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8. The Academic Footprint of Women in Transplantation: Leaky Pipeline Persists

Author

Choubey, Ankur P., primary, Reilly, Margaret, additional, Bullock, Brenna, additional, Ireland, Megan, additional, Brown, Meghan, additional, Ortiz, Alejandro, additional, Pai, Kavya, additional, Sureddi, Sriya, additional, Khan, Samar A., additional, Mishra, Anil, additional, Koizumi, Naoru, additional, Pearson, Terra, additional, and Ortiz, Jorge, additional

Published
2021
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9. Can performance-based financing be used to reform health systems in developing countries?/Le financement lie aux resultats peut-il etre utilise pour reformer les systemes de sante dans les pays en voie de developpement?/Se puede utilizar la financiacion basada en el rendimiento para reformar les sistemas sanitarios en paises en desarrollo?

Author

Ireland, Megan, Paul, Elisabeth, and Dujardina, Bruno

Subjects
Analysis, Health policy, Developing countries -- Health policy, Health care reform -- Analysis, Employee performance -- Analysis
Abstract

Introduction Performance-based financing (PBF) is an intervention that is gaining significant momentum as a solution to poor performance and the health worker crisis in low-income countries, particularly in Africa. (1) [...], Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool to reform the health sector. We resist such a notion on the grounds that results-based and economically driven interventions do not, on their own, adequately respond to patient and community needs, upon which health system reform should be based. We also think the debate surrounding performance-based financing is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the performance-based financing package. Au cours des 15 dernieres annees, le financement base sur les resultats a ete mis en place dans un nombre croissant de pays en voie de developpement, en particulier en Nrique, comme un moyen d'ameliorer les resultats du personnel soignant. Le passage a la mise en place nationale, au Burundi et au Rwanda, du financement base sur les resultats a encourage ses partisans a le considerer comme etant plus qu'un simple mecanisme de financement, mais de plus en plus comme un outil strategique permettant de reformer le secteur de la sante. Nous nous opposons a cette opinion, arguant que les interventions basees sur tes resultats et dictees par des considerations economiques ne repondent pas de maniere adequate, a elles seules, aux besoins des patients et de la communaute, sur lesquels la reforme du systeme de sante doit reposer. Nous pensons egalement que le debat autour du financement base sur les resultats est influence par des preuves insuffisantes et non fondees qui ne prennent pas correctement en compte le contexte ni ne demelent les differents elements du plan de financement base sur les resultats. Durante los ultimos 15 anos, la financiacien basada en el rendimiento se ha implementado en un numero cada vez mayor de paises en desarrollo, particularmente en Africa, como un medio para mejorar el rendimiento del trabajador sanitario. La ampliacien de la implementacien nacional en Burundi y Ruanda ha animado a les partidarios de la financiaci5n basada en el rendimiento a que se considere corne algo mas que un mero mecanismo de financiacion y a que se tenga en cuenta cada vez mas corne una herramienta estrategica utilizada para reformar el sector sanitario. Nos oponemos a dicha nocion, basandonos en que las intervenciones basadas en los resultados y motivadas por la economia no responden adecuadamente, por si mismas, a las necesidades de los pacientes y la comunidad, que es en lo que se debefia basar la reforma del sistema sanitario. Tambien opinamos que el debate sobre la financiacion basada en el rendimiento esta sesgado por la falta de evidencias y por fundamentos que no tienen en cuenta el contexto adecuadamente y que no esclarecen los diversos elementos incluidos en el paquete de financiacion basada en el rendimiento.

Published
2011
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11. Computed Tomography-Measured Psoas Muscle Density as a Predictive Factor for Hypophosphatemia Associated With Refeeding.

