Dynamic inference of healthcare expenditure on economic growth in Sub-Saharan Africa: a dynamic heterogenous panel data analysis

PurposeThis article investigates the dynamic implication of healthcare expenditure on economic growth in the selected ten Sub-Saharan African countries over the period 2000–2018.Design/methodology/approachThe study methodology included dynamic heterogenous panel, using mean group and pooled mean group estimators. The investigation of the healthcare expenditure and economic growth nexus was achieved while controlling the effects of investment, savings, labor force and life expectancy via interaction terms.FindingsThe results from linear healthcare expenditure have a significant positive impact on economic growth, while the nonlinear estimates through the interaction terms between healthcare expenditure and investment have a negative statistically significant impact on growth. The marginal effect of healthcare expenditure evaluated at the minimum and maximum level of investment is positive, suggesting the impact of health expenditure on growth does not vary with the level of investments. This result responds to the primary objective of the article.Research limitations/implicationsIn policy terms, the impact of investment on healthcare is essential to addressing future health crises. The impact of coronavirus disease 2019 (COVID-19) can never be separated from the shortages or low prioritization of health against other sectors of the economy. The article also provides an insight to policymakers on the demand for policy reform that will boost and make the health sector attractive to both domestic and foreign direct investment.Originality/valueGiven the vulnerability of SSA to the health crisis, there are limited studies to examine this phenomenon and first to address the needed investment priorities to the health sector infrastructure in SSA.

A sub-group evaluation of the multi-month dispensing strategy for differentiated HIV care: is personalization of care guidelines warranted in Haiti?

Background Differentiated care strategies are rapidly becoming the norm for HIV care delivery globally. Building upon an interest in tailoring antiretroviral therapy (ART) delivery for client-centered needs, the Ministry of Health and Population in Haiti formally endorsed multiple-month dispenses (MMD) in the 2016 national ART guidelines This study explores heterogeneity in retention in care with MMD for specific Haitian populations living with HIV and evaluates if a targeted algorithm for optimal ART prescription intervals is warranted in Haiti. Methods This study included ART-naïve individuals who started ART on or after January 1st, 2017 in Haiti. To identify subgroups in which to explore heterogeneity of retention, we implemented a double-lasso regression method to determine which individual characteristics would define the subgroups. Characteristics evaluated for potential subgroup definition included: sex, age category, WHO clinical stage, and body mass index category. We employed instrumental variable models to estimate the causal effect of increasing ART dispensing length on ART retention, by client subgroup. The outcome of interest was retention in care after one year in treatment. We then estimated the marginal effect of a 30-day increase to ART dispensing length to retention in care for each of these subgroups. Results There was evidence for heterogeneity in the effect of extending ART dispensing intervals on retention by WHO clinical stage. We observed significant improvements to retention in care at one year with a 30-day increase in ART dispense length for all subgroups defined by WHO clinical stages 1-4. The effects ranged from a 14.7% increase (95% CI: 12.4-17.0) to the likelihood of retention for people with HIV in WHO stage 1 to a 21.6% increase (95% CI: 18.7-24.5) to the likelihood of retention for those in WHO stage 3. Conclusions All the subgroups defined by WHO clinical stage experienced a benefit of extending ART intervals to retention in care at one year. Though the effect did differ slightly by WHO stage, the effects went in the same direction and were of similar magnitude. Therefore, a standardized recommendation for MMD among those living with HIV and new on ART is appropriate for Haiti treatment guidelines.

Association Among Spinnbarkeit, Electrical Conductivity, and Crystallization of Cervical Mucus and Pregnancy Rate in Egyptian Baladi Cows

