Area Yield Crop Insurance and Diversification in Ghana: An Agricultural Household Programming Model

Although diversification and insurance are acknowledged as important in ameliorating risk, to our knowledge, no empirical study has investigated how the two approaches work in concert in developing countries. Given increasing climate variability and the risks it poses to rain-fed agriculture, this study uses the Expected Utility Framework to develop two non-separable household mathematical programming and simulation models to examine the relationship between crop-diversification and index-based (area-yield) insurance for a representative agricultural household. The representative household is constructed using the IMPACT Lite household survey on Ghana, collected by the Consultative Group on International Agricultural Research Program on Climate Change, Agriculture and Food Security. In the base model, the household manages risk by diversifying their activities and allocating resources among six crop activities without the option of insurance. In the second model, the household has the option of both diversification and area yield insurance. Also, we assess how insurance coverage level and premium subsidies influence household participation and overall welfare benefits from insurance using sensitivity analysis. The results point to a highly risk averse representative household with a coefficient of absolute risk aversion of 0.016. The level of diversification increases with risk aversion in both the base and insurance models. Although insurance does not completely substitute for crop diversification, it reduces the degree of diversification. The degree of diversification for low and very high risk averse households is 23% and 35% more in the base model than in the insurance model, respectively. At 70% insurance coverage, the representative household insures all of its available land, regardless of risk aversion and premium subsidies. However, it only insures part of its available land at 90% coverage, due to higher premiums, and the portion under insurance decreases as risk aversion rises. For the ii household to insure all of its available land at the 90% coverage level, 80% of its premiums must be subsidised. Regardless of risk aversion, coverage level or subsidy, the availability of insurance increases the household’s expected value of consumption and thus increases welfare. Comparing welfare (as measured by the expected value of consumption) in the base and baseline insurance models (i.e., no subsidy and 70% coverage level), our results show that insurance increases welfare by approximate 45% and 55% for low and very high risk averse households, respectively. For policy makers, this study provides empirical evidence suggesting that even in the presence of diversification, introducing area yield insurance would help reduce the perceived riskiness of rain-fed agriculture and increase agricultural households’ welfare

Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins

Objectives:Recurrent varicose veins may result from poor initial surgical technique or progression of varicosities in collateral veins. In some cases new veins may develop at the saphenofemoral junction (neovascularisation) and cause recurrent saphenofemoral incompetence. This was a histological study of recurrent varicose veins.Design:This clinicopathological study included 20 patients (median age 55 years) who had surgery for recurrent saphenofemoral incompetence.Materials and methods:A total of 28 legs had groin re-exploration with repeat flush saphenofemoral ligation. The venous tissue block from the saphenofemoral region (including the proximal thigh varicosity) was excised and orientated for histological analysis. Evidence of neovascularisation was sought using routine histological sections and S100 immunohistochemistry.Results:At operation, thin-walled, serpentine neovascular veins were detected clinically as the principal cause of recurrence in 19 groins. In five groins recurrence was due to a residual missed vein at the saphenofemoral junction, and in four recurrence was caused by cross groin collaterals. On histological sections, evidence of neovascularisation was present in 27 of 28 groins. In eight it co-existed with the veins missed at the original operation but it was the sole identified cause of recurrent saphenofemoral incompetence in 19 (68%) groins.Conclusions:Neovascularisation was the principal cause of recurrent saphenofemoral incompetence in this series

THE POSITIVE AND NEGATIVE INFLUENCE OF GLOBALIZATION ON THE ACTIVITIES OF INTERNATIONAL BUSINESS (BASED ON APPLE INC.)

Актуальні питання розвитку науки та забезпечення якості освіти у ХХІ столітті : тези доповідей XLІІІ Міжнародної наукової студентської конференції за підсумками науково-дослідних робіт студентів за 2019 рік (м. Полтава, 07–08 квітня 2020 р.) : у 2 ч., ч. 1. – Полтава : ПУЕТ, 2020. – 255 с. – Текст укр., рос., англ., нім. мовами

PD-1 Co-inhibitory and OX40 Co-stimulatory Crosstalk Regulates Helper T Cell Differentiation and Anti-Plasmodium Humoral Immunity

SummaryThe differentiation and protective capacity of Plasmodium-specific T cells are regulated by both positive and negative signals during malaria, but the molecular and cellular details remain poorly defined. Here we show that malaria patients and Plasmodium-infected rodents exhibit atypical expression of the co-stimulatory receptor OX40 on CD4 T cells and that therapeutic enhancement of OX40 signaling enhances helper CD4 T cell activity, humoral immunity, and parasite clearance in rodents. However, these beneficial effects of OX40 signaling are abrogated following coordinate blockade of PD-1 co-inhibitory pathways, which are also upregulated during malaria and associated with elevated parasitemia. Co-administration of biologics blocking PD-1 and promoting OX40 signaling induces excessive interferon-gamma that directly limits helper T cell-mediated support of humoral immunity and decreases parasite control. Our results show that targeting OX40 can enhance Plasmodium control and that crosstalk between co-inhibitory and co-stimulatory pathways in pathogen-specific CD4 T cells can impact pathogen clearance

