What Type of Resources? Household Effects and Female Electoral Participation

Mechanisms behind partner effects are contingent on women's individual resource endowment. While low and medium educated women most strongly profit from higher educational partner resources, i.e. from a compensatory mechanism, the resource “time” seems to particularly confine political involvement of women with both high professional status or no employment.

COCHRAN: Stata module to test for equality of proportions in matched samples (Cochran's Q)

-cochran- performs a test for equality of two or more proportions in matched samples. The chi-squared calculated by -cochran- is known as Cochran's Q (Cochran 1950)

The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective

Background Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Methods Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. Results The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. Conclusion The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients' views

PURPOSE: Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the stigma actually perceived by the mentally ill persons themselves. METHOD: A convenience sample of 403 participants (210 men, mean age 32.4 ± 12.3 years) from urban regions in Accra, Cape Coast and Pantang filled in the Community Attitudes towards the Mentally Ill (CAMI) questionnaire. In addition, 105 patients (75 men, mean age 35.9 ± 11.0 years) of Ghana's three psychiatric hospitals (Accra Psychiatry Hospital, Ankaful Hospital, Pantang Hospital) answered the Perceived Stigma and Discrimination Scale. RESULTS: High levels of stigma prevailed in the population as shown by high proportions of assent to items expressing authoritarian and socially restrictive views, coexisting with agreement with more benevolent attitudes. A higher level of education was associated with more positive attitudes on all subscales (Authoritarianism, Social Restrictiveness, Benevolence and Acceptance of Community Based Mental Health Services). The patients reported a high degree of experienced stigma with secrecy concerning the illness as a widespread coping strategy. Perceived stigma was not associated with sex or age. DISCUSSION: The extent of stigmatising attitudes within the urban population of Southern Ghana is in line with the scant research in other countries in sub-Saharan Africa and mirrored by the experienced stigma reported by the patients. These results have to be seen in the context of the extreme scarcity of resources within the Ghanaian psychiatric system. Anti-stigma efforts should include interventions for mentally ill persons themselves and not exclusively focus on public attitudes.

Indigenous knowledge related to climate variability and change: insights from droughts in semi-arid areas of former Makueni District, Kenya

This article describes the indigenous knowledge (IK) that agro-pastoralists in larger Makueni District, Kenya hold and how they use it to monitor, mitigate and adapt to drought. It examines ways of integrating IK into formal monitoring, how to enhance its value and acceptability. Data was collected through target interviews, group discussions and questionnaires covering 127 households in eight villages. Daily rainfall data from 1961–2003 were analysed. Results show that agro-pastoralists hold IK on indicators of rainfall variability; they believe in IK efficacy and they rely on them. Because agro-pastoralists consult additional sources, the authors interpret that IK forms a basic knowledge frame within which agro-pastoralists position and interpret meteorological forecasts. Only a few agro-pastoralists adapt their practices in anticipation of IK-based forecasts partly due to the conditioning of the actors to the high rainfall variability characteristic of the area and partly due to lack of resources. Non-drought factors such as poverty, inadequate resources and lack of preparedness expose agro-pastoralists to drought impacts and limit their adaptive capacity. These factors need to be understood and effectively addressed to increase agro-pastoralists’ decision options and the influence of IK-based forecasts on their decision-making patterns. The limited intergenerational transfer of IK currently threatens its existence in the longer term. One way to ensure its continued existence and use is to integrate IK into the education curriculum and to link IK with formal climate change research through the participation of the local people. However, further studies are necessary to address the reliability and validity of the identified IK indicators of climate variability and change.

Screening for Chlamydia trachomatis: a systematic review of the economic evaluations and modelling

