Organisational Legitimacy, Capacity and Capacity Development

The European Centre for Development Policy Management (ECDPM) has undertaken a study of capacity development, with a focus on organisational change and performance enhancement. Both individual organisations and networks of organisations have been studied with the aim of identifying important relationships among endogenous change factors (e.g. ownership, commitment and managerial style), key internal organisation variables (e.g. structures, procedures, staffing and management systems), performance and sustainability outcomes, and external environmental factors (e.g. policy frameworks, resource availability, politics, stakeholders, governance regimes, etc.).To date, the ECDPM study team has conducted 16 case studies (see Appendix). Among the findings that have emerged from several of the cases is the presence of an organisation's legitimacy as a factor contributing to successful capacity and performance. To delve in more detail into the concept of legitimacy, and to identify the implications for capacity building, ECDPM commissioned a working paper on the topic. This exploratory paper reviews the relevant literature and examines: differing definitions, types and sources of legitimacy; the links between legitimacy and organisational capacity, performance and sustainability; and management strategies for building and maintaining legitimacy. It discusses a selected set of the ECDPM cases in terms of the legitimacy concept

Decentralized Local Governance In Fragile States: Learning From Iraq

This article examines the role that local governance plays in creating an effective state and in building constructive state—society relations. Reconstruction efforts in fragile, post-conflict states have focused largely on central government, yet decentralized local authorities offer a number of positive features. Looking at the governance reconstruction experience in Iraq, the analysis explores the extent to which these positive features have characterized Iraqi sub-national government. The article draws lessons for governance reconstruction more generally, addressing decentralization choices, capacity-building, and political factors

Decentralized Local Governance In Fragile States: Learning From Iraq

This article examines the role that local governance plays in creating an effective state and in building constructive state—society relations. Reconstruction efforts in fragile, post-conflict states have focused largely on central government, yet decentralized local authorities offer a number of positive features. Looking at the governance reconstruction experience in Iraq, the analysis explores the extent to which these positive features have characterized Iraqi sub-national government. The article draws lessons for governance reconstruction more generally, addressing decentralization choices, capacity-building, and political factors

Governance and service delivery: Practical applications of social accountability across sectors

RTI International has extensive experience implementing international donor-funded programs and projects, including single-sector and multisector policy and service-delivery improvement efforts, as well as governance and public management reforms. Drawing on that experience, this collection examines six recent RTI International projects, funded mostly by the United States Agency for International Development, that pursued several different paths to integrating service delivery and governance through engaging citizens, public officials, and service providers on issues related to accountability and sectoral services. The six cases illustrate the multiple ways in which citizen participation in accountability, called social accountability, can lead to positive effects on governance, citizen empowerment, and service delivery. The analysis focuses on both the intended and actual effects, and unpacks the influence of context on implementation and the outcomes achieved

Building a transformative agenda for accountability in SRHR: Lessons learned from SRHR and accountability literatures

Global strategies and commitments for sexual and reproductive health and rights (SRHR) underscore the need to strengthen rights-based accountability processes. Yet there are gaps between these ambitious SRHR rights frameworks and the constrained socio-political lived realities within which these frameworks are implemented. This paper addresses these gaps by reviewing the evidence on the dynamics and concerns related to operationalising accountability in the context of SRHR. It is based on a secondary analysis of a systematic review that examined the published evidence on SRHR and accountability and also draws on the broader literature on accountability for health. Key themes include the political and ideological context, enhancing community voice and health system responsiveness, and recognising the complexity of health systems. While there is a range of accountability relationships that can be leveraged in the health system, the characteristics specific to SRHR need to be considered as they colour the capabilities and conditions in which accountability efforts occur

Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis

BACKGROUND: The comparative efficacy and safety of balanced crystalloid solutions and saline for fluid therapy in critically ill adults remain uncertain. METHODS: We systematically reviewed randomized clinical trials (RCTs) comparing the use of balanced crystalloids with saline in critically ill adults. The primary outcome was 90-day mortality after pooling data from low-risk-of-bias trials using a random-effects model. We also performed a Bayesian meta-analysis to describe the primary treatment effect in probability terms. Secondary outcomes included the incidence of acute kidney injury (AKI), new treatment with renal replacement therapy (RRT), and ventilator-free and vasopressor-free days to day 28. RESULTS: We identified 13 RCTs, comprising 35,884 participants. From six trials (34,450 participants) with a low risk of bias, the risk ratio (RR) for 90-day mortality with balanced crystalloids versus saline was 0.96 (95% confidence interval [CI], 0.91 to 1.01; I2 = 12.1%); using vague priors, the posterior probability that balanced crystalloids reduce mortality was 89.5%. The RRs of developing AKI and of being treated with RRT with balanced crystalloids versus saline were 0.96 (95% CI, 0.89 to 1.02) and 0.95 (95% CI, 0.81 to 1.11), respectively. Ventilator-free days (mean difference, 0.18 days; 95% CI, −0.45 to 0.81) and vasopressor-free days (mean difference, 0.19 days; 95% CI, −0.14 to 0.51) were similar between groups. CONCLUSIONS: The estimated effect of using balanced crystalloids versus saline in critically ill adults ranges from a 9% relative reduction to a 1% relative increase in the risk of death, with a high probability that the average effect of using balanced crystalloids is to reduce mortality

Automatic diagnosis of the 12-lead ECG using a deep neural network

The role of automatic electrocardiogram (ECG) analysis in clinical practice is limited by the accuracy of existing models. Deep Neural Networks (DNNs) are models composed of stacked transformations that learn tasks by examples. This technology has recently achieved striking success in a variety of task and there are great expectations on how it might improve clinical practice. Here we present a DNN model trained in a dataset with more than 2 million labeled exams analyzed by the Telehealth Network of Minas Gerais and collected under the scope of the CODE (Clinical Outcomes in Digital Electrocardiology) study. The DNN outperform cardiology resident medical doctors in recognizing 6 types of abnormalities in 12-lead ECG recordings, with F1 scores above 80% and specificity over 99%. These results indicate ECG analysis based on DNNs, previously studied in a single-lead setup, generalizes well to 12-lead exams, taking the technology closer to the standard clinical practice

The Treasured Hunt: Collecting Medieval and Renaissance Manuscripts, Past, Present, and Future

Welcome and Opening Remarks: E. Ann Matter, University of Pennsylvania, and Lynn Ransom, Free Library of Philadelphia Session 1. Beginnings: Collecting in the Middle Ages and Renaissance Session Chair: Emily Steiner, Department of English, University of Pennsylvania Claire Richter Sherman, Center for Advanced Study in the Visual Arts at the National Gallery of Art, The Manuscript Collection of King Charles V of France: The Personal and the Political David Rundle, History Faculty and Corpus Christi College, Oxford University, The Butcher of England and the Renaissance Arts of Book-Collecting Session 2: Civic Service: The Legacies of Philadelphia-Area Collectors Chair: Peter Stallybrass, Department of English, University of Pennsylvania James Tanis, Director of Libraries and Professor of History Emeritus, Bryn Mawr College, Migrating Manuscripts Derick Dreher, Director, The Rosenbach Museum & Library, Of Private Collectors and Public Libraries: Dr. A. S. W. Rosenbach and John Frederick Lewis Session 3: Keynote address Welcome: H. Carton Rogers, Vice Provost & Director of Libraries, University of Pennsylvania Chair: Robert Maxwell, Department of the History of Art, University of Pennsylvania Christopher de Hamel, Gaylord Donnelley Fellow Librarian, Corpus Christi College, Cambridge University, The Manuscript Collection of C. L. Ricketts (1859-1941) Session 4: The Hunters and the Hunted: A Roundtable Discussion with Private and Institutional Collectors Chair: David Wallace, Department of English, University of Pennsylvania Moderator: Richard Linenthal, Bernard Quaritch Ltd. Panelists: Lawrence J. Schoenberg, Private Collector Gifford Combs, Private Collector Toshiyuki Takamiya, Private Collector, Keio University Consuelo Dutschke, Curator of Medieval and Renaissance Manuscripts, Columbia University William Noel, Curator of Manuscripts and Rare Books, The Walters Art Museu