A Review of Generalist and Specialist Community Health Workers for Delivering Adolescent Health Services in sub-Saharan Africa.

The health of adolescents is increasingly seen as an important international priority because the world's one point eight billion young people (aged 10 to 24 years) accounts for 15.5% of the global burden of disease and are disproportionately located in low- and middle-income countries (LMICs). Furthermore, an estimated 70% of premature adult deaths are attributable to unhealthy behaviors often initiated in adolescence (such as smoking, obesity, and physical inactivity). In order for health services to reach adolescents in LMICs, innovative service delivery models need to be explored and tested. This paper reviews the literature on generalist and specialist community health workers (CHWs) to assess their potential for strengthening the delivery of adolescent health services. We reviewed the literature on CHWs using Medline (PubMed), EBSCO Global Health, and Global Health Archive. Search terms (n = 19) were sourced from various review articles and combined with subject heading 'sub-Saharan Africa' to identify English language abstracts of original research articles on generalist and specialist CHWs. A total of 106 articles, from 1985 to 2012, and representing 24 African countries, matched our search criteria. A single study in sub-Saharan Africa used CHWs to deliver adolescent health services with promising results. Though few comprehensive evaluations of large-scale CHW programs exist, we found mixed evidence to support the use of either generalist or specialist CHW models for delivering adolescent health services. This review found that innovative service delivery approaches, such as those potentially offered by CHWs, for adolescents in sub-Saharan Africa are lacking, CHW programs have proliferated despite the absence of high quality evaluations, rigorous studies to establish the comparative effectiveness of generalist versus specialist CHW programs are needed, and further investigation of the role of CHWs in providing adolescent health services in sub-Saharan Africa is warranted

Binary Asteroid Observation Orbits from a Global Dynamical Perspective

We study spacecraft motion near a binary asteroid by means of theoretical and computational tools from geometric mechanics and dynamical systems. We model the system assuming that one of the asteroids is a rigid body (ellipsoid) and the other a sphere. In particular, we are interested in finding periodic and quasi-periodic orbits for the spacecraft near the asteroid pair that are suitable for observations and measurements. First, using reduction theory, we study the full two body problem (gravitational interaction between the ellipsoid and the sphere) and use the energy-momentum method to prove nonlinear stability of certain relative equilibria. This study allows us to construct the restricted full three-body problem (RF3BP) for the spacecraft motion around the binary, assuming that the asteroid pair is in relative equilibrium. Then, we compute the modified Lagrangian fixed points and study their spectral stability. The fixed points of the restricted three-body problem are modified in the RF3BP because one of the primaries is a rigid body and not a point mass. A systematic studydepending on the parameters of the problem is performed in an effort to understand the rigid body effects on the Lagrangian stability regions. Finally, using frequency analysis, we study the global dynamics near these modified Lagrangian points. From this global picture, we are able to identify (almost-) invariant tori in the stability region near the modified Lagrangian points. Quasi-periodic trajectories on these invariant tori are potentially convenient places to park the spacecraft while it is observing the asteroid pair

Application of dynamical systems theory to a very low energy transfer

We use lobe dynamics in the restricted three-body problem to design orbits with prescribed itineraries with respect to the resonance regions within a Hill’s region. The application we envision is the design of a low energy trajectory to orbit three of Jupiter’s moons using the patched three-body approximation (P3BA). We introduce the “switching region,” the P3BA analogue to the “sphere of influence.” Numerical results are given for the problem of finding the fastest trajectory from an initial region of phase space (escape orbits from moon A) to a target region (orbits captured by moon B) using small controls

Constructing a Low Energy Transfer Between Jovian Moons

There has recently been considerable interest in sending a spacecraft to orbit Europa, the smallest of the four Galilean moons of Jupiter. The trajectory design involved in effecting a capture by Europa presents formidable challenges to traditional conic analysis since the regimes of motion involved depend heavily on three-body dynamics. New three-body perspectives are required to design successful and efficient missions which take full advantage of the natural dynamics. Not only does a three-body approach provide low-fuel trajectories, but it also increases the flexibility and versatility of missions. We apply this approach to design a new mission concept wherein a spacecraft "leap-frogs" between moons, orbiting each for a desired duration in a temporary capture orbit. We call this concept the "Petit Grand Tour." For this application, we apply dynamical systems techniques developed in a previous paper to design a Europa capture orbit. We show how it is possible, using a gravitional boost from Ganymede, to go from a jovicentric orbit beyond the orbit of Ganymede to a ballistic capture orbit around Europa. The main new technical result is the employment of dynamical channels in the phase space - tubes in the energy surface which naturally link the vicinity of Ganymede to the vicinity of Europa. The transfer V necessary to jump from one moon to another is less than half that required by a standard Hohmann transfer

Design of a Multi-Moon Orbiter

The Multi-Moon Orbiter concept is introduced, wherein a single spacecraft orbits several moons of Jupiter, allowing long duration observations. The ΔV requirements for this mission can be low if ballistic captures and resonant gravity assists by Jupiter’s moons are used. For example, using only 22 m/s, a spacecraft initially injected in a jovian orbit can be directed into a capture orbit around Europa, orbiting both Callisto and Ganymede enroute. The time of flight for this preliminary trajectory is four years, but may be reduced by striking a compromise between fuel and time optimization during the inter-moon transfer phases

