Priority setting of public spending in developing countries: do not try to do everything for everybody.

From Rio to Iragua--sustainability versus efficiency and equity for preventive health interventions.

Innovations in pneumonia diagnosis and treatment: a call to action on World Pneumonia Day, 2013.

This article reviews the principles involved in establishing the cost effectiveness of mass drug therapy for the major intestinal nematodes and the intestinal form of schistosomiasis, as well as the extent to which the available studies have provided definitive answers. For governments or agencies that have decided to introduce a control programme, there is considerable evidence about the comparative cost effectiveness of different types of delivery strategies. For example, mass treatment is more cost effective than selective treatment (treatment after individual screening) in high prevalence areas and at observed prices. Mass treatment targeted at known high risk groups, such as schoolchildren, for the major intestinal helminths (apart from hookworm) can be more cost effective than population-based mass treatment. However, this raises the question whether any form of mass anthelmintic chemotherapy is an efficient use of scare health resources in view of the competing demands for scarce public funds, and for the scarce resources of other funders of healthcare including donors, nongovernmental organisations and missions. Some evidence that it is an efficient use of resources is available; this article concludes by outlining the type of information that is required to strengthen the argument for mass therapy.

High Altitude Platforms (HAPs) is the name of a new technology to provide wireless narrowband and broadband services. A unique property of HAPs is the ability of preparing emergency telecommunication facilities once the catastrophic events occur. In these situations efficient use of limited spectrum resources would be of great importance. This paper presented a fuzzy channel allocation scheme in HAPs for emergency mobile communications. The suggested scheme is based on guard channel policy. It dynamically adjusts optimum number of reserved channels according to important quality of service (QoS) parameters to make an efficient use of resources, while prioritizes on-going calls over new calls. Simulation compares the proposed fuzzy scheme with fixed guard channel scheme and complete sharing scheme. Results show that, the fuzzy scheme is able to achieve a better grade of service (GoS), while can keep handoff failures low as network traffic load changes.

The global economic impact of basketball is measured in tens of billions of dollars and requires the efficient use of resources to maximize success on and off the court. Today, coaches, players, investors, and owners need to take full advantage of modern analytical methods and digital video software capabilities to make the most efficient use of a teams resources. This research is the first in a series that makes full use of modern analytic methods and begins to define new defensive and offensive criteria to supplement the decades old game box score performance information. Data envelopment analysis and statistical methods are used to evaluate two new defensive performance metrics on defensive efficiency. The two new defensive metrics are contested and uncontested passes that are fully defined in the articles appendix. Future research will expand the sample size and allow for more comprehensive models of basketball team defensive efficiency.

There is general agreement among the major stakeholders—providers, consumers, payors, and managed behavioral health companies—that managed care poses significant challenges for behavioral health professionals, particularly those whose primary work has been in independent practice rather than organized care settings. In traditional independent practice, clinicians were free to employ relatively unstructured, goal-free approaches to care with an emphasis on patient insight and self-knowledge. Formal written treatment plans were a rarity and there was little external pressure on clinicians to complete treatment within any specified period of time. Often, little attention was paid to the efficient use of financial and service resources, and decisions to begin and end treatment were the purview of the therapist and the patient. Patients were generally seen as financially responsible for their treatment regardless of employment based benefits. Indeed, such an approach to practice was consistent with the ways in which most behavioral health professionals were trained. In contrast, clinicians practicing in today's managed care environment are typically required to develop written, goal-focused, time limited treatment plans emphasizing the return of the patient to an adequate level of day-to-day functioning while making efficient use of resources (Austad & Berman, 1991). Decisions to begin and end treatment, at least the part to be paid for through the benefit plan, are made by the therapist and patient together with a third party—the managed care entity. In order to work effectively within this context, clinicians must be both willing and able to change their practice patterns, to at least accommodate

