Saving, Microinsurance: Why You Should Do Both or Nothing. A Behavioral Experiment on the Philippines

This paper analyzes data from a novel field experiment designed to test the impact of two different insurance products and a secret saving device on solidarity in risk-sharing groups among rural villagers in the Philippines. Risk is simulated by a lottery, risk-sharing is possible in solidarity groups of three and insurance is introduced via less risky lotteries. Our main hypothesis is that formal market-based products lead to lower transfers among network members. We also test for the persistence of this crowding-out of solidarity. We find evidence for a reduction of solidarity by insurance if shocks are observable. Depending on insurance design, there is also evidence for persistence of this effect even if insurance is removed. Simulations using our regression results show that the benefits of insurance are completely offset by the reduction in transfers. However, if secret saving is possible solidarity is very low in general and there is no crowding out effect of insurance. This suggests that introducing formal insurance is not as effective as it is hoped for when the monetary situation can be closely monitored, but that it might be a very important complement when savings inhibit observing financial resources. --

On tailored three-dimensional optical materials by atomic layer deposition

Atomic Layer Deposition in combination with selective etch processes is exploited as a tool to impart tailored optical functionality to a three-dimensional polymeric nano-template made by Direct-Laser-Writing lithography. This way, tailor-doped semiconductor films and the first photonic crystal exhibiting a complete photonic bandgap in the visible are fabricated and characterized. The photonic crystal is shown to drastically modify the spontaneous emission of embedded emitters

The Targon®-PH Nail, an intramedullary fixator for unstable capital humeral fractures in the elderly patient: a retrospective study of 39 patients

The proximal humeral fracture occurs very often especially in elderly patients suffering from osteoporosis. Minimally invasive internal fixation with the Targon®-PH proximal humeral nail may lead to quick recovery. Thirty-nine patients with unstable humeral head fractures with two or four fragments were included into this study. The application of the humeral nail was achieved by deltoid split technique. Patients were followed-up clinically and radiologically including a Constant Score. The mean age was 72.9±3.3years of the male and 74.9±1.8years of the female patients. The subjective parameters of the Constant-Murley Score were significantly lowered in both the female and the male sample compared with the healthy side (female 30.0±1.1 vs. 33.7±0.7; P<0.05; and male 30.3±1.4 vs. 34.0±0.7; P<0.05). The objective parameters were significantly lowered also in both the female and the male sample compared with the non-operated side (female 34.5±2.0 vs. 45.2±1.1; P<0.001; and male 37.7±5.4 vs. 50.6±1.7; P<0.05). Even under lowered functionality, the subjective satisfaction was high; therefore, nailing of proximal humeral head fractures may represent a method for early functional recovery in elderly patient

Evaluation of medication safety in the discharge medication of 509 surgical inpatients using electronic prescription support software and an extended operational interaction classification

Purpose: Our aim was to study drug interactions and dose adjustments in patients with renal impairment in the discharge medication of surgical inpatients and to evaluate the strengths and limitations of clinical decision support software (CDSS) for this task. Methods: This was a cross-sectional study involving 509 surgical patients of a primary care hospital. We developed a customized interface for the CDSS MediQ, which we used for automated retrospective identification of drug interactions in the patients' discharge medication. The clinical relevance of the interactions was evaluated based on the Zurich Interaction System (ZHIAS) that incorporates the operational classification of drug interactions (ORCA). Prescriptions were further analyzed for recommended dose adjustments in patients with a glomerular filtration rate <60ml/min. Results: For the total of 2,729 prescriptions written for the 509 patients enrolled in the study, MediQ generated 2,558 interaction alerts and 1,849 comments. Among these were ten "high danger” and 551 "average danger” alerts that we reclassified according to ORCA criteria. This reclassification resulted in ten contraindicated combinations, 77 provisionally contraindicated combinations, and 310 with a conditional and 164 with a minimal risk of adverse outcomes. The ZHIAS classification also provides categorical information on expected adverse outcomes and management recommendations, which are presented in detail. We identified 56 prescriptions without a recommended dose adjustment for impaired renal function. Conclusions: CDSS identified a large number of drug interactions in surgical discharge medication, but according to ZHIAS criteria only a minor fraction of these appeared to involve a substantial risk to the patient. CDSS should therefore aim at reducing over-alerting and improve usability in order to become more efficacious in terms of the prevention of adverse drug events in clinical practic

