Household decision-making about delivery in health facilities: evidence from Tanzania.

This study investigated how partners' perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a health facility were agreement of partners on the importance of delivering in a health facility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility

Stellar laboratories. IX. New Se V, Sr IV - VII, Te VI, and I VI oscillator strengths and the Se, Sr, Te, and I abundances in the hot white dwarfs G191-B2B and RE 0503-289

To analyze spectra of hot stars, advanced non-local thermodynamic equilibrium (NLTE) model-atmosphere techniques are mandatory. Reliable atomic data is for the calculation of such model atmospheres. We aim to calculate new Sr IV - VII oscillator strengths to identify for the first time Sr spectral lines in hot white dwarf (WD) stars and to determine the photospheric Sr abundances. o measure the abundances of Se, Te, and I in hot WDs, we aim to compute new Se V, Te VI, and I VI oscillator strengths. To consider radiative and collisional bound-bound transitions of Se V, Sr IV - VII, Te VI, and I VI in our NLTE atmosphere models, we calculated oscillator strengths for these ions. We newly identified four Se V, 23 Sr V, 1 Te VI, and three I VI lines in the ultraviolet (UV) spectrum of RE0503-289. We measured a photospheric Sr abundance of 6.5 +3.8/-2.4 x 10**-4 (mass fraction, 9500 - 23800 times solar). We determined the abundances of Se (1.6 +0.9/-0.6 x 10**-3, 8000 - 20000), Te (2.5 +1.5/-0.9 x 10**-4, 11000 - 28000), and I (1.4 +0.8/-0.5 x 10**-5, 2700 - 6700). No Se, Sr, Te, and I line was found in the UV spectra of G191-B2B and we could determine only upper abundance limits of approximately 100 times solar. All identified Se V, Sr V, Te VI, and I VI lines in the UV spectrum of RE0503-289 were simultaneously well reproduced with our newly calculated oscillator strengths.Comment: 26 pages, 5 figure

Why do older adults stand-up differently to young adults?: investigation of compensatory movement strategies in sit-to-walk

Functional motor redundancy enables humans to move with distinct muscle activation patterns while achieving a similar outcome. Since humans select similar strategies, there seems to be an optimal control. However, older adults move differently to young adults. The question is whether this is this due to an altered reinforcement scheme, altered sensory inputs, or due to alterations in the neuromusculoskeletal systems, so that it is no longer optimal or possible to execute the same movement strategies. The aim of this study was to analyse natural compensation strategies in the vital daily-life-task, sit-to-walk, in relation to neuromuscular capacity and movement objectives in younger (27.2 ± 4.6 years, N = 27, 14♀) and elderly (75.9 ± 6.3 years, N = 23, 12♀) adults. Aspects of the neuromuscular system that are prone to age-related decline and feasible to quantify were assessed (i.e. strength, nerve conductivity, fear of falling). Kinematics and muscle activity were recorded and joint kinetics were estimated using biomechanical models. Elderly men consistently used their arms when standing up. This strategy was not associated with a lack of or a reduction in strength, but with a reduction, but no lack of, ankle joint range of motion, and with increased fear of falling. The results show that humans preferentially maintain a minimum threshold of neuromuscular reserve to cope with uncertainties which results in compensation prior to coming up against physical limitations. Smaller base of support while standing up, a compensatory strategy with possibly greater risk of falls, was associated with muscular weakness, and longer nerve conduction latencies

Health service quality in 2929 facilities in six low-income and middle-income countries: a positive deviance analysis

BACKGROUND: Primary care is of insufficient quality in many low-income and middle-income countries. Some health facilities perform better than others despite operating in similar contexts, although the factors that characterise best performance are not well known. Existing best-performance analyses are concentrated in high-income countries and focus on hospitals. We used the positive deviance approach to identify the factors that differentiate best from worst primary care performance among health facilities across six low-resource health systems. METHODS: This positive deviance analysis used nationally representative samples of public and private health facilities from Service Provision Assessments of the Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania. Data were collected starting June 11, 2013, in Malawi and ending Feb 28, 2020, in Senegal. We assessed facility performance through completion of the Good Medical Practice Index (GMPI) of essential clinical actions (eg, taking a thorough history, conducting an adequate physical examination) according to clinical guidelines and measured with direct observations of care. We identified hospitals and clinics in the top decile of performance (defined as best performers) and conducted a quantitative, cross-national positive deviance analysis to compare them with facilities performing below the median (defined as worst performers) and identify facility-level factors that explain the gap between best and worst performance. FINDINGS: We identified 132 best-performing and 664 worst-performing hospitals, and 355 best-performing and 1778 worst-performing clinics based on clinical performance across countries. The mean GMPI score was 0.81 (SD 0.07) for the best-performing hospitals and 0.44 (0.09) for the worst-performing hospitals. Among clinics, mean GMPI scores were 0.75 (0.07) for the best performers and 0.34 (0.10) for the worst performers. High-quality governance, management, and community engagement were associated with best performance compared with worst performance. Private facilities out-performed government-owned hospitals and clinics. INTERPRETATION: Our findings suggest that best-performing health facilities are characterised by good management and leaders who can engage staff and community members. Governments should look to best performers to identify scalable practices and conditions for success that can improve primary care quality overall and decrease quality gaps between health facilities. FUNDING: Bill & Melinda Gates Foundation

