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Despite their ostensible differences, both randomized controlled trials (RCTs) and neoclassical economics, which undergirds neoliberalism, are characterized by unrealistic assumptions. This is not accidental but stems from a common desire for scientism, despite a substitution of “economic man” by what we call “behavioral man” in the former. However, the interactions between human behavior and context produce much greater diversity than allowed for in such approaches. As a result of these failings, RCTs do not challenge neoliberalism, but rather can be inserted into and help legitimize it. Consequently they do not alter the structural conditions producing poverty, but represent a form of “virtualism” that attempts to make the real conform to the ideal of neoclassical economics through “nudging.” This is often associated with conditionality, representing a continuation of the historically Northern-centered coloniality of power, which sometimes leads to ethical breaches and perverse development outcomes. Some examples from RCTs conducted or published by the World Bank—which has become a lead agency in promoting RCTs to assess the effectiveness of aid—in Africa are presented to illustrate our argument.

The paper begins with consideration of Plato and Aristotle, but the question addressed in this essay is the following: What has been meant--and what role has been played--in the succession of doctrines of physics we have had since the seventeenth century, by notions (not necessarily technical) of “power” and of “cause”? The essay concludes with consideration of (classical) field theories set in relativistic space-time.

Neurally adjusted ventilatory assist (NAVA) ventilation allows patients to determine their peak inspiratory pressure and tidal volume on a breath-by-breath basis. Apprehension exists about premature neonates' ability to self-regulate breath size. This study describes peak pressure and tidal volume distribution of neonates on NAVA and non-invasive NAVA. This is a retrospective study of stored ventilator data with exploratory analysis. Summary statistics were calculated. Distributional assessment of peak pressure and tidal volume were evaluated, overall and per NAVA level. Over 1 million breaths were evaluated from 56 subjects. Mean peak pressure was 16.4 ± 6.4 in the NAVA group, and 15.8 ± 6.4 in the NIV-NAVA group (t test, p 0.001). Mean tidal volume was 3.5 ± 2.7 ml/kg.Conclusion:In neonates on NAVA, most pressures and volumes were within or lower than recommended ranges with pressure-limited or volume-guarantee ventilation. What is known: • Limiting peak inspiratory pressures or tidal volumes are the main strategies to minimize ventilator-induced lung injury in neonates. Neurally adjusted ventilatory assist allows neonates to regulate their own peak inspiratory pressures and tidal volumes on a breath-to-breath basis using neural feedback. What is new: • When neonates chose the size of their breaths based on neural feedback, the majority of peak inspiratory pressures and tidal volumes were within or lower than the recommended peak inspiratory pressure or tidal volume ranges with pressure-limited or volume guarantee ventilation.

Background: Premature neonates are exposed to numerous painful procedures. Physiologic fluctuations in heart rate (HR), respiratory rate, and oxygen saturation are typically used to determine the response to pain. Neurally assisted ventilatory assist (NAVA) delivers inspiratory pressure in proportion to the electrical activity of the diaphragm (Edi). Since NAVA allows self-regulation of peak inspiratory pressures (PIP), there is apprehension that painful stimulus may increase respiratory drive and result in ex- cessive PIP. This study evaluated changes in respiratory drive, measured by Edi, in response to a painful procedure (heel stick) to determine if there was excessive PIP delivered from the ventilator. Methods: Prospective, single-center study; subjects

Background Neonates with apnea of prematurity often fail CPAP because it does not provide adequate support during apnea. NAVA provides proportional ventilator support based on electrical activity of the diaphragm. When the NAVA level is 0 cmH20/mcV, the patient receives minimal support above PEEP when breathing and backup ventilation when apneic. This study compares number of clinically significant events on CPAP versus noninvasive NAVA level 0. Methods Retrospective study of preterm neonates having apnea of prematurity on nasal CPAP. Patients were then placed on NAVA level 0. The number of events on each mode was collected. Statistics were paired t-test. Results Seventeen subjects with gestational age 26.1 ± 1.7 weeks, study age 19.5 ± 12.5 days. Events decreased from 17.9 ± 7.8 on CPAP to 10.2 ± 8.1 events on NAVA level 0 (p = 0.00047). Conclusions NAVA level 0 reduced the number of clinically significant events compared with CPAP in premature neonates with apnea of prematurity.

