Underutilization of Social Insurance among the Poor: Evidence from the Philippines

Many developing countries promote social health insurance as a means to eliminate unmet health needs. However, this strategy may be ineffective if there are barriers to fully utilizing insurance.We analyzed the utilization of social health insurance in 30 hospital districts in the central regions of the Philippines between 2003 and 2007. Data for the study came from the Quality Improvement Demonstration Study (QIDS) and included detailed patient information from exit interviews of children under 5 years of age conducted in seven waves among public hospital districts located in the four central regions of the Philippines. These data were used to estimate and identify predictors of underutilization of insurance benefits--defined as the likelihood of not filing claims despite having legitimate insurance coverage--using logistic regression.Multivariate analyses using QIDS data from 2004 to 2007 reveal that underutilization averaged about 15% throughout the study period. Underutilization, however, declined over time. Among insured hospitalized children, increasing length of stay in the hospital and mother's education, were associated with less underutilization. Being in a QIDS intervention site was also associated with less underutilization and partially accounts for the downward trend in underutilization over time.The surprisingly high level of insurance underutilization by insured patients in the QIDS sites undermines the potentially positive impact of social health insurance on the health of the marginalized. In the Philippines, where the largest burden of health care spending falls on households, underutilization suggests ineffective distribution of public funds, failing to reach a significant proportion of households which are by and large poor. Interventions that improve benefit awareness may combat the problem of underutilization and should be the focus of further research in this area

Testing the Interaction Between a Substellar Companion and a Debris Disk in the Hr 2562 System

The HR 2562 system is a rare case where a brown dwarf companion resides in a cleared inner hole of a debris disk, offering invaluable opportunities to study the dynamical interaction between a substellar companion and a dusty disk. We present the first ALMA observation of the system as well as the continued Gemini Planet Imager monitoring of the companion\u27s orbit with six new epochs from 2016 to 2018. We update the orbital fit, and in combination with absolute astrometry from GAIA, place a 3σ upper limit of 18.5 M J on the companion\u27s mass. To interpret the ALMA observations, we used radiative transfer modeling to determine the disk properties. We find that the disk is well resolved and nearly edge-on. While the misalignment angle between the disk and the orbit is weakly constrained, due to the short orbital arc available, the data strongly support a (near) coplanar geometry for the system. Furthermore, we find that the models that describe the ALMA data best have inner radii that are close to the companion\u27s semimajor axis. Including a posteriori knowledge of the system\u27s SED further narrows the constraints on the disk\u27s inner radius and places it at a location that is in reasonable agreement with (possibly interior to) predictions from existing dynamical models of disk truncation by an interior substellar companion. HR 2562 has the potential over the next few years to become a new test bed for dynamical interaction between a debris disk and a substellar companion

Testing the Interaction between a Substellar Companion and a Debris Disk in the HR 2562 System

The HR 2562 system is a rare case where a brown dwarf companion resides in a cleared inner hole of a debris disk, offering invaluable opportunities to study the dynamical interaction between a substellar companion and a dusty disk. We present the first ALMA observation of the system as well as the continued Gemini Planet Imager monitoring of the companion's orbit with six new epochs from 2016 to 2018. We update the orbital fit, and in combination with absolute astrometry from GAIA, place a 3σ upper limit of 18.5 MJ on the companion's mass. To interpret the ALMA observations, we used radiative transfer modeling to determine the disk properties. We find that the disk is well resolved and nearly edge-on. While the misalignment angle between the disk and the orbit is weakly constrained, due to the short orbital arc available, the data strongly support a (near) coplanar geometry for the system. Furthermore, we find that the models that describe the ALMA data best have inner radii that are close to the companion's semimajor axis. Including a posteriori knowledge of the system's SED further narrows the constraints on the disk's inner radius and places it at a location that is in reasonable agreement with (possibly interior to) predictions from existing dynamical models of disk truncation by an interior substellar companion. HR 2562 has the potential over the next few years to become a new test bed for dynamical interaction between a debris disk and a substellar companion

Analysis of positional candidate genes in the AAA1 susceptibility locus for abdominal aortic aneurysms on chromosome 19

