GOVERNMENT MARKET INTERVENTION: AN ECONOMETRIC STUDY OF TANZANIAN FOOD GRAIN MARKETS

The paper is organized into six major sections. Background and trends in agricultural production and trade are presented in Section II. The extent of government intervention in food grain production and trade is described in Section III. This provides a foundation for Section IV where the behavioral equations for defining government intervention in food grain markets are specified. These equations, along with the retail demand and farm level supply equations, yield six equations in six endogenous variables for each of the food grain crops, maize, wheat and rice. It is shown in Section V that the model provides a good fit to the data. In the concluding sections, simulations are performed to obtain insights into the effect on and motivation for government intervention in food grain markets.Agricultural and Food Policy,

Addressing the Challenges of Globalization: An Independent Evaluation of the World Bank's Approach to Global Programs

Following on a phase 1 report completed in 2002 and a meta-evaluation in 2003, this report evaluates the World Bank's involvement in global programs using 26 case studies, including Global Water Partnership and Water and Sanitation Program. Given the rapid acceleration of Bank involvement in global and regional programs at this time, the report sought to derive lessons for the design and implementation of individual global programs and for the development of a broader strategic framework involving program selectivity, governance, management, financing and evaluation. Case studies were assessed for relevance, efficacy, efficiency, and bank performance

Association of cardiac rehabilitation and health-related quality of life following acute myocardial infarction

OBJECTIVE: To study the association of cardiac rehabilitation and physical activity with temporal changes in health-related quality of life (HRQoL) following acute myocardial infarction (AMI). METHODS: Evaluation of the Methods and Management of Acute Coronary Events-3 is a nationwide longitudinal prospective cohort study of 4570 patients admitted with an AMI between 1 November 2011 and 17 September 2013. HRQoL was estimated using EuroQol 5-Dimension-3 Level Questionnaire at hospitalisation, 30 days, and 6 and 12 months following hospital discharge. The association of cardiac rehabilitation and self-reported physical activity on temporal changes in HRQoL was quantified using inverse probability of treatment weighting propensity score and multilevel regression analyses. RESULTS: Cardiac rehabilitation attendees had higher HRQoL scores than non-attendees at 30 days (mean EuroQol 5-Visual Analogue Scale (EQ-VAS) scores: 71.0 (SD 16.8) vs 68.6 (SD 19.8)), 6 months (76.0 (SD 16.4) vs 70.2 (SD 19.0)) and 12 months (76.9 (SD 16.8) vs 70.4 (SD 20.4)). Attendees who were physically active ≥150 min/week had higher HRQoL scores compared with those who only attended cardiac rehabilitation at 30 days (mean EQ-VAS scores: 79.3 (SD 14.6) vs 70.2 (SD 17.0)), 6 months (82.2 (SD 13.9) vs 74.9 (SD 16.7)) and 12 months (84.1 (SD 12.1) vs 75.6 (SD 17.0)). Cardiac rehabilitation and self-reported physical activity of ≥150 min/week were each positively associated with temporal improvements in HRQoL (coefficient: 2.12 (95% CI 0.68 to 3.55) and 4.75 (95% CI 3.16 to 6.34), respectively). CONCLUSIONS: Cardiac rehabilitation was independently associated with temporal improvements in HRQoL at up to 12 months following hospitalisation, with such changes further improved in patients who were physically active

Phenotypic and functional analyses show stem cell-derived hepatocyte-like cells better mimic fetal rather than adult hepatocytes

Background & Aims: Hepatocyte-like cells (HLCs), differentiated from pluripotent stem cells by the use of soluble factors, can model human liver function and toxicity. However, at present HLC maturity and whether any deficit represents a true fetal state or aberrant differentiation is unclear and compounded by comparison to potentially deteriorated adult hepatocytes. Therefore, we generated HLCs from multiple lineages, using two different protocols, for direct comparison with fresh fetal and adult hepatocytes. Methods: Protocols were developed for robust differentiation. Multiple transcript, protein and functional analyses compared HLCs to fresh human fetal and adult hepatocytes. Results: HLCs were comparable to those of other laboratories by multiple parameters. Transcriptional changes during differentiation mimicked human embryogenesis and showed more similarity to pericentral than periportal hepatocytes. Unbiased proteomics demonstrated greater proximity to liver than 30 other human organs or tissues. However, by comparison to fresh material, HLC maturity was proven by transcript, protein and function to be fetal-like and short of the adult phenotype. The expression of 81% phase 1 enzymes in HLCs was significantly upregulated and half were statistically not different from fetal hepatocytes. HLCs secreted albumin and metabolized testosterone (CYP3A) and dextrorphan (CYP2D6) like fetal hepatocytes. In seven bespoke tests, devised by principal components analysis to distinguish fetal from adult hepatocytes, HLCs from two different source laboratories consistently demonstrated fetal characteristics. Conclusions: HLCs from different sources are broadly comparable with unbiased proteomic evidence for faithful differentiation down the liver lineage. This current phenotype mimics human fetal rather than adult hepatocytes