Early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration: the EVRA RCT

Background Venous ulceration is a common and costly health-care issue worldwide, with poor healing rates greatly affecting patient quality of life. Compression bandaging has been shown to improve healing rates and reduce recurrence, but does not address the underlying cause, which is often superficial venous reflux. Surgical correction of the reflux reduces ulcer recurrence; however, the effect of early endovenous ablation of superficial venous reflux on ulcer healing is unclear. Objectives To determine the clinical effectiveness and cost-effectiveness of compression therapy with early endovenous ablation of superficial venous reflux compared with compression therapy with deferred endovenous ablation in patients with venous ulceration. Design A pragmatic, two-arm, multicentre, parallel-group, open randomised controlled trial with a health economic evaluation. Setting Secondary care vascular centres in England. Participants Patients aged ≥ 18 years with a venous leg ulcer of between 6 weeks’ and 6 months’ duration and an ankle–brachial pressure index of ≥ 0.8 who could tolerate compression and were deemed suitable for endovenous ablation of superficial venous reflux. Interventions Participants were randomised 1 : 1 to either early ablation (compression therapy and superficial endovenous ablation within 2 weeks of randomisation) or deferred ablation (compression therapy followed by endovenous ablation once the ulcer had healed). Main outcome measures The primary outcome measure was time from randomisation to ulcer healing, confirmed by blinded assessment. Secondary outcomes included 24-week ulcer healing rates, ulcer-free time, clinical success (in addition to quality of life), costs and quality-adjusted life-years (QALYs). All analyses were performed on an intention-to-treat basis. Results A total of 450 participants were recruited (224 to early and 226 to deferred superficial endovenous ablation). Baseline characteristics were similar between the two groups. Time to ulcer healing was shorter in participants randomised to early superficial endovenous ablation than in those randomised to deferred ablation [hazard ratio 1.38, 95% confidence interval (CI) 1.13 to 1.68; p = 0.001]. Median time to ulcer healing was 56 (95% CI 49 to 66) days in the early ablation group and 82 (95% CI 69 to 92) days in the deferred ablation group. The ulcer healing rate at 24 weeks was 85.6% in the early ablation group, compared with 76.3% in the deferred ablation group. Median ulcer-free time was 306 [interquartile range (IQR) 240–328] days in the early ablation group and 278 (IQR 175–324) days in the deferred endovenous ablation group (p = 0.002). The most common complications of superficial endovenous ablation were pain and deep-vein thrombosis. Differences in repeated measures of Aberdeen Varicose Vein Questionnaire scores (p < 0.001), EuroQol-5 Dimensions index values (p = 0.03) and Short Form questionnaire-36 items body pain (p = 0.05) over the follow-up period were observed, in favour of early ablation. The mean difference in total costs between the early ablation and deferred ablation groups was £163 [standard error (SE) £318; p = 0.607]; however, there was a substantial and statistically significant gain in QALY over 1 year [mean difference between groups 0.041 (SE 0.017) QALYs; p = 0.017]. The incremental cost-effectiveness ratio of early ablation at 1 year was £3976 per QALY, with a high probability (89%) of being more cost-effective than deferred ablation at conventional UK decision-making thresholds (currently £20,000 per QALY). Sensitivity analyses using alternative statistical models give qualitatively similar results. Limitations Only 7% of screened patients were recruited, treatment regimens varied significantly and technical success was assessed only in the early ablation group. Conclusions Early endovenous ablation of superficial venous reflux, in addition to compression therapy and wound dressings, reduces the time to healing of venous leg ulcers, increases ulcer-free time and is highly likely to be cost-effective. Future work Longer-term follow-up is ongoing and will determine if early ablation will affect recurrence rates in the medium and long term. Trial registration Current Controlled Trials ISRCTN02335796. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 24. See the NIHR Journals Library website for further project information

Coagulation factors and natural anticoagulants as surrogate markers of preeclampsia and its subtypes: A case-control study in a Ghanaian population

Preeclampsia (PE) is associated with endothelial injury and hemostatic abnormalities. However, the diagnostic role of coagulation parameters and natural anticoagulants in predicting PE has not been explored in Ghana. This study assessed plasma levels of these factors as surrogate markers of PE and its subtypes. This case-control study included 90 women with PE (cases) and 90 normotensive pregnant women (controls). Blood samples were drawn for the estimation of complete blood count and coagulation tests. The prothrombin time (PT), activated partial thromboplastin time (APTT), and the calculation of the international normalized ratio (INR) were determined by an ACL elite coagulometer while the levels of protein C (PC), protein S (PS), antithrombin III (ATIII), and D-dimers were also measured using the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. All statistical analyses were performed using the R Language for Statistical Computing. Results showed significantly (p \u3c .05) shortened APTT (28.25 s) and higher D-dimer levels (1219.00 ng/mL) among PE women, as well as low levels of PC (1.02 g/mL), PS (6.58 g/mL), and ATIII (3.99 ng/mL). No significant difference was found in terms of PT and INR. From the receiver operating characteristic analysis, PC, PS, and ATIII could significantly predict PE and its subtypes at certain cutoffs with high accuracies (area under the curve [AUC] ≥ 0.70). Most women with PE are in a hypercoagulable state with lower natural anticoagulants. PC, PS, and ATIII are good predictive and diagnostic markers of PE and its subtypes (early-onset PE [EO-PE] and late-onset PE [LO-PE]) and should be explored in future studies

Photodynamic therapy in the management of angioplasty restenosis

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN003660 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

THE POSITIVE AND NEGATIVE INFLUENCE OF GLOBALIZATION ON THE ACTIVITIES OF INTERNATIONAL BUSINESS (BASED ON APPLE INC.)

Актуальні питання розвитку науки та забезпечення якості освіти у ХХІ столітті : тези доповідей XLІІІ Міжнародної наукової студентської конференції за підсумками науково-дослідних робіт студентів за 2019 рік (м. Полтава, 07–08 квітня 2020 р.) : у 2 ч., ч. 1. – Полтава : ПУЕТ, 2020. – 255 с. – Текст укр., рос., англ., нім. мовами