A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care

Background: Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. Methods. An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). Results: The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n=45), episodic care (n=19), and chronic disease management (n=11). They were undertaken in a number of countries including Australia (n=25), USA (n=25), and UK (n=15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n=46 studies) or as a combination of two (n=20) or more strategies (n=9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n=43 studies), patient support (n=29), provision of new services (n=19), workforce development (n=11), and financial incentives (n=9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results. Conclusions: This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these. © 2012 Comino et al.; licensee BioMed Central Ltd

FiberGLAST: a scintillating fiber approach to the GLAST mission

FiberGLAST is a scintillating fiber gamma-ray detector designed for the GLAST mission. The system described below provides superior effective area and field of view for modest cost and risk. An overview of the FiberGLAST instrument is presented, as well as a more detailed description of the principle elements of the primary detector volume. The triggering and readout electronics are described, and Monte Carlo Simulations of the instrument performance are presented

Possible structure in the cosmic ray electron spectrum measured by the ATIC-2 and ATIC-4 experiments

A strong excess in a form of a wide peak in the energy range of 300-800 GeV was discovered in the first measurements of the electron spectrum in the energy range from 20 GeV to 3 TeV by the balloon-borne experiment ATIC (J. Chang et al. Nature, 2008). The experimental data processing and analysis of the electron spectrum with different criteria for selection of electrons, completely independent of the results reported in (J. Chang et al. Nature, 2008) is employed in the present paper. The new independent analysis generally confirms the results of (J. Chang et al. Nature, 2008), but shows that the spectrum in the region of the excess is represented by a number of narrow peaks. The measured spectrum is compared to the spectrum of (J. Chang et al. Nature, 2008) and to the spectrum of the Fermi/LAT experiment.Comment: LaTeX2e, 10 pages, 4 figures, a paper for ECRS 2010 (Turku, Finland); http://www.astrophys-space-sci-trans.net/7/119/2011

Beam test results for the FiberGLAST instrument

The FiberGLAST scintillating fiber telescope is a large-area instrument concept for NASA\u27s GLAST program. The detector is designed for high-energy gamma-ray astronomy, and uses plastic scintillating fibers to combine a photon pair tracking telescope and a calorimeter into a single instrument. A small prototype detector has been tested with high energy photons at the Thomas Jefferson National Accelerator Facility. We report on the result of this beam test, including scintillating fiber performance, photon track reconstruction, angular resolution, and detector efficiency

Development and testing of a fiber/multianode photomultiplier system for use on FiberGLAST

A scintillating fiber detector is currently being studied for the NASA Gamma-Ray Large Area Space Telescope (GLAST) mission. This detector utilizes modules composed of a thin converter sheet followed by an x, y plane of scintillating fibers to examine the shower of particles created by high energy gamma-rays interacting in the converter material. The detector is composed of a tracker with 90 such modular planes and a calorimeter with 36 planes. The two major component of this detector are the scintillating fibers and their associated photodetectors. Here we present current status of development and test result of both of these. The Hamamatsu R5900-00-M64 multianode photomultiplier tube (MAPMT) is the baseline readout device. A characterization of this device has been performed including noise, cross- talk, gain variation, vibration, and thermal/vacuum test. A prototype fiber/MAPMT system has been tested at the Center for Advanced Microstructures and Devices at Louisiana State University with a photon beam and preliminary results are presented

Reduced sediment supply in a fast eroding landscape? A multi-proxy sediment budget of the upper Rhone basin, Central Alps

Alpine water and sediment supply influence the sediment budget of many important European fluvial systems such as the Rhine, Rhône and Po rivers. In the light of human induced climate change and landscape modification, it becomes increasingly important to understand the mechanisms of sediment production and supply in Alpine sediment systems. This study aims to investigate the modern sediment budget of the upper Rhône basin, one of the largest Alpine intramontane watersheds, located in the Central Alps of southwestern Switzerland. Major areas of sediment generation are fingerprinted by framework petrography, heavy mineral concentrations and bulk geochemistry. The relative contributions of the three major sources to the sediment of the trunk Rhône river are identified by compositional mixing modelling. Concentrations of the terrestrial cosmogenic nuclide 10Be measured in quartz separated from fluvial sediments provide spatially averaged denudation rates for selected tributary basins. Results from sediment fingerprinting and mixing modelling suggest that tributaries located in the North and the East of the catchment are generating most of the sediment transported by the Rhône river to its primary sedimentary sink in Lake Geneva. Despite having some of the highest denudation rates within the basin, tributaries located in the southern area of the Rhône basin are relatively underrepresented in the sediment budget of the Rhône river. These tributaries are severely affected by human activities, for example through sediment mining as well as water and sediment abstraction in large hydropower reservoirs. Together, these processes reduce the basin-wide sediment discharge by about 50%, thereby explaining most of the observed compositional pattern. In addition, there is evidence suggesting that large amounts of glaciogenic sediments are currently supplied by retreating glaciers. Glaciogenic material with its low 10Be concentrations can lead to a significant overestimation of denudation rates and thus limit the applicability of cosmogenic nuclide analysis in such glaciated settings

