The reign of Leo VI (886-912) : personal relationships and political ideologies

Leo VI (886-912) is an emperor who has suffered from a hostile and inadequate press. He has been portrayed as a weak and careless emperor, known mainly for his dubious parentage and marital exploits. This thesis questions these popular perceptions of Leo, and attempts to present a more realistic account of the emperor and the politics of his age. The aspects of the reign tackled focus on essential elements of Leo's life and rule, presented in a rough chronological framework, and the themes of personal relationships and political ideologies are recurrent. Chapter One examines Leo's relationship with Basil I and his attitude to his Macedonian heritage. Chapter Two considers the fate of the monumental figure of Photios at the emperor's hands. Chapter Three deals with the position and role of the 'all powerful' Stylianos Zaoutzes during the first half of the reign. Chapter Four ponders the origin and meaning of Leo's 'wise' epithet. Chapter Five focuses on the emperor's four marriages. Chapter Six turns to the course of foreign affairs during the reign, concentrating on Bulgaria and the Arab navy, and considers the emperor's attitude towards these military problems. Chapter Seven examines the emperor's relationship with his senatorial officials, focusing on two distinct groups, eunuchs and the generals who originated from families of the eastern frontier. Finally Chapter Eight addresses the tense relationship that existed between Leo and his brother and co-emperor Alexander. What emerges from a consideration of these aspects of Leo and his reign is that this is an emperor who does not deserve the popular perceptions that still persist about him. He was an emperor who forged a 'new' and distinctive imperial style, a style that should not deceive us; he may have been literate, sedentary and city-based, but he was also forceful, strong-willed and conscientious

The private commercial sector distribution chain for antimalarial drugs in Benin - Findings from a rapid survey

In November 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would administer the first phase of an ambitious scheme to increase the availability of effective treatment for malaria, the Affordable Medicines Facility – malaria (AMFm). Artemisinin‐based combination therapies (ACTs) are highly‐effective, but remain prohibitively expensive for those who are most vulnerable to malaria infection.  AMFm aims to reduce significantly the price of ACTs by offering a co‐payment for ACTs purchased by eligible buyers at the top of the supply chain.    Recognizing that the public and private sectors are important sources of antimalarials in most endemic countries, both public and private sector buyers will be entitled to purchase subsidized ACTs.  The involvement of the private sector is an innovative element of AMFm, as many countries already have experience distributing ACTs in the public sector. To ensure that subsidized ACTs reach patients at the lowest possible cost, it is necessary to gain a better understanding of the private sector supply chains for antimalarials in each country participating in AMFm.   The objective of the rapid supply chain survey was therefore to assist Benin, which is one of the 11 countries invited to apply to the first phase of AMFm, in the development of an effective implementation plan by providing an understanding of the current supply chain for antimalarials, and the way in which subsidised ACTs are likely to travel through this chain to reach patients.  This report presents the findings of a series of semi‐structured interviews conducted with government officials and private suppliers of malaria treatment operating at the various levels of the chain.   At the time of the survey, antimalarial products sold in the private commercial sector were procured from international and domestic manufacturers by 3 active registered wholesalers and Benin’s public sector procurement agent: the Centrale d’Achat des Médicaments Essentiels et des Consommables médicaux (CAME). Manufacturers do not have sole distributorship agreements for registered pharmaceuticals, or other special relationships with particular wholesalers. Consequently, each wholesaler regularly stocks a large proportion of the antimalarials registered in Benin. CAME is responsible for procuring the generic medicines on the National Essential Medicines List. In practice CAME procures and supplies antimalarials not included on the National Essential Medicines List, as it is currently out of date

Comparative analysis of two methods for measuring sales volumes during malaria medicine outlet surveys.

BACKGROUND: There is increased interest in using commercial providers for improving access to quality malaria treatment. Understanding their current role is an essential first step, notably in terms of the volume of diagnostics and anti-malarials they sell. Sales volume data can be used to measure the importance of different provider and product types, frequency of parasitological diagnosis and impact of interventions. Several methods for measuring sales volumes are available, yet all have methodological challenges and evidence is lacking on the comparability of different methods. METHODS: Using sales volume data on anti-malarials and rapid diagnostic tests (RDTs) for malaria collected through provider recall (RC) and retail audits (RA), this study measures the degree of agreement between the two methods at wholesale and retail commercial providers in Cambodia following the Bland-Altman approach. Relative strengths and weaknesses of the methods were also investigated through qualitative research with fieldworkers. RESULTS: A total of 67 wholesalers and 107 retailers were sampled. Wholesale sales volumes were estimated through both methods for 62 anti-malarials and 23 RDTs and retail volumes for 113 anti-malarials and 33 RDTs. At wholesale outlets, RA estimates for anti-malarial sales were on average higher than RC estimates (mean difference of four adult equivalent treatment doses (95% CI 0.6-7.2)), equivalent to 30% of mean sales volumes. For RDTs at wholesalers, the between-method mean difference was not statistically significant (one test, 95% CI -6.0-4.0). At retail outlets, between-method differences for both anti-malarials and RDTs increased with larger volumes being measured, so mean differences were not a meaningful measure of agreement between the methods. Qualitative research revealed that in Cambodia where sales volumes are small, RC had key advantages: providers were perceived to remember more easily their sales volumes and find RC less invasive; fieldworkers found it more convenient; and it was cheaper to implement than RA. DISCUSSION/CONCLUSIONS: Both RA and RC had implementation challenges and were prone to data collection errors. Choice of empirical methods is likely to have important implications for data quality depending on the study context

