Four countries' experiences of universal health coverage implementation: lessons for the future

AbstractBackgroundThe WHO defines universal health coverage (UHC) as access for all people to the health services they need (prevention, promotion, treatment, and rehabilitation) without financial hardship. But UHC implementation is a daunting undertaking for many countries. To commit to UHC, countries and their leaders must address questions such as: can the country afford it? What services should be provided and who should have access to them? Who should be responsible for managing insurance? And how can providers project demand and ensure adequate supply of services? Health ministers, who often serve only short terms, must address these questions about UHC, while also managing policy and services for many other health issues. We undertook case studies of four countries' experiences in implementing UHC—Thailand, Ghana, Vietnam, and Rwanda to help inform health ministers from countries still working towards the goal of UHC.MethodsWe used published information and conducted interviews with leaders from Thailand, Ghana, Vietnam, and Rwanda. We asked questions about how UHC was funded (including the package of services and population covered, with attention to the values informing these choices); the political process accompanying implementation; the sustainability of the programme; and the outcomes achieved so far in terms of measurable health benefits. We compiled each country's experience in case studies and exhibits.FindingsTeaching cases were used for a Ministerial Leadership in Health forum held at the Harvard School of Public Health and will be published as part of an open-access case collection in global health delivery. Although each country offers a unique experience and approach, there were some responses common to all countries, the most important of which was the generation of political will and accountability. Other key tactics in the successful implementation of UHC were provision of incentives for expansion of care for the most vulnerable, and adaptation and monitoring of the programme over time.InterpretationTeaching cases that document country experiences of UHC implementation and approaches to other complex health issues will contribute to an understanding of how we can improve health care for populations around the world.FundingThis research received funding from the Rockefeller Foundation and Harvard School of Public Health

The Coronal X-ray Spectrum of the Multiple Weak-Lined T Tauri Star System HD 98800

We present high-resolution X-ray spectra of the multiple (hierarchical quadruple) weak-lined T Tauri star system HD 98800, obtained with the High Energy Transmission Gratings Spectrograph (HETGS) aboard the Chandra X-ray Observatory (CXO). In the zeroth-order CXO/HETGS X-ray image, both principle binary components of HD 98800 (A and B, separation 0.8'') are detected; component A was observed to flare during the observation. The infrared excess (dust disk) component, HD 98800B, is a factor ~4 fainter in X-rays than the apparently ``diskless'' HD 98800A, in quiescence. The line ratios of He-like species (e.g., Ne IX, O VII) in the HD 98800A spectrum indicate that the X-ray-emitting plasma around HD 98800 is in a typical coronal density regime (log n <~ 11). We conclude that the dominant X-ray-emitting component(s) of HD 98800 is (are) coronally active. The sharp spectral differences between HD 98800 and the classical T Tauri star TW Hya demonstrate the potential utility of high-resolution X-ray spectroscopy in providing diagnostics of pre-main sequence accretion processes.Comment: 11 pages, 5 figures; to appear in the Astrophysical Journal (Letters

Infrared Space Observatory Polarimetric Imaging of the Egg Nebula (RAFGL 2688)

We present polarimetric imaging of the protoplanetary nebula RAFGL 2688 obtained at 4.5 microns with the Infrared Space Observatory (ISO). We have deconvolved the images to remove the signature of the point spread function of the ISO telescope, to the extent possible. The deconvolved 4.5 micron image and polarimetric map reveal a bright point source with faint, surrounding reflection nebulosity. The reflection nebula is brightest to the north-northeast, in agreement with previous ground- and space-based infrared imaging. Comparison with previous near-infrared polarimetric imaging suggests that the polarization of starlight induced by the dust grains in RAFGL 2688 is more or less independent of wavelength between 2 microns and 4.5 microns. This, in turn, indicates that scattering dominates over thermal emission at wavelengths as long as ~5 microns, and that the dust grains have characteristic radii < 1 micron.Comment: 27 pages, 9 figures; to appear in the Astronomical Journal, May 2002 issu

Orbital motion of the young brown dwarf companion TWA 5 B

With more adaptive optics images available, we aim at detecting orbital motion for the first time in the system TWA 5 A+B. We measured separation and position angle between TWA 5 A and B in each high-resolution image available and followed their change in time, because B should orbit around A. The astrometric measurement precision is about one milli arc sec. With ten year difference in epoch, we can clearly detect orbital motion of B around A, a decrease in separation by ~ 0.0054 arc sec per year and a decrease in position angle by ~ 0.26 degrees per year. TWA 5 B is a brown dwarf with ~ 25 Jupiter masses (Neuh\"auser et al. 2000), but having large error bars (4 to 145 Jupiter masses, Neuh\"auser et al. 2009). Given its large projected separation from the primary star, ~ 86 AU, and its young age ~ 10 Myrs), it has probably formed star-like, and would then be a brown dwarf companion. Given the relatively large changes in separation and position angle between TWA 5 A and B, we can conclude that they orbit around each other on an eccentric orbit. Some evidence is found for a curvature in the orbital motion of B around A - most consistent with an elliptic (e=0.45) orbit. Residuals around the best-fit ellipse are detected and show a small-amplitude (~ 18 mas) periodic sinusoid with ~ 5.7 yr period, i.e., fully consistent with the orbit of the inner close pair TWA 5 Aa+b. Measuring these residuals caused by the photocenter wobble - even in unresolved images - can yield the total mass of the inner pair, so can test theoretical pre-main sequence models.Comment: 6 pages, 4 figures, accepted for publication in A&A; corrected typo in amplitude below Fig.

