Unmet medical needs and health care accessibility in seven countries of Eastern Europe

The study investigated the magnitude and structure of health care access barriers and utilisation inequalities in seven countries of Eastern Europe. Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, and Slovakia were examined over the period 2005-2009. The dataset containing 574,390 observations was derived from the European Union Statistics on Income and Living Conditions (EU-SILC). Logit and multinomial logit models were estimated for each country-year combination to inspect the relationship between respondents’ socio-economic characteristics, the probability of reporting unmet needs for examination or treatment, and the reason for the need not being met. We found that health care was most easily accessible in the Czech Republic and Slovakia. Affordability issues and prohibitive waiting times were prevalent in Poland and the Baltic States. Mobility and information represented minor access barriers. The poorest households, the unemployed, working age cohorts and women were more exposed to problems in accessing health care than the population at large. Access conditions improved over the analysed period. Substantial differences exist among countries that constitute an arguably homogenous group of post-communist, new EU member states. The nature of access barriers is indicative of coverage gaps and inadequacy of public sector resources relative to need, which call for systemic solutions

Unmet medical needs and health care accessibility in seven countries of Eastern Europe

The study investigated the magnitude and structure of health care access barriers and utilisation inequalities in seven countries of Eastern Europe. Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, and Slovakia were examined over the period 2005-2009. The dataset containing 574,390 observations was derived from the European Union Statistics on Income and Living Conditions (EU-SILC). Logit and multinomial logit models were estimated for each country-year combination to inspect the relationship between respondents’ socio-economic characteristics, the probability of reporting unmet needs for examination or treatment, and the reason for the need not being met. We found that health care was most easily accessible in the Czech Republic and Slovakia. Affordability issues and prohibitive waiting times were prevalent in Poland and the Baltic States. Mobility and information represented minor access barriers. The poorest households, the unemployed, working age cohorts and women were more exposed to problems in accessing health care than the population at large. Access conditions improved over the analysed period. Substantial differences exist among countries that constitute an arguably homogenous group of post-communist, new EU member states. The nature of access barriers is indicative of coverage gaps and inadequacy of public sector resources relative to need, which call for systemic solutions

Traceable characterisation of fibre-coupled single-photon detectors

The detection of single photons plays an essential role in advancing single-photon science and technologies. Yet, within the visible/near-infrared spectral region, accurate fibre-based optical power measurements at the few-photon level are not yet well-established. In this study, we report on a fibre-based setup, enabling traceable optical power measurements at the few-photon level in this spectral region. The setup was used to calibrate the detection efficiency (DE) of four single-photon avalanche diode (SPAD) detectors. The relative standard uncertainties on the mean DE values obtained from repeat fibre-to-detector couplings ranged from 0.67% to 0.81% (k = 2). However, the relative standard deviation of DE values, which ranged from 1.38% to 3.20% (k = 2), poses a challenge for the metrology of these devices and applications that require high accuracy and repeatability. We investigated the source of these variations by spatially mapping the response of a detector’s fibre connector port, using a focused free-space beam, allowing us to estimate the detector’s spatial non-uniformity. In addition, we realise a novel calibration approach for fibre-coupled SPADs in a free-space configuration, enabling a direct comparison between the fibre-based setup and the National Physical Laboratory’s established free-space facility using a single SPAD. Finally, we investigated alternative coupling methods, testing the repeatability of different fibre-to-fibre connectors in addition to direct fibre-to-detector couplings: SPADs from three manufacturers were tested, with both single-mode and multi-mode fibre

Spatializing the Ecological Leviathan: Territorial Strategies and the Production of Regional Natures

This paper explores a dual absence – the absence of the state within contemporary geographical analyses of nature; and the absence of nature within contemporary explorations of state power. We argue that the modern state continues to play a crucial role in framing social interactions with nature, while nature is still vital to states within their realization of different forms of material and ideological power. In order to reconnect analyses of the state and nature, this paper combines work on the production of nature and state strategy with Lefebvre’s recently translated writings on state space and territory. By focusing on the production of territory (or state space), we explore the interaction of the state and nature in the context of the political management of social and ecological space. We unravel the spatial entanglements of the state and nature through an analysis of the British state’s territorial strategies within the West Midlands region. By considering three key historical periods within the history of the West Mid-lands we reveal how the emergence of the regional space called the West Midlands is a product of the ongoing spatial dialectics of state and nature therein

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation

Thresholds for adding degraded tropical forest to the conservation estate

Logged and disturbed forests are often viewed as degraded and depauperate environments compared with primary forest. However, they are dynamic ecosystems1 that provide refugia for large amounts of biodiversity2,3, so we cannot afford to underestimate their conservation value4. Here we present empirically defined thresholds for categorizing the conservation value of logged forests, using one of the most comprehensive assessments of taxon responses to habitat degradation in any tropical forest environment. We analysed the impact of logging intensity on the individual occurrence patterns of 1,681 taxa belonging to 86 taxonomic orders and 126 functional groups in Sabah, Malaysia. Our results demonstrate the existence of two conservation-relevant thresholds. First, lightly logged forests (68%) of their biomass removed, and these are likely to require more expensive measures to recover their biodiversity value. Overall, our data confirm that primary forests are irreplaceable5, but they also reinforce the message that logged forests retain considerable conservation value that should not be overlooked

Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study

Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9–6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. Funding UK Research and Innovation and National Institute for Health Research

Structure and mechanism of inhibition of plant acetohydroxyacid synthase

Plants and microorganisms synthesize valine, leucine and isoleucine via a common pathway in which the first reaction is catalysed by acetohydroxyacid synthase (AHAS, EC 2.2.1.6). This enzyme is of substantial importance because it is the target of several herbicides, including all members of the popular sulfonylurea and imidazolinone families. However, the emergence of resistant weeds due to mutations that interfere with the inhibition of AHAS is now a worldwide problem. Here we summarize recent ideas on the way in which these herbicides inhibit the enzyme, based on the 3D structure of Arabidopsis thaliana AHAS. This structure also reveals important clues for understanding how various mutations can lead to herbicide resistance