Examining decentralization and managerial decision making for child immunization program performance in India

Despite widespread adoption of decentralization reforms, the impact of decentralization on health system attributes, such as access to health services, responsiveness to population health needs, and effectiveness in affecting health outcomes, remains unclear. This study examines how decision space, institutional capacities, and accountability mechanisms of the Intensified Mission Indradhanush (IMI) in India relate to measurable performance of the immunization program. Data on decision space and its related dimensions of institutional capacity and accountability were collected by conducting structured interviews with managers based in 24 districts, 61 blocks, and 279 subcenters. Two measures by which to assess performance were selected: (1) proportion reduction in the DTP3 coverage gap (i.e., effectiveness), and (2) total IMI doses delivered per incremental USD spent on program implementation (i.e., efficiency). Descriptive statistics on decision space, institutional capacity, and accountability for IMI managers were generated. Structural equation models (SEM) were specified to detect any potential associations between decision space dimensions and performance measures. The majority of districts and blocks indicated low levels of decision space. Institutional capacity and accountability were similar across areas. Increases in decision space were associated with less progress towards closing the immunization coverage gap in the IMI context. Initiatives to support health workers and managers based on their specific contextual challenges could further improve outcomes of the program. Similar to previous studies, results revealed strong associations between each of the three decentralization dimensions. Health systems should consider the impact that management structures have on the efficiency and effectiveness of health services delivery. Future research could provide greater evidence for directionality of direct and indirect effects, interaction effects, and/or mediators of relationships

Direct observation of homogeneous cavitation in nanopores

We report on the evaporation of hexane from porous alumina and silicon membranes. These membranes contain billions of independent nanopores tailored to an ink-bottle shape, where a cavity several tens of nanometers in diameter is separated from the bulk vapor by a constriction. For alumina membranes with narrow enough constrictions, we demonstrate that cavity evaporation proceeds by cavitation. Measurements of the pressure dependence of the cavitation rate follow the predictions of the bulk, homogeneous, classical nucleation theory, definitively establishing the relevance of homogeneous cavitation as an evaporation mechanism in mesoporous materials. Our results imply that porous alumina membranes are a promising new system to study liquids in a deeply metastable state.Comment: 14 pages , 4 figures. Source files also contain Supplemental Material (Doebele_HomogeneousCavitationMembranes_SM.pdf

Momentum flux estimates accompanying multiscale gravity waves over Mount Cook, New Zealand, on 13 July 2014 during the DEEPWAVE campaign

Observations performed with a Rayleigh lidar and an Advanced Mesosphere Temperature Mapper aboard the National Science Foundation/National Center for Atmospheric Research Gulfstream V research aircraft on 13 July 2014 during the Deep Propagating Gravity Wave Experiment (DEEPWAVE) measurement program revealed a large-amplitude, multiscale gravity wave (GW) environment extending from ~20 to 90 km on flight tracks over Mount Cook, New Zealand. Data from four successive flight tracks are employed here to assess the characteristics and variability of the larger- and smaller-scale GWs, including their spatial scales, amplitudes, phase speeds, and momentum fluxes. On each flight, a large-scale mountain wave (MW) having a horizontal wavelength ~200-300 km was observed. Smaller-scale GWs over the island appeared to correlate within the warmer phase of this large-scale MW. This analysis reveals that momentum fluxes accompanying small-scale MWs and propagating GWs significantly exceed those of the large-scale MW and the mean values typical for these altitudes, with maxima for the various small-scale events in the range ~20-105 m2 s-2. Key Points Mountain waves penetrate the mesosphere under suitable propagation conditions Small-scale gravity waves can attain very large momentum fluxes Occurrence of peak momentum fluxes is often dictated by multiscale environments. © 2015. American Geophysical Union. All Rights Reserved

Quench Protection Study of a Single-Aperture 11 T Nb3Sn Demonstrator Dipole for LHC Upgrades

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Development and Test of a Single-Aperture 11 T Nb3Sn Demonstrator Dipole for LHC Upgrades

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Field Quality Measurements in a Single-Aperture 11 T Nb3Sn Demonstrator Dipole for LHC Upgrades

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An ex-post view of inequality of opportunity in France and its regions

This paper proposes an ex-post measure of inequality of opportunity in France and its regions by assessing the inequality between individuals exerting the same effort. To this end, we define a fair income that fulfils ex-post equality of opportunity requirements. Unfairness is measured by an unfair Gini based on the distance between the actual income and the fair income. Our findings reveal that the measures of ex-post inequality of opportunity largely vary across regions, and that this is due to di_erences in reward schemes and in the impact of the non responsibility factors of income. We find that most regions have actual incomes closer to fair incomes than to average income, excepted Ile de France where the actual income looks poorly related to effort variables. Finally, we find that income inequality and inequality of opportunity are positively correlated among regions

Ethanol seeking triggered by environmental context is attenuated by blocking dopamine D1 receptors in the nucleus accumbens core and shell in rats

Conditioned behavioral responses to discrete drug-associated cues can be modulated by the environmental context in which those cues are experienced, a process that may facilitate relapse in humans. Rodent models of drug self-administration have been adapted to reveal the capacity of contexts to trigger drug seeking, thereby enabling neurobiological investigations of this effect. We tested the hypothesis that dopamine transmission in the nucleus accumbens, a neural structure that mediates reinforcement, is necessary for context-induced reinstatement of responding for ethanol-associated cues. Rats pressed one lever (active) for oral ethanol (0.1 ml; 10% v/v) in operant conditioning chambers distinguished by specific visual, olfactory, and tactile contextual stimuli. Ethanol delivery was paired with a discrete (4 s) light-noise stimulus. Responses on a second lever (inactive) were not reinforced. Behavior was then extinguished by withholding ethanol but not the discrete stimulus in a different context. Reinstatement, expressed as elevated responding for the discrete stimulus without ethanol delivery, was tested by placing rats into the prior self-administration context after administration of saline or the dopamine D1 receptor antagonist, SCH 23390 (0.006, 0.06, and 0.6 μg/side), into the nucleus accumbens core or shell. Compared with extinction responding, active lever pressing in saline-pretreated rats was enhanced by placement into the prior ethanol self-administration context. SCH 23390 dose-dependently reduced reinstatement after infusion into the core or shell. These findings suggest a critical role for dopamine acting via D1 receptors in the nucleus accumbens in the reinstatement of responding for ethanol cues triggered by placement into an ethanol-associated context