Author

Ireland, Megan, Lo, Wilson, Villarreal, Michael, Coleman, Lisa, Schubauer, Kathryn, Strassels, Scott, Peters, Zoe, Woodling, Karina, Evans, David, and Wisler, Jon

Subjects
PSOAS muscles, HYPOPHOSPHATEMIA, COMPUTED tomography, REFEEDING syndrome, PARENTERAL feeding
Abstract

Background: Initiation of parenteral nutrition (PN) after a period of starvation can be complicated by refeeding syndrome (RFS). RFS is associated with electrolyte abnormalities including hypomagnesemia, hyponatremia, and hypophosphatemia. Risk factors include recent weight loss, low body mass index, and electrolyte deficiencies; however, these associations are not strong. We hypothesized that a validated measure of nutrition risk, computed tomography (CT)-measured psoas muscle density, can be used to predict the development of hypophosphatemia associated with RFS.Methods: A retrospective analysis of surgical patients initiated on PN with an abdominal CT scan within the past 3 months was conducted. CT-measured psoas muscle density was assessed as a predictive variable for the development of electrolyte abnormalities. Daily electrolyte and clinical outcome measures were recorded.Results: One hundred nine patients were stratified based on Hounsfield unit average calculation (HUAC). The lowest 25th percentile of patients had HUAC <25. Low HUAC was associated with a significant percent decrease in phosphate levels from baseline to PN day 3 (P < .01) and significant difference in serum phosphate value on PN day 3 (P < .01). The low muscle density quartile also experienced longer days on the mechanical ventilator (P = .01) compared with patients with a higher psoas muscle density.Conclusion: Psoas muscle density predicted the development of hypophosphatemia in patients initiated on PN. This measurement may aid in identifying patients at highest risk of experiencing RFS. A mean psoas HU <25 may prompt additional precautions, including additional phosphate replacement and slower initiation of PN. [ABSTRACT FROM AUTHOR]

Published
2021
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13. The evaluation of the Paris declaration on aid effectiveness: what does it tell us? What results for the health sector?

Author

Martini, Jessica, Paul, Elisabeth, Ireland, Megan, and Dujardin, Bruno

Subjects
Santé publique
Abstract

Five years after the signing of the Paris Declaration on aid effectiveness by donors and developing countries, there is a climate of high expectations about the results achieved and the impact at sector level. Several evaluations and monitoring surveys have been conducted by the OECD to measure progress made so far in implementing the principles of ownership, alignment, harmonisation, results and mutual accountability. For the health sector, results have also been documented in the context of the International Health Partnership (IHP+). We critically reviewed all the aid effectiveness surveys and evaluations published since 2005 by the OECD and IHP+ so as to analyse what results have been achieved so far as well as the relevance of the frameworks used. To date, results of the implementation of the Paris Declaration are mixed. In the health sector, good progress has been achieved in terms of country ownership and coordination, while alignment and use of country systems, managing for results and mutual accountability lag behind. However, the results recorded often reflect different interpretation of the indicators depending on the respondent, the data available or the time of the survey. Making generalisations is therefore difficult and comparisons between country surveys and over time may not be appropriate. Linking progress in aid effectiveness with improvements in health outcomes is also controversial. Results from the evaluations of the Paris Declaration should be used with caution in the current debate about aid effectiveness. What do the indicators used actually tell us? How realistically can aggregated scores reflect complex issues such as aid effectiveness in different countries, by different donors and over time? Improved evaluation is clearly needed. Data collection should be more rigorous and at sector level contextual factors and behaviour change should be better assessed, over a longer term and through more qualitative comprehensive methods., FLWIN, info:eu-repo/semantics/published, s of the 7th European Congress on Tropical Medicine and International Health, Barcelone, Espagne, 3-6 octobre 2011

Published
2011

16. Results from the implementation of aid effectiveness principles in the health sector in Mali

Author

Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, Dujardin, Bruno, Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, and Dujardin, Bruno

Abstract

The international community holds high expectations for aid producing demonstrable results in the health sector, at the global and developing country levels. Yet, measuring the effectiveness of aid presents methodological challenges. Existing evaluation frameworks are not sufficiently geared toward learning whether and how practices have changed. We present a framework for measuring the results of implementing aid effectiveness principles at three levels: implementation process, health system strengthening, and outcomes/impact. We developed this framework in the context of monitoring results on the effectiveness of the aid agenda in the health sector in Mali. Despite some changes in behavior that resulted in increased aid effectiveness and improved results at system and outcome levels, overall, the aid effectiveness principles have not been fully implemented. Thus expectations in terms of health outcomes should be realistic., info:eu-repo/semantics/published

Published
2013

17. Results from implementation of aid effectiveness principles in the health sector in Mali

Author

Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, Dujardin, Bruno, Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, and Dujardin, Bruno

Abstract

The international community holds high expectations for aid producing demonstrable results in the health sector, at the global and developing country levels. Yet, measuring the effectiveness of aid presents methodological challenges. Existing evaluation frameworks are not sufficiently geared toward learning whether and how practices have changed. We present a framework for measuring the results of implementing aid effectiveness principles at three levels: implementation process, health system strengthening, and outcomes/impact. We developed this framework in the context of monitoring results on the effectiveness of the aid agenda in the health sector in Mali. Despite some changes in behavior that resulted in increased aid effectiveness and improved results at system and outcome levels, overall, the aid effectiveness principles have not been fully implemented. Thus expectations in terms of health outcomes should be realistic., info:eu-repo/semantics/published

Published
2013

18. Comparative modelling of the spectra of cool giantsstarstarstar

Author

Lebzelter, Thomas, Heiter, Ulrike, Abia, C., Eriksson, K., Ireland, Megan, Neilson, H., Nowotny, Walter, Maldonado, J., Merle, Thibault, Peterson, Robert, Plez, B., Short, C.~I., Wahlgren, G.~M., Worley, Clare C.C., Aringer, B., Bladh, S., De Laverny, P., Goswami, A., Mora, A., Norris, R.~P., Recio-Blanco, Alejandra, Scholz, M., Thévenin, F., Tsuji, T., Kordopatis, G., Montesinos, B., Wing, R.~F., Lebzelter, Thomas, Heiter, Ulrike, Abia, C., Eriksson, K., Ireland, Megan, Neilson, H., Nowotny, Walter, Maldonado, J., Merle, Thibault, Peterson, Robert, Plez, B., Short, C.~I., Wahlgren, G.~M., Worley, Clare C.C., Aringer, B., Bladh, S., De Laverny, P., Goswami, A., Mora, A., Norris, R.~P., Recio-Blanco, Alejandra, Scholz, M., Thévenin, F., Tsuji, T., Kordopatis, G., Montesinos, B., and Wing, R.~F.

Abstract

info:eu-repo/semantics/published

Published
2012

19. What results can be expected from the agenda for aid effectiveness? Analysis and application to Mali

Author

Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, Dujardin, Bruno, Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, and Dujardin, Bruno

Abstract

INTRODUCTION. Currently there is a climate of high expectations with regard to producing demonstrable results of aid effectiveness in the health sector. Yet, commitments to aid effectiveness have only partially been implemented so far. Existing evaluation frameworks developed in the context of the Paris Declaration and International Health Partnership (IHP+) are not sufficiently geared toward whether and how practices have changed at donor, central and operational levels, and thus how reforms have actually been implemented. Measuring their impact also presents methodological challenges.METHODSThis communication aims to present an outline of how to measure results from the agenda for aid effectiveness. It argues that it should be carried out at three levels. A first, critical step for evaluating the results from the Paris Declaration and IHP+ is to evaluate its implementation process and the direct effects it has had on changes in behaviour for all stakeholders (donors, government, service providers, etc.). A second level of evaluation is to assess how far donor support and implementation of Paris principles have contributed to health system strengthening (HSS) up to the level of service delivery. The third level where improvement is expected and should be measured is at health outcome/status level. Qualitative methods can help to understand what constraining factors are, what reforms have led to improvements and why, and finally the impact on population health.RESULTSThis three-level assessment was made in Mali. We found that some progress and positive changes have been observed in recent years that can be attributed to the agenda for aid effectiveness; outcome and impact indicators have also improved in the past years. However, donors have not fulfilled all their commitments.CONCLUSIONWhilst changes in behaviour and practices are occurring, adherence to the principles of aid effectiveness is far from complete, thus expectations should be realistic., FLWIN, info:eu-repo/semantics/published, s of the 7th European congress on tropical medicine and international health, Barcelone, Espagne, 3-6 octobre 2011

