Delivering Diabetes Care in the Philippines and Vietnam: Policy and Practice Issues

The aim of this study is the comparison of 2 studies looking at the barriers to access of diabetes care and medicines in the Philippines and Vietnam. These studies used the Rapid Assessment Protocol for Insulin Access. Diabetes care is provided in specialized facilities and appropriate referral systems are lacking. In Vietnam, no problems were reported with regard to diagnostic tools, whereas this was a concern in the public sector in the Philippines. Both countries had high prices for medicines in comparison to international standards. Availability of medicines was better in Vietnam than in the Philippines, especially with regard to insulin. This affected adherence as did a lack of patient education. As countries aim to provide health care to the majority of their populations through universal coverage, the challenge of diabetes cannot be neglected. Trying to achieve universal coverage in parallel to decentralization, national and local governments need adapted guidance for this

Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

BACKGROUND: In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews. METHODS: The Rapid Assessment Protocol for Insulin Access draws on the principles of Rapid Assessment Protocols which have been developed and implemented in several different areas. This protocol was adapted through a thorough literature review on diabetes, chronic condition management and medicine supply in developing countries. A visit to three countries in sub-Saharan Africa and meetings with different experts in the field of diabetes helped refine the questionnaires. Following the development of the questionnaires these were tested with various people familiar with diabetes and/or healthcare in developing countries. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali. Translations of questionnaires were made into local languages when necessary, with back translation to ensure precision. RESULTS: In each country the protocol was implemented in 3 areas – the capital city, a large urban centre and a predominantly rural area and their respective surroundings. Interviews were carried out by local teams trained on how to use the tool. Data was then collected and entered into a database for analysis. CONCLUSION: The Rapid Assessment Protocol for Insulin Access was developed to provide a situational analysis of Type 1 diabetes, in order to make recommendations to the national Ministries of Health and Diabetes Associations. It provided valuable information on patients' access to insulin, syringes, monitoring and care. It was thus able to sketch a picture of the health care system with regards to its ability to care for people with diabetes. In all countries where this tool was used the involvement of local stakeholders resulted in the process acting as a catalyst in bringing diabetes to the attention of the health authorities

Hydrograph Prediction - How much skill?

International audienceThe matching of estimated to observed hydrograph shape is central to much hydrological analysis. This research note quantifies built-in biases that tend to inflate goodness of fit indicies, biases that arise from the similarity of geometry between observed and estimated hydrographs

Ordering phenomena and transport properties of Bi1/2Sr1/2MnO3 single crystals

Measurements of the electrical and thermal conductivities, thermopower and paramagnetic susceptibility have been performed on single crystal samples of Bi1/2Sr1/2MnO3 and complemented with the X-ray powder diffraction data. A pronounced hysteretic behavior, observed below the cubic-to- orthorhombic transition at Tcrit = 535 K, is related to the onset of long-range charge order at TCO = 450 K and its further evolution down to about 330 K. The diffraction data suggest that the charge ordered state is formed by Zener pairs, represented by Mn4+ dimers linked by one extra eg electron, and is possibly stabilized by cooperative Bi,Sr displacements. An extremely low thermal conductivity is observed down to the lowest temperatures, without any recovery at the anti- ferromagnetic ordering temperature TN = 150 K. Such be- havior points to a presence of strong scatterers of phonons. Their possible origin can be linked to "optical-like" oscilla- tions which are associated with fluctuating charges within the Zener pairs.Comment: LATeX file, 4 EPS figures, zipped in 1 file BiSr50.zi

Phase boundaries in deterministic dense coding

We consider dense coding with partially entangled states on bipartite systems of dimension $d\times d$, studying the conditions under which a given number of messages, $N$, can be deterministically transmitted. It is known that the largest Schmidt coefficient, $\lambda_0$, must obey the bound $\lambda_0\le d/N$, and considerable empirical evidence points to the conclusion that there exist states satisfying $\lambda_0=d/N$ for every $d$ and $N$ except the special cases $N=d+1$ and $N=d^2-1$. We provide additional conditions under which this bound cannot be reached -- that is, when it must be that $\lambda_0<d/N$ -- yielding insight into the shapes of boundaries separating entangled states that allow $N$ messages from those that allow only $N-1$. We also show that these conclusions hold no matter what operations are used for the encoding, and in so doing, identify circumstances under which unitary encoding is strictly better than non-unitary.Comment: 7 pages, 1 figur

Effective Dielectric Tensor for Electromagnetic Wave Propagation in Random Media

We derive exact strong-contrast expansions for the effective dielectric tensor \epeff of electromagnetic waves propagating in a two-phase composite random medium with isotropic components explicitly in terms of certain integrals over the $n$-point correlation functions of the medium. Our focus is the long-wavelength regime, i.e., when the wavelength is much larger than the scale of inhomogeneities in the medium. Lower-order truncations of these expansions lead to approximations for the effective dielectric constant that depend upon whether the medium is below or above the percolation threshold. In particular, we apply two- and three-point approximations for \epeff to a variety of different three-dimensional model microstructures, including dispersions of hard spheres, hard oriented spheroids and fully penetrable spheres as well as Debye random media, the random checkerboard, and power-law-correlated materials. We demonstrate the importance of employing $n$-point correlation functions of order higher than two for high dielectric-phase-contrast ratio. We show that disorder in the microstructure results in an imaginary component of the effective dielectric tensor that is directly related to the {\it coarseness} of the composite, i.e., local volume-fraction fluctuations for infinitely large windows. The source of this imaginary component is the attenuation of the coherent homogenized wave due to scattering. We also remark on whether there is such attenuation in the case of a two-phase medium with a quasiperiodic structure.Comment: 40 pages, 13 figure

Long-range memory model of trading activity and volatility

Earlier we proposed the stochastic point process model, which reproduces a variety of self-affine time series exhibiting power spectral density S(f) scaling as power of the frequency f and derived a stochastic differential equation with the same long range memory properties. Here we present a stochastic differential equation as a dynamical model of the observed memory in the financial time series. The continuous stochastic process reproduces the statistical properties of the trading activity and serves as a background model for the modeling waiting time, return and volatility. Empirically observed statistical properties: exponents of the power-law probability distributions and power spectral density of the long-range memory financial variables are reproduced with the same values of few model parameters.Comment: 12 pages, 5 figure