Taking stock of 10 years of published research on the ASHA programme: Examining India’s national community health worker programme from a health systems perspective

Background: As India’s accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW–health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight

Measurement of single top-quark production in the s-channel in proton–proton collisions at √s = 13 TeV with the ATLAS detector

A measurement of single top-quark production in the s-channel is performed in proton–proton collisions at a centre-of-mass energy of 13 TeV with the ATLAS detector at the CERN Large Hadron Collider. The dataset corresponds to an integrated luminosity of 139 fb−1. The analysis is performed on events with an electron or muon, missing transverse momentum and exactly two b-tagged jets in the final state. A discriminant based on matrix element calculations is used to separate single-top-quark s-channel events from the main background contributions, which are top-quark pair production and W-boson production in association with jets. The observed (expected) signal significance over the background-only hypothesis is 3.3 (3.9) standard deviations, and the measured cross-section is σ=8.2+3.5−2.9 pb, consistent with the Standard Model prediction of σSM=10.32+0.40−0.36 pb

Magnitude and Determinants of the Ratio between Prevalence of Low Vision and Blindness in Rapid Assessment of Avoidable Blindness Surveys

Purpose: To determine the magnitude and determinants of the ratio between prevalence of low vision and prevalence of blindness in rapid assessment of avoidable blindness (RAAB) surveys globally. Methods: Standard RAAB reports were downloaded from the repository or requested from principal investigators. Potential predictor variables included prevalence of uncorrected refractive error (URE) as well as gross domestic product (GDP) per capita, health expenditure per capita of the country across World Bank regions. Univariate and multivariate linear regression were used to investigate the correlation between potential predictor variables and the ratio. Results: The results of 94 surveys from 43 countries showed that the ratio ranged from 1.35 in Mozambique to 11.03 in India with a median value of 3.90 (Interquartile range 3.06;5.38). Univariate regression analysis showed that prevalence of URE (p = 0.04), logarithm of GDP per capita (p = 0.01) and logarithm of health expenditure per capita (p = 0.03) were significantly associated with the higher ratio. However, only prevalence of URE was found to be significant in multivariate regression analysis (p = 0.03). Conclusion: There is a wide variation in the ratio of the prevalence of low vision to the prevalence of blindness. Eye care service utilization indicators such as the prevalence of URE may explain some of the variation across the regions.</p

Heterogeneous returns to chemical fertilizer at the intensive margins: insights from Nepal

Increased fertilizer use is considered important for agricultural development in low-income countries. Promoting increased use of chemical fertilizer by lowering its price may be ineffective if demand is price inelastic. In theory, the price elasticity of demand depends on the returns to its use, but the evidence is scarce. Furthermore, while returns are often estimated for small changes in chemical fertilizer use, returns to larger changes in its use (intensive margins) are less understood. Through the inter-zonal comparisons in Nepal, we provide indicative evidence that greater returns to chemical fertilizer are associated with greater price elasticities of demand. Moreover, the evidence suggests that returns at the intensive margins, rather than returns to small changes, may largely account for inter-zonal differences in returns to chemical fertilizer within Nepal. The results suggest that better understanding the returns at the intensive margins is critical for effective agricultural inputs policies in developing countries

A Rare Presentation of Pericardial Tumor Presenting as Chronic Cough

Chronic cough can pose various diagnostic and therapeutic dilemmas to physicians. Airway narrowing secondary to endoluminal disease or extrinsic compression are known etiologies of chronic cough. We report an extremely rare case of chronic cough due to extrinsic airway compression by a large pericardial lipoma with subsequent resolution of symptoms after the resection of the mass. This case provides insight into the rare etiology of chronic cough that is addressable with surgical intervention

Receptor Induced Doping of Conjugated Polymer Transistors: A Strategy for Selective and Ultrasensitive Phosphate Detection in Complex Aqueous Environments

Phosphate oxyanions play central roles in biological, agricultural, industrial, and ecological processes. Their high hydration energies and dynamic properties present a number of critical challenges limiting the development of sensing technologies that are cost-effective, selective, sensitive, field-deployable, and which operate in real-time within complex aqueous environments. Here, a strategy that enables the fabrication of an electrolyte-gated organic field-effect transistor (EGOFET) is demonstrated, which overcomes these challenges and enables sensitive phosphate quantification in challenging aqueous environments such as seawater. The device channel comprises a composite layer incorporating a diketopyrrolopyrrole-based semiconducting polymer and a π-conjugated penta-t-butylpentacyanopentabenzo[25]annulene “cyanostar” receptor capable of oxyanion recognition and embodies a new concept, where the receptor synergistically enhances the stability and transport characteristics via doping. Upon exposure of the device to phosphate, a current reduction is observed, consistent with dedoping upon analyte binding. Sensing studies demonstrate ultrasensitive and selective phosphate detection within remarkably low limits of detection of 178 × 10−12 m (17.3 parts per trillion) in buffered samples and stable operation in seawater. This receptor-based doping strategy, in conjunction with the versatility of EGOFETs for miniaturization and monolithic integration, enables manifold opportunities in diagnostics, healthcare, and environmental monitoring

Isocupressic Acid Blocks Progesterone Production from Bovine Luteal Cells

Abstract: The needles of ponderosa pine (Pinus ponderosa Laws.) were reported to induce abortions when fed to late-term pregnant beef cows in North America. An in vivo study of pregnant cows suggested that isocupressic acid (IA) was the main abortifacient isolated from needles and bark of the pine. However, the mechanism of abortifacient activity of IA is not clear yet. In a pregnant cow, the corpus luteum of the ovary helps the maintenance of pregnancy by its progesterone production. This study involved the IA extracted from the root of the Taiwan cypress (Juniperus formosana) and used a frozen-thawed bovine luteal cell culture system to investigate the action of IA on progesterone production. Thawed bovine luteal cells (1 × 10 5 cells/ml/well) in M199 medium were cultured in 24-well culture plates at 37°C in a 5% CO 2 incubator. Ten ml of tested drugs, IA at 1 to 1000 ng/ ml and/or ovine luteinizing hormone (oLH) at 1 to 100 ng/µl or 8-bromo-cyclic adenosine monophosphate (8-Br-cAMP) with 0.1-10 mM, were added into each well. After 4 hours of incubation, the media were harvested and assayed for progesterone by an enzyme immunoassay. Progesterone production from cells was the indicator used to evaluate the action of IA. All tested doses of IA significantly inhibited progesterone production in both basal and oLH stimulating conditions. Also those dosages inhibited cyclic adenosine-3&apos;,5&apos;-monophosphate (cAMP) stimulation, suggesting a post-cAMP mechanism is involved in the IA action. We concluded that IA can induce pregnant cows to abort partly through blocking luteal function and may be identified as a new abortifacient chemical

Influence of Heat Treatments on the Properties of ZnO Nanorods Prepared by Hydrothermal Synthesis

ZnO nanorods were grown on bare or SiO2-coated Si wafers by the hydrothermal method. The ZnO nanorods were annealed at 200, 400, and 600??C, respectively. The structural, optical, and electrical property variation of the ZnO nanorods with the annealing temperature was investigated by X-ray diffraction, field-emission scanning electron microscopy, photoluminescence, and current???voltage measurements. For the ZnO nanorods, compressive strain was detected, which decreased with annealing. Moreover, annealing at 600??C led to nanorod agglomeration. The ZnO nanorods annealed at 400??C exhibited the highest crystallinity