Strengthening the Healthy Start Workforce: A Mixed-Methods Study to Understand the Roles of Community Health Workers in Healthy Start and Inform the Development of a Standardized Training Program

Introduction Healthy Start (HS) is dedicated to preventing infant mortality, improving birth outcomes, and reducing disparities in maternal and infant health. In 2014, the HS program was reenvisioned and standardization of services and workforce development were prioritized. This study examined how HS community health workers (CHW), as critical members of the workforce, serve families and communities in order to inform the development of a CHW training program to advance program goals. Methods In 2015, an online organizational survey of all 100 HS programs was conducted. Ninety-three sites (93%) responded. Three discussion groups were subsequently conducted with HS CHWs (n = 21) and two discussion groups with HS CHW trainers/supervisors (n = 14). Results Most (91%) respondent HS programs employed CHWs. Survey respondents ranked health education (90%), assessing participant needs (85%), outreach/recruitment (85%), and connecting participants to services (85%) as the most central roles to the CHW’s job. Survey findings indicated large variation in CHW training, both in the amount and content provided. Discussion group findings provided further examples of the knowledge and skills required by HS CHWs. Conclusions The study results, combined with a scan of existing competencies, led to a tailored set of competencies that serve as the foundation for a HS CHW training program. This training program has the capacity to advance strategic goals for HS by strengthening HS CHWs’ capacity nationwide to respond to complex participant needs. Other maternal and child health programs may find these results of interest as they consider how CHWs could be used to strengthen service delivery. Keywords: Healthy start; Community health worker; Infant mortality; Maternal health; social determinants of healt

A great contributor to the French urological science: Michel Daudon

AbstractThe 40years of Michel Daudon’s working life in the field of urolithiasis are difficult to sum up in a few lines. His knowledge, expertise and publications in the fields of biology, chemistry, nephrology, and eventually urology have contributed to make him a national and international recognized researcher in the understanding of the complex mechanisms of urolithogenesis. His great collaboration with the community of nephrologists, kidney physiologists, biologists, and urologists, seniors or in training, has widely contributed to improve modern and complete treatments of urolithiasis, which is at the origin of complicated urinary stones causing severe consequences on renal function and true public health problems. His hard working, his willingness, and the clarity of his presentations contributed to make him a national and international recognized lecturer in France and North Africa, where he created a network connecting laboratories with clinicians. Always looking forward in his scientific field, he has established links with approved research teams, making them interested in working on urolithiasis, even though research on urolithiasis disease seems to be less important than research on cancer

Construire une nouvelle expérience en formation continue

International audienc

Accompagner le changement de pratiques des conseillers agricoles en mobilisant un dispositif de conception-évaluation de formation : l'exemple de la formation conseiller demain en agronomie

National audienceEn France, les nouvelles politiques publiques dans le domaine agricole visent une obligation de résultats à court et moyen terme, notamment en ce qui concerne les impacts environnementaux des activités agricoles. Elles suggèrent la construction et la mise en œuvre d'une offre de formation adaptée aux besoins, notamment des conseillers agricoles, pour accompagner ce qui apparaît comme un changement majeur, autant dans le domaine du raisonnement agronomique que dans le métier du conseil. De telles formations commencent à exister. A partir de l'exemple d'une formation continue pour des conseillers en agronomie, nous proposons d'identifier les bénéfices d'un dispositif associant (i) une conception qui articule deux dimensions du changement (le raisonnement en agronomie, et le raisonnement du conseil) (ii) un dispositif d'évaluations pensé pour accompagner l'opérationnalisation de ces changements. Nous montrerons que ce type de formation, au-delà de ses bénéfices auprès des destinataires, permet d'approfondir des connaissances sur les activités des conseillers, et les difficultés qu'ils rencontrent dans les évolutions actuelles

Extragalactic Science, Cosmology and Galactic Archaeology with the Subaru Prime Focus Spectrograph (PFS)

The Subaru Prime Focus Spectrograph (PFS) is a massively-multiplexed fiber-fed optical and near-infrared 3-arm spectrograph (N_fiber=2400, 380<lambda<1260nm, 1.3 degree diameter FoV), offering unique opportunities in survey astronomy. Here we summarize the science case feasible for a survey of Subaru 300 nights. We describe plans to constrain the nature of dark energy via a survey of emission line galaxies spanning a comoving volume of 9.3 (Gpc/h)^3 in the redshift range 0.8<z<2.4. In each of 6 redshift bins, the cosmological distances will be measured to 3% precision via BAO, and redshift-space distortions will be used to constrain structure growth to 6% precision. In the GA program, radial velocities and chemical abundances of stars in the Milky Way and M31 will be used to infer the past assembly histories of spiral galaxies and the structure of their dark matter halos. Data will be secured for 10^6 stars in the Galactic thick-disk, halo and tidal streams as faint as V~22, including stars with V < 20 to complement the goals of the Gaia mission. A medium-resolution mode with R = 5000 to be implemented in the red arm will allow the measurement of multiple alpha-element abundances and more precise velocities for Galactic stars, elucidating the detailed chemo-dynamical structure and evolution of each of the main stellar components of the Milky Way Galaxy and of its dwarf spheroidal galaxies. For the extragalactic program, our simulations suggest the wide avelength range will be powerful in probing the galaxy population and its clustering over a wide redshift range. We propose to conduct a color-selected survey of 1<z<2 galaxies and AGN over 16 deg^2 to J~23.4, yielding a fair sample of galaxies with stellar masses above ~10^{10}Ms at z~2. A two-tiered survey of higher redshift LBGs and LAEs will quantify the properties of early systems close to the reionization epoch.Comment: This document describes the scientific program and requirements for the Subaru Prime Focus Spectrograph (PFS) project. Made significant revision based on studies for the Preliminary Design Review (PRD) held in Feb 2013. The higher-resolution paper file is available from http://member.ipmu.jp/masahiro.takada/pfs_astroph_rv.pd

