Non-viral gene delivery vectors were developed for efficient gene transfer to hard to transfect mouse mammary epithelial cells. Ten modified versions of the same base poly(beta-amino ester), poly(1,4-butanediol diacrylate-co-5-amino-1-pentanol), were tested in both traditional 2-D monolayer and in 3-D organotypic cultures. The polymers self-assembled with plasmid DNA encoding enhanced green fluorescent protein to form nanoparticles (~100 nm) used to transfect the cells. Nanoparticle transfection efficacy was tuned by changes in synthesis and fabrication conditions and the transfection efficacy was analyzed using confocal microscopy and flow cytometry. The best performing polymeric nanoparticles transfected 57±6% of the cells in 2-D culture and 6±1% of the cells in 3-D culture. Small modifications to the polymer end-capping molecules and tuning of polymer molecular weight could either significantly enhance the transfection efficacy up to 6-fold or instead abolish efficacy completely. The efficacy of leading polymers was higher than that of the commercial transfection agent FuGENE® HD by a factor of 13 in 2-D and 2 in 3-D. These non-viral nanoparticles may be useful as delivery reagents or targeted therapeutics for breast cancer. This gene delivery strategy is also a promising approach for studying the normal development of the mammary gland.
The government of Myanmar, with support from international donors, plans to address household financial risks from ill health and expand coverage. But evidence to design policy is limited. WHS (World Health Survey) data for 6045 households were used to investigate the association of out-of-pocket (OOP) health spending, catastrophic expenditures, and household borrowing and asset sales associated with illness with key socioeconomic and demographic correlates in Myanmar. Households with elderly and young children and chronically ill individuals, poor households, and ethnic minorities face higher financial stress from illness. Rural households use less care, suggesting their lower OOP health spending may be at the cost of health. Poorer groups rely more on public sector health services than richer groups. Better targeting, increased budgetary allocations, and more effective use of resources via designing cost-effective benefits packages appear key to sustainably addressing financial risks from ill health in Myanmar.
Myanmar is expanding public spending on health and has recently launched an innovative programme for supporting hospital-based care for poor households. Our findings suggest the need for interventions to address OOP expenses associated with outpatient care (including drugs) for chronic conditions in Myanmar's population.
Objectives
Many low‐ and middle‐income countries (LMICs) provide subsidised access to health services for the poor. Proxy means tests (PMTs) for income are typically employed to identify eligible beneficiaries for subsidised services but often result in significant mistargeting of benefits. We assessed the PMT approach used in Myanmar's hospital equity fund (HEF).
Methods
We analysed inclusion/exclusion errors by comparing household eligibility under the PMT used for HEF with household consumption (the gold standard proxy for income in LMICs). We assessed receipt of benefits post‐hospitalisation against HEF eligibility rules and household income. Focus groups/interviews were conducted to understand administrative factors that influence targeting. We modelled (linear regression) predictors of household consumption to improve PMT accuracy.
Results
We found large targeting errors (86% of households in the bottom consumption quartile would be excluded and 15% of households in the top consumption quartile deemed eligible). HEF scores for PMT held little explanatory power for household income: 93% of individuals meeting the HEF eligibility criteria did not receive benefits post‐hospitalisation, while 23% of ineligible individuals received programme support. Re‐weighting PMT indicators on electricity access, land ownership and livestock ownership, and assigning weights to home‐ownership, households with elderly/disabled members and household head education levels could significantly improve targeting accuracy. Poor programme awareness and uneven adherence to official eligibility determination procedures among staff likely affected targeting.
Conclusions
Re‐weighting PMT indicators and increasing training and communication about qualification procedures could improve allocation of limited funds, though accurate targeting may continue to be challenging in contexts of low state capacity.
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