Delivering Diabetes Care in the Philippines and Vietnam: Policy and Practice Issues

The aim of this study is the comparison of 2 studies looking at the barriers to access of diabetes care and medicines in the Philippines and Vietnam. These studies used the Rapid Assessment Protocol for Insulin Access. Diabetes care is provided in specialized facilities and appropriate referral systems are lacking. In Vietnam, no problems were reported with regard to diagnostic tools, whereas this was a concern in the public sector in the Philippines. Both countries had high prices for medicines in comparison to international standards. Availability of medicines was better in Vietnam than in the Philippines, especially with regard to insulin. This affected adherence as did a lack of patient education. As countries aim to provide health care to the majority of their populations through universal coverage, the challenge of diabetes cannot be neglected. Trying to achieve universal coverage in parallel to decentralization, national and local governments need adapted guidance for this

Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

BACKGROUND: In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews. METHODS: The Rapid Assessment Protocol for Insulin Access draws on the principles of Rapid Assessment Protocols which have been developed and implemented in several different areas. This protocol was adapted through a thorough literature review on diabetes, chronic condition management and medicine supply in developing countries. A visit to three countries in sub-Saharan Africa and meetings with different experts in the field of diabetes helped refine the questionnaires. Following the development of the questionnaires these were tested with various people familiar with diabetes and/or healthcare in developing countries. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali. Translations of questionnaires were made into local languages when necessary, with back translation to ensure precision. RESULTS: In each country the protocol was implemented in 3 areas – the capital city, a large urban centre and a predominantly rural area and their respective surroundings. Interviews were carried out by local teams trained on how to use the tool. Data was then collected and entered into a database for analysis. CONCLUSION: The Rapid Assessment Protocol for Insulin Access was developed to provide a situational analysis of Type 1 diabetes, in order to make recommendations to the national Ministries of Health and Diabetes Associations. It provided valuable information on patients' access to insulin, syringes, monitoring and care. It was thus able to sketch a picture of the health care system with regards to its ability to care for people with diabetes. In all countries where this tool was used the involvement of local stakeholders resulted in the process acting as a catalyst in bringing diabetes to the attention of the health authorities

Long-range memory model of trading activity and volatility

Earlier we proposed the stochastic point process model, which reproduces a variety of self-affine time series exhibiting power spectral density S(f) scaling as power of the frequency f and derived a stochastic differential equation with the same long range memory properties. Here we present a stochastic differential equation as a dynamical model of the observed memory in the financial time series. The continuous stochastic process reproduces the statistical properties of the trading activity and serves as a background model for the modeling waiting time, return and volatility. Empirically observed statistical properties: exponents of the power-law probability distributions and power spectral density of the long-range memory financial variables are reproduced with the same values of few model parameters.Comment: 12 pages, 5 figure

Sequential analysis of biomarkers in cerebrospinal fluid and serum during invasive meningococcal disease

The aim of the present study was to determine the profile of different inflammatory molecules in serum and cerebrospinal fluid (CSF) during invasive meningococcal disease (IMD). Their relationship with IMD severity was also assessed. A cohort of 12 patients with IMD was investigated. Paired serum and CSF samples were obtained at the time of diagnostic and follow-up lumbar puncture and were examined using Luminex® analysis. IMD severity correlated with serum interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) on admission. Furthermore, the CSF levels of IL-1β, IL-1ra, IL-6, IL-8, macrophage inflammatory protein-1β (MIP-1β), and monocyte chemoattractant protein-1 (MCP-1) were significantly higher than their respective serum levels. The strongest correlations were found between serum concentrations of IL-1β and IL-1ra, IL-6, IL-8, and MIP-1β, whereas the strongest correlations in CSF were found between endotoxin and IL-8, IL-17, MIP-1β, and MCP-1. As was expected, the concentrations of inflammatory molecules in both serum and CSF significantly decreased after antibiotic treatment. With regard to kinetics, a severe course of IMD correlated positively with rapid declines of CSF IL-6 and cortisol levels. Sequential multiple analyses revealed patterns of inflammatory responses that were associated with the severity of IMD, as well as with the compartmentalization and kinetics of the immune reaction

Kochen-Specker Sets and Generalized Orthoarguesian Equations

Every set (finite or infinite) of quantum vectors (states) satisfies generalized orthoarguesian equations ($n$OA). We consider two 3-dim Kochen-Specker (KS) sets of vectors and show how each of them should be represented by means of a Hasse diagram---a lattice, an algebra of subspaces of a Hilbert space--that contains rays and planes determined by the vectors so as to satisfy $n$OA. That also shows why they cannot be represented by a special kind of Hasse diagram called a Greechie diagram, as has been erroneously done in the literature. One of the KS sets (Peres') is an example of a lattice in which 6OA pass and 7OA fails, and that closes an open question of whether the 7oa class of lattices properly contains the 6oa class. This result is important because it provides additional evidence that our previously given proof of noa =< (n+1)oa can be extended to proper inclusion noa < (n+1)oa and that nOA form an infinite sequence of successively stronger equations.Comment: 16 pages and 5 figure

The Composite Fermion Hierarchy: Condensed States of Composite Fermion Excitations?

A composite Fermion hierarchy theory is constructed in a way related to the original Haldane picture by applying the composite Fermion (CF) transformation to quasiparticles of Jain states. It is shown that the Jain theory coincides with the Haldane hierarchy theory for principal CF fillings. Within the Fermi liquid approach for few electron systems on the sphere a simple interpretation of many-quasiparticle spectra is given and provides an explanation of failure of CF hierarchy picture when applied to the hierarchical $4/11$ state.Comment: 6 pages, Revtex, 4 figures in PostScript, submitted to Phys. Rev. Let

Theory of the Half-Polarized Quantum Hall States

We report a theoretical analysis of the half-polarized quantum Hall states observed in a recent experiment. Our numerical results indicate that the ground state energy of the quantum Hall $\nu= 2/3$ and $\nu= 2/5$ states versus spin polarization has a downward cusp at half the maximal spin polarization. We map the two-component fermion system onto a system of excitons and describe the ground state as a liquid state of excitons with non-zero values of exciton angular momentum.Comment: 4 pages (RevTeX), 3 figures (PostScript), added reference

Temperature Dependence of Hall Response in Doped Antiferromagnets

Using finite-temperature Lanczos method the frequency-dependent Hall response is calculated numerically for the t-J model on the square lattice and on ladders. At low doping, both the high-frequency RH* and the d.c. Hall coefficient RH0 follow qualitatively similar behavior at higher temperatures: being hole-like for T > Ts~1.5J and weakly electron-like for T < Ts. Consistent with experiments on cuprates, RH0 changes, in contrast to RH*, again to the hole-like sign below the pseudogap temperature T*, revealing a strong temperature variation for T->0.Comment: LaTeX, 4 pages, 4 figures, submitted to PR