Assessment of national health systems performance in the WHO African region

There is growing peer and donor pressure on African countries to utilize available resources more efficiently in a bid to support the ongoing efforts to expand coverage of health interventions with a view to achieving the health-related Millennium Development Goals. The purpose of this study was to estimate the technical and scale efficiency of national health systems in African continent. Methods The study applied the Data Envelopment Analysis approach to estimate the technical efficiency and scale efficiency among the 53 countries of the African Continent. Results Out of the 38 low-income African countries, 12 countries national health systems manifested a constant returns to scale technical efficiency (CRSTE) score of 100%; 15 countries had a VRSTE score of 100%; and 12 countries had a SE score of one. The average variable returns to scale technical efficiency (VRSTE) score was 95% and the mean scale efficiency (SE) score was 59%; meaning that while on average the degree of inefficiency was only 5%, the magnitude of scale inefficiency was 41%. Of the 15 middle-income countries, 5 countries, 9 countries and 5 countries had CRSTE, VRSTE and SE scores of 100%. Ten countries, six countries and 10 countries had CRSTE, VRSTE and SE scores of less than 100%; and thus, they were deemed inefficient. The average VRSTE (i.e. pure efficiency) score was 97.6%. The average SE score was 49.9%. Conclusion There are large unmet need for health and health-related services among countries of the African Continent. Thus, it would not be advisable for health policy-makers address NHS inefficiencies through reduction in excess human resources for health. Instead, it would be more prudent for them to leverage health promotion approaches and universal access prepaid (tax-based, insurance-based or mixtures) health financing systems to create demand for under utilised health services/interventions with a view to increasing ultimate health outputs to efficient target levels.

Therapeutic potential of statins and the induction of heme oxygenase-1 in preeclampsia

Heme oxygenase (Hmox) is an endogenous system that offers protection against placental cytotoxic damage associated with preeclampsia. The Hmox1/carbon monoxide (CO) pathway inhibits soluble Flt-1 (sFlt-1) and soluble Endoglin (sEng). More importantly, statins induce Hmox1 and suppress the release of sFlt-1 and sEng; thus, statins and Hmox1 activators are potential novel therapeutic agents for treating preeclampsia. The contribution of the Hmox system to the pathogenesis of preeclampsia has been further indicated by the incidence of preeclampsia being reduced by a third in smokers, who had reduced levels of circulating sFlt-1. Interestingly, preeclamptic women exhale less CO compared with women with healthy pregnancies. Hmox1 is reduced prior to the increase in sFlt-1 as Hmox1 mRNA expression in the trophoblast is decreased in the first trimester in women who go on to develop preeclampsia. Induction of Hmox1 or exposure to CO or bilirubin has been shown to inhibit the release of sFlt-1 and sEng in animal models of preeclampsia. The functional benefit of statins and Hmox1 induction in women with preeclampsia is valid not only because they inhibit sFlt-1 release, but also because statins and Hmox1 are associated with anti-apoptotic, anti-inflammatory, and anti-oxidant properties. The StAmP trial is the first randomized control trial (RCT) evaluating the use of pravastatin to ameliorate severe preeclampsia. This proof-of-concept study will pave the way for future global RCT, the success of which will greatly contribute to achieving the United Nations Millennium Development Goals (MDG4 and MDG5) and offering an affordable and easily accessible therapy for preeclampsia. © 2014 The Authors.

The development of collaborative skills in young children

This thesis examines young children's early collaborative development when engaged in joint tasks with both a peer and a parent. It begins by examining how the term "collaborative" has been applied and researched in previous literature. As collaboration is found to usually require dialogue, and intersubjectivity is seen as an important component in the construction of both collaboration and dialogue, the ability to construct intersubjectivity is the subject of the rest of the chapter. The chapter concludes by introducing the research questions that underpin the experiments that follow. A number of experiments are then described. Experiments 1 and 2 investigate age differences in interaction styles and the communication strategies used by similar aged dyads. Experiments 3 and 4 investigate differences due to the age of the child and/or the status of the information giver (either parent or child) in the styles of interaction and the communication strategies used by parent and child dyads. Experiment 5 investigates the benefits of collaborating with a parent, and finally, Experiment 6 examines the collaborative ability of pre-schools. The thesis identifies a series of skills required for successful collaboration. These include recognition of a joint goal and the need to suppress individual desires, the ability to structure joint interaction, moving from role-based to a negotiating style, and communicative skills, for example, asking for clarification. Other reasons for children's failure in collaborative tasks involve task-related skills, such as the development of spatial terms, and failure to recognise the need for accuracy. The findings support Vygotsky's theory that when working with an adult, children perform at a higher level than when working with a peer. Evidence was also found of parents scaffolding the interaction for their children. However, further research is necessary to establish that such scaffolding skills affect the child's development of collaborative interactive skills.

