Real romance came out of dreamland into life H. G. Wells as a romancer

The aim of this study is to demonstrate that Wells's early works are the supreme fruits of his ambiguous and complicated reaction against, and interaction with, romance and realism in fiction. Wells's efforts concentrate on combating against and, at the same time, capitalising on the popular narratives that flooded the expanding fin-de-siècle mass market and the powerful influence of the continental and American Realists. In so doing, Wells eventually purports to revive and modify the English novel tradition from Chaucer to Scott and Dickens, and the romantic transformation of everyday life without losing a sense of reality. By reading Wells's fictional and non-fictional works published between the 1890s and the 1900s, this thesis maintains that Wells is a novelist who could exploit romance contingencies in his fiction Wells's early literary criticism demonstrates that his theory of the novel is preoccupied with the potential of the romance rather than with the strict realistic representation of everyday life advocated by Naturalists and Realists. His non-scientific romances reveal Wells's instinctive grasp of the romance potential Wells's major scientific romances confirm his effort in writing within the established romance grammar and deconstruct the forms and themes of fìn-de-siècle popular romances. Mikhail Bakhtin's theory of carnivalism and Foucaulťs theory of power are also applied to Wells's texts. This study contends that Wells's major scientific romances not only differentiate themselves from other popular narratives but also create a new genre: the carnivalesque romance. Wells's early twentieth century Utopian projects continue the carnival theme, and develop the carnivalised narrative space in which the sociologist's logical speculation is mixed with the romancer’s dream. Reading Wells's Edwardian novels, Tono-Bungay and The History of Mr Polly as marking a turning point in his literary career, the thesis advocates that when Wells ceased to be a romancer, his creative energy began to wane

Neonatal mortality in the developing world

This paper examines age patterns and trends of early and late neonatal mortality in developing countries, using birth history data from the Demographic and Health Surveys (DHS). Data quality was assessed both by examination of internal consistency and by comparison with historic age patterns of neonatal mortality from England and Wales. The median neonatal mortality rate (NMR) across 108 nationally-representative surveys was 33 per 1000 live births. NMR averaged an annual decline of 1.7 % in the 1980s and 1990s. Declines have been faster for late than for early neonatal mortality and slower in Sub-Saharan Africa than in other regions. Age patterns of neonatal mortality were comparable with those of historical data, indicating no significant underreporting of early neonatal deaths in DHS birth histories.birth history, early neonatal mortality rate, heaping, late neonatal mortality rate, mortality, neonatal mortality

Death distribution methods for estimating adult mortality

TThe General Growth Balance (GGB) and Synthetic Extinct Generations (SEG) methods have been widely used to evaluate the coverage of registered deaths in developing countries. However, relatively little is known about how the methods behave in the presence of different data errors. This paper applies the methods (both singly and in combination) using non-stable populations of known mortality to which various data distortions in a variety of combinations have been applied. Results show that the methods work very well when the only errors in the data are those for which the methods were developed. For other types of error, performance is more variable, but on average, adjusted mortality estimates using the methods are closer to the true values than the unadjusted. The methods do surprisingly well in the presence of typical patterns of age misreporting, though GGB is more sensitive to coverage errors that change with age; the Basic SEG method (e.g. not adjusting for any slope with age of completeness estimates) is very sensitive to changes in census coverage; but once slope is adjusted for changing census, coverage has little effect. Fitting to the age range 5+ to 65+ is clearly preferable to fitting to 15+ to 55+. Both GGB and SEG are very sensitive to net migration, which is an Achilles heel for all of the methodologies in this paper. In populations not greatly affected by migration, our results suggest that an optimal strategy would be to apply GGB to estimate census coverage change, adjust for it and then apply SEG; in populations affected by migration, applying both GGB and SEG, fitting both to the age range 30+ to 65+, and averaging the results appears best.adult mortality, death distribution methods, estimation, sensitivity analysis, simulation