713-4 Inhibition of Vascular Superoxide Production in Hypercholesterolemic Rabbit Aorta by L-Arginine Contributes to Restored Endothelium-dependent Relaxation

Chronic oral administration of L-arginine (L-ARG) has been shown to enhance endothelial function in cholesterol (CHOL)-fed rabbits and to reduce atherogenesis. We investigated whether modulation of endogenous NO production (as assessed by urinary NO3-excretion) by L-ARG and the inhibitor of NO synthesis, L-NAME, affects vascular superoxide (O2-) production in hypercholesterolemic rabbits. Phorbol-myristate-acetate (PMA)-stimulated O2-production from isolated aortic rings was increased in rabbits given CHOL (+159±28%) or CHOL + L-NAME (+149±37%) as compared to controls (-22±7%), and endothelium-dependent relaxations by acetylcholine were diminished in both groups. In aortic rings from rabbits given CHOL + L-ARG, PMA-induced O2-production was restored to control levels (+14±17%; p&lt;0.05), and endothelium-dependent cholinergic relaxations were also partly restored. Urinary NO3-excretion decreased in all animals fed a CHOL-enriched diet (p&lt;0.01). As NO inactivated by O2-is also oxidized to NO3-, this indicates a decreased endothelial production of NO. NO3-excretion was further decreased by L-NAME (p&lt;0.05 vs. CHOL), and partly restored by L-ARG (p&lt;0.05). We conclude that both a decreased production of NO and an enhanced breakdown of NO by O2-contribute to the diminished biological activity of endothelial NO in hypercholesterolemia. L-ARG restores endothelial function by enhancing NO formation and by protecting NO from early breakdown by O2-

Restoring vascular nitric oxide formation by l-arginine improves the symptoms of intermittent claudication in patients with peripheral arterial occlusive disease

AbstractBackground. Administration of l-arginine improves nitric oxide (NO) formation and endothelium-dependent vasodilation in atherosclerotic patients.Objectives. We investigated in this double-blind, controlled study whether prolonged intermittent infusion therapy with l-arginine improves the clinical symptoms of patients with intermittent claudication, as compared with the endothelium-independent vasodilator prostaglandin E1, and control patients.Methods. Thirty-nine patients with intermittent claudication were randomly assigned to receive 2 × 8 g l-arginine/day, or 2 × 40 μg prostaglandin E1(PGE1)/day or no hemodynamically active treatment, for 3 weeks. The pain-free and absolute walking distances were assessed on a walking treadmill at 3 km/h, 12% slope, and NO-mediated, flow-induced vasodilation of the femoral artery was assessed by ultrasonography at baseline, at 1, 2 and 3 weeks of therapy and 6 weeks after the end of treatment. Urinary nitrate and cyclic guanosine-3′, 5′-monophosphate (GMP) were assessed as indices of endogenous NO production.Results. l-Arginine improved the pain-free walking distance by 230 ± 63% and the absolute walking distance by 155 ± 48% (each p < 0.05). Prostaglandin E1improved both parameters by 209 ± 63% and 144 ± 28%, respectively (each p < 0.05), whereas control patients experienced no significant change. l-Arginine therapy also improved endothelium-dependent vasodilation in the femoral artery, whereas PGE1had no such effect. There was a significant linear correlation between the l-arginine/asymmetric dimethylarginine (ADMA) ratio and the pain-free walking distance at baseline (r = 0.359, p < 0.03). l-Arginine treatment elevated the plasma l-arginine/ADMA ratio and increased urinary nitrate and cyclic GMP excretion rates, indicating normalized endogenous NO formation. Prostaglandin E1therapy had no significant effect on any of these parameters. Symptom scores assessed on a visual analog scale increased from 3.51 ± 0.18 to 8.3 ± 0.4 (l-arginine) and 7.0 ± 0.5 (PGE1; each p < 0.05), but did not significantly change in the control group (4.3 ± 0.4).Conclusions. Restoring NO formation and endothelium-dependent vasodilation by l-arginine improves the clinical symptoms of intermittent claudication in patients with peripheral arterial occlusive disease

Building trust in rural producer organizations: results from a randomized controlled trial

