The Health Systems Funding Platform : is this where we thought we were going?

Background: In March 2009, the Task Force for Innovative International Financing for Health Systems recommended "a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies." Momentum to establish the Health Systems Funding Platform was swift, with the World Bank convening a Technical Workshop on Health Systems Strengthening (HSS), and serial meetings organized to progress the agenda. Despite its potential significance, there has been little comment in peer-reviewed literature, though some disquiet in the international development community around the scope of the Platform and the capacity of the partners, which appears disproportionate to the available information. Methods: This case study uses documentary analysis, participant observation and 24 in-depth interviews to examine the processes of development and key issues raised by the Platform. Results: The findings show a fluid and volatile process, with debate over whether ongoing engagement in HSS by Global Fund and GAVI represents a dilution of organizational focus, risking ongoing support, or a paradigm shift that facilitates the achievement of targeted objectives, builds systems capacity, and will attract additional resources. Uncertainty in the development of the Platform reflects the flexibility of the recently formed global health initiatives, and the instability of donor commitments, particularly in the current financial climate. But implicit in the conflict is tension between key global stakeholders over defining and ownership of the health systems agenda. Conclusions: The tensions appear to have been resolved through a focus on national planning, applying International Health Partnership principles, though the global financial crisis and key personnel changes may yet alter outcomes. Despite its dynamic evolution, the Platform may offer an incremental path towards increasing integration around health systems, that has not been previously possible

Practical application and statistical analysis of titrimetric monitoring of water and sludge samples

Titrimetry offers the possibility of simultaneous measurement at low cost of several (buffering) components. A first step in the study towards practical application of the titrimetric technique was the titrimetric analysis by up- or down-titration of standard solutions, standard mixtures, solids digester samples and water samples coming from autotrophic nitrogen-removal reactors. The resulting raw data were further processed with an Excel-based program. This program first converts the raw data into a buffer curve upon which a linear buffer capacity model is fitted to the experimental data by estimating the (buffer) concentrations and corresponding pKa values. As such the type of component and the concentration can be determined. As a second step the resulting calculated concentrations were analysed statistically to assess the accuracy and precision of the titrimetric technique. For this purpose, the data were paired, i.e. the difference between the concentration obtained with titrimetry and the concentration obtained with another technique such as colorimetry or gas chromatography was calculated. First the normality of the paired data was assessed. Then, a paired t-test (normal data) or a paired Wilcoxon test (normal data) was used to statistically compare the results obtained with the titrimetric technique to either the stock solution concentration or measurements with another method (colorimetry or gas chromatography). The statistical tests showed that, depending on the titrant concentration, concentrations from 50 mg/. to 3 000 mg/. could adequately be measured with the titrimetric technique

Combining eight research areas to foster the uptake of ecosystem-based management in fresh waters

Freshwater ecosystems are under a constant risk of being irreversibly damaged by human pressures that threaten their biodiversity, the sustainability of ecosystem services (ESs), and human well-being. Despite the implementation of various environmental regulations, the challenges of safeguarding freshwater assets have so far not been tackled successfully. A promising way forward to stop the loss of freshwater biodiversity and to sustain freshwater-based ESs is by implementing ecosystem-based management (EBM), an environmental planning and adaptive management approach that jointly considers social and ecological needs. Responsible for considerable recent success in sustainably managing and conserving marine ecosystems, EBM has not yet been championed for fresh waters. A major reason for the delayed uptake of EBM in fresh waters is likely to be its complexity, requiring planners to be familiar with the latest developments in a range of different research areas. EBM would therefore benefit from becoming more tangible to receive attention on the ground. To facilitate uptake, eight core research areas for EBM and their innovations are introduced, and the way in which they feed into the workflow that guides the EBM planning stage is explained. The workflow links biodiversity distributions with ES supply-and-demand modelling and SMART (specific, measurable, attainable, relevant, and timely) target planning, including scenario- and cross-realm perspectives, the prioritization of management alternatives, spatial prioritization of biodiversity conservation and ES areas, and the quantification of uncertainties. Given the extensive resources, time, and technical capacity required to implement the full workflow, a light and an ultralight version of the workflow are also provided. Applied in concert, the eight well-known research areas allow for better planning and operationalizing, and eventually for implementing EBM in freshwater ecosystems. EBM has great potential to increase public acceptance by introducing the consideration of human needs and aspirations into typically biodiversity-driven conservation and management approaches. This will ultimately improve the integrity of freshwater ecosystems. © 2019 John Wiley & Sons, Ltd.German Federal Ministry of Education and Research, Grant/Award Number: 01 LN1320A; Horizon 2020 Framework Programme, Grant/Award Number: 642317; Marie Sklodowska‐Curie Global Fellowship, Grant/Award Number: 748625; Ramón y Cajal, Grant/Award Number: RYC‐2013‐1397

How to make ecological models useful for environmental management

Understanding and predicting the ecological consequences of different management alternatives is becoming increasingly important to support environmental management decisions. Ecological models could contribute to such predictions, but in the past this was often not the case. Ecological models are often developed within research projects but are rarely used for practical applications. In this synthesis paper, we discuss how to strengthen the role of ecological modeling in supporting environmental management decisions with a focus on methodological aspects. We address mainly ecological modellers but also potential users of modeling results. Various modeling approaches can be used to predict the response of ecosystems to anthropogenic interventions, including mechanistic models, statistical models, and machine learning approaches. Regardless of the chosen approach, we outline how to better align the modeling to the decision making process, and identify six requirements that we believe are important to increase the usefulness of ecological models for management support, especially if management decisions need to be justified to the public. These cover: (i) a mechanistic understanding regarding causality, (ii) alignment of model input and output with the management decision, (iii) appropriate spatial and temporal resolutions, (iv) uncertainty quantification, (v) sufficient predictive performance, and (vi) transparent communication. We discuss challenges and synthesize suggestions for addressing these points. © 2019 The Author(s)This paper was initialized during a special session on Ecological Modelling at the 10th Symposium for European Freshwater Science 2017 ( http://www.sefs10.cz/ ) and further developed during the AQUACROSS project, funded by European Union's Horizon 2020 research and innovation programme (Grant agreement No. 642317 ). SD, SDL and MF were partly funded by the “GLANCE” project (Global Change Effects in River Ecosystems; 01 LN1320A) through the German Federal Ministry of Education and Research ( BMBF ). SDL has received additional funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No. 748625 . JML acknowledges the support of the Spanish Government through María de Maeztu excellence accreditation 2018–2021 (Ref. MDM-2017-0714 )

