The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review

Background: Infant mortality has shown a steady decline in recent years but a marked socioeconomic gradient persists. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but the effectiveness of specific antenatal care programmes as a means of reducing infant mortality in socioeconomically disadvantaged and vulnerable groups of women has not been rigorously evaluated.Methods: We conducted a systematic review, focusing on evidence from high income countries, to evaluate the effectiveness of alternative models of organising or delivering antenatal care to disadvantaged and vulnerable groups of women vs. standard antenatal care. We searched Medline, Embase, Cinahl, PsychINFO, HMIC, CENTRAL, DARE, MIDIRS and a number of online resources to identify relevant randomised and observational studies. We assessed effects on infant mortality and its major medical causes (preterm birth, congenital anomalies and sudden infant death syndrome (SIDS)).Results: We identified 36 distinct eligible studies covering a wide range of interventions, including group antenatal care, clinic-based augmented care, teenage clinics, prenatal substance abuse programmes, home visiting programmes, maternal care coordination and nutritional programmes. Fifteen studies had adequate internal validity: of these, only one was considered to demonstrate a beneficial effect on an outcome of interest. Six interventions were considered 'promising'.Conclusions: There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women. Several interventions merit further more rigorous evaluation

The Observatory for Multi-Epoch Gravitational Lens Astrophysics (OMEGA) - art. no. 70101B

Dark matter in a universe dominated by a cosmological constant seeds the formation of structure and is the scaffolding for galaxy formation. The nature of dark matter remains one of the fundamental unsolved problems in astrophysics and physics even though it represents 85% of the mass in the universe, and nearly one quarter of its total mass-energy budget. The mass function of dark matter "substructure" on sub-galactic scales may be enormously sensitive to the mass and properties of the dark matter particle. On astrophysical scales, especially at cosmological distances, dark matter substructure may only be detected through its gravitational influence on light from distant varying sources. Specifically, these are largely active galactic nuclei (AGN), which are accreting super-massive black holes in the centers of galaxies, some of the most extreme objects ever found. With enough measurements of the flux from AGN at different wavelengths, and their variability over time, the detailed structure around AGN, and even the mass of the super-massive black hole can be measured. The Observatory for Multi-Epoch Gravitational Lens Astrophysics (OMEGA) is a mission concept for a 1.5-m near-UV through near-IR space observatory that will be dedicated to frequent imaging and spectroscopic monitoring of-100 multiply-imaged active galactic nuclei over the whole sky. Using wavelength-tailored dichroics with extremely high transmittance, efficient imaging in six channels will be done simultaneously during each visit to each target. The separate spectroscopic mode, engaged through a flip-in mirror, uses an image slicer spectrograph. After a period of many visits to all targets, the resulting multidimensional movies can then be analyzed to a) measure the mass function of dark matter substructure; b) measure precise masses of the accreting black holes as well as the structure of their accretion disks and their environments over several decades of physical scale; and c) measure a combination of Hubble's local expansion constant and cosmological distances to unprecedented precision. We present the novel OMEGA instrumentation suite, and how its integrated design is ideal for opening the time domain of known cosmologically-distant variable sources, to achieve the stated scientific goals