Performance of private sector health care: implications for universal health coverage

Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers—including their size, objectives, and technical competence—the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole

Testing and Data Recovery Excavations at Prehistoric Occupation Site 41HR1114, Harris County, Texas

This report documents the National Register significance testing and data recovery investigations conducted from February 27-March 15, 2012 (testing), and June 11-25, 2012 (data recovery), at the site of 41HR1114 by Moore Archeological Consulting, Inc. The site is located just west of Lower Mayde Creek, in west Harris County, Texas. The site had been first located during a February, 2012 survey conducted by Moore Archeological Consulting, Inc. in preparation for a proposed extension of the Park Row Boulevard Right-of-Way (Moore and Driver 2012). The survey alignment was privately owned at the time of the survey, and therefore, neither the Antiquities Code of Texas nor Section 106 of the National Historic Preservation Act of 1966 mandated the survey. However, the survey was carried out as proactive due diligence as a key element of the future regulatory requirements for a private development project on an ambitious development schedule. The survey identified three sites, 41HR1114, 41HR1115, and 41HR1116. Significance testing excavations at 41HR1114 were conducted in February and March, 2012, and were also carried out as proactive due diligence. The test excavations consisted of hand excavation and backhoe trenching with a focus on geomorphological assessment of the site, including the depositional reconstruction and identification of the degree of intactness of the deposits. These investigations determined that the site possessed the potential for future research, and should be considered eligible for listing on the National Register of Historic Places (NRHP). At that point, the development project was subsumed within the Harris County Improvement District No. 4, DBA Energy Corridor Management District, and further investigations fell under the jurisdiction of the Texas Historic Commission (THC) permitting process. To facilitate planned development schedules, the proposed Park Row Boulevard Right-of-Way alignment was divided into smaller segments, with 41HR1114 located in the Phase 1 segment. This portion of the alignment measures approximately 850 m (2800 ft) in length, and the area of potential effect (APE) in the area of 41HR1114 is limited to a 36.5 m (120 ft) wide ROW (Figure 1). The data recovery investigations at 41HR1114 were conducted under Texas Antiquities Permit Number 6274. During the significance testing and data recovery field investigations at 41HR1114, a total of sixteen 1 x 1 m hand units (XU 1-16) were excavated. XUs 1-4 were conducted as distinct 1 x 1 m units (XUs 1, 2, and 4 were placed adjacent to backhoe trenches) during the testing phase, while the remainder of the hand excavations were conducted as two 2 x 3 m block excavations (subdivided into XUs 5-10 and 11-16) as part of the data recovery phase. Three backhoe trenches (BHTs 1-3) totaling 45 m in length were excavated, two during the testing phase and one during the data recovery operations. The excavations produced a total of 4431 artifacts. These materials were recovered from Levels 1-14 (0-150 cmbs), but with the highest concentrations of artifacts encountered in Levels 3-7. The chronologically diagnostic dart point types, in conjunction with the presence of ceramics and the lack of arrow points, indicate occupations at the site spanning the Middle Archaic to Early Ceramic periods. However, the vertical distribution of diagnostic artifacts and the geoarchaeological assessment of the site deposits indicate the presence of significant bioturbation-related disturbance of cultural materials located throughout the site. Consequently, the real, and quite significant contribution of this project is instead, the intensive geoarcheological analysis of the Late Pleistocene and Early Holocene alluvium and of the nature and appearance of soil formation within such deposits at the site, and by extension for the Houston area. The current investigation has considerably diminished the paucity of information on the deposits lain down by small streams in the region, as well as provided insight into the pedogenic processes associated with argillic horizons in the late Pleistocene and Holocene soils of Southeast Texas. We may conclude by reiterating that the Data Recovery excavations at 41HR1114 were successful in providing new information on the prehistory of the site and the broader Houston region. The contribution from the strictly archeological analysis of the cultural materials and contexts yielded by the site are modest. In contrast, the results of the intensive geoarcheological analysis of the site are quite novel and important, and have considerable broader application in the future analysis and evaluation of prehistoric sites within the Houston region. No further archeological work is recommended for 41HR1114. Once the current report is finalized, the artifacts recovered from 41HR1114 will be curated at TARL

Contribution of Nepal’s Free Delivery Care Policies in Improving Utilisation of Maternal Health Services

