Capacity for health economics research and practice in Jordan, Lebanon, the occupied Palestinian territories and Turkey: needs assessment and options for development

Background: Capacity for health economics analysis and research is indispensable for evidence-informed allocations of scarce health resources, however little is known about the experience and capacity strengthening preferences of academics and practitioners in the Eastern Mediterranean region. This study aimed to assess the needs for strengthening health economics capacity in Jordan, Lebanon, the occupied Palestinian territories and Turkey as part of the Research for Health in Conflict in Middle East and North Africa (R4HC-MENA) project. Methods: Bibliometric analysis of health economics outputs combined with an online survey of academic researchers and non-academic practitioners. The bibliometric analysis was based on a literature search conducted across seven databases. Included records were original studies and reviews with an explicit economic outcome related to health, disease or disability; had at least one author in Jordan, Lebanon, Palestine or Turkey; and were published between January 2014 and December 2018. Two types of analyses were conducted using VOSviewer software: keyword co-occurrence; and co-publication networks across countries and organizations. The online survey asked academic researchers, analysts and decision-makers – identified through the bibliometric analysis and regional professional networks – about previous exposure to and preference for capacity development in health economics. Results: Of 15,185 records returned by the literature search, 566 were included in the bibliometric analysis. Organizations in Turkey contributed more than 80% of records and had the broadest and most diverse network of collaborators, nationally and internationally. Only 1% (n=7) studies were collaborations between researchers in two or more different jurisdictions. Cost analysis, cost-effectiveness analysis and health system economics were the main health economics topics across the included studies. Economic evaluation, measuring the economic burden of disease and health equity were reported by survey respondents (n=80) as the most important areas to develop in. Short courses, learn-by-doing and mentoring from an experienced professional were, in aggregate, the most preferred capacity development modalities. Conclusions: Existing pockets of health economic expertise in the region can constitute the base of future capacity development efforts. Building confidence toward applying specific methods and trust toward stimulating cross-jurisdiction collaborations appear essential components for sustainably developing health economics capacity

On the geometry of Siegel-Jacobi domains

We study the holomorphic unitary representations of the Jacobi group based on Siegel-Jacobi domains. Explicit polynomial orthonormal bases of the Fock spaces based on the Siegel-Jacobi disk are obtained. The scalar holomorphic discrete series of the Jacobi group for the Siegel-Jacobi disk is constructed and polynomial orthonormal bases of the representation spaces are given.Comment: 15 pages, Latex, AMS fonts, paper presented at the the International Conference "Differential Geometry and Dynamical Systems", August 25-28, 2010, University Politehnica of Bucharest, Romani

Using formal methods to support testing

Formal methods and testing are two important approaches that assist in the development of high quality software. While traditionally these approaches have been seen as rivals, in recent years a new consensus has developed in which they are seen as complementary. This article reviews the state of the art regarding ways in which the presence of a formal specification can be used to assist testing

Cost-effectiveness of eye care services in Zambia.

OBJECTIVE: To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia. METHODS: Primary data on costs and health related quality of life were collected in a prospective cohort study of 170 cataract and 113 refractive error/presbyopia patients recruited from three health facilities. Six months later, follow-up data were available from 77 and 41 patients who had received cataract surgery and spectacles, respectively. Costs were determined from patient interviews and micro-costing at the three health facilities. Utility values were gathered by administering the EQ-5D quality of life instrument immediately before and six months after cataract surgery or acquiring spectacles. A probabilistic state-transition model was used to generate cost-effectiveness estimates with uncertainty ranges. RESULTS: Utility values significantly improved across the patient sample after cataract surgery and acquiring spectacles. Incremental costs per Quality Adjusted Life Years gained were US$259 for cataract surgery and US$ 375 for refractive error correction. The probabilities of the incremental cost-effectiveness ratios being below the Zambian gross national income per capita were 95% for both cataract surgery and refractive error correction. CONCLUSION: In spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions

On acceptance conditions for membrane systems: characterisations of L and NL

In this paper we investigate the affect of various acceptance conditions on recogniser membrane systems without dissolution. We demonstrate that two particular acceptance conditions (one easier to program, the other easier to prove correctness) both characterise the same complexity class, NL. We also find that by restricting the acceptance conditions we obtain a characterisation of L. We obtain these results by investigating the connectivity properties of dependency graphs that model membrane system computations

