Zooming In: Analyzing Annual Meeting Format Changes Amidst a Global Pandemic

Beginning in March of 2020, public companies in the United States were forced to take unprecedented measures to observe corporate formalities while following the government-mandated health and safety measures resulting from the COVID-19 pandemic. Those measures made in-person activities and meetings either incredibly challenging or, in certain jurisdictions, illegal. Because “proxy season,” the time when public companies typically hold their annual meetings of stockholders, followed shortly after the mass implementation of COVID-19 lockdowns and quarantines, public companies that had historically held these meetings in-person were left scrambling to find an alternative means to meet. Nearly overnight, the pandemic caused an explosive transition from in-person annual meetings to virtual annual meetings. This article examines that trend, both qualitatively and quantitatively. More specifically, this article presents the results of primary research that quantifies the prevalence of virtual annual meetings before, during and (depending on one’s view of the current state of affairs) after the height of the COVID-19 pandemic. The results are offered using a series of different metrics to provide a comprehensive picture regarding the sudden transition and theorizes a new normal in one of the most important investor-relations tools available to public companies

Exploiting the emergent nature of mixed methods designs: insights from a mixed methods impact evaluation in Malawi.

The application of mixed methods in Health Policy and Systems Research (HPSR) has expanded remarkably. Nevertheless, a recent review has highlighted how many mixed methods studies do not conceptualize the quantitative and the qualitative component as part of a single research effort, failing to make use of integrated approaches to data collection and analysis. More specifically, current mixed methods studies rarely rely on emergent designs as a specific feature of this methodological approach. In our work, we postulate that explicitly acknowledging the emergent nature of mixed methods research by building on a continuous exchange between quantitative and qualitative strains of data collection and analysis leads to a richer and more informative application in the field of HPSR. We illustrate our point by reflecting on our own experience conducting the mixed methods impact evaluation of a complex health system intervention in Malawi, the Results Based Financing for Maternal and Newborn Health Initiative. We describe how in the light of a contradiction between the initial set of quantitative and qualitative findings, we modified our design multiple times to include additional sources of quantitative and qualitative data and analytical approaches. To find an answer to the initial riddle, we made use of household survey data, routine health facility data, and multiple rounds of interviews with both healthcare workers and service users. We highlight what contextual factors made it possible for us to maintain the high level of methodological flexibility that ultimately allowed us to solve the riddle. This process of constant reiteration between quantitative and qualitative data allowed us to provide policymakers with a more credible and comprehensive picture of what dynamics the intervention had triggered and with what effects, in a way that we would have never been able to do had we kept faithful to our original mixed methods design

Cooperative Throttle and Brake Fuzzy Control for ACC+Stop&Go Maneuvers

The authors are with the Industrial Computer Science Department, Instituto de Automática Industrial (CSIC), 28500 Madrid, SpainThe goal that a car be driven autonomously is far in the future and probably unreachable, but as a first step in that direction, adaptive cruise control (ACC) and Stop&Go maneuver systems are being developed. These kind of controllers adapt the speed of a car to that of the preceding one (ACC) and get the car to stop if the lead car stops. This paper presents one such system and related experiments performed on a real road with real cars. The driving system gets its input via an RTK DGPS device and communicates its positions to one another via a wireless local area network link. It outputs signals controlling the pressure on the throttle and brake pedals. The control system is based on fuzzy logic, which is considered best to deal with processes as complex as driving. Two mass produced Citroën Berlingo electric vans have been instrumented, providing them with computer controlled actuators over the brake and the throttle to achieve human-like driving. The results of the experiments show that the behavior of the vehicles is very close to human and that they adapt to driving incidences, increasing the safety of the driving and permitting cooperation with manually driven cars.This work was supported in part by the Spanish Ministry of Education under Grant ISAAC CICYT DPI2002-04064-C05-02, by the Spanish Ministry of Public Works under Grant COPOS BOE 280 22/11/2002, and by the Res. 22778, Citroën España S.A. under Contract “Adquirir nuevos conocimientos sobre la introducción de las tecnologías de la información en el mundo del automóvil y para difundirlos en los ámbitos científicos, empresariales y comerciales (AUTOPIA),” and by Cybecars-2 Project UE-STREP 28062, 6th Framework Programme, 2006.Peer reviewe

A qualitative study assessing the acceptability and adoption of implementing a results based financing intervention to improve maternal and neonatal health in Malawi

