Promoting universal financial protection: a study assessing the effects of knowledge and perception towards enrolment in health insurance schemes among clienteles using tertiary health services

Objective: To assess the evidence of the effects of knowledge and perception of health insurance on the willingness to enrol and utilize health insurance among clienteles using tertiary health services.Method: This was a cross-sectional descriptive study. The instrument was a pre tested, semi-structured self administered questionnaire. Descriptive statistics as well as chi-square test and regression analysis were done to show statistically significant associations.Results: The findings reveal that majority of the respondents had heard about health insurance at 275(78.6%), a significant number at 265(75.7%) had the right understanding of what it is; with the electronic and print media accounting for the major source of knowledge of health insurance at 85(24.3%) and 117(33.4%) respectively. Notwithstanding, most of the respondents 202(57.7%) felt that their current knowledge of health insurance is still very limited of such scheme(s) and as such affects their interest in enrolling in a scheme. Statistically significant association between the level of knowledge and the willingness to enrol in an insurance scheme feeling that they need more information on health insurance and the willingness to enrol in a health insurance scheme was shown (X2= 6.689, df= 1, p-value= 0.01). Accordingly, most respondents were willing to enrol and utilize the benefits of different types of health insurance services.Conclusion: The findings from this study has brought to the fore the relationship(s) between knowledge and perception of clients using health services and the effect(s) on their desire and willingness to participate in health insurance schemes. Still, there are concerns that necessitate wide spread advocacy for health insurance.Keywords: Health insurance, Knowledge, Perception, Enrolment, Nigeri

Cost-utility of transcatheter aortic valve implantation for inoperable patients with severe aortic stenosis treated by medical management: a UK cost-utility analysis based on patient-level data from the ADVANCE study.

OBJECTIVE: To use patient-level data from the ADVANCE study to evaluate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared to medical management (MM) in patients with severe aortic stenosis from the perspective of the UK NHS. METHODS: A published decision-analytic model was adapted to include information on TAVI from the ADVANCE study. Patient-level data informed the choice as well as the form of mathematical functions that were used to model all-cause mortality, health-related quality of life and hospitalisations. TAVI-related resource use protocols were based on the ADVANCE study. MM was modelled on publicly available information from the PARTNER-B study. The outcome measures were incremental cost-effectiveness ratios (ICERs) estimated at a range of time horizons with benefits expressed as quality-adjusted life-years (QALY). Extensive sensitivity/subgroup analyses were undertaken to explore the impact of uncertainty in key clinical areas. RESULTS: Using a 5-year time horizon, the ICER for the comparison of all ADVANCE to all PARTNER-B patients was £13 943 per QALY gained. For the subset of ADVANCE patients classified as high risk (Logistic EuroSCORE >20%) the ICER was £17 718 per QALY gained). The ICER was below £30 000 per QALY gained in all sensitivity analyses relating to choice of MM data source and alternative modelling approaches for key parameters. When the time horizon was extended to 10 years, all ICERs generated in all analyses were below £20 000 per QALY gained. CONCLUSION: TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis

Wound care in older adults

Wound care in older adults is complex. A logical, structured approach should be taken, using a nursing process such as assessing, planning, implementing and evaluating. This clinical focus paper outlines the nursing process to support wound care in this patient group. It recommends considering dressing selection as a cost-effective, prescribing decision because of the risks and comorbidities associated with these patient

Coronary artery fistula; coronary computed topography – The diagnostic modality of choice

Coronary artery fistulae (CAF) are rare anomalies. They are vascular communications between the coronary arteries and other cardiac structures, either cardiac chambers or great vessels. There can be considerable variation in the course of a coronary artery fistula. We report a case of a coronary artery fistula between the left circumflex coronary artery and the right and left atria. CAF are often diagnosed by coronary angiogram, however with the advent of new technologies such as Coronary Computed Tomography Angiography (Coronary CTA) the course and communications of these fistulae can be delineated non-invasively and with greater accuracy

Interstellar Dust Close to the Sun

The low density interstellar medium (ISM) close to the Sun and inside of the heliosphere provides a unique laboratory for studying interstellar dust grains. Grain characteristics in the nearby ISM are obtained from observations of interstellar gas and dust inside of the heliosphere and the interstellar gas towards nearby stars. Comparison between the gas composition and solar abundances suggests that grains are dominated by olivines and possibly some form of iron oxide. Measurements of the interstellar Ne/O ratio by the Interstellar Boundary Explorer spacecraft indicate that a high fraction of interstellar oxygen in the ISM must be depleted onto dust grains. Local interstellar abundances are consistent with grain destruction in ~150 km/s interstellar shocks, provided that the carbonaceous component is hydrogenated amorphous carbon and carbon abundances are correct. Variations in relative abundances of refractories in gas suggest variations in the history of grain destruction in nearby ISM. The large observed grains, > 1 micron, may indicate a nearby reservoir of denser ISM. Theoretical three-dimensional models of the interaction between interstellar dust grains and the solar wind predict that plumes of about 0.18 micron dust grains form around the heliosphere.Comment: 2011 AGOS Taiwan meeting; accepted for publication in Earth, Planets and Spac

Recognition memory, self-other source memory, and theory-of-mind in children with autism spectrum disorder.