Understanding the Role of the Ventrolateral Prefrontal Cortex in Emotional Memory using Transcranial Direct Current Stimulation and Transcranial Magnetic Stimulation

Emotional stimuli can have both beneficial and detrimental effects on memory, such that emotional stimuli can be distracting from current neutral working memory goals, while also leading to enhanced episodic memory for the distracting emotional stimuli. Recent evidence suggests that the ventrolateral prefrontal cortex (VLPFC) has multiple roles in the enhancing effects of emotion on memory through top-down/controlled processes, including 1) coping with negative distraction and 2) elaborative encoding of negative information. Additionally, previous research has alluded to hemispheric differences in the VLPFC (Chapter 1). However, previous research has been correlational, with no strong laterality tests of the VLPFC. Two experiments tested the roles of the left and right VLPFC in working memory and/or episodic memory tasks two using non-invasive brain stimulation techniques; transcranial direct current stimulation (tDCS) was used to increase cortical excitability of the VLFPC in Experiment 1 and transcranial magnetic stimulation (TMS) was used to inhibit the VLPFC in Experiment 2. Experiment 1 (Chapter 2) used tDCS to test whether the VLPFC is involved in working memory and episodic memory, and whether there are hemispheric differences. Results showed that the tDCS over left VLPFC led to improved working memory tasks with both neutral and negative distractors, and also indicated that there might be a greater demand on the VLPFC with negative distraction. The right VLPFC played a role in linking together working memory and episodic memory performance. Experiment 2 (Chapter 3) used TMS to test whether the involvement of the VLPFC in “emotional enhancement of episodic memory effect” was: 1) dependent on the available attentional resources, and 2) dependent on valence and/or arousal. Inhibiting the right VLPFC led to a reduced emotional enhancement of episodic memory effect for both “negative arousing” and “negative nonarousing” words. In contrast, inhibiting the left VLPFC under full attention reduced the emotional enhancement of episodic memory effect for “negative nonarousing” words only, suggesting that the role of the left VLPFC is dependent upon stimulus type and controlled processing. Together, these results point to a role for the VLPFC in: 1) working memory for both negative and neutral information, and 2) enhanced episodic memory for emotional stimuli, which is likely related its role in controlled processing. Additionally, our results show hemispheric differences, and suggest that the left VLPFC is important for controlled processing, whereas the right VLPFC is important for controlled and automatic processing

Celebrity culture and public connection: bridge or chasm?

Media and cultural research has an important contribution to make to recent debates about declines in democratic engagement: is for example celebrity culture a route into democratic engagement for those otherwise disengaged? This article contributes to this debate by reviewing qualitative and quantitative findings from a UK project on 'public connection'. Using self-produced diaries (with in-depth multiple interviews) as well as a nationwide survey, the authors argue that while celebrity culture is an important point of social connection sustained by media use, it is not linked in citizens' own accounts to issues of public concern. Survey data suggest that those who particularly follow celebrity culture are the least engaged in politics and least likely to use their social networks to involve themselves in action or discussion about public-type issues. This does not mean 'celebrity culture' is 'bad', but it challenges suggestions of how popular culture might contribute to effective democracy

The Oregon State University Writing Center : history and context

The Oregon State University (OSU) Writing Center: History and Context provides a detailed and multi-faceted view of the Writing Center from its start in 1976 through the present. The information was gathered from interviews, annual reports, archival sources, and scholarly research. Chapter One examines the scholarly conversation about writing centers, drawing on several major contributors to identify a number of themes that recur in research on writing centers and their history Chapter One also describes the cultural historiographic approach employed in this thesis. Chapter Two offers an overview of writing center theory and practice, in order to provide a helpful context for Chapters Three and Four. Chapter Three explores the early history and pre-history of the OSU Writing Center and examines it in the context of the Center for Writing and Learning and of OSU. Chapter Four looks at the Writing Center itself, discussing the coordinators who have worked there and their contributions, the writing assistants and their training, the students, and the director's role in the Center. Chapter Five concludes this thesis by reexamining the writing center themes identified in Chapter One in light of what has been learned about the OSU Writing Center. Various appendices provide supplemental data