Growth of health maintenance organisations in Nigeria and the potential for a role in promoting universal coverage efforts.

: There has been growing interest in the potential for private health insurance (PHI) and private organisations to contribute to universal health coverage (UHC). Yet evidence from low and middle income countries remains very thin. This paper examines the evolution of health maintenance organisations (HMOs) in Nigeria, the nature of the PHI plans and social health insurance (SHI) programmes and their performance, and the implications of their business practices for providing PHI and UHC-related SHI programmes. An embedded case study design was used with multiple subunits of analysis (individual HMOs and the HMO industry) and mixed (qualitative and quantitative) methods, and the study was guided by the structure-conduct-performance paradigm that has its roots in the neo-classical theory of the firm. Quantitative data collection and 35 in-depth interviews were carried out between October 2012 to July 2013. Although HMOs first emerged in Nigeria to supply PHI, their expansion was driven by their role as purchasers in the government's national health insurance scheme that finances SHI programmes, and facilitated by a weak accreditation system. HMOs' characteristics distinguish the market they operate in as monopolistically competitive, and HMOs as multiproduct firms operating multiple risk pools through parallel administrative systems. The considerable product differentiation and consequent risk selection by private insurers promote inefficiencies. Where HMOs and similar private organisations play roles in health financing systems, effective regulatory institutions and mandates must be established to guide their behaviours towards attainment of public health goals and to identify and control undesirable business practices. Lessons are drawn for policy makers and programme implementers especially in those low and middle-income countries considering the use of private organisations in their health financing systems.<br/

DEVELOPMENT AND DEPLOYMENT OF THE MOBILE ARM RETRIEVAL SYSTEM (MARS) - 12187

Washington River Protection Solutions (WRPS) is developing and deploying Mobile Arm Retrieval System (MARS) technologies solutions to support retrieval of radioactive and chemical waste from underground single shell storage tanks (SST) located at the Hanford Site, which is near Richland, Washington. WRPS has developed the MARS using a standardized platform that is capable of deploying multiple retrieval technologies. To date, WRPS, working with their mentor-protege company, Columbia Energy and Environmental Services (CEES), has developed two retrieval mechanisms, MARS-Sluicing (MARS-S) and MARS-Vacuum (MARS-V). MARS-S uses pressurized fluids routed through spray nozzles to mobilize waste materials to a centrally located slurry pump (deployed in 2011). MARS-V uses pressurized fluids routed through an eductor nozzle. The eductor nozzle allows a vacuum to be drawn on the waste materials. The vacuum allows the waste materials to be moved to an in-tank vessel, then extracted from the SST and subsequently pumped to newer and safer double shell tanks (DST) for storage until the waste is treated for disposal. The MARS-S system is targeted for sound SSTs (i.e., non leaking tanks). The MARS-V is targeted for assumed leaking tanks or those tanks that are of questionable integrity. Both versions of MARS are being/have been developed in compliance with WRPS's TFC-PLN-90, Technology Development Management Plan. TFC-PLN-90 includes a phased approach to design, testing, and ultimate deployment of new technologies. The MARS-V is scheduled to be deployed in tank 241-C-105 in late 2012

Historical factors associated with past environments influence the biogeography of thermophilic endospores in Arctic marine sediments

Selection by the local, contemporary environment plays a prominent role in shaping the biogeography of microbes. However, the importance of historical factors in microbial biogeography is more debatable. Historical factors include past ecological and evolutionary circumstances that may have influenced present-day microbial diversity, such as dispersal and past environmental conditions. Diverse thermophilic sulphate-reducing Desulfotomaculum are present as dormant endospores in marine sediments worldwide where temperatures are too low to support their growth. Therefore, they are dispersed to here from elsewhere, presumably a hot, anoxic habitat. While dispersal through ocean currents must influence their distribution in cold marine sediments, it is not clear whether even earlier historical factors, related to the source habitat where these organisms were once active, also have an effect. We investigated whether these historical factors may have influenced the diversity and distribution of thermophilic endospores by comparing their diversity in 10 Arctic fjord surface sediments. Although community composition varied spatially, clear biogeographic patterns were only evident at a high level of taxonomic resolution (>97% sequence similarity of the 16S rRNA gene) achieved with oligotyping. In particular, the diversity and distribution of oligotypes differed for the two most prominent OTUs (defined using a standard 97% similarity cutoff). One OTU was dominated by a single ubiquitous oligotype, while the other OTU consisted of ten more spatially localised oligotypes that decreased in compositional similarity with geographic distance. These patterns are consistent with differences in historical factors that occurred when and where the taxa were once active, prior to sporulation. Further, the influence of history on biogeographic patterns was only revealed by analysing microdiversity within OTUs, suggesting that populations within standard OTU-level groupings do not necessarily share a common ecological and evolutionary history

