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

Indirect radiative forcing by ion-mediated nucleation of aerosol

A clear understanding of particle formation mechanisms is critical for assessing aerosol indirect radiative forcing and associated climate feedback processes. Recent studies reveal the importance of ion-mediated nucleation (IMN) in generating new particles and cloud condensation nuclei (CCN) in the atmosphere. Here we implement the IMN scheme into the Community Atmosphere Model version 5 (CAM5). Our simulations show that, compared to globally averaged results based on H<sub>2</sub>SO<sub>4</sub>-H<sub>2</sub>O binary homogeneous nucleation (BHN), the presence of ionization (i.e., IMN) halves H<sub>2</sub>SO<sub>4</sub> column burden, but increases the column integrated nucleation rate by around one order of magnitude, total particle number burden by a factor of ~3, CCN burden by ~10% (at 0.2% supersaturation) to 65% (at 1.0% supersaturation), and cloud droplet number burden by ~18%. Compared to BHN, IMN increases cloud liquid water path by 7.5%, decreases precipitation by 1.1%, and increases total cloud cover by 1.9%. This leads to an increase of total shortwave cloud radiative forcing (SWCF) by 3.67 W m<sup>−2</sup> (more negative) and longwave cloud forcing by 1.78 W m<sup>−2</sup> (more positive), with large spatial variations. The effect of ionization on SWCF derived from this study (3.67 W m<sup>−2</sup>) is a factor of ~3 higher that of a previous study (1.15 W m<sup>−2</sup>) based on a different ion nucleation scheme and climate model. Based on the present CAM5 simulation, the 5-yr mean impacts of solar cycle induced changes in ionization rates on CCN and cloud forcing are small (~−0.02 W m<sup>−2</sup>) but have larger inter-annual (from −0.18 to 0.17 W m<sup>−2</sup>) and spatial variations

High Repetition-Rate Wakefield Electron Source Generated by Few-millijoule, 30 femtosecond Laser Pulses on a Density Downramp

We report on an experimental demonstration of laser wakefield electron acceleration using a sub-TW power laser by tightly focusing 30-fs laser pulses with only 8 mJ pulse energy on a 100 \mu m scale gas target. The experiments are carried out at an unprecedented 0.5 kHz repetition rate, allowing "real time" optimization of accelerator parameters. Well-collimated and stable electron beams with a quasi-monoenergetic peak in excess of 100 keV are measured. Particle-in-cell simulations show excellent agreement with the experimental results and suggest an acceleration mechanism based on electron trapping on the density downramp, due to the time varying phase velocity of the plasma waves.Comment: 4 pages, 5 figures, submitted to Phys. Rev. Let

The Role of Albedo in Color Discrimination of Spider Monkeys

The problem of color discrimination of animals has been variously discussed by writers. While it is generally conceded that the cones are the receptors of color, the different theories of vision as expounded by Young and Helmholtz, Hering, Ladd-Franklin and others are not always in essential agreement that specific cones are the receptors of specific wave lengths of light. While form discrimination of rats has been clearly demonstrated in the researches of Fields, Fritz, Lashley and others, the discrimination of color by the lower forms of animals is not so well established. Writers also differ as to primates, but since the infra-human eye has many of the morphological and anatomical characteristics of the human eye it is reasonable to assume that the functions are similar. As the functional aspects become more nearly like those of the human, the perception of color becomes a greater possibility

Criminal Justice and Suicide Outcomes with Indiana's Risk-Based Gun Seizure Law

This article examines the application and effectiveness of a 2006 Indiana law designed to prevent gun violence by authorizing police officers to separate firearms from persons who present imminent or future risk of injury to self or others, or display a propensity for violent or emotionally unstable conduct. A court hearing is held to determine ongoing risk in these cases; a judge decides whether to return the seized firearms or retain them for up to five years. The study examines the frequency of criminal arrest as well as suicide outcomes for 395 gun-removal actions in Indiana. Fourteen individuals (3.5%) died from suicide, seven (1.8%) using a firearm. The study population's annualized suicide rate was about 31 times higher than that of the general adult population in Indiana, demonstrating that the law is being applied to a population genuinely at high risk. By extrapolating information on the case fatality rate for different methods of suicide, we calculated that one life was saved for every 10 gun-removal actions, similar to results of a previous study in Connecticut. Perspectives from key stakeholders are also presented along with implications for gun policy reform and implementation

Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams

OBJECTIVE: Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams. METHODS: A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study's standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion. RESULTS: The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (61%), but the rate of 58% for the retained sample (those who completed a follow-up interview, N=116) was not significantly different from the standard. Rates for peers and clinicians did not differ significantly from each other for either sample. PAD quality was similar to that achieved in the prior study. Four consumer variables predicted completion: independent living status, problematic substance use, length of time served by the ACT team, and no perceived unmet need for hospitalization in crisis. CONCLUSIONS: Peers and clinicians can play a crucial role in increasing the number of consumers with PADs, an important step toward improving implementation of PADs in mental health care

High Repetition-Rate Wakefield Electron Source Generated by Few-millijoule, 30 Femtosecond Laser Pulses on a Density Downramp

International audienceWe report on an experimental demonstration of laser wakefield electron acceleration using a sub-TW power laser by tightly focusing 30-fs laser pulses with 8 mJ pulse energy on a 100 µm scale gas target. The experiments are carried out at an unprecedented 0.5 kHz repetition rate, allowing " real time " optimization of accelerator parameters. Well-collimated and stable electron beams with quasi-monoenergetic peaks around 100 keV are measured. Particle-in-cell simulations show excellent agreement with the experimental results and suggest an acceleration mechanism based on electron trapping on the density downramp, due to the time varying phase velocity of the plasma waves

High Repetition-Rate Wakefield Electron Source Generated by Few-millijoule, 30 Femtosecond Laser Pulses on a Density Downramp

International audienceWe report on an experimental demonstration of laser wakefield electron acceleration using a sub-TW power laser by tightly focusing 30-fs laser pulses with 8 mJ pulse energy on a 100 µm scale gas target. The experiments are carried out at an unprecedented 0.5 kHz repetition rate, allowing " real time " optimization of accelerator parameters. Well-collimated and stable electron beams with quasi-monoenergetic peaks around 100 keV are measured. Particle-in-cell simulations show excellent agreement with the experimental results and suggest an acceleration mechanism based on electron trapping on the density downramp, due to the time varying phase velocity of the plasma waves