Unconventional approaches to mortality estimation

Most developing countries do not have complete registration of deaths on which to base mortality estimates. Four broad categories of unconventional methods have been developed to provide mortality estimates in such settings. The first consists of approaches for evaluation adjustment of incompletely recorded deaths by comparison with recorded age distributions. The second consists of alternative data collection methodologies collecting information about deaths by age. The third consists of approaches based on asking respondents about the survival or otherwise of close relatives. The fourth estimates mortality from changes in age distributions, interpreting cohort attrition as mortality. Methods in the first two categories offer the greatest potential for contributing information on developing country mortality to the Human Mortality Database. Methods in the first category are illustrated here by application to data from the Republic of Korea for the second half of the 20th century. In populations with good age reporting and little net migration, these methods work well and offer the opportunity to include developing country data in the HMD.adult mortality, developing countries, estimation, Human Mortality Database

Health sector decentralization and Indonesia ' s nutrition programs : opportunities and challenges

This policy concept paper is intended to assist the center in navigating the tension between opportunities and challenges as activities are adapted to the decentralized national nutrition policy, and to help guide districts and provinces in the conduct o f locally appropriate nutrition programs. The paper synthesizes the findings of an extensive study undertaken by the World Bank with a summary of the results, while the conclusions are discussed in detail in the four annexes. It begins with a review of the accomplishments and remaining nutrition challenges for Indonesia. It then turns to look at the regional diversity in Indonesia ' s nutrition challenges and asks which type of nutrition programs are most cost-effective. The paper concludes with an assessment of the existing institutional arrangement for nutrition service delivery, and discusses steps Indonesia can take to further improve population nutrition and health. The annexes provide extensive data and analysis to shed light on the opportunities and challenges in the new institutional environment.Health Monitoring & Evaluation,Nutrition,Early Child and Children ' s Health,Population Policies,Rural Development Knowledge & Information Systems

Reconceptualizing measurement of emergency contraceptive use : comparison of approaches to estimate the use of emergency contraception

Estimated use of emergency contraception (EC) remains low, and one reason is measurement challenges. The study aims to compare EC use estimates using five approaches. Data come from Performance Monitoring and Accountability 2020 surveys from 10 countries, representative sample surveys of women aged 15 to 49 years. We explore EC use employing the five definitions and calculate absolute differences between a reference definition (percentage of women currently using EC as the most effective method) and each of the subsequent four, including the most inclusive (percentage of women having used EC in the past year). Across the 17 geographies, estimated use varies greatly by definition and EC use employing the most inclusive definition is statistically significantly higher than the reference estimate. Impact of using various definitions is most pronounced among unmarried sexually active women. The conventional definition of EC use likely underestimates the magnitude of EC use, which has unique programmatic implications

Comparison of Medicine Availability Measurements at Health Facilities: Evidence from Service Provision Assessment Surveys in Five Sub-Saharan African Countries.

With growing emphasis on health systems strengthening in global health, various health facility assessment methods have been used increasingly to measure medicine and commodity availability. However, few studies have systematically compared estimates of availability based on different definitions. The objective of this study was to compare estimates of medicine availability based on different definitions. A secondary data analysis was conducted using data from the Service Provision Assessment (SPA) - a nationally representative sample survey of health facilities - conducted in five countries: Kenya SPA 2010, Namibia SPA 2009, Rwanda SPA 2007, Tanzania SPA 2006, and Uganda SPA 2007. For 32 medicines, percent of facilities having the medicine were estimated using five definitions: four for current availability and one for six-month period availability. 'Observed availability of at least one valid unit' was used as a reference definition, and ratios between the reference and each of the other four estimates were calculated. Summary statistics of the ratios among the 32 medicines were calculated by country. The ratios were compared further between public and non-public facilities within each country. Across five countries, compared to current observed availability of at least one valid unit, 'reported availability without observation' was on average 6% higher (ranging from 3% in Rwanda to 8% in Namibia), 'observed availability where all units were valid' was 11% lower (ranging from 2% in Tanzania to 19% in Uganda), and 'six-month period availability' was 14% lower (ranging from 5% in Namibia to 25% in Uganda). Medicine availability estimates vary substantially across definitions, and need to be interpreted with careful consideration of the methods used

