Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India

Background In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care

Interstitial cell network volume is reduced in the terminal bowel of ageing mice

Ageing is associated with impaired neuromuscular function of the terminal gastrointestinal (GI) tract, which can result in chronic constipation, faecal impaction and incontinence. Interstitial cells of cajal (ICC) play an important role in regulation of intestinal smooth muscle contraction. However, changes in ICC volume with age in the terminal GI tract (the anal canal including the anal sphincter region and rectum)have not been studied. Here, the distribution, morphology and network volume of ICC in the terminal GI tract of 3‐to 4‐month‐old and 26‐to 28‐month‐old C57BL/6mice were investigated. ICC were identified by immunofluorescence labelling of wholemount preparations with an antibody against c‐Kit. ICC network volume was measured by software‐based 3D volume rendering of confocal Z stacks. A significant reduction in ICC network volume per unit volume of muscle was measured in aged animals. No age‐associated change in ICC morphology was detected. The thickness of the circular muscle layer of the anal sphincter region and rectum increased with age, while that in the distal colon decreased. These results suggest that ageing is associated with a reduction in the network volume of ICC in the terminal GI tract, which may influence the normal function of these regions

Communication Skills Instruction Utilizing Interdisciplinary Peer Teachers: Program Development and Student Perceptions

Lack of curricular time, faculty time, and funding are potential limitations for communication skills training in dentistry. Interdisciplinary collaboration amongst health care faculties could address these limitations. This article describes the development, implementation, and student perceptions of a communication skills program in dentistry. The program has four components: Knowledge, Observation, Simulation, and Experience (KOSE) and spans over the second and third years of dental school. KOSE allows students to obtain knowledge of and observe effective communication skills and practice these skills in the simulated and nonsimulated environment. A key feature of KOSE is the utilization of fourth-year medical and dental students as peer teachers. Evaluation of KOSE was geared toward student perceptions. Cross-sectional data were gathered via written surveys from 143 learners (second- and third-year dental students) in 2006–07. Students perceived the ability to recognize effective communication, demonstrated awareness of their communication strengths and weaknesses, and reported that skills gained were transferable to actual patient care. Interdisciplinary collaboration was a feasible way to address the lack of resources in the development of a communications skills program, which was perceived to be worthwhile by learners

THE EFFECT OF INDIVIDUALISED COACHING INTERVENTIONS ON ELITE YOUNG FAST BOWLERS‘ TECHNIQUE

Fast bowling in cricket is an activity well recognised as having a high injury prevalence. Previous research has associated lower back injury with aspects of fast bowling technique. Coaching interventions that may decrease the likelihood of injury, whilst maintaining or increasing ball speed, remain a priority within the sport. Selected kinematics of the bowling action of 14 elite young fast bowlers were measured using an 18 camera Vicon Motion Analysis System. Subjects were tested before and after a two year coaching intervention period, during which subject-specific coaching interventions were provided. Mann-Whitney tests were used to identify significant differences in the change in the selected kinematics between those bowlers who were coached or un-coached on each specific aspect. Coached athletes demonstrated a significant change in shoulder alignment at back foot contact (more side-on, P = 0.002) and shoulder counter-rotation (decreased, P = 0.001) relative to un-coached athletes. There was no difference in the amount of change in flexion angles of the front or back knee or lower trunk side-flexion between those who received coaching intervention and those that did not. This study shows that specific aspects of fast bowling technique in elite players can change over a two year period and may be attributed to coaching intervention

Fire Return Interval Within the Northern Boundary of the Larch Forest

Larch (Larix spp.) dominant forests compose a large proportion of the forests of Russia (i.e., about 40% of forested areas). These forests range from the Yenisei ridge on the west to the Pacific Ocean on the east, and from Lake Baikal on the south to the 73rd parallel in the north. Larch stands comprise the world s northern most forest at Ary-Mas (72 deg 28' N, 102 deg 15' E). Larch dominated forests occupy about 70% of the permafrost areas in Siberia. Larch forms high closure stands as well as open forests, and is found mainly over permafrost, where other tree species barely survive. Wildfires are typical for this territory with the majority occurring as ground fires due to low crown closure. Due to the thin active layer in permafrost soils and a dense lichen-moss cover, ground fires may cause stand mortality. The vast areas of larch-dominant forests is generally considered as a "carbon sink"; however, positive long-term temperature trends at higher latitudes are expected to result in an increase of fire frequency, and thus may convert this area to a source for greenhouse gases. There are recent observations regarding the increase of fire frequency within non-protected territories. Surprisingly, there are few publications on fire chronoseqences for the huge forested territory between the Ural Mountains and the Pacific Ocean. Also there is a general understanding that bimodal (late spring -- early summer and late summer-beginning of fall) fire seasonal distribution in the south becomes uni-modal (late spring -- early summer) in the north. The purpose of this study is to investigate the wildfire history at the northern edge of the zone of larch dominance

Diurnal changes in reflectance factor due to Sun-row direction interactions

Over a two year period, data were collected regarding the canopies of soybeans grown in rows in planter boxes placed on a turntable in an effort to investigate changes in the spectral reflectance factor related to row direction, Sun direction, soil background, and crop development stage. Results demonstrate that the direction of rows in a soybean canopy can affect the reflectance factor of the canopy by as much as 230%. The results for the red spectral region tend to support the validity of canopy reflectance models; results for the infrared region do not

