Governance and human resources for health

Despite an increase in efforts to address shortage and performance of Human Resources for Health (HRH), HRH problems continue to hamper quality service delivery. We believe that the influence of governance is undervalued in addressing the HRH crisis, both globally and at country level. This thematic series has aimed to expand the evidence base on the role of governance in addressing the HRH crisis. The six articles comprising the series present a range of experiences. The articles report on governance in relation to developing a joint vision, building adherence and strengthening accountability, and on governance with respect to planning, implementation, and monitoring. Other governance issues warrant attention as well, such as corruption and transparency in decision-making in HRH policies and strategies. Acknowledging and dealing with governance should be part and parcel of HRH planning and implementation. To date, few experiences have been shared on improving governance for HRH policy making and implementation, and many questions remain unanswered. There is an urgent need to document experiences and for mutual learning

Monitoring of climate variables in semi-closed greenhouses

Growers and Dutch government have concluded a covenant in which they express the ambition to reduce the carbon footprint of greenhouse production in order to improve the energy neutrality of newly built greenhouses. Conditioned cultivation in (semi-)closed greenhouses is seen as one of the instruments to reach this goal. It is appointed in the covenant to arrive in 2011 at 700 ha and in 2020 at 2,500 ha semi-closed greenhouses. This paper describes the instruments used to monitor the results of conditioned cultivation in eight semi-closed greenhouses in practice. It addresses the monitoring process, the installations involved and highlights some of the measured data

"I Don't Have Options but to Persevere." Experiences and practices of care for HIV and diabetes in rural Tanzania: a qualitative study of patients and family caregivers.

The high prevalence of chronic diseases in Tanzania is putting a strain on the already stretched health care services, patients and their families. This study sought to find out how health care for diabetes and HIV is perceived, practiced and experienced by patients and family caregivers, to inform strategies to improve continuity of care. Thirty two in-depth interviews were conducted among 19 patients (10 HIV, 9 diabetes) and 13 family caregivers (6 HIV, 7 diabetes). Diabetes patients and caregivers were accessed through one referral facility. HIV patients and caregivers were accessed through HIV clinics at the district hospital, one health centre and one dispensary respectively. The innovative care for chronic conditions framework informed the study design. Data was analysed with the help of Nvivo 10. Three major themes emerged; preparedness and practices in care, health care at health facilities and community support in care for HIV and diabetes. In preparedness and practices, HIV patients and caregivers knew more about aspects of HIV than did diabetes patients and caregivers on diabetes aspects. Continued education on care for the conditions was better structured for HIV than diabetes. On care at facilities, HIV and diabetes patients reported that they appreciated familiarity with providers, warm reception, gentle correction of mistakes and privacy during care. HIV services were free of charge at all levels. Costs involved in seeking services resulted in some diabetes patients to not keep appointments. There was limited community support for care of diabetes patients. Community support for HIV care was through community health workers, patient groups, and village leaders. Diabetes and HIV have socio-cultural and economic implications for patients and their families. The HIV programme is successfully using decentralization of health services, task shifting and CHWs to address these implications. For diabetes and NCDs, decentralization and task shifting are also important and, strengthening of community involvement is warranted for continuity of care and patient centeredness in care. While considering differences between HIV and diabetes, we have shown that Tanzania's rich experiences in community involvement in health can be leveraged for care and treatment of diabetes and other NCDs

Observation of Andreev Reflection Enhanced Shot Noise

We have experimentally investigated the quasiparticle shot noise in NbN/MgO/NbN superconductor - insulator - superconductor tunnel junctions. The observed shot noise is significantly larger than theoretically expected. We attribute this to the occurrence of multiple Andreev reflection processes in pinholes present in the MgO barrier. This mechanism causes the current to flow in large charge quanta (Andreev clusters), with a voltage dependent average value of m = 1+ 2 Delta/eV times the electron charge. Because of this charge enhancement effect, the shot noise is increased by the factor m.Comment: 4 pages, 5 figures include

A qualitative study of the determinants of HIV guidelines implementation in two south-eastern districts of Tanzania.