Alteration of the biophysical and biochemical characteristics of cervical mucus (CM) due to differences in steroid hormones through the estrus cycle leads to different pregnancy rates. This investigation aims to study the possible relationship between CM properties with biochemical profiles, macro-mineral levels, and steroid hormones concentrations, and their effects on pregnancy rates of Egyptian cows. Fourteen Baladi cows were used and synchronized. The model log-likelihood ratio was highly significant (P=0.0009), and reported that the spinnbarkeit (SPK), electrical conductivity (EC), and crystallization (CRS) had significant effect on high pregnancy rate. The 3rd level of SPK (>13.5 cm) and EC (>15 mS/cm) was the highest significant (P=0.0016 & 0.0517, respectively) and a clear positive of estimate marginal effect (20.2543 & 10.6192, respectively) attitude towards the pregnancy rate. However, in case of the CRS, the significant effect was in the first two levels (P=0.0321 & 0.0425, respectively) with a high pregnancy rate, reverse the last 2 levels. Total protein, cholesterol, glucose, potassium, chloride levels, and estradiol concentrations were observed higher with increasing levels of SPK and EC and appearance of typical fern patterns (first two levels of CRS), in contrast to sodium, and progesterone concentrations that decreased with elevating levels of SPK and EC and appearance of atypical fern patterns (last two levels of CRS). There was a close correlation between CM properties and steroid hormones (P4 & E2). So, alterations in CM properties, especially SPK, EC, and CRS, can be utilized to foresee estrus time and, as a result, insemination time.

Incorporation of CENP-A/CID into centromeres during early Drosophila embryogenesis does not require RNA polymerase II–mediated transcription

In many species, centromere identity is specified epigenetically by special nucleosomes containing a centromere-specific histone H3 variant, designated as CENP-A in humans and CID in Drosophila melanogaster. After partitioning of centromere-specific nucleosomes onto newly replicated sister centromeres, loading of additional CENP-A/CID into centromeric chromatin is required for centromere maintenance in proliferating cells. Analyses with cultured cells have indicated that transcription of centromeric DNA by RNA polymerase II is required for deposition of new CID into centromere chromatin. However, a dependence of centromeric CID loading on transcription is difficult to reconcile with the notion that the initial embryonic stages appear to proceed in the absence of transcription in Drosophila, as also in many other animal species. To address the role of RNA polymerase II–mediated transcription for CID loading in early Drosophila embryos, we have quantified the effects of alpha-amanitin and triptolide on centromeric CID-EGFP levels. Our analyses demonstrate that microinjection of these two potent inhibitors of RNA polymerase II–mediated transcription has at most a marginal effect on centromeric CID deposition during progression through the early embryonic cleavage cycles. Thus, we conclude that at least during early Drosophila embryogenesis, incorporation of CID into centromeres does not depend on RNA polymerase II–mediated transcription.

Association between health-related quality of life and menopausal status and symptoms in women living with HIV aged 45–60 years in England: An analysis of the PRIME study

Objectives: The aim of this study was to compare the health-related quality of life between mid-life women with HIV and the general population and to investigate the association between health-related quality of life and menopausal (1) status and (2) symptoms among women with HIV. Methods: Cross-sectional data of women with HIV aged 45–60 years from the Positive Transitions Through the Menopause Study. Health-related quality of life was assessed using the Euroqol questionnaire with utility scores categorizing health as perfect (score = 1.00), sub-optimal (0.75–0.99) or poor (< 0.75). Scores were compared between Positive Transitions Through the Menopause study participants and women (aged 45–59 years) from the Health Survey for England. Associations between health-related quality of life and menopausal status/symptoms in Positive Transitions Through the Menopause participants were assessed using a multivariable two-part regression model, the results of which are combined to produce a single marginal effect. Results: In total, 813 women from the Positive Transitions Through the Menopause study were included (median age 49 (interquartile range: 47–53) years); the majority were of Black African ethnicity (72.2%). Overall, 20.9%, 43.7% and 35.3% of women were pre-, peri- and post-menopausal, respectively, and 69.7% experienced mild/moderate/severe menopausal symptoms. Approximately, 40% reported perfect health, 22.1% sub-optimal health and 39.0% poor health, similar to women from the Health Survey for England (perfect health: 36.9%, sub-optimal health: 25.2%, poor health: 37.9%). In multivariable models, we found an association between health-related quality of life and peri-menopausal status (marginal effect: 0.07 (0.02, 0.12)); however, the association with post-menopausal status was attenuated (marginal effect: 0.01 (–0.05, 0.06)). There remained a strong association between lower utility scores and moderate (marginal effect: 0.16 (0.11, 0.20)) and severe (marginal effect: 0.32 (0.27, 0.39)) menopausal symptoms. Conclusion: There were no differences in health-related quality of life between women with HIV (Positive Transitions Through the Menopause participants) and women from the Health Survey for England dataset. Among Positive Transitions Through the Menopause participants, health-related quality of life was reduced in peri-menopausal women and those with increasingly severe menopausal symptoms. Our findings highlight the importance of proactive assessment of menopausal status and symptoms to optimize health-related quality of life in women living with HIV as they reach mid-life and beyond.