Spaceborne Potential for Examining Taiga-Tundra Ecotone Form and Vulnerability

In the taiga-tundra ecotone (TTE), site-dependent forest structure characteristics can influence the subtle and heterogeneous structural changes that occur across the broad circumpolar extent. Such changes may be related to ecotone form, described by the horizontal and vertical patterns of forest structure (e.g., tree cover, density and height) within TTE forest patches, driven by local site conditions, and linked to ecotone dynamics. The unique circumstance of subtle, variable and widespread vegetation change warrants the application of spaceborne data including high-resolution (less than 5m) spaceborne imagery (HRSI) across broad scales for examining TTE form and predicting dynamics. This study analyzes forest structure at the patch-scale in the TTE to provide a means to examine both vertical and horizontal components of ecotone form. We demonstrate the potential of spaceborne data for integrating forest height and density to assess TTE form at the scale of forest patches across the circumpolar biome by (1) mapping forest patches in study sites along the TTE in northern Siberia with a multi-resolution suite of spaceborne data, and (2) examining the uncertainty of forest patch height from this suite of data across sites of primarily diffuse TTE forms. Results demonstrate the opportunities for improving patch-scale spaceborne estimates of forest height, the vertical component of TTE form, with HRSI. The distribution of relative maximum height uncertainty based on prediction intervals is centered at approximately 40%, constraining the use of height for discerning differences in forest patches. We discuss this uncertainty in light of a conceptual model of general ecotone forms, and highlight how the uncertainty of spaceborne estimates of height can contribute to the uncertainty in identifying TTE forms. A focus on reducing the uncertainty of height estimates in forest patches may improve depiction of TTE form, which may help explain variable forest responses in the TTE to climate change and the vulnerability of portions of the TTE to forest structure change. structural changes

MODIS Tree Cover Validation for the Circumpolar Taiga-Tundra Transition Zone

A validation of the 2005 500m MODIS vegetation continuous fields (VCF) tree cover product in the circumpolar taiga-tundra ecotone was performed using high resolution Quickbird imagery. Assessing the VCF's performance near the northern limits of the boreal forest can help quantify the accuracy of the product within this vegetation transition area. The circumpolar region was divided into longitudinal zones and validation sites were selected in areas of varying tree cover where Quickbird imagery is available in Google Earth. Each site was linked to the corresponding VCF pixel and overlaid with a regular dot grid within the VCF pixel's boundary to estimate percent tree crown cover in the area. Percent tree crown cover was estimated using Quickbird imagery for 396 sites throughout the circumpolar region and related to the VCF's estimates of canopy cover for 2000-2005. Regression results of VCF inter-annual comparisons (2000-2005) and VCF-Quickbird image-interpreted estimates indicate that: (1) Pixel-level, inter-annual comparisons of VCF estimates of percent canopy cover were linearly related (mean R(sup 2) = 0.77) and exhibited an average root mean square error (RMSE) of 10.1 % and an average root mean square difference (RMSD) of 7.3%. (2) A comparison of image-interpreted percent tree crown cover estimates based on dot counts on Quickbird color images by two different interpreters were more variable (R(sup 2) = 0.73, RMSE = 14.8%, RMSD = 18.7%) than VCF inter-annual comparisons. (3) Across the circumpolar boreal region, 2005 VCF-Quickbird comparisons were linearly related, with an R(sup 2) = 0.57, a RMSE = 13.4% and a RMSD = 21.3%, with a tendency to over-estimate areas of low percent tree cover and anomalous VCF results in Scandinavia. The relationship of the VCF estimates and ground reference indicate to potential users that the VCF's tree cover values for individual pixels, particularly those below 20% tree cover, may not be precise enough to monitor 500m pixel-level tree cover in the taiga-tundra transition zone

Preclinical Evaluation of Novel All-in-one Formulations of 5-Fluorouracil and Folinic Acid with Reduced Toxicity Profiles - Supplementary Data

Objectives: 5-Fluorouracil (5-FU) in combination with its synergistic biomodulator folinic acid maintains a pivotal position in cancer chemotherapy. However, clinical limitations persist with the administration of these drugs in combination including phlebitis and catheter blockages, which are associated with reduced efficacy and/or quality of life for patients. We have previously reported novel all-in-one, pH neutral, parenteral 5-FU and folinic acid formulations (termed Fluorodex) incorporating beta-cyclodextrins. Fluorodex maintains potency while overcoming the accepted incompatibility of 5-FU and folinic acid.Methods: We performed toxicological, pharmacokinetic and biodistribution, and efficacy evaluations of Fluorodex compared to 5-FU:folinic acid using several administration routes and schedules in two rodent models. These were compared to dose-matched sequential administration of 5-FU:folinic acid.Results: Fluorodex showed bioequivalence to 5-FU:folinic acid as assessed by tissue distribution and pharmacokinetics of 5-FU, but was generally better tolerated as determined by weight loss, hematological and other clinical parameters. Compared to 5-FU:folinic acid, Fluorodex was also associated with reduced phlebitis using a rabbit ear vein model. Furthermore, equivalent to enhanced efficacy of Fluorodex compared to 5-FU:folinic acid against human carcinoma tumour models in mice was observed.Conclusions: These novel all-in-one formulations represent a superior injectable form of 5- FU that allows co-delivery of folinic acid. This should translate to improved patient tolerability with potential for enhanced efficacy