The impact of a mosquito net voucher subsidy programme on incremental ownership: The case of the Tanzania National Voucher Scheme

The subsidisation of mosquito nets has been widely used to increase ownership in countries where malaria represents a public health problem. However, an important question that has not been addressed empirically is how far net subsidy programmes increase ownership above the level that would have prevailed in the absence of the subsidy (i.e., incremental ownership). This study addresses that gap by investigating the impact of a large‐scale mosquito net voucher subsidy––the Tanzania National Voucher Scheme (TNVS)––on short‐term demand for unsubsidised commercial nets, estimating a household demand model with nationally representative household survey data. The results suggest that, despite the TNVS using a categorical targeting approach that did not discriminate by wealth, it still led to a large increase in incremental ownership of mosquito nets, with limited evidence of displacement of unsubsidised sales. Although no evidence is found of an additional TNVS voucher decreasing the number of unsubsidised sales in the same period, results indicate that an additional TNVS voucher reduced the probability of purchasing any unsubsidised net in the same period by 14%. The findings also highlight the critical role played by social learning or campaign messaging in increasing mosquito net ownership.     

A novel technique of detecting MRI‐negative lesion in focal symptomatic epilepsy: Intraoperative ShearWave Elastography

Focal symptomatic epilepsy is the most common form of epilepsy that can often be cured with surgery. A small proportion of patients with focal symptomatic epilepsy do not have identifiable lesions on magnetic resonance imaging (MRI). The most common pathology in this group is type II focal cortical dysplasia (FCD), which is a subtype of malformative brain lesion associated with medication‐resistant epilepsy. We present a patient with MRI‐negative focal symptomatic epilepsy who underwent invasive electrode recordings. At the time of surgery, a novel ultrasound‐based technique called ShearWave Elastography (SWE) was performed. A 0.5 cc lesion was demonstrated on SWE but was absent on B‐mode ultrasound and 3‐T MRI. Electroencephalography (EEG), positron emission tomography (PET), and magnetoencephalography (MEG) scans demonstrated an abnormality in the right frontal region. On the basis of this finding, a depth electrode was implanted into the lesion. Surgical resection and histology confirmed the lesion to be type IIb FCD. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .     

What is a new drug worth? An innovative model for performance‐based pricing

This article focuses on a novel method to derive prices for new pharmaceuticals by making price a function of drug performance. We briefly review current models for determining price for a new product and discuss alternatives that have historically been favoured by various funding bodies. The progressive approach to drug pricing, proposed herein, may better address the views and concerns of multiple stakeholders in a developed healthcare system by acknowledging and incorporating input from disparate parties via comprehensive and successive negotiation stages. In proposing a valid construct for performance‐based pricing, the following model seeks to achieve several crucial objectives: earlier and wider access to new treatments; improved transparency in drug pricing; multi‐stakeholder involvement through phased pricing negotiations; recognition of innovative product performance and latent changes in value; an earlier and more predictable return for developers without sacrificing total return on investment (ROI); more involved and informed risk sharing by the end‐user.     

A new method for the acquisition of ultrasonic strain image volumes

This article presents a new method for acquiring three-dimensional (3-D) volumes of ultrasonic axial strain data. The method uses a mechanically-swept probe to sweep out a single volume while applying a continuously varying axial compression. Acquisition of a volume takes 15-20 s. A strain volume is then calculated by comparing frame pairs throughout the sequence. The method uses strain quality estimates to automatically pick out high quality frame pairs, and so does not require careful control of the axial compression. In a series of in vitro and in vivo experiments, we quantify the image quality of the new method and also assess its ease of use. Results are compared with those for the current best alternative, which calculates strain between two complete volumes. The volume pair approach can produce high quality data, but skillful scanning is required to acquire two volumes with appropriate relative strain. In the new method, the automatic quality-weighted selection of image pairs overcomes this difficulty and the method produces superior quality images with a relatively relaxed scanning technique. (E-mail: rjh80@eng.cam.ac.uk)     

Intestinal Protein Characterisation of SARS-CoV-2 Entry Molecules ACE2 and TMPRSS2 in Inflammatory Bowel Disease (IBD) and Fatal COVID-19 Infection

Inflammation - The coronavirus SARS-CoV-2 contributes to morbidity and mortality mainly as a result of immune-pathology in the lungs. Recent data has shown multi-system involvement with widespread...     

Endocrine outcomes in Endoscopic Pituitary Surgery: A Literature Review

Background  

Since the introduction of fully endoscopic surgery this new technique has been adopted with enthusiasm by many but not all pituitary surgeons. Whilst some advantages of minimal access have been recognised, the information on endocrine outcomes has been slow to accumulate.     

The relationship between panic attacks and chemical dependencies

The purposes of the present study were to (a) determine the prevalence and characteristics of panic attacks in an alcohol/drug abuse inpatient population, (b) compare patients who reported experiencing panic attacks to patients who have never experienced a panic attack on various self-report measures of psychopathology and on ratings completed by Caregivers, and (c) to examine differences within groups of panickers. One hundred forty-four patients completed the questionnaires over a 17 week period. Over 50% of the patients reported experiencing one or more attacks in the three weeks prior to testing. These panickers scored higher than non-panickers on various measures of psychopathology. Over 83% of panickers reported using alcohol to self-medicate their panic attacks with almost 72% of them believing this procedure to be effective for preventing or reducing panic attacks. Male panickers differed from female panickers on several measures as did panickers who reported their panic attacks began before the alcohol abuse compared to those who did not believe this. The mean history of panic attacks was 103.4 months while the mean history of alcohol abuse was 134.6 months.     

Reflex responses to baroreceptor, chemoreceptor and nociceptor inputs in single renal sympathetic neurones in the rabbit and the effects of anaesthesia on them

Reflex responses of renal postganglionic neurones to stimulation of arterial baroreceptors, arterial and central chemoreceptors and cutaneous nociceptors, and the rhythmicity of their resting activity were studied in paralyzed, artificially ventilated rabbits, anaesthetized with either alfathesin or chloralose-urethane. A 'vasoconstrictor' response pattern was seen in all units. Perivascular balloon-induced falls in blood pressure increased firing while pressure rises silenced 90% of units and reduced firing in the rest. Resting activity was linked to pressure changes within the cardiac cycle and to the artificial respiratory cycle. The largest excitation occurred during hypoxia and injections of CO2 saturated solutions into the carotid artery while hypercapnia and stimulation of cutaneous nociceptors only slightly increased firing. Parameters characterizing rhythmicities and reflex responses were unimodally distributed with no apparent subgrouping of units on quantitative grounds. Unit response patterns were similar to those recorded in the whole renal nerve. With one exception, no silent units were found which responded to the afferent inputs studied. Nor was there a small-spike fibre group which was excited by angiotensin. However, reflex responses were significantly influenced by the anaesthetic regime selected for use. Under alfathesin, baroreceptor and chemoreceptor reflexes were double those found with chloralose-urethane. Under chloralose-urethane, hypoxia increased both rhythmicities, while under alfathesin, cardiac rhythmicity was decreased and respiratory rhythmicity was variably affected. We concluded that renal sympathetic neurones are a functionally uniform population which behave like vasoconstrictors.