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

Streamlined islands and the English Channel megaflood hypothesis

Recognising ice-age catastrophic megafloods is important because they had significant impact on large-scale drainage evolution and patterns of water and sediment movement to the oceans, and likely induced very rapid, short-term effects on climate. It has been previously proposed that a drainage system on the floor of the English Channel was initiated by catastrophic flooding in the Pleistocene but this suggestion has remained controversial. Here we examine this hypothesis through an analysis of key landform features. We use a new compilation of multi- and single-beam bathymetry together with sub-bottom profiler data to establish the internal structure, planform geometry and hence origin of a set of 36 mid-channel islands. Whilst there is evidence of modern-day surficial sediment processes, the majority of the islands can be clearly demonstrated to be formed of bedrock, and are hence erosional remnants rather than depositional features. The islands display classic lemniscate or tear-drop outlines, with elongated tips pointing downstream, typical of streamlined islands formed during high-magnitude water flow. The length-to-width ratio for the entire island population is 3.4 ± 1.3 and the degree-of-elongation or k-value is 3.7 ± 1.4. These values are comparable to streamlined islands in other proven Pleistocene catastrophic flood terrains and are distinctly different to values found in modern-day rivers. The island geometries show a correlation with bedrock type: with those carved from Upper Cretaceous chalk having larger length-to-width ratios (3.2 ± 1.3) than those carved into more mixed Paleogene terrigenous sandstones, siltstones and mudstones (3.0 ± 1.5). We attribute these differences to the former rock unit having a lower skin friction which allowed longer island growth to achieve minimum drag. The Paleogene islands, although less numerous than the Chalk islands, also assume more perfect lemniscate shapes. These lithologies therefore reached island equilibrium shape more quickly but were also susceptible to total erosion. Our observations support the hypothesis that the islands were initially carved by high-water volume flows via a unique catastrophic drainage of a pro-glacial lake in the southern North Sea at the Dover Strait rather than by fluvial erosion throughout the Pleistocene

Predicting The Outcome of Marketing Negotiations: Role-Playing versus Unaided Opinions

Role -playing and unaided opinions were used to forecast the outcome of three negotiations. Consistent with prior re search, role-playing yielded more accurate predictions. In two studies on marketing negotiations, the predictions based on role-playing were correct for 53% of the predictions while unaided opinions were correct for only 7% (ppredicting, negotiations, marketing, role-playing, unaided opinion

Listen to the market, hear the best policy decision, but don’t always choose it

The updated version of this working paper (28 February 2019) is available in ORE at http://hdl.handle.net/10871/36180Real-world policymakers want to extract investors' private information about a policy's likely effects by 'listening to' asset markets. However, this brings the risk that investors will profitably 'manipulate' prices to steer policy. We model the interaction between a policymaker and an informed (profit-seeking) investor who can buy/short-sell an asset from uninformed traders. We characterize when the investor's incentives do not align with the policymaker's, implying that to induce truth-telling behavior the policymaker must commit to sometimes ignoring the signal (as revealed by the investor's behavior driving the asset's price). This implies a commitment to executing the policy with a probability depending on the asset's price. We develop a taxonomy for the full set of relationships between private signals, asset values, and policymaker welfare, characterizing the optimal indirect mechanism for each case. We find that where the policymaker is ex-ante indifferent, she commits to sometimes/never executing after a bad signal, but always executes after a good signal. Generically, this 'listening' mechanism leads to higher (policymaker) welfare then ignoring the signals. We discuss real-world evidence, implications for legislative processes, and phenomena such as 'trial balloons' and 'committing political capital'

Local structure of Liquid-Vapour Interfaces

The structure of a simple liquid may be characterised in terms of ground state clusters of small numbers of atoms of that same liquid. Here we use this sensitive structural probe to consider the effect of a liquid-vapour interface upon the liquid structure. At higher temperatures (above around half the critical temperature) we find that the predominant effect of the interface is to reduce the local density, which significantly suppresses the local cluster populations. At lower temperatures, however, pronounced interfacial layering is found. This appears to be connected with significant orientational ordering of clusters based on 3- and 5-membered rings, with the rings aligning perpendicular and parallel to the interface respectively. At all temperatures, we find that the population of five-fold symmetric structures is suppressed, rather than enhanced, close to the interface.Comment: 10 pages, 8 figures, accepted for publication by Molecular Physic

Some triviality results for quasi-Einstein manifolds and Einstein warped products

In this paper we prove a number of triviality results for Einstein warped products and quasi-Einstein manifolds using different techniques and under assumptions of various nature. In particular we obtain and exploit gradient estimates for solutions of weighted Poisson-type equations and adaptations to the weighted setting of some Liouville-type theorems.Comment: 15 pages, fixed minor mistakes in Section

Alexander representation of tangles

A tangle is an oriented 1-submanifold of the cylinder whose endpoints lie on the two disks in the boundary of the cylinder. Using an algebraic tool developed by Lescop, we extend the Burau representation of braids to a functor from the category of oriented tangles to the category of Z[t,t^{-1}]-modules. For (1,1)-tangles (i.e., tangles with one endpoint on each disk) this invariant coincides with the Alexander polynomial of the link obtained by taking the closure of the tangle. We use the notion of plat position of a tangle to give a constructive proof of invariance in this case.Comment: 13 pages, 5 figure

Water, oceanic fracture zones and the lubrication of subducting plate boundaries - insights from seismicity

We investigate the relationship between subduction processes and related seismicity for the Lesser Antilles Arc using the Gutenberg-Richter law. This power lawdescribes the earthquakemagnitude distribution, with the gradient of the cumulative magnitude distribution being commonly known as the b-value. The Lesser Antilles Arc was chosen because of its alongstrike variability in sediment subduction and the transition from subduction to strike-slip movement towards its northern and southern ends. The data are derived from the seismicity catalogues from the Seismic Research Centre of The University of the West Indies and the Observatoires Volcanologiques et Sismologiques of the Institut de Physique du Globe de Paris and consist of subcrustal events primarily from the slab interface. The b-value is found using a Kolmogorov-Smirnov test for a maximum-likelihood straight line-fitting routine. We investigate spatial variations in b-values using a grid-search with circular cells as well as an along-arc projection. Tests with different algorithms and the two independent earthquake cataloges provide confidence in the robustness of our results. We observe a strong spatial variability of the b-value that cannot be explained by the uncertainties. Rather than obtaining a simple north-south b-value distribution suggestive of the dominant control on earthquake triggering being water released from the sedimentary cover on the incoming American Plates, or a b-value distribution that correlates with on the obliquity of subduction, we obtain a series of discrete, high b-value 'bull's-eyes' along strike. These bull's-eyes, which indicate stress release through a higher fraction of small earthquakes, coincide with the locations of known incoming oceanic fracture zones on the American Plates. We interpret the results in terms of water being delivered to the Lesser Antilles subduction zone in the vicinity of fracture zones providing lubrication and thus changing the character of the related seismicity. Our results suggest serpentinization around mid-ocean ridge transform faults, which go on to become fracture zones on the incoming plate, plays a significant role in the delivery of water into the mantle at subduction zones