ABSTRACT: BACKGROUND: Abdominal aortic aneurysm (AAA) is a complex disorder with multiple genetic risk factors. Using affected relative pair linkage analysis, we previously identified an AAA susceptibility locus on chromosome 19q13. This locus has been designated as the AAA1 susceptibility locus in the Online Mendelian Inheritance in Man (OMIM) database. METHODS: Nine candidate genes were selected from the AAA1 locus based on their function, as well as mRNA expression levels in the aorta. A sample of 394 cases and 419 controls was genotyped for 41 SNPs located in or around the selected nine candidate genes using the Illumina GoldenGate platform. Single marker and haplotype analyses were performed. Three genes (CEBPG, PEPD and CD22) were selected for DNA sequencing based on the association study results, and exonic regions were analyzed. Immunohistochemical staining of aortic tissue sections from AAA and control individuals was carried out for the CD22 and PEPD proteins with specific antibodies. RESULTS: Several SNPs were nominally associated with AAA (p < 0.05). The SNPs with most significant p-values were located near the CCAAT enhancer binding protein (CEBPG), peptidase D (PEPD), and CD22. Haplotype analysis found a nominally associated 5-SNP haplotype in the CEBPG/PEPD locus, as well as a nominally associated 2-SNP haplotype in the CD22 locus. DNA sequencing of the coding regions revealed no variation in CEBPG. Seven sequence variants were identified in PEPD, including three not present in the NCBI SNP (dbSNP) database. Sequencing of all 14 exons of CD22 identified 20 sequence variants, five of which were in the coding region and six were in the 3'-untranslated region. Five variants were not present in dbSNP. Immunohistochemical staining for CD22 revealed protein expression in lymphocytes present in the aneurysmal aortic wall only and no detectable expression in control aorta. PEPD protein was expressed in fibroblasts and myofibroblasts in the media-adventitia border in both aneurysmal and non-aneurysmal tissue samples. CONCLUSIONS: Association testing of the functional positional candidate genes on the AAA1 locus on chromosome 19q13 demonstrated nominal association in three genes. PEPD and CD22 were considered the most promising candidate genes for altering AAA risk, based on gene function, association evidence, gene expression, and protein expression

Genetic analyses of the electrocardiographic QT interval and its components identify additional loci and pathways

The QT interval is an electrocardiographic measure representing the sum of ventricular depolarization and repolarization, estimated by QRS duration and JT interval, respectively. QT interval abnormalities are associated with potentially fatal ventricular arrhythmia. Using genome-wide multi-ancestry analyses (&gt;250,000 individuals) we identify 177, 156 and 121 independent loci for QT, JT and QRS, respectively, including a male-specific X-chromosome locus. Using gene-based rare-variant methods, we identify associations with Mendelian disease genes. Enrichments are observed in established pathways for QT and JT, and previously unreported genes indicated in insulin-receptor signalling and cardiac energy metabolism. In contrast for QRS, connective tissue components and processes for cell growth and extracellular matrix interactions are significantly enriched. We demonstrate polygenic risk score associations with atrial fibrillation, conduction disease and sudden cardiac death. Prioritization of druggable genes highlight potential therapeutic targets for arrhythmia. Together, these results substantially advance our understanding of the genetic architecture of ventricular depolarization and repolarization

BLOOM: A 176B-Parameter Open-Access Multilingual Language Model

Large language models (LLMs) have been shown to be able to perform new tasks based on a few demonstrations or natural language instructions. While these capabilities have led to widespread adoption, most LLMs are developed by resource-rich organizations and are frequently kept from the public. As a step towards democratizing this powerful technology, we present BLOOM, a 176B-parameter open-access language model designed and built thanks to a collaboration of hundreds of researchers. BLOOM is a decoder-only Transformer language model that was trained on the ROOTS corpus, a dataset comprising hundreds of sources in 46 natural and 13 programming languages (59 in total). We find that BLOOM achieves competitive performance on a wide variety of benchmarks, with stronger results after undergoing multitask prompted finetuning. To facilitate future research and applications using LLMs, we publicly release our models and code under the Responsible AI License

Atomic Force Microscopy Study of Lrp Protein-DNA Interaction at the Solid-liquid Interface.

A phase variation control mechanism involving Pap B, Pap I, catabolite activator protein (CAP), leucine responsive regulatory protein (Lrp) and deoxyadenosine methylase (Dam) regulate the expression of pyelonephritis-associated pilus (Pap). This study centers on elucidating the role of Lrp in the transcription of Pap pilus. Specifically, we will measure the translocation of Lrp bound to plasmid DNA of Escherichia coli induced by Pap I. A hypothesis is that three Lrp dimers interact with the Pap I and translocate 102 base pairs from a GATC-II to a GATC-I sequence. In preparation for this measurement, we have obtained Atomic Force Microscopy (AFM) images that show Lrp bound to a particular binding site on DNA in buffer solution

Beamforming Galvanic Coupling Signals for IoMT Implant-to-Relay Communication

Implants are poised to revolutionize personalized healthcare by monitoring and actuating physiological functions. Such implants operate under challenging constraints of limited battery energy, heterogeneous tissue-dependent channel conditions and human-safety regulations. To address these issues, we propose a new cross-layer protocol for galvanic coupled implants wherein weak electrical currents are used in place of classical radio frequency (RF) links. As the first step, we devise a method that allows multiple implants to communicate individual sensed data to each other through code division multiple access (CDMA) combined with compressive sensing (CS) method to lower the transmission time and save energy, as well as delegates the computational burden of dispreading and decoding only to the on-body surface relays. Then, we devise a distributed beamforming approach that allows coordinated transmissions from the implants to the relays by considering the specific tissue path chosen and tissue heating-related safety constraints.We then proceed to implement distributed beamforming on a phantom of human tissue and prove an increase in received signal strength and decrease in BER due to constructive interference of the signals of each implant. Our contributions are two fold: First, we devise a collision-free protocol that prevents undue interference at neighboring implants, especially for multiple deployments. Second, this is the first application of near-field distributed beamforming in human tissue. Simulation results reveal significant improvement in the network lifetime for implants of up to 79% compared to the galvanic coupled links without beamforming. Additionally, implementation on phantom tissue proves improved communication metrics when beamforming is used