Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania

BackgroundThe success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes.MethodsWe conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change.ResultsProgramme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding.ConclusionOur study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.

Characterisation and diagnosis of heritage concrete: case studies at the Eduardo Torroja Institute, Madrid, Spain

That the preservation of twentieth concrete heritage is an area scantly explored can be attributed to a lack of appreciation for such a young material. In most cases conservation is broached from a technical perspective with little regard for heritage value. Ongoing assessment of the condition of structures is the primary strategy to minimise such misguided action. This study involved characterising the condition of the concrete in a number of singular elements forming part of the Eduardo Torroja Institute for Construction Science headquarters at Madrid, Spain, a modernist compound listed by the city of Madrid as a protected asset. The in situ findings using non-destructive and laboratory techniques revealed the core concrete to be in good condition. The surface material, however, exhibits signs of durability issues calling for conservation treatments and techniques compatible with the preservation of the integrity and authenticity of this young heritage material.

China Innovation Capacity Growth Index 2015 and 2020

ABSTRACT It is of interest in China and across the world to predict whether China will catch up with the most economically advanced nations in innovation capacity. To facilitate an ongoing assessment of China's innovation capacity, the article develops a China Innovation Capacity Growth Index composed of eight separate measures. China's performance in 2020 is compared to the baseline from 2015, showing that China has progressed in six of the eight measures. This article and the accompanying Technical Appendix explain each of the measures, including the sources for the data, and report the changes in performance over time.

Learning needs of health visitors and family nurses in the care of preterm infants in Scotland

In Scotland and across the UK, health visitors and family nurses provide ongoing assessment and care for the preterm infant and their family following discharge from hospital. This study demonstrates that health professionals in Scotland feel underprepared for this responsibility and that the causes of are multifaceted. Practitioners highlight areas of concern that will guide educational providers to consider amendments to their curricula or provision of continuing professional development.

Can Relational Feed-Forward Enhance Students’ Cognitive and Affective Responses to Assessment?

Assessment feedback should be an integral part of learning in higher education, but students can find this process emotionally and cognitively challenging. Instructors need to consider how to manage students’ responses to feedback so that students feel capable of improving their work and maintaining their wellbeing. In this paper, we examine the role of instructor-student relational feed-forward, enacted as a dialogue relating to ongoing assessment, in dissipating student anxiety, enabling productive learning attitudes and behaviours, and supporting wellbeing. We undertook qualitative data collection within two undergraduate teaching units that were adopting a relational feed-forward intervention over the 2019–2020 academic year. Student responses were elicited via small group, semi-structured interviews and personal reflective diaries, and were analysed inductively using thematic analysis. The results demonstrate that relational feed-forward promotes many elements of student feedback literacy, such as appreciating the purpose and value of feedback, judging work against a rubric, exercising volition and agency to act, and managing affect. Students were keen for instructors to help them manage their emotions related to assessment, believing this would promote their wellbeing. We conclude by exploring academic strategies and pedagogies that position relational instructor feed-forward as an act of care, and we summarize the key characteristics of emotionally resonant relational feed-forward meetings.

ARCHES DUNHUANG: HERITAGE INVENTORY SYSTEM FOR CONSERVATION OF GROTTO RESOURCES ON THE GANSU SECTION OF THE SILK ROAD IN CHINA

The cultural heritage of the Buddhist grottoes on the Gansu section of the Silk Road in China has important historical, cultural and artistic values. In order to better protect these precious cultural sites including through facilitating ongoing assessment of their condition, the Dunhuang Academy has created a pilot inventory based on the Arches open-source software platform. This paper first briefly introduces the most important grottoes and the representative caves in Gansu province. It then, in view of the diversity of the grotto architecture layout, describes the Arches semantic graph data modelling technology and how the flexibility of Arches Designer was used to design the resource models, which not only meet data management needs, but also ensure data interoperability and longevity through incorporation of the CIDOC-CRM ontology. In addition, through design of the grottoes map plugin and resource components within Arches, the simple interaction and intuitive visualization of grottoes information was achieved. The Dunhuang Academy’s deployment of Arches will serve the need for grottoes data management and provide support for the establishment of a more scientific and effective protection and management system for the grottoes on the Silk Road in Gansu province. It is hoped that this project will demonstrate the suitability of the Arches platform to support the management of other grotto sites outside of Gansu province, as well as for heritage management elsewhere in China.

