User costs and informal payments for care in the largest maternity hospital in Kathmandu, Nepal

Background: Maternity care costs in Nepal include formal and informal payment. Formal include for example the cost for blood or drugs; Informal payments can be voluntary such as gratitude payments, or bribes which patients are ‘expected’ to pay to get decent care or any care at all. One problem is that these payments are missing from formal accounts and they are not taken into account in health-policy decision-making. The aim of the present study was to estimate out-of-pocket expenses (formal/informal) for delivery care in the largest government maternity hospital in Kathmandu, Nepal and establish factors that affect informal costs. Methods: We used mixed-methods approach. We used questionnaire-based interviews with 234 women who had delivered in this hospital followed by semi-structured in-depth interviews with sub-sample of ten couples. SPSS software was used for analysis and cross tabulations and chi square tests, binary logistic regression were performed. Results: Women occurred various costs during a hospital confinement. The qualitative data suggested that some, but not all had started to save prior to the delivery. There is a significant association between making informal payments and whether or not the birth was planned to be in hospital or whether it was an emergency, p=0.025, ANC visits, p=0.008, woman’s occupation,p=0.025 and husband’s employment, p=0.022. Logistic regression suggested four factors associated with making informal payments, indicating a possible socio-economic link with ability to make informal payments. Conclusions: Although informal payments around birth itself were not substantial, such payments are very common. Better understanding of informal payments is important as the illegal status of unofficial health care payments means that it is difficult to establish the prevalence of this phenomenon. Moreover it forms a part of the private health expenditure rarely included in the national health statistics, they create perverse incentives, potentially reduce motivation for reform and will provide information about economic barriers to care

Ambient noise cross-correlation observations of fundamental and higher-mode Rayleigh wave propagation governed by basement resonance

Measurement of basement seismic resonance frequencies can elucidate shallow velocity structure, an important factor in earthquake hazard estimation. Ambient noise cross correlation, which is well-suited to studying shallow earth structure, is commonly used to analyze fundamental-mode Rayleigh waves and, increasingly, Love waves. Here we show via multicomponent ambient noise cross correlation that the basement resonance frequency in the Canterbury region of New Zealand can be straightforwardly determined based on the horizontal to vertical amplitude ratio (H/V ratio) of the first higher-mode Rayleigh waves. At periods of 1–3 s, the first higher-mode is evident on the radial-radial cross-correlation functions but almost absent in the vertical-vertical cross-correlation functions, implying longitudinal motion and a high H/V ratio. A one-dimensional regional velocity model incorporating a ~ 1.5 km-thick sedimentary layer fits both the observed H/V ratio and Rayleigh wave group velocity. Similar analysis may enable resonance characteristics of other sedimentary basins to be determined

Reaching millennium development goal 4 - the Gambia.

UNLABELLED: To describe how, through a DSS in a rural area of The Gambia, it has been possible to measure substantial reductions in child mortality rates and how we investigated whether the decline paralleled the registered fall in malaria incidence in the country. METHODS: Demographic surveillance data spanning 19.5 years (1 April 1989-30 September 2008) from 42 villages around the town of Farafenni, The Gambia, were used to estimate childhood mortality rates for neonatal, infant, child (1-4 years) and under-5 age groups. Data were presented in five a priori defined time periods, and annual rates per 1000 live births were derived from Kaplan-Meier survival probabilities. RESULTS: From 1989-1992 to 2004-2008, under-5 mortality declined by 56% (95% CI: 48-63%), from 165 (95% CI: 151-181) per 1000 live births to 74 (95% CI: 65-84) per 1000 live births. In 1- to 4-year-olds, mortality during the period 2004-2008 was 69% (95% CI: 60-76%) less than in 1989-1992. The corresponding mortality decline in infants was 39% (95% CI: 23-52%); in neonates, it was 38% (95% CI: 13-66%). The derived annual under-5 mortality rates declined from 159 per 1000 live births in 1990 to 45 per 1000 live births in 2008, thus implying an attainment of MDG4 seven years in advance of the target year of 2015. CONCLUSION: Achieving MDG4 is possible in poor, rural areas of Africa through widespread deployment of relatively simple measures that improve child survival, such as immunisation and effective malaria control

Seismic observations of crevasse growth following rain-induced glacier acceleration, Haupapa/Tasman Glacier, New Zealand

Changing rates of water input can affect both the flow of glaciers and ice sheets and their propensity to crevasse. Here we examine geodetic and seismic observations during two substantial (10–18-times background velocity) rain-induced glacier accelerations at Haupapa/Tasman Glacier, New Zealand. Changes in rain rate result in glacier acceleration and associated uplift, which propagate down-glacier. This pattern of acceleration results in a change to the strain rate field, which correlates with an order of magnitude increase in the apparent seismicity rate and an overall down-glacier migration in located seismicity. After each acceleration event the apparent seismicity rate decreases to below the pre-acceleration rate for 3 days. This suggests that seismic events associated with surface crevasse growth occur early during phases of glacier acceleration due to elevated extensional stresses, and then do not occur again until stresses recover

Seismic Response to Injection Well Stimulation in a High-Temperature, High-Permeability Reservoir

