Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.

ABSTRACT: BACKGROUND: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. METHODS: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. RESULTS: Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. CONCLUSION: The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty

Magnetic relaxation of a system of superparamagnetic particles weakly coupled by dipole-dipole interactions

The effect of long range dipole-dipole interactions on the thermal fluctuations of the magnetization of an assembly of single-domain ferromagnetic particles is considered. If orientational correlations between the particles are neglected, the evolution of the magnetization orientations may be described by a nonlinear Fokker-Planck equation (FPE) reducing to the usual linear one in the limit of infinite dilution [W.F. Brown Jr, Phys. Rev. 130, 1677 (1963)]. The thermally activated relaxation time scale of the assembly is estimated, leading to a simple modification of the axially symmetric asymptotes for the superparamagnetic relaxation time.Comment: 31 pages, 3 figures, regular articl

Contribution of the stochastic forces to the fluctuation theorem

In some recent papers, the use of random forces has been related to a systematic breakdown of the fluctuation theorem. In the framework of nonequilibrium molecular dynamics, we provide a derivation of this theorem for systems driven by both deterministic and stochastic forces. It turns out that it is still valid and describes the total dissipation, explicitly the sum of two dimensionless works for which fluctuation relations may fail. We numerically study their range of validity, comment on experimental results, and point out in which limit a noise can be neglected

Identifying policy gaps in a COVID-19 online tool using the five-factor framework

Introduction: Worldwide health systems are being faced with unprecedented COVID-19-related challenges, ranging from the problems of a novel condition and a shortage of personal protective equipment to frequently changing medical guidelines. Many institutions were forced to innovate and many hospitals, as well as telehealth providers, set up online forward triage tools (OFTTs). Using an OFTT before visiting the emergency department or a doctor's practice became common practice. A policy can be defined as what an institution or government chooses to do or not to do. An OFTT, in this case, has become both a policy and a practice. Methods: The study was part of a broader multiphase sequential explanatory design. First, an online survey was carried out using a questionnaire to n = 176 patients who consented during OFTT usage. Descriptive analysis was carried out to identify who used the tool, for what purpose, and if the participant followed the recommendations. The quantitative results shaped the interview guide's development. Second, in-depth interviews were held with a purposeful sample of n = 19, selected from the OFTT users who had consented to a further qualitative study. The qualitative findings were meant to explain the quantitative results. Third, in-depth interviews were held with healthcare providers and authorities (n = 5) that were privy to the tool. Framework analysis was adopted using the five-factor framework as a lens with which to analyze the qualitative data only. Results: The five-factor framework proved useful in identifying gaps that affected the utility of the COVID-19 OFTT. The identified gaps could fit and be represented by five factors: primary, secondary, tertiary, and extraneous factors, along with a lack of systems thinking. Conclusion: A theory or framework provides a road map to systematically identify those factors affecting policy implementation. Knowing how and why policy practice gaps come about in a COVID-19 OFFT context facilitates better future OFTTs. The framework in this study, although developed in a universal health coverage (UHC) context in South Africa, proved useful in a telehealth context in Switzerland, in Europe. The importance of systems thinking in developing digital tools cannot be overemphasized. © 2022 by the authors

Texture as a Diagnostic Signal in Mammograms

Radiologists can discriminate between normal and abnormal breast tissue at a glance, suggesting that radiologists might be using some “global signal” of abnormality. Our study investigated whether texture descriptions can be used to characterize the global signal of abnormality and whether radiologists use this information during interpretation. Synthetic images were generated using a texture synthesis algorithm trained on texture descriptions extracted from sections of mammograms. Radiologists completed a task that required rating the abnormality of briefly presented tissue sections. When the abnormal tissue had no visible lesion, radiologists seemed to use texture descriptions; performance was similar across real and synthesized tissue sections. However, when the abnormal tissue had a visible lesion, radiologists seemed to rely on additional mechanisms beyond the texture descriptions; performance increased for the real tissue sections. These findings suggest that radiologists can use texture descriptions as global signals of abnormality in interpretation of breast tissue

Metformin-mediated increase in DICER1 regulates microRNA expression and cellular senescence

Metformin, an oral hypoglycemic agent, has been used for decades to treat type 2 diabetes mellitus. Recent studies indicate that mice treated with metformin live longer and have fewer manifestations of age-related chronic disease. However, the molecular mechanisms underlying this phenotype are unknown. Here, we show that metformin treatment increases the levels of the microRNA-processing protein DICER1 in mice and in humans with diabetes mellitus. Our results indicate that metformin upregulates DICER1 through a post-transcriptional mechanism involving the RNA-binding protein AUF1. Treatment with metformin altered the subcellular localization of AUF1, disrupting its interaction with DICER1 mRNA and rendering DICER1 mRNA stable, allowing DICER1 to accumulate. Consistent with the role of DICER1 in the biogenesis of microRNAs, we found differential patterns of microRNA expression in mice treated with metformin or caloric restriction, two proven life-extending interventions. Interestingly, several microRNAs previously associated with senescence and aging, including miR-20a, miR-34a, miR-130a, miR-106b, miR-125, and let-7c, were found elevated. In agreement with these findings, treatment with metformin decreased cellular senescence in several senescence models in a DICER1- dependent manner. Metformin lowered p16 and p21 protein levels and the abundance of inflammatory cytokines and oncogenes that are hallmarks of the senescence-associated secretory phenotype (SASP). These data lead us to hypothesize that changes in DICER1 levels may be important for organismal aging and to propose that interventions that upregulate DICER1 expression (e.g., metformin) may offer new pharmacotherapeutic approaches for age-related disease

Nitric oxide and proteoglycan biosynthesis by human articular chondrocytes in alginate culture

AbstractInterleukin-1α and β induced the production of large amounts of nitric oxide by normal, human articular chondrocytes in alginate culture; at the same time the biosynthesis of proteoglycan was strongly suppressed. In a dose-dependent manner, NG-monomethyl-l-arginine both inhibited nitric oxide formation and relieved the suppression of proteoglycan synthesis. However concentrations of NG-monomethyl-l-arginine which completely prevented nitric oxide production only partially restored proteoglycan biosynthesis, even at low doses of interleukin-1 where suppression of proteoglycan synthesis was modest. The organic donor of nitric oxide, S-nitrosyl-acetyl-d,l- penicillamine also inhibited proteoglycan biosynthesis, but not as extensively as interleukin-1. These data suggest that interleukin-1 suppresses synthesis of the cartilaginous matrix through more than one mechanism, at least one of which is dependent upon the production of nitric oxide

Smart gateways for terabit/s satellite

To reach the terabit per second of throughput, telecommunication satellites cannot make use of frequency below Ka band only. Therefore, the use of broad portion of the spectrum available at Q/V (40/50 GHz) band is foreseen for the feeder link. This study presents the evaluation of performances of different macro-diversity schemes that may allow mitigating the deep fades experienced at Q/V bands by introducing cooperation and a limited redundancy between the different gateways of the system. Two different solutions are firstly described. The performances resulting from the use of those assumptions are derived in a second stage