Comparison of Medicine Availability Measurements at Health Facilities: Evidence from Service Provision Assessment Surveys in Five Sub-Saharan African Countries.

With growing emphasis on health systems strengthening in global health, various health facility assessment methods have been used increasingly to measure medicine and commodity availability. However, few studies have systematically compared estimates of availability based on different definitions. The objective of this study was to compare estimates of medicine availability based on different definitions. A secondary data analysis was conducted using data from the Service Provision Assessment (SPA) - a nationally representative sample survey of health facilities - conducted in five countries: Kenya SPA 2010, Namibia SPA 2009, Rwanda SPA 2007, Tanzania SPA 2006, and Uganda SPA 2007. For 32 medicines, percent of facilities having the medicine were estimated using five definitions: four for current availability and one for six-month period availability. 'Observed availability of at least one valid unit' was used as a reference definition, and ratios between the reference and each of the other four estimates were calculated. Summary statistics of the ratios among the 32 medicines were calculated by country. The ratios were compared further between public and non-public facilities within each country. Across five countries, compared to current observed availability of at least one valid unit, 'reported availability without observation' was on average 6% higher (ranging from 3% in Rwanda to 8% in Namibia), 'observed availability where all units were valid' was 11% lower (ranging from 2% in Tanzania to 19% in Uganda), and 'six-month period availability' was 14% lower (ranging from 5% in Namibia to 25% in Uganda). Medicine availability estimates vary substantially across definitions, and need to be interpreted with careful consideration of the methods used

Spurious modes in extended RPA theories

Necessary conditions that the spurious state associated with the translational motion and its double-phonon state have zero excitation energy in extended RPA (ERPA) theories which include both one-body and two-body amplitudes are investigated using the small amplitude limit of the time-dependent density-matrix theory (STDDM). STDDM provides us with a quite general form of ERPA as compared with other similar theories in the sense that all components of one-body and two-body amplitudes are taken into account. Two conditions are found necessary to guarantee the above property of the single and double spurious states: The first is that no truncation in the single-particle space should be made. This condition is necessary for the closure relation to be used and is common for the single and double spurious states. The second depends on the mode. For the single spurious state all components of the one-body amplitudes must be included, and for the double spurious state all components of one-body and two-body amplitudes have to be included. It is also shown that the Kohn theorem and the continuity equations for transition densities and currents hold under the same conditions as the spurious states. ERPA theories formulated using the Hartree-Fock ground state have a non-hermiticity problem. A method for formulating ERPA with hermiticity is also proposed using the time-dependent density-matrix formalism.Comment: 15 page

An Initial Investigation of Structural and Nonstructural Flood Control Alternatives for Cypress Creak, Texas

Paper by Peter G. Rowe, James B. Blackburn, Jr., and Philip B. Bedien

The Minstrel Boy / music by Harry Rowe Shelley; words by Harry Rowe Shelley

https://egrove.olemiss.edu/sharris_a/1014/thumbnail.jp

Validity of the new lifestyles NL-1000 accelerometer for measuring time spent in moderate-to-vigorous physical activity in school settings

Current interest in promoting physical activity in the school environment necessitates an inexpensive, accurate method of measuring physical activity in such settings. Additionally, it is recognized that physical activity must be of at least moderate intensity in order to yield substantial health benefits. The purpose of the study, therefore, was to determine the validity of the New Lifestyles NL-1000 (New Lifestyles, Inc., Lee's Summit, Missouri, USA) accelerometer for measuring moderate-to-vigorous physical activity in school settings, using the Actigraph GT1M (ActiGraph, Pensacola, Florida, USA) as the criterion. Data were collected during a cross-country run (n = 12), physical education (n = 18), and classroom-based physical activities (n = 42). Significant and meaningful intraclass correlations between methods were found, and NL-1000 estimates of moderate-to-vigorous physical activity were not meaningfully different from GT1M-estimated moderate- to-vigorous physical activity. The NL-1000 therefore shows promising validity evidence as an inexpensive, convenient method of measuring moderate-to-vigorous physical activity in school settings

The School Sport Co-ordinator Programme: Changing the Role of the Physical Education Teacher?

Over the last decade or so, young people have increasingly become a focus of UK sport policy. Fuelled in part by concerns such as the increasing levels of childhood inactivity and obesity, and the lack of international success in sport, a plethora of policy initiatives aimed at young people have been developed. In April 2000, the government published its sport strategy document, A Sporting Future for All, pulling together all the threads of recent policies, and in it, restating its commitment to youth sport, sport in education, excellence and sport in the community. One such policy initiative, the School Sport Co-ordinator programme, is the focus of this paper. The School Sport Co-ordinator programme, currently being introduced into schools in England, is an initiative that involves two government departments (sport and education) and a number of other agencies, reflecting the government's current agenda to ensure 'joined up policy' thinking. It aims to develop opportunities for youth sport through co-ordinated links between PE and sport in schools, both within and outside of the formal curriculum, with those in local community sports settings. The essence of the School Sport Co-ordinator programme is to free up nominated teachers in schools from teaching to allow them time for development activities, specifically to encourage schools and community sports providers to work in partnership. This paper draws on data from an ongoing research project examining the implementation of one School Sport Co-ordinator partnership, 'northbridge'. Drawing on in-depth interviews, it explores the perceptions of the newly established School Sport Co-ordinators of their changing role. The paper highlights some of the initial tensions and challenges for them in their task of working across different educational and sporting contexts

District Health Managers' Perceptions of Supervision in Malawi and Tanzania.

Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. This qualitative study took place as part of a broader project, "Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers". Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level

Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy

Objectives To derive priority weights for access to bariatric surgery for obese adults, from the perspective of the public. Setting Australian public hospital system. Participants Adults (N=1994), reflecting the age and gender distribution of Queensland and South Australia. Primary and secondary outcome measures A discrete choice experiment in which respondents indicated which of two individuals with different characteristics should be prioritised for surgery in repeated hypothetical choices. Potential surgery recipients were described by seven key characteristics or attributes: body mass index (BMI), presence of comorbid conditions, age, family history, commitment to lifestyle change, time on the surgical wait list and chance of maintaining weight loss following surgery. A multinomial logit model was used to evaluate preferences and derive priority weights (primary analysis), with a latent class model used to explore respondent characteristics that were associated with variation in preference across the sample (see online supplementary analysis). Results A preference was observed to prioritise individuals who demonstrated a strong commitment to maintaining a healthy lifestyle as well as individuals categorised with very severe (BMI≥50 kg/m2) or (to a lesser extent) severe (BMI≥40 kg/m2) obesity, those who already have obesity-related comorbidity, with a family history of obesity, with a greater chance of maintaining weight loss or who had spent a longer time on the wait list. Lifestyle commitment was considered to be more than twice as important as any other criterion. There was little tendency to prioritise according to the age of the recipient. Respondent preferences were dependent on their BMI, previous experience with weight management surgery, current health state and education level. Conclusions This study extends our understanding of the publics’ preferences for priority setting to the context of bariatric surgery, and derives priority weights that could be used to assist bodies responsible for commissioning bariatric services