Background: Nepal has made remarkable improvements in maternal health outcomes. The implementation of demand and supply side strategies have often been attributed with the observed increase in utilization of maternal healthcare services. In 2005, Free Delivery Care (FDC) policy was implemented under the name of Maternity Incentive Scheme (MIS), with the intention of reducing transport costs associated with giving birth in a health facility. In 2009, MIS was expanded to include free delivery services. The new expanded programme was named “Aama” programme, and further provided a cash incentive for attending four or more antenatal visits. This article analysed the influence of FDC policies, individual and community level factors in the utilisation of four antenatal care (4 ANC) visits and institutional deliveries in Nepal. Methods: Demographic and health survey data from 1996, 2001, 2006 and 2011 were used and a multi-level analysis was employed to determine the effect of FDC policy intervention, individual and community level factors in utilisation of 4 ANC visits and institutional delivery services. Results: Multivariate analysis suggests that FDC policy had the largest effect in the utilisation of 4 ANC visits and institutional delivery compared to individual and community factors. After the implementation of MIS in 2005, women were three times (adjusted odds ratio [AOR]=3.020, P<.001) more likely to attend 4 ANC visits than when there was no FDC policy. After the implementation of Aama programme in 2009, the likelihood of attending 4 ANC visits increased six-folds (AOR=6.006, P<.001) compared prior to the implementation of FDC policy. Similarly, institutional deliveries increased two times after the implementation of the MIS (AOR=2.117, P<.001) than when there was no FDC policy. The institutional deliveries increased five-folds (AOR=5.116, P<.001) after the implementation of Aama compared to no FDC policy. Conclusion: Results from this study suggest that MIS and Aama policies have had a strong positive influence on the utilisation of 4 ANC visits and institutional deliveries in Nepal. Nevertheless, results also show that FDC policies may not be sufficient in raising demand for maternal health services withoutadequately considering the individual and community level factors

Development of a sensitive method to extract and detect low numbers of Cryptosporidium oocysts from adult cattle faecal samples:results from the MRC ALL97 clinical trial

AbstractCryptosporidium transmission studies to date have concluded that adult cattle are not a significant source of oocysts contributing to clinical cryptosporidiosis in calves on farm. However current methods of sample processing have been optimised for calf faecal samples and may be less sensitive when used on adult samples due to lower numbers of oocysts and larger size of samples. A modified and novel method of oocyst extraction and concentration was developed and applied in an experiment involving spiking adult cattle faecal samples with known concentrations of Cryptosporidium oocysts. The results showed an increased sensitivity of detection from 100oocysts/g of faecal sample using conventional protocols to 5oocysts/g using the newly developed method. As it is important to be able to accurately assess the contribution of adult ruminants to the transmission of Cryptosporidium, both on farm and in the environment, the development of the techniques described here is likely to make an important contribution to Cryptosporidium transmission studies in future and in subsequent control strategies aimed at the reduction of Cryptosporidium infection in calves on farm

A national certification programme for academic degrees in cyber security

With a growing need for cyber security skills, there has been a notable increase in the number of academic degrees targeting this topic area, at both undergraduate and postgraduate levels. However, with a widening and varied choice available to them, prospective students and employers require a means to identify academic degrees that offer appropriate and high-quality education in the subject area. This paper presents a case study of the establishment and operation of a certification programme for academic degrees in cyber security. It describes the means by which appropriate topic themes and subject areas for relevant degrees were identified and defined, leading to a certification programme that addresses degrees in general cyber security as well as notable specialisations including digital forensics and network security. The success of the programme is evidenced by 25 degrees across 19 universities having been certified to date, and a continued response to new calls for certification

Incentivizing universal safe delivery in Nepal: ten years of experience

Payments to users and providers of health services are an important ingredient in attempts to promote universal health coverage in low resource settings. The maternal health programme in Nepal explicitly recognizes that ensuring universal access to safe delivery care requires policies that both ensure effective services and overcome demand-side barriers. The programme has used three innovative financing initiatives to stimulate an increase in the use of facility-based delivery: the maternity incentive scheme (2005) reimbursing women for accessing a facility, activity payments in poor districts (2006) and universal free-delivery (2009). We examine the impact of these mechanisms on access to safe delivery services. Multiple waves of the Demographic and Health Survey were merged to provide household-level cross-sectional data on maternity services. A multilevel logit model was used to investigate the roll-out of the three policies across ecological zones assuming a district-wide treatment effect. An interrupted time-series approach that includes cross sectional data on deliveries at each period is used to detect the association between outcomes and policy. The maternal Incentive programme was associated with an increase in service delivery in hill and tarai areas. A positive effect in mountain areas was detectable as a result of the supply side payments made to facilities for delivery. Although use among the non-poor increased across the country, a positive effect on the poorest population was only present in mountain areas. The beneficial impact of maternal financing policies in Nepal is skewed towards areas and households that are geographically more accessible and wealthy. Inferior services in remote areas reduce the impact of financing policies. Policy may need to be refocused on poorer, less accessible areas if improvements in access to maternal health services are to continue

