Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali.

Malaria is the most common cause of morbidity and mortality in children under 5 in Mali. Health centres provide primary care, including malaria treatment, under a system of cost recovery. In 2005, Médecins sans Frontieres (MSF) started supporting health centres in Kangaba with the provision of rapid malaria diagnostic tests and artemisinin-based combination therapy. Initially MSF subsidized malaria tests and drugs to reduce the overall cost for patients. In a second phase, MSF abolished fees for all children under 5 irrespective of their illness and for pregnant women with fever. This second phase was associated with a trebling of both primary health care utilization and malaria treatment coverage for these groups. MSF's experience in Mali suggests that removing user fees for vulnerable groups significantly improves utilization and coverage of essential health services, including for malaria interventions. This effect is far more marked than simply subsidizing or providing malaria drugs and diagnostic tests free of charge. Following the free care strategy, utilization of services increased significantly and under-5 mortality was reduced. Fee removal also allowed for more efficient use of existing resources, reducing average cost per patient treated. These results are particularly relevant for the context of Mali and other countries with ambitious malaria treatment coverage objectives, in accordance with the United Nations Millennium Development Goals. This article questions the effectiveness of the current national policy, and the effectiveness of reducing the cost of drugs only (i.e. partial subsidies) or providing malaria tests and drugs free for under-5s, without abolishing other related fees. National and international budgets, in particular those that target health systems strengthening, could be used to complement existing subsidies and be directed towards effective abolition of user fees. This would contribute to increasing the impact of interventions on population health and, in turn, the effectiveness of aid

Gain properties of dye-doped polymer thin films

Hybrid pumping appears as a promising compromise in order to reach the much coveted goal of an electrically pumped organic laser. In such configuration the organic material is optically pumped by an electrically pumped inorganic device on chip. This engineering solution requires therefore an optimization of the organic gain medium under optical pumping. Here, we report a detailed study of the gain features of dye-doped polymer thin films. In particular we introduce the gain efficiency $K$, in order to facilitate comparison between different materials and experimental conditions. The gain efficiency was measured with various setups (pump-probe amplification, variable stripe length method, laser thresholds) in order to study several factors which modify the actual gain of a layer, namely the confinement factor, the pump polarization, the molecular anisotropy, and the re-absorption. For instance, for a 600 nm thick 5 wt\% DCM doped PMMA layer, the different experimental approaches give a consistent value $K\simeq$ 80 cm.MW$^{-1}$. On the contrary, the usual model predicting the gain from the characteristics of the material leads to an overestimation by two orders of magnitude, which raises a serious problem in the design of actual devices. In this context, we demonstrate the feasibility to infer the gain efficiency from the laser threshold of well-calibrated devices. Besides, temporal measurements at the picosecond scale were carried out to support the analysis.Comment: 15 pages, 17 figure

An insight into polarization states of solid-state organic lasers

The polarization states of lasers are crucial issues both for practical applications and fundamental research. In general, they depend in a combined manner on the properties of the gain material and on the structure of the electromagnetic modes. In this paper, we address this issue in the case of solid-state organic lasers, a technology which enables to vary independently gain and mode properties. Different kinds of resonators are investigated: in-plane micro-resonators with Fabry-Perot, square, pentagon, stadium, disk, and kite shapes, and external vertical resonators. The degree of polarization P is measured in each case. It is shown that although TE modes prevail generally (P>0), kite-shaped micro-laser generates negative values for P, i.e. a flip of the dominant polarization which becomes mostly TM polarized. We at last investigated two degrees of freedom that are available to tailor the polarization of organic lasers, in addition to the pump polarization and the resonator geometry: upon using resonant energy transfer (RET) or upon pumping the laser dye to an higher excited state. We then demonstrate that significantly lower P factors can be obtained.Comment: 12 pages, 12 figure

