Evaluating Nubian Population Structure from Cranial Nonmetric Traits: Gene Flow, Genetic Drift, and Population History of the Nubian Nile Valle

Paleolithic archaeological and skeletal remains from the Nile Valley have yielded a complex picture of life along the river. Sociocultural and sociopolitical events during this timeframe shaped population structure, while gene flow and genetic drift further developed it. In this paper, we take a population genetics approach to modeling Nubian biological relationships in an effort to describe how an accumulation of events formed Nubian population structure. A variety of Nubian samples were utilized, spanning the Mesolithic-Christian time periods, and geographically, from just above the first through the third cataracts. Population genetics statistics were employed to estimate and depict biological affinities (Mahalanobis D2 with a tetrachoric matrix, principal coordinates analysis, Fst, and Relethford Blangero residuals) and supplemented by spatial-temporal modeling (Mantel tests and PROTESTs). Variation is high amongst these groups, indicating an intricate pattern of relationships in their population history where similar levels of gene flow probably stemmed from extensive cultural contact with Egypt and other populations in a variety of contexts. Genetic drift is also apparent in some of these sites, which is consistent with social and political histories of these groups. Traditional modeling of spatial-temporal patterning was not successful, which may be attributed to the non-linear, loose clustering of Nubian groups by site. Collectively, the archaeological, biological, and environmental evidence support the ideas of multiple populations living in Lower Nubia during the Paleolithic, and/or a new population entering the area and shaping Nubian population structure

The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya

Background Disrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that also affect women’s decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Little is known about interventions aimed at lowering the frequency of disrespectful and abusive behaviors. Methods Between 2011 and 2014, a pre-and-post study measured D & A levels in a three-tiered intervention at 13 facilities in Kenya under the Heshima project. The intervention involved working with policymakers to encourage greater focus on D & A, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance. At participating facilities, postpartum women were approached at discharge and asked to participate in the study; those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys. Results Overall D & A decreased from 20–13 % (p < 0.004) and among four of the six typologies D & A decreased from 40–50 %. Night shift deliveries were associated with greater verbal and physical abuse. Patient and infant detainment declined dramatically from 8.0–0.8 %, though this was partially attributable to the 2013 national free delivery care policy. Conclusion Although a number of contextual factors may have influenced these findings, the magnitude and consistency of the observed decreases suggest that the multi-component intervention may have the potential to reduce the frequency of D & A. Greater efforts are needed to develop stronger evaluation methods for assessing D & A in other settings

The relationship between healthy lifestyle behaviours and outcomes for people living with and beyond cancer: an overview of Systematic Reviews

There are an extensive number of published evidence reviews examining the influence of lifestyle behaviours on cancer outcomes. Healthy lifestyles are a significant topic of debate in oncology and in policy and practice organisations that support people living with and beyond cancer. Such reviews vary in quality, address different relationships, outcomes and cancers, and there is often more than one review on important topics. This makes it difficult for policy and practice professionals to make decisions about the prescription and promotion of lifestyle behaviours for cancer populations. An overview of systematic reviews provides a single, overarching summary of evidence from published systematic reviews and compares and contrasts the findings of systematic reviews, providing healthcare professionals with the evidence needed for more effective decision making (Smith et al. 2011). This overview of systematic reviews synthesises evidence from systematic reviews on smoking, physical activity, dietary behaviours and alcohol consumption to present a summary of evidence about the relationships between these lifestyle behaviours and outcomes for people living with and beyond cancer

Estimating willingness to pay for maternal health services: The Kenya reproductive health voucher programme

As part of a broad evaluation of a reproductive health voucher programme aimed at determining its effect on health outcomes, a willingness to pay (WTP) study was conducted. The purpose of the study was to estimate WTP values for a broad range of reproductive health (RH) services namely: antenatal care (ANC), delivery, postnatal care (PNC) and family planning (FP) services. The study also sought to investigate the effect of the voucher programme on respondents’ stated WTP values for the RH services. Women utilizing RH services at both voucher and non-voucher facilities were asked about their WTP for the RH services and WTP values were elicited using a stated preferences method. The study found that women were willing to pay a positive price to access RH services. Results also point to a differential learning effect or experience of the voucher on WTP for ANC, PNC, FP and delivery services. Further analysis also highlights endowment and reference effects with the voucher cost impacting on stated WTP amounts. The findings point to the potential for designing a sliding scale payment mechanism with effective targeting of subsidies such as vouchers to the neediest segments of the population. This will allow potential service users to pay for services within their willingness and ability to pay while also freeing resources to cater for the neediest segments of the population.The reproductive health voucher programme is implemented by the Government of Kenya with major funding from the German Development Bank (KfW). The evaluation project was funded by the Bill & Melinda Gates Foundation and implemented by the Population Council in collaboration with the National Council for Population and Development (NCPD), the Ministry of Health and PriceWaterhouseCoopers

