Performance-based financing as a health system reform : mapping the key dimensions for monitoring and evaluation

Peer reviewedPublisher PD

Osteopontin as Candidate Biomarker of Coronary Disease despite Low Cardiovascular Risk: Insights from CAPIRE Study

Stratification according high cardiovascular (CV) risk categories, still represents a clinical challenge. In this analysis of the CAPIRE study (NCT02157662), we investigate whether inflammation could fit between CV risk factors (RFs) and the presence of coronary artery disease (CAD). In total, 544 patients were included and categorized according with the presence of CAD and CV risk factor burden (low/multiple). The primary endpoint was to verify any independent association of neutrophil-related biomarkers with CAD across CV risk categories. The highest values of osteo-pontin (OPN) were detected in the low RF group and associated with CAD (23.2 vs. 19.4 ng/mL; p = 0.001), although no correlation with plaque extent and/or composition were observed. Con-versely, myeloperoxidase (MPO) and resistin did not differ by CAD presence. Again, OPN was identified as independent variable associated with CAD but only in the low RF group (adjOR 8.42 [95% CI 8.42\u201346.83]; p-value = 0.015). As an ancillary finding, a correlation linked OPN with the neutrophil degranulation biomarker MPO (r = 0.085; p = 0.048) and resistin (r = 0.177; p = 3.4 7 10 125 ). In the present study, OPN further strengthens its role as biomarker of CAD, potentially bridging subclinical CV risk with development of atherosclerosis

Supergravity Duals to the Noncommutative N=4 SYM theory in the Infinite Momentum Frame

In this work the construction of supergravity duals to the noncommutative ${\cal N}=4$ SYM theory in the infinite momentum frame but with constant momentum density is attempted. In the absence of the content of noncommutativity, it has been known for some time that the previous $AdS_{5}/CFT_{4}$ correspondence should be replaced by the $K_{5}/CFT_{4}$ (with $K_{(p+2)}$ denoting the generalized Kaigorodov spacetime) correspondence with the pp-wave propagating on the BPS brane worldvolume. Interestingly enough, putting together the two contents, i.e., the introduction of noncommutativity and at the same time that of the pp-wave along the brane worldvolume, leads to quite nontrivial consequences such as the emergence of ``time-space'' noncommutativity in addition to the ``space-space'' noncommutativity in the manifold on which the dual gauge theory is defined. Taking the gravity decoupling limit, it has been realized that for small $u$, the solutions all reduce to $K_{5}\times S^5$ geometry confirming our expectation that the IR dynamics of the dual gauge theory should be unaffected by the noncommutativity while as $u\to \infty$, the solutions start to deviate significantly from $K_{5}\times S^5$ limit indicating that the UV dynamics of the dual gauge theory would be heavily distorted by the effect of noncommutativity.Comment: 21 pages, Latex, One expression changed, a reference added, to appear in Phys. Rev.

Assessing Communities of Practice in health policy : A conceptual framework as a first step towards empirical research

Peer reviewe

Non-extremal black holes from the generalised r-map

We review the timelike dimensional reduction of a class of five-dimensional theories that generalises 5D, N = 2 supergravity coupled to vector multiplets. As an application we construct instanton solutions to the four-dimensional Euclidean theory, and investigate the criteria for solutions to lift to static non-extremal black holes in five dimensions. We focus specifically on two classes of models: STU-like models, and models with a block diagonal target space metric. For STU-like models the second order equations of motion of the four-dimensional theory can be solved explicitly, and we obtain the general solution. For block diagonal models we find a restricted class of solutions, where the number of independent scalar fields depends on the number of blocks. When lifting these solutions to five dimensions we show, by explicit calculation, that one obtains static non-extremal black holes with scalar fields that take finite values on the horizon only if the number of integration constants reduces by exactly half.Comment: 22 pages. Based on talk by OV at "Black Objects in Supergravity School" (BOSS2011), INFN, Frascati, Italy, 9-13 May, 201

Penrose limits, supergravity and brane dynamics

We investigate the Penrose limits of classical string and M-theory backgrounds. We prove that the number of (super)symmetries of a supergravity background never decreases in the limit. We classify all the possible Penrose limits of AdS x S spacetimes and of supergravity brane solutions. We also present the Penrose limits of various other solutions: intersecting branes, supersymmetric black holes and strings in diverse dimensions, and cosmological models. We explore the Penrose limit of an isometrically embedded spacetime and find a generalisation to spaces with more than one time. Finally, we show that the Penrose limit is a large tension limit for all branes including those with fields of Born--Infeld type.Comment: 67 page

Cosmological solutions from fake N=2 EYM supergravity

We characterise the (fake) supersymmetric solutions of Wick-rotated N=2 d=4 gauged supergravity coupled to non-Abelian vector multiplets. In the time-like case we obtain generalisations of Kastor & Traschen's cosmological black holes: they have a specific time-dependence and the base-space must be 3-dimensional hyperCR/Gauduchon-Tod space. In the null-case, we find that the metric has a holonomy contained in Sim(2), give a general characterisation of the solutions, and give some examples. Finally, we point out that in some cases the solutions we found are non-BPS solutions to N=2 d=4 supergravity coupled to vector multiplets.Comment: 30 pages. Comments and references added, typos correcte

A literature review of the disruptive effects of user fee exemption policies on health systems

BACKGROUND: Several low- and middle-income countries have exempted patients from user fees in certain categories of population or of services. These exemptions are very effective in lifting part of the financial barrier to access to services, but they have been organized within unstable health systems where there are sometimes numerous dysfunctions. The objective of this article is to bring to light the disruptions triggered by exemption policies in health systems of low- and middle-income countries. METHODS: Scoping review of 23 scientific articles. The data were synthesized according to the six essential functions of health systems. RESULTS: The disruptions included specifically: 1) immediate and significant increases in service utilization; 2) perceived heavier workloads for health workers, feelings of being exploited and overworked, and decline in morale; 3) lack of information about free services provided and their reimbursement; 4) unavailability of drugs and delays in the distribution of consumables; 5) unpredictable and insufficient funding, revenue losses for health centres, reimbursement delays; 6) the multiplicity of actors and the difficulty of identifying who is responsible ('no blame' game), and deficiencies in planning and communication. CONCLUSIONS: These disruptive elements give us an idea of what is to be expected if exemption policies do not put in place all the required conditions in terms of preparation, planning and complementary measures. There is a lack of knowledge on the effects of exemptions on all the functions of health systems because so few studies have been carried out from this perspective