Neonates with apnea of prematurity (AOP) deteriorate clinically because CPAP often provides inadequate support during apnea. NAVA provides proportional ventilator support from the electrical activity of the diaphragm. When NAVA level is 0 cmH20/mcV (NN0), patients receive minimal support when breathing and backup ventilation when apneic. This study addresses feasibility of NN0 and time spent in back up ventilation. This was a prospective, two center, observational study of preterm neonates on NN0 for AOP. Ventilator data were downloaded for 24 hours. Number of Clinically Significant Events (CSEs) and switches to back up were collected. Statistics were paired t-test. There were twenty-eight subjects with gestational age of 25 + 1.8 weeks; study age 28 ± 23 days. Number of events were 4±4.39 per 24 hours. Subjects were on NN0 approximately 90% each minute, back-up mode 2.5±1.1 times/minute with 10.6±7.2% in back-up. Conclusion: Preterm neonates on NAVA level 0 had few clinically significant events with minimal time in back up ventilation.

Poincare is a pre-eminent figure: as one of the greatest of mathematicians; as a contributor of prime importance to the development of physical theory at a time when physics was undergoing a profound transformation; and as a philosopher. However, I think that Poincare, with all this virtue, made a serious philosophical mistake. In Poincare’s own work, this error seems to me to have kept him from several fundamental discoveries in physics. The hypothesis that Poincare would have made these discoveries if he had not been misled by a philosophical error is not one that lends itself to conclusive assessment; but what I wish to do is to lay out the main circumstances of the case so as to make clear, at least, that the issue of philosophic principle involved, and the questions of fundamental physics under discussion, are of considerable mutual relevance.

Industrial parks have proliferated in virtually every region of the world in line with the growing interest in industrial transformation in developing countries. While a good deal of literature has focused on the operation of these parks, less has been written on the broader dimensions that have allowed the parks to become catalysts for structurally transforming economies. The issue is not simply one of developing policy strategies but of understanding how to transform organizational capacities and institutional relationships that concatenate industrial hubs to each other and to other key sectors of the economy. The chapter critically assesses mainstream policy advice on industrial parks and draws on institutional and other economic traditions to generate a theoretical understanding of the systemic prerequisites and policy alternatives that will help determine the success or failure of industrial parks.

The use of noninvasive ventilation (NIV) has increased over the past decade. Most NICUs use various forms of noninvasive positive pressure ventilation that is influenced by leaks at the interface. This limits the effectiveness of using a flow trigger for synchronous delivery of each breath and the resultant asynchrony contributes to the failure of NIV. Two novel approaches to NIV are now available. Noninvasive neurally adjusted ventilatory assist uses a neural trigger to detect the electrical activation of the diaphragm. Each breath is then proportionally assisted based on the onset, strength, and duration of this electrical signal. It is therefore leak-independent and overcomes the challenges of flow-triggered ventilation. High-frequency nasal ventilation is an extension of bubble continuous positive airway pressure and delivers small tidal volumes at high frequencies that can be adjusted to provide appropriate noninvasive support. The functionality of both these modalities will be discussed, including the clinical evidence available to support their use with NIV.

Apnea time allows the clinician to set a minimum spontaneous respiratory frequency when using noninvasive neurally-adjusted ventilatory assist (NIV-NAVA). Short apnea times may provide backup ventilation during periods of physiologic variability causing overventilation and suppression of spontaneous respiratory drive. Longer apnea times may allow more spontaneous ventilation but can result in insufficient respiratory support. The purpose of this study was to evaluate various apnea times in neonates on NIV-NAVA.This was a 2-center, prospective, 1-factorial, interventional study of neonates30 weeks gestational age on NIV-NAVA. Clinically important events and ventilator data were recorded for apnea times of 2 s and 5 s for 2 h each.15 neonates (26 ± 1.6 weeks gestational age, birthweight 893 ± 202 g) were studied. When compared to the 5-s apnea time, the 2-s apnea time showed increased switches into backup ventilation from 0.5 switches/min to 2.5 switches/min (Short apnea times resulted in more switches into backup ventilation and longer time in backup ventilation but promoted clinical stability with fewer clinically important events in neonates ventilated with NIV-NAVA.

Nigeria’s transition to civil rule in 1999 and the eventual consolidation of a liberalized economy by successive administrations have resulted in the signing of several business deals with the Chinese government and Chinese enterprises. A key agreement was the establishment of two Chinese constructed and operated special economic zones in Lagos and Ogun States as part of a plan to create zones in five countries under the auspices of the Forum on China–Africa Cooperation (FOCAC). The hope was that zones would attract Chinese manufacturing businesses and help Nigeria diversify the economy away from oil dependency. This chapter will investigate the relationship between China and Nigeria in general with a focus on textile production and trade and the nature of the zones in particular to assess if China’s growing presence in Nigeria is in the image of Prometheus or Leviathan.

