Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review

Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted

A cohesive network approach for modelling fibre and matrix damage in composite laminates

In the current study a high fidelity analysis approach is used to predict the failure process of notched composite structures. Discrete cracking is explicitly modelled by incorporating cohesive interface elements along potential failure paths. These elements form an interconnected network to account for the interaction between interlaminar and intralaminar failure modes. Finite element models of these configurations were created in the commercial analysis software ABAQUS and a user defined material subroutine (UMAT) was used to describe the behaviour of the cohesive elements. The material subroutine ensured that the model remained stable despite significant damage, which is a significant challenge for implicit damage simulations. Two analysis approaches were adopted using either the as-measured or modified (in-situ) ply strengths. Both approaches were capable of closely predicting the mean ultimate strength for a range of hole diameters. However, using the measured ply properties resulted in extensive matrix cracking in the surface ply which caused a deviation from the experimentally measured surface strain. The results demonstrate that high fidelity physically based modelling approaches have the ability to complement or replace certain experimental programs focussed on the design and certification of composite structures

Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up

Introduction Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre. Patients and methods Between 2000 and 2002, 94 consecutive THAs were performed using the 170 mm Lubinus SP II anatomical femoral stem in our institution. Patient demographics, operative details and clinical outcomes were collected prospectively in an arthroplasty database. Patient records and national radiographic archives were reviewed finally at a mean of 21.5 years (SD 0.7) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture. Results Mean patient age at surgery was 65.8 years (SD 12.5, 34–88 years). There were 48 women (51%). Osteoarthritis was the operative indication in 88 patients (94%). Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (95% confidence interval [CI], 98.0–99.3%) at 10 years and 96.7% (94.5–98.9%) at 21 years. The 20-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line > 2 mm) and no stems required revision. Patient demographics did not appear to influence risk of revision (p > 0.05). There were 2 revisions in total (2 for acetabular loosening with original stems retained). There were no PPFs identified at mean 21.5 year follow-up and 5 dislocations (5%). Conclusions The Lubinus SP II 170 mm stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA.Peer reviewe

Process evaluation of integrated early child development care at private clinics in poor urban Pakistan: a mixed methods study

Background: In poor urban Pakistan, private GP clinics lack adequate services to promote early child development (ECD) care. A clinic-based contextualised ECD intervention was developed for quarterly tool-assisted counselling of mothers. Aim: To explore the experience and implementation of ECD intervention by the private care providers and clients, for further adaptation for scaling of quality ECD care, at primary level private healthcare facilities in Pakistan. Design & setting: A mixed methods approach using quantitative records review and qualitative interviews at poor urban clinics in Rawalpindi and Lahore, Pakistan. Method: Quantitative data from study-specific records were reviewed for 1242 mother–child pairs registered in the intervention. A total of 18 semi-structured interviews with clinic staff, mothers, and research staff were conducted at four clinics. The interviews were audiorecorded and transcribed verbatim. Results: District Health Office (DHO) support allowed transparent and effective selection and training of clinic providers. Public endorsement of ECD care at private clinics and the addition of community advocates promoted ECD care uptake. Clinic settings were found feasible for clinic assistants, and acceptable to mothers, for counselling sessions. Mothers found ECD counselling methods more engaging compared to the usual care provided. Conclusion: In poor urban settings where public health care is scarce, minimal programme investment on staff training and provision of minor equipment can engage private clinics effectively in delivering ECD care

Delivering integrated child development care in Pakistan: protocol for a clustered randomised trial

Background: Early childhood developmental delay is associated with significant disadvantage in adult life. In Pakistan, high prevalence of developmental delay is associated with poverty, under-nutrition, and maternal depression. Aim: To assess the effectiveness of an early child development counselling intervention delivered at private GP clinics, in poor urban communities. Design & setting: A clustered randomised trial in Pakistan. Method: The intervention was developed following a period of formative research, and in consultation with local experts. A total of 2112 mother–child pairs will be recruited at 32 clinics, from within the locality (cluster); 16 clinics per arm. A primary care counselling intervention (promoting child development, nutrition, and maternal mental health) will be delivered at 6 weeks, 3, 6, and 9 months of the child’s age. Monitoring, assessment, and treatment will also be performed at quarterly visits in intervention clinics. Primary outcome is the developmental delay at 12 months (ASQ-3 scores). Secondary outcomes are stunting rate, and maternal depression (PHQ-9 score). In addition, a process evaluation and costing study will be conducted. Discussion: This trial will be the first to assess an early child development intervention, delivered in private GP clinics for poor urban communities in Pakistan. If found to be effective, this public–private model may offer a more sustainable, and feasible option for populations in poor urban settings, where private GP clinics are the most accessible provider of primary health care. There is scope for scale-up at provincial level, should the intervention be effective. Trial registration: The trial has been registered with the Current Controlled Trials ISRCTN48032200

Studies in the Treatment of Malaria: XXIII. Oral Administration of Quinine Sulphate Grains 30 on Each of Two Consecutive Days Weekly, Over a Period of Five Weeks, in Malignant Tertian Malaria

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Studies in the Treatment of Malaria: XIII.—Oral Administration of Quinine Sulphate Grains 90 on Two Consecutive Days Only, in Simple Tertian Malaria[Second Series]

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Superconductivity in the Correlated Pyrochlore Cd_2Re_2O_7

We report the observation of superconductivity in high-quality Cd$_2$Re$_2$O$_7$ single crystals with room-temperature pyrochlore structure. Resistivity and ac susceptibility measurements establish an onset transition temperature T$_c^{onset}$ = 1.47 K with transition width $\Delta$T$_c$ = 0.25 K. In applied magnetic field, the resistive transition shows a type-II character, with an approximately linear temperature-dependence of the upper critical field H$_{c2}$. The bulk nature of the superconductivity is confirmed by the specific heat jump with $\Delta$C = 37.9 mJ/mol-K. Using the $\gamma$ value extracted from normal-state specific heat data, we obtain $\Delta$C/$\gamma$T$_c$ = 1.29, close to the weak coupling BCS value. In the normal state, a negative Hall coefficient below 100 K suggests electron-like conduction in this material. The resistivity exhibits a quadratic T-dependence between 2 and 60 K, i.e., $\rho =\rho_0$+AT$^2$, indicative of Fermi-liquid behavior. The values of the Kadowaki-Woods ratio A/$\gamma^2$ and the Wilson ratio are comparable to that for strongly correlated materials.Comment: 4 pages, 5 figure