Health financing reform in Kenya- assessing the social health insurance proposal

Kenya has had a history of health financing policy changes since its   independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a tr&nsition period. Questions of economic  feasibility and political acceptability continue to be discussed, with   stakeholders voicing concerns on design features of the new proposal   submitted to the  Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be  necessary, which is likely to last more than a decade. However, important objectives such as access to health care  and avoiding impoverishment due to direct health care payments should be recognised from the start so that  steady progress towards effective universal coverage can be planned and achieved

Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer

Purpose: Advance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer. Methods: This study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account. Results: The majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders. Conclusions: Perceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning. Trial registration number: NTR6584 Date of registration: 30 June 2017 Implications for Cancer Survivors: Patients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising

Practical Applications as a Source of Credibility: A Comparison of Three Fields of Dutch Academic Chemistry

In many Western science systems, funding structures increasingly stimulate academic research to contribute to practical applications, but at the same time the rise of bibliometric performance assessments have strengthened the pressure on academics to conduct excellent basic research that can be published in scholarly literature. We analyze the interplay between these two developments in a set of three case studies of fields of chemistry in the Netherlands. First, we describe how the conditions under which academic chemists work have changed since 1975. Second, we investigate whether practical applications have become a source of credibility for individual researchers. Indeed, this turns out to be the case in catalysis, where connecting with industrial applications helps in many steps of the credibility cycle. Practical applications yield much less credibility in environmental chemistry, where application-oriented research agendas help to acquire funding, but not to publish prestigious papers or to earn peer recognition. In biochemistry practical applications hardly help in gaining credibility, as this field is still strongly oriented at fundamental questions. The differences between the fields can be explained by the presence or absence of powerful upstream end-users, who can afford to invest in academic research with promising long term benefits

Using flotsam lines for improving predictions of hydraulic loads on coastal dikes

Flotsam lines may arise on coastal dikes after a storm surge. These lines are generated when material due to debris accumulation on the foreshore has been transported onto the dike surface by wave run-up. Hydraulic engineers who used flotsam line measurements, interpreted a flotsam line as a line which is marking the highest wave run-up. In the past, flotsam lines were used to assess the safety of coastal dikes along the Wadden Sea. Currently, models (SWAN and WAQUA) fulfil this function and this may result in losing the value of flotsam lines. This study aims to rediscover the value of flotsam lines.The objective of this study was to shed light on the value of flotsam lines. Using the spatial information obtained from flotsam levels it is investigated whether flotsam levels can be used to assess the quality of models (SWAN and WAQUA). This was done by calculating flotsam lines using a sequence of models and wave run-up formulas and then compare to measured flotsam lines. This study showed that the upper side of the flotsam line marked the maximum wave run-up in case of a small layer of flotsam. Besides, a relative thick layer of flotsam was able to absorb the force of the wave run-up and remained in position. This means that the amount of flotsam can disturb the wave run-up and eventually flotsam levels. It also was determined that the analysis of (calculated) flotsam lines gives an indication of the performance of the applied set of models (SWAN and WAQUA) and wave run-up formulas, provided that a systematic comparison between modelled and measured data is performed. A large database of detailed flotsam lines with corresponding storm conditions (water level, wave conditions, wind, etc) can provide valuable information to low costs. This database can be used to detect spatial variations which might give more insight in certain processes during storm conditionsCivil Engineering | Hydraulic Engineering | Hydraulic Structures and Flood Ris

The effect of a local mesh refinement on hydraulic modelling of river meanders

Large-scale river models are generally discretized by relatively large mesh cells resulting in bathymetry discretization errors and numerical effects. These hydraulic models are generally calibrated by altering the bed roughness to compensate for these errors and effects. Consequently, the calibrated roughness values are mesh-dependent while generally local mesh refinements are executed after model calibration to study the effects of river interventions. This study shows both the errors caused by bathymetry discretization and numerical effects for locally refined meshes. First, schematised river meanders with a flat bed in the transverse flow direction are analysed to isolate the induced numerical effects by the mesh. Afterwards, a case study is considered to verify if similar mesh influences are found in natural river meanders. Curvilinear, triangular and hybrid (combination of curvilinear and triangular cells) meshes are used with different resolutions. The analysis shows that in the schematised river meanders lower depth-averaged flow velocities and larger water depths are simulated with coarser meshes. In the case study, substantial differences in hydrodynamics between the meshes are obtained suggesting that the bathymetry discretization is more influential than the numerical effects. Finally, it was found that triangular meshes, and rivers with narrow meander bends, are most sensitive to mesh resolution. Especially in these cases, it is desirable to refine the mesh at the desired locations before model calibration

Red blood cells as oxygen carrier during normothermic machine perfusion of kidney grafts:Friend or foe?

Renal ex vivo normothermic machine perfusion (NMP) is under development as an assessment tool for high-risk kidney grafts and as a means of achieving more physiologically accurate organ preservation. On-going hemolysis has been reported during NMP, as this technique relies on red blood cells for oxygen delivery. In this study, we confirm the occurrence of progressive hemolysis during 6-hour kidney NMP. NMP-associated erythrostasis in the glomeruli and in peri-glomerular vascular networks points to an interaction between the red blood cells and the graft. Continuous hemolysis resulted in prooxidative changes in the perfusate, which could be quenched by addition of fresh frozen plasma. In a cell-based system, this hemolysis induced redox stress and exhibited toxic effects at high concentrations. These findings highlight the need for a more refined oxygen carrier in the context of renal NMP.</p

Red blood cells as oxygen carrier during normothermic machine perfusion of kidney grafts:Friend or foe?

Renal ex vivo normothermic machine perfusion (NMP) is under development as an assessment tool for high-risk kidney grafts and as a means of achieving more physiologically accurate organ preservation. On-going hemolysis has been reported during NMP, as this technique relies on red blood cells for oxygen delivery. In this study, we confirm the occurrence of progressive hemolysis during 6-hour kidney NMP. NMP-associated erythrostasis in the glomeruli and in peri-glomerular vascular networks points to an interaction between the red blood cells and the graft. Continuous hemolysis resulted in prooxidative changes in the perfusate, which could be quenched by addition of fresh frozen plasma. In a cell-based system, this hemolysis induced redox stress and exhibited toxic effects at high concentrations. These findings highlight the need for a more refined oxygen carrier in the context of renal NMP.</p