Stationary phase slip state in quasi-one-dimensional rings

The nonuniform superconducting state in a ring in which the order parameter vanishing at one point is studied. This state is characterized by a jump of the phase by $\pi$ at the point where the order parameter becomes zero. In uniform rings such a state is a saddle-point state and consequently unstable. However, for non-uniform rings with e.g. variations of geometrical or physical parameters or with attached wires this state can be stabilized and may be realized experimentally.Comment: 6 pages, 7 figures, RevTex 4.0 styl

Purchasing for high-quality care using national health insurance: evidence from Zambia

Improving the quality of care is essential for progress toward universal health coverage. Health financing arrangements offer opportunities for governments to incentivize and reward improvements in the quality of care provided. This study examines the extent to which the purchasing arrangements established within Zambia's new National Health Insurance can improve equitable access to high-quality care. We adopt the Strategic Purchasing Progress and the Lancet Commission for High-Quality Health Systems frameworks to critically examine the broader health system and the purchasing dimensions of this insurance scheme and its implications for quality care. We reviewed policy documents and conducted 31 key-informant interviews with stakeholders at national, sub-national, and health facility levels. We find that the new health insurance could boost financial resources in higher-levels of care, improve access to high-cost interventions and improve care experiences for its beneficiaries as well as integrate the public and private sectors. Our findings also suggest that the health insurance will likely improve some aspects of structural quality but may not be able to influence process and outcome measures of quality. It is also not clear if health insurance will improve efficiency in service delivery, and whether benefits realized will be distributed in an equitable manner. These potential limitations are attributable to the existing governance and financial challenges, low investments in primary care, and shortcomings in the design and implementation of the purchasing arrangements of health insurance. Although Zambia has made progress in a short span, there is a need to improve its provider payment mechanisms, and monitoring and accounting for higher quality of care

A Multinational Analysis of Mutations and Heterogeneity in PZase, RpsA, and PanD Associated with Pyrazinamide Resistance in M/XDR Mycobacterium tuberculosis.

Pyrazinamide (PZA) is an important first-line drug in all existing and new tuberculosis (TB) treatment regimens. PZA-resistance in M. tuberculosis is increasing, especially among M/XDR cases. Noted issues with PZA Drug Susceptibility Testing (DST) have driven the search for alternative tests. This study provides a comprehensive assessment of PZA molecular diagnostics in M/XDR TB cases. A set of 296, mostly XDR, clinical M. tuberculosis isolates from four countries were subjected to DST for eight drugs, confirmatory Wayne's assay, and whole-genome sequencing. Three genes implicated in PZA resistance, pncA, rpsA, and panD were investigated. Assuming all non-synonymous mutations cause resistance, we report 90% sensitivity and 65% specificity for a pncA-based molecular test. The addition of rpsA and panD potentially provides 2% increase in sensitivity. Molecular heterogeneity in pncA was associated with resistance and should be evaluated as a diagnostic tool. Mutations near the N-terminus and C-terminus of PZase were associated with East-Asian and Euro-American lineages, respectively. Finally, Euro-American isolates are most likely to have a wild-type PZase and escape molecular detection. Overall, the 8-10% resistance without markers may point to alternative mechanisms of resistance. Confirmatory mutagenesis may improve the disconcertingly low specificity but reduce sensitivity since not all mutations may cause resistance

Health insurance coverage in low-income and middle-income countries: progress made to date and related changes in private and public health expenditure

INTRODUCTION: Several low-income and middle-income countries (LMICs) have implemented health insurance programmes to foster accessibility to healthcare and reduce catastrophic household health expenditure. However, there is little information regarding the population coverage of health insurance schemes in LMICs and on the relationship between coverage and health expenditure. This study used open-access data to assess the level of health insurance coverage in LMICs and its relationship with health expenditure. METHODS: We searched for health insurance data for all LMICs and combined this with health expenditure data. We used descriptive statistics to explore levels of and trends in health insurance coverage over time. We then used linear regression models to investigate the relationship between health insurance coverage and sources of health expenditure and catastrophic household health expenditure. RESULTS: We found health insurance data for 100 LMICs and combined this with overall health expenditure data for 99 countries and household health expenditure data for 89 countries. Mean health insurance coverage was 31.1% (range: 0%-98.7%), with wide variations across country-income groups. Average health insurance coverage was 7.9% in low-income countries, 27.3% in lower middle-income countries and 52.5% in upper middle-income countries. We did not find any association between health insurance coverage and health expenditure overall, though coverage was positively associated with public health spending. Additionally, health insurance coverage was not associated with levels of or reductions in catastrophic household health expenditure or impoverishment due to health expenditure. CONCLUSION: These findings indicate that LMICs continue to have low levels of health insurance coverage and that health insurance may not necessarily reduce household health expenditure. However, the lack of regular estimates of health insurance coverage in LMICs does not allow us to draw solid conclusions on the relationship between health insurance coverage and health expenditure