Effect of autonomic blocking agents on the respiratory-related oscillations of ventricular action potential duration in humans

Ventricular action potential duration (APD) is an important component of many physiological functions including arrhythmogenesis. APD oscillations have recently been reported in humans at the respiratory frequency. This study investigates the contribution of the autonomic nervous system to these oscillations. In 10 patients undergoing treatment for supraventricular arrhythmias, activation recovery intervals (ARI; a conventional surrogate for APD) were measured from multiple left and right ventricular (RV) endocardial sites, together with femoral artery pressure. Respiration was voluntarily regulated and heart rate clamped by RV pacing. Sympathetic and parasympathetic blockade was achieved using intravenous metoprolol and atropine, respectively. Metroprolol reduced the rate of pressure development (maximal change in pressure over time): 1,271 (± 646) vs. 930 (± 433) mmHg/s; P < 0.01. Systolic blood pressure (SBP) showed a trend to decrease after metoprolol, 133 (± 21) vs. 128 (± 25) mmHg; P = 0.06, and atropine infusion, 122 (± 26) mmHg; P < 0.05. ARI and SBP exhibited significant cyclical variations (P < 0.05) with respiration in all subjects with peak-to-peak amplitudes ranging between 0.7 and 17.0 mmHg and 1 and 16 ms, respectively. Infusion of metoprolol reduced the mean peak-to-peak amplitude [ARI, 6.2 (± 1.4) vs. 4.4 (± 1.0) ms, P = 0.008; SBP, 8.4 (± 1.6) vs. 6.2 (± 2.0) mmHg, P = 0.002]. The addition of atropine had no significant effect. ARI, SBP, and respiration showed significant coupling (P < 0.05) at the breathing frequency in all subjects. Directed coherence from respiration to ARI was high and reduced after metoprolol infusion [0.70 (± 0.17) vs. 0.50 (± 0.23); P < 0.05]. These results suggest a role of respiration in modulating the electrophysiology of ventricular myocardium in humans, which is partly, but not totally, mediated by β-adrenergic mechanisms

Controlling the quantum dynamics of a mesoscopic spin bath in diamond

Understanding and mitigating decoherence is a key challenge for quantum science and technology. The main source of decoherence for solid-state spin systems is the uncontrolled spin bath environment. Here, we demonstrate quantum control of a mesoscopic spin bath in diamond at room temperature that is composed of electron spins of substitutional nitrogen impurities. The resulting spin bath dynamics are probed using a single nitrogen-vacancy (NV) centre electron spin as a magnetic field sensor. We exploit the spin bath control to dynamically suppress dephasing of the NV spin by the spin bath. Furthermore, by combining spin bath control with dynamical decoupling, we directly measure the coherence and temporal correlations of different groups of bath spins. These results uncover a new arena for fundamental studies on decoherence and enable novel avenues for spin-based magnetometry and quantum information processing

Which family members use the best nets? An analysis of the condition of mosquito nets and their distribution within households in Tanzania

