Health-Related Financial Catastrophe,Inequality and Chronic Illness in Bangladesh

Background

Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk.

Objective

This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe.

Methods

A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively.

Results

On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults.

Conclusion

Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system''s dependency on OOP payments and providing more financial risk protection.     

Humans,fire and landscape pattern: understanding a maquis‐forest complex,Mont Do,New Caledonia,using a spatial ‘state‐and‐transition’ model

Abstract Aim The research explores how changes in disturbance regime resulting from human settlement may affect landscape structure. A spatially explicit grid‐based simulation model is used to explore the interplay between humans, fire regime and landscape composition. Location The study site for this research is the botanical reserve at Mont Do, New Caledonia. The endemic conifer Araucaria laubenfelsii (Araucariaceae) forms a key component of the landscape at Mont Do. This species is unusual in that it is found scattered as an emergent in maquis and as a canopy species in adjacent rain forest patches. Although now dominated by a low maquis, prior to human settlement of New Caledonia, montane landscapes such as Mont Do are likely to have been heavily forested. Methods A spatially explicit simulation model, based on field data and palaeoecological information, was used to explore interactions between disturbance regime and the landscape. The model is described briefly here and more fully in Perry & Enright (2002) Ecological Modelling, 152 , 279. Results The model suggests that human‐influenced changes to the fire regime at Mont Do have been important in generating the current landscape structure. The origin and maintenance of forest landscapes and maquis‐forest mosaic landscapes are considered in the context of alternative stable states. Strong feedback loops between fire size and landscape composition, mediated at the smaller scale by other similar mechanisms, are capable of driving landscape change. The utility of a spatial state and transition modelling approach is demonstrated. Main conclusions The current landscape pattern on Mont Do is likely the result of changes to the fire regime occurring since human settlement. The specific mechanisms for this change outlined here may occur in a number of other similar systems. Understanding the origin and persistence of these ‘fire landscapes’ in New Caledonia and in the south‐west Pacific in general is crucial for their effective management.     

Neutral communities in fragmented landscapes

Habitat fragmentation displays a crucial role in conservation biology. Despite this, little is known about the detailed ecological consequences of habitat fragmentation due to the scarce number of controlled experimental surveys. The species–area relationship, a fundamental concept in ecology, requires the understanding of the fragmentation effects in a long term perspective, which turns this task even harder. Here we address the spatial patterns of species distribution in fragmented landscapes, assuming a neutral community model. We study the species area relationship and how its shape changes as the landscape becomes more fragmented. Recent investigations, based on extensive computer simulation, have contributed to establish some definite conclusions in the study of non‐fragmented landscapes: the existence of a three‐regime or two‐regime scenario for the species–area relationship, the emergence of a power‐law regime at intermediate scales and the augment of the species–area exponent z with the speciation rate. Despite the recent efforts, some other questions remain, such as the dependence of z in the whole range of the speciation rate. Questions like these are currently debated but generalizations cannot be drawn. This is the first paper, to our knowledge, that uses the coalescence method and neutral theory to examine biodiversity on more complex spatial structures. Our simulation results corroborate that the fragmentation plays a crucial role in shaping the species–area relationship, by determining the existence and extension of the power‐law regime associated with small and intermediate areas. On the other hand, when individuals are allowed to disperse over longer distances the species–area relationship now displays the classic triphasic pattern, and the intermediate regime, which is well described by a power‐law, is established even for highly fragmented landscapes.     

Vatra Româneasca and resurgent nationalism in Romania

Abstract

The swift rise of the Vatra Româneasca movement has taken place in the context of a shattered Romanian economy and attendant political turbulence that has left a badly desocialized citizenry ripe for populist mobilization. Vatra has adapted important elements of Ceau?escu's nationalist ideology for use in the post‐communist age. Its success in articulating a campaign against policies of cultural pluralism and minority rights has extended the influence of office‐holders appointed under Communism in minority and mixed areas. Its rhetoric and symbols have been borrowed by the Iliescu regime which lacks a grass‐roots presence or a coherent ideology of its own. The political inexperience of this movement has not prevented it from creating an image of the nation and a set of values designed to enable a disorientated population to come to terms with bewildering changes. Whatever electoral prospects it may have, its rise is the clearest indication that nationalism of an implacable kind is well‐placed to fill the political vacuum left by the collapse of Communism.     

Effects of green tea consumption on human fecal microbiota with special reference to Bifidobacterium species

Green tea is one of the most popular beverages in the world. Its beneficial health effects and components have been extensively reviewed. However, little is known about the influence of green tea consumption on the human intestinal microbiota (HIM), which plays a crucial role in human health. Ten volunteers who did not usually consume green tea, drank it for 10 days and then stopped drinking it for 7 days. Their fecal samples were collected at three time points: before beginning the 10‐day green‐tea regime, at the conclusion of that 10 days, and 7 days after stopping the regime. Their fecal samples were analyzed by terminal restriction fragment length polymorphism with specific primer‐restriction enzyme systems for HIM and by using a real‐time PCR method for the Bifidobacterium species. Although the HIM of each subject was relatively stable, the proportion of Bifidobacterium species played an important role in the classification of their fecal microbiota. Although there were inter‐individual differences in the Bifidobacterium species, an overall tendency for the proportion of bifidobacteria to increase because of green tea consumption was noted. However, little change was observed in the composition of Bifidobacterium species in each sample. This suggests that the change in proportion was induced, not by an inter‐species transition, but by an intra‐species increase and/or decrease. In conclusion, green tea consumption might act as a prebiotic and improve the colon environment by increasing the proportion of the Bifidobacterium species.     

基于杜邦模型的非营利性医院财务状况宏观分析

目的 通过对我国非营利性医院财务状况的分析,评估非营利性医院资金运营状况。方法 运用经典财务分析系统——杜邦模型对全国非营利性医院2002—2007年财务年度指标进行计算和分析。结果 非营利性医院固定资产快速增加,业务收支结余为负,净资产收益率大都为负值,医院基本处于亏损经营状态。结论 现阶段非营利性医院成本快速上升是造成亏损的主要原因,医院仍然处于“粗放”式经营阶段。     

INFLUENCE OF LOW LIGHT AND A LIGHT: DARK CYCLE ON NO3– UPTAKE,INTRACELLULAR NO3–, AND NITROGEN ISOTOPE FRACTIONATION BY MARINE PHYTOPLANKTON1

The nitrogen isotope enrichment factor (ɛ) of four species of marine phytoplankton grown in batch cultures was determined during growth in continuous saturating light, continuous low light, and a 12:12‐h light:dark cycle, with nitrate as a nitrogen source. The low growth rate that resulted from low irradiance caused an increased accumulation of the intracellular nitrate pool and/or a reduction in cell volume and was correlated to a species‐specific increase in the measured ɛ value, compared with the saturating light conditions. The largest response was in the diatom Thalassiosira weissflogii (Grun.) Fryxell et Hasle, which showed a nearly 3‐fold increase between high and low light conditions (6.2–15.2‰). The smallest response was in T. pseudonana (Hustedt) Hasle et Heimdal, which showed no change in the ɛ value of approximately 5‰ in both high and low light conditions. There was significant but smaller increases in the ɛ value for the diatom T. rotula Meunier (2.7–5.6‰) and the prymnesiophyte Emiliania huxleyi (Lohm.) Hay et Mohler (4.5–9.4‰) between high and low light levels. In the light:dark experiments, all three diatoms but not the prymnesiophyte exhibited an increase in ɛ. This increase was linked to the ability of diatoms to assimilate nitrate at night. The results of the these experiments suggest that the light regime influences the relative uptake, assimilation, and efflux rates of nitrate and results in differences in the expression of the isotope effect by the enzyme nitrate reductase. Therefore, variations in nitrate isotope fractionation in nature can be more accurately interpreted when the light regime and species composition are taken into consideration.     