Pathophysiological and clinical aspects of interaction between coronavirus disease 2019 and thyroid

In patients who were not previously diagnosed with any thyroid conditions, the scenario of COVID-19 related anomalies of the thyroid may include either: a process of central thyroid-stimulating hormone disturbances via virus‑related hypophysitis; an atypical type of subacute thyroiditis which is connected to the virus spread or to excessive cytokine production including a destructive process with irreversible damage to the gland or low triiodothyronine syndrome (non-thyroidal illness syndrome) which is not specifically related to the COVID‑19 infection, but which is associated with a very severe illness status. This review aimed to investigate thyroid changes resulted from the COVID-19 infection. Ongoing assessment of the effects of the COVID-19 pandemic will reveal more information on coronavirus-induced thyroid conditions. Routine thyroid assays performed in patients with severe infection/acute phase of COVID-19 are encouraged to detect thyrotoxicosis. After recovery, thyroid function should be assessed to identify potential hypothyroidism. There remain unanswered questions related to the predictive value of interleukin-6 in infected patients, especially in cases of cytokine storm, and the necessity of thyroid hormone replacement in subjects with hypophysitis-related central hypothyroidism.

Exploring Quality of Life Reported by Norwegian Older Adults Using Classification Tree Approach on Group Profiles

This study aims to explore the variation between- and within subgroups of older adults with regard to low, medium, and high levels of self-reported quality of life (QoL) measured by the WHOQOL-BREF scale. The contribution of interacting personal and contextual life conditions to QoL was examined in a sample of 1,910 (sample frame 6,000) Norwegian men and women aged 62 to 99 years. The data collected by a postal questionnaire were analyzed using the Chi-square Automatic Interaction Detection (CHAID) classification method in order to detect unique profiles of groups who shared common characteristics. The CHAID model revealed 15 relatively homogenous groups, but distinct from one another, whose profiles were defined by unique constellations of several interacting variables significantly related to a given QoL level. Mental functioning was predominantly linked to perception of life meaning along with health status, and/or in some cases living arrangement, loneliness, neighborhood quality, and satisfaction with income, and placed an individual at different likelihood levels of reporting low, medium, or high QoL. Socio-demographics had no statistically significant impact on QoL for any subgroup. Through this individual-oriented approach, a periodically ongoing assessment of subjective quality of life (QoL) may be sufficiently powerful to allow detecting and addressing personal concerns and specific needs that detract from quality of life in advancing age.

Unsound sleep, wound-up mind: a longitudinal examination of acute suicidal affective disturbance features among an eating disorder sample

Background Suicide is one of the most commonly reported causes of death in individuals with eating disorders. However, the mechanisms underlying the suicide and disordered eating link are largely unknown, and current assessments are still unable to accurately predict future suicidal thoughts and behaviors. The purpose of this study is to test the utility of two promising proximal risk factors, sleep quality and agitation, in predicting suicidal ideation in a sample of individuals with elevated suicidal thoughts and behaviors, namely those with eating disorders. Methods Women (N = 97) receiving treatment at an eating disorder treatment center completed weekly questionnaires assessing suicidal ideation, agitation, and sleep. General linear mixed models examined whether agitation and/or sleep quality were concurrently or prospectively associated with suicidal ideation across 12 weeks of treatment. Results There was a significant interaction between within-person agitation and sleep quality on suicidal ideation [B(s.e.) = −0.02(0.01), p < 0.05], such that on weeks when an individual experienced both higher than their average agitation and lower than their average sleep quality, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation. Conclusions This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results suggest that ongoing assessment for overarousal symptoms, such as agitation and poor sleep quality, in individuals with eating disorders may be warranted in order to manage suicidal ideation among this vulnerable population.