African participation and partnership in performance-based financing : a case study in global health policy

This report forms part of a research programme led by the Regional Network for Equity in Health in East and Southern Africa (EQUINET). The case study focuses on the participation of African actors in global health governance in terms of performance-based funding (PBF). It investigates how global health actors in South Africa, Tanzania and Zambia participate in decision-making processes related to the PBF mechanisms associated with the Global Fund and World Bank. African agency lies in the strength of a country’s health system, which determines the ability to say no to external funders and to set their own policy preferences

Health System Resilience—The Foundation For Pandemic Preparedness

peer reviewe

Excitation Spectrum and Superexchange Pathways in the Spin Dimer VODPO_4 . 1/2 D_2O

Magnetic excitations have been investigated in the spin dimer material VODPO_4 \cdot 1/2 D_2O using inelastic neutron scattering. A dispersionless magnetic mode was observed at an energy of 7.81(4) meV. The wavevector dependence of the scattering intensityfrom this mode is consistent with the excitation of isolated V^{4+} spin dimers with a V-V separation of 4.43(7) \AA. This result is unexpected since the V-V pair previously thought to constitute themagnetic dimer has a separation of 3.09 \AA. We identify an alternative V-V pair as the likely magnetic dimer, which involves superexchange pathways through a covalently bonded PO_4 group. This surprising result casts doubt on the interpretation of (VO)_2P_2O_7 as a spin ladder.Comment: 4 pages, 4 postscript figures - identical to previous paper but figure 2 and 3 hopefully more compatible .p

A randomized, placebo-controlled trial of late Na current inhibition (ranolazine) in coronary microvascular dysfunction (CMD): impact on angina and myocardial perfusion reserve.

AimsThe mechanistic basis of the symptoms and signs of myocardial ischaemia in patients without obstructive coronary artery disease (CAD) and evidence of coronary microvascular dysfunction (CMD) is unclear. The aim of this study was to mechanistically test short-term late sodium current inhibition (ranolazine) in such subjects on angina, myocardial perfusion reserve index, and diastolic filling.Materials and resultsRandomized, double-blind, placebo-controlled, crossover, mechanistic trial in subjects with evidence of CMD [invasive coronary reactivity testing or non-invasive cardiac magnetic resonance imaging myocardial perfusion reserve index (MPRI)]. Short-term oral ranolazine 500-1000 mg twice daily for 2 weeks vs. placebo. Angina measured by Seattle Angina Questionnaire (SAQ) and SAQ-7 (co-primaries), diary angina (secondary), stress MPRI, diastolic filling, quality of life (QoL). Of 128 (96% women) subjects, no treatment differences in the outcomes were observed. Peak heart rate was lower during pharmacological stress during ranolazine (-3.55 b.p.m., P < 0.001). The change in SAQ-7 directly correlated with the change in MPRI (correlation 0.25, P = 0.005). The change in MPRI predicted the change in SAQ QoL, adjusted for body mass index (BMI), prior myocardial infarction, and site (P = 0.0032). Low coronary flow reserve (CFR <2.5) subjects improved MPRI (P < 0.0137), SAQ angina frequency (P = 0.027), and SAQ-7 (P = 0.041).ConclusionsIn this mechanistic trial among symptomatic subjects, no obstructive CAD, short-term late sodium current inhibition was not generally effective for SAQ angina. Angina and myocardial perfusion reserve changes were related, supporting the notion that strategies to improve ischaemia should be tested in these subjects.Trial registrationclinicaltrials.gov Identifier: NCT01342029

A Place to Call Home: Amphibian Use of Created and Restored Wetlands

Loss and degradation of wetland habitats are major contributing factors to the global decline of amphibians. Creation and restoration of wetlands could be a valuable tool for increasing local amphibian species richness and abundance. We synthesized the peer-reviewed literature addressing amphibian use of created and restored wetlands, focusing on aquatic habitat, upland habitat, and wetland connectivity and configuration. Amphibian species richness or abundance at created and restored wetlands was either similar to or greater than reference wetlands in 89% of studies. Use of created and restored wetlands by individual species was driven by aquatic and terrestrial habitat preferences, as well as ability to disperse from source wetlands. We conclude that creating and restoring wetlands can be valuable tools for amphibian conservation. However, the ecological needs and preferences of target species must be considered to maximize the potential for successful colonization and long-term persistence

Spin gap in the Quasi-One-Dimensional S=1/2 Antiferromagnet: Cu2(1,4-diazacycloheptane)2Cl4

Cu_{2}(1,4-diazacycloheptane)_{2}Cl_{4} contains double chains of spin 1/2 Cu^{2+} ions. We report ac susceptibility, specific heat, and inelastic neutron scattering measurements on this material. The magnetic susceptibility, $\chi(T)$, shows a rounded maximum at T = 8 K indicative of a low dimensional antiferromagnet with no zero field magnetic phase transition. We compare the $\chi(T)$ data to exact diagonalization results for various one dimensional spin Hamiltonians and find excellent agreement for a spin ladder with intra-rung coupling $J_1 = 1.143(3)$ meV and two mutually frustrating inter-rung interactions: $J_2 = 0.21(3)$ meV and $J_3 = 0.09(5)$ meV. The specific heat in zero field is exponentially activated with an activation energy $\Delta = 0.89(1)$ meV. A spin gap is also found through inelastic neutron scattering on powder samples which identify a band of magnetic excitations for $0.8 < \hbar\omega < 1.5$ meV. Using sum-rules we derive an expression for the dynamic spin correlation function associated with non-interacting propagating triplets in a spin ladder. The van-Hove singularities of such a model are not observed in our scattering data indicating that magnetic excitations in Cu_{2}(1,4-diazacycloheptane)_{2}Cl_{4} are more complicated. For magnetic fields above $H_{c1} \simeq 7.2$ T specific heat data versus temperature show anomalies indicating a phase transition to an ordered state below T = 1 K.Comment: 9 pages, 8 postscript figures, LaTeX, Submitted to PRB 8/4/97, e-mail Comments to [email protected]