Imperial ecologies and extinction in H.G. Wells’s island stories

This chapter analyses how two of H.G. Wells’s island stories, “Aepyornis Island” from The Stolen Bacillus (1894), and The Island of Doctor Moreau (1896), expose the extirpative consequences of human, animal and plant colonization in the context of the British Empire. In both texts, humans, human-animal hybrids, previously extinct and non-native species colonize island locations, dramatically transforming their ecological structures. These new nightmare environments allow evolutionarily “inferior” creatures such as the extinct Aepyornis and medically-manufactured Beast People to threaten human domination. Reading Wells’s fiction as examples of anti-Robinsonades that are grounded in the realities of Victorian colonial expansion, and in dialogue with scientific writings by Wells and Charles Darwin, this chapter shows how Wells questions scientific and imperialist narratives of development by presenting extinction as a possibility for all forms of life

Evaluation of a Cluster-Randomized Controlled Trial of a Package of Community-Based Maternal and Newborn Interventions in Mirzapur, Bangladesh

To evaluate a delivery strategy for newborn interventions in rural Bangladesh.A cluster-randomized controlled trial was conducted in Mirzapur, Bangladesh. Twelve unions were randomized to intervention or comparison arm. All women of reproductive age were eligible to participate. In the intervention arm, community health workers identified pregnant women; made two antenatal home visits to promote birth and newborn care preparedness; made four postnatal home visits to negotiate preventive care practices and to assess newborns for illness; and referred sick neonates to a hospital and facilitated compliance. Primary outcome measures were antenatal and immediate newborn care behaviours, knowledge of danger signs, care seeking for neonatal complications, and neonatal mortality.A total of 4616 and 5241 live births were recorded from 9987 and 11153 participants in the intervention and comparison arm, respectively. High coverage of antenatal (91% visited twice) and postnatal (69% visited on days 0 or 1) home visitations was achieved. Indicators of care practices and knowledge of maternal and neonatal danger signs improved. Adjusted mortality hazard ratio in the intervention arm, compared to the comparison arm, was 1.02 (95% CI: 0.80-1.30) at baseline and 0.87 (95% CI: 0.68-1.12) at endline. Primary causes of death were birth asphyxia (49%) and prematurity (26%). No adverse events associated with interventions were reported.Lack of evidence for mortality impact despite high program coverage and quality assurance of implementation, and improvements in targeted newborn care practices suggests the intervention did not adequately address risk factors for mortality. The level and cause-structure of neonatal mortality in the local population must be considered in developing interventions. Programs must ensure skilled care during childbirth, including management of birth asphyxia and prematurity, and curative postnatal care during the first two days of life, in addition to essential newborn care and infection prevention and management.Clinicaltrials.gov NCT00198627

Health system performance at the district level in Indonesia after decentralization

<p>Abstract</p> <p>Background</p> <p>Assessments over the last two decades have showed an overall low level of performance of the health system in Indonesia with wide variation between districts. The reasons advanced for these low levels of performance include the low level of public funding for health and the lack of discretion for health system managers at the district level. When, in 2001, Indonesia implemented a radical decentralization and significantly increased the central transfer of funds to district governments it was widely expected that the performance of the health system would improve. This paper assesses the extent to which the performance of the health system has improved since decentralization.</p> <p>Methods</p> <p>We measured a set of indicators relevant to assessing changes in performance of the health system between two surveys in three areas: utilization of maternal antenatal and delivery care; immunization coverage; and contraceptive source and use. We also measured respondents' demographic characteristics and their living circumstances. These measurements were made in population-based surveys in 10 districts in 2002-03 and repeated in 2007 in the same 10 districts using the same instruments and sampling methods.</p> <p>Results</p> <p>The dominant providers of maternal and child health in these 10 districts are in the private sector. There was a significant decrease in birth deliveries at home, and a corresponding increase in deliveries in health facilities in 5 of the 10 districts, largely due to increased use of private facilities with little change in the already low use of public facilities. Overall, there was no improvement in vaccination of mothers and their children. Of those using modern contraceptive methods, the majority obtained them from the private sector in all districts.</p> <p>Conclusions</p> <p>There has been little improvement in the performance of the health system since decentralization occurred in 2001 even though there have also been significant increases in public funding for health. In fact, the decentralization has been limited in extent and structural problems make management of the system as a whole difficult. At the national level there has been no real attempt to envision the health system that Indonesia will need for the next 20 to 30 years or how the substantial public subsidy to this lightly regulated private system could be used in creative ways to stimulate innovation, mitigate market failures, improve equity and quality, and to enhance the performance of the system as a whole.</p