How Free Is Free Health Care? An Assessment of Universal Health Coverage Among Jamaicans with Sickle Cell Disease.

Purpose: In an effort to transition toward universal health coverage (UHC), Jamaica abolished user fees at all public health facilities in 2008. We aimed to determine the extent of out-of-pocket payments (OPPs) and the other cost barriers to UHC among patients with sickle cell disease (SCD). Methods: Patients presenting to the Sickle Cell Unit in Kingston, Jamaica, for routine care between October 2019 and August 2020 were consecutively recruited and interviewed about their latest hospitalization within the previous 4 weeks. Parents or guardians completed the questionnaire on behalf of pediatric patients. The questionnaire included the Patient Satisfaction Questionnaire Short Form (PSQ)-18 and the health module of the Jamaica Survey of Living Conditions. Results: There were 103 patients with ages ranging from 7 months to 56 years (51.5% female, 60.2% public hospitalizations, and 54.4% pediatric). The modal income (J$6200-$11,999 per week) was similar to the minimum wage and 48.5% lived in overcrowded households. Government drug-subsidy cards were owned by 39.8%. OPPs were made by 19.4% of persons for items and tests that were unavailable at public facilities. There were no costs reported by 69.6%, who visited public pharmacies. Similarly, the cost of admission to public hospitals was free for 95.4% of subjects. Using public transportation, private hospitalization, and having more disease complications were predictive of a perception that health care is unaffordable. Conclusion: Most SCD subjects reported no expense with public hospitalizations; however, approximately one in five reported OPPs. Efforts are needed to increase the availability of subsidized items, and the use of drug-subsidy cards, to improve UHC.

Expression of murine muscle-enriched A-type lamin-interacting protein (MLIP) is regulated by tissue-specific alternative transcription start sites.

Muscle-enriched lamin-interacting protein (Mlip) is an alternatively spliced gene whose splicing specificity is dictated by tissue type. MLIP is most abundantly expressed in brain, cardiac, and skeletal muscle. In the present study, we systematically mapped the transcriptional start and stop sites of murine Mlip Rapid amplification of cDNA ends (RACE) of Mlip transcripts from the brain, heart, and skeletal muscle revealed two transcriptional start sites (TSSs), exon 1a and exon 1b, and only one transcriptional termination site. RT-PCR analysis of the usage of the two identified TSSs revealed that the heart utilizes only exon 1a for MLIP expression, whereas the brain exclusively uses exon 1b TSS. Loss of Mlip exon 1a in mice resulted in a 7-fold increase in the prevalence of centralized nuclei in muscle fibers with the Mlip exon1a-deficient satellite cells on single fibers exhibiting a significant delay in commitment to a MYOD-positive phenotype. Furthermore, we demonstrate that the A-type lamin-binding domain in MLIP is encoded in exon 1a, indicating that MLIP isoforms generated with exon 1b TSS lack the A-type lamin-binding domain. Collectively these findings suggest that Mlip tissue-specific expression and alternative splicing play a critical role in determining MLIP's functions in mice.

Improved light olefin yield from methyl bromide coupling over modified SAPO-34 molecular sieves.

As an alternative to the partial oxidation of methane to synthesis gas followed by methanol synthesis and the subsequent generation of olefins, we have studied the production of light olefins (ethylene and propylene) from the reaction of methyl bromide over various modified microporous silico-aluminophosphate molecular-sieve catalysts with an emphasis on SAPO-34. Some comparisons of methyl halides and methanol as reaction intermediates in their conversion to olefins are presented. Increasing the ratio of Si/Al and incorporation of Co into the catalyst framework improved the methyl bromide yield of light olefins over that obtained using standard SAPO-34.

Triple tandem catalyst mixtures for the synthesis of polyethylenes with varying structures.

Tandem catalysis in a single medium presents challenges and opportunities for creating novel synthetic protocols. Thus far, only two homogeneous catalysts have been used in tandem. Herein, we report that it is possible to coordinate the action of three well-defined homogeneous catalysts to produce a wide range of branched polyethylenes from a single monomer. Thus, ([(eta(5)-C(5)Me(4))SiMe(2)(eta(1)-NCMe(3))]TiMe)(MeB(C(6)F(5))(3)) (1), [(C(6)H(5))(2)PC(6)H(4)C(OB(C(6)F(5))(3))O-kappa(2)P,O]Ni(eta(3)-CH(2)C(6)H(5)) (2), and ((H(3)C)C[N(C(6)H(5))]C[O-B(C(6)F(5))(3)][N(C(6)H(5))]-kappa(2)N,N)Ni(eta(3)-CH(2)C(6)H(5)) (3) react with ethylene to produce branched polyethylene with structures that cannot be obtained using a single- or a two-component catalyst combination. The properties of the polyethylene depend on the ratio of the three catalysts. High-throughput screening techniques proved essential for optimizing reaction conditions and for probing how the catalyst composition influences the polymer properties.

Primary cutaneous phaeohyphomycosis. Report of three cases.

Dematiaceous fungi have a diverse clinical spectrum that presents a difficult problem in diagnosis and treatment. These opportunistic pathogens are of concern in healthy, debilitated, or immunocompromised individuals. We describe three patients with localized cutaneous infections produced by dematiaceous filamentous fungal organisms with varying clinical presentations. Two patients were immunocompromised, and a third was otherwise healthy. The unusual clinical and unique histologic features of these difficult infections are reported in detail, as is their successful medical management with ketoconazole (Nizoral) and an experimental antifungal agent, fluconazole.