Operational Plan for HMIS Rollout to be Read in Conjunction with the MoH&SW Document of October 2007

The MoH&SW, with a consortium of partners, in October 2007, developed a Proposal to Strengthen the HMIS in Tanzania. This document builds on that proposal to develop a budgeted 6‐month plan to kick‐start implementation of the Revised MTUHA in one region and at national level, to develop a replicable model that can be scaled up to other regions as additional funds become available. The overall HMIS revision process will ensure that, within a period of five years the HMIS will be functional in all 21 regions of the country, in a phased manner Six months intensive systems and database development in Mtwara region Eighteen months implementation in one region in each of the six zones Within 5 years, National rollout to every region The initial six months implementation process, described in depth in this document, will use action research and participatory development methodology that will integrate the six work packages in the HMIS document, in line with the HSSP III proposals for strengthening M&E. A number of dedicated teams will roll out the HMIS, develop a toolkit for implementation in other regions and produce a modern web based data warehouse. The project logframe aims to provide quality routine data for monitoring MDGs and the NHSSPIII by producing five outputs – HMIS revision, HMIS implementation, Capacity development, the DHIS software and action research. Terms of reference are developed for each of the HMIS teams, based on the activities in the logframe – Indicator and dataset revision, HMIS design, Database development and training team. An action‐based budget of US$15 million is provided for three years that envisages The model region will cost$1,25 million for the first year, including the rollout activities, the development of training material, adaptation of software etc. The other six regions will cost 1,05million for first year; all regions will reduce to $500,000 for the second year and$300,000 in the third year. National level costs will reduce from $700,000 to 500,000 a year as local consultants replace international technical assistance and Ministry takes over running expenses. Rollout for the other 14 regions will need a separate budgeting process after the six regions, but should be in the range of 1,8 million a year (or less if costs can be reduced). The activities in the model initiation region will cost$1,2 million for the first year, including the rollout activities, the development of training material, adaptation of software et

A vacation tour at the Antipodes: through Victoria, Tasmania, New South Wales, Queensland, and New Zealand, in 1861-1862

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Pedagogical Agents for Fostering Question-Asking Skills in Children

Question asking is an important tool for constructing academic knowledge, and a self-reinforcing driver of curiosity. However, research has found that question asking is infrequent in the classroom and children's questions are often superficial, lacking deep reasoning. In this work, we developed a pedagogical agent that encourages children to ask divergent-thinking questions, a more complex form of questions that is associated with curiosity. We conducted a study with 95 fifth grade students, who interacted with an agent that encourages either convergent-thinking or divergent-thinking questions. Results showed that both interventions increased the number of divergent-thinking questions and the fluency of question asking, while they did not significantly alter children's perception of curiosity despite their high intrinsic motivation scores. In addition, children's curiosity trait has a mediating effect on question asking under the divergent-thinking agent, suggesting that question-asking interventions must be personalized to each student based on their tendency to be curious.Comment: Accepted at CHI 202

Portraying the nature of corruption: Using an explorative case-study design

What is the nature of corruption in Western democracies? To answer this research question, the authors study 10 Dutch corruption cases in depth, looking at confidential criminal files. The cases allow them to sketch a general profile of a corruption case. The authors offer nine propositions to portray the nature of corruption. They conclude that corruption usually takes place within enduring relationships, that the process of becoming corrupt can be characterized as a slippery slope, and that important motives for corruption, aside from material gain, include friendship or love, status, and the desire to impress others. The explorative multiple case study methodology helps to expand our understanding of the way in which officials become corrupt. © 2008 The American Society for Public Administration

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability