Scorecards and social accountability for improved maternal and newborn health services: a pilot in the Ashanti and Volta regions of Ghana

Background: With the limited availability of quality emergency obstetric and newborn care (EmONC) in Ghana, and a lack of dialogue on the issue at district level, the Evidence for Action (E4A) program (2011-2015) initiated a pilot intervention using a social accountability approach in two regions of Ghana. Objective: Using scorecards to assess and improve maternal and newborn health services, the intervention study evaluated the effectiveness of engaging multiple, health and non-health sector stakeholders at district level to improve the enabling environment for quality EmONC. Methods: The quantitative study component comprised two rounds of assessments in 37 health facilities. The qualitative component is based on an independent prospective policy study. Results: Results show a marked growth in a culture of accountability, with heightened levels of community participation, transparency, and improved clarity of lines of accountability among decision-makers. The breadth and type of quality of care improvements were dependent on the strength of community and government engagement in the process, especially in regard to more complex systemic changes. Conclusion: Engaging a broad network of stakeholders to support MNH services has great potential if implemented in ways that are context-appropriate and that build around full collaboration with government and civil society stakeholders

Linguistic Features of Uzbek

This poster provides a preliminary description of the linguistic features of Uzbek, the official language of Uzbekistan. Uzbek is characterized as an Eastern Turkic language within the Altaic language family and, although it is spoken by over 18 million people around the world, it is highly under-documented in linguistic literature. Over the course of a semester, our group met with a native speaker of Uzbek to document the phonological, morphological, and syntactic features of the language. This analysis, along with recordings made by our group, serves the greater linguistic community by providing theoretical linguists with new language data to support their research

Mineralogy of sulfides

Metal sulphides are the most important group of ore minerals. As shown in this brief introduction, much is known about their compositions, crystal structures, phase relations and paragenesis. Much less is known about their surface chemistry and, in particular, about their biogeochemistry, and about the formation and behaviour of ‘nanoparticle’ sulphides, whether formed abiotically or biogenically. These are large and complex topics which can only be touched upon in this article which also serves to direct readers to more comprehensive accounts

Seeking Abraham: A Report of Furman University\u27s Task Force on Slavery and Justice

After more than a year of study, the Furman University Task Force on Slavery and Justice presents its findings in this report. The report includes the Task Force’s values and process, a presentation of the history of Furman’s early ties to slavery, a number of short vignettes by individual Task Force members, and a number of recommendations for the university to address. Members of the Task Force represent diverse students and alumni, as well as faculty and staff. The report is the result of commissioning a history, activating student research projects, hosting scholars who consulted with the Task Force, creating oral histories and curating viewpoints, and attending Universities Studying Slavery, a consortium headquartered at the University of Virginia with more than 40 international colleges and universities. The university has made a commitment to serious consideration of the entire report

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Multiculturalism on Hadrian’s Wall

This chapter considers notions of multiculturalism in the frontier zone of Hadrian’s Wall. Beginning with a consideration of what we understand by multiculturalism when applied to the past, the chapter examines how identities were constructed, adopted, and projected in the frontier zone. Ways of understanding identity through materiality are investigated, and case studies reveal the ways in which individuals projected their identity in life and in death. The chapter considers how concepts of otherness can be seen to influence the reaction of individuals and groups in terms of consciously exhibiting their identity in a multicultural space. Military identities are considered together with how these overlap with the complex identities of people in a frontier zone

Multiculturalism on Hadrian’s Wall

This chapter considers notions of multiculturalism in the frontier zone of Hadrian’s Wall. Beginning with a consideration of what we understand by multiculturalism when applied to the past, the chapter examines how identities were constructed, adopted, and projected in the frontier zone. Ways of understanding identity through materiality are investigated, and case studies reveal the ways in which individuals projected their identity in life and in death. The chapter considers how concepts of otherness can be seen to influence the reaction of individuals and groups in terms of consciously exhibiting their identity in a multicultural space. Military identities are considered together with how these overlap with the complex identities of people in a frontier zone