The international guidelines for surveillance following the finding of a small tubular adenoma vary between no surveillance or colonoscopy at 5 or 10 years, whereas surveillance after an advanced adenoma is 3 years. Optimization of surveillance reduces the risk of colorectal cancer (CRC) with efficient use of colonoscopy resources. We assessed the risks of advanced colorectal neoplasia following a baseline finding of a small adenoma compared with advanced adenoma. A retrospective audit was undertaken of patients enrolled in a CRC surveillance program, wherein regular colonoscopies and screening with faecal immunochemical test (FIT) were provided. Patients diagnosed with either small or advanced adenoma followed by at least one surveillance colonoscopy were included. Advanced adenoma included adenomas with features of villous change, size of at least 10 mm, high-grade dysplasia, three or more small tubular adenomas and traditional and sessile serrated adenomas. Subdistribution hazard ratios were calculated for advanced neoplasia (CRC or advanced adenoma). Overall, 378 patients (62.6±11.2 years, 57.9% male) were included, with 44.2% diagnosed with small adenoma and 55.5% with advanced adenoma at baseline. The crude cumulative incidence of advanced neoplasia at first surveillance was 13.2 and 18.5% after small and advanced adenoma (P=0.16) (at 45.9 and 35.6 months, respectively), which became significant for advanced adenoma after adjustment (subdistribution hazard ratio=2.55, 95% confidence interval=1.49-4.35, P<001). A positive FIT was the only independent predictor of advanced neoplasia after a small adenoma at baseline colonoscopy (odds ratio=5.05, 95% confidence interval=1.27-20.02, P=0.02). The risk of advanced neoplasia following a small adenoma was lower than that following an advanced adenoma, but was strongly predicted by a positive FIT. Reducing frequency of colonoscopy while providing regular FIT might be a more efficient use of resources for this population.

Resource use efficiency (RUE) is an ecological concept that measures the proportion of supplied resources, which is converted into new biomass, i.e. it relates realized to potential productivity. It is also commonly perceived as one of the main mechanisms linking biodiversity to ecosystem functioning based on the assumption that higher species numbers lead to more complementary and consequently more efficient use of the available resources. While there exists a large body of literature lending theoretical and experimental support to this hypothesis, there are a number of inconsistencies regarding its application: First, empirical tests use highly divergent approaches to calculate RUE. Second, the quantification of RUE is commonly based on measures of standing stock instead of productivity rates and total pools of nutrients instead of their bioavailable fractions, which both vary across systems and therefore can introduce considerable bias. Third, conceptual studies suggest that the relationship between biodiversity, productivity and RUE involves many more mechanisms than complementary resource use, resulting in variable magnitude and direction of biodiversity effects on productivity. Moreover, RUE has mainly been applied to single elements, ignoring stoichiometric or metabolic constraints that lead to co-limitation by multiple resources. In this review we illustrate and discuss the use of RUE within and across systems and highlight how the various drivers of RUE affect the diversity-productivity relationship with increasing temporal and spatial scales as well as under anthropogenic global change. We illustrate how resource supply, resource uptake and RUE interactively determine ecosystem productivity. In addition, we illustrate how in the context of biodiversity and ecosystem functioning, the addition of a species will only result in more efficient resource use and consequently higher community productivity if the species’ traits related to resource uptake and RUE are positively correlated.

Background: Pneumonia and diarrhea are the leading causes of under-five (U5) child mortality in Bangladesh. Seeking appropriate care in timely manner may prevent U5 child mortality due to pneumonia and diarrhea, and thus, it is important to understand perception and barriers of health-seeking behavior of parents during childhood pneumonia and diarrhea in order to develop healthcare policies, and design programs to improve health care utilization practices in disadvantaged areas. The study aimed to explore the factors affecting health-seeking behavior during the first episode of childhood diarrhea and pneumonia.Methods: In a cross-sectional study, survey interviews with 392 mothers, and two focus group discussions (FGD) with fathers (n = 16) were conducted in two villages of Teknaf Upazila in a coastal district in Bangladesh.Results: Logistic regression analysis indicated that during childhood diarrhea, mother’s age, household monthly income, monthly health expenditure and mother’s knowledge regarding danger signs, and during childhood pneumonia, mothers’ education level, monthly household income, monthly expenditure for treatment, household size, and knowledge regarding danger signs were the predictors of mothers’ health-seeking behavior. Results from FGDs indicate that financial problems, low education, distance to health facilities, poor transport facilities hinder the ability to seek timely care during childhood diarrhea and pneumonia.Conclusions: Policies and programs should be in place to address barriers of health-seeking behaviors to reduce child mortality due to diarrhea and pneumonia in coastal areas.

BackgroundThe South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC.MethodsSemi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes.ResultsCPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice.ConclusionCPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training, workforce availability, scarce resources, an escalating number of patients requiring complex rehabilitation, and local knowledge. Concerted attempts to implement locally relevant CPGs for AH primary care in South Africa are required to improve widespread commitment to evidence-based care, as well as to plan efficient and effective service delivery models.