OVC cost model

This item is archived in the repository for materials published for the USAID supported Orphans and Vulnerable Children Comprehensive Action Research Project (OVC-CARE) at the Boston University Center for Global Health and Development

Ammianus Marcellinus on the Empress Eusebia: a Split Personality?

The Roman empress Eusebia, wife of the Christian emperor Constantius II (A.D. 337–361), owes what fame she enjoys amongst historians to her role in the life of Julian the Apostate, the last pagan emperor (361–363); in the years 354–355 the empress emerged as the saviour and advocate of her (still in the closet) pagan in-law. However in this article I wish to focus exclusively on the treatment of the empress Eusebia in the history of Ammianus Marcellinus, the great historian of Late Antiquity and himself a devotee of Julian. This treatment merits attention not just for the undoubtedly interesting fact that Eusebia is one of the few female characters to surface in the history, but also because in the history the empress is cast in seemingly different personae. She is the kind and beautiful empress, akin to the image Julian himself created of her in his Speech of Thanks to Eusebia, written in commemoration of his salvation at her hands; but she is also a devious player, as we find too in Zosimus' treatment of the empress, though in Ammianus her deviousness is malevolent. It is this contradictory characterization aspect of the treatment that I wish to explore here. For whilst general attempts have been made to reconcile these images in the context of political history, the repercussions for our understanding of Ammianus have been little explored. How can the historian let these contrasting images co-exist? Has he merely assembled his history clumsily, or is there a more rewarding explanation for the impression of the empress's split personality

The advocacy of an empress: Julian and Eusebia

The importance of the role of the empress Eusebia1 in the watershed years (354–5) of the life of Julian is not in question. The narrative runs as follows. When Julian was summoned to Milan in 354 to the court of his Christian cousin Constantius (337–61) in the aftermath of the execution of his half-brother Gallus for treason and was questioned about his loyalty to the emperor, it was the empress who secured an audience for him with the emperor and who effected his liberation in 355. His subsequent residency at Athens was also the suggestion of the empress. Not much later in the same year, when Julian was again recalled to the court at Milan to be appointed Caesar on 6 November, the empress supported his promotion, if not indeed being the very proponent of it. Thus began Julian's imperial career, which led him to succeed Constantius as emperor in 361

The private commercial sector distribution chain for antimalarial drugs in Nigeria - Findings from a rapid survey

In November of 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would administer the first phase of an ambitious scheme to increase the availability of effective treatment for malaria, the Affordable Medicines Facility-malaria (AMFm). Artemisinin-based combination therapies (ACTs) are highly effective, but remain prohibitively expensive for those who are most vulnerable to malaria infection.1 The AMFm aims to significantly reduce the price of ACTs by offering a co-payment for ACTs purchased by eligible buyers at the top of the supply chain. Recognizing that the public and private sectors are important sources of antimalarials in most endemic countries, both public and private sector buyers will be entitled to purchase subsidised ACTs. The involvement of the private sector is an innovative element of AMFm, as many countries already have experience distributing ACTs in the public sector. To ensure that subsidised ACTs reach patients at the lowest possible cost, it is necessary to gain a better understanding of the private sector supply chains for antimalarials in each country participating in the AMFm. The objective of the rapid supply chain survey was therefore to assist Nigeria, which is one of the 11 countries invited to apply to the first phase of the AMFm, in the development of an effective implementation plan by providing an understanding of the current supply chain for antimalarials, and the way in which subsidised ACTs are likely to travel through this chain to reach patients. This report presents the findings of a series of semi-structured interviews conducted with government officials and private suppliers of malaria treatment operating at the various levels of the chain. Supplemental sections include brief discussions on the Nigerian drug monitoring system, on the proposed tax exemption for subsidised ACTs under the AMFm, and also on the private sector capacity to repackage and re-label imported subsidised ACTs. In addition, data from the December 2008 report on the first round of the ACTwatch Outlet Survey in Nigeria were used to estimate key variables, such as antimalarial market shares