A prediction of outcomes: a psychological investigation into cognitive and affective development within the framework of adult literacy provision

This investigation seeks to explore the hypothesis, derived from observation and practice, that there is a strong relationship between the development of literacy skills and the growth of confidence in adult literacy students. Implicit in the developmental approach is the notion of progression towards some cognitive goal. Such a goal necessitates the establishment of a base line of existing attainment, together with subsequent assessment so that progress and development can be measured. The study includes an evaluation of existing formal and informal methods of initial and subsequent assessment and diagnosis available at the time for Adult Literacy Scheme Co-ordinators. Underlying the funding by Cheshire County Council for the project is the assumption that the results will be available for all practitioners and that the tools of measurement may be used by other Adult Literacy Co-ordinators in the County. It is intended, therefore, that this research should result in practical outcomes in which methods of assessment will involve active participation by students as well as by tutors, becoming part of the learning process. It is hypothesised that this kind of co-operation could lead ultimately to self-directed learning and student-independence. For the purposes of this research, a balance is attempted in the use of assessment tools, between standardised tests and informal methods. The study provides facts about students! reading habits; as well as their reading levels, their spelling levels, their handwriting, their writing skills and their writing habits. The study seeks to show the students' feelings towards education, their educational attainments and the type of school which they attended. The study also attempts to come to some measurement of those aspects of student personality which relate to confidence, by means of tests and questionnaires. The study concludes with an examination of the link between cognitive and affective progress.

Evaluation of public housing strategies in Mexico City : an exploratory goal programming approach

This thesis describes the development and use of a goal programming methodology for the evaluation of public housjng strategies in Mexico City, The methodology responds to the need to incorporate the location, size and densities of housing projects on the one hand, and "external" constraints such as the ability of low income families to pay for housing, and the amounts of capital and land available, on the other. The provision of low cost housing by public housing agencies in Mexico City is becoming increasingly difficult because there are so many constraints to be met and overcome, the most important of which is the ability of families to pay for housing. Other important limiting factors are the availability of capital and of land plots of the right size in desired locations. The location of public housing projects is significant because it determines the cost and pattern of work trips, which in a metropolitan area such as Mexico City are of considerable importance to both planners and potential. house owners. In addition, since the price of land is closely related to its location, the last factor is also significant in determining the price of the total housing package. Consequently there is a major trade-off between a housing strategy based on the provision of housing at locations close to employment, and the opposite one based on the provjsion of housjng at locations where employment accessibility is poorer but housing can be provided at a lower price. The goal programming evaluation methodology presented in this thesis was developed to aid housing planners to evaluate housing strategies which incorporate the issues raised above,

Obstacles and solutions to maximising biodiversity in major urban development schemes

The current rate of global biodiversity loss led many governments to sign the international agreement ‘Halting Biodiversity Loss by 2010 and beyond’ in 2001. The UK government was one of these and has a number of methods to tackle this, such as: commissioning specific technical guidance and supporting the UK Biodiversity Acton Plan (BAP) targets. However, by far the most effective influence the government has upon current biodiversity levels is through the town planning system. This is due to the control it has over all phases of a new development scheme’s lifecycle.There is an increasing myriad of regulations, policies and legislation, which deal with biodiversity protection and enhancement across the hierarchical spectrum: from the global and European level, down to regional and local levels. With these drivers in place, coupled with the promotion of benefits and incentives, increasing biodiversity value ought to be an achievable goal on most, if not all development sites. However, in the professional world, this is not the case due to a number of obstructions. Many of these tend to be ‘process’ barriers, which are particularly prevalent with ‘urban’ and ‘major’ development schemes, and is where the focus of this research paper lies.The paper summarises and discusses the results of a questionnaire survey, regarding obstacles to maximising biodiversity enhancements on major urban development schemes. The questionnaire was completed by Local Government Ecologists in England. The paper additionally refers to insights from previous action research, specialist interviews, and case studies, to reveal the key process obstacles.Solutions to these obstacles are then alluded to and recommendations are made within the discussion.

