Explore the vast range of titles available.

Background Since the advent of democracy, the South African government has been putting charters, policies, strategies and plans in place in an effort to strengthen public health system performance and enhance service delivery. However, public health programme performance and outcomes remained poor while the burden of disease increased. This was also the case in the Free State Province, where major public health system challenges occurred around 2012. Assessment was necessary in order to inform health system strengthening. Methods The study entailed a multi-method situation appraisal utilising information collated in 44 reports generated in 2013 through presentations by unit managers, subdistrict assessments by district clinical specialist teams, and group discussions with district managers, clinic supervisors, primary health care managers and chief executive and clinical officers of hospitals. These data were validated through community and provincial health indabas including non-governmental organisations, councils and academics, as well as unannounced facility visits involving discussions with a wide range of functionaries and patients. The reports were reviewed using the World Health Organization health system building blocks as a priori themes with subsequent identification of emerging subthemes. Data from the different methods employed were triangulated in a causal loop diagram showing the complex interactions between the components of an (in) effective health system. Results The major subthemes or challenges that emerged under each a priori theme included: firstly, under the ‘ service delivery ’ a priori theme, ‘ fragmentation of health services ’ (42 reports); secondly, under the ‘ health workforce ’ a priori theme, ‘ staff shortages ’ (39 reports); thirdly, under the ‘ health financing ’ a priori theme, ‘ financial/cash-flow problems ’ (39 reports); fourthly, under the ‘ leadership and governance ’ a priori theme, ‘ risk to patient care ’ (38 reports); fifthly, under the ‘ medical products/technologies ’ a priori theme, ‘ dysfunctional communication technology ’ (27 reports); and, sixthly, under the ‘ information ’ a priori theme, ‘ poor information management ’ (26 reports). Conclusion The major overall public health system challenges reported by stakeholders involved fragmentation of services, staff shortages and financial/cash-flow problems. In order to effect health systems strengthening there was particularly a need to improve integration and address human and financial deficiencies in this setting.

The goal of this mixed-methods study was to identify and compare the key capacity considerations regarding public health system resilience before and after the 2023 Türkiye-Syria earthquakes. Public health system resilience was assessed through online and face-to-face workshops using the United Nations Public Health System Resilience Scorecard. The pre-earthquake evaluation was conducted in Istanbul and Trabzon in 2021; the post-earthquake evaluation took place in Hatay and Kahramanmaraş in 2023, with a total of 41 participants each. The online workshops lasted approximately four days, while the face-to-face workshops lasted one day. The study found a significant decrease in the scores for most scorecard resilience indicators in the post-earthquake assessment. Qualitative analysis showed that this decline was largely due to infrastructure collapse. Additionally, defining the roles of health disciplines in disaster management and having data transmission procedures between public health system stakeholders in disasters were among the main capacity considerations in both the pre-and post-earthquake assessments. The post-earthquake evaluation revealed several capacity gaps that had not been addressed in pre-earthquake assessments in areas such as disaster preparedness of vulnerable populations and logistics. The findings highlight the critical importance of strengthening building stock and infrastructure to establish a disaster-resilient public health system.

\"Donors, leaders of nonprofits, and public policy makers usually have the best of intentions to serve society and improve social conditions. But often their solutions fall far short of what they want to accomplish and what is truly needed. Moreover, the answers they propose and fund often produce the opposite of what they want over time. We end up with temporary shelters that increase homelessness, drug busts that increase drug-related crime, or food aid that increases starvation. How do these unintended consequences come about and how can we avoid them? By applying conventional thinking to complex social problems, we often perpetuate the very problems we try so hard to solve, but it is possible to think differently, and get different results. Systems Thinking for Social Change enables readers to contribute more effectively to society by helping them understand what systems thinking is and why it is so important in their work. It also gives concrete guidance on how to incorporate systems thinking in problem solving, decision making, and strategic planning without becoming a technical expert. Systems thinking leader David Stroh walks readers through techniques he has used to help people end homelessness and increase affordable housing, improve public health, strengthen public education and access to early childhood development services, protect child welfare, reform the criminal justice system, resolve identity-based conflicts, and more. The result is a highly readable, effective guide to understanding systems and using that knowledge to get the results you want\"-- Provided by publisher.

In order to seek the optimal time-profiles of public health systems (PHS) Intervention to favor vaccine propensity, we apply optimal control (OC) to a SIR model with voluntary vaccination and PHS intervention. We focus on short-term horizons, and on both continuous control strategies resulting from the forward–backward sweep deterministic algorithm, and piecewise-constant strategies (which are closer to the PHS way of working) investigated by the simulated annealing (SA) stochastic algorithm. For childhood diseases, where disease costs are much larger than vaccination costs, the OC solution sets at its maximum for most of the policy horizon, meaning that the PHS cannot further improve perceptions about the net benefit of immunization. Thus, the subsequent dynamics of vaccine uptake stems entirely from the declining perceived risk of infection (due to declining prevalence) which is communicated by direct contacts among parents, and unavoidably yields a future decline in vaccine uptake. We find that for relatively low communication costs, the piecewise control is close to the continuous control. For large communication costs the SA algorithm converges towards a non-monotone OC that can have oscillations.

\"The American Society of Civil Engineers has, in its latest report, given American roads and bridges a grade of D and C+, respectively, and has described roughly sixty-five thousand bridges in the United States as 'structurally deficient.' This crisis--and one need look no further than the I-35W bridge collapse in Minnesota to see that it is indeed a crisis--shows little sign of abating short of a massive change in attitude amongst politicians and the American public. In [this book], ... historian Henry Petroski explores our core infrastructure from historical and contemporary perspectives and explains how essential their maintenance is to America's economic health\"-- Provided by publisher.

Knowledge of interfering noise is necessary for the correct design of a public address system. Noise sound levels can be obtained, for example, from BS 5389-1. It is more difficult to acquire knowledge of the interfering noise spectra, and the spectrum is also important for calculating speech intelligibility. As shown in the paper, for crowd noise, it is possible to determine the spectrum by pairing the level of noise to the speech spectrum for appropriate vocal effort. The error in determining the speech transmission index for public address systems for such selected noise spectra, relative to values for measurement-acquired noise spectra, is acceptable.

To precision calculate the speech transmission index (STI), it is necessary to know the level and spectrum of the interfering noise. Simplified design methods used in public address systems are limited to obtaining an appropriate signal-to-noise ratio based on A weighted sound levels. For this reason, among others, guidelines for designers usually contain information on typical interfering noise levels and do not provide information on the noise spectrum. As shown in the paper, the effect of the noise spectrum on STI can be very high, and when such spectrum cannot be obtained by measurement or computation, standardised spectra appropriate for a given type of noise can be used for STI calculations.