A Study of the S=1/2 Alternating Chain using Multiprecision Methods

In this paper we present results for the ground state and low-lying excitations of the $S=1/2$ alternating Heisenberg antiferromagnetic chain. Our more conventional techniques include perturbation theory about the dimer limit and numerical diagonalization of systems of up to 28 spins. A novel application of multiple precision numerical diagonalization allows us to determine analytical perturbation series to high order; the results found using this approach include ninth-order perturbation series for the ground state energy and one magnon gap, which were previously known only to third order. We also give the fifth-order dispersion relation and third-order exclusive neutron scattering structure factor for one-magnon modes and numerical and analytical binding energies of S=0 and S=1 two-magnon bound states.Comment: 16 pages, 9 figures. for submission to Phys.Rev.B. PICT files of figs available at http://csep2.phy.ornl.gov/theory_group/people/barnes/barnes.htm

Surfing Corona waves – instead of breaking them: Rethinking the role of natural immunity in COVID-19 policy [version 3; peer review: 2 approved, 1 approved with reservations]

In the first two years of the pandemic, COVID-19 response policies have aimed to break Corona waves through non-pharmaceutical interventions and mass vaccination. However, for long-term strategies to be effective and efficient, and to avoid massive disruption and social harms, it is crucial to introduce the role of natural immunity in our thinking about COVID-19 (or future “Disease-X”) control and prevention. We argue that any Corona or similar virus control policy must appropriately balance five key elements simultaneously: balancing the various fundamental interests of the nation, as well as the various interventions within the health sector; tailoring the prevention measures and treatments to individual needs; limiting social interaction restrictions; and balancing the role of vaccinations against the role of naturally induced immunity. Given the high infectivity of SARS-CoV-2 and its differential impact on population segments, we examine this last element in more detail and argue that an important aspect of ‘living with the virus’ will be to better understand the role of naturally induced immunity in our overall COVID-19 policy response. In our eyes, a policy approach that factors natural immunity should be considered for persons without major comorbidities and those having ‘encountered’ the antigen in the past

A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries.

Pay for performance (P4P) programmes are popular health system-focused interventions aiming to improve health outcomes in low-and middle-income countries (LMICs). This realist review aims to understand how, why and under what circumstance P4P works in LMICs.We systematically searched peer-reviewed and grey literature databases, and examined the mechanisms underpinning P4P effects on: utilisation of services, patient satisfaction, provider productivity and broader health system, and contextual factors moderating these. This evidence was then used to construct a causal loop diagram.We included 112 records (19 grey literature; 93 peer-reviewed articles) assessing P4P schemes in 36 countries. Although we found mixed evidence of P4P's effects on identified outcomes, common pathways to improved outcomes include: community outreach; adherence to clinical guidelines, patient-provider interactions, patient trust, facility improvements, access to drugs and equipment, facility autonomy, and lower user fees. Contextual factors shaping the system response to P4P include: degree of facility autonomy, efficiency of banking, role of user charges in financing public services; staffing levels; staff training and motivation, quality of facility infrastructure and community social norms. Programme design features supporting or impeding health system effects of P4P included: scope of incentivised indicators, fairness and reach of incentives, timely payments and a supportive, robust verification system that does not overburden staff. Facility bonuses are a key element of P4P, but rely on provider autonomy for maximum effect. If health system inputs are vastly underperforming pre-P4P, they are unlikely to improve only due to P4P. This is the first realist review describing how and why P4P initiatives work (or fail) in different LMIC contexts by exploring the underlying mechanisms and contextual and programme design moderators. Future studies should systematically examine health system pathways to outcomes for P4P and other health system strengthening initiatives, and offer more understanding of how programme design shapes mechanisms and effects

Recent advances in electronic structure theory and their influence on the accuracy of ab initio potential energy surfaces

Recent advances in electronic structure theory and the availability of high speed vector processors have substantially increased the accuracy of ab initio potential energy surfaces. The recently developed atomic natural orbital approach for basis set contraction has reduced both the basis set incompleteness and superposition errors in molecular calculations. Furthermore, full CI calculations can often be used to calibrate a CASSCF/MRCI approach that quantitatively accounts for the valence correlation energy. These computational advances also provide a vehicle for systematically improving the calculations and for estimating the residual error in the calculations. Calculations on selected diatomic and triatomic systems will be used to illustrate the accuracy that currently can be achieved for molecular systems. In particular, the F+H2 yields HF+H potential energy hypersurface is used to illustrate the impact of these computational advances on the calculation of potential energy surfaces