Identification of a perinuclear positioning element in human subtelomeres that requires A‐type lamins and CTCF

The localization of genes within the nuclear space is of paramount importance for proper genome functions. However, very little is known on the cis‐acting elements determining subnuclear positioning of chromosome segments. We show here that the D4Z4 human subtelomeric repeat localizes a telomere at the nuclear periphery. This perinuclear activity lies within an 80 bp sequence included within a region known to interact with CTCF and A‐type Lamins. We further show that a reduced level of either CTCF or A‐type Lamins suppresses the perinuclear activities of D4Z4 and that an array of multimerized D4Z4 sequence, which has lost its ability to bind CTCF and A‐type Lamins, is not localized at the periphery. Overall, these findings reveal the existence of an 80 bp D4Z4 sequence that is sufficient to position an adjacent telomere to the nuclear periphery in a CTCF and A‐type lamins‐dependent manner. Strikingly, this sequence includes a 30 bp GA‐rich motif, which binds CTCF and is present at several locations in the human genome.     

A personal narrative of particular things: Tevau (feather money) from Santa Cruz,Solomon Islands

In October 2006, Salome Samou, from Santa Cruz Island, Solomon Islands, visited the British Museum, London, to see the collections from her home island. This paper presents her response to the tevau in the collection (frequently referred to as ‘feather money’). Tevau are objects of prestige and value, formerly used in a regional network of exchange. They were especially important in bridewealth payments, but have not been used on Santa Cruz Island since the 1980s. Today, Samou wants to revive their use, a re‐introduction that reflects a linkage of tevau and their manufacture to contemporary ideas of social identity. This paper explores Samou’s interaction with the tevau in the collection, including past interpretations of their use. For Samou, the process of viewing the tevau produced a narrative that embraced personal memories as well as challenged perspectives on past cultural and social practices. I discuss how these particular objects materialise transformed, and transforming, regimes of value.     

A new type of 3‐D peripheral ultrastructure in Glaucocystis (Glaucocystales,Glaucophyta) as revealed by ultra‐high voltage electron microscopy

The coccoid glaucophyte genus Glaucocystis is characterized by having a thick cell wall, which has to date prohibited examination of the native ultrastructural features of the protoplast periphery. Recently, however, the three‐dimensional (3‐D) ultrastructure of the protoplast periphery was revealed in two divergent Glaucocystis species, with the world's most powerful ultra‐high voltage electron microscope (UHVEM). The two species exhibit morphological diversity in terms of their 3‐D ultrastructural features. However, these two types do not seem to encompass actual ultrastructural diversity in the genetically diverse genus Glaucocystis. Here, we report a new type of peripheral 3‐D ultrastructure resolved in “G. incrassata” SAG 229‐2 cells by 3‐D modeling based on UHVEM tomography using high‐pressure freezing and freeze‐substitution fixation. The plasma membrane and underlying flattened vesicles in “G. incrassata” SAG 229‐2 exhibited grooves at intervals of 200–600 nm, and the flattened vesicles often overlapped one another at the protoplast periphery. This 3‐D ultrastructure differs from those of the two types previously reported in other species of Glaucocystis. The possibility of classification of Glaucocystis species based on the 3‐D ultrastructure of the protoplast periphery is discussed.     

An Approach for Calculating the Environmental External Costs of the Belgian Building Sector

This article describes an approach developed to estimate the environmental external costs of the Belgian building sector. Several existing methods and related data sets for determining the monetary value of environmental impacts were reviewed and compared in light of their relevance to an impact assessment of the construction sector. This study concludes that the methods available consider different impacts and differ substantially in monetary values for identical impacts. A harmonized and transparent method is recommended to improve the feasibility and acceptance of internalizing external costs; agreement on the impacts to be assessed and their external costs based on current insights is important. Here, a new method is proposed for a life cycle impact assessment‐based valuation of environmental external costs for application to the Belgian building sector. To enable a comprehensive assessment, it became clear that solely considering “key” pollutants is insufficient. Although this article focuses on the development and not on the implementation of the method proposed, implementation revealed that the life cycle environmental external cost of new buildings (meeting current insulation standards or better) is relatively small compared to the life cycle financial cost.     

