An extension of the Alma-Ata vision for primary health care in light of twenty-first century evidence and realities [version 1; referees: 1 approved, 2 approved with reservations]

This paper builds upon and extends the definition of primary health care in the 1978 Declaration of Alma-Ata. The definition proposes a stronger role for community-based delivery of services and community mobilization, participation and empowerment. It calls for a stronger integration with vertical, disease-specific programs. And, finally, it calls for a strong role for certain curative services (including basic and essential surgery) that many today would not consider as part of primary health care. There is growing evidence that communities can and should play a stronger role than has traditionally been the case, that community-level workers who are properly trained and supported can provide effective services outside of health facilities, and that primary health centers staffed with non-specialist physicians and even non-physician clinicians can perform many of the lower-level inpatient services now performed at first-level referral hospitals. An approach to primary health care that is appropriate to the local context and that merges local epidemiological priorities with the communities' perceived priorities will make it possible to engage communities as partners. Currently, essential and basic health care services are available to only one-half of the world’s population. The full development of primary health care as envisioned here will accelerate progress in achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978

Deployment of regulatory genes during gastrulation and germ layer specification in a model spiralian mollusc Crepidula

© 2015 Wiley Periodicals, Inc. Background: During gastrulation, endoderm and mesoderm are specified from a bipotential precursor (endomesoderm) that is argued to be homologous across bilaterians. Spiralians also generate mesoderm from ectodermal precursors (ectomesoderm), which arises near the blastopore. While a conserved gene regulatory network controls specification of endomesoderm in deuterostomes and ecdysozoans, little is known about genes controlling specification or behavior of either source of spiralian mesoderm or the digestive tract. Results: Using the mollusc Crepidula, we examined conserved regulatory factors and compared their expression to fate maps to score expression in the germ layers, blastopore lip, and digestive tract. Many genes were expressed in both ecto- and endomesoderm, but only five were expressed in ectomesoderm exclusively. The latter may contribute to epithelial-to-mesenchymal transition seen in ectomesoderm. Conclusions: We present the first comparison of genes expressed during spiralian gastrulation in the context of high-resolution fate maps. We found variation of genes expressed in the blastopore lip, mouth, and cells that will form the anus. Shared expression of many genes in both mesodermal sources suggests that components of the conserved endomesoderm program were either co-opted for ectomesoderm formation or that ecto- and endomesoderm are derived from a common mesodermal precursor that became subdivided into distinct domains during evolution.Spanish MICINN and the UAM, and funded by project CGL2011-29916 (MICINN)Peer Reviewe

Euarchontan opsin variation brings new focus to primate origins

Debate on the adaptive origins of primates has long focused on the functional ecology of the primate visual system. For example, it is hypothesized that variable expression of short- (SWS1) and middle-to-long-wavelength sensitive (M/LWS) opsins, which confer color vision, can be used to infer ancestral activity patterns and therefore selective ecological pressures. A problem with this approach is that opsin gene variation is incompletely known in the grandorder Euarchonta, i.e., the orders Scandentia (treeshrews), Dermoptera (colugos), and Primates. The ancestral state of primate color vision is therefore uncertain. Here we report on the genes (OPN1SW and OPN1LW) that encode SWS1 and M/LWS opsins in seven species of treeshrew, including the sole nocturnal scandentian Ptilocercus lowii. In addition, we examined the opsin genes of the Central American woolly opossum (Caluromys derbianus), an enduring ecological analogue in the debate on primate origins. Our results indicate: 1) retention of ultraviolet (UV) sensitivity in C. derbianus and a shift from UV to blue spectral sensitivities at the base of Euarchonta; 2) ancient pseudogenization of OPN1SW in the ancestors of P. lowii, but a signature of purifying selection in those of C. derbianus; and, 3) the absence of OPN1LW polymorphism among diurnal treeshrews. These findings suggest functional variation in color vision of nocturnal mammals and a distinctive visual ecology of early primates, perhaps one that demanded greater spatial resolution under light levels that could support cone-mediated color discrimination

Assessing the Effectiveness of House-to-House Visits on Routine Oral Polio Immunization Completion and Tracking of Defaulters

Strengthening routine immunization is one of the four prongs of the Global Polio Eradication Initiative. Using data collected through 30-cluster sample household surveys of caretakers of children aged 12-23 months, this paper assessed the effectiveness of house-to-house visits on routine oral polio immunization completion, using simple frequency tables, bivariate and multivariate logistic regression analyses. Logistic regression results demonstrated that children in households where the caregivers reported receiving a household visit by health workers were more likely to be fully immunized for polio through routine immunization than other children, although results were significant only after correcting for confounders. In Ethiopia and India, children of caregivers who remembered a house-to-house visit were significantly and positively associated with routine polio vaccination completion (OR=2.2 and OR=2.2 respectively). In Angola, the association was positive, though not significant (OR=1.3). The evidence suggests that targeting high-risk areas for house-to-house visits played a role in increasing routine polio vaccination

Validation of the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care at District Hospitals in Ghana