Background: Results Based Financing (RBF) interventions have recently gained significant momentum, especially in sub-Saharan Africa. However, most of the research has focused on the evaluation of the impacts of this approach, providing little insight into how the contextual circumstances surrounding the implementation have contributed to its success or failure. This study aims to fill a void in the current literature on RBF by focusing explicitly on the process of implementing a RBF intervention rather than on its impact. Specifically, this study focuses on the acceptability and adoption of the RBF intervention’s implementation among local and international key stakeholders with the aim to inform further implementation. Methods: The Results Based Financing for Maternal and Neonatal Health (RBF4MNH) Initiative is currently being implemented in Malawi. Our study employed an exploratory cross-sectional qualitative design to explore the factors affecting the acceptability and adoption of the intervention’s implementation. Purposeful sampling techniques were used to identify each key stakeholder who participated in all or parts of the implementation process. In-depth interviews were conducted and analyzed using a deductive open coding approach. The final interpretation of the findings emerged through active discussion among the co-authors. Results: Despite encountering several challenges, such as delay in procurement of equipment and difficulties in arranging local bank accounts, all stakeholders responded positively to the RBF4MNH Initiative. Stakeholders’ acceptance of the RBF4MNH Initiative grew stronger over time as understanding of the intervention improved and was supported by early inclusion during the design and implementation process. In addition, stakeholders took on functions not directly incentivized by the intervention, suggesting that they turned adoption into actual ownership. All stakeholders raised concerns that the intervention may not be sustainable after its initial program phase would end, which contributed to hesitancy in fully accepting the intervention. Conclusions: Based on the results of this study, we recommend the inclusion of local stakeholders into the intervention’s implementation process at the earliest stages. We also recommend setting up continuous feedback mechanisms to tackle challenges encountered during the implementation process. The sustainability of the intervention and its incorporation into national budgets should be addressed from the earliest stages

Impact of results-based financing on effective obstetric care coverage : evidence from a quasi-experimental study in Malawi

Background: Results-based financing (RBF) describes health system approaches addressing both service quality and use. Effective coverage is a metric measuring progress towards universal health coverage (UHC). Although considered a means towards achieving UHC in settings with weak health financing modalities, the impact of RBF on effective coverage has not been explicitly studied. Methods: Malawi introduced the Results-Based Financing For Maternal and Neonatal Health (RBF4MNH) Initiative in 2013 to improve quality of maternal and newborn health services at emergency obstetric care facilities. Using a quasi-experimental design, we examined the impact of the RBF4MNH on both crude and effective coverage of pregnant women across four districts during the two years following implementation. Results: There was no effect on crude coverage. With a larger proportion of women in intervention areas receiving more effective care over time, the overall net increase in effective coverage was 7.1%-points (p = 0.07). The strongest impact on effective coverage (31.0%-point increase, p = 0.02) occurred only at lower cut-off level (60% of maximum score) of obstetric care effectiveness. Design-specific and wider health system factors likely limited the program's potential to produce stronger effects. Conclusion: The RBF4MNH improved effective coverage of pregnant women and seems to be a promising reform approach towards reaching UHC. Given the short study period, the full potential of the current RBF scheme has likely not yet been reached.Peer reviewe

Improved placement precision of implanted donor spin qubits in silicon using molecule ions

Donor spins in silicon-28 ($^{28}$Si) are among the most performant qubits in the solid state, offering record coherence times and gate fidelities above 99%. Donor spin qubits can be fabricated using the semiconductor-industry compatible method of deterministic ion implantation. Here we show that the precision of this fabrication method can be boosted by implanting molecule ions instead of single atoms. The bystander ions, co-implanted with the dopant of interest, carry additional kinetic energy and thus increase the detection confidence of deterministic donor implantation employing single ion detectors to signal the induced electron-hole pairs. This allows the placement uncertainty of donor qubits to be minimised without compromising on detection confidence. We investigate the suitability of phosphorus difluoride (PF$_2^+$) molecule ions to produce high quality P donor qubits. Since $^{19}$F nuclei have a spin of $I = 1/2$, it is imperative to ensure that they do not hyperfine couple to P donor electrons as they would cause decoherence by adding magnetic noise. Using secondary ion mass spectrometry, we confirm that F diffuses away from the active region of qubit devices while the P donors remain close to their original location during a donor activation anneal. PF$_2$-implanted qubit devices were then fabricated and electron spin resonance (ESR) measurements were performed on the P donor electron. A pure dephasing time of $T_2^* = 20.5 \pm 0.5$ $\mu$s and a coherence time of $T_2^{Hahn} = 424 \pm 5$ $\mu$s were extracted for the P donor electron-values comparable to those found in previous P-implanted qubit devices. Closer investigation of the P donor ESR spectrum revealed that no $^{19}$F nuclear spins were found in the vicinity of the P donor. Molecule ions therefore show great promise for producing high-precision deterministically-implanted arrays of long-lived donor spin qubits.Comment: 8 pages, 5 figures, 1 tabl