Current HIV policies in Tanzania have adopted the three long-term impact results of zero new infections, zero HIV deaths and zero stigma and discrimination. Strategies to reach these results include scaling-up HIV Testing and Counselling (HTC); Preventing Mother-To-Child Transmission (PMTCT); and strengthening Care and Treatment Clinic (CTC) services. Previous studies showed that HIV policy and guideline recommendations were not always implemented in rural South Tanzania. This study aims to identify the determinants of HIV guideline implementation. A qualitative study of 23 semi-structured interviews with facility in-charges; healthcare workers; district, regional and national HIV coordinators was conducted. Five health facilities were purposively selected by level, ownership and proximity to district headquarters. Interviews were analysed according to Fleuren's five determinants of innovation uptake related to: strategies used in guideline development and dissemination; guideline characteristics; the guideline implementing organization; guideline users; and the socio-cultural and regulatory context. None of the facilities had the HTC national guideline document. Non-involvement of providers in revisions and weak planning for guideline dissemination impeded their implementation. Lengthy guidelines and those written in English were under-used, and activities perceived to be complicated, like WHO-staging, were avoided. Availability of staff and lack of supplies like test kits and medication impeded implementation. Collaboration between facilities enhanced implementation, as did peer-support among providers. Provider characteristics including education level, knowledge of, and commitment to the guideline influenced implementation. According to providers, determinants of clients' service use included gender norms, stigma, trust and perceived benefits. The regulatory context prohibited private hospitals from buying HIV supplies. Being tools for bringing policies to practice, national guidelines are crucial in the efforts towards the three zeros. Strategies to improve providers' adherence to guidelines should include development of clearer guideline dissemination plans, strengthening of the health system, and possibly addressing of provider-perceived patient-level barriers to utilizing HIV services

Scoutwijzer

Dit document is een FAB-scoutwijzer. FAB staat voor Functional Agrobiodiversity. Het biedt een handleiding in het veld. Tijdens scouting in het veld wordt de boer met deze scoutwijzer in de hand snel wijzer! De wijzer is voor boeren die op zoek naar minder gebruik en emissie van gewasbeschermingsmiddelen en meststoffen, maar met behoud van een goed eindproduct. Zo laat de wijzer bijvoorbeeld zien of en welke natuurlijke vijanden ingezet kunnen worden tegen een plaagdier

Non-equilibrium current noise in mesoscopic disordered SNS junctions

Current noise in superconductor-normal metal-superconductor (SNS) junctions is calculated within the scattering theory of multiple Andreev reflections (MAR). It is shown that the noise exhibits subharmonic gap singularities at $eV=2\Delta/n$, $n=1,2,...$ both in single-mode junctions with arbitrary transparency $D$ and in multi-mode disordered junctions. The subharmonic structure is superimposed with monotonic increase of the effective transferred charge $q^*=S_I(0)/2I$ with decreasing bias voltage. Other features of the noise include a step-like increase of $q^*$ in junctions with small $D$, and a divergence $S_I(0) \propto V^{-1/2}$ at small voltages and excess noise $S_{ex} = 2eI_{ex}$, where $I_{ex}$ is the excess current, at large voltages, in junctions with diffusive transport.Comment: 5 page

Multiple Andreev reflections and enhanced shot noise in diffusive SNS junctions

We study the dc conductance and current fluctuations in diffusive voltage biased SNS junctions with a tunnel barrier inside the mesoscopic normal region. We find that at subgap voltages, eV<2Delta/n, the current associated with the chain of n Andreev reflections is mapped onto the quasiparticle flow through a structure of n+1 voltage biased barriers connected by diffusive conductors. As a result, the current-voltage characteristic of a long SNINS structure obeys Ohm's law, in spite of the complex multiparticle transport process. At the same time, nonequilibrium heating of subgap electrons produces giant shot noise with pronounced subharmonic gap structure which corresponds to stepwise growth of the effective transferred charge. At eV\to 0, the shot noise approaches the magnitude of the Johnson-Nyquist noise with the effective temperature T^*=Delta/3, and the effective charge increases as (e/3)(1 + 2Delta/eV), with the universal ``one third suppression'' factor. We analyse the role of inelastic scattering and present a criterion of strong nonequilibrium.Comment: 4 pages, 2 figure

Resistively-shunted superconducting quantum point contacts

We have studied the Josephson dynamics of resistively-shunted ballistic superconducting quantum point contacts at finite temperatures and arbitrary number of conducting modes. Compared to the classical Josephson dynamics of tunnel junctions, dynamics of quantum point contacts exhibits several new features associated with temporal fluctuations of the Josephson potential caused by fluctuations in the occupation of the current-carrying Andreev levels.Comment: 5 pages, RevTex, 3 postscript figures include

Protocol for the development and validation procedure of the managing the link and strengthening transition from child to adult mental health care (MILESTONE) suite of measures

Background: Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition. Methods: The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries. Discussion: There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process. Trial registration: MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017