A 3.74-kg term male infant is delivered at an outlying hospital via primary cesarean section because of a maternal history of hip surgery after prolonged rupture of membranes. The mother is a 26-year-old gravida 3, para 0, blood type A positive woman who is rubella equivocal, hepatitis B antibody negative, group B Streptococcus negative, Chlamydia trachomatis and Neisseria gonorrhoeae negative, rapid plasma reagin nonreactive, and human immunodeficiency virus negative. Rupture of membranes is unknown, but occurred at least 1 day before arrival. Significant finding at delivery includes thick, meconium-stained amniotic fluid. The infant’s 1-minute Apgar score is 5. He has stridor and respiratory distress. The DeLee suction is used on the stomach, and continuous positive airway pressure is initiated. His 5-minute Apgar score improves to 7, and he makes a successful transition to oxygen by nasal cannula. Due to the prolonged rupture of membranes, meconium-stained amniotic fluid, and persistence of respiratory distress, a blood culture specimen is obtained and he starts empiric treatment with ampicillin and gentamicin. He is transferred to the special care nursery, where he continues to have stridor at rest. The stridor worsens with agitation. Chest radiography shows pneumomediastinum and pneumothorax. Over the next few days he continues to require intermittent oxygen via nasal cannula to maintain his saturations above 90%. A dose of racemic epinephrine and then albuterol do not improve the stridor. He is able to feed up to 47 mL of breast milk or formula every 3 hours. Blood cultures remain negative, and he …

It is generally held that one mechanism to enable inclusive growth in Tanzania is enabling farmers to access credit to raise productivity and incomes. The formalisation of property rights in Tanzania is being undertaken by a multiplicity of actors at great expense to donors, individuals and the government. While there have been a variety of different justifications for allocating Certificates of Customary Rights of Occupancy (CCROs) to farmers in Tanzania, perhaps the most prominent argument is that it will enable farmers to finally overcome the divide between ‘informal’ customary rights and the formal banking sector. CCROs would provide the collateral that would induce banks to lend money to small-scale farmers. As part of a six-year investigation in Manyara, Mbeya and Dodoma regions, our research team evaluated the impact of formalisation on farmers’ access to credit. The paper will present the results while pointing to the continuing institutional and market imperfections that perpetuate the fo...

There is a new wave of external borrowing by African governments on private sovereign bond markets. The findings in this paper indicate that African economies pay higher-than-normal coupon rates on these markets; observed risk measures like agency ratings and debt to GDP ratios do not explain the deviation from the norm. We also find that countries in better financial standing tend to self-select into the private markets, such that their risk profiles cannot explain the high coupon rates. Further research steps and policy implications are discussed.

Allison A Vanderbilt,1 Scott M Pappada,2 Howard Stein,3 David Harper,4 Thomas J Papadimos5 1Department of Family Medicine, 2Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, 3Department of Pediatrics, ProMedica Toledo Children’s Hospital, 4Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, 5Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one’s knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum. Keywords: interprofessional health care teams, handoffs, neonates, patient safety, communication

The term ‘logicism’ refers to the doctrine that mathematics is a part of (deductive) logic. It is often said that Gottlob Frege and Bertrand Russell were the first proponents of such a view; this is inaccurate, in that Frege did not make such a claim for all of mathematics. On the other hand, Richard Dedekind deserves to be mentioned among those who first expressed the conviction that arithmetic is a branch of logic. The logicist claim has two parts: that our knowledge of mathematical theorems is grounded fully in logical demonstrations from basic truths of logic; and that the concepts involved in such theorems, and the objects whose existence they imply, are of a purely logical nature. Thus Frege maintained that arithmetic requires no assumptions besides those of logic; that the concept of number is a concept of pure logic; and that numbers themselves are, as he put it, logical objects. This view of mathematics would not have been possible without a profound transformation of logic that occurred in the late nineteenth century – most especially through the work of Frege. Before that time, actual mathematical reasoning could not be carried out under the recognized logical forms of argument: this circumstance lent considerable plausibility to Immanuel Kant’s teaching that mathematical reasoning is not ‘purely discursive’, but relies upon ‘constructions’ grounded in intuition. The new logic, however, made it possible to represent standard mathematical reasoning in the form of purely logical derivations – as Frege, on the one hand, and Russell, in collaboration with Whitehead, on the other, undertook to show in detail. It is now generally held that logicism has been undermined by two developments: first, the discovery that the principles assumed in Frege’s major work are inconsistent, and the more or less unsatisfying character (or so it is claimed) of the systems devised to remedy this defect; second, the epoch-making discovery by Kurt Gödel that the ‘logic’ that would be required for derivability of all mathematical truths can in principle not be ‘formalized’. Whether these considerations ‘refute’ logicism will be considered further below.

