Trends in catastrophic health expenditure in India: 1993 to 2014

OBJECTIVE: To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition. METHODS: We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-ofpocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. FINDINGS: Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993–1994 expenditure survey (12.4%) and the 2011–2012 expenditure survey (18.2%) and 2.24-fold between the 1995–1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76–3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31–2.89), with a female head (aOR: 1.32; 95% CI: 1.19–1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20–1.35). CONCLUSION: The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure

On the Complexity of an Unregulated Traffic Crossing

The steady development of motor vehicle technology will enable cars of the near future to assume an ever increasing role in the decision making and control of the vehicle itself. In the foreseeable future, cars will have the ability to communicate with one another in order to better coordinate their motion. This motivates a number of interesting algorithmic problems. One of the most challenging aspects of traffic coordination involves traffic intersections. In this paper we consider two formulations of a simple and fundamental geometric optimization problem involving coordinating the motion of vehicles through an intersection. We are given a set of $n$ vehicles in the plane, each modeled as a unit length line segment that moves monotonically, either horizontally or vertically, subject to a maximum speed limit. Each vehicle is described by a start and goal position and a start time and deadline. The question is whether, subject to the speed limit, there exists a collision-free motion plan so that each vehicle travels from its start position to its goal position prior to its deadline. We present three results. We begin by showing that this problem is NP-complete with a reduction from 3-SAT. Second, we consider a constrained version in which cars traveling horizontally can alter their speeds while cars traveling vertically cannot. We present a simple algorithm that solves this problem in $O(n \log n)$ time. Finally, we provide a solution to the discrete version of the problem and prove its asymptotic optimality in terms of the maximum delay of a vehicle

Prevalence and correlates of 'sexual competence' at first heterosexual intercourse among young people in Britain.

Background A greater understanding of the circumstances of first sexual intercourse, as opposed to an exclusive focus on age at occurrence, is required in order that sexual health and well-being can be promoted from the onset of sexual activity. Methods We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) conducted in Britain. Participants were categorised as ‘sexually competent’ at first heterosexual intercourse if the following self-reported criteria applied to the event: contraceptive use, autonomy of decision, both partners ‘equally willing’, and occurrence at the perceived ‘right time’. We examined the prevalence of ‘sexual competence’, and its component parts, by age at first intercourse among 17–24-year-olds. Using multivariable logistic regression, we explored associations between sexual competence and potential explanatory factors. Results Variation in ‘sexual competence’ and its component parts was associated with, but not fully explained by, age at first sex: 22.4% and 36.2% of men and women who had first sex at age 13–14 years were categorised as ‘sexually competent’, rising to 63.7% and 60.4% among those aged ≥18 years at first intercourse. Lack of sexual competence was independently associated with: first intercourse before the age of 16 years, area-level deprivation (men only), lower educational level, black ethnicity (women only), reporting ‘friends’ as main source of learning about sex (women only), non-’steady’ relationship at first sex, and uncertainty of first partner’s virginity status. Conclusions A substantial proportion of young people in Britain transition into sexual activity under circumstances incompatible with positive sexual health. Social inequalities in sexual health are reflected in the context of first intercours

Deep 230-470 MHz VLA observations of the mini-halo in the Perseus cluster

© 2017 The Authors. We present a low-frequency view of the Perseus cluster with new observations from the Karl G. Jansky Very Large Array (JVLA) at 230-470 MHz. The data reveal a multitude of new structures associated with the mini-halo. The mini-halo seems to be influenced both by the AGN activity and the sloshing motion of the cool core cluster's gas. In addition, it has a filamentary structure similar to that seen in radio relics found in merging clusters. We present a detailed description of the data reduction and imaging process of the dataset. The depth and resolution of the observations allow us to conduct for the first time a detailed comparison of the mini-halo structure with the X-ray structure as seen in the Chandra X-ray images. The resulting image very clearly shows that the mini-halo emission is mostly contained behind the western cold front, similar to that predicted by simulations of gas sloshing in galaxy clusters, but fainter emission is also seen beyond, as if particles are leaking out. However, due to the proximity of the Perseus cluster, as well as the quality of the data at low radio frequencies and at X-ray wavelengths, we also find evidence of fine structure. This structure includes several radial radio filaments extending in different directions, a concave radio structure associated with the southern X-ray bay and sharp radio edges that correlate with X-ray edges. Minihaloes are therefore not simply diffuse, uniform radio sources, but rather have a rich variety of complex structures. These results illustrate the high-quality images that can be obtained with the new JVLA at low radio frequencies, as well as the necessity to obtain deeper, higher fidelity radio images of mini-haloes in clusters to further understand their origin

