Helping members of a community-based health insurance scheme access quality inpatient care through development of a preferred provider system in rural Gujarat.

We describe and analyse the experience of piloting a preferred provider system (PPS) for rural members of Vimo SEWA, a fixed-indemnity, community-based health insurance (CBHI) scheme run by the Self-Employed Women's Association (SEWA). The objectives of the PPS were (i) to facilitate access to hospitalization by providing financial benefits at the time of service utilization; (ii) to shift the burden of compiling a claim away from members and towards Vimo SEWA staff; and (iii) to direct members to inpatient facilities of acceptable quality. The PPS was launched between August and October 2004, in 8 subdistricts covering 15,000 insured. The impact of the scheme was analysed using data from a household survey of claimants and qualitative data from in-depth interviews and focus group discussions. The PPS appears to have been successful in terms of two of the three primary objectives--it has transferred much of the burden of compiling a health Insurance claim onto Vimo SEWA staff, and it has directed members to inpatient facilities with acceptable levels of technical quality (defined in terms of structural Indicators). However, even under the PPS, user fees pose a financial barrier, as the insured have to mobilize funds to cover the costs of medicines, supplies, registration fee, etc. before receipt of cash payment from Vimo SEWA. Other barriers to the success of the PPS were the geographic Inaccessibility of some of the selected hospitals, lack of awareness about the PPS among members and a variety of administrative problems. This pilot project provides useful lessons relating to strategic purchasing by CBHI schemes and, more broadly, managed care in India. In particular, the pragmatic approach taken to assessing hospitals and identifying preferred providers is likely to be useful elsewhere

Relationships among classifications of ayurvedic medicine diagnostics for imbalances and western measures of psychological states: An exploratory study.

BackgroundAccording to Ayurveda, the traditional medical system of India, doshas are a combination of characteristics based on a five-element philosophy that drive our mental and physical tendencies. When the doshas, or functional principles, are out of balance in quality or quantity, wellbeing is adversely affected and symptoms manifest.ObjectiveThis study examined relationships among imbalances in the doshas (termed Vikruti) reported via questionnaire and Western measures of psychological states.Materials and methodsStudy participants were 101 women (n = 81) and men (n = 20), mean age 53.9 years (SD = 11.7; range 32-80). Participants completed questionnaires to categorize their Vikruti type and psychological states, which included depressed mood (CESD), anxiety (PROMIS), rumination & reflection (RRQ), mindfulness (MAAS), stress (PSS), and quality of life (Ryff).ResultsMultivariate general linear modeling, controlling for age, gender and body mass index (BMI), showed that Vata imbalance was associated with more anxiety (p ≤ 0.05), more rumination (p ≤ 0.01), less mindfulness (p ≤ 0.05), and lower overall quality of life (p ≤ 0.01). Pitta imbalance was associated with poorer mood (p ≤ 0.01) and less mindfulness (p ≤ 0.05), more anxiety (p ≤ 0.05) and stress (p ≤ 0.05). Kapha imbalance was associated with more stress (p ≤ 0.05), more rumination (p ≤ 0.05) and less reflection (p ≤ 0.05).ConclusionThese findings suggest that symptoms of mind-body imbalances in Ayurveda are differentially associated with western assessments of psychological states. Ayurvedic dosha assessment may be an effective way to assess physical as well as emotional wellbeing in research and clinical settings

Identification and validation of the dopamine agonist bromocriptine as a novel therapy for high-risk myelodysplastic syndromes and secondary acute myeloid leukemia

Myelodysplastic syndromes (MDS) represent a broad spectrum of diseases characterized by their clinical manifestation as one or more cytopenias, or a reduction in circulating blood cells. MDS is predominantly a disease of the elderly, with a median age in the UK of around 75. Approximately one third of MDS patients will develop secondary acute myeloid leukemia (sAML) that has a very poor prognosis. Unfortunately, most standard cytotoxic agents are often too toxic for older patients. This means there is a pressing unmet need for novel therapies that have fewer side effects to assist this vulnerable group. This challenge was tackled using bioinformatic analysis of available transcriptomic data to establish a gene-based signature of the development and progression of MDS. This signature was then used to identify novel therapeutic compounds via statistically-significant connectivity mapping. This approach suggested re-purposing an existing and widely-prescribed drug, bromocriptine as a novel potential therapy in these disease settings. This drug has shown selectivity for leukemic cells as well as synergy with current therapies

16S rRNA gene profiling and genome reconstruction reveal community metabolic interactions and prebiotic potential of medicinal herbs used in neurodegenerative disease and as nootropics.