The effect of adenotonsillectomy and rapid maxillary expansion on the upper airway in pediatric obstructive sleep apnea: a randomized crossover-controlled trial

Study Objectives We aimed to determine the effects of adenotonsillectomy (AT) and rapid maxillary expansion (RME) on the apnea-hypopnea index (AHI) and compare volumetric changes in the upper airway (UA) arising from AT and RME. Methods Thirty-nine children who presented with maxillary constriction and grade III/IV tonsillar hypertrophy were randomized into two groups. One group underwent AT as the first treatment, and the other group underwent RME. Polysomnography (PSG) and cone-beam computed tomography (CBCT) were conducted before (T0) and 6 months after the first treatment (T1). In a crossover design, individuals with AHI&gt;1 received the second treatment. Six months later, they underwent PSG and CBCT (T2). The influence of age, sex, tonsil and adenoid hypertrophy, initial AHI severity, initial volume of the UA, first treatment, and maxillary expansion amount was evaluated using linear regression analysis. Intra- and inter-group comparisons for AHI and inter-group comparisons of volumetric changes in each region of the UA were performed using a paired t-test and Wilcoxon test. Results The initial AHI severity and therapeutic sequence in which AT was the first treatment explained for 95.6% of AHI improvement. AT caused significant improvements in the AHI and volumetric increases in the buccopharynx and total UA areas compared to RME. Conclusions The initial AHI severity and AT as the first treatment accounted for most of the AHI improvement. Most reductions in AHI were due to AT, which promoted more volumetric increases in UA areas than RME. RME may have a marginal effect on pediatric obstructive sleep apnea.

Metaproteomic Profiling of Fungal Gut Colonization in Gnotobiotic Mice

Background: Eukaryotic microbes can modulate mammalian host health and disease states, yet the molecular contribution of gut fungi remains nascent. We previously showed that mice exclusively colonised with fungi displayed increased sensitivity to allergic airway inflammation and had fecal metabolite profiles similar to germ-free mice. This marginal effect on the host metabolome suggested that fungi do not primarily use metabolites to modulate the host immune system.Methods: To describe functional changes attributed to fungal colonisation, we performed mass spectrometry-based analyses of feces (Label-Free Quantitative; LFQ) and the small intestine (labeling with Tandem Mass Tag; TMT) of gnotobiotic mice colonised with defined consortia of twelve bacterial species, five fungal species, or both. We also evaluated the effect of microbiome perturbances on the metaproteome by analysing feces from mouse pups treated with an antibiotic or antifungal.Results: We detected 6,675 proteins in the mice feces, of which 3,845 had determined LFQ levels. Analysis of variance showed changes in the different gnotobiotic mouse groups; specifically, 46% of 2,860 bacterial, 15% of 580 fungal, and 76% of 405 mouse quantified proteins displayed differential levels. The antimicrobial treatments resulted in lasting changes in the bacterial and fungal proteomes, suggesting that the antimicrobials impacted the entire community. Fungal colonisation resulted in changes in host proteins functional in innate immunity as well as metabolism, predicting specific roles of gut fungi on host systems during early developmental stages. Several of the detected fungal proteins (3% of 1,492) have been previously reported as part of extracellular vesicles and having immunomodulating properties. Using an isobaric labelling TMT approach for profiling low abundant proteins of the jejunal tissue, we confirmed that the five fungal species differentially impacted the host intestinal proteome compared to the bacterial consortium. The detected changes in mouse jejunal proteins (4% of 1,514) were mainly driven by metabolic proteins. Conclusions: We used quantitative proteomic profiling of gnotobiotic conditions to show how colonisation with selected fungal species impacts the host gut proteome. Our results suggest that an increased abundance of certain gut fungal species in early life may affect the developing intracellular attributes of epithelial and immune cells.