ALMA captures feeding and feedback from the active galactic nucleus in NGC 613

We report ALMA observations of CO(3-2) emission in the Seyfert/nuclear starburst galaxy NGC 613, at a spatial resolution of 17 pc, as part of our NUclei of GAlaxies (NUGA) sample. Our aim is to investigate the morphology and dynamics of the gas inside the central kiloparsec, and to probe nuclear fueling and feedback phenomena. The morphology of CO(3-2) line emission reveals a two-arm trailing nuclear spiral at r≤ 100 pc and a circumnuclear ring at a radius of ∼350 pc that is coincident with the star-forming ring seen in the optical images. Also, we find evidence for a filamentary structure connecting the ring and the nuclear spiral. The ring reveals two breaks into two winding spiral arms corresponding to the dust lanes in the optical images. The molecular gas in the galaxy disk is in a remarkably regular rotation, however the kinematics in the nuclear region are very skewed. The nuclear spectrum of CO and dense gas tracers HCN(4-3), HCO+(4-3), and CS(7-6) show broad wings up to \ub1300 km s-1, associated with a molecular outflow emanating from the nucleus (r ∼ 25 pc). We derive a molecular outflow mass Mout=2 7 106 M⊙ and a mass outflow rate of M out = 27 M⊙ yr-1. The molecular outflow energetics exceed the values predicted by AGN feedback models: the kinetic power of the outflow corresponds to PK, out=20%LAGN and the momentum rate is M outv ∼400LAGN/c. The outflow is mainly boosted by the AGN through entrainment by the radio jet, but given the weak nuclear activity of NGC 613, we might be witnessing a fossil outflow resulting from a previously strong AGN that has now faded. Furthermore, the nuclear trailing spiral observed in CO emission is inside the inner Lindblad resonance ring of the bar. We compute the gravitational torques exerted in the gas to estimate the efficiency of the angular momentum exchange. The gravity torques are negative from 25 to 100 pc and the gas loses its angular momentum in a rotation period, providing evidence for a highly efficient inflow towards the center. This phenomenon shows that the massive central black hole has significant dynamical influence on the gas, triggering the inflowing of molecular gas to feed the black hole

Multi-phase characterization of AGN winds in 5 local type-2 quasars

We present MEGARA (Multi-Espectr\'ografo en GTC de Alta Resoluci\'on para Astronom\'ia) Integral Field Unit (IFU) observations of 5 local type-2 quasars (QSO2s, z $\sim 0.1$) from the Quasar Feedback (QSOFEED) sample. These active galactic nuclei (AGN) have bolometric luminosities of 10$^{45.5-46}$ erg/s and stellar masses of $\sim$10$^{11}$ M$_{\odot}$. We explore the kinematics of the ionized gas through the [O~III]$\lambda$5007 $\r{A}$ emission line. The nuclear spectra of the 5 QSO2s, extracted in a circular aperture of $\sim$ 1.2" ($\sim$ 2.2 kpc) in diameter, show signatures of high velocity winds in the form of broad (full width at half maximum; 1300$\leq$FWHM$\leq$2240 km/s and blueshifted components. We find that 4 out of the 5 QSO2s present outflows that we can resolve with our seeing-limited data, and they have radii ranging from 3.1 to 12.6 kpc. In the case of the two QSO2s with extended radio emission, we find that it is well-aligned with the outflows, suggesting that low-power jets might be compressing and accelerating the ionized gas in these radio-quiet QSO2s. In the four QSO2s with spatially resolved outflows, we measure ionized mass outflow rates of 3.3-6.5 Msun/yr when we use [S~II]-based densities, and of 0.7-1.6 Msun/yr when trans-auroral line-based densities are considered instead. We compare them with the corresponding molecular mass outflow rates (8 - 16 Msun/yr), derived from CO(2-1) ALMA observations at 0.2" resolution. Both phases show lower outflow mass rates than those expected from observational scaling relations where uniform assumptions on the outflow properties were adopted. This might be indicating that the AGN luminosity is not the only driver of massive outflows and/or that these relations need to be re-scaled using accurate outflow properties. We do not find a significant impact of the outflows on the global star formation rates.Comment: 24 pages, 13 figures and 4 tables. Accepted for publication in A&A; A&A 665, A55 (2023); doi: 10.1051/0004-6361/20234771