Interpreting ambiguous ‘trace’ results in Schistosoma mansoni CCA Tests: Estimating sensitivity and specificity of ambiguous results with no gold standard

Background The development of new diagnostics is an important tool in the fight against disease. Latent Class Analysis (LCA) is used to estimate the sensitivity and specificity of tests in the absence of a gold standard. The main field diagnostic for Schistosoma mansoni infection, Kato-Katz (KK), is not very sensitive at low infection intensities. A point-of-care circulating cathodic antigen (CCA) test has been shown to be more sensitive than KK. However, CCA can return an ambiguous ‘trace’ result between ‘positive’ and ‘negative’, and much debate has focused on interpretation of traces results. Methodology/Principle findings We show how LCA can be extended to include ambiguous trace results and analyse S. mansoni studies from both Côte d’Ivoire (CdI) and Uganda. We compare the diagnostic performance of KK and CCA and the observed results by each test to the estimated infection prevalence in the population. Prevalence by KK was higher in CdI (13.4%) than in Uganda (6.1%), but prevalence by CCA was similar between countries, both when trace was assumed to be negative (CCAtn: 11.7% in CdI and 9.7% in Uganda) and positive (CCAtp: 20.1% in CdI and 22.5% in Uganda). The estimated sensitivity of CCA was more consistent between countries than the estimated sensitivity of KK, and estimated infection prevalence did not significantly differ between CdI (20.5%) and Uganda (19.1%). The prevalence by CCA with trace as positive did not differ significantly from estimates of infection prevalence in either country, whereas both KK and CCA with trace as negative significantly underestimated infection prevalence in both countries. Conclusions Incorporation of ambiguous results into an LCA enables the effect of different treatment thresholds to be directly assessed and is applicable in many fields. Our results showed that CCA with trace as positive most accurately estimated infection prevalence

Energy dependence of Ti/Fe ratio in the Galactic cosmic rays measured by the ATIC-2 experiment

Titanium is a rare, secondary nucleus among Galactic cosmic rays. Using the Silicon matrix in the ATIC experiment, Titanium has been separated. The energy dependence of the Ti to Fe flux ratio in the energy region from 5 GeV per nucleon to about 500 GeV per nucleon is presented.Comment: 8 pages, 4 figures, accepted for publication in Astronomy Letter

POEMMA: Probe Of Extreme Multi-Messenger Astrophysics

The Probe Of Extreme Multi-Messenger Astrophysics (POEMMA) mission is being designed to establish charged-particle astronomy with ultra-high energy cosmic rays (UHECRs) and to observe cosmogenic tau neutrinos (CTNs). The study of UHECRs and CTNs from space will yield orders-of-magnitude increase in statistics of observed UHECRs at the highest energies, and the observation of the cosmogenic flux of neutrinos for a range of UHECR models. These observations should solve the long-standing puzzle of the origin of the highest energy particles ever observed, providing a new window onto the most energetic environments and events in the Universe, while studying particle interactions well beyond accelerator energies. The discovery of CTNs will help solve the puzzle of the origin of UHECRs and begin a new field of Astroparticle Physics with the study of neutrino properties at ultra-high energies.Comment: 8 pages, in the Proceedings of the 35th International Cosmic Ray Conference, ICRC217, Busan, Kore

The Electron Calorimeter (ECAL) Long Duration Balloon Experiment

Accurate measurements of the cosmic ray electron energy spectrum in the energy region 50 GeV to greater than 1 TeV may reveal structure caused by the annihilation of exotic dark matter particles and/or individual cosmic ray sources. Here we describe a new long duration balloon (LDB) experiment, ECAL, optimized to directly measure cosmic ray electrons up to several TeV. ECAL includes a double layer silicon matrix, a scintillating optical fiber track imager, a neutron detector and a fully active calorimeter to identify more than 90% of the incident electrons with an energy resolution of about 1.7% while misidentifying only 1 in 200,000 protons and 0.8% of secondary gamma rays as electrons. Two ECAL flights in Antarctica are planned for a total exposure of 50 days with the first flight anticipate for December 2009