Occurrence and profiles of PCBs and PBDEs in harbour seals and harbour porpoises from the southern North Sea

Harbour porpoises (Phocoena phocoen) and harbour seals (Phoca vitulina), two representative top coastal pollution. Concentrations of sum PCBs were 1-2 orders of magnitude higher than concentrations of sum PBDEs (with median values of 23.1 μg.g- lw (lipid weight) and 12.4 μ.g-1 lw for sum PCBs and 0.33 μ.g- lw and 0.76 μ.g-1 lw for sum PBDEs in harbour seals and harbour porpoises respectively) and were highly dependent of age group and gender. For both species, the highest PCB concentrations were observed in adult males as the result of accumulation for years and years, while the highest PBDE concentrations were measured in juveniles probably due to better developed metabolic capacities for these congeners with age in adults. Results for PCBs were higher than observations in harbour seals and porpoises from other areas, while results for PBDEs were comparable indicating that the North Sea is a highly contaminated area. Relative PCB and PBDE profiles were constructed to compare metabolic capacities between harbour seals and porpoises. A higher contribution of lower chlorinated and nonpersistent congeners, such as CB 52, CB 95, CB 101, CB 118 and CB 149 indicated that harbour porpoises are unable to metabolize these compounds. Similar to PCBs, higher contributions of other PBDEs than BDE 47 were observed in harbour porpoises, suggesting that this species has difficulties to metabolize these congeners. In contrast, harbour seals showed a higher ability to metabolize PCBs and PBDEs

N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study

Background Contemporary reconsideration of diagnostic N-terminal pro–B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed. Objectives This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting. Methods Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (−) likelihood ratios (LRs) for acute HF. Results Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR− was 0.09 (95% CI: 0.05 to 0.13). Conclusions In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF

Gold-silver alloy nanoshells: a new candidate for nanotherapeutics and diagnostics

We have developed novel gold-silver alloy nanoshells as magnetic resonance imaging (MRI) dual T1 (positive) and T2 (negative) contrast agents as an alternative to typical gadolinium (Gd)-based contrast agents. Specifically, we have doped iron oxide nanoparticles with Gd ions and sequestered the ions within the core by coating the nanoparticles with an alloy of gold and silver. Thus, these nanoparticles are very innovative and have the potential to overcome toxicities related to renal clearance of contrast agents such as nephrogenic systemic fibrosis. The morphology of the attained nanoparticles was characterized by XRD which demonstrated the successful incorporation of Gd(III) ions into the structure of the magnetite, with no major alterations of the spinel structure, as well as the growth of the gold-silver alloy shells. This was supported by TEM, ICP-AES, and SEM/EDS data. The nanoshells showed a saturation magnetization of 38 emu/g because of the presence of Gd ions within the crystalline structure with r1 and r2 values of 0.0119 and 0.9229 mL mg-1 s-1, respectively (Au:Ag alloy = 1:1). T1- and T2-weighted images of the nanoshells showed that these agents can both increase the surrounding water proton signals in the T1-weighted image and reduce the signal in T2-weighted images. The as-synthesized nanoparticles exhibited strong absorption in the range of 600-800 nm, their optical properties being strongly dependent upon the thickness of the gold-silver alloy shell. Thus, these nanoshells have the potential to be utilized for tumor cell ablation because of their absorption as well as an imaging agent

Collective quadrupole excitations in the 50<Z,N<82 nuclei with the generalized Bohr Hamiltonian

The generalized Bohr Hamiltonian is applied to a description of low-lying collective excitations in even-even isotopes of Te, Xe, Ba, Ce, Nd and Sm. The collective potential and inertial functions are determined by means of the Strutinsky method and the cranking model, respectively. A shell-dependent parametrization of the Nilsson potential is used. An approximate particle-number projection is performed in treatment of pairing correlations. The effect of coupling with the pairing vibrations is taken into account approximately when determining the inertial functions. The calculation does not contain any free parameter.Comment: Latex2e source, 20 pages, 14 figures in EPS format, tar gzipped fil