The diagnostic process from primary care to child and adolescent mental healthcare services: the incremental value of information conveyed through referral letters, screening questionnaires and structured multi-informant assessment

Pathways through Adolescenc

Assessing the psychometric properties and the perceived usefulness of the BasisRaadsOnderzoek (BARO) as a first-line screening instrument for juvenile offenders

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to investigate the psychometric properties and the perceived usefulness of the BARO (Dutch: BAsisRaadsOnderzoek; Protection Board Preliminary Examination of Juvenile Suspects). The BARO is a first-line screening instrument for the identification of psychiatric disorders, adverse environmental factors, and levels of (dys)function in adolescent offenders (age 12 to 18), to be used by social workers of the Child Protection Board (CPB) following a police arrest.</p> <p>Method</p> <p>CPB workers administered the BARO to 295 juvenile offenders (91% boys, 9% girls). A subgroup of 66 offenders (89% boys, 11% girls) underwent an elaborate diagnostic assessment by forensic psychologists and psychiatrists. Using these assessments the most relevant psychometric properties of the BARO were studied. The perceived usefulness was studied using questionnaires to be filled in by the CPB social workers.</p> <p>Results</p> <p>The internal consistency of the instrument was sufficient to good, the concurrent validity of the CPB social workers applying the BARO and the forensic experts carrying out the comprehensive diagnostic assessment was strong, the discriminatory value of the instrument was moderate to strong, and the perceived usefulness of the instrument was evaluated as good to very good by the majority of the CPB workers.</p> <p>Discussion</p> <p>The BARO has sufficient to good psychometric properties including moderate to strong discriminatory value and is considered a good screening instrument by the CPB social workers. In conclusion, the BARO seems to be a very promising first-line screening instrument to identify psychiatric and psychosocial problems in young offenders.</p

Classroom-evaluated school performance at nine years of age after very preterm birth

Objective: To determine classroom-evaluated school performance nine years after preterm birth, predicted by perinatal risk factors and neonatal brain abnormalities.Study design: Children were recruited from a consecutive cohort of 113 preterm infants (<32 weeks’ gestation), participating in a longitudinal prospective study, investigating brain injury and neurodevelopmental outcome. Data on perinatal risk factors, presence of brain injury at term-equivalent age, and maternal education were collected. Information on school performance included enrollment in special (primary) education, grade repetition and school results from the nationwide standardized Dutch Pupil Monitoring System regarding reading comprehension, spelling, and mathematics.Results: Information on school enrollment was available for 87 children (77%), of whom 7 (8%) were in special primary education and 19 (22%) repeated a grade. This was significantly higher compared to national rates (p ≤ .05). Results on school performance were available for 74 children (65%) and showed clearly below average scores in reading comprehension (p = .006), spelling (p = .014) and mathematics (p <.001). Univariate analysis showed that lower performance in reading comprehension was predicted by male sex and low maternal education; spelling by male sex; and mathematics by BPD, white matter injury and maternal education. In a multivariate model, male sex and maternal education were predictive for reading comprehension and white matter injury for mathematics. Conclusion: Preterm born children more often need special primary education and have higher grade repeat rates. They perform poorer on reading comprehension, spelling and mathematics. Regular follow-up remains important for preterm born children during school age. New methods for child psychiatric diagnosis and treatment outcome evaluatio

The Validity of d′ Measures

Subliminal perception occurs when prime stimuli that participants claim not to be aware of nevertheless influence subsequent processing of a target. This claim, however, critically depends on correct methods to assess prime awareness. Typically, d′ (“d prime”) tasks administered after a priming task are used to establish that people are unable to discriminate between different primes. Here, we show that such d′ tasks are influenced by the nature of the target, by attentional factors, and by the delay between stimulus presentation and response. Our results suggest that the standard d′ task is not a straightforward measure of prime visibility. We discuss the implications of our findings for subliminal perception research

Childhood traumatic experiences and mental health problems in sexually offending and non-sexually offending juveniles

OBJECTIVE: To examine the relationship between a history of childhood abuse and mental health problems in juveniles who sexually offended (JSOs) over and above general offending behavior. METHODS: A sample of 44 JSOs incarcerated in two juvenile detention centers in the Netherlands between May 2008 and March 2014 were examined for childhood abuse history (Childhood Trauma Questionnaire-Short Form) and mental health problems (Massachusetts Youth Screening Instrument-Version 2). Furthermore, the connection between childhood abuse and mental health problems in JSOs was compared to a sample of 44 propensity score matched juveniles who offended non-sexually (non-JSOs). RESULTS: In JSOs, sexual abuse was related to anger problems, suicidal ideation, and thought disturbance. These associations were significantly stronger in JSOs than in non-JSOs. CONCLUSIONS: Our results suggest that the relationship between childhood abuse and both internalizing and externalizing mental health problems is of more salience for understanding sexual offending than non-sexual offending, and should, therefore, be an important focus in the assessment and treatment of JSOs