Effective coverage and systems effectiveness for malaria case management in sub-saharan african countries

Scale-up of malaria preventive and control interventions over the last decade resulted in substantial declines in mortality and morbidity from the disease in sub-Saharan Africa and many other parts of the world. Sustaining these gains will depend on the health system performance. Treatment provides individual benefits by curing infection and preventing progression to severe disease as well as community-level benefits by reducing the infectious reservoir and averting emergence and spread of drug resistance. However many patients with malaria do not access care, providers do not comply with treatment guidelines, and hence, patients do not necessarily receive the correct regimen. Even when the correct regimen is administered some patients will not adhere and others will be treated with counterfeit or substandard medication leading to treatment failures and spread of drug resistance. We apply systems effectiveness concepts that explicitly consider implications of health system factors such as treatment seeking, provider compliance, adherence, and quality of medication to estimate treatment outcomes for malaria case management. We compile data for these indicators to derive estimates of effective coverage for 43 high-burden Sub-Saharan African countries. Parameters are populated from the Demographic and Health Surveys and other published sources. We assess the relative importance of these factors on the level of effective coverage and consider variation in these health systems indicators across countries. Our findings suggest that effective coverage for malaria case management ranges from 8% to 72% in the region. Different factors account for health system inefficiencies in different countries. Significant losses in effectiveness of treatment are estimated in all countries. The patterns of inter-country variation suggest that these are system failures that are amenable to change. Identifying the reasons for the poor health system performance and intervening to tac them become key priority areas for malaria control and elimination policies in the region

Filaments of crime: Informing policing via thresholded ridge estimation

Objectives: We introduce a new method for reducing crime in hot spots and across cities through ridge estimation. In doing so, our goal is to explore the application of density ridges to hot spots and patrol optimization, and to contribute to the policing literature in police patrolling and crime reduction strategies. Methods: We make use of the subspace-constrained mean shift algorithm, a recently introduced approach for ridge estimation further developed in cosmology, which we modify and extend for geospatial datasets and hot spot analysis. Our experiments extract density ridges of Part I crime incidents from the City of Chicago during the year 2018 and early 2019 to demonstrate the application to current data. Results: Our results demonstrate nonlinear mode-following ridges in agreement with broader kernel density estimates. Using early 2019 incidents with predictive ridges extracted from 2018 data, we create multi-run confidence intervals and show that our patrol templates cover around 94% of incidents for 0.1-mile envelopes around ridges, quickly rising to near-complete coverage. We also develop and provide researchers, as well as practitioners, with a user-friendly and open-source software for fast geospatial density ridge estimation. Conclusions: We show that ridges following crime report densities can be used to enhance patrolling capabilities. Our empirical tests show the stability of ridges based on past data, offering an accessible way of identifying routes within hot spots instead of patrolling epicenters. We suggest further research into the application and efficacy of density ridges for patrolling.Comment: 17 pages, 3 figure

Examining unused pharmaceuticals in the environment

Unused pharmaceuticals take an unhealthy toll on both the environment and human health. In the US alone, an estimated {dollar}1 billion of prescription drugs are thrown away each year. Increasing availability, marketing, and purchasing of both prescription and over-the-counter medications, coupled with the tendency of patients to discontinue use of and to stockpile drugs at home, is a unique problem that has garnered increasing attention among scientists, policymakers, and the media in the last ten years; These accumulated household drugs become unused pharmaceutical waste. This waste must be discarded and disposed of by the consumer. Historically, consumers have been instructed by health care professionals to dispose of unwanted medications into the sewage system. Inserts in some pharmaceutical packaging have also instructed consumer to flush expired and unused medications down the toilet. This method has historically also applied to pharmaceuticals stored in locations other than the consumer household; In the past decade studies have consistently identified amounts of pharmaceutical residues in water systems throughout the country. However, it has yet to be determined if the source of these substances found in the waterways is from excretion or disposal. While it is most likely a combination of both, it has been difficult to assess to what extent disposal takes place. Namely, there has been no source of data that would convey how often disposal takes place, what are the more common pharmaceutical compounds disposed, and in what quantities these compounds are flushed into our sewage systems; This dissertation describes a new methodology---compiling inventory data from coroner offices---which can provide a source of data detailing exactly how much of a specific pharmaceutical ingredient has been disposed in a particular geographic area and the frequency with which that compound is found in the disposal inventories. Further, this work assesses the many, varied, and often overlooked sites of accumulation of unused medications, the approximate relative contributions generated at each site, and common reasons why they accumulate in their respective locations. Finally, this work assesses the risk associated with inappropriate transfers of pharmaceuticals, and potential means for mitigating the risks

“Soft” policing at hot spots—do police community support officers work? A randomized controlled trial

