce households' vulnerability.•Ex-ante feasibility studies facilitate policy-makers and micro insurance schemes.
Synthetic aperture radar tomography (SARTom) is the natural extension of SAR interferometry to solve for multiple phase centers within a resolution cell and obtain the 3-D representation of a scene. ...This paper deals with the determination of the minimum number of tracks required to perform SARTom. Through the prolate spheroidal wave functions, the number of equivalent targets of a volumetric source is derived, and from it, the minimum number of observations required to apply subspace superresolution methods is computed. The minimum tomographic aperture length is also investigated. The results are validated on real data acquired in L-band by the experimental SAR system of the German Aerospace Center.
•Light modulates the HR of tobacco plants to Pto DC3000 infection.•Red light delays the HR of tobacco plants to Pto DC3000 infection.•Alterations at the cellular level include: loss of membrane ...integrity and nuclei.•Alterations also include DNA degradation and changes in nuclease profiles.
Light modulates almost every aspect of plant physiology, including plant-pathogen interactions. Among these, the hypersensitive response (HR) of plants to pathogens is characterized by a rapid and localized programmed cell death (PCD), which is critical to restrict the spread of pathogens from the infection site. The aim of this work was to study the role of light in the interaction between Pseudomonas syringae pv. tomato DC3000 (Pto DC3000) and non-host tobacco plants. To this end, we examined the HR under different light treatments (white and red light) by using a range of well-established markers of PCD. The alterations found at the cellular level included: i) loss of membrane integrity and nuclei, ii) RuBisCo and DNA degradation, and iii) changes in nuclease profiles and accumulation of cysteine proteinases. Our results suggest that red light plays a role during the HR of tobacco plants to Pto DC3000 infection, delaying the PCD process.
Numerous studies have demonstrated that drugs of abuse activate the mesolimbic dopamine reward pathway, and it is widely held that this activation contributes to the motivational and positive ...reinforcing properties of these substances. However, there is evidence that endogenous opioid systems within this brain reward circuit also play a role in drug reinforcement and drug-seeking behavior. Using microdialysis in freely moving rats, we sought to determine whether various drugs of abuse (i.e., ethanol, cocaine, d-amphetamine, and nicotine) would increase neurotransmission of endogenous opioid peptides (i.e., endorphins) in the nucleus accumbens. Drugs were administered intraperitoneally twice at 3 h intervals, and the endorphin content of microdialysates was analyzed by a solid-phase radioimmunoassay. Acute administration of ethanol, cocaine, and d-amphetamine transiently elevated extracellular levels of endorphins in the nucleus accumbens, whereas nicotine and saline were without effect. We hypothesize that this drug-induced release of endorphins may contribute to the positive reinforcing and motivating properties of ethanol and psychostimulants.
Several traits related to foraging behaviour were assessed in young‐of‐the‐year produced from largemouth bass Micropterus salmoides that had been exposed to four generations of artificial selection ...for vulnerability to angling. As recreational angling may target foraging ability, this study tested the hypothesis that selection for vulnerability to angling would affect behaviours associated with foraging ecology and prey capture success. Fish selected for low vulnerability to angling captured more prey and attempted more captures than high vulnerability fish. The higher capture attempts, however, ultimately resulted in a lower capture success for low vulnerability fish. Low vulnerability fish also had higher prey rejection rates, marginally shorter reactive distance and were more efficient at converting prey consumed into growth than their high vulnerability counterparts. Selection due to recreational fishing has the potential to affect many aspects of the foraging ecology of the targeted population and highlights the importance of understanding evolutionary effects and how these need to be considered when managing populations.
Despite its proven activity as third-line treatment in gastrointestinal stromal tumors (GIST), regorafenib can present a poor tolerability profile which often leads to treatment modifications and ...transient or permanent discontinuation; thus, in clinical practice physicians usually adopt various dosing and interval schedules to counteract regorafenib-related adverse events and avoid treatment interruption. The aim of this real-world study was to investigate the efficacy and safety of personalized schedules of regorafenib in patients with metastatic GIST, in comparison with the standard schedule (160 mg daily, 3-weeks-on, 1-week-off).
Institutional registries across seven Italian reference centers were retrospectively reviewed and data of interest retrieved to identify patients with GIST who had received regorafenib from February 2013 to January 2021. The Kaplan–Meier method was used to estimate survival and the log-rank test to make comparisons.
Of a total of 152 patients with GIST, 49 were treated with standard dose, while 103 received personalized schedules. At a median follow-up of 36.5 months, median progression-free survival was 5.6 months 95% confidence interval (CI) 3.73-11.0 months versus 9.7 months (95% CI 7.9-14.5 months) in the standard-dose and the personalized schedule groups, respectively hazard ratio (HR) 0.51; 95% CI 0.34-0.75; P = 0.00052. Median overall survival was 16.6 months (95% CI 14.1-21.8 months) versus 20.5 months (95% CI 15.0-25.4 months), respectively (HR 0.75; 95% CI 0.49-1.22; P = 0.16).
Regorafenib-personalized schedules are commonly adopted in daily clinical practice of high-volume GIST expert centers and correlate with significant improvement of therapeutic outcomes. Therefore, regorafenib treatment optimization in patients with GIST may represent the best strategy to maximize long-term therapy.
•Regorafenib-personalized schedules are commonly adopted in daily clinical practice.•Regorafenib-personalized schedules correlate with statistically significant improvement of therapeutic outcomes.•A prompt personalization of regorafenib could help clinicians avoid early treatment discontinuation due to adverse events.•A patient-tailored approach could be applied to other metastatic solid tumors treated with regorafenib.
Tracheal granular cell tumors are rare neurogenic neoplasms characterized by an indolent behavior. We report the case of a young woman affected by this tumor with non-specific clinical presentation. ...We performed a literature search in order to identify all the cases of tracheal granular cell tumor and to summarize the current state of knowledge about this rare disease.
We present the planar co-integration of an ion-exchange Young interferometer with a microfluidic sensing chamber for photothermal analyte detection. Being exclusively fabricated and packaged in ...borosilicate glass, the sensor is well suited for a vast range of applications in chemical analysis, including ionizing environments. Local absorption of a pulsed excitation laser by the analyte in the fluid generates a change of the fluid refractive index which translates to a shift of the interference pattern. The detection limit of fringe movement was measured to be 1.8×10−3×2π and the corresponding refractive index resolution was Δn=7.5×10−6. Absorption measurements of cobalt(II) nitrate in ethanol yielded a detection limit of c=6×10−4M, equivalent to an absorption coefficient of α=1.2×10−2cm−1 and a minimum detectable absorbance of K=1.4×10−5. At a probed volume of 20pl, a quantity of 12fmol of Co(II) was detected.
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