eRegistries: Electronic registries for maternal and child health.

BACKGROUND: The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women's, Children's and Adolescent's Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. METHODS: In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005-2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. RESULTS: eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. CONCLUSIONS: Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children.

What Does It Take to Be an Effective National Steward of Digital Health Integration for Health Systems Strengthening in Low- and Middle-Income Countries?

BACKGROUND: Digital innovations have evolved over the last 15 years to support health activities, and their introduction in low- and middle-income countries has shown the potential to catalyze gains in health systems and service delivery. Despite widespread efforts to roll out these technologies, standardized approaches for formalizing national stewardship responsibilities and ensuring that digital health is a routine, mature, sustainable, and country-owned component of the health system are lacking. In this paper, we define digital health stewardship, with a focus on the ministry of health's role; describe practices undertaken to date; and identify gaps where increased attention could improve sustainability, impact, and local ownership. METHODS: We conducted a purposeful review of peer-reviewed and gray literature. Of the 404 identified resources from the peer-reviewed literature, 12 met all of the inclusion criteria. After searching various online gray literature repositories, we identified 6 sources based on their quality, source, and relevance. Selected resources were abstracted for relevance to our stewardship themes and synthesized. RESULTS: Findings are presented in 4 broad thematic areas: strategic direction, policies and procedures, roles and responsibilities, and health service delivery implications. Evidence related to strategic direction offers guidance on the main responsibilities under digital health stewardship, including regulations and incentives to promote compliance with standards, mechanisms for oversight, and structures to support evidence-based decisions, and the potential institutional structures and goals that could be used to achieve them. A number of examples of high-level policies and implementation-oriented procedures, such as from the European Commission and the World Health Organization, demonstrate how to operationalize the strategic direction. Available evidence for the remaining themes was sparse, drawing attention to key areas for future work. CONCLUSIONS: Despite the importance of country-owned stewardship of digital health, the guidance available is limited and aspirational. Concrete recommendations, including how to adapt existing innovations to the local context, are needed. In particular, the role of external partners needs to be oriented toward building and supporting country capacity to achieve digital health stewardship's potential to support health systems into the future.

Rovibrational energy transfer in the 4nu CH manifold of acetylene viewed by IR-UV double resonance spectroscopy. 2. Perturbed states with J = 17 and 18.

Collision-induced state-to-state molecular energy transfer between rovibrational states in the 12,700 cm(-1) 4nu(CH) manifold of the electronic ground state X of acetylene (C(2)H(2)) is monitored by time-resolved infrared-ultraviolet double resonance (IR-UV DR) spectroscopy. Rotational J-states associated with the (nu(1) + 3nu(3)) or (1 0 3 0 0)(0) vibrational combination level, initially prepared by an IR pulse, are probed at approximately 299, approximately 296, or approximately 323 nm with UV laser-induced fluorescence via the Alpha electronic state. The rovibrational J-states of interest belong to a congested manifold that is affected by anharmonic, l-resonance, and Coriolis couplings, yielding complex intramolecular dynamics. Consequently, collision-induced rovibrational satellites observed by IR-UV DR comprise not only regular even-DeltaJ features but also supposedly forbidden odd-DeltaJ features. A preceding paper (J. Phys. Chem. A 2003, 107, 10759) focused on low-J-value rovibrational levels of the 4nu(CH) manifold (particularly those with J = 0 and J = 1) whereas this paper examines locally perturbed states at higher values of J (particularly J = 17 and 18, which display anomalous doublet structure in IR-absorption spectra). Three complementary forms of IR-UV DR experiments (IR-scanned, UV-scanned, and kinetic) are used to address the extent to which intramolecular perturbations influence the efficiency of J-resolved collision-induced energy transfer with both even and odd DeltaJ.

Rovibrational energy transfer in the 4nuCH manifold of acetylene, viewed by IR-UV double resonance spectroscopy. 5. Detailed kinetic model.

Time-resolved infrared-ultraviolet double resonance (IR-UV DR) spectroscopy provides a distinctive way to examine collision-induced state-to-state energy transfer between rotational J-levels in vibrational manifolds of small polyatomic molecules, such as acetylene (C2H2) in its electronic ground state X. We consider the 4nuCH rovibrational manifold of C2H2 at approximately 12,700 cm(-1), where the principal source of IR-brightness is the (nu1+3nu3) or (1 0 3 0 0)0 Sigma+u vibrational combination level. In this highly congested manifold, anharmonic, l-resonance, and Coriolis couplings affect the J-levels of interest, implicating them in a complicated variety of intramolecular dynamics. Previous papers of this series have reported several seemingly anomalous J-resolved phenomena induced by collisions in C2H2 gas at room temperature with pressures and IR-UV pump-probe delay intervals corresponding to remarkably high Lennard-Jones collisional efficiencies P: odd-DeltaJ rotational energy transfer (10(-3)

Rovibrational energy transfer in the 4nu(CH) manifold of acetylene, viewed by IR-UV double-resonance spectroscopy. 4. Collision-induced quasi-continuous background effects.

The 4nu(CH) rovibrational manifold around 12 700 cm(-1) in the electronic ground state, X, of acetylene (C2H2) is monitored by time-resolved infrared-ultraviolet double-resonance (IR-UV DR) spectroscopy. An IR laser pulse initially prepares rotational J states, associated with the "IR-bright" (nu1 + 3nu3) or (1 0 3 0 0)0 vibrational combination level, and subsequent collision-induced state-to-state energy transfer is probed by UV laser-induced fluorescence. Anharmonic, l-resonance, and Coriolis couplings affect the J states of interest, resulting in a congested rovibrational manifold that exhibits complex intramolecular dynamics. In preceding papers in this series, we have described three complementary forms of the IR-UV DR experiment (IR-scanned, UV-scanned, and kinetic) on collision-induced rovibrational satellites, comprising both regular even-DeltaJ features and unexpected odd-DeltaJ features. This paper examines an unusual collision-induced quasi-continuous background (CIQCB) effect that is apparently ubiquitous, accompanying regular even-DeltaJ rovibrational energy transfer and accounting for much of the observed collision-induced odd-DeltaJ satellite structure; certain IR-bright (1 0 3 0 0)0 rovibrational states (e.g., J = 12) are particularly prominent in this regard. We examine the mechanism of this CIQCB phenomenon in terms of a congested IR-dark rovibrational manifold that is populated by collisional transfer from the nearly isoenergetic IR-bright (1 0 3 0 0)0 submanifold.