Insecurity in the Southern Highlands: the nature, triggers and consequences of violence in Hela region

"Violence is widely perceived to be a serious problem in Papua New Guinea (PNG), but there is substantial geographical variation and data is limited on the nature and causes of violence. There is some evidence to suggest that violent trauma is a leading cause of injury and death in PNG, and in some parts of the Highlands provinces, trauma is the leading cause of death amongst adults and a large proportion of injuries are intentionally inflicted ..." - page 1AusAI

Community participation for transformative action on women's, children's and adolescents' health.

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals

The Orbits of the Gamma-ray Binaries LS I +61 303 and LS 5039

LS I +61 303 and LS 5039 are two of only a handful of known high mass X-ray binaries (HMXBs) that exhibit very high energy emission in the MeV-TeV range, and these "gamma-ray binaries" are of renewed interest due to the recent launch of the Fermi Gamma-ray Space Telescope. Here we present new radial velocities of both systems based on recent red and blue optical spectra. Both systems have somewhat discrepant orbital solutions available in the literature, and our new measurements result in improved orbital elements and resolve the disagreements. The improved geometry of each orbit will aid in studies of the high energy emission region near each source.Comment: Accepted to ApJ, 13 pages, preprint2 styl

Strengthening the policy, implementation, and accountability environment for quality care: experiences from quality of care network countries

Despite global commitment to universal health coverage with quality, poor quality of care (QOC) continues to impact health outcomes for mothers and newborns, especially in low-and-middle income countries. Although there is much experience from small-scale projects, without a long-term perspective it is unclear how to implement quality of care effectively and consistently for impact. In 2017, ten countries together with the WHO and a coalition of partners established the Network for Improving Quality of Care for Maternal, Newborn and Child Health (the Network). The Network agreed to pursue four strategic objectives—Leadership, Action, Learning and Accountability (LALA) for QOC. This paper describes, analyses and reflects on what has worked and some of the challenges faced in implementation of the LALA framework. The implementation of the LALA framework has served as a catalyst to develop an enabling environment for QOC in the Network countries through strengthening the policy, implementation, accountability and community engagement for quality care. Developing an enabling health system environment takes time, but it is possible and shows results. The implementation shows that health systems continue to face persistent challenges such as capacities to quickly scale up changes across subnational levels, limited workforce capability to implement quality improvement consistently and gaps in quality of relevant data. The implementation has also highlighted the need to develop new mechanisms for community engagement and learning systems that inform scaling up of good QOC practices across programmes and levels of care. Moving forward, the Network countries will build on the experiences and lessons learned and continue to strengthen the implementation of LALA strategic objectives for impact. We hope the Network experience will encourage other countries and partners to adopt the Network implementation model to enable delivery of quality care for everyone, everywhere, and actively collaborate and contribute to the QOC global learning network

The Astropy Problem

The Astropy Project (http://astropy.org) is, in its own words, "a community effort to develop a single core package for Astronomy in Python and foster interoperability between Python astronomy packages." For five years this project has been managed, written, and operated as a grassroots, self-organized, almost entirely volunteer effort while the software is used by the majority of the astronomical community. Despite this, the project has always been and remains to this day effectively unfunded. Further, contributors receive little or no formal recognition for creating and supporting what is now critical software. This paper explores the problem in detail, outlines possible solutions to correct this, and presents a few suggestions on how to address the sustainability of general purpose astronomical software

Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery A Randomized Clinical Trial and Systematic Review

Importance: small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.Objective: to evaluate the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.Design, setting, and participants: OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.Interventions: patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366).Main outcomes and measures: the primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care–free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay.Results: baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, ?0.3% to 13.9%]; P?=?.07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]).Conclusions and relevance: in a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rate

Business not as usual: how multisectoral collaboration can promote transformative change for health and sustainable development.

• We present a model of enabling fac-tors for effective multisectoral collabo-ration for improvements in health and sustainable development. • Drive change: assess whether desired change is better off achieved by mul-tisectoral collaboration; drive forward collaboration by mobilising a critical mass of policy and public attention. • Define: frame the problem strategi-cally and holistically so that all sec-tors and stakeholders can see the benefits of collaboration and contri-bution to the public good• Design: create solutions relevant to context, building on existing mecha-nisms, and leverage the strengths of diverse sectors for collective impact. • Relate: ensure resources for multi-sectoral collaboration mechanisms, including for open communication and deliberation on evidence, norms, and innovation across all components of collaboration. • Realise: learn by doing, and adapt with regular feedback. Remain open to redefining and redesigning the collaboration to ensure relevance, effectiveness, and responsiveness to change. • Capture success: agree on success markers, using qualitative and quan-titative methods to monitor results regularly and comprehensively, and learn from both failures and successes to inform action and sustain gains