This study investigated semantic and episodic memory in autism spectrum disorder (ASD), using a task which assessed recognition and self-other source memory. Children with ASD showed undiminished recognition memory but significantly diminished source memory, relative to age- and verbal ability-matched comparison children. Both children with and without ASD showed an “enactment effect”, demonstrating significantly better recognition and source memory for self-performed actions than other-person-performed actions. Within the comparison group, theory-of-mind (ToM) task performance was significantly correlated with source memory, specifically for other-person-performed actions (after statistically controlling for verbal ability). Within the ASD group, ToM task performance was not significantly correlated with source memory (after controlling for verbal ability). Possible explanations for these relations between source memory and ToM are considered

Toward homochiral protocells in noncatalytic peptide systems

The activation-polymerization-epimerization-depolymerization (APED) model of Plasson et al. has recently been proposed as a mechanism for the evolution of homochirality on prebiotic Earth. The dynamics of the APED model in two-dimensional spatially-extended systems is investigated for various realistic reaction parameters. It is found that the APED system allows for the formation of isolated homochiral proto-domains surrounded by a racemate. A diffusive slowdown of the APED network such as induced through tidal motion or evaporating pools and lagoons leads to the stabilization of homochiral bounded structures as expected in the first self-assembled protocells.Comment: 10 pages, 5 figure

Epileptic networks in focal cortical dysplasia revealed using electroencephalography-functional magnetic resonance imaging.

Surgical treatment of focal epilepsy in patients with focal cortical dysplasia (FCD) is most successful if all epileptogenic tissue is resected. This may not be evident on structural magnetic resonance imaging (MRI), so intracranial electroencephalography (icEEG) is needed to delineate the seizure onset zone (SOZ). EEG-functional MRI (fMRI) can reveal interictal discharge (IED)-related hemodynamic changes in the irritative zone (IZ). We assessed the value of EEG-fMRI in patients with FCD-associated focal epilepsy by examining the relationship between IED-related hemodynamic changes, icEEG findings, and postoperative outcome

Photorhabdus adhesion modification protein (Pam) binds extracellular polysaccharide and alters bacterial attachment.

Journal ArticleResearch Support, Non-U.S. Gov'tBACKGROUND: Photorhabdus are Gram-negative nematode-symbiotic and insect-pathogenic bacteria. The species Photorhabdus asymbiotica is able to infect humans as well as insects. We investigated the secreted proteome of a clinical isolate of P. asymbiotica at different temperatures in order to identify proteins relevant to the infection of the two different hosts. RESULTS: A comparison of the proteins secreted by a clinical isolate of P. asymbiotica at simulated insect (28 degrees C) and human (37 degrees C) temperatures led to the identification of a small and highly abundant protein, designated Pam, that is only secreted at the lower temperature. The pam gene is present in all Photorhabdus strains tested and shows a high level of conservation across the whole genus, suggesting it is both ancestral to the genus and probably important to the biology of the bacterium. The Pam protein shows limited sequence similarity to the 13.6 kDa component of a binary toxin of Bacillus thuringiensis. Nevertheless, injection or feeding of heterologously produced Pam showed no insecticidal activity to either Galleria mellonella or Manduca sexta larvae. In bacterial colonies, Pam is associated with an extracellular polysaccharide (EPS)-like matrix, and modifies the ability of wild-type cells to attach to an artificial surface. Interestingly, Surface Plasmon Resonance (SPR) binding studies revealed that the Pam protein itself has adhesive properties. Although Pam is produced throughout insect infection, genetic knockout does not affect either insect virulence or the ability of P. luminescens to form a symbiotic association with its host nematode, Heterorhabditis bacteriophora. CONCLUSIONS: We studied a highly abundant protein, Pam, which is secreted in a temperature-dependent manner in P. asymbiotica. Our findings indicate that Pam plays an important role in enhancing surface attachment in insect blood. Its association with exopolysaccharide suggests it may exert its effect through mediation of EPS properties. Despite its abundance and conservation in the genus, we find no evidence for a role of Pam in either virulence or symbiosis.BBSRCWellcome TrustEMBEK

Transit Timing and Duration Variations for the Discovery and Characterization of Exoplanets

Transiting exoplanets in multi-planet systems have non-Keplerian orbits which can cause the times and durations of transits to vary. The theory and observations of transit timing variations (TTV) and transit duration variations (TDV) are reviewed. Since the last review, the Kepler spacecraft has detected several hundred perturbed planets. In a few cases, these data have been used to discover additional planets, similar to the historical discovery of Neptune in our own Solar System. However, the more impactful aspect of TTV and TDV studies has been characterization of planetary systems in which multiple planets transit. After addressing the equations of motion and parameter scalings, the main dynamical mechanisms for TTV and TDV are described, with citations to the observational literature for real examples. We describe parameter constraints, particularly the origin of the mass/eccentricity degeneracy and how it is overcome by the high-frequency component of the signal. On the observational side, derivation of timing precision and introduction to the timing diagram are given. Science results are reviewed, with an emphasis on mass measurements of transiting sub-Neptunes and super-Earths, from which bulk compositions may be inferred.Comment: Revised version. Invited review submitted to 'Handbook of Exoplanets,' Exoplanet Discovery Methods section, Springer Reference Works, Juan Antonio Belmonte and Hans Deeg, Eds. TeX and figures may be found at https://github.com/ericagol/TTV_revie