Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya.

BACKGROUND:Cervical cancer is the most frequent neoplasm among Kenyan women, with 4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will help planners and policymakers design, implement, and scale programs. METHODS:We conducted HPV-based cervical cancer screening via self-collection in 12 communities in rural Migori County, Kenya. Six communities were randomized to community health campaigns (CHCs), and six to screening at government clinics. All HPV-positive women were referred for cryotherapy at Migori County Hospital. We prospectively estimated direct costs from the health system perspective, using micro-costing methods. Cost data were extracted from expenditure records, staff interviews, and time and motion logs. Total costs per woman screening included three activities: outreach, HPV-based screening, and notification. Types of inputs include personnel, recurrent goods, capital goods, and services. We costed potential changes to implementation for scaling. RESULTS:From January to September 2016, 2899 women were screened in CHCs and 2042 in clinics. Each CHC lasted for 30 working days, 10 days each for outreach, screening, and notification. The mean cost per woman screened was $25.00 for CHCs [median:$25.09; Range: $22.06-30.21] and$29.56 for clinics [$28.90;$25.27-37.08]. Clinics had higher costs than CHCs for personnel ($14.27 vs.$11.26) and capital ($5.55 vs.$2.80). Screening costs were higher for clinics at $21.84, compared to$17.48 for CHCs. In contrast, CHCs had higher outreach costs ($3.34 vs.$0.17). After modeling a reduction in staffing, clinic per-screening costs ($25.69) were approximately equivalent to CHCs. CONCLUSIONS:HPV-based cervical cancer screening through community health campaigns achieved lower costs per woman screened, compared to screening at clinics. Periodic high-volume CHCs appear to be a viable low-cost strategy for implementing cervical cancer screening

NITROGEN MANAGEMENT IN SOUTHEASTERN MINNESOTA

Crop Production/Industries,

Airspace Technology Demonstration 3 (ATD-3): Dynamic Routes for Arrivals in Weather (DRAW) Technology Transfer Document Summary Version 2.0

Airspace Technology Demonstration 3 (ATD-3) is part of NASAs Airspace Operations and Safety Program (AOSP) specifically, its Airspace Technology Demonstrations (ATD) Project. ATD-3 is a multi-year research and development effort which proposes to develop and demonstrate automation technologies and operating concepts that enable air navigation service providers and airspace users to continuously assess weather, winds, traffic, and other information to identify, evaluate, and implement workable opportunities for flight plan route corrections that can result in significant flight time and fuel savings in en route airspace. In order to ensure that the products of this tech-transfer are relevant and useful, NASA has created strong partnerships with the FAA and key industry stakeholders. This summary document and accompanying technology artifacts satisfy the third Research Transition Product (RTP) defined in the Applied Traffic Flow Management (ATFM) Research Transition Team (RTT) Plan, which is Dynamic Routes for Arrivals in Weather (DRAW). This technology transfer consists of artifacts for DRAW Arrival Metering (AM) Operations delivered in June 2018, DRAW AM updates, and DRAW Extended Metering (XM) Operations. Blue highlighting indicates the new or modified deliverables. Some of the artifacts in this technology transfer have distribution restrictions that need to be followed. Distribution information is noted in each section. DRAW is a trajectory-based system that combines the legacy Dynamic Weather Routes (DWR) weather avoidance technology with an arrival-specific rerouting algorithm and arrival scheduler to improve traffic flows on weather-impacted arrival routes into major airports. First, DRAW identifies flights that could be rerouted to more efficient Standard Terminal Arrival Routes (STARs) that may have previously been impacted by weather. Second, when weather is impacting the arrival routing, DRAW proposes simple arrival route corrections that enable aircraft to stay on their flight plan while avoiding weather. The DRAW system proposes reroutes early enough to allow Time Based Flow Management (TBFM) to make the necessary schedule adjustments. As a result, metering operations can be sustained longer and more consistently in the presence of weather because the arrival schedule accounts for the dynamic routing intent of arrival flights to deviate around weather. The first DRAW tech transfer in June 2018 focused on arrival metering operations with the DRAW algorithm implemented in the NASA Center TRACON Automation System (CTAS) automation software. This tech transfer delivery includes updates for DRAW implemented in FAAs TBFM 4.7 automation software and preliminary research into DRAW for XM operations