© 2016, The Author(s). Objectives: To determine whether crime-reduction effects of increased police patrols in hot spots are dependent on the “hard” threat of immediate physical arrest, or whether “soft” patrols by civilian (but uniformed) police staff with few arrest powers and no weapons can also reduce crime. We also sought to assess whether the number of discrete patrol visits to a hot spot was more or less important than the total minutes of police presence across all visits, and whether effects based on counts of crime would be consistent with effects on a Crime Harm Index outcome. Methods: We randomly assigned 72 hot spots into 34 treatment units and 38 controls. Treatment consisted of increases in foot patrol by uniformed, unarmed, Police Community Support Officers (PCSOs) who carry no weapons and hold few arrest powers beyond those of ordinary citizens. GPS-trackers on every PCSO and Constable in the city yielded precise measurements of all patrol time in all hot spots. Standardized mean differences (Cohen’s d), OLS regression model, and Weighted Displacement Quotient are used to assess main effects, to model the interaction effect of GPS data with treatment, and to measure the diffusion-of-benefits of the intervention, respectively. Outcomes included counts of incidents as well as the Cambridge Crime Harm Index. Results: As intended, patrol visits and minutes by Police Constables were equal across the treatment and control groups. The sole difference in policing between the treatments groups was in visits to the hot spots by PCSOs, in both the mean daily frequency of discrete visits (T = 4.65, C = 2.66; p ≤.001) and total minutes across all visits (T = 37.41, C = 15.92; p ≤.001), approximately two more ten-minute visits per day in treatment than in control. Main effect estimates suggest 39 % less crime by difference-in-difference analysis of reported crimes compared to control conditions, and 20 % reductions in emergency calls-for-service compared to controls. Crime in surrounding areas showed a diffusion of benefits rather than displacement for treatment hot spots compared to controls. A “Reiss’s Reward” effect was observed, with more proactive patrols predicting less crime across treatment hot spots, while more reactive PCSO time predicted more crime across control hot spots. Crime Harm Index estimates of the seriousness value of crime prevented ranged from 85 to 360 potential days of imprisonment in each treatment group hot spot (relative to controls) by a mean difference of 21 more minutes of PCSO patrol per day, for a potential return on investment of up to 26 to 1. Conclusions: A crime reduction effect of extra patrols in hot spots is not conditional on “hard” police power. Even small differences in foot patrols showing the “soft power” of unarmed paraprofessionals, holding constant vehicular patrols by Police Constables, were causally linked to both lower counts of crimes and a substantially lower crime harm index score. Correlational evidence within the treatment group suggests that greater frequency of discrete PCSO visits may yield more crime reduction benefit than greater duration of those visits, but RCTs are needed for better evidence on this crucial issue

Historical Institutionalism and the Politics of a Knowledge Economy

This dissertation examines the role that domestic institutions can play in the implementation of international intellectual property rights standards. In doing so, it argues that the path dependence of existing institutions can alter how international standards are actually implemented on the ground. It further argues that this altering of standards can create feedback effects that influence related state policies and the international standards themselves. This argument adds to the IPE literature on the creation of international intellectual property (IP) rights, which thus far, has tended to focus primarily on international-level negotiations rather than national-level implementation. It challenges the dominant \u27market power\u27 explanation that emphasizes the role of economic power in setting international regulatory standards. It does so by examining a critical case study of Canada and its implementation of trade-related intellectual property standards. Canada is a critical case due to its high trade dependence on the United States, which makes it \u27least likely\u27 to resist US market power. The dissertation shows how Canada has managed its adoption of trade-related IP standards through institutional layering and conversion strategies at various levels of governance. The analysis argues for, and significantly supports, the value of historical institutionalism in the study of international political economy

Bureaucratic entrepreneurship and morality politics: Dividing lines within the state

Based on a qualitative and quantitative research design, this article examines the implementation of a morality policy—the medical cannabis policy in Switzerland—to investigate three understudied aspects of bureaucratic entrepreneurship. First, moving away from mono-professional studies, the focus is on a policy characterized by a dispute between two groups of bureaucrats: physicians and jurists. Second, key conditions triggering bureaucratic policy entrepreneurship are identified, with a focus on mid-level administrative entrepreneurs. Third, vertical alliances between bureaucrats and politicians of the executive and legislative branches are examined and these processes are reflected in the wider perspective of the politics-administration dichotomy. Results show that law obsolescence, disputes between groups of bureaucrats and the need for political arbitration are favorable conditions for bureaucratic policy entrepreneurship. The study also shows that within the traditional separation of powers, bureaucratic entrepreneurship reinforces the executive power and creates dividing lines within the different branches of government

Access Control and Service-Oriented Architectures.

Access Control and Service-Oriented Architectures" investigates in which way logical access control can be achieved effectively, in particular in highly dynamic environments such as service-oriented architectures (SOA's). The author combines state-of-the-art best-practice and projects these onto the SOA. In doing so, he identifies strengths of current approaches, but also pinpoints weaknesses. These weaknesses are subsequently mitigated by introducing an innovative new framework called EFSOC. The framework is validated empirically and preliminary implementations are discussed.