Neurally adjusted ventilatory assist (NAVA) uses the electrical activity of the diaphragm (Edi) as a neural trigger to synchronize mechanical ventilatory breaths with the patient's neural respiratory drive. Using this signal enables the ventilator to proportionally support the patient's instantaneous drive on a breath-by-breath basis. Synchrony can be achieved even in the presence of significant air leaks, which make this an attractive choice for invasive and non-invasive ventilation of the neonate. This paper describes the Edi signal, neuroventilatory coupling, and patient-ventilator synchrony including the functional concept of NAVA. Safety features, NAVA terminology, and clinical application of NAVA to unload respiratory musculature are presented. The use of the Edi signal as a respiratory vital sign for conventional ventilation is discussed. The results of animal and adult studies are briefly summarized and detailed descriptions of all NAVA-related research in pediatric and neonatal patients are provided. Further studies are needed to determine whether NAVA will have significant impact on the overall outcomes of neonates.

Noninvasive ventilation (NIV) is frequently used in the NICU to avoid intubation or as postextubation support for spontaneously breathing infants experiencing respiratory distress. Neurally adjusted ventilatory assist (NAVA) is used as a mode of noninvasive support in which both the timing and degree of ventilatory assist are controlled by the patient. NIV-NAVA has been successfully used clinically in neonates as a mode of ventilation to prevent intubation, allow early extubation, and as a novel way to deliver nasal continuous positive airway pressure.

Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation in which both the timing and degree of ventilatory assist are controlled by the patient. Since NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized non-invasive NAVA (NIV-NAVA) regardless of leaks and to monitor continuously patient respiratory pattern and drive. Advantages of NIV-NAVA over conventional modes include improved patient-ventilator interaction, reliable respiratory monitoring and self-regulation of respiratory support. In theory, these characteristics make NIV-NAVA an ideal mode to provide effective, appropriate non-invasive support to newborns with respiratory insufficiency. NIV-NAVA has been successfully used clinically in neonates as a mode of ventilation to prevent intubation, to allow early extubation, and as a novel way to deliver nasal continuous positive airway pressure. The use of NAVA in neonates is described with an emphasis on studies and clinical experience with NIV-NAVA.

Sub-Saharan Africa (SSA) as a whole did remarkably well during the Great Recession. On average, over the 2008–13 period, SSA (excluding South Africa) grew at a rate that was 2.9 per cent higher than that achieved by the world as a whole. The paper explores the reason for this performance. First, a number of African countries in recent years have built up significant reserves and tapped new sources of finance. Like many Latin American and Asian countries, they were able to avoid IMF loans and create policy space for the adoption of anti-cyclical fiscal and monetary policies. Second, SSA countries reoriented their economies away from traditional export markets and sources of FDI toward Asian and other emerging countries which had been less badly affected than their traditional western partners by the recession. Third, both before and during the Great Recession SSA countries continued to rely heavily on commodity production, which allowed them to ride the boom in commodity prices. However, in the long run this reliance generates structural weaknesses that are a threat to the sustainability of growth in SSA.

BACKGROUND: Electrical activity of the diaphragm (Edi) has been proposed as a parameter to evaluate respiratory function. Normative values of electrical activity of the diaphragm in full-term neonates are not known. This is a small case series to establish preliminary values of Edi in term neonates and to determine how these values vary while awake and asleep and during feeding states. METHODS: Three term neonates in room air and nippling feeds at the time of the study were observed for 4 hours. Edi was measured by electrodes within a nasogastric tube positioned at the level of the diaphragm. Respiratory rate and heart rate were also recorded. Time while awake and asleep were noted. Feeding states included feeding, 30 min pre-prandial, and 30 min post-prandial. Statistics were analysis of variance and t tests, with P RESULTS: Mean Edi peak was 11 ± 5 μV. Mean Edi minimum was 3 ± 2 μV. Edi peak and minimum were higher while awake. Edi peak was lower post-prandial. Respiratory rate was higher post-prandial. CONCLUSIONS: These are the first preliminary values for Edi in neonates. Higher Edi peak while awake may reflect larger tidal volume to meet increased metabolic requirements when awake and active. Post-prandial lower Edi peak and higher respiratory rate may indicate compensation for decreased tidal volume from increased intra-abdominal pressure. These data may be useful in identifying respiratory pathology in neonates and monitoring progression toward respiratory health.