Computing Fast and Reliable Gravitational Waveforms of Binary Neutron Star Merger Remnants

Gravitational waves have been detected from the inspiral of a binary neutron-star, GW170817, which allowed constraints to be placed on the neutron star equation of state. The equation of state can be further constrained if gravitational waves from a post-merger remnant are detected. Post-merger waveforms are currently generated by numerical-relativity simulations, which are computationally expensive. Here we introduce a hierarchical model trained on numerical-relativity simulations, which can generate reliable post-merger spectra in a fraction of a second. Our spectra have mean fitting factors of 0.95, which compares to fitting factors of 0.76 and 0.85 between different numerical-relativity codes that simulate the same physical system. This method is the first step towards generating large template banks of spectra for use in post-merger detection and parameter estimation.Comment: Submitted to PRL. 6 pages, 4 figure

Impact of cloud-borne aerosol representation on aerosol direct and indirect effects

International audienceAerosol particles attached to cloud droplets are much more likely to be removed from the atmosphere and are much less efficient at scattering sunlight than if unattached. Models used to estimate direct and indirect effects of aerosols employ a variety of representations of such cloud-borne particles. Here we use a global aerosol model with a relatively complete treatment of cloud-borne particles to estimate the sensitivity of simulated aerosol, cloud and radiation fields to various approximations to the representation of cloud-borne particles. We find that neglecting transport of cloud-borne particles introduces little error, but that diagnosing cloud-borne particles produces global mean biases of 20% and local errors of up to 40% for aerosol, droplet number, and direct and indirect radiative forcing. Aerosol number, aerosol optical depth and droplet number are significantly underestimated in regions and seasons where and when wet removal is primarily by stratiform rather than convective clouds (polar regions during winter), but direct and indirect effects are less biased because of the limited sunlight there and then. A treatment that predicts the total mass concentration of cloud-borne particles for each mode yields smaller errors and runs 20% faster than the complete treatment. The errors are much smaller than current estimates of uncertainty in direct and indirect effects of aerosols, which suggests that the treatment of cloud-borne aerosol is not a significant source of uncertainty in estimates of direct and indirect effects

Retinal synaptic arrays: Continuing development in the adult goldfish

We report a light- and electron-microscopic examination of the inner plexiform layer of the central retina of young (c. 1 year) and old (3–4 year) goldfish. There were no new neurons added to this region during the growth period. Nonetheless, there were substantially more synapses (per cell, per mm 2 , or per degree 2 ) in the older retinas. This result is discussed in the contexts of retinal function and neural development.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50006/1/901850210_ftp.pd

Obstetric near misses among women with serious mental illness: data linkage cohort study.

BACKGROUND: Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. AIMS: To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). METHOD: We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort - all women with a live or still birth in 2007-2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort - all women with a live or still birth in 2007-2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). RESULTS: The rate of obstetric near misses was 884.3/100 000 (95% CI 733.2-1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0-607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3-2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1-3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1-4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6-5.8, P < 0.001). CONCLUSIONS: Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI

Airspace Technology Demonstration 3 (ATD-3) Traffic Aware Strategic Aircrew Requests (TASAR) Technology Transfer Document Summary Version 1.0

This summary document and accompanying technology artifacts satisfy the fourth of five Research Transition Products (RTPs) defined in the Applied Traffic Flow Management (ATFM) Research Transition Team (RTT) Plan. This transfer consists of NASA's Traffic Aware Strategic Aircrew Requests (TASAR). NASA's concept of TASAR offers onboard automation for the purpose of advising the pilot of traffic-compatible trajectory changes that would be beneficial to the flight