Fluid injection into the Earth's crust can induce seismic events that cause damage to local infrastructure but also offer valuable insight into seismogenesis. The factors that influence the magnitude, location, and number of induced events remain poorly understood but include injection flow rate and pressure as well as reservoir temperature and permeability. The relationship between injection parameters and injection-induced seismicity in high-temperature, high-permeability reservoirs has not been extensively studied. Here we focus on the Ngatamariki geothermal field in the central Taupō Volcanic Zone, New Zealand, where three stimulation/injection tests have occurred since 2012. We present a catalog of seismicity from 2012 to 2015 created using a matched-filter detection technique. We analyze the stress state in the reservoir during the injection tests from first motion-derived focal mechanisms, yielding an average direction of maximum horizontal compressive stress (SHmax) consistent with the regional NE-SW trend. However, there is significant variation in the direction of maximum compressive stress (σ1), which may reflect geological differences between wells. We use the ratio of injection flow rate to overpressure, referred to as injectivity index, as a proxy for near-well permeability and compare changes in injectivity index to spatiotemporal characteristics of seismicity accompanying each test. Observed increases in injectivity index are generally poorly correlated with seismicity, suggesting that the locations of microearthquakes are not coincident with the zone of stimulation (i.e., increased permeability). Our findings augment a growing body of work suggesting that aseismic opening or slip, rather than seismic shear, is the active process driving well stimulation in many environments

Comparison of Electronic Data Capture (EDC) with the Standard Data Capture Method for Clinical Trial Data

BACKGROUND: Traditionally, clinical research studies rely on collecting data with case report forms, which are subsequently entered into a database to create electronic records. Although well established, this method is time-consuming and error-prone. This study compares four electronic data capture (EDC) methods with the conventional approach with respect to duration of data capture and accuracy. It was performed in a West African setting, where clinical trials involve data collection from urban, rural and often remote locations. METHODOLOGY/PRINCIPAL FINDINGS: Three types of commonly available EDC tools were assessed in face-to-face interviews; netbook, PDA, and tablet PC. EDC performance during telephone interviews via mobile phone was evaluated as a fourth method. The Graeco Latin square study design allowed comparison of all four methods to standard paper-based recording followed by data double entry while controlling simultaneously for possible confounding factors such as interview order, interviewer and interviewee. Over a study period of three weeks the error rates decreased considerably for all EDC methods. In the last week of the study the data accuracy for the netbook (5.1%, CI95%: 3.5-7.2%) and the tablet PC (5.2%, CI95%: 3.7-7.4%) was not significantly different from the accuracy of the conventional paper-based method (3.6%, CI95%: 2.2-5.5%), but error rates for the PDA (7.9%, CI95%: 6.0-10.5%) and telephone (6.3%, CI95% 4.6-8.6%) remained significantly higher. While EDC-interviews take slightly longer, data become readily available after download, making EDC more time effective. Free text and date fields were associated with higher error rates than numerical, single select and skip fields. CONCLUSIONS: EDC solutions have the potential to produce similar data accuracy compared to paper-based methods. Given the considerable reduction in the time from data collection to database lock, EDC holds the promise to reduce research-associated costs. However, the successful implementation of EDC requires adjustment of work processes and reallocation of resources

To Trust or Not to Trust? Developing Trusted Digital Spaces through Timely Reliable and Personalized Provenance

Organizations are increasingly dependent on data stored and processed by distributed, heterogeneous services to make critical, high-value decisions. However, these service-oriented computing environments are dynamic in nature and are becoming ever more complex systems of systems. In such evolving and dynamic eco-system infrastructures, knowing how data was derived is of significant importance in determining its validity and reliability. To address this, a number of advocates and theorists postulate that provenance is critical to building trust in data and the services that generated it as it provides evidence for data consumers to judge the integrity of the results. This paper presents a summary of the STRAPP (trusted digital Spaces through Timely Reliable And Personalised Provenance) project, which is designing and engineering mechanisms to achieve a holistic solution to a number of real-world service-based decision-support systems

Budesonide/Glycopyrrolate/Formoterol for the Management of COPD in a UK Primary Care Population : Real-World Use and Early Medication Success

We thank Johann Castaneda for his contribution to protocol development, analysis and interpretation of data. Dr Ruth B Murray (Medscript NZ Ltd) provided medical writing assistance under the direction of the authors, funded by AstraZeneca.Peer reviewe

Ambient seismic noise tomography of Canada and adjacent regions: Part I. Crustal structures

This paper presents the first continental-scale study of the crust and upper mantle shear velocity (V_s) structure of Canada and adjacent regions using ambient noise tomography. Continuous waveform data recorded between 2003 and 2009 with 788 broadband seismograph stations in Canada and adjacent regions were used in the analysis. The higher primary frequency band of the ambient noise provides better resolution of crustal structures than previous tomographic models based on earthquake waveforms. Prominent low velocity anomalies are observed at shallow depths (<20 km) beneath the Gulf of St. Lawrence in east Canada, the sedimentary basins of west Canada, and the Cordillera. In contrast, the Canadian Shield exhibits high crustal velocities. We characterize the crust-mantle transition in terms of not only its depth and velocity but also its sharpness, defined by its thickness and the amount of velocity increase. Considerable variations in the physical properties of the crust-mantle transition are observed across Canada. Positive correlations between the crustal thickness, Moho velocity, and the thickness of the transition are evident throughout most of the craton except near Hudson Bay where the uppermost mantle V_s is relatively low. Prominent vertical V_s gradients are observed in the midcrust beneath the Cordillera and beneath most of the Canadian Shield. The midcrust velocity contrast beneath the Cordillera may correspond to a detachment zone associated with high temperatures immediately beneath, whereas the large midcrust velocity gradient beneath the Canadian Shield probably represents an ancient rheological boundary between the upper and lower crust