Paying primary health care centers for performance in Rwanda

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities'input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.Health Monitoring&Evaluation,Population Policies,Health Systems Development&Reform,Disease Control&Prevention,Adolescent Health

Characterization of Hafnia alvei by biochemical tests, random amplified polymorphic DNA PCR, and partial sequencing of 16S rRNA gene

Hafnia alvei strains which possess the attachment-effacement gene (eaeA) may have clinical importance as new diarrhea-causing pathogens and should therefore be differentiated from other H. alvei strains. We characterized diarrheal H. alvei strains, which were positive in the PCR test for the eaeA gene, using biochemical tests not routinely used for identification of members of the family Enterobacteriaceae, and compared them with eaeA-negative strains isolated from different clinical and nonclinical sources to find characteristics useful for identification. Random amplified polymorphic DNA (RAPD)-PCR and partial sequencing of the 16S rRNA gene were utilized to study the genetic diversity of the isolates. The eaeA-positive strains were found to have many characteristic biochemical properties. Negative reactions in the 2- ketogluconate and histidine assimilation tests and a positive reaction in the 3-hydroxybenzoate assimilation test may be useful in routine diagnostics. Nearly identical RAPD-PCR profiles and identical 353-bp fragments of the 16S rRNA genes indicated little genetic diversity among the eaeA-positive strains. The low level of homology (92%) in the partial 16S rRNA genes of eaeA-positive and -negative H. alvei strains raises questions about the taxonomic positioning of eaeA-positive H. alvei

Hafnia alvei in stool specimens from patients with diarrhea and healthy controls

We found an epidemiological association of Hafnia alvei with diarrhea, because the organism was isolated from 12 of 77 (16%) adult Finnish tourists to Morocco who developed diarrhea and from 0 of 321 tourists without diarrhea (P < 0.001). From another group of 112 adult Finnish diarrheal patients, only 2 (2%) yielded H. alvei. In contrast to some Bangladeshi strains of H. alvei, the Finnish strains were negative for the attachment-effacement lesion by an in vitro fluorescent acting staining test and also did not show homology to the Escherichia coli attachment-effacement gene (eaeA) by PCR. These results suggest that a mechanism or mechanisms other than the attachment-effacement lesion may also be involved in the association of H. alvei with diarrhea

Metabolic and physiological adjustment of Suaeda maritima to combined salinity and hypoxia

BACKGROUND AND AIMS: Suaeda maritima is a halophyte commonly found on coastal wetlands in the intertidal zone. Due to its habitat S. maritima has evolved tolerance to high salt concentrations and hypoxic conditions in the soil caused by periodic flooding. In the present work, the adaptive mechanisms of S. maritima to salinity combined with hypoxia were investigated on a physiological and metabolic level. METHODS: To compare the adaptive mechanisms to deficient, optimal and stressful salt concentrations, S. maritima plants were grown in a hydroponic culture under low, medium and high salt concentrations. Additionally, hypoxic conditions were applied to investigate the impact of hypoxia combined with different salt concentrations. A non-targeted metabolic approach was used to clarify the biochemical pathways underlying the metabolic and physiological adaptation mechanisms of S. maritima . KEY RESULTS: Roots exposed to hypoxic conditions showed an increased level of tricarboxylic acid (TCA)-cycle intermediates such as succinate, malate and citrate. During hypoxia, the concentration of free amino acids increased in shoots and roots. Osmoprotectants such as proline and glycine betaine increased in concentrations as the external salinity was increased under hypoxic conditions. CONCLUSIONS: The combination of high salinity and hypoxia caused an ionic imbalance and an increase of metabolites associated with osmotic stress and photorespiration, indicating a severe physiological and metabolic response under these conditions. Disturbed proline degradation in the roots induced an enhanced proline accumulation under hypoxia. The enhanced alanine fermentation combined with a partial flux of the TCA cycle might contribute to the tolerance of S. maritima to hypoxic conditions

Perspectives and spatial approaches for quantifying ecosystem services

Contains fulltext : 232782.pdf (Publisher’s version ) (Open Access)This thesis contributed to the development and improvement of tools for quantifying ecosystem services at local and regional scales. Approaches for the spatial assessment of ecosystem services at high spatial and thematic detail, ranging across diverse value domains, were developed. A framework for operationalising the process of ecosystem service delivery was effectively implemented to operationalise and quantify the supply and demand of ecosystem services identified in the literature and within two case studies conducted in this thesis. Additionally, theoretical and practical examples covered in this thesis revealed that the approaches presented can be adopted in practice to support decision-making. By integrating local knowledge and data as input within assessment approaches, ecosystem services were reified at high spatial and thematic detail and tools facilitating environmental decision-making were successfully developed.Radboud University, 06 mei 2021Promotores : Breure, A.M., Hendriks, A.J. Co-promotores : Rutgers, M., Nijs, T. de299 p

Offshore pipelines in cold regions - Environmental loadings &amp; geotechnical considerations

International Conference and Exhibition on Performance of Ships and Structures in Ice 2008, ICETECH 2008406-41

Application of the Natural Capital Model to assess changes in ecosystem services from changes in green infrastructure in Amsterdam

This paper demonstrates the utility of local models for assessing ecosystem services to support urban planning. It does so by application of the NC-Model, a spatially-explicit set of models for assessing ecosystem services in the Netherlands, to assess changes in ecosystem services in the Municipality of Amsterdam given the implementation of strategies from the Green Quality Impulse. The Green Quality Impulse is a spatial plan that envisions the development of Amsterdam's green infrastructure by 2025 to support the needs of Amsterdam's growing population. The NC-Model was implemented to spatially quantify six ecosystem services within a ‘business-as-usual’ scenario (only residential and population expansion considered) and three scenarios that capture changes in green infrastructure from the implementation of strategies from the Green Quality Impulse. Incorporation of local knowledge and data enabled quantification of ecosystem services at a high spatial resolution and identification of key factors that influence ecosystem service delivery. Such an approach can support urban planners who wish to better-understand the mechanism by which green infrastructure generates value for urban dwellers, to develop scientifically-sound spatial strategies that optimize ecosystem service supply and use, and to further communicate this information to decision-makers, investors, and local inhabitants in an accessible manner.</p