A high resolution, hard x-ray photoemission investigation of La_(2-2x)Sr_(1+2x)Mn_2O_7 (0.30<x<0.50): on microscopic phase separation and the surface electronic structure of a bilayered CMR manganite

Photoemission data taken with hard x-ray radiation on cleaved single crystals of the bilayered, colossal magnetoresistant manganite La_(2-2x)Sr_(1+2x)Mn_2O_7 (LSMO) with 0.30<x<0.50 are presented. Making use of the increased bulk-sensitivity upon hard x-ray excitation it is shown that the core level footprint of the electronic structure of the LSMO cleavage surface is identical to that of the bulk. Furthermore, by comparing the core level shift of the different elements as a function of doping level x, it is shown that microscopic phase separation is unlikely to occur for this particular manganite well above the Curie temperature.Comment: 7 pages, 5 figure

Paramagnetic Meissner effect in superconductors from self-consistent solutions of Ginzburg-Landau equations

The paramagnetic Meissner effect (PME) is observed in small superconducting samples, and a number of controversial explanations of this effect are proposed, but there is as yet no clear understanding of its nature. In the present paper PME is considered on the base of the Ginzburg-Landau theory (GL). The one-dimensional solutions are obtained in a model case of a long superconducting cylinder for different cylinder radii R, the GL-parameters \kappa and vorticities m. Acording to GL-theory, PME is caused by the presence of vortices inside the sample. The superconducting current flows around the vortex to screeen the vortex own field from the bulk of the sample. Another current flows at the boundary to screen the external field H from entering the sample. These screening currents flow in opposite directions and contribute with opposite signs to the total magnetic moment (or magnetization) of the sample. Depending on H, the total magnetization M may be either negative (diamagnetism), or positive (paramagnetism). A very complicated saw-like dependence M(H) (and other characteristics), which are obtained on the base of self-consistent solutions of the GL-equations, are discussed.Comment: 6 pages, 5 figures, RevTex, submitted to Phys. Rev.

Developing a quality assurance metric: a panoptic view

This article is a post-print of the published article that may be accessed at the link below. Copyright @ 2006 Sage Publications.There are a variety of techniques that lecturers can use to get feedback on their teaching - for example, module feedback and coursework results. However, a question arises about how reliable and valid are the content that goes into these quality assurance metrics. The aim of this article is to present a new approach for collecting and analysing qualitative feedback from students that could be used as the first stage in developing more reliable quality assurance metrics. The approach, known as the multi-dimensional crystal view, is based on the belief that individuals have different views on the benefits that the embedded process in a system can have on the behaviour of the system. The results of this study indicate that in the context of evaluation and feedback methods, the multi-dimensional approach appears to provide the opportunity for developing more effective student feedback mechanisms

Equity in health insurance schemes enrollment in low and middle-income countries: a systematic review and meta-analysis

BACKGROUND: Ensuring access to essential quality health services and reducing financial hardship for all individuals regardless of their ability to pay are the main goals of universal health coverage. Various health insurance schemes have been recently implemented in low- and middle-income countries (LMICs) to achieve both of these objectives. We systematically reviewed all available literature to assess the extent to which current health insurance schemes truly reach the poor and underserved populations in LMICs. METHODS: In the systematic review, we searched on PubMed, Web of Science, EconLit and Google Scholar to identify eligible studies which captured health insurance enrollment information in LMICs from 2010 up to September 2019. Two authors independently selected studies, extracted data, and appraised included studies. The primary outcome of interest was health insurance enrollment of the most vulnerable populations relative to enrollment of the best-off subgroups. We classified households both with respect to their highest educational attainment and their relative wealth and used random-effects meta-analysis to estimate average enrollment gaps. RESULTS: 48 studies from 17 countries met the inclusion criteria. The average enrollment rate into health insurance schemes for vulnerable populations was 36% with an inter-quartile range of 26%. On average, across countries, households from the wealthiest subgroup had 61% higher odds (95% CI: 1.49 to 1.73) of insurance enrollment than households in the poorest group in the same country. Similarly, the most educated groups had 64% (95% CI: 1.32 to 1.95) higher odds of enrollment than the least educated groups. CONCLUSION: The results of this study show that despite major efforts by governments, health insurance schemes in low-and middle-income countries are generally not reaching the targeted underserved populations and predominantly supporting better-off population groups. Current health insurance designs should be carefully scrutinized, and the extent to which health insurance can be used to support the most vulnerable populations carefully re-assessed by countries, which are aiming to use health insurance schemes as means to reach their UHC goals. Furthermore, studies exploring best practices to include vulnerable groups in health insurance schemes are needed. REGISTRATION: Not available