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Making the links between women’s health and women’s lives in Papua New Guinea: Implications for policy and health care delivery

International perspectives of women’s health have drawn on biomedical solutions and pathology-based aspects, and one of the main components of a changing and evolving definition of women’s health is to provide an alternative to these perspectives that are grounded in the western framework. There has been a tendency by researchers and health professionals to utilise approaches that prioritize only one dimension of woman’s lives such as their biological, reproductive or maternal roles to the detriment of understanding the complexity of women’s histories, cultural contexts and lived experiences. The overall goal of this study was to investigate women’s health within the socio-historical context of Papua New Guinea (PNG) to firstly, understand the self-identified heath concerns of women, secondly to examine the critical points in the lifespan for effecting positive change in the health status of women and finally, to ascertain if the divergence between the perceptions of service providers and the real needs of women can be reduced.The study was set in Patigo (Wosera sub-district), in the East Sepik Province, a rural area and one of the least developed areas of Papua New Guinea. There is a heavy reliance on subsistence production for household consumption, high infant and maternal mortality and morbidity rates, limited cash earning opportunities and low per capita incomes in the district. Women conduct most of the daily subsistence and domestic duties. Women’s health and social development statistics are poor in the Wosera and it is easy to see solutions as either medical or matters of health education. However the health status of women reflects the complex and changing social and structural conditions of women’s lives and in particular, the gender-based inequalities that women face are fundamental variables affecting health.This study was conceptualised using an interpretive qualitative methodology within an ethnographic and rights-based framework, based on the real experiences of women’s daily lives. The study was conducted during a four month study period from July to October 2005 and in February 2006. The investigation strategy utilised a within-method triangulation approach, using a combination of qualitative and participatory methods. To enable an understanding of the diverse health needs of women and the key determinants of health across the lifespan, the socio-cultural and gender perspectives of young, adult, older women were examined. Discussions were also held with young and adult men and key community members considered to have specific knowledge of women’s health issues.Women’s narratives show that reproductive health problems did not figure prominently among the health issues women described. Health was related to the social and material circumstances of women’s lives. It was discussed as a social and cultural experience, not an isolated and individual condition and all women prioritized people and relationships. Women were part of a nexus of complex social relationships that were socially and historically layered with links to many generations. The types of relationships women experienced were influenced by personality, faith and socio-cultural values.The relationship between women’s health and the social conditions of their lives is given token recognition in health policy and women’s health programming in Papua New Guinea. Women face a health system that pre-imposes a narrow definition of women’s health to the detriment of gender issues and women’s empowerment. The findings reveal that in the Wosera women’s work and the physical burden of women’s roles, marriage and risk and experience of violence, and an unresponsive and inappropriate health service were major risk factors and barriers to women’s health. Based on this finding a holistic and rights based approach to women’s health policy, programming and advocacy is proposed. It is argued that the daily inequalities, discrimination and oppression that women face in their everyday lives, affects their ability to achieve the right to health and a host of interrelated rights such as the right to education, right to food and nutrition and freedom from discrimination.The study also emphasized the relevance of psychosocial constraints for women’s health. Psychosocial factors, linked to material circumstances and individual behaviour, exerted a powerful influence over health and affected a woman’s ability to cope with difficult life circumstances. Feelings of powerlessness, helplessness and stress-related disorders among women were related to the gender inequalities that worked to perpetuate the low status of women throughout the life span. Women who could not count on male support (husbands, male relatives, sons) and were the target of constant abuse and neglect were identified to be particularly vulnerable and at a risk of depression and stress.The study also documented that women throughout the life cycle displayed inherent resilience and adopted different coping strategies for dealing with the demanding and complex circumstances of their lives but some women were better positioned than others to cope. The active coping mechanisms of women showed a strength, assertiveness and resourcefulness in response to constant hardship. Resilience was enhanced when women had access to social networks and supportive social relationships and were therefore better able to deal with constraints to health. A particular threat to coping was found to result from a woman’s experience with gender constraints, violence and lack of social support.The findings from this study contribute to a rethinking of the traditional biomedical approach to women’s health research. The study challenges the worldview that prioritizes reproductive health over an approach to women’s health that concerns the totality of women’s lived experiences throughout the life span. This study calls for the need to increase the focus of research on the application of psychosocial and rights-based perspectives to understand the diversity of women’s health-related experiences, the complexity of their social relations and the relationship between challenging social and material circumstances and health outcomes. Recommendation and implications for further research, education, policy, advocacy and programming action, are proposed and discussed