Background: A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and nonfinancial incentives on motivation and retention.

BackgroundObesity has become a world-wide epidemic and is spreading to countries with emerging economies. Previously tested interventions are often too costly to maintain in the long term. This leaves a need for improved strategies for management of the epidemic. Nudge Theory presents a new collection of methods, deemed “nudges”, which have the potential for low-cost and broad application to guide healthier lifestyle choices without the need for restrictive regulation. There has not yet been a large-scale examination of the effectiveness of nudges, despite several policy making bodies now considering their use.MethodsTo address this gap in knowledge, an adapted systematic review methodology was used to collect and consolidate results from current Nudge papers and to determine whether Nudge strategies are successful in changing adults’ dietary choices for healthier ones.ResultsIt was found that nudges resulted in an average 15.3 % increase in healthier dietary or nutritional choices, as measured by a change in frequency of healthy choices or a change in overall caloric consumption. All of the included studies were from wealthy nations, with a particular emphasis on the United States with 31 of 42 included experiments.ConclusionsThis analysis demonstrates Nudge holds promise as a public health strategy to combat obesity. More research is needed in varied settings, however, and future studies should aim to replicate previous results in more geographically and socioeconomically diverse countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3272-x) contains supplementary material, which is available to authorized users.

BackgroundJob satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies.ObjectiveThe objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa.MethodsWe undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave.ResultsThere were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave.ConclusionsWe have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date.

Background: There is growing evidence that informal payments for health care are fairly common in many low-and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention.

A Galerkin finite element formulation is developed for the numerical simulation of water flow in variably saturated soil systems. Included in this formulation is a solution strategy based on Picard and Newton‐Raphson algorithms. Both algorithms are designed especially to cope with severely nonlinear field problems. The two algorithms are formulated for both rectangular and triangular elements. The element matrices are evaluated in a simple and efficient manner using a technique referred to as the “influence coefficient” technique. This technique avoids numerical integration and leads to a substantial saving of computational cost. Four examples are presented to demonstrate the effectiveness of the present finite element approach. These examples show that the nonlinear solution schemes are capable of accomodating cases involving large variations in the saturated hydraulic conductivity, as well as highly nonlinear soil moisture characteristics. A comparative study of the Picard and the Newton‐Raphson algorithms is also provided. The study indicates that despite the higher cost per iteration of the Newton‐Raphson scheme, it usually requires a substantially smaller number of iterations than the Picard scheme. In some instances where convergence difficulties are experienced with the latter scheme, it is desirable to use the Newton‐Raphson scheme in order to obtain a cost‐effective solution to the problem.

The widespread collection of unofficial fees at health facilities is a common form of rent-seeking behaviour in Bangladesh. Typically, unofficial fees come in the form of cash payments for the performance of required services, for direct purchase of drugs and medical-surgical requisites, and for service access. Using observational and interview methods, this study explores linkages between official and unofficial fees at three Bangladesh health facility levels; primary care Thana Health Complexes, secondary or district hospitals, and medical college hospitals. The study estimates payment levels for different income classes and different payor types at these facilities, thereby highlighting potential equity, price and institutional questions associated with unofficial fees. Not only does the practice have clear income and equity effects, there also appear to be direct effects upon patient satisfaction, perception of quality, and the ability to pay for health services. The article concludes with a discussion of 'rent capture' processes at Bangladesh facilities and the effect of unofficial fees in six areas of health sector reform: displaced official policies, reduced merit goods production, upward income redistribution, distorted human resource development, growth of facility inefficiency, and obstruction of market reforms.

An extensive programme of research into the influence of undissolved gas bubbles on the behaviour of fine-grained onshore soils is reviewed. The programme has been based on the development of a laboratory technique for the preparation of reconstituted soil samples containing a uniform distribution of gas bubbles. The structure of these samples is similar to that observed in sediment recovered from the sea bed, and consists of large gas-filled cavities surrounded by a matrix of saturated soil. It is found that surface tension effects limit the difference between gas pressure and pore water pressure, and that the overall void size is effectively a function of the strength of the matrix, so that changes in void volume may be modelled by cavity expansion and contraction in an ideal plastic medium, leading to limits on the difference between gas pressure and mean total stress. A new parameter, operative stress, is shown to influence both the consolidation and the strength of these gassy soils. Thus, during consolidation, the gas volume is controlled by the total stress and the water volume by the operative stress; the undrained shear strength may be increased or decreased by the presence of the gas, depending on the specific values of total stress and operative stress. The operative stress for a gassy soil may therefore be seen as being analogous in its definition (total stress minus pore water pressure) to the effective stress for a saturated soil, but different from the effective stress in that it does not, on its own, control the strains and strength. Gas bubbles are shown to have a major influence on the acoustic behaviour of fine-grained offshore soils. L'article passe en revue un programme de grande envergure pour étudier l'influence exercée par des bulles de gaz non-dissoutes sur le comportement des sols à grains fins en mer. Le programme a été basé sur le développement d'une technique de laboratoire pour la préparation d'échantillons de sols reconstitués comprenant une distribution uniforme de bulles de gaz. La structure de ces échantillons ressemble à celle observée dans des sédiments obtenus au fond de la mer, comprenant de grandes cavités remplies de gaz entourées d'une matrice de sol saturé. Il a été trouvé que des effets de tension superficielle limitent la différence entre la pression du gaz et la pression de l'eau interstitielle et aussi que la valeur totale des vides dépend effectivement de la résistance de la matrice, de sorte que des changements dans le volume des vides peuvent être modelesés par l'expansion et la contraction des cavités dans un milieu idéal plastique, conduisant à des limites sur la différence entre la pression du gaz et la contrainte totale moyenne. On démontre la façon dont cette différence représente un nouveau paramètre (contrainte effective) qui influence à la fois la consolidation et la résistance de ces sols gazeux. Par exemple, pendant la consolidation le volume de gaz est contrôlé par la contrainte totale, tandis que le volume d'eau est contrôlé par cette contrainte effective. Selon les valeurs spécifiques de la contrainte totale et de la contrainte effective la résistance au cisaillement non-drainé peut être augmentée ou diminuée par la présence du gaz. On peut alors considérer que cette définition de la contrainte effective dans le cas d'un sol gazeux (contrainte totale moins pression d'eau interstitielle) est analogue à la contrainte effective pour un sol saturé mais diffère de celle-ci en ce qu'elle seul ne contrôle pas les déformations ni la résistance. On démontre que les bulles de gaz exercent une influence très importante sur le comportement acoustique des sols à grains fins en mer.

The average construction time of the 34 units that started up in the world between 2003 and July 2013 was 9.4 years. Reactor Status and Nuclear Programs • Startups and Shutdowns. Only three reactors started up in 2012, while six were shut down 10 and in 2013 up to 1 July, only one started up, while four shutdown decisions-all in the U.S.-were taken in the first half of 2013. 11 Three of those four units faced costly repairs, but one, Kewaunee, Wisconsin, was running well and had received a license renewal just two years ago to operate up to a total of 60 years; it simply became uneconomic to run. As of 1 July 2013, there were only two reactors operating in Japan and how many others will receive permission to restart and over what timeframe remains highly uncertain. • Newcomer Program Delays. Engagement in nuclear programs has been delayed by most of the potential newcomer countries, including Bangladesh,