Psychological wellbeing in a resource-limited work environment: examining levels and determinants among health workers in rural Malawi.

BACKGROUND: A competent, responsive, and productive health workforce is central to a well-performing health system capable of providing universal access to high-quality care. Ensuring health workers' psychological wellbeing is critical to sustaining their availability and productivity. This is particularly true in heavily constrained health systems in low- and lower-middle-income countries. Research on the issue, however, is scarce. This study aimed to contribute to filling the gap in knowledge by investigating levels of and factors associated with psychological wellbeing of mid-level health workers in Malawi. METHODS: The study relied on a cross-sectional sample of 174 health workers from 33 primary- and secondary-level health facilities in four districts of Malawi. Psychological wellbeing was measured using the WHO-5 Wellbeing Index. Data were analyzed using linear and logistic regression models. RESULTS: Twenty-five percent of respondents had WHO-5 scores indicative of poor psychological wellbeing. Analyses of factors related to psychological wellbeing showed no association with sex, cadre, having dependents, supervision, perceived coworker support, satisfaction with the physical work environment, satisfaction with remuneration, and motivation; a positive association with respondents' satisfaction with interpersonal relationships at work; and a negative association with having received professional training recently. Results were inconclusive in regard to personal relationship status, seniority and responsibility at the health facility, clinical knowledge, perceived competence, perceived supervisor support, satisfaction with job demands, health facility level, data collection year, and exposure to performance-based financing. CONCLUSIONS: The high proportion of health workers with poor wellbeing scores is concerning in light of the general health workforce shortage in Malawi and strong links between wellbeing and work performance. While more research is needed to draw conclusions and provide recommendations as to how to enhance wellbeing, our results underline the importance of considering this as a key concern for human resources for health

Quality of maternal obstetric and neonatal care in low-income countries: development of a composite index

Background: In low-income countries, studies demonstrate greater access and utilization of maternal and neonatal health services, yet mortality rates remain high with poor quality increasingly scrutinized as a potential point of failure in achieving expected goals. Comprehensive measures reflecting the multi-dimensional nature of quality of care could prove useful to quality improvement. However, existing tools often lack a systematic approach reflecting all aspects of quality considered relevant to maternal and newborn care. We aim to address this gap by illustrating the development of a composite index using a step-wise approach to evaluate the quality of maternal obstetric and neonatal healthcare in low-income countries. Methods: The following steps were employed in creating a composite index: 1) developing a theoretical framework; 2) metric selection; 3) imputation of missing data; 4) initial data analysis 5) normalization 6) weighting and aggregating; 7) uncertainty and sensitivity analysis of resulting composite score; 8) and deconstruction of the index into its components. Based on this approach, we developed a base composite index and tested alternatives by altering the decisions taken at different stages of the construction process to account for missing values, normalization, and aggregation. The resulting single composite scores representing overall maternal obstetric and neonatal healthcare quality were used to create facility rankings and further disaggregated into sub-composites of quality of care. Results: The resulting composite scores varied considerably in absolute values and ranges based on method choice. However, the respective coefficients produced by the Spearman rank correlations comparing facility rankings by method choice showed a high degree of correlation. Differences in method of aggregation had the greatest amount of variation in facility rankings compared to the base case. Z-score standardization most closely aligned with the base case, but limited comparability at disaggregated levels. Conclusions: This paper illustrates development of a composite index reflecting the multi-dimensional nature of maternal obstetric and neonatal healthcare. We employ a step-wise process applicable to a wide range of obstetric quality of care assessment programs in low-income countries which is adaptable to setting and context. In exploring alternative approaches, certain decisions influencing the interpretation of a given index are highlighted

Implementation research to improve quality of maternal and newborn health care, Malawi.

OBJECTIVE: To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. METHODS: We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities' essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. FINDINGS: We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants' adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. CONCLUSION: Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care