Heteroclinic connections between periodic orbits and resonance transitions in celestial mechanics

In this paper we apply dynamical systems techniques to the problem of heteroclinic connections and resonance transitions in the planar circular restricted three-body problem. These related phenomena have been of concern for some time in topics such as the capture of comets and asteroids and with the design of trajectories for space missions such as the Genesis Discovery Mission. The main new technical result in this paper is the numerical demonstration of the existence of a heteroclinic connection between pairs of periodic orbits: one around the libration point L1 and the other around L2, with the two periodic orbits having the same energy. This result is applied to the resonance transition problem and to the explicit numerical construction of interesting orbits with prescribed itineraries. The point of view developed in this paper is that the invariant manifold structures associated to L1 and L2 as well as the aforementioned heteroclinic connection are fundamental tools that can aid in understanding dynamical channels throughout the solar system as well as transport between the "interior" and "exterior" Hill's regions and other resonant phenomena

Invariant Manifolds, the Spatial Three-Body Problem and Space Mission Design

The invariant manifold structures of the collinear libration points for the spatial restricted three-body problem provide the framework for understanding complex dynamical phenomena from a geometric point of view. In particular, the stable and unstable invariant manifold \tubes" associated to libration point orbits are the phase space structures that provide a conduit for orbits between primary bodies for separate three-body systems. These invariant manifold tubes can be used to construct new spacecraft trajectories, such as a \Petit Grand Tour" of the moons of Jupiter. Previous work focused on the planar circular restricted three-body problem. The current work extends the results to the spatial case

Optimal control for halo orbit missions

This paper addresses the computation of the required trajectory correction maneuvers (TCM) for a halo orbit space mission to compensate for the launch velocity errors introduced by inaccuracies of the launch vehicle. By combiningdynamical systems theory with optimal control techniques, we produce a portrait of the complex landscape of the trajectory design space. This approach enables parametric studies not available to mission designers a few years ago, such as how the magnitude of the errors and the timingof the first TCM affect the correction ΔV. The impetus for combiningdynamical systems theory and optimal control in this problem arises from design issues for the Genesis Discovery mission being developed for NASA by the Jet Propulsion Laboratory

[Accepted Manuscript] Nurses’ perceptions of universal health coverage and its implications for the Kenyan health sector

Universal health coverage, comprehensive access to affordable and quality health services, is a key component of the newly adopted 2015 Sustainable Development Goals. Prior to the UN resolution, several countries began incorporating elements of universal health coverage into their domestic policy arenas. In 2013, the newly elected President of Kenya announced initiatives aimed at moving towards universal health coverage, which have proven to be controversial. Little is known about how frontline workers, increasingly politically active and responsible for executing these mandates, view these changes. To understand more about how actors make sense of universal health coverage policies, we conducted an interpretive policy analysis using well-established methods from critical policy studies. This study utilized in-depth semi-structured interviews from a cross section of 60 nurses in three health facilities (public and private) in Kenya. Nurses were found to be largely unfamiliar with universal health coverage and interpreted it in myriad ways. One policy in particular, free maternal health care, was interpreted positively in theory and negatively in practice. Nurses often relied on symbolic language to express powerlessness in the wake of significant health systems reform. Study participants linked many of these frustrations to disorganization in the health sector as well as the changing political landscape in Kenya. These interpretations provide insight into charged policy positions held by frontline workers that threaten to interrupt service delivery and undermine the movement towards universal health coverage in Kenya

Framing and the health policy process: a scoping review.

Framing research seeks to understand the forces that shape human behaviour in the policy process. It assumes that policy is a social construct and can be cast in a variety of ways to imply multiple legitimate value considerations. Frames provide the cognitive means of making sense of the social world, but discordance among them forms the basis of policy contestation. Framing, as both theory and method, has proven to generate considerable insight into the nature of policy debates in a variety of disciplines. Despite its salience for understanding health policy debates; however, little is known about the ways frames influence the health policy process. A scoping review using the Arksey and O'Malley framework was conducted. The literature on framing in the health sector was reviewed using nine health and social science databases. Articles were included that explicitly reported theory and methods used, data source(s), at least one frame, frame sponsor and evidence of a given frame's effect on the health policy process. A total of 52 articles, from 1996 to 2014, and representing 12 countries, were identified. Much of the research came from the policy studies/political science literature (n = 17) and used a constructivist epistemology. The term 'frame' was used as a label to describe a variety of ideas, packaged as values, social problems, metaphors or arguments. Frames were characterized at various levels of abstraction ranging from general ideological orientations to specific policy positions. Most articles presented multiple frames and showed how actors advocated for them in a highly contested political process. Framing is increasingly an important, yet overlooked aspect of the policy process. Further analysis on frames, framing processes and frame conflict can help researchers and policymakers to understand opaque and highly charged policy issues, which may facilitate the resolution of protracted policy controversies