BACKGROUND: Household ownership of insecticide-treated mosquito nets (ITNs) is increasing, and coverage targets have been revised to address universal coverage with ITNs. However, many households do not have enough nets to cover everyone, and the nets available vary in physical condition and insecticide treatment status. Since 2004, the Government of Tanzania has been implementing the Tanzania National Voucher Scheme (TNVS), which distributes vouchers for ITNs through antenatal clinics to target pregnant women and their infants. This analysis aimed to determine the following: (1) coverage patterns of bed nets within households according to physical condition and treatment status; (2) who might be at risk if mosquitoes were diverted from occupants of untreated nets to those not using nets? (3) the degree to which those at highest risk of malaria use the most protective nets. METHODS: Data from the 2006 TNVS household survey were analysed to assess within-household distribution of net use. The associations between net characteristics and net user were also evaluated. Multivariate analysis was applied to the relationship between the number of holes per net and user characteristics while adjusting for confounders. RESULTS: In households with a net:person ratio better than 1:4 (one net for every four household members), more than 80% of the people in such households reported using a net the previous night. ITNs were most likely to be used by infants, young children (1-4 y), and women of childbearing age; they were least likely to be used by older women (>or=50 y), older children (5-14 y), and adult men. The nets used by infants and women of childbearing age were in better-than-average physical condition; the nets used by older women and older children were in worse-than-average condition; while young children and adult men used nets in intermediate (average) condition. When adjusted for confounders, the nets used by young and older children had more holes than nets used by infants. CONCLUSIONS: Infants and other vulnerable groups were most likely to sleep under the most protective nets. Nevertheless, more communication efforts are needed to increase use of intact ITNs within households for children. Further research is necessary to fully understand motivations influencing within-household net distribution

Decoherence-protected quantum gates for a hybrid solid-state spin register

Protecting the dynamics of coupled quantum systems from decoherence by the environment is a key challenge for solid-state quantum information processing. An idle qubit can be efficiently insulated from the outside world via dynamical decoupling, as has recently been demonstrated for individual solid-state qubits. However, protection of qubit coherence during a multi-qubit gate poses a non-trivial problem: in general the decoupling disrupts the inter-qubit dynamics, and hence conflicts with gate operation. This problem is particularly salient for hybrid systems, wherein different types of qubits evolve and decohere at vastly different rates. Here we present the integration of dynamical decoupling into quantum gates for a paradigmatic hybrid system, the electron-nuclear spin register. Our design harnesses the internal resonance in the coupled-spin system to resolve the conflict between gate operation and decoupling. We experimentally demonstrate these gates on a two-qubit register in diamond operating at room temperature. Quantum tomography reveals that the qubits involved in the gate operation are protected as accurately as idle qubits. We further illustrate the power of our design by executing Grover's quantum search algorithm, achieving fidelities above 90% even though the execution time exceeds the electron spin dephasing time by two orders of magnitude. Our results directly enable decoherence-protected interface gates between different types of promising solid-state qubits. Ultimately, quantum gates with integrated decoupling may enable reaching the accuracy threshold for fault-tolerant quantum information processing with solid-state devices.Comment: This is original submitted version of the paper. The revised and finalized version is in print, and is subjected to the embargo and other editorial restrictions of the Nature journa

Mosquito nets in a rural area of Western Kenya: ownership, use and quality

<p>Abstract</p> <p>Background</p> <p>Insecticide-treated nets (ITNs) are regarded as one of the most effective strategies to prevent malaria in Africa. This study analyses the use and quality of nets owned by households in an area of high net coverage.</p> <p>Methods</p> <p>A structured questionnaire on ownership and use of nets was administered to the households of individuals sampled from a local health centre in south Kisii district, Kenya. A physical inspection of all the nets in the households was done and their conditions recorded on spot check forms designed for that purpose.</p> <p>Results</p> <p>Of the 670 households surveyed, 95% owned at least one net. Only 59% of household residents slept under a net during the night prior to the survey. 77% of those who slept under a net used an insecticide-treated net (ITN) or long-lasting insecticide-treated nets (LLIN). Out of 1,627 nets in the survey households, 40% were deemed to be of poor quality because of holes. Compared to other age groups, children aged 5-14 years were most likely to have slept under nets of poor quality (odds ratio 1.41; <it>p </it>= 0.007).</p> <p>Conclusions</p> <p>Although net ownership was high following increased delivery of ITNs, continuous promotion of effective maintenance and routine use is needed and efforts to replace damaged nets must be implemented.</p