Anti-Candida targets and cytotoxicity of casuarinin isolated from Plinia cauliflora leaves in a bioactivity-guided study

Peer reviewedPublisher PD

A systematic overview of reviews of the effectiveness and cost effectiveness of interventions to promote healthy lifestyle behaviours in people living with or beyond cancer

An overview of systematic reviews synthesised evidence on the relationship between smoking, physical activity, dietary behaviours and alcohol consumption and important outcomes for people living with and beyond cancer. That review demonstrated that some lifestyle behaviours may be associated with important outcomes in people living with and beyond cancer (PLWBC). However it did not inform us of whether specifically delivering interventions aimed at modifying lifestyle behaviours effectively improve outcomes for PLWBC. How to promote and sustain healthy lifestyle behaviours in cancer populations is not well understood. A single, overarching summary of evidence from published systematic reviews of lifestyle interventions which compares and contrasts findings can provide policy and practice professionals with the evidence needed for more effective decision making. This overview of systematic reviews provides a synthesis of evidence on the effectiveness and cost-effectiveness of interventions aimed at altering lifestyle behaviours for improving outcomes for people living with and beyond cancer

Health State Utility Values Among Children and Adolescents with Disabilities: Protocol for a Systematic Review

Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. INTRODUCTION: Increasingly, assessment of healthcare technologies and interventions requires the assessment of both costs and utilities. Health state utility values (HSUVs) are measured using a range of generic and condition-specific measures. While reviews have identified that generic measures of HSUVs may lack validity in adults with conditions that result in physical disability, there is little information available on the methods used to obtain HSUVs in children and adolescents with disabilities. The objectives of this systematic review are to describe the methods used to obtain HSUVs, including mode of administration and psychometric properties, and provide summary statistics for HSUVs among children and adolescents with disabilities. METHODS AND ANALYSIS: The following databases will be searched from inception for English-language studies of any design: PubMed, PsychInfo, Medline, Scopus, CINAHL Plus, Econlit and EMBASE databases. Two reviewers will independently screen titles, abstracts and full text articles for studies reporting HSUVs and/or data on the psychometric properties of preference-based measures for children and adolescents with disabilities aged up to 19 years. Two reviewers will independently extract data items including descriptors of the study methods and sample, instruments used to capture HSUVs, summary statistics for HSUVs and items relating to the quality of reporting. A descriptive summary of results from included studies and summary statistics for HSUVs will be presented. If sufficient data is identified, we will pool summary statistics for HSUVs according to the method used to obtain the HSUV using a random effects model. In addition, we will explore the determinants of the HSUVs using a meta-regression. ETHICS AND DISSEMINATION: Ethical approval will not be required as no original data will be collected as part of this review. The completed review will be submitted for publication in a peer-reviewed journal and presentation at conferences.Research Catalyst Award from the Institute of Environment, Health and Societies, Brunel University London

Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme

This study tests the group-level causal relationship between the expansion of Kenya’s Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program’s causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counselling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and new-born. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement

Theoretical description of adiabatic laser alignment and mixed-field orientation: the need for a non-adiabatic model

We present a theoretical study of recent laser-alignment and mixed-field-orientation experiments of asymmetric top molecules. In these experiments, pendular states were created using linearly polarized strong ac electric fields from pulsed lasers in combination with weak electrostatic fields. We compare the outcome of our calculations with experimental results obtained for the prototypical large molecule benzonitrile (C$_7$H$_5$N) [J.L. Hansen et al, Phys. Rev. A, 83, 023406 (2011)] and explore the directional properties of the molecular ensemble for several field configurations, i.e., for various field strengths and angles between ac and dc fields. For perpendicular fields one obtains pure alignment, which is well reproduced by the simulations. For tilted fields, we show that a fully adiabatic description of the process does not reproduce the experimentally observed orientation, and it is mandatory to use a diabatic model for population transfer between rotational states. We develop such a model and compare its outcome to the experimental data confirming the importance of non-adiabatic processes in the field-dressed molecular dynamics.Comment: 11 pages, 9 figure

Does a voucher program improve reproductive health service delivery and access in Kenya?

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background - Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program. Methods - A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analysed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Results - Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions. Conclusions - Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.This work was supported by the Bill and Melinda Gates Foundation to the Population Council as part of a multi country study evaluation of voucher-andaccreditation interventions. Grant number 51761