Monitoring and evaluation of human resources for health: an international perspective

BACKGROUND: Despite the undoubted importance of human resources to the functions of health systems, there is little consistency between countries in how human resource strategies are monitored and evaluated. This paper presents an integrated approach for developing an evidence base on human resources for health (HRH) to support decision-making, drawing on a framework for health systems performance assessment. METHODS: Conceptual and methodological issues for selecting indicators for HRH monitoring and evaluation are discussed, and a range of primary and secondary data sources that might be used to generate indicators are reviewed. Descriptive analyses are conducted drawing primarily on one type of source, namely routinely reported data on the numbers of health personnel and medical schools as covered by national reporting systems and compiled by the World Health Organization. Regression techniques are used to triangulate a given HRH indicator calculated from different data sources across multiple countries. RESULTS: Major variations in the supply of health personnel and training opportunities are found to occur by region. However, certain discrepancies are also observed in measuring the same indicator from different sources, possibly related to the occupational classification or to the sources' representation. CONCLUSION: Evidence-based information is needed to better understand trends in HRH. Although a range of sources exist that can potentially be used for HRH assessment, the information that can be derived from many of these individual sources precludes refined analysis. A variety of data sources and analytical approaches, each with its own strengths and limitations, is required to reflect the complexity of HRH issues. In order to enhance cross-national comparability, data collection efforts should be processed through the use of internationally standardized classifications (in particular, for occupation, industry and education) at the greatest level of detail possible

Assessment of offshore platforms under extreme waves by probabilistic incremental wave analysis

In this study, a novel probabilistic framework named Probabilistic Incremental Wave Analysis (PIWA) is established in order to assess the performance of jacket offshore platforms under extreme waves. The PIWA can take into account the uncertainties in three main elements consisting of sea state parameters, structural response and collapse capacity. The main advantage of the PIWA approach is reflected in decoupling of the wave hazard and structural analyses via an intermediate variable known as the wave height intensity measure. Despite the fact that most of the uncertainties associated with structural response are concentrated in wave hazard, this will enable the PIWA to estimate the probability of failure accurately. Moreover, both static and dynamic wave analyses can be utilized in the PIWA procedure. In this approach, multiple incremental wave analyses are employed to estimate the distribution of structural demand for a wide range of wave height intensities. Subsequently, the mean annual frequency of exceeding a structural limit state is calculated for which this research addresses two different methodologies including demand-based and wave height-based approaches. Furthermore, a new probabilistic-based Reserve Strength Ratio (RSR) is proposed and the probability of exceeding various levels of RSR is provided. To reduce the large number of simulations and hence improving the computational effort in the PIWA procedure, a combination of Latin Hypercube Sampling and Simulated Annealing optimization technique is utilized as an efficient sampling scheme. The PIWA procedure is employed in probabilistic assessment of an existing jacket offshore platform located in the Persian Gulf as well

Promoting a european Dimension of Intercultural Education. Focus on Training

Special issue of the European Journal of Intercultural Studies, Vol.9 supplement, 1998 (ISSN: 0952-391X). It includes eight contributions focusing on issues of intercultural education and teacher and headteacher training at the European as well at the National level. It reviews intercultural education teacher training key methodological elements and supports the idea that such training should be provided to all teachers

Genetic modifiers of Huntington's disease differentially influence motor and cognitive domains.

Genome-wide association studies (GWAS) of Huntington’s disease (HD) have identified six DNA maintenance gene loci (among others) as modifiers and implicated a two step-mechanism of pathogenesis: somatic instability of the causative HTT CAG repeat with subsequent triggering of neuronal damage. The largest studies have been limited to HD individuals with a rater-estimated age at motor onset. To capitalize on the wealth of phenotypic data in several large HD natural history studies, we have performed algorithmic prediction using common motor and cognitive measures to predict age at other disease landmarks as additional phenotypes for GWAS. Combined with imputation using the Trans-Omics for Precision Medicine reference panel, predictions using integrated measures provided objective landmark phenotypes with greater power to detect most modifier loci. Importantly, substantial differences in the relative modifier signal across loci, highlighted by comparing common modifiers at MSH3 and FAN1, revealed that individual modifier effects can act preferentially in the motor or cognitive domains. Individual components of the DNA maintenance modifier mechanisms may therefore act differentially on the neuronal circuits underlying the corresponding clinical measures. In addition, we identified new modifier effects at the PMS1 and PMS2 loci and implicated a potential new locus on chromosome 7. These findings indicate that broadened discovery and characterization of HD genetic modifiers based on additional quantitative or qualitative phenotypes offers not only the promise of in-human validated therapeutic targets, but also a route to dissecting the mechanisms and cell types involved in both the somatic instability and toxicity components of HD pathogenesis