Fe‐N‐C Oxygen Reduction Fuel Cell Catalyst Derived from Carbendazim: Synthesis,Structure, and Reactivity

New non‐PGM catalysts from the family of Fe‐N‐C pyrolyzed materials are reported. They are synthesized using a templating silica powder with iron nitrate and carbendazim (CBDZ) precursors (sacrificial support method). The synthesis involves high temperature pyrolysis, followed by etching of the sacrificial support (silica) and obtaining a “self‐supported” open frame morphology catalyst. Both the temperature of heat treatment and Fe to CBDZ ratio play a crucial role in the final catalytic activity in oxygen reduction reaction (ORR). Prepared materials have extremely high durability in RDE tests, ending up with more than 94% of initial activity (by E_1/2 value) after 10 000 cycles in an oxygen atmosphere, which is the result we report for the first time. Evaluation of these new M‐N‐C catalysts in a single membrane electrode assembly (MEA) has shown an exceptionally high open circuit voltage (OCV) of 1 V and the world's second best performance with no IR correction. MEA tests have shown high current density of 700 mA cm^‐2 at 0.6 V and 120 mA cm^‐2 at 0.8 V. In‐depth structure‐to‐property correlation presents an evidence that Fe‐N_x centers are the active sites playing a key role in oxygen reduction reaction.     

Firm Type,Feed‐in Tariff,and Wind Energy Investment in Germany: An Investigation of Decision Making Factors of Energy Producers Regarding Investing in Wind Energy Capacity

The development of renewable and sustainable energy is advanced by public financial support. This is particularly so in the German Energiewende, which seeks to replace nuclear and fossil electricity generation with wind, sun, and biomass. We study the impact of the (changes in the) feed‐in tariff (FIT) policy on the investment in wind electricity generation capacity in Germany in the period 2000–2014. We estimate a generic investment model that includes this support mechanism, the cost of capital, investment risks such as wind and price volatility, and manufacturing costs. We discuss specific features for different types of wind energy investors, such as the incumbents, small private investors, diversified companies, and independent power producers. We find that a change in the FIT has a negative impact on investment capacity regarding the generation of wind energy: A one monetary unit increase in the variation of the tariff is to be associated with a decrease by 0.17 megawatts of wind capacity installed. We argue that it is policy uncertainty that makes investors shy away from making real investments. We also argue that the drivers for wind energy investment can differ along different types of firms. For the traditional power producers, especially electricity price volatility, construction costs, and carbon prices seem to matter. But for the other investor types, the FIT is crucial indeed.     

Direct seeding and outplantings in drylands of Argentinean Patagonia: estimated costs,and prospects for large‐scale restoration and rehabilitation

In large areas of the world that are deeply scarred by desertification and hampered by low capacity for natural regeneration, the scaling up of ecological restoration and rehabilitation can be achieved only if it is low in cost with high return on investment, and shows promise of providing long‐lasting social‐economic as well as ecological benefits. In the Monte Austral region of Patagonia Argentina, concerted efforts are underway to facilitate scaling up of ecological restoration and rehabilitation practices. Here, we evaluate financial costs and preliminary results of direct seeding as compared to outplanting of nursery‐grown seedlings of three native species (Atriplex lampa, Senecio subulatus var. subulatus, and Hyalis argentea var. latisquama) considered to be high‐priority dryland framework species. Comparative success is expressed in terms of plant survival and in monetary terms. The three candidate species showed low survival rates, ranging from 4.3 to 22.3%, after the first summer following direct seeding. In contrast, survival rates for planted seedlings of the same three taxa varied between 84 and 91%, after the first summer following reintroduction. However, cost of direct seeding varied between 1,693 and 1,772 US$ less per hectare, that is, 64% less than the cost of outplanting nursery seedlings. Therefore, in the search for ways to scale up ecological restoration and rehabilitation in drylands, direct seeding should receive more attention. We discuss the social and ecological perspectives and the way forward for direct seeding techniques in Patagonia. We also consider how costs could be reduced and effectiveness improved in large‐scale efforts.     