Multiphase characterization of AGN winds in five local type-2 quasars

SWe present MEGARA integral field unit (IFU) observations of five local type-2 quasars (QSO2s, z 0:1) from the Quasar Feedback (QSOFEED) sample. These active galactic nuclei (AGN) have bolometric luminosities of 045:546 erg s1 and stellar masses of 1011 M. The LR-V grating of MEGARA allows us to explore the kinematics of the ionized gas through the [O III]5007Å emission line. The nuclear spectra of the five QSO2s, extracted in a circular aperture of 1:200 (2.2 kpc) in diameter, matching the resolution of these seeing-limited observations, show signatures of high velocity winds in the form of broad (full width at half maximum, 1300 FWHM 2240 km s1) and blueshifted components. We found that four out of the five QSO2s present outflows that we can resolve with our seeing-limited data, and they have radii ranging from 3.1 to 12.6 kpc. In the case of the two QSO2s with extended radio emission, we found that it is well aligned with the outflows, suggesting that low-power jets might be compressing and accelerating the ionized gas in these radio-quiet QSO2s. In the four QSO2s with spatially resolved outflows, we measured ionized mass outflow rates of 3.3–6.5 M yr1 when we used [S II]-based densities, and of 0.7–1.6 M yr1 when trans-auroral line-based densities were considered instead. We compared them with the corresponding molecular mass outflow rates (8–16 M yr1), derived from CO(2–1) ALMA observations at 0.200 resolution. The cold molecular outflows carry more mass than their ionized counterparts. However, both phases show lower outflow mass rates than those expected from observational scaling relations where uniform assumptions on the outflow properties were adopted. This might be indicating that the AGN luminosity is not the only driver of massive outflows and/or that these relations need to be rescaled using accurate outflow properties (i.e., electron density and radius).We did not find a significant impact of the outflows on the global star formation rates when considering the energy budget of the molecular and ionized outflows together. However, spatially resolved measurements of recent star formation in these targets are needed in order to evaluate this fairly, considering the dynamical timescales of the outflows, of 3–20 Myr for the ionized gas and 1–10 Myr for the molecular gas

An expression signature of the angiogenic response in gastrointestinal neuroendocrine tumours: correlation with tumour phenotype and survival outcomes.

BACKGROUND: Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are heterogeneous with respect to biological behaviour and prognosis. As angiogenesis is a renowned pathogenic hallmark as well as a therapeutic target, we aimed to investigate the prognostic and clinico-pathological role of tissue markers of hypoxia and angiogenesis in GEP-NETs. METHODS: Tissue microarray (TMA) blocks were constructed with 86 tumours diagnosed from 1988 to 2010. Tissue microarray sections were immunostained for hypoxia inducible factor 1α (Hif-1α), vascular endothelial growth factor-A (VEGF-A), carbonic anhydrase IX (Ca-IX) and somatostatin receptors (SSTR) 1–5, Ki-67 and CD31. Biomarker expression was correlated with clinico-pathological variables and tested for survival prediction using Kaplan–Meier and Cox regression methods. RESULTS: Eighty-six consecutive cases were included: 51% male, median age 51 (range 16–82), 68% presenting with a pancreatic primary, 95% well differentiated, 51% metastatic. Higher grading (P=0.03), advanced stage (P<0.001), high Hif-1α and low SSTR-2 expression (P=0.03) predicted for shorter overall survival (OS) on univariate analyses. Stage, SSTR-2 and Hif-1α expression were confirmed as multivariate predictors of OS. Median OS for patients with SSTR-2+/Hif-1α-tumours was not reached after median follow up of 8.8 years, whereas SSTR-2-/Hif-1α+ GEP-NETs had a median survival of only 4.2 years (P=0.006). CONCLUSION: We have identified a coherent expression signature by immunohistochemistry that can be used for patient stratification and to optimise treatment decisions in GEP-NETs independently from stage and grading. Tumours with preserved SSTR-2 and low Hif-1α expression have an indolent phenotype and may be offered less aggressive management and less stringent follow up

Molecular excitation in the Interstellar Medium: recent advances in collisional, radiative and chemical processes

We review the different excitation processes in the interstellar mediumComment: Accepted in Chem. Re

Maintaining quality of health services after abolition of user fees: A Uganda case study

<p>Abstract</p> <p>Background</p> <p>It has been argued that quality improvements that result from user charges reduce their negative impact on utilization especially of the poor. In Uganda, because there was no concrete evidence for improvements in quality of care following the introduction of user charges, the government abolished user fees in all public health units on 1^stMarch 2001. This gave us the opportunity to prospectively study how different aspects of quality of care change, as a country changes its health financing options from user charges to free services, in a developing country setting. The outcome of the study may then provide insights into policy actions to maintain quality of care following removal of user fees.</p> <p>Methods</p> <p>A population cohort and representative health facilities were studied longitudinally over 3 years after the abolition of user fees. Quantitative and qualitative methods were used to obtain data. Parameters evaluated in relation to quality of care included availability of drugs and supplies and; health worker variables.</p> <p>Results</p> <p>Different quality variables assessed showed that interventions that were put in place were able to maintain, or improve the technical quality of services. There were significant increases in utilization of services, average drug quantities and stock out days improved, and communities reported health workers to be hardworking, good and dedicated to their work to mention but a few. Communities were more appreciative of the services, though expectations were lower. However, health workers felt they were not adequately motivated given the increased workload.</p> <p>Conclusion</p> <p>The levels of technical quality of care attained in a system with user fees can be maintained, or even improved without the fees through adoption of basic, sustainable system modifications that are within the reach of developing countries. However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should guide such a policy change.</p