The prebiotic potential of nervine herbal medicines has been scarcely studied. We therefore used anaerobic human fecal cultivation to investigate whether medicinal herbs commonly used as treatment in neurological health and disease in Ayurveda and other traditional systems of medicine modulate gut microbiota. Profiling of fecal cultures supplemented with either Kapikacchu, Gotu Kola, Bacopa/Brahmi, Shankhapushpi, Boswellia/Frankincense, Jatamansi, Bhringaraj, Guduchi, Ashwagandha or Shatavari by 16S rRNA sequencing revealed profound changes in diverse taxa. Principal coordinate analysis highlights that each herb drives the formation of unique microbial communities predicted to display unique metabolic potential. The relative abundance of approximately one-third of the 243 enumerated species was altered by all herbs. Additional species were impacted in an herb-specific manner. In this study, we combine genome reconstruction of sugar utilization and short chain fatty acid (SCFA) pathways encoded in the genomes of 216 profiled taxa with monosaccharide composition analysis of each medicinal herb by quantitative mass spectrometry to enhance the interpretation of resulting microbial communities and discern potential drivers of microbiota restructuring. Collectively, our results indicate that gut microbiota engage in both protein and glycan catabolism, providing amino acid and sugar substrates that are consumed by fermentative species. We identified taxa that are efficient amino acid fermenters and those capable of both amino acid and sugar fermentation. Herb-induced microbial communities are predicted to alter the relative abundance of taxa encoding SCFA (butyrate and propionate) pathways. Co-occurrence network analyses identified a large number of taxa pairs in medicinal herb cultures. Some of these pairs displayed related culture growth relationships in replicate cultures highlighting potential functional interactions among medicinal herb-induced taxa

Executive Summary: Research Autism Cygnet Mentoring Project

The support requirements of intellectually able adults with autism can be just as nuanced as those for people who have significant learning difficulties/disabilities. Intellectual ability can often mask this, leaving individuals without the backup they require in order to thrive. At the 2007 forum ‘Successful Futures for Adults with Autism’ participants’ highlighted challenges around navigating social life, managing practical and financial affairs, accessing education and training opportunities, securing and maintaining employment, and good physical and mental health. Participants deemed existing models of support, often involving being part of a large group, stressful and inadequate. Many expressed preference for a one-to-one relationship (which could then be broadened over time), based on time-limited goal-oriented, specialist mentoring or life coaching

Does ‘mentoring’ offer effective support to autistic adults?: a mixed methods pilot study

The Research Autism Cygnet Mentoring project was a two-year pilot study, completed in 2016, which aimed to develop, trial and evaluate a mentoring scheme designed with input from autistic people, their families and supporters. The mentoring scheme involved 12 matched pairs (mentor/mentee) meeting once per week for one hour, over a six month period. All mentors attended a training day, led by the principles of Personal Construct Theory (PCT) and an emancipatory research ethos. The project and training involved significant involvement of autistic people in both its design and delivery. Participants on the autism spectrum found their mentoring experience very helpful in enabling them to progress toward self-identified goals, and mentees felt empowered by the person-centred ethos and methods employed on the project. However, a number of aspects of the mentoring project have been identified for requiring further investigation, including: caution over offering mentoring without formal structures, boundary setting, supervision, flexibility, and the matching of mentees with mentors. The project has highlighted the potential benefits of time-limited goal-orientated mentoring and the negligible evidence base underpinning current mentoring practice with adults on the autism spectrum. In order for the project to realise its emancipatory aim, there is a need for a large-scale quantitative study and a health-economics analysis to provide the necessary evidence base for mentoring to be recommended as a cost-effective intervention with clear benefits for individual wellbeing

Variants in the Mannose-binding Lectin Gene MBL2 do not Associate With Sepsis Susceptibility or Survival in a Large European Cohort

We use a large cohort of immune competent adults to analyze the influence of MBL2 genetic variants on sepsis susceptibility and survival. We find no significant associations with the 4 main functional single nucleotide polymorphisms in MBL2, or any combination of genotype

Nigeria Presidential and National Assembly Elections:25 February 2023

In line with the provisions of the 2018 Revised Commonwealth Guidelines for the Conduct of Election Observation in Member Countries, the Commonwealth Secretary-General, Rt Hon Patricia Scotland KC, constituted an Observer Group for the 25 February 2023 presidential and National Assembly elections in Nigeria, following an invitation from the Chair of the Independent National Electoral Commission (INEC).The Commonwealth Observer Group was led by His Excellency Thabo Mbeki, former President of the Republic of South Africa, and comprised 16 other eminent Commonwealth citizens. A staff team of 11 from the Commonwealth Secretariat provided technical support to the Group