EC 11481-2303 - A Peculiar Subdwarf OB Star Revisited

EC 11481-2303 is a peculiar, hot, high-gravity pre-white dwarf. Previous optical spectroscopy revealed that it is a sdOB star with an effective temperature (Teff) of 41790 K, a surface gravity log(g)= 5.84, and He/H = 0.014 by number. We present an on-going spectral analysis by means of non-LTE model-atmosphere techniques based on high-resolution, high-S/N optical (VLT-UVES) and ultraviolet (FUSE, IUE) observations. We are able to reproduce the optical and UV observations simultaneously with a chemically homogeneous NLTE model atmosphere with a significantly higher effective temperature and lower He abundance (Teff = 55000 K, log (g) = 5.8, and He / H = 0.0025 by number). While C, N, and O appear less than 0.15 times solar, the iron-group abundance is strongly enhanced by at least a factor of ten.Comment: 8 pages, 11 figure

Asteroids seen by JWST-MIRI: Radiometric Size, Distance and Orbit Constraints

Infrared measurements of asteroids are crucial for the determination of physical and thermal properties of individual objects, and for the understanding of the small-body populations in the solar system as a whole. But standard radiometric methods can only be applied if the orbit of an object is known, hence its position at the time of the observation. We present MIRI observations of the outer-belt asteroid 10920 and an unknown object, detected in all 9 MIRI bands in close proximity to 10920. We developed a new method "STM-ORBIT" to interpret the multi-band measurements without knowing the object's true location. The method leads to a confirmation of radiometric size-albedo solution for 10920 and puts constraints on the asteroid's location and orbit in agreement with its true orbit. Groundbased lightcurve observations of 10920, combined with Gaia data, indicate a very elongated object (a/b >= 1.5), with a spin-pole at (l, b) = (178{\deg}, 81{\deg}), and a rotation period of 4.861191 h. A thermophysical study leads to a size of 14.5 - 16.5 km, a geometric albedo between 0.05 and 0.10, and a thermal inertia in the range 9 to 35 Jm-2s-0.5K-1. For the newly discovered MIRI object, the STM-ORBIT method revealed a size of 100-230 m. The new asteroid must be on a very low-inclination orbit and it was located in the inner main-belt region during JWST observations. A beaming parameter {\eta} larger than 1.0 would push the size even below 100 meter, a main-belt regime which escaped IR detections so far. These kind of MIRI observations can therefore contribute to formation and evolution studies via classical size-frequency studies which are currently limited to objects larger than about one kilometer in size. We estimate that MIRI frames with pointings close to the ecliptic and only short integration times of a few seconds will always include a few asteroids, most of them will be unknown objects.Comment: 17 pages, 10 figures, 4 tables, accepted for A&A publication on Nov 22, 202

Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women

Objective: In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences. Methods: We fielded a structured questionnaire that included a discrete choice experiment to investigate women’s preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models. Results: 3,003 women participated in the discrete choice experiment (93% response rate) completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001), followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001) and modern medical equipment and drugs (β = 0.66 p<0.001). Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital. Conclusions: Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care

The Clumping Transition in Niche Competition: a Robust Critical Phenomenon

We show analytically and numerically that the appearance of lumps and gaps in the distribution of n competing species along a niche axis is a robust phenomenon whenever the finiteness of the niche space is taken into account. In this case depending if the niche width of the species $\sigma$ is above or below a threshold $\sigma_c$, which for large n coincides with 2/n, there are two different regimes. For $\sigma > sigma_c$ the lumpy pattern emerges directly from the dominant eigenvector of the competition matrix because its corresponding eigenvalue becomes negative. For $\sigma </- sigma_c$ the lumpy pattern disappears. Furthermore, this clumping transition exhibits critical slowing down as $\sigma$ is approached from above. We also find that the number of lumps of species vs. $\sigma$ displays a stair-step structure. The positions of these steps are distributed according to a power-law. It is thus straightforward to predict the number of groups that can be packed along a niche axis and it coincides with field measurements for a wide range of the model parameters.Comment: 16 pages, 7 figures; http://iopscience.iop.org/1742-5468/2010/05/P0500

CalFUSE v3: A Data-Reduction Pipeline for the Far Ultraviolet Spectroscopic Explorer

Since its launch in 1999, the Far Ultraviolet Spectroscopic Explorer (FUSE) has made over 4600 observations of some 2500 individual targets. The data are reduced by the Principal Investigator team at the Johns Hopkins University and archived at the Multimission Archive at Space Telescope (MAST). The data-reduction software package, called CalFUSE, has evolved considerably over the lifetime of the mission. The entire FUSE data set has recently been reprocessed with CalFUSE v3.2, the latest version of this software. This paper describes CalFUSE v3.2, the instrument calibrations upon which it is based, and the format of the resulting calibrated data files.Comment: To appear in PASP; 29 pages, 13 figures, uses aastex, emulateap