The effect of Young's modulus on the neuronal differentiation of mouse embryonic stem cells

There is substantial evidence that cells produce a diverse response to changes in ECM stiffness depending on their identity. Our aim was to understand how stiffness impacts neuronal differentiation of embryonic stem cells (ESC's), and how this varies at three specific stages of the differentiation process. In this investigation, three effects of stiffness on cells were considered; attachment, expansion and phenotypic changes during differentiation. Stiffness was varied from 2 kPa to 18 kPa to finally 35 kPa. Attachment was found to decrease with increasing stiffness for both ESC's (with a 95% decrease on 35 kPa compared to 2 kPa) and neural precursors (with a 83% decrease on 35 kPa). The attachment of immature neurons was unaffected by stiffness. Expansion was independent of stiffness for all cell types, implying that the proliferation of cells during this differentiation process was independent of Young's modulus. Stiffness had no effect upon phenotypic changes during differentiation for mESC's and neural precursors. 2 kPa increased the proportion of cells that differentiated from immature into mature neurons. Taken together our findings imply that the impact of Young's modulus on attachment diminishes as neuronal cells become more mature. Conversely, the impact of Young's modulus on changes in phenotype increased as cells became more mature

Seismic geomorphology of cretaceous megaslides offshore Namibia (Orange Basin):Insights into segmentation and degradation of gravity-driven linked systems

This study applies modern seismic geomorphology techniques to deep-water collapse features in the Orange Basin (Namibian margin, Southwest Africa) in order to provide unprecedented insights into the segmentation and degradation processes of gravity-driven linked systems. The seismic analysis was carried out using a high-quality, depth-migrated 3D volume that images the Upper Cretaceous post-rift succession of the basin, where two buried collapse features with strongly contrasting seismic expression are observed. The lower Megaslide Complex is a typical margin-scale, extensional-contractional gravity-driven linked system that deformed at least 2 km of post-rift section. The complex is laterally segmented into scoop-shaped megaslides up to 20 km wide that extend downdip for distances in excess of 30 km. The megaslides comprise extensional headwall fault systems with associated 3D rollover structures and thrust imbricates at their toes. Lateral segmentation occurs along sidewall fault systems which, in the proximal part of the megaslides, exhibit oblique extensional motion and define horst structures up to 6 km wide between individual megaslides. In the toe areas, reverse slip along these same sidewall faults, creates lateral ramps with hanging wall thrust-related folds up to 2 km wide. Headwall rollover anticlines, sidewall horsts and ramp anticlines may represent novel traps for hydrocarbon exploration on the Namibian margin.The Megaslide Complex is unconformably overlain by few hundreds of metres of highly contorted strata which define an upper Slump Complex. Combined seismic attributes and detailed seismic facies analysis allowed mapping of headscarps, thrust imbrications and longitudinal shear zones within the Slump Complex that indicate a dominantly downslope movement of a number of coalesced collapse systems. Spatial and stratal relationships between these shallow failures and the underlying megaslides suggest that the Slump Complex was likely triggered by the development of topography created by the activation of the main structural elements of the lower Megaslide Complex. This study reveals that gravity-driven linked systems undergo lateral segmentation during their evolution, and that their upper section can become unstable, favouring the initiation of a number of shallow failures that produce widespread degradation of the underlying megaslide structures. Gravity-driven linked systems along other margins are likely to share similar processes of segmentation and degradation, implying that the megaslide-related, hydrocarbon trapping structures discovered in the Namibian margin may be common elsewhere, making megaslides an attractive element of deep-water exploration along other gravitationally unstable margins

Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study

Contains fulltext : 80758.pdf (publisher's version ) (Open Access)BACKGROUND: Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. METHODS: A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. RESULTS: GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. CONCLUSION: GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme