While the exact threshold immunity to interrupt transmission is

While the exact threshold immunity to interrupt transmission is not known for northern Nigeria, seroprevalence in Kano, Nigeria is well below the levels reported from Egypt and India (98-99%) in the final stages of eradication [21] and [22]. Although such extremely high immunity levels were probably not needed in the Nigerian context to interrupt transmission, the data does suggest that further increase in vaccination coverage in both routine and SIAs must be achieved to improve and sustain high immunity levels.
Our study had limitations, mainly associated with facility-based design. This study was not population-based and thus the results are not generalizable to the entire population. Nevertheless, our survey demonstrated that in the study sglt inhibitors who accessed care in a general government hospital, the seroprevalence rates were suboptimal. It is probably safe to assume that the seroprevalence levels could be even lower in other populations without access to health services. For data collection, we had to rely on parental recall for a number of variables, including vaccination history, maternal education, and age. In addition, the study design and sample size were not meant to be able to assess differences in small sub-populations.
Though the community-level acceptance for vaccination was variable in the area, we observed a good parental response for participation in the seroprevalence survey in the health facility-based surveys. We plan to repeat seroprevalence surveys in Kano Nigeria to monitor the population immunity and measure the impact of tOPV-bOPV switch and introduction of IPV in the routine immunization program.
Funding
World Health Organization (using a Grant from Rotary International).
Ethical approvals
Research Ethics Committee of Aminu Kano Teaching Hospital and Ethical Review Committee of World Health Organization, Geneva.
Conflict of interest
No authors reported a conflict of interest.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other collaborating agencies.
AcknowledgementsWe acknowledge the contributions of staff of Aminu Kano Teaching Hospital Kano, Murtala Mohammad Specialist Hospital Kano, Kano State Government, NPHCDA and WHO, who were involved in this seroprevalence survey. We recognize the contributions of Yiting Zhang, Sharla McDonald, and the rest of the CDC Population Immunity Team for performing the serology tests. We acknowledge Rotary International for funding this work through WHO.
Vaccine H56 antigen cDNA (1), fused to TTFC (tetanus toxin fragment C) or UB (ubiquitin) cDNA (2) and modified to flank CD8+ T cell epitope’; C-termini with a glutamic acid residue (3) was administered by tattoo immunization. Linkage to either TTFC or UB enhanced CD8+ T cell responses to all epitopes, while replacement of C-terminal epitope flanks for a Glu residue further increased the CD8+ T cell response to 4 out of 6 epitopes. These strategies can be exploited for vaccine design.Figure optionsDownload full-size imageDownload as PowerPoint slide