The conserved apicomplexan Aurora kinase TgArk3 is involved in endodyogeny,duplication rate and parasite virulence

Aurora kinases are eukaryotic serine/threonine protein kinases that regulate key events associated with chromatin condensation, centrosome and spindle function and cytokinesis. Elucidating the roles of Aurora kinases in apicomplexan parasites is crucial to understand the cell cycle control during Plasmodium schizogony or Toxoplasma endodyogeny. Here, we report on the localization of two previously uncharacterized Toxoplasma Aurora‐related kinases (Ark2 and Ark3) in tachyzoites and of the uncharacterized Ark3 orthologue in Plasmodium falciparum erythrocytic stages. In Toxoplasma gondii, we show that TgArk2 and TgArk3 concentrate at specific sub‐cellular structures linked to parasite division: the mitotic spindle and intranuclear mitotic structures (TgArk2), and the outer core of the centrosome and the budding daughter cells cytoskeleton (TgArk3). By tagging the endogenous PfArk3 gene with the green fluorescent protein in live parasites, we show that PfArk3 protein expression peaks late in schizogony and localizes at the periphery of budding schizonts. Disruption of the TgArk2 gene reveals no essential function for tachyzoite propagation in vitro, which is surprising giving that the P. falciparum and P. berghei orthologues are essential for erythrocyte schizogony. In contrast, knock‐down of TgArk3 protein results in pronounced defects in parasite division and a major growth deficiency. TgArk3‐depleted parasites display several defects, such as reduced parasite growth rate, delayed egress and parasite duplication, defect in rosette formation, reduced parasite size and invasion efficiency and lack of virulence in mice. Our study provides new insights into cell cycle control in Toxoplasma and malaria parasites and highlights Aurora kinase 3 as potential drug target.     

The cost to government of maintaining a commercially unviable fishery: The case of newfoundland 1981/82 to 1990/91

The commercial fishery for northern cod off Newfoundland has been closed since 1992. Since then, the recreational “food fishery”; has also been closed, as have the fisheries for many additional cod and other groundfish stocks. The Newfoundland fisheries had been commercially unviable for many years before the closures. This article records the federal and provincial governments’ financial outlays (expenditures, transfer payments to individuals, subsidies, net equity purchases, and net loans) on the fishery during the decade following 1981. Special emphasis is placed on the cost of the financial restructuring of the industry in the mid‐1980s, net unemployment insurance payments, and social overhead capital expenditures.     

High genetic diversity declines towards the geographic range periphery of Adonis vernalis,a Eurasian dry grassland plant

Genetic diversity is important for species' fitness and evolutionary processes but our knowledge on how it varies across a species' distribution range is limited. The abundant centre hypothesis (ACH) predicts that populations become smaller and more isolated towards the geographic range periphery – a pattern that in turn should be associated with decreasing genetic diversity and increasing genetic differentiation. We tested this hypothesis in Adonis vernalis, a dry grassland plant with an extensive Eurasian distribution. Its life‐history traits and distribution characteristics suggest a low genetic diversity that decreases and a high genetic differentiation that increases towards the range edge. We analysed AFLP fingerprints in 28 populations along a 4698‐km transect from the geographic range core in Russia to the western range periphery in Central and Western Europe. Contrary to our expectation, our analysis revealed high genetic diversity (range of proportion of polymorphic bands = 56–81%, He = 0.168–0.238) and low genetic differentiation across populations (Φ_ST = 0.18). However, in congruence with the genetic predictions of the ACH, genetic diversity decreased and genetic differentiation increased towards the range periphery. Spanish populations were genetically distinct, suggesting a divergent post‐glacial history in this region. The high genetic diversity and low genetic differentiation in the remaining A. vernalis populations is surprising given the species' life‐history traits and points to the possibility that the species has been widely distributed in the studied region or that it has migrated from a diverse source in an East–West direction, in the past.     

Major disturbances test resilience at a long‐term boreal forest monitoring site

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Transmission of the malaria parasite requires ferlin for gamete egress from the red blood cell

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