Financially incentivized knowledge assessments to improve provider compliance with treatment guidelines: a cluster-randomized controlled trial

BACKGROUND: Despite increasing access to health care, under-5 mortality remains high in many parts of Sub-Saharan Africa. Interventions to improve quality of care have mostly focused on additional training for medical staff, but generally shown little impact. We will assess the impact of financially incentivized quarterly provider knowledge assessment on compliance with Integrated Management of Childhood Illness (IMCI) protocols in Congo, DRC. METHODS: Out of a total of 1738 facilities currently receiving results-based financing under an ongoing health financing program, 110 facilities were chosen for this study. All health care workers providing outpatient services to children under age 5 in these facilities will be included in the study. Facilities were randomized with equal probability to control and treatment. Treatment facilities will receive quarterly medical staff knowledge assessments using interactive vignettes. Performance on these vignettes will be rewarded through financial bonus payments to facilities. A baseline survey of health worker knowledge was conducted in 2018. An endline assessment is scheduled to start in the second half of 2021. The primary outcome of interest is health worker compliance with Integrated Management of Childhood Illness (IMCI) guidelines. Compliance will be verified through direct observation of medical staff-patient interactions. DISCUSSION: This is to our knowledge the first trial assessing whether linking health financing to health care worker performance on knowledge assessments can increase compliance with under-5 case management protocols. TRIAL REGISTRATION: ClinicalTrials.gov NCT04634019 . Registered on November 18, 2020

Observed crustal uplift near the Southern Patagonian Icefield constrains improved viscoelastic Earth model

Thirty‒one GPS geodetic measurements of crustal uplift in southernmost South America determined extraordinarily high trend rates (> 35 mm/yr) in the north‒central part of the Southern Patagonian Icefield. These trends have a coherent pattern, motivating a refined viscoelastic glacial isostatic adjustment model to explain the observations. Two end‒member models provide good fits: both require a lithospheric thickness of 36.5 ± 5.3 km. However, one end‒member has a mantle viscosity near η =1.6 ×1018 Pa s and an ice collapse rate from the Little Ice Age (LIA) maximum comparable to a lowest recent estimate of 1995–2012 ice loss at about −11 Gt/yr. In contrast, the other end‒member has much larger viscosity: η = 8.0 ×1018 Pa s, half the post–LIA collapse rate, and a steadily rising loss rate in the twentieth century after AD 1943, reaching −25.9 Gt/yr during 1995–2012.Fil: Lange, H.. Technische Universitaet Dresden; AlemaniaFil: Casassa, G.. Centro de Estudios Cientificos; Chile. Universidad de Magallanes; ChileFil: Ivins, E. R.. Institute of Technology. Jet propulsion Laboratory; Estados UnidosFil: Schroeder, L.. Technische Universitaet Dresden; AlemaniaFil: Fritsche, M.. Technische Universitaet Dresden; AlemaniaFil: Richter, Andreas Jorg. Technische Universitaet Dresden; Alemania. Universidad Nacional de la Plata. Facultad de Ciencias Astronómicas y Geofísicas. Departamento de Astrometría; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Groh, A.. Technische Universitaet Dresden; AlemaniaFil: Dietrich, R.. Technische Universitaet Dresden; Alemani

An analytic framework for exploring sampling and observation process biases in genome and phenome‐wide association studies using electronic health records

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155932/1/sim8524.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155932/2/SIM8524-sup-0001-supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155932/3/sim8524_am.pd

Quality of care for children with severe disease in the Democratic Republic of the Congo

BACKGROUND: Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI) guidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income countries, child mortality remains high in many settings. One possible explanation of the continued high mortality burden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of children with severe illness in the Democratic Republic of the Congo (DRC). METHODS: One thousand one hundred eighty under-five clinical visits were observed across a regionally representative sample of 321 facilities in the DRC. Based on a detailed list of disease symptoms observed, patients with severe febrile disease (including malaria), severe pneumonia, and severe dehydration were identified. For all three disease categories, treatments were then compared to recommended case management following IMCI guidelines. RESULTS: Out of 1180 under-five consultations observed, 332 patients (28%) had signs of severe febrile disease, 189 patients (16%) had signs of severe pneumonia, and 19 patients (2%) had signs of severe dehydration. Overall, providers gave the IMCI-recommended treatment in 42% of cases of these three severe diseases. Less than 15% of children with severe disease were recommended to receive in-patient care either in the facility they visited or in a higher-level facility. CONCLUSIONS: These results suggest that adherence to IMCI protocols for severe disease remains remarkably low in the DRC. There is a critical need to identify and implement effective approaches for improving the quality of care for severely ill children in settings with high child mortality

Brief stimuli cast a persistent long-term trace in visual cortex

Visual processing is strongly influenced by the recent stimulus history - a phenomenon termed adaptation. Prominent theories cast adaptation as a consequence of optimized encoding of visual information, by exploiting the temporal statistics of the world. However, this would require the visual system to track the history of individual briefly experienced events, within a stream of visual input, to build up statistical representations over longer timescales. Here, using an openly available dataset from the Allen Brain Observatory, we show that neurons in the early visual cortex of the mouse indeed maintain long-term traces of individual past stimuli that persist despite the presentation of several intervening stimuli, leading to long-term and stimulus-specific adaptation over dozens of seconds. Long-term adaptation was selectively expressed in cortical, but not in thalamic neurons, which only showed short-term adaptation. Early visual cortex thus maintains concurrent stimulus-specific memory traces of past input, enabling the visual system to build up a statistical representation of the world to optimize the encoding of new information in a changing environment.SIGNIFICANCE STATEMENTIn the natural world, previous sensory input is predictive of current input over multi-second timescales. The visual system could exploit these predictabilities by adapting current visual processing to the long-term history of visual input. However, it is unclear whether the visual system can track the history of individual briefly experienced images, within a stream of input, to build up statistical representations over such long timescales. Here, we show that neurons in early visual cortex of the mouse brain exhibit remarkably long-term adaptation to brief stimuli, persisting over dozens of seconds, and despite the presentation of several intervening stimuli. The visual cortex thus maintains long-term traces of individual briefly experienced past images, enabling the formation of statistical representations over extended timescales

Sir Patrick Manson: good medicine for the people of Hong Kong

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