A goal-based modeling approach to develop requirements of an adaptive system with environmental uncertainty

Dynamically adaptive systems (DASs) are intended to monitor the execution environment and then dynamically adapt their behavior in response to changing environmental conditions. The uncertainty of the execution environment is a major motivation for dynamic adaptation; it is impossible to know at development time all of the possible combinations of environmental conditions that will be encountered. To date, the work performed in requirements engineering for a DAS includes requirements monitoring and reasoning about the correctness of adaptations, where the DAS requirements are assumed to exist. This paper introduces a goal-based modeling approach to develop the requirements for a DAS, while explicitly factoring uncertainty into the process and resulting requirements. We introduce a variation of threat modeling to identify sources of uncertainty and demonstrate how the RELAX specification language can be used to specify more flexible requirements within a goal model to handle the uncertainty. © 2009 Springer Berlin Heidelberg.

New Europe’s new development aid

This book examines the international development policies of five East Central European new EU member states, the Czech Republic, Hungary, Poland, Slovakia and Slovenia. These countries turned from being aid recipients to donors after the turn of the millennium in the run-up to EU accession in 2004. The book explains the evolution subsequent to EU accession and current state of foreign aid policies in the region and the reasons why these deviate from many of the internationally agreed best practices in development cooperation. It argues that after the turn of the millennium, a 'Global Consensus' has emerged on how to make foreign aid more effective for development. A comparison between the elements of the Global Consensus and the performance of the five countries reveals that while they have generally implemented little of these recommendations, there are also emerging differences between the countries, with the Czech Republic and Slovenia clearly aspiring to become globally responsible donors. Building on the literatures on foreign policy analysis, international socialization and interest group influence, the book develops a model of foreign aid policy making in order to explain the general reluctance of the five countries in implementing international best practices, and also the differences in their relative performance.

Formal methods for the development and verification of autonomic IT systems

This chapter explores ways in which rigorous mathematical techniques, termed formal methods, can be employed to improve the predictability and dependability of autonomic computing. Model checking, formal specification, and quantitative verification are presented in the contexts of conflict detection in autonomic computing policies, and of implementation of goal and utility-function policies in autonomic IT systems, respectively. Each of these techniques is illustrated using a detailed case study, and analysed to establish its merits and limitations. The analysis is then used as a basis for discussing the challenges and opportunities of this endeavour to transition the development of autonomic IT systems from the current practice of using ad-hoc methods and heuristic towards a more principled approach. © 2012, IGI Global.

The effectiveness of workplace coaching:A meta-analysis of learning and performance outcomes; scale development; theoretical model of individual differences and longitudinal study

The extant literature on workplace coaching is characterised by a lack of theoretical and empirical understanding regarding the effectiveness of coaching as a learning and development tool; the types of outcomes one can expect from coaching; the tools that can be used to measure coaching outcomes; the underlying processes that explain why and how coaching works and the factors that may impact on coaching effectiveness. This thesis sought to address these substantial gaps in the literature with three linked studies. Firstly, a meta-analysis of workplace coaching effectiveness (k = 17), synthesizing the existing research was presented. A framework of coaching outcomes was developed and utilised to code the studies. Analysis indicated that coaching had positive effects on all outcomes. Next, the framework of outcomes was utilised as the deductive start-point to the development of the scale measuring perceived coaching effectiveness. Utilising a multi-stage approach (n = 201), the analysis indicated that perceived coaching effectiveness may be organised into a six factor structure: career clarity; team performance; work well-being; performance; planning and organizing and personal effectiveness and adaptability. The final study was a longitudinal field experiment to test a theoretical model of individual differences and coaching effectiveness developed in this thesis. An organizational sample of 84 employees each participated in a coaching intervention, completed self-report surveys, and had their job performance rated by peers, direct reports and supervisors (a total of 352 employees provided data on participant performance). The results demonstrate that compared to a control group, the coaching intervention generated a number of positive outcomes. The analysis indicated that coachees’ enthusiasm, intellect and orderliness influenced the impact of coaching on outcomes. Mediation analysis suggested that mastery goal orientation, performance goal orientation and approach motivation in the form of behavioural activation system (BAS) drive, were significant mediators between personality and outcomes. Overall, the findings of this thesis make an original contribution to the understanding of the types of outcomes that can be expected from coaching, and the magnitude of impact coaching has on outcomes. The thesis also provides a tool for reliably measuring coaching effectiveness and a theoretical model to understand the influence of coachee individual differences on coaching outcomes.