Next-generation digital broadcasting system transmits the DASH segment files. Delays and inefficient use of resources are the major challenges in the transmission of DASH segment files in broadcasting systems. Because the size of DASH segment files varies even though the files have the same quality, and broadcasting systems uses the fixed resource. Delay is an important problem in broadcasting systems because these are real-time systems. Therefore, next-generation digital broadcasting systems should minimize delays and use resource efficiently. This paper proposes a transmission model that can analyze delays as well as efficient use of resources.

Resource efficiency has always been a hot topic for the steel industry, due to the large amounts of primary raw materials, by products and water, which are handled in the steelmaking cycle as well as the considerable energy consumptions. The ever more stringent environmental regulations also contribute to pressurize the iron and steel industry to strengthen further its research activities fostering an optimal management and exploitation of resources. Thus important research efforts are spent in order to find the best way to recover wastes and wastewater also involving the implementation of retrofit actions and major plant modifications allowing also the reduction of primary raw material consumption and of waste disposal. In order to achieve such ambitious objective, which implies both environmental benefits and cost savings, process integration is a powerful tool. The assessment of the viability of process integration solution necessarily include a final experimental stage to be performed at plant level, which can be expensive or unsafe. To this aim process simulation can be a useful alternative to accomplish preliminary feasibility studies allowing a deep analysis of all the aspect of a particular technology or retrofit actions, which also allows testing conditions that are very difficult to replicate within practical experiments. Different levels of detail can be achieved and a comprehensive analysis can be carried out. The present paper provides an overview of the simulation techniques exploited during the project entitled Efficient Use of Resources in Steel Plants through Process Integration to the aim of optimizing the use of resources in an Italian integrated steelmaking plant. In particular, different case studies are proposed and the obtained meaningful and practical results are presented and discussed.

Public procurement is the process by which contracting authorities acquire goods, works, or services from economic operators, regulated by Law No. 131/2015. This process is crucial for managing public funds, impacting economic development and market dynamics. Key principles include transparency, fair competition, and efficient resource use, promoting sustainable development and environmental protection. In the European Union, public procurement is modernized through digital transformation and new technologies, while Moldova aligns with European standards to reduce corruption and ensure a fair process.

Humanity faces an enormous challenge: how to increase agricultural production to achieve food security in the 21st century and feed a population that is expected to grow to 10 billion people. This must be done while maintaining sustainable agricultural systems while facing challenges such as climate change, depletion of water resources and the potential for increased erosion and loss of productivity due to extreme weather events. The article deals with the problem of agricultural losses and food waste, which reaches a third of all food production. What affects the inefficient use of resources and what leads to economic, social and environmental problems. Reducing waste and improving the efficiency of resource use is one of the 17 Sustainable Development Goals (SDGs) of the UN General Assembly 2015. Results and discussions are presented on a new economic paradigm - a green economy. Highlighted the need for sustainable agricultural production, which includes: - increasing the efficiency of the use of labor and natural resources; – conservation and improvement of natural resources; - social development of rural areas and inclusive development of the agricultural sector; – increasing the resilience of human communities and ecosystems to external influences; – a sustainable system for managing the agro-food complex through the introduction of transparent and effective legislation, maintaining a balance of private initiative and public administration. Agricultural losses and food waste are climate change factors, accounting for about 8% of greenhouse gas emissions, for example. The main sources of greenhouse gases are: agriculture, animal husbandry, food systems that require energy costs, and recycling.

Enhancing the productivity of agriculture is vital for Sub-Saharan Africa's economic future and is one of the most important tools to end extreme poverty and boost shared prosperity in the region. How governments elect to spend public resources has significant development impact in this regard. Choosing to catalyze a shift toward more effective, efficient, and climate-resilient public spending in agriculture can accelerate change and unleash growth. Not only does agricultural public spending in Sub-Saharan Africa lag behind other developing regions but its impact is vitiated by subsidy programs and transfers that tend to benefit elites to the detriment of poor people and the agricultural sector itself. Shortcomings in the budgeting processes also reduce spending effectiveness. In light of this scenario, addressing the quality of public spending and the efficiency of resource use becomes even more important than addressing only the level of spending. Improvements in the policy environment, better institutions, and investments in rural public goods positively affect agricultural productivity. These, combined with smarter use of public funds, have helped lay the foundations for agricultural productivity growth around the world, resulting in a wealth of important lessons from which African policy makers and development practitioners can draw. The rigorous analysis presented in this book provides options for reform with a view to boosting the productivity of African agriculture and eventually increasing development impact.