The World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (hereafter called the WHO Tool) has been used in more than 25 countries and is the largest effort to assess surgical care in the world. However, it has not yet been independently validated. Test–retest reliability is one way to validate the degree to which tests instruments are free from random error. The aim of the present field study was to determine the test–retest reliability of the WHO Tool. The WHO Tool was mailed to 10 district hospitals in Ghana. Written instructions were provided along with a letter from the Ghana Health Services requesting the hospital administrator to complete the survey tool. After ensuring delivery and completion of the forms, the study team readministered the WHO Tool at the time of an on-site visit less than 1 month later. The results of the two tests were compared to calculate kappa statistics for each of the 152 questions in the WHO Tool. The kappa statistic is a statistical measure of the degree of agreement above what would be expected based on chance alone. Ten hospitals were surveyed twice over a short interval (i.e., less than 1 month). Weighted and unweighted kappa statistics were calculated for 152 questions. The median unweighted kappa for the entire survey was 0.43 (interquartile range 0–0.84). The infrastructure section (24 questions) had a median kappa of 0.81; the human resources section (13 questions) had a median kappa of 0.77; the surgical procedures section (67 questions) had a median kappa of 0.00; and the emergency surgical equipment section (48 questions) had a median kappa of 0.81. Hospital capacity survey questions related to infrastructure characteristics had high reliability. However, questions related to process of care had poor reliability and may benefit from supplemental data gathered by direct observation. Limitations to the study include the small sample size: 10 district hospitals in a single country. Consistent and high correlations calculated from the field testing within the present analysis suggest that the WHO Tool for Situational Analysis is a reliable tool where it measures structure and setting, but it should be revised for measuring process of care

Absolute dimensions of eclipsing binaries. XXVIII. BK Pegasi and other F-type binaries: Prospects for calibration of convective core overshoot

We present a detailed study of the F-type detached eclipsing binary BK Peg, based on new photometric and spectroscopic observations. The two components, which have evolved to the upper half of the main-sequence band, are quite different with masses and radii of (1.414 +/- 0.007 Msun, 1.988 +/- 0.008 Rsun) and (1.257 +/- 0.005 Msun, 1.474 +/- 0.017 Rsun), respectively. The 5.49 day period orbit of BK Peg is slightly eccentric (e = 0.053). The measured rotational velocities are 16.6 +/- 0.2 (primary) and 13.4 +/- 0.2 (secondary) km/s. For the secondary component this corresponds to (pseudo)synchronous rotation, whereas the primary component seems to rotate at a slightly lower rate. We derive an iron abundance of [Fe/H] =-0.12 +/- 0.07 and similar abundances for Si, Ca, Sc, Ti, Cr and Ni. Yonsei-Yale and Victoria-Regina evolutionary models for the observed metal abundance reproduce BK Peg at ages of 2.75 and 2.50 Gyr, respectively, but tend to predict a lower age for the more massive primary component than for the secondary. We find the same age trend for three other upper main-sequence systems in a sample of well studied eclipsing binaries with components in the 1.15-1.70 Msun range, where convective core overshoot is gradually ramped up in the models. We also find that the Yonsei-Yale models systematically predict higher ages than the Victoria-Regina models. The sample includes BW Aqr, and as a supplement we have determined a [Fe/H] abundance of -0.07 +/- 0.11 for this late F-type binary. We propose to use BK Peg, BW Aqr, and other well-studied 1.15-1.70 Msun eclipsing binaries to fine-tune convective core overshoot, diffusion, and possibly other ingredients of modern theoretical evolutionary models.Comment: Accepted for publication in Astronomy and Astrophysic

A review of the dodo and its ecosystem: insights from a vertebrate concentration Lagerstätte in Mauritius

The dodo Raphus cucullatus Linnaeus,1758, an extinct and flightless, giant pigeon endemic to Mauritius, has fascinated people since its discovery, yet has remained surprisingly poorly known. Until the mid-19th century, almost all that was known about the dodo was based on illustrations and written accounts by 17th century mariners, often of questionable accuracy. Furthermore, only a few fragmentary remains of dodos collected prior to the bird's extinction exist. Our understanding of the dodo's anatomy was substantially enhanced by the discovery in 1865 of subfossil bones in a marsh called the Mare aux Songes, situated in southeastern Mauritius. However, no contextual information was recorded during early excavation efforts, and the majority of excavated material comprised larger dodo bones, almost all of which were unassociated. Here we present a modern interdisciplinary analysis of the Mare aux Songes, a 4200-year-old multitaxic vertebrate concentration Lagerstätte. Our analysis of the deposits at this site provides the first detailed overview of the ecosystem inhabited by the dodo. The interplay of climatic and geological conditions led to the exceptional preservation of the animal and associated plant remains at the Mare aux Songes and provides a window into the past ecosystem of Mauritius. This interdisciplinary research approach provides an ecological framework for the dodo, complementing insights on its anatomy derived from the only associated dodo skeletons known, both of which were collected by Etienne Thirioux and are the primary subject of this memoir.Additional co-authors: Anneke H. Van Heteren, Vikash Rupear, Gorah Beebeejaun, Alan Grihault, J. (Hans) Van Der Plicht, Marijke Besselink, Juliën K. Lubeek, Max Jansen, Hege Hollund, Beth Shapiro, Matthew Collins, Mike Buckley, Ranjith M. Jayasena, Nicolas Porch, Rene Floore, Frans Bunnik, Andrew Biedlingmaier, Jennifer Leavitt, Gregory Monfette, Anna Kimelblatt, Adrienne Randall, Pieter Floore & Leon P. A. M. Claessen