OBJECTIVE: To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening. METHODS: Systematic review. A search of 11 electronic bibliographic databases from the earliest date available to August 2004 using keywords including chlamydia, pelvic inflammatory disease, economic evaluation, and cost. We included studies of chlamydia screening in males and/or females over 14 years, including studies of diagnostic tests, contact tracing, and treatment as part of a screening programme. Outcomes included cases of chlamydia identified and major outcomes averted. We assessed methodological quality and the modelling approach used. RESULTS: Of 713 identified papers we included 57 formal economic evaluations and two cost studies. Most studies found chlamydia screening to be cost effective, partner notification to be an effective adjunct, and testing with nucleic acid amplification tests, and treatment with azithromycin to be cost effective. Methodological problems limited the validity of these findings: most studies used static models that are inappropriate for infectious diseases; restricted outcomes were used as a basis for policy recommendations; and high estimates of the probability of chlamydia associated complications might have overestimated cost effectiveness. Two high quality dynamic modelling studies found opportunistic screening to be cost effective but poor reporting or uncertainty about complication rates make interpretation difficult. CONCLUSION: The inappropriate use of static models to study interventions to prevent a communicable disease means that uncertainty remains about whether chlamydia screening programmes are cost effective or not. The results of this review can be used by health service managers in the allocation of resources, and health economists and other researchers who are considering further research in this area.

Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models

Background: WHO's 2013 revisions to its Consolidated Guidelines on antiretroviral drugs recommend routine viral load monitoring, rather than clinical or immunological monitoring, as the preferred monitoring approach on the basis of clinical evidence. However, HIV programmes in resource-limited settings require guidance on the most cost-effective use of resources in view of other competing priorities such as expansion of antiretroviral therapy coverage. We assessed the cost-effectiveness of alternative patient monitoring strategies. Methods: We evaluated a range of monitoring strategies, including clinical, CD4 cell count, and viral load monitoring, alone and together, at different frequencies and with different criteria for switching to second-line therapies. We used three independently constructed and validated models simultaneously. We estimated costs on the basis of resource use projected in the models and associated unit costs; we quantified impact as disability-adjusted life years (DALYs) averted. We compared alternatives using incremental cost-effectiveness analysis. Findings: All models show that clinical monitoring delivers significant benefit compared with a hypothetical baseline scenario with no monitoring or switching. Regular CD4 cell count monitoring confers a benefit over clinical monitoring alone, at an incremental cost that makes it affordable in more settings than viral load monitoring, which is currently more expensive. Viral load monitoring without CD4 cell count every 6—12 months provides the greatest reductions in morbidity and mortality, but incurs a high cost per DALY averted, resulting in lost opportunities to generate health gains if implemented instead of increasing antiretroviral therapy coverage or expanding antiretroviral therapy eligibility. Interpretation: The priority for HIV programmes should be to expand antiretroviral therapy coverage, firstly at CD4 cell count lower than 350 cells per μL, and then at a CD4 cell count lower than 500 cells per μL, using lower-cost clinical or CD4 monitoring. At current costs, viral load monitoring should be considered only after high antiretroviral therapy coverage has been achieved. Point-of-care technologies and other factors reducing costs might make viral load monitoring more affordable in future. Funding: Bill & Melinda Gates Foundation, WHO.

The impact of absolute importance on prospective memory: Instructions matter

Prospective memory (ProM) is the ability to remember and carry out a planned intention in the future. ProM performance can be improved by instructing participants to prioritize the ProM task over the ongoing task. However, the improvement of ProM performance by emphasizing the relative importance typically restricted to situations in which the overlap between processing requirements of the ProM task and the ongoing task is low. Thus, additional processing resources are allocated to the ProM task and consequently, a cost emerges for the ongoing task. The aim of the present study was to further investigate this relationship. Participants were asked to respond to either semantic or perceptual ProM cues, which were embedded in a complex ongoing short term memory task. We manipulated absolute rather than relative importance by emphasizing the importance of the ProM task to half of the participants (i.e., without instructing them to prioritize it over the ongoing task). The results revealed that importance boosted ProM performance independent of the processing overlap between the ProM task and the ongoing task. Moreover, no additional cost was associated with absolute importance. These results challenge the view that importance always enhances the allocation of resources to the ProM task.

What determines the impact of alien birds and mammals in Europe?

An often-cited reason for studying the process of invasion by alien species is that the understanding sought can be used to mitigate the impacts of the invaders. Here, we present an analysis of the correlates of local impacts of established alien bird and mammal species in Europe, using a recently described metric to quantify impact. Large-bodied, habitat generalist bird and mammal species that are widespread in their native range, have the greatest impacts in their alien European ranges, supporting our hypothesis that surrogates for the breadth and the amount of resources a species uses are good indicators of its impact. However, not all surrogates are equally suitable. Impacts are generally greater for mammal species giving birth to larger litters, but in contrast are greater for bird species laying smaller clutches. There is no effect of diet breadth on impacts in birds or mammals. On average, mammals have higher impacts than birds. However, the relationships between impact and several traits show common slopes for birds and mammals, and relationships between impact and body mass and latitude do not differ between birds and mammals. These results may help to anticipate which species would have large impacts if introduced, and so direct efforts to prevent such introductions.