Published
2011

20. Can performance-based financing be used to reform health systems in developing countries?

Author

Ireland, Megan, Paul, Elisabeth, Dujardin, Bruno, Ireland, Megan, Paul, Elisabeth, and Dujardin, Bruno

Abstract

Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool to reform the health sector. We resist such a notion on the grounds that results-based and economically driven interventions do not, on their own, adequately respond to patient and community needs, upon which health system reform should be based. We also think the debate surrounding performance-based financing is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the performance-based financing package., (WHO Roundtable), SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2011

21. The evaluation of the Paris declaration on aid effectiveness: what does it tell us? What results for the health sector?

Author

European congress on tropical medicine and international health (3-6/10/2011: Barcelona), Martini, Jessica, Paul, Elisabeth, Ireland, Megan, Dujardin, Bruno, European congress on tropical medicine and international health (3-6/10/2011: Barcelona), Martini, Jessica, Paul, Elisabeth, Ireland, Megan, and Dujardin, Bruno

Abstract

Five years after the signing of the Paris Declaration on aid effectiveness by donors and developing countries, there is a climate of high expectations about the results achieved and the impact at sector level. Several evaluations and monitoring surveys have been conducted by the OECD to measure progress made so far in implementing the principles of ownership, alignment, harmonisation, results and mutual accountability. For the health sector, results have also been documented in the context of the International Health Partnership (IHP+). We critically reviewed all the aid effectiveness surveys and evaluations published since 2005 by the OECD and IHP+ so as to analyse what results have been achieved so far as well as the relevance of the frameworks used. To date, results of the implementation of the Paris Declaration are mixed. In the health sector, good progress has been achieved in terms of country ownership and coordination, while alignment and use of country systems, managing for results and mutual accountability lag behind. However, the results recorded often reflect different interpretation of the indicators depending on the respondent, the data available or the time of the survey. Making generalisations is therefore difficult and comparisons between country surveys and over time may not be appropriate. Linking progress in aid effectiveness with improvements in health outcomes is also controversial. Results from the evaluations of the Paris Declaration should be used with caution in the current debate about aid effectiveness. What do the indicators used actually tell us? How realistically can aggregated scores reflect complex issues such as aid effectiveness in different countries, by different donors and over time? Improved evaluation is clearly needed. Data collection should be more rigorous and at sector level contextual factors and behaviour change should be better assessed, over a longer term and through more qualitative comprehensive methods., info:eu-repo/semantics/published

Published
2011

22. What results can be expected from the agenda for aid effectiveness?

Author

7th European Congress on Tropical Medicine & International Health. (3-6/10/2011: Barcelone), Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, Dujardin, Bruno, 7th European Congress on Tropical Medicine & International Health. (3-6/10/2011: Barcelone), Paul, Elisabeth, Ireland, Megan, Martini, Jessica, Zinnen, Véronique, Ronse, Ignace, Samake, Salif, and Dujardin, Bruno

Abstract

Introduction: Currently there is a climate of high expectations with regard to producing demonstrable results of aid effectiveness in the health sector. Yet, commitments to aid effectiveness have only partially been implemented so far. Existing evaluation frameworks developed in the context of the Paris Declaration and International Health Partnership (IHP+) are not sufficiently geared toward whether and how practices have changed at donor, central and operational levels, and thus how reforms have actually been implemented. Measuring their impact also presents methodological challenges. Methods: This communication aims to present an outline of how to measure results from the agenda for aid effectiveness. It argues that it should be carried out at three levels. A first, critical step for evaluating the results from the Paris Declaration and IHP+ is to evaluate its implementation process and the direct effects it has had on changes in behaviour for all stakeholders (donors, government, service providers, etc.). A second level of evaluation is to assess how far donor support and implementation of Paris principles have contributed to health system strengthening (HSS) up to the level of service delivery. The third level where improvement is expected and should be measured is at health outcome/status level. Qualitative methods can help to understand what constraining factors are, what reforms have led to improvements and why, and finally the impact on population health. Results: This three-level assessment was made in Mali. We found that some progress and positive changes have been observed in recent years that can be attributed to the agenda for aid effectiveness; outcome and impact indicators have also improved in the past years. However, donors have not fulfilled all their commitments. Conclusion: Whilst changes in behaviour and practices are occurring, adherence to the principles of aid effectiveness is far from complete, thus expectations should be realistic., info:eu-repo/semantics/nonPublished