Trust is considered an important factor for successful collective action in groups of smallholder farmers. A prime example is collective commercialization of agricultural produce through producer organizations. While previous research has focused on trust as an exogenous determinant of participation in groups, this article tests whether trust within existing groups can be improved using a training program. We conduct a cluster-randomized controlled trial in rural Senegal to identify the effects of training members and/or leaders with respect to commercialization on intragroup trust. Our design allows identifying both direct treatment effects of having participated in the training and spillover effects on farmers who did not partake. Looking at different measures of trust in leaders’ competence and motives and of trust in members, we find that participating in the training significantly enhances both trust in leaders and trust in members. For trust in leaders, we also find a strong spillover effect. Our findings suggest that relatively soft and noncostly interventions such as group training appear to positively affect trust within producer organizations

Ecology impacts the decrease of Spirochaetes and Prevotella in the fecal gut microbiota of urban humans

Compared to the huge microbial diversity in most mammals, human gut microbiomes have lost diversity while becoming specialized for animal-based diets - especially compared to chimps, their genetically closest ancestors. The lowered microbial diversity within the gut of westernized populations has also been associated with different kinds of chronic inflammatory diseases in humans. To further deepen our knowledge on phylogenetic and ecologic impacts on human health and fitness, we established the herein presented biobank as well as its comprehensive microbiota analysis. In total, 368 stool samples from 38 different animal species, including Homo sapiens, belonging to four diverse mammalian orders were collected at seven different locations and analyzed by 16S rRNA gene amplicon sequencing. Comprehensive data analysis was performed to (i) determine the overall impact of host phylogeny vs. diet, location, and ecology and to (ii) examine the general pattern of fecal bacterial diversity across captive mammals and humans.By using a controlled study design with captive mammals we could verify that host phylogeny is the most dominant driver of mammalian gut microbiota composition. However, the effect of ecology appears to be able to overcome host phylogeny and should therefore be studied in more detail in future studies. Most importantly, our study could observe a remarkable decrease of Spirochaetes and Prevotella in westernized humans and platyrrhines, which is probably not only due to diet, but also to the social behavior and structure in these communities.Our study highlights the importance of phylogenetic relationship and ecology within the evolution of mammalian fecal microbiota composition. Particularly, the observed decrease of Spirochaetes and Prevotella in westernized communities might be associated to lifestyle dependent rapid evolutionary changes, potentially involved in the establishment of dysbiotic microbiomes, which promote the etiology of chronic diseases

Evaluation of intracranial stenting in a simulated training and assessment environment for neuroendovascular procedures

PurposeGiven the inherent complexity of neurointerventional procedures and the associated risks of ionizing radiation exposure, it is crucial to prioritize ongoing training and improve safety protocols. The aim of this study is to assess a training and evaluation in-vitro environment using a vascular model of M1 stenosis, within a clinical angiography suite, without relying on animal models or X-ray radiation.Materials and methodsUsing a transparent model replicating M1 stenosis, we conducted intracranial stenting procedures with four different setups (Gateway &amp; Wingspan, Gateway &amp; Enterprise, Neurospeed &amp; Acclino, and Pharos Vitesse). A video camera was integrated with the angiography system’s monitor for real-time visualization, while a foot switch was employed to simulate live fluoroscopy. Three neuroradiologists with varying levels of expertise performed each procedure for three times. The total duration of fluoroscopy as well as the time from passing the stenosis with the wire to completion of the procedure were recorded using a dedicated software designed for this experimental setup.ResultsCompared to the Gateway &amp; Wingspan procedure, the total fluoroscopy time reduced significantly with the Gateway &amp; Enterprise, Neurospeed &amp; Acclino, and Pharos Vitesse procedures by 51.56 s, 111.33 s, and 144.89 s, respectively (p &lt; 0.001). Additionally, physicians with under 2 years and over 5 years of experience reduced FT by 62.83 s and 106.42 s, respectively, (p &lt; 0.001), compared to a novice physician. Similar trends were noted for the time of wire distal to stenosis, with significant reductions for Neurospeed &amp; Acclino and Pharos Vitesse compared to both Gateway &amp; Wingspan as well as Gateway &amp; Enterprise (all p &lt; 0.001).ConclusionProcedures requiring wire exchange maneuvers exhibited nearly twice the fluoroscopy time in comparison to balloon-mounted stenting or stent-placement via PTA balloon catheters. The more experienced neuroradiologist demonstrated significantly quicker performance in line with expectations in a real-life clinical setting, when compared to the less experienced interventionalist. This in-vitro setup allowed the evaluation of alternative technical approaches and differences in experience of operators without the use of animal models or X-ray. The setup combines advantages of simulators and silicone vessel models in a realistic working environment