Simulator Network project report: a tool for improvement of teaching materials and targeted resource usage in Skills Labs

During the last decade, medical education in the German-speaking world has been striving to become more practice-oriented. This is currently being achieved in many schools through the implementation of simulation-based instruction in Skills Labs. Simulators are thus an essential part of this type of medical training, and their acquisition and operation by a Skills Lab require a large outlay of resources. Therefore, the Practical Skills Committee of the Medical Education Society (GMA) introduced a new project, which aims to improve the flow of information between the Skills Labs and enable a transparent assessment of the simulators via an online database (the Simulator Network).

Scheduling the production of rolling ingots: Industrial context, model, and solution method

We study a real-world scheduling problem arising in the context of a rolling ingots production. First we review the production process and discuss peculiarities that have to be observed when scheduling a given set of production orders on the production facilities. We then show how to model this scheduling problem using prescribed time lags between operations, different kinds of resources, and sequence-dependent changeovers. A branch-and-bound solution procedure is presented in the second part. The basic principle is to relax the resource constraints by assuming infinite resource availability. Resulting resource conflicts are then stepwise resolved by introducing precedence relationships among operations competing for the same resources. The algorithm has been implemented as a beam search heuristic enumerating alternative sets of precedence relationships.

The Contested Floodplain. Institutional Change of the Commons in the Kafue Flats, Zambia

The Contested Floodplain tells the story of institutional changes in the management of common pool resources (pasture, wildlife, and fisheries) among Ila and Balundwe agro-pastoralists and Batwa fishermen in the Kafue Flats, in southern Zambia. It explains how and why a once rich floodplain area, managed under local common property regimes, becomes a poor man’s place and a degraded resource area. Based on social anthropological field research, the book explains how well working institutions in the past, regulating communal access to resources, have turned into state property and open access or privatization. The study focuses on the historic developments taking place since pre-colonial and colonial times up to today. Haller shows how the commons had been well regulated by local institutions in the past, often embedded in religious belief systems. He then explains the transformation from common property to state property since colonial times. When the state is unable to provide well-functioning institutions due to a lack in financial income, it contributes to de facto open access and degradation of the commons. The Zambian copper-based economy has faced crisis since 1975, and many Zambians have to look for economic alternatives and find ways to profit from the lack of state control (a paradox of the present-absent state). And while the state is absent, external actors use the ideology of citizenship to justify free use of resources during conflicts with local people. Also within Zambian communities, floodplain resources are highly contested, which is illustrated through conflicts over a proposed irrigation scheme in the area.

Evolution of dominance under frequency-dependent intraspecific competition

A population-genetic analysis is performed of a two-locus two-allele model, in which the primary locus has a major effect on a quantitative trait that is under frequency-dependent disruptive selection caused by intraspecific competition for a continuum of resources. The modifier locus determines the degree of dominance at the trait level. We establish the conditions when a modifier allele can invade and when it becomes fixed if sufficiently frequent. In general, these are not equivalent because an unstable internal equilibrium may exist and the condition for successful invasion of the modifier is more restrictive than that for eventual fixation from already high frequency. However, successful invasion implies global fixation, i.e., fixation from any initial condition. Modifiers of large effect can become fixed, and also invade, in a wider parameter range than modifiers of small effect. We also study modifiers with a direct, frequency-independent deleterious fitness effect. We show that they can invade if they induce a sufficiently high level of dominance and if disruptive selection on the ecological trait is strong enough. For deleterious modifiers, successful invasion no longer implies global fixation because they can become stuck at an intermediate frequency due to a stable internal equilibrium. Although the conditions for invasion and for fixation if sufficiently frequent are independent of the linkage relation between the two loci, the rate of spread depends strongly on it. The present study provides further support to the view that evolution of dominance may be an efficient mechanism to remove unfit heterozygotes that are maintained by balancing selection. It also demonstrates that an invasion analysis of mutants of very small effect is insufficient to obtain a full understanding of the evolutionary dynamics under frequency-dependent selection.