Making Maps Of The Cosmic Microwave Background: The MAXIMA Example

This work describes Cosmic Microwave Background (CMB) data analysis algorithms and their implementations, developed to produce a pixelized map of the sky and a corresponding pixel-pixel noise correlation matrix from time ordered data for a CMB mapping experiment. We discuss in turn algorithms for estimating noise properties from the time ordered data, techniques for manipulating the time ordered data, and a number of variants of the maximum likelihood map-making procedure. We pay particular attention to issues pertinent to real CMB data, and present ways of incorporating them within the framework of maximum likelihood map-making. Making a map of the sky is shown to be not only an intermediate step rendering an image of the sky, but also an important diagnostic stage, when tests for and/or removal of systematic effects can efficiently be performed. The case under study is the MAXIMA data set. However, the methods discussed are expected to be applicable to the analysis of other current and forthcoming CMB experiments.Comment: Replaced to match the published version, only minor change

Reionization: Characteristic Scales, Topology and Observability

Recently the numerical simulations of the process of reionization of the universe at z>6 have made a qualitative leap forward, reaching sufficient sizes and dynamic range to determine the characteristic scales of this process. This allowed making the first realistic predictions for a variety of observational signatures. We discuss recent results from large-scale radiative transfer and structure formation simulations on the observability of high-redshift Ly-alpha sources. We also briefly discuss the dependence of the characteristic scales and topology of the ionized and neutral patches on the reionization parameters.Comment: 4 pages, 5 figures (4 in color), to appear in Astronomy and Space Science special issue "Space Astronomy: The UV window to the Universe", proceedings of 1st NUVA Conference ``Space Astronomy: The UV window to the Universe'' in El Escorial (Spain

Total ankle replacement versus ankle arthrodesis for patients aged 50-85 years with end-stage ankle osteoarthritis: the TARVA RCT

BACKGROUND: We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the treatment of end-stage ankle osteoarthritis. METHODS: This was a pragmatic, multicentre, parallel-group, non-blinded randomised controlled trial. Patients with end-stage ankle osteoarthritis who were aged 50-85 years and were suitable for both procedures were recruited from 17 UK hospitals and randomised using minimisation. The primary outcome was the change in the Manchester-Oxford Foot Questionnaire walking/standing domain scores between the preoperative baseline and 52 weeks post surgery. RESULTS: Between March 2015 and January 2019, 303 participants were randomised using a minimisation algorithm: 152 to total ankle replacement and 151 to ankle fusion. At 52 weeks, the mean (standard deviation) Manchester-Oxford Foot Questionnaire walking/standing domain score was 31.4 (30.4) in the total ankle replacement arm (n = 136) and 36.8 (30.6) in the ankle fusion arm (n = 140); the adjusted difference in the change was -5.6 (95% confidence interval -12.5 to 1.4; p = 0.12) in the intention-to-treat analysis. By week 52, one patient in the total ankle replacement arm required revision. Rates of wound-healing issues (13.4% vs. 5.7%) and nerve injuries (4.2% vs. < 1%) were higher and the rate of thromboembolic events was lower (2.9% vs. 4.9%) in the total ankle replacement arm than in the ankle fusion arm. The bone non-union rate (based on plain radiographs) in the ankle fusion arm was 12.1%, but only 7.1% of patients had symptoms. A post hoc analysis of fixed-bearing total ankle replacement showed a statistically significant improvement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score (-11.1, 95% confidence interval -19.3 to -2.9; p = 0.008). We estimate a 69% likelihood that total ankle replacement is cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over the patient's lifetime. LIMITATIONS: This initial report contains only 52-week data, which must therefore be interpreted with caution. In addition, the pragmatic nature of the study means that there was heterogeneity between surgical implants and techniques. The trial was run across 17 NHS centres to ensure that decision-making streams reflected the standard of care in the NHS as closely as possible. CONCLUSIONS: Both total ankle replacement and ankle fusion improved patients' quality of life at 1 year, and both appear to be safe. When total ankle replacement was compared with ankle fusion overall, we were unable to show a statistically significant difference between the two arms in terms of our primary outcome measure. The total ankle replacement versus ankle arthrodesis (TARVA) trial is inconclusive in terms of superiority of total ankle replacement, as the 95% confidence interval for the adjusted treatment effect includes both a difference of zero and the minimal important difference of 12, but it can rule out the superiority of ankle fusion. A post hoc analysis comparing fixed-bearing total ankle replacement with ankle fusion showed a statistically significant improvement of total ankle replacement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score. Total ankle replacement appears to be cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over a patient's lifetime based on long-term economic modelling. FUTURE WORK: We recommend long-term follow-up of this important cohort, in particular radiological and clinical progress. We also recommend studies to explore the sensitivity of clinical scores to detect clinically important differences between arms when both have already achieved a significant improvement from baseline. TRIAL REGISTRATION: This trial is registered as ISRCTN60672307 and ClinicalTrials.gov NCT02128555. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 5. See the NIHR Journals Library website for further project information