The paper examines the relationship between neoliberal policies and the Great Recession with a focus on the persistence of the policy paradigm in spite of overwhelming evidence of its role in creating the crisis. These economic problems are only the latest that have arisen in the wake of the three long decade experiment with these policy packages. The paper investigates the ideological, methodological, historical, theoretical, political and economic interests underlying the perpetuation of neoliberalism.

The original logic underlying the World Bank's structural adjustment policies in Africa was that the removal of state-created distortions would not only improve efficiency in the operation of markets but also enhance income equality and reduce poverty. The paper explores the linkage between adjustment and the deteriorating income distribution and rising poverty in sub-Saharan Africa with a focus on the rural sector where most of the population earns its livelihoods. The pattern observed is a logical outcome of the strategies embedded in World Bank policies that need to change if we are to counter the persistence of inequality and poverty on the continent. The paper outlines an alternative approach aimed at increasing rural incomes to reduce poverty and inequality.

The paper documents and analyses the World Bank's promotion of foreign ownership of banking in developing countries. In the wake of two decades of financial crises following exercises of orthodox financial reform, the World Bank has not only continued to push privatisation, but now sees foreign banks as the missing component that will deal with the downside risks of financial liberalisation. Concerns that foreign banks might reduce small and medium enterprise (SME) loan access because of information problems are largely dismissed by the Bank. In fact the World Bank argues for the very opposite, the existence of foreign banks is likely to have the effect of pushing local banks into SME markets where they have a greater comparative advantage. The question of access to credit for the private sector, particularly the locally owned small and medium size enterprises, is central to the issue of employment generation and poverty reduction in developing countries where the bulk of new jobs are typically created by these companies. This article traces the development of the World Bank's agenda on foreign ownership. It critically assesses the arguments and empirical work underlying the World Bank analysis and draws on alternative empirical testing and case studies to raise serious questions about the downside risks associated with the internationalisation of banking. Copyright The Author 2009. Published by Oxford University Press on behalf of the Cambridge Political Economy Society. All rights reserved., Oxford University Press.

Many referring facilities and transport teams function under the assumption that faster is better. However, data on the benefits of air ambulance (AA) use in neonatal transport are sparse. At our referral hospital in northwest Ohio, we compared the total time from telephone request for transport to arrival in the referral nursery by ground ambulance vs AA for each of our referring facilities and evaluated if this had an impact on patient outcomes. Time from transport call to arrival at the referring hospital was 72 ± 17 minutes by AA and 95 ± 23 minutes by ground ambulance. We demonstrated that although it was approximately 25% faster to fly to a referring hospital compared with traveling by ground, the time saved had no impact on outcome. On the basis of these data, we continue to encourage ground transport whenever possible and reserve the use of the AA for the sickest neonates located in the furthest referring hospitals.

Objective Even when initially successful, many interventions aimed at reducing the toll of water-related infectious disease have not been sustainable over longer periods of time. Here we review historical practices in water-related infectious disease research and propose an interdisciplinary public health oriented systems approach to research and intervention design. Data sources On the basis of the literature and the authors’ experiences, we summarize contributions from key disciplines and identify common problems and trends. Practices in developing countries, where the disease burden is the most severe, are emphasized. Data extraction We define waterborne and water-associated vectorborne diseases and identify disciplinary themes and conceptual needs by drawing from ecologic, anthropologic, engineering, political/economic, and public health fields. A case study examines one of the classes of water-related infectious disease. Data synthesis The limited success in designing sustainable interventions is attributable to factors that include the complexity and interactions among the social, ecologic, engineering, political/economic, and public health domains; incomplete data; a lack of relevant indicators; and most important, an inadequate understanding of the proximal and distal factors that cause water-related infectious disease. Fundamental change is needed for research on water-related infectious diseases, and we advocate a systems approach framework using an ongoing evidence-based health outcomes focus with an extended time horizon. The examples and case study in the review show many opportunities for interdisciplinary collaborations, data fusion techniques, and other advances. Conclusions The proposed framework will facilitate research by addressing the complexity and divergent scales of problems and by engaging scientists in the disciplines needed to tackle these difficult problems. Such research can enhance the prevention and control of water-related infectious diseases in a manner that is sustainable and focused on public health outcomes.