Reducing vortex density in superconductors using the ratchet effect

A serious obstacle that impedes the application of low and high temperature superconductor (SC) devices is the presence of trapped flux. Flux lines or vortices are induced by fields as small as the Earth's magnetic field. Once present, vortices dissipate energy and generate internal noise, limiting the operation of numerous superconducting devices. Methods used to overcome this difficulty include the pinning of vortices by the incorporation of impurities and defects, the construction of flux dams, slots and holes and magnetic shields which block the penetration of new flux lines in the bulk of the SC or reduce the magnetic field in the immediate vicinity of the superconducting device. Naturally, the most desirable would be to remove the vortices from the bulk of the SC. There is no known phenomenon, however, that could form the basis for such a process. Here we show that the application of an ac current to a SC that is patterned with an asymmetric pinning potential can induce vortex motion whose direction is determined only by the asymmetry of the pattern. The mechanism responsible for this phenomenon is the so called ratchet effect, and its working principle applies to both low and high temperature SCs. As a first step here we demonstrate that with an appropriate choice of the pinning potential the ratchet effect can be used to remove vortices from low temperature SCs in the parameter range required for various applications.Comment: 7 pages, 4 figures, Nature (in press

How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England.

BACKGROUND: Studies have been published regarding the impact of major system change (MSC) on care quality and outcomes, but few evaluate implementation costs or include them in cost-effectiveness analysis (CEA). This is despite large potential costs of MSC: change planning, purchasing or repurposing assets, and staff time. Implementation costs can influence implementation decisions. We describe our framework and principles for costing MSC implementation and illustrate them using a case study. METHODS: We outlined MSC implementation stages and identified components, using a framework conceived during our work on MSC in stroke services. We present a case study of MSC of specialist surgery services for prostate, bladder, renal and oesophagogastric cancers, focusing on North Central and North East London and West Essex. Health economists collaborated with qualitative researchers, clinicians and managers, identifying key reconfiguration stages and expenditures. Data sources (n = approximately 100) included meeting minutes, interviews, and business cases. National Health Service (NHS) finance and service managers and clinicians were consulted. Using bottom-up costing, items were identified, and unit costs based on salaries, asset costs and consultancy fees assigned. Itemised costs were adjusted and summed. RESULTS: Cost components included options appraisal, bidding process, external review; stakeholder engagement events; planning/monitoring boards/meetings; and making the change: new assets, facilities, posts. Other considerations included hospital tariff changes; costs to patients; patient population; and lifetime of changes. Using the framework facilitated data identification and collection. The total adjusted implementation cost was estimated at £7.2 million, broken down as replacing robots (£4.0 million), consultancy fees (£1.9 million), staff time costs (£1.1 million) and other costs (£0.2 million). CONCLUSIONS: These principles can be used by funders, service providers and commissioners planning MSC and researchers evaluating MSC. Health economists should be involved early, alongside qualitative and health-service colleagues, as retrospective capture risks information loss. These analyses are challenging; many cost factors are difficult to identify, access and measure, and assumptions regarding lifetime of the changes are important. Including implementation costs in CEA might make MSC appear less cost effective, influencing future decisions. Future work will incorporate this implementation cost into the full CEAs of the London Cancer MSC. TRIAL REGISTRATION: Not applicable

Some Like It Fat: Comparative Ultrastructure of the Embryo in Two Demosponges of the Genus Mycale (Order Poecilosclerida) from Antarctica and the Caribbean

0000-0002-7993-1523© 2015 Riesgo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License [4.0], which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The attached file is the published version of the article

Measuring Fluorescent Dye in the Bubbly and Sediment-Laden Surfzone

Decisions about recreational beach closures would be enhanced if better estimates of surfzone contaminant transport and dilution were available. In situ methods for measuring fluorescent Rhodamine WT dye tracer in the surfzone are presented, increasing the temporal and spatial resolution over previous surfzone techniques. Bubbles and sand suspended by breaking waves in the surfzone interfere with in situ optical fluorometer dye measurements, increasing the lower bound for dye detection (≈ 1 ppb) and reducing (quenching) measured dye concentrations. Simultaneous turbidity measurements are used to estimate the level of bubble and sand interference and correct dye estimates. After correction, root-mean-square dye concentration errors are estimated to be < 5% of dye concentration magnitude, thus demonstrating the viability of in situ surfzone fluorescent dye measurements. The surfzone techniques developed here may be applicable to other environments with high bubble and sand concentrations (e.g., cascading rivers and streams)

Improving fleet solution – a case study

Transportation management is a logistical activity with a high impact on a company’s ability to compete in the market. Although the focus on cost reduction is the most usual concern with this activity, lead times and the quality of the service provided should also be considered depending on the market to be served. The goal of this research was to compare different fleet alternatives for a specific construction materials company and discuss which scenario is the most suited to fulfil the company’s customer service policy. A case study approach was developed, and four alternative scenarios were considered. These were compared both regarding the costs they involve, which was analysed using a vehicle routing problem heuristic, and the quality of the customer service they allow, which was assessed based on their ability to provide flexibility in the fleet occupancy rate to respond to unexpected orders. Evidence showed that the current fleet solution is not adequate and investment should be made only if the demand level increases, otherwise outsourcing should be considered along with a minimum level of the self-owned fleet.info:eu-repo/semantics/acceptedVersio