Published
2011

23. Avantages et difficultés de l'intégration des programmes verticaux et horizontaux

Author

Fometro :Un demi siècle d'assistance médicale. Passé et Avenir de la Coopération Belge en Afrique Centrale (11 Juin 2010: Bruxelles), Dujardin, Bruno, Ireland, Megan, Fometro :Un demi siècle d'assistance médicale. Passé et Avenir de la Coopération Belge en Afrique Centrale (11 Juin 2010: Bruxelles), Dujardin, Bruno, and Ireland, Megan

Abstract

info:eu-repo/semantics/nonPublished

Published
2010

24. Improved aid effectiveness but waiting for results: What are the missing links?

Author

Global symposium on health system research (1: 16-19 novembre 2010: Montreux, Suisse), Paul, Elisabeth, Martini, Jessica, Ireland, Megan, Dujardin, Bruno, Global symposium on health system research (1: 16-19 novembre 2010: Montreux, Suisse), Paul, Elisabeth, Martini, Jessica, Ireland, Megan, and Dujardin, Bruno

Abstract

Session parallèle: "The Paris Declaration on aid effectiveness and sector wide approaches", 17 novembre 2010, info:eu-repo/semantics/nonPublished

Published
2010

25. Improved aid effectiveness but waiting for results: What are the missing links?

Author

Global Symposium on Health Sytem Research (1: 16-19 Novembre 2010: Montreux, Suisse), Paul, Elisabeth, Martini, Jessica, Ireland, Megan, Dujardin, Bruno, Global Symposium on Health Sytem Research (1: 16-19 Novembre 2010: Montreux, Suisse), Paul, Elisabeth, Martini, Jessica, Ireland, Megan, and Dujardin, Bruno

Abstract

info:eu-repo/semantics/nonPublished

Published
2010

26. Research methods for evaluating the influence of international aid policies on health systems functioning

Author

Global Symposium on Health Sytem Research (1: 16-19 Novembre 2010: Montreux, Suisse), Dujardin, Bruno, Martini, Jessica, Ireland, Megan, Zinnen, Véronique, Macq, Jean, Ribesse, Nathalie, Paul, Elisabeth, Global Symposium on Health Sytem Research (1: 16-19 Novembre 2010: Montreux, Suisse), Dujardin, Bruno, Martini, Jessica, Ireland, Megan, Zinnen, Véronique, Macq, Jean, Ribesse, Nathalie, and Paul, Elisabeth

Abstract

info:eu-repo/semantics/nonPublished

Published
2010

29. Teacher attitudes toward inclusion

Author

Ireland, Megan E.

Subjects
Inclusive education; Middle school teachers--Attitudes, Educational Psychology
Abstract

The purpose of this study was to examine the type of attitude towards inclusion that exists among regular classroom teachers, special education teachers, and specialist teachers in a middle school setting. Seventy-one subjects – forty-nine regular classroom teachers, ten special education teachers, and twelve specialist teachers – from a suburban New Jersey community were studied. Participants were given the Survey of Attitudes Toward the Inclusion of Students with Special Needs, a twenty item Likert-type scale. Data was analyzed using a one-way ANOVA and the Games-Howell post hoc test. Findings suggest that regular and specialist teachers believed that inclusion results in a lower amount of positive effects on children and setting than special education teachers. Regular and specialist teachers also held significantly higher attitudes in regard to the negative effects of inclusion on children and believed that inclusion results in a higher amount of workload for teachers. Significant results were also found regarding differences between teaching experience and attitudes toward inclusion. Those with more experience held significantly lower beliefs on the positive effects of inclusion, higher beliefs on the negative effects of inclusion, and higher beliefs on the amount of workload resulting from inclusion than those with less experience.

Published
2002

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