The organizational concept of "backward engineering" is used as a hermeneutic device to illuminate processes that were employed to implement the Holocaust. Here we study how rationality can be used in the service of irrationality. In particular, rationalized, engineered and bureaucratically organized inputs, throughputs, and outputs contain unconscious processes embodied in the engineering of atrocity. The process of the "conversion" of experiencing subjects into disposable objects is examined. Finally, the psychodynamics of the inability to look backward and take apart the vast supply chain leading to the actual killing are examined. An understanding of organizational psychodynamics contributes to the psychohistorical study of atrocity on a vast scale.

OBJECTIVES: To evaluate the generalizability of stringent protocol-driven weaning in improving total duration of opioid treatment and length of inpatient hospital stay after treatment of neonatal abstinence syndrome (NAS). METHODS: We conducted a retrospective cohort analysis of 981 infants who completed pharmacologic treatment of NAS with methadone or morphine from January 2012 through August 2014. Before July 2013, 3 of 6 neonatology provider groups (representing Ohio’s 6 children’s hospitals) directed NAS nursery care by using group-specific treatment protocols containing explicit weaning guidelines. In July 2013, a standardized weaning protocol was adopted by all 6 groups. Statistical analysis was performed to identify effects of adoption of the multicenter weaning protocol on total duration of opioid treatment and length of hospital stay at the protocol-adopting sites and at the sites with preexisting protocol-driven weaning. RESULTS: After adoption of the multicenter protocol, infants treated by the 3 groups previously without stringent weaning guidelines experienced shorter duration of opioid treatment (23.0 vs 34.0 days, P < .001) and length of inpatient hospital stay (23.7 vs 31.6 days, P < .001). Protocol-adopting sites also experienced a lower rate of adjunctive drug therapy (5% vs 21%, P = .004). Outcomes were sustained by the 3 groups who initially had specific weaning guidelines after multicenter adoption (duration of treatment = 17.0 days and length of hospital stay = 23.3 days). CONCLUSIONS: Adoption of a stringent weaning protocol resulted in improved NAS outcomes, demonstrating generalizability of the protocol-driven weaning approach. Opportunity remains for additional protocol refinement.

During the 1990s development funders 1 officially incorporated into their rhetoric the ideal of passing control of the design, implementation, and monitoring of projects and programmes to recipient ‘stakeholders’, 2 a goal summarised in the term ‘national ownership’. Ownership has joined a list of funder-agency concerns that in recent years has included governance, institutions, poverty reduction, sustainable development, participation, and decentralisation. Whether or not economic performance improves with greater ownership, the move to encourage recipient country ownership represents a change in the aid relationship. Numerous and detailed policy conditionalities characterised the Washington Consensus programmes of the 1990s. The rhetoric of ownership appeared to signal a retreat from that approach to the relationship between funding agencies and recipient governments (‘development partnerships’). This article explores the implications of a commitment to recipient ownership. The conditionalities associated with loans and grants are central to the discussion, particularly in the context of the Millennium Development Goals. Most attention has focused on the seven poverty reduction goals. Less has been directed to goal eight, which calls for new partnerships for development. The article discusses these issues in the context of recent developments in aid delivery in Tanzania. The definition of ‘ownership’ is central to an analytical discussion. The meaning varies across donors, lenders and governments, in part reflecting the history of agencies and intergovernmental relations, as well as ideology. 3 For example, the interpretation by the Swedish International Development Agency (SIDA) of ownership, which was profoundly affected by the politics of international aid in Sweden from the 1970s onwards, differs considerably from that of the World Bank. 4 Similarly, the Ethiopian government’s more literal interpretation and the more funder-accommodating approach of the Tanzanian government are influenced by the different histories of these countries. The lack of an agreed definition arises partly because recipient control of development assistance means different things in different concrete circumstances. In addition, vagueness may serve the interest of parties less willing to reform the more obvious manifestations of ‘donorship’ (a funder-driven process). Thus, one must be cautious in attributing too much meaning to the emerging consensus among development funders that ownership is central to aid policy. 5