Factors Influencing Intention to Use Mobility as a Service: Case Study of Gyeonggi Province, Korea

Mobility as a service (MaaS) integrates various transportation modalities and connects these modalities to enable users to travel from departure points to destination points. The objectives of this study were to analyze the factors influencing the intention to use MaaS and determine a direction for the implementation of this service. Hence, this study utilized an ordered probit model and marginal effect analysis. Specifically, a survey was conducted based on citizens living in Gyeonggi-do, South Korea, to prepare logical MaaS operation measures customized in this province. Subsequently, variables related to MaaS were classified, and statistical analysis was performed based on these variables. The need for integrated transportation service, intention to use shared mobility, gender, household income, and region are found to have significant effects. Moreover, demographic groups with high levels of intention to use MaaS were identified. Finally, the intention to use MaaS was found to be mainly affected by whether public transportation was the primary means of transportation or whether the subjects spent a comparatively long time commuting. It is expected that these findings will serve as the basis for MaaS implementation in the future and will also be used as fundamental data for transportation service planning.

Evaluation of the Influence between Local Meteorology and Air Quality in Beijing Using Generalized Additive Models

Previous studies have confirmed the inextricable connection between meteorological factors and air pollutants. This study presents the complex nonlinear relationship between meteorological variables and four major air pollutants under high-concentration air pollution in Beijing. The generalized additive model combined with marginal effects is used for quantitative analysis. After controlling the confounding factors such as long-term trends, seasonality and spatio-temporal deviation, the final fitting results exhibit that temperature, relative humidity and visibility are the most significant meteorological variables associating with PM2.5 concentration, and the marginal effect reaches 80%, −23% and 270%, respectively. Temperature and relative humidity are the most significant variables for SO2, and the marginal effect reaches 15% and 7%. The most significant variables for O3 are temperature and solar radiation, with marginal effect of up to 70% and 8%. Atmospheric pressure and temperature results in a positive effect on CO, and the marginal effect can reach 18% and 80%. All these indicate that local meteorological variables are a significant driving factor for air quality in Beijing. Other variables, such as wind speed, visibility, and precipitation, display some influence on air pollutants, but have less explanatory power in the model. Overall, our study provides a better understanding of the relationship between local meteorological variables and air quality, as well as an insight into how climate change affects air quality.

The Effect of Incubation Temperature, Substrate and Initial pH Value on Plantaricin Activity and the Relative Transcription of pln Genes of Six Sourdough Derived Lactiplantibacillus plantarum Strains

The aim of the present study was to assess the effect of sourdough related parameters on the growth and plantaricin activity of six Lactiplantibacillus plantarum strains against a mixture of 5 Listeria monocytogenes strains and to analyze the transcriptomic response of their pln genes. Parameters included 3 substrates (MRS broth, mMRS broth, WFE), 3 temperatures (20, 30, 37 °C), 2 initial pH values (5.0, 6.0), 2 NaCl concentrations (0.0, 1.8%) and 12 time points (ranging from 0 to 33 h). The transcriptomic response of the plantaricin genes to the aforementioned parameters was assessed after 21 h of growth. In general, plantaricin activity was strain dependent with that of Lp. plantarum strains LQC 2422, 2441, 2485 and 2516, harboring four pln genes, namely, pln423 (plαΑ), plαΒ, plαC and plαD, reaching 2560 AU/mL. However, strains LQC 2320 and 2520, in which 18 pln genes were detected, namely, plNC8a, plNC8b, plNC8c, plnL, plnR, plnJ, plnK, plnE, plnF, plnH, plnS, plnY, plNC8-IF, plNC8-HK, plnD, plnI, plnM and plnG, exhibited plantaricin activity barely reaching 160 AU/mL. Substrate, temperature, initial pH value and strains significantly affected plantaricin activity, while NaCl had only a marginal effect. Similarly, growth substrate and temperature had a more pronounced effect than initial pH value on gene transcription. A strong correlation between the transcription of the genes belonging to the same locus was observed; however, only a weak correlation, if any, was observed between plantaricin activity and the transcription of the genes assessed.