Performance-based Financing and Strengthening Health Governance in the Fragile State of the Democratic Republic of Congo

This article explores the outcomes of performance-based financing for strengthening the health system in the context of state-building in the Democratic Republic of Congo. It focuses specifically on health system governance, which plays a pivotal role in the process of building the health system. Based on long-term qualitative field research, it examines the effectiveness of PBF in three areas of health system governance: structural governance from a capacity-building perspective, health service-provision management and demand-side empowerment for effective accountability. In general, the study found that PBF has positively impacted the process of health system-building in these three areas. Although much is still lacking, health governance and the provision of services improved, while patient-centered care and social accountability strengthened the provider–patient relationship. However, donors, state officials and other stakeholders doubted their sustainability. In addition to structural threats related to state fragility and uncertain sustainability, transforming transactional motivation into transformational change is a challenge. Ultimately, PBF supports state-building in the health sector, but it cannot repair a collapsed state

Regulating the old game of smuggling? Coltan mining, trade and reforms in the Democratic Republic of Congo

This article examines the smuggling of coltan into and out of artisanal mining areas in northern Katanga where the ITRI Tin Supply Chain Initiative (iTSCi), a policy on conflict minerals, tries to improve transparency in trading tin, tantalum (coltan) and tungsten. The article approaches smuggling from a sociology of economic life perspective, closely examining how and why artisanal miners and mine-based middlemen (négociants) helped smugglers (hiboux) in the trafficking of coltan. The findings indicate that the social networks in which miners and mine-based négociants are embedded allow the miners, négociants and smugglers to maintain close relationships and to breach official regulations, but miners and mine-based négociants also rely on the same networks to cheat in their dealings with the smugglers. This article concludes that, rather than considering coltan mining areas to be ‘enclaves of regulations’, understanding and addressing smuggling at both local and broader contexts call for a comprehensive, more contextualised approach

Humanitarianism's Contested Culture in War Zones

Humanitarians are no longer simply seen as selfless angels. Their motivations and mastery, their principles and products are questioned from within and from without. Understanding the ongoing transformations in contemporary humanitarianism requires examining the nature and evolution of humanitarian culture away from an agreed culture of cooperation to a contested one of competition. The latter reflects militarization, politicization, and marketization. What is required is a learning culture for practitioners and a consequentialist ethics more oriented to responsible reflection than rapid reaction

Par@Graph-a parallel toolbox for the construction and analysis of large complex climate networks

© 2015 Author(s). In this paper, we present Par@Graph, a software toolbox to reconstruct and analyze complex climate networks having a large number of nodes (up to at least 106) and edges (up to at least 1012). The key innovation is an efficient set of parallel software tools designed to leverage the inherited hybrid parallelism in distributed-memory clusters of multi-core machines. The performance of the toolbox is illustrated through networks derived from sea surface height (SSH) data of a global high-resolution ocean model. Less than 8 min are needed on 90 Intel Xeon E5-4650 processors to reconstruct a climate network including the preprocessing and the correlation of 3 × 105 SSH time series, resulting in a weighted graph with the same number of vertices and about 3.2 × 108 edges. In less than 14 min on 30 processors, the resulted graph's degree centrality, strength, connected components, eigenvector centrality, entropy and clustering coefficient metrics were obtained. These results indicate that a complete cycle to construct and analyze a large-scale climate network is available under 22 min Par@Graph therefore facilitates the application of climate network analysis on high-resolution observations and model results, by enabling fast network reconstruct from the calculation of statistical similarities between climate time series. It also enables network analysis at unprecedented scales on a variety of different sizes of input data sets

Study Protocol on Cognitive Performance in Bulgaria, Croatia, and the Netherlands: The Normacog Brief Battery

The Normacog Brief Battery (NBB) provides a comprehensive overview of an individual’s cognitive functioning within a short amount of time. It was originally developed for the Spanish population in Spain. However, there is a considerable need for brief batteries in clinical neuropsychological assessment, especially in eastern European countries. Cultural background and other individual characteristics—such as age, level of education, and sex—are shown to influence both cognition and patients’ performance on neuropsychological tests. Therefore, it is important to develop understanding of how and why culture impacts on cognitive testing and determine which sociodemographic variables affect cognitive performance. The current study aims to translate, adapt, and standardize the NBB in Bulgaria, Croatia, and the Netherlands, and to analyze the effect of sex, age, and education level on cognitive performance between these three countries. This brief battery assesses eleven cognitive domains, including those most currently relevant in cognition such as premorbid intelligence, attention, executive function, processing speed, and memory. The translation and adaptation of the battery for different cultures will be done using the back-translation process. After exclusion criteria, the current study will include a total sample of three hundred participants (≥18 years old). The samples of 100 participants per country will be balanced through the consideration of their age and level of education. Effects of the sociodemographic variables (age, level of education, and sex) on cognitive performance are expected. Furthermore, this relationship is expected to differ across countries. A multivariate hierarchical linear regression will be used and exploratory analysis will be carried out to investigate further effects. The results will be particularly valuable for future research and assessment in cognitive performance. The growing demand for accurate and fast neuropsychological assessment shows the importance of creating a universal brief assessment tool for wider cross-cultural application

Towards a nanospecific approach for risk assessment.

In the current paper, a new strategy for risk assessment of nanomaterials is described, which builds upon previous project outcomes and is developed within the FP7 NANoREG project. NANoREG has the aim to develop, for the long term, new testing strategies adapted to a high number of nanomaterials where many factors can affect their environmental and health impact. In the proposed risk assessment strategy, approaches for (Quantitative) Structure Activity Relationships ((Q)SARs), grouping and read-across are integrated and expanded to guide the user how to prioritise those nanomaterial applications that may lead to high risks for human health. Furthermore, those aspects of exposure, kinetics and hazard assessment that are most likely to be influenced by the nanospecific properties of the material under assessment are identified. These aspects are summarised in six elements, which play a key role in the strategy: exposure potential, dissolution, nanomaterial transformation, accumulation, genotoxicity and immunotoxicity. With the current approach it is possible to identify those situations where the use of nanospecific grouping, read-across and (Q)SAR tools is likely to become feasible in the future, and to point towards the generation of the type of data that is needed for scientific justification, which may lead to regulatory acceptance of nanospecific applications of these tools.The research leading to these results has been partially funded by the European Union Seventh Framework Programme (FP7/ 2007e2013) under the project NANoREG (A common European approach to the regulatory testing of nanomaterials), grant agreement 310584.info:eu-repo/semantics/publishedVersio

Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings

Background: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. Methods: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and UN agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. Results: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. Conclusions: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of “relevance” and “excellence.” Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions. (Harv Rev Psychiatry 2012;20:25–36.