Removal of immunoglobulin G Immunoglobulin G

2.8. Removal of immunoglobulin G
Immunoglobulin G (IgG) of serum samples from immunized mice was separated using Protein G Sepharose Beads [12]. Briefly, 200 渭L Protein G Sepharose Beads was washed three times with cold PBS. After the final wash, the supernatant was aspirated after centrifugation, and 100 渭L pooled serum was added. The serum-beads mixture was incubated at 4 °C under rotary agitation for 1 h, centrifuged, and the supernatant was stored as IgG-depleted serum. All the steps were repeated thrice to remove abundant IgG.
2.9. Screening and Isolation of mAbs from mice
Five another SPF female 6-8 week old BALB/c female mice (Shanghai Slaccas, China) were administrated with the above sequential alzheimer\’s association regimen. Two weeks after the last immunization, mice were sacrificed, and splenocytes were collected to fuse with SP2/0-Ag14 myeloma cell lines. Hybridomas were screened with the above pseudovirus-based neutralization assays. Antibodies were purified by HiTrap Protein G HP columns (GE Healthcare, NJ, USA) from supernatants of positive hybridomas. Mouse IgG (E978, Santa Cruz Biotechnology, CA, USA) was used as a negative control.
2.10. Vaccination and challenge
DNA vaccines were administered intramuscularly (i.m.) in specific pathogen free (SPF) female 6-8 week old BALB/c mice (Shanghai Slaccas, China) as scheduled in Table 1. Two weeks after the last immunization, mice were intranasally challenged with PR8 virus (A/Puerto Rico/8/1934 (H1N1), provided by Shanghai Public Health Clinical Center, at a dose equivalent to 100 TCID50. Survival and body weight loss were monitored for 14 days.
2.11. Statistical tests and data analysis
All data plots and statistical analyses were generated using Prism4 (GraphPad). All values are plotted as mean ± SD or GMT ± 95% CI. Comparison between the groups was performed by Student’;s t-test. P-values at or below 0.05 are considered statistically significant. For endpoint titers, the cutoff was considered to be the mean optical density (OD) measured for secondary antibody-only wells plus three standard deviations.
3. Results
3.1. Immunogenicity of sequential vaccines regimen
We constructed DNA vaccines pVKD1.0-CON H1, pVKD1.0-CON H3, and pVKD1.0-CON H5, which express the HA antigen consensus sequences of H1, H3, and H5 subtypes, respectively. These consensus H1, H3, and H5 antigens were deduced by the alignment of all the published HA amino acid sequences from 2006 to 2009, and designated as CON H1, CON H3, and CON H5, respectively. In order to determine the immunogenicity of the sequential immunization of influenza vaccines, we compared the immune responses between sequential immunization with CON H1, CON H3, and CON H5 vaccines and vaccination with the mixture of CON H1, CON H3, and CON H5 vaccines (Fig. 1 and Table 1). We first tested the cellular immune response of immunized mice by IFN-纬 based ELISPOT with a dominant epitope peptide HA533 (IYSTVASSL) [19], [20] and [21]. Compared with the control mice (Mock group, 11 ± 5 Spot Forming Cells (SFCs)/106 splenocytes), all vaccine immunized groups were induced significantly more cellular responses (p < 0.0001 for Seq. group vs Mock group; p < 0.0001 for mixed group vs Mock group) (Fig. 2A). The sequential immunization group (Seq. group, 948 ± 54 SFCs/106 splenocytes) exhibited a similar level of cellular response as compared to the mixed immunization group (Mix. group, 985 ± 192 SFCs/106 splenocytes) with less variation observed in Seq. group.
Fig. 1. Schematic representation of sequential immunization strategy. BALB/c mice were randomly assigned into three groups. The mock control group received 100 渭g/dose pVKD1.0 vectors. The sequential group (Seq.) received 100 渭g/dose CON H1, CON H3, CON H5 DNA vaccines in order. The mixing group (Mix.) received 100 渭g/dose mixture DNA vaccines which included CON H1, CON H3, CON H5.Figure optionsDownload full-size imageDownload high-quality image (136 K)Download as PowerPoint slide

Variables which increase the probability of being

Variables which increase the probability of being selected only by the PMT are those included in the PMT formula such as household size, owning a bicycle, and having no solid walls. However, number of cows also increases the probability of being selected by the PMT only. Variables increasing the probability of being selected by the topoisomerase inhibitors only are being Christian or Animist (these variables are associated with PMT exclusion errors), being a widow, and borrowing land. Having secondary education, household size, having no solid walls, solid roof or toilets decrease the probability of being selected by CBT only (compared to being selected by PMT and CBT). Also, being a member of an association decreases the probability of being selected by PMT only or by CBT only. Finally, self-evaluated bad health and not owning land decrease the probability of being in each of the three categories, which suggest that households with these deprivations tend to be selected by both CBT and PMT. Some deprivations are only taken into account by CBT, such as being a widow, but in general, households with a given deprivation have a greater probability of being selected by both targeting methods. These results suggest that CBT and PMT do not diverge radically but that CBT focuses more on the socio-economic condition of households (e.g., being a widow, borrowing land) rather than on household assets.
Overall, and consistent with findings from other countries (Alatas et al., 2012 and Pop, 2014), the regression results suggest that CBT does not focus on low per capita consumption and its correlates (house material, etc.) and uses different criteria than PMT targeting. Specifically, CBT seem to exclude households with obvious signs of physical wealth (cows, physical assets) and include more households with low human capital (education and health) and limited resources (widows, households with no land or no agricultural material, etc.). Therefore, we evaluate CBT selection under alternative definitions of poverty.
(c). Alternative assessments of CBT
First, CBT efficiency in selecting the most food insecure households is assessed. A Household Food Insecurity Access Scale (HFIAS) score is constructed following Coates, Swindale, and Bilinsky (2007). As when poverty is defined as per capita consumption, the 67% households with the highest HFIAS scores are defined as poor (food insecure) (similarly to Scenario 1, see 2(c) 2()) and errors of inclusion and exclusion for PMT and CBT are computed as before.
Second, CBT efficiency in selecting multidimensionally poor households is assessed. A multidimensional poverty (MDP) index is constructed following a counting approach, which counts and aggregates dimensions in which each household is deprived (Alkire and Foster, 2011 and Stoeffler et al., 2015). The dimensions considered are health, education, nutrition and food security, living standards, physical assets, vulnerability, and self-evaluated poverty status (details available upon request). Again, the 67% of households with the highest MDP index are defined as poor and errors of inclusion and exclusion for CBT and PMT are computed.

Interestingly the hierarchical mode of economic reasoning also

Interestingly, the hierarchical mode of economic reasoning also influences the relationship that the group microenterprises develop with partners, both the NGO Amade and UNICEF. By identifying themselves as weaker/poorer than the partners, the groups expect to receive the benefits of patronage—a relationship contrary to market relations of parties of equal standing (Graeber, 2011, p. 108). About this project, you see, what we see is that we’;re really poor… Countries are really different, you see, and in here, at our place, we are really poor (…). As for me, what I could say about this price (of the lamp), it Q-VD(OMe)-OPh is that there are people here who cannot have these eight thousand francs. There are widows, people who do not have such means, whether or not they are with money. That’;s where the difficulty lies. There are all those widows and other vulnerable people (0135 P5, Makamba Kigamba). Just like the speaker in the above quote, a large part of the group members univocally identified themselves as poor or very poor. With chronic poverty still prevalent in the rural areas of Burundi, the group members strive for basic needs fulfillment, in particular the provisioning of food and clothing. Diverting scarce resources from these priorities is a cognitive decision entailing sacrifices on the part of the entire household—a decision that is both risky, and difficult to take. They (NGO Amade and UNICEF) can help us by giving us credit… So that some of us could buy the basic things, buy clothes, and raise goats because without goat manure we cannot cook, and we cannot eat. There are many of us who do not have any goat now, because of poverty, and so I ask them to really help us (P13, 0127, Gitega, Kigara).
This way of perceiving the partnership is, in ways, at odds with the free-market mechanisms of exchange. In barter economies, the objects being traded are seen as equal, and so are the people involved in the transaction (Graeber, 2011). In contrast, in societies with strong hierarchical relationships, independent exchange of goods and services and parallel partnerships are almost non-existent. “Whenever the lines of superiority and inferiority are clearly drawn and accepted by all parties as the framework of a relationship, and relations are sufficiently ongoing that we are no longer simply dealing with arbitrary force, the relations will be seen as being regulated by a web of habit and custom” ( Graeber, 2011, p. 110). In the case of the groups under study, these hierarchical relationships have been legitimized by the many years in which the NGO/UNICEF assumed the role of the leaders/providers, and the groups adopted the identity of aid recipients/beneficiaries. It can be deduced that in some ways these naturalized forms of authority, hierarchy and stratification hinder the groups from pursuing independent entrepreneurial efforts (Table 6). The next section analyzes this issue in more detail, explaining the rules and principles that were found to govern the inter- and intra-group relations in our study.