From Rags to Riches: Assessing poverty and vulnerability in urban Nepal

Urbanisation brings with it rapid socio-economic change with volatile livelihoods and unstable ownership of assets. Yet, current measures of wealth are based predominantly on static livelihoods found in rural areas. We sought to assess the extent to which seven common measures of wealth appropriately capture vulnerability to poverty in urban areas. We then sought to develop a measure that captures the characteristics of one urban area in Nepal. We collected and analysed data from 1,180 households collected during a survey conducted between November 2017 and January 2018 and designed to be representative of the Kathmandu valley. A separate survey of a sub set of households was conducted using participatory qualitative methods in slum and non-slum neighbourhoods. A series of currently used indices of deprivation were calculated from questionnaire data. We used bivariate statistical methods to examine the association between each index and identify characteristics of poor and non-poor. Qualitative data was used to identify characteristics of poverty from the perspective of urban poor communities which were used to construct an Urban Poverty Index that combined asset and consumption focused context specific measures of poverty that could be proxied by easily measured indicators as assessed through multivariate modelling. We found a strong but not perfect association between each measure of poverty. There was disagreement when comparing the consumption and deprivation index on the classification of 19% of the sample. Choice of short-term monetary and longer-term capital approaches accounted for much of the difference. Those who reported migrating due to economic necessity were most likely to be categorised as poor. A combined index was developed to capture these dimension of poverty and understand urban vulnerability. A second version of the index was constructed that can be computed using a smaller range of variables to identify those in poverty. Current measures may hide important aspects of urban poverty. Those who migrate out of economic necessity are particularly vulnerable. A composite index of socioeconomic status helps to capture the complex nature of economic vulnerability

2004-2005 International Whaling Commission-Southern Ocean Whale and Ecosystem Research (IWC-SOWER) Cruise, Area III

We conducted the 27th annual IWC-SOWER (formerly IDCR) Cruise in Area III (000°-070°E) aboard the Japanese Research Vessels Shonan Maru and Shonan Maru No.2. The 65-day cruise departed Cape Town, South Africa on 4 January 2005 and returned to Fremantle, Australia on 9 March 2005. After transiting to the study area, we carried out a minke whale survey and several research experiments from 12 January to 25 February. A systematic minke whale survey was conducted in Area IIIW (000°-035°E) from 12 January until 8 February. The survey design was intentionally similar to that used during the IWC/IDCR second circumpolar series of cruises (CPII) to provide information towards addressing the effect of changing cruise track design on Antarctic minke whale abundance estimates. 000°-020°E was surveyed in two contiguous strata (Northern and Southern), from 64°30'S to the ice edge. Poor weather limited the coverage 020°E-035°E to the Southern Stratum only. A total of 1788.2 nmiles was surveyed (000°-035°E) including 935.5 nmiles in closing mode and 930.3 nmiles in independent observer mode, and a total of 466 minke whales were sighted. Minke whale visual dive time experiments were conducted during the minke whale survey. 35 trials were completed, recording surfacing cues for a total of 45.81 hours. From 10-22 February the ships conducted collaborative studies with the Japanese icebreaker, Shirase to investigate the relationship between minke whale abundance and the sea ice. During this study the SOWER vessels surveyed for minke whales in the near-ice area from 035°-050°E. 575.3 nmiles were covered and a total of 22 minke whales were detected. The Shirase surveyed in the pack ice zone 040°-050°E from 12-15 February. Two methods-testing experiments were carried out during the cruise: Adaptive Line Transect Sampling and ‘BT Mode.’ Adaptive Line Transect Sampling was tested during survey in Area IIIW. BT Mode trials were conducted 22-25 February in the area between 050° and 065°E. A direct electronic data acquisition program was evaluated during the cruise on both ships. Sightings for the entire cruise included: minke whales (237 groups/515 animals); blue whales (13 groups/46 individuals) of which 6 groups (28 individuals) were identified as true blue whales and 3 groups (3 individuals) were identified as pygmy blue whales; fin whales (14/132); humpback whales (251/646); sperm whales (35/49); killer whales (23/217); southern bottlenose whales (32/60); Gray’s beaked whales (1/7); Layard’s beaked whales (2/3); pilot whales (4/265); hourglass dolphins (4/17); striped dolphins (3/435) and common bottlenose dolphins (1/20). Opportunistic research during the cruise included blue whale research on 8 groups/29 animals resulting in 5 biopsies and images of 23 individuals for photo-identification studies. Biopsy samples and photo-ID images were also obtained opportunistically from other species. Biopsies were collected from 6 humpback whales and 1 southern right whale. Photo-ID images were collected from 45 humpback whales, 1 southern right whale and 8 groups of killer whales. Estimated Angle and Distance Training Exercise and Experiment were each completed on both vessels

Pulsar Searches with the SKA

The Square Kilometre Array will be an amazing instrument for pulsar astronomy. While the full SKA will be sensitive enough to detect all pulsars in the Galaxy visible from Earth, already with SKA1, pulsar searches will discover enough pulsars to increase the currently known population by a factor of four, no doubt including a range of amazing unknown sources. Real time processing is needed to deal with the 60 PB of pulsar search data collected per day, using a signal processing pipeline required to perform more than 10 POps. Here we present the suggested design of the pulsar search engine for the SKA and discuss challenges and solutions to the pulsar search venture.Comment: 4 pages, 1 figure. To be published in Proceedings of IAU Symposium 337: Pulsar Astrophysics - The Next 50 Year