Policy Experimentation and Innovation as a Response to Complexity in China’s Management of Health Reforms

There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China’s reforms; this article argues that these processes have been important in rebuilding China’s health system. While China’s current system still has many problems, progress is being made in developing a functioning system able to ensure broad population access. The article analyses Chinese thinking on policy experimentation and innovation and their use in management of complex reforms. It argues that China’s management of reform allows space for policy tailoring and innovation by sub-national governments under a broad agreement over the ends of reform, and that shared understandings of policy innovation, alongside informational infrastructures for the systemic propagation and codification of useful practices, provide a framework for managing change in complex environments and under conditions of uncertainty in which ‘what works’ is not knowable in advance. The article situates China’s use of experimentation and innovation in management of health system reform in relation to recent literature which applies complex systems thinking to global health, and concludes that there are lessons to be learnt from China’s approaches to managing complexity in development of health systems for the benefit of the poor

A checklist for health research priority setting: nine common themes of good practice

Health research priority setting processes assist researchers and policymakers in effectively targeting research that has the greatest potential public health benefit. Many different approaches to health research prioritization exist, but there is no agreement on what might constitute best practice. Moreover, because of the many different contexts for which priorities can be set, attempting to produce one best practice is in fact not appropriate, as the optimal approach varies per exercise. Therefore, following a literature review and an analysis of health research priority setting exercises that were organized or coordinated by the World Health Organization since 2005, we propose a checklist for health research priority setting that allows for informed choices on different approaches and outlines nine common themes of good practice. It is intended to provide generic assistance for planning health research prioritization processes. The checklist explains what needs to be clarified in order to establish the context for which priorities are set; it reviews available approaches to health research priority setting; it offers discussions on stakeholder participation and information gathering; it sets out options for use of criteria and different methods for deciding upon priorities; and it emphasizes the importance of well-planned implementation, evaluation and transparency

Soil seed banks as predictors of invasiveness of alien plants

Identifying reliable predictors of plant species’ invasiveness, the ability of a species to become established and spread in its non-native range, represents a pressing research question in invasion ecology. Soil seed banks are a major source of propagules and genetic diversity, thus playing a key role in the recruitment and persistence of many species reproducing by seeds. Yet, only recently the characteristics of the seed bank have started to be included among potential predictors of invasiveness. To assess the role of seed bank traits in plant invasions, (1) we compared the type (transient vs. persistent) and density of the seed bank of invasive congeners and non-invasive congeners, in their non-native range, and (2) in their native range; and (3) we compared seed bank traits of invasive species in their native and non-native range. To address these questions, we used a dataset comprising 15240 records, for 2002 species, including 149 genera for which seed bank data for invasive and non-invasive congeners are available (759 species), and 196 invasive species for which seed bank data are available in their native and non-native range. The results indicate that, in their non-native range, invasive species have a higher probability to form a persistent seed bank than their non-invasive congeners, suggesting that seed bank persistence is an important determinant of plant species’ invasiveness. Moreover, invasive species were more likely to form a persistent seed bank in their non-native rather than native range, suggesting rapid adaptive changes towards more persistent seeds. The final results of models of seed bank type and density accounting for taxonomy and phylogeny will be presented, providing insights into the role of seed bank traits as determinants of invasiveness and the importance of adaptation and pre-adaptation with respect to these traits in the successful establishment of alien species in their non-native range

Incorporating clonality into the plant ecology research agenda

A longstanding research divide exists in plant ecology: either focusing on plant clonality, with no ambition to address nonclonal plants, or focusing on all plants, ignoring that many ecological processes can be affected by the fact that some plants are clonal while others are not. This gap cascades into a lack of distinction and knowledge about the similarities and differences between clonal and nonclonal plants. Here we aim to bridge this gap by identifying areas that would benefit from the incorporation of clonal growth into one integrated research platform: namely, response to productivity and disturbance, biotic interactions, and population dynamics. We are convinced that this will provide a roadmap to gain valuable insights into the ecoevolutionary dynamics relevant to all plants

A prospective study showing an excellent response of patients with low-risk differentiated thyroid cancer who did not undergo radioiodine remnant ablation after total thyroidectomy

Objectives: To prospectively evaluate the outcome of patients with low-risk papillary thyroid carcinoma treated with total thyroidectomy (TT) who did not undergo radioiodine remnant ablation (RRA). Study Design: We prospectively followed up 57 patients3 months after TT, thyroglobulin (Tg) assessment and neck ultrasonography (US) were performed while patients were taking L-T-4, presenting suppressed TSH. Six months after TT, patients underwent stimulated Tg testing and whole-body scan (WBS) after recombinant TSH (rhTSH). Then, 18 months after TT, the patients were evaluated by neck US and Tg under TSH between 0.5 and 2.0 mIU/ml. Two years after TT, we performed another rhTSH assessment, measuring Tg and making a WBS. The patients were then annually monitored with neck US and Tg measurement under TSH between 0.5 and 2.0 mIU/l for 36-84 months. Results: Neck US of all patients, 3 months after TT, presented no evidence of abnormal residual tissues or metastatic lymph nodes (negative neck US)at this time, the mean Tg level was 0.42 ng/ml. Six months after surgery, after rhTSH, the mean thyroid bed uptake was 1.82%, and Tg levels ranged from 0.10 to 22.30 ng/ml (mean, 2.89 ng/ml). The patients were followed up without any sign of recurrence (negative neck US and stable or decreasing Tg levels). During the ongoing follow-up, the Tg trend was stable or decreasing, independently of the initial suppressed or stimulated Tg level, or WBS uptake. Conclusions: In patients with low-risk differentiated thyroid cancer, who were operated by TT and who did not undergo RRA, an excellent response to treatment may be confirmed by annual neck US and Tg trend. (C) 2015 European Thyroid Association Published by S. Karger AG, BaselThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São PauloThyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, BrazilThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669,11th Floor, BR-04039032 Sao Paulo, SP, Brazil.Web of ScienceBrazilian Ministry of Health [25000.168513/2008-11]Brazilian Ministry of Health: 25000.168513/2008-1