In the previous sections we explained the

In the previous sections, we explained the assumptions of the project under study, outlining both its social objectives and sustainable business credentials. With reference to the social enterprise definition discussed at length in the theoretical section, we feel confident to claim that project Lumière exemplifies a model social enterprise: an organization seeking market-based solutions to social problems. Table 4 summarizes the criteria outlined by Haugh (2007), highlighting the relevant features of project “Lumière”.
Table 4.
Social enterprise criteria with reference to the Lumière project, based on Haugh (2007)Social Enterprise CriteriaProject Lumière—Child protection committeesPursue a social purpose.Social—benefit organizations, with multiple bottom linesOperate via trading in a market placeThe groups sell rechargeable lamps at production cost and then generate income by selling energy to lamp owners (supply-demand model)Business-led solutionsThe pricing model tailored for the local context, in accordance with a business model that assumes full sustainability over the period of two yearsProfits re-invested to create order T-5224 benefitAll profits pulled to benefit the orphan’;s fundNon-financial measuresImpact on household wellbeing as measure of success, sustainabilityFull-size tableTable optionsView in workspaceDownload as CSV
Importantly, the details outlined above also illustrate how the social enterprise model adopted by the project embodies what Michener (1998) described as strong participation. The nine pilot groups are in fact supposed to become semi-autonomous economic structures, holistically responsible for the execution of the project. The sales, marketing, and distribution of the lamps, managing the energy generator, marketing and accounting of energy sales, balancing credit for the machine, and re-investing the profits in the orphans’; fund are only some of the tasks that the groups are to perform. Partnership and ceding control are the benchmarks of the intervention, ushering into a seemingly new way of practicing development.
In the light of the recent work of Swidler and Watkins (2009), “the doctrine of sustainability adds to these participatory approaches a profoundly moral invocation to the poor: that they should become self-reliant, mobilizing their own energies and resources to solve their own problems” (1184). The authors further argue that projects might achieve sustainability generating their own revenues. In the following section, we take a closer look at the environment in which the social enterprises are supposed to function, highlighting both the challenges and success factors.
(d). Prospects and pitfalls—three months into the project
Actually, we are all here in this association (child protection committee, CPC). So after joining this association called NAWE NUZE (Kirundi: “Come on, you too!”), there came a time when they (the NGO) came to teach us a new thing. They told us they would give us the lamps and this lamp is called MURIKIRANIGE (Kirundi: “Give me light so that I can study”). They told us that this lamp will reduce our problems, that very soon we will no longer have sore eyes and that this light, this lamp, does not break down easily. They also told us that we can attach this lamp on the forehead, so that we don’;t have to hold energy flow in hand while at work (P2, 0141, Bururi, Murago). (…) They also told us that the machine was not a gift; we would give a certain amount (P19, 0128, Gitega, Mvaro) (…). We welcomed the proposed light because before the arrival of these lamps, people were concerned about the means of education for the children. So we welcomed this project and yes, it helps us a lot. (…) It delights us much (P1, 0134, Makamba).6

Previous research Numer http www RG COM

3. Previous research
Numerous studies exist on the many aspects of the TGP; including, the decision making process surrounding its construction (Heggelund, 2004), the political economy and socio-economic impacts (Jackson & Sleigh, 2001) opposition to the project (Topping, 1995), purchase PF-573228 production (Dai, 1989) and the advantages and challenges (Wang, 2002). Chinese universities (for discussion see Guo et al., 2003, Li, 2000 and Tan, 2008) and the Chinese Academy of Social Sciences (CASS) also conducted a number of surveys, most recently in 2014 (F. Niu, personal communication, January 8th, 2004; J. Shan, personal communication, September 9th 2014).
These studies reported a range of “outcomes”, as did mine. Studies found high levels of dissatisfaction among people displaced by the Project (Jun, 2000 and Padovani, 2006), feminization of agriculture in the region (Tan, 2008) and high levels of outmigration (Hwang, Xi, Cao, Feng, & Qiao, 2007). A report commissioned by the Chinese government found that compensation levels were too low, employment was a problem, job training programs were not always effective, and land to support the displaced farmers was lacking (Tilt, 2015).
My first study compared data from 2003-04 with the resettlers’; recollections of their pre-resettlement livelihoods. Choosing a timeframe for assessing the project is difficult (for further discussion see Hirschman (1967)), however, scholarly literature reports that the first five years following displacement is typically a time of adjustment (Scudder & Colson, purchase PF-573228 1982). The majority of households in the survey had been resettled in the late 1990s (although inundation did not occur until 2003). From June 2003 to June 2004 I surveyed 521 resettled households in the TGRA to determine how Anterograde were faring after their resettlement. With my colleagues, I found that despite improvements to infrastructure and housing (Wilmsen, Webber, & Duan, 2011a), incomes generally declined, livelihoods were dismantled, and permanent employment was replaced by more temporary employment (McDonald, 2006). Most were living off a combination of compensation, savings, and loans. The research suggested that although the Chinese government attempted to equitably share the benefits of the project and associated development through the PSP, the majority of resettlers were experiencing lower living standards than before resettlement (Wilmsen et al., 2011a). However, there was one finding that suggested that in time, as development initiatives were expanded, the benefits might flow to the affected population—the income growth of a minority of urban residents was significantly correlated to employment in an enterprise (McDonald, Webber, & Duan, 2008). The question remains: if resettlement is conceptualized and planned as a development opportunity, can the livelihoods of the resettlers improve over time?
All these studies contribute to our understanding about how the resettlers fared during the construction of the TGP. Beyond the construction period, however, there are no publicly available longitudinal assessments of the TGP resettlement. Moreover, longitudinal research in the field of Development Forced Displacement and Resettlement (DFDR) is lacking. The key resettlement theorists have been calling for more such research for many decades to inform theory, policy, and practice (for example Scudder, 1997, Cernea, 1999 and Downing, 2002). This paper offers the first publicly available assessment of the longitudinal outcomes since construction of the TGP was completed.

Brain derived neurotrophic factor The BDNF

Brain-derived neurotrophic factor
The BDNF gene has an unusual splicing pattern in that the 22 described splice variants all generate the same buy Tubastatin A HCl BDNF peptide ( Fig. 4). In the case of BDNF, the different splice variants contribute to the control of BDNF expression by differential regulation in different areas of the buy Tubastatin A HCl or in other tissues, such as skeletal muscle [8]. In inflammatory pain, only transcripts containing exons 1, 2a, b, c, and 3 increased in primary sensory neurons [106] (Fig. 4). These transcripts, particularly those containing exon 1, are rapidly increased by nerve growth factor (NGF) in culture, suggesting that this potent algesic growth factor exerts effects through control of BDNF differential splicing.
Figure 4. Alternative splicing of the brain-derived neurotrophic factor (BDNF) mRNA. BDNF splicing is unusual in that, although there are at least 22 differently spliced transcripts, all generate the same final peptide. There are at least noncoding 5″ exons (1-8) and a short noncoding sequence in exon 9 (9a) that that can be differentially spliced at the 5-end of the mRNA. In addition, there are three alternative splice sites in exon 2 (denoted by the different shades of blue). The 3-coding exon 9 contains two alternative poly-adenylation sites in exon 9 (denoted by A). The coding sequence (shown in orange) is found in all splice variants. The translation start site (ATG) is denoted by a vertical arrow. At least nine different promoters are present in the BDNF gene, and final expression level, regional or subcellular site(s) of expression of BDNF peptide is controlled by differential expression of the different splice variants. Redrawn from [8].Figure optionsDownload full-size imageDownload high-quality image (210 K)Download as PowerPoint slide
Nerve growth factor
Both NGF and its receptor TrkA have splice variants 107 and 108. The TrkA slice variants do not seem to differ in their functional responses [108] and, surprisingly, there is no published literature relating to different actions of known NGF splice variants in nociception.
Targeting alternative splicing as a therapeutic strategy
Although alternative splicing has been considered as a potential therapeutic in pathologies such as cancer, eye disease, inherited diseases, such as spinal muscular atrophy, and viral infection 109, 110, 111 and 112, to date few clinical trials based on the therapeutic control of alternative splicing have been reported 113 and 114. Further trials are reportedly in progress for cholangiocarcinoma (NCT02128282, clinicaltrails.gov), and spinal muscular atrophy (NCT02240355, clinicaltrials.gov). As this review highlights, understanding of alternative splicing and its therapeutic targeting should not be limited to such pathologies, because it can inform or manipulate divergent areas such as physiological processes, pathology, and regional drug differences or adverse effects. Importantly, alternative splicing, as opposed to constitutive splicing, could be an untapped therapeutic approach in areas such as nociception and/or pain, and neuroprotection 102, 105 and 115.
Over the past 13 years, several strategies for the control of alternative splicing have been suggested, including targeted oligonucleotides against splice sites [116], or targeting splice factors, such as SR proteins [117].
Chemically modified oligonucleotides resistant to degradation have proved effective at inducing either exon skipping or blocking splice sites in animal models and in some clinical trials, with the aim of repair of defective mRNAs [118]. This approach can result in the restoration of functional protein in conditions such as Duchenne muscular dystrophy, where splicing events result in nonfunctional dystrophin. There has been some minor success in a few clinical trials using this approach. Alternatively, oligonucleotides can be targeted to block aberrant splicing events, restoring functional protein, such as in developing approaches to treat spinal muscular atrophy and beta-thalassemia [118]. Theoretically, these approaches can also be used to control alternative splicing by blocking alternative splice sites to direct splice variant expression; there has been some reported success in this area in animal models [119].

Figure Projected changes in forest and pasture areas at municipality

Figure 6.1. Projected changes in forest and pasture areas at municipality level, 2008-30.Figure optionsDownload full-size imageDownload as PowerPoint slide
Cropland (the sum of annual and perennial cropland) is projected to increase by a total of 500,000 hectares. Figure 6.2 shows projected change for two of the crops with the largest growth in area. Most of the growth for these two crops occurs outside the Amazon region and appears concentrated in the Andes and Caribbean regions. Among the annual crops considered, sugarcane shows the greatest projected change in area with a gain of 87,000 hectares. Rice and maize areas are projected to increase by some 36,000, and 26,000 hectares respectively. Area allocated to perennial crops is also projected to increase. For example, coffee, oil palm, and plantain areas increase by 12,000, 28,000, and 32,000 hectares respectively.
Figure 6.2. Projected changes in sugarcane and oil palm area at municipality level, 2008-30.Figure optionsDownload full-size imageDownload as PowerPoint slide
Projected changes in land use translate into changes in carbon stocks, and these are reported in Table 6.3. The model results show a net decrease in carbon stock, a total of 599 Tg C. This large reduction in the stock of carbon is due mostly to the decrease in forested area.
Table 6.4 reports the estimated changes in GHG emissions from cropland and pastureland. By far, the greatest change in emissions is connected to pastureland expansion and rice production. The next significant increase in GHG emissions comes from oil palm and plantain cultivation. This is projected to generate an average yearly increase in emissions equivalent to 12 Tg of CO2 eq. Note that these changes are driven completely by changes in land use, and we assumed that land management practices, as well as livestock management practices remain unchanged for the entire pi3k inhibitors considered.
7. Policy simulations
Colombian public and private sectors are actively involved in finding viable strategies for reducing emissions from the agriculture sector and from land use change. A series of meetings were held with the objective of soliciting opinions and ideas on high-priority objectives from government officials, private-sector representatives, producers’; organizations, and researchers. Our goal was to internalize in our simulations the interests and priorities of a wide range of stakeholders interested or involved in the design of low emission strategies. Given urethra some of the policy targets identified were clearly aspirational, we simulated two stages of accomplishment, (1) scenario in which the target is fully met and (2) scenario in which only half of the target is achieved. It is essential to note that the policies were evaluated with respect to the baseline which represents our best prediction of what the landscape and emissions will be in 2030.
For all scenarios, we evaluated the effects on carbon stock and GHG emissions and the impact on profits. Computing the impact on profits was particularly challenging given the lack of data on production costs. However, we believe that even limited insights into these effects can provide important information to policymakers who need to decide which policies are best to pursue. In order to accomplish this, data needed to be compiled from multiple sources. We used the change in commodity prices projected by IMPACT (Table 6.1) to compute changes in revenues. Data on production costs related to crop production (Table 7.1) are available relatively well disaggregated by region.4 Unfortunately, key costs associated with other policy simulations are much more uncertain. Costs related to improving the quality of pasture were derived from a single study on the issue (Martínez, 2009) and from direct communications with the cattle producers’; association (FEDEGAN). Costs of preventing deforestation were extracted from current studies on Nationally Appropriate Mitigation Actions and projects in the Amazon that aim at the valorization of local production compatible with standing forest.5 The data obtained, however accurate and sound, represent very limited experiences. Therefore, results will have to be revisited as more data become available.

br The most viable solution seems to be controlling the

The most viable solution seems to be controlling the hydrogen desorption duration, as it was presented based on the ANSYS CFX calculations, in which extending the desorption time to 10 s yielded relative pressures in the nanotube equal to 130.2 kPa with a relative strain of 135%. These maximum hydrogen desorption rates may be expected in future reversible hydrogen storage systems; therefore, that level of necessary safety strain has been taken as the benchmark for experimental fatigue tensile tests for various types of graphene. The results are presented in the next section.

3.6. Fatigue resistance tensile tests

For tensile test measurements, the relationship between the relative pdk 1 of the sample and its tensile strength was determined by measuring changes in conductivity. Typical characteristics of these relationships for CVD graphene (black line) and HSMG graphene (blue line) are shown in Fig. 9. In addition, the course of the curve showing a relative deformation of the sample during the test is marked with a red line. The deformation values are shown on the right axis of the graph.

Fig. 9. (a) Changes in the resistances of the HSMG and CVD graphene samples as a function of cyclic loading; (b) zoomed area that shows the loss of conductivity for the CVD graphene.Figure optionsDownload full-size imageDownload high-quality image (444 K)Download as PowerPoint slide

The study showed significant differences in the tensile strengths for both materials. The CVD graphene lost conductivity at a relative elongation of approx. 40%, while the value for the HSMG graphene was as high as 140%. For both materials, increased elongation caused a gradual increase of resistance. This increase was proportional to the elongation. More regular behavior was observed for the HSMG graphene, in which extension led to a proportional increase in the resistance; however, after reducing the strain it returned to its previous value. Hence, on the chart regular cycles of resistance changes corresponding to the amplitude distortion are noted. This regularity occurs with relative deformations of up to 100%. Above this value, within the same range of strain, a progressive increase in the sample resistance is visible until the loss of its continuity at a resistance of approximately 55 MOhm. In this case, CVD graphene behaves with less stability. From the initial stage of the test there is a large inhomogeneity of the resistance changes and the obtained values are significantly higher than for HSMG graphene. Hence, the lower resistance value (approx. 4 MOhm) was measured for the CVD graphene at its fracture point. In earlier work [24] in the static tensile pdk 1 test conducted until the graphene structure fractured, the CVD graphene lost electrical contact at approximately ∼16% elongation. In the literature, the maximum elongation values are in the range from 1 to >10% [43], [44] and [45], while the metallurgical graphene maintains electrical conductivity dependent upon the crystal structure defects, even at an elongation of approximately ∼33% [24]. In the case of fatigue tests, obtained strains are approximately three times higher for both the CVD and the HSMG graphene. Similar studies were conducted by Xiao Li\’s group [43]. In that experiment, polydimethylsiloxane (PDMS) was used as a substrate for the graphene grids, which were subjected to varying loads over time. They received an increase in resistance with increasing deformation, which is consistent with the results presented in this paper. In the case of a PDMS-graphene system the critical elongation was 15–20%. In the present study, CVD graphene loses continuity at a relative deformation of approximately 40%, while HSMG graphene can reach deformation of more than 100% before a loss in continuity occurs. The discrepancy between the results of the cited work and the presented experimental data may result from different substrates and form of graphene (grid, plane), the quality of the transfer and the fatigue test conditions.

br Results and discussion br First step production determinants

3. Results and discussion

3.1. First step: production determinants

We proposed two production indicators following the specification in equation (2): “Number of Fully Immunized Children” and “Total Number of Doses Administered” per facility. Although both dependent variables relate to the service production capacity of a facility, the “Number of Fully Immunized Children” involves a quality dimension (it requires children identification, on-time follow-up, etc.).

As fixed facilities – with no outreach activities – are responsible for explaining immunization performance in Moldova, explanatory variables used in the regression are related to health center characteristics: facility level inputs (human resources and infrastructure), proxy variables explaining logistics required for vaccine distribution i.e. distance to vaccine collection site, size of TASIN-1 in a facility catchment area and facility type. In addition, the variable “wastage rate” was included as proxy for managerial effectiveness at the provider level. 5

Table 2 presents the results of this regression. Firstly, human resources are positive and significant related at 1% level on facility outputs, with similar magnitude and relevance in all specifications.6 Furthermore, two alternative measures of capital were included: facility square meters and the cold chain capital index,7 intending both to capture productivity issues related to infrastructure. In the case of total number of doses administered, coefficients of both variables show to be significant at 5% level, although their effects on productivity are smaller than those of human resources. Cold chain capital index does not affect FIC but has positive and statistically significant association on the total doses delivered, and its relevance is greater that of square meters.

The number of infants in a catchment population, show to have positive relationship in explaining higher immunization outputs, but its magnitude is lower when their coefficients are compared with those which relates to human resources.

The distance to vaccine collection site and type of medical facility do not have statistically significant influence on productivity. On the other hand, the presence of doctors in the facility has strongest influence on the number of doses delivered and number of FICs produced. All specifications show to be statistically significant at 1% level.8

Finally, wastage rate have negative coefficients on both output indicators, statistically significant at 1% level, although with slightly stronger implications for the total number of doses administered.

Beyond the predictive capacity of the model implemented, the obtained R2 might be also the result of the small size of the sample available to pursue the analysis. The same consideration applies to the results reached at the second estimation step.

3.2. Second step: cost determinants

For evaluating determinants of costs we used Eq. (3) described earlier, with two alternative approaches. The first approach used facility-specific scale and input prices variables—specifications (1) through (4) in Table 3, reflecting prices of identified main labor and capital inputs used in vaccination activities, such as hourly USD wages for mid career nurses, unit USD prices for ice packs and refrigerators, for which data is present and available across all facilities.9

In the second approach, in addition to price variables, hybrid specifications were considered, by adding two variables—specifications (5) to (8) in Table 3. The first one relates to a facility management practice associated to efficiency in the use of resources (wastage rates). The second variable accounts for demand-side factors – characteristics of households – (income, educational level, etc.), which may affect demand for health services [17] and [18]. As potential demand side variables were strongly cross-correlated, we only retained the share of population with university education.