Effects of a community scorecard on improving the local health system in Eastern Democratic Republic of Congo: qualitative evidence using the most significant change technique.

BACKGROUND: More than a decade of conflict has weakened the health system in the Democratic Republic of Congo and decreased its ability to respond to the needs of the population. Community scorecards have been conceived as a way to increase accountability and responsiveness of service providers, but there is limited evidence of their effects, particularly in fragile and conflict-affected contexts. This paper describes the implementation of community scorecards within a community-driven reconstruction project in two provinces of eastern Democratic Republic of Congo. METHODS: Between June 2012 and November 2013, 45 stories of change in the health system were collected from village development committee, health committee, community members (20 men and 18 women) and healthcare providers (n = 7) in 25 sites using the Most Significant Change technique. Stories were analyzed qualitatively for content related to the types and mechanisms of change observed. RESULTS: The most salient changes were related to increased transparency and community participation in health facility management, and improved quality of care. Quality of care included increased access to services, improved patient-provider relationships, improved performance of service providers, and improved maintenance of physical infrastructure. Changes occurred through many different mechanisms including provider actions in response to information, pressure from community representatives, or supervisors; and joint action and improved collaboration by health facility committees and providers. CONCLUSIONS: Although it is often assumed that confrontation is a primary mechanism for citizens to change state-provided services, this study demonstrates that healthcare providers may also be motivated to change through other means. Positive experiences of community scorecards can provide a structured space for interface between community members and the health system, allowing users to voice their opinions and preferences and bridge information gaps for both users and frontline healthcare providers. When solutions to problems identified through the scorecard are locally accessible, users and healthcare providers are able to work together to implement mutually acceptable solutions that improve quality of health services, and make them more responsive to users' needs

Co-targeting of DNA, RNA, and protein molecules provides optimal outcomes for treating osteosarcoma and pulmonary metastasis in spontaneous and experimental metastasis mouse models.

Metastasis is a major cause of mortality for cancer patients and remains as the greatest challenge in cancer therapy. Driven by multiple factors, metastasis may not be controlled by the inhibition of single target. This study was aimed at assessing the hypothesis that drugs could be rationally combined to co-target critical DNA, RNA and protein molecules to achieve "saturation attack" against metastasis. Independent actions of the model drugs DNA-intercalating doxorubicin, RNA-interfering miR-34a and protein-inhibiting sorafenib on DNA replication, RNA translation and protein kinase signaling in highly metastatic, human osteosarcoma 143B cells were demonstrated by the increase of γH2A.X foci formation, reduction of c-MET expression and inhibition of Erk1/2 phosphorylation, respectively, and optimal effects were found for triple-drug combination. Consequently, triple-drug treatment showed a strong synergism in suppressing 143B cell proliferation and the greatest effects in reducing cell invasion. Compared to single- and dual-drug treatment, triple-drug therapy suppressed pulmonary metastases and orthotopic osteosarcoma progression to significantly greater degrees in orthotopic osteosarcoma xenograft/spontaneous metastases mouse models, while none showed significant toxicity. In addition, triple-drug therapy improved the overall survival to the greatest extent in experimental metastases mouse models. These findings demonstrate co-targeting of DNA, RNA and protein molecules as a novel therapeutic strategy for the treatment of metastasis

Health system resilience during COVID-19 understanding SRH service adaptation in North Kivu

Background There is often collateral damage to health systems during epidemics, affecting women and girls the most, with reduced access to non-outbreak related services, particularly in humanitarian settings. This rapid case study examines sexual and reproductive health (SRH) services in the Democratic Republic of the Congo when the COVID-19 hit, towards the end of an Ebola Virus Disease (EVD) outbreak, and in a context of protracted insecurity. Methods This study draws on quantitative analysis of routine data from four health zones, a document review of policies and protocols, and 13 key-informant interviews with staff from the Ministry of Public Health, United Nations agencies, international and national non-governmental organizations, and civil society organizations. Results Utilization of SRH services decreased initially but recovered by August 2020. Significant fluctuations remained across areas, due to the end of free care once Ebola funding ceased, insecurity, number of COVID-19 cases, and funding levels. The response to COVID-19 was top-down, focused on infection and prevention control measures, with a lack of funding, technical expertise and overall momentum that characterized the EVD response. Communities and civil society did not play an active role for the planning of the COVID-19 response. While health zone and facility staff showed resilience, developing adaptations to maintain SRH provision, these adaptations were short-lived and inconsistent without external support and funding. Conclusion The EVD outbreak was an opportunity for health system strengthening that was not sustained during COVID-19. This had consequences for access to SRH services, with limited-resources available and deprioritization of SRH

AR2, a novel automatic muscle artifact reduction software method for ictal EEG interpretation: Validation and comparison of performance with commercially available software.

Objective: To develop a novel software method (AR2) for reducing muscle contamination of ictal scalp electroencephalogram (EEG), and validate this method on the basis of its performance in comparison to a commercially available software method (AR1) to accurately depict seizure-onset location. Methods: A blinded investigation used 23 EEG recordings of seizures from 8 patients. Each recording was uninterpretable with digital filtering because of muscle artifact and processed using AR1 and AR2 and reviewed by 26 EEG specialists. EEG readers assessed seizure-onset time, lateralization, and region, and specified confidence for each determination. The two methods were validated on the basis of the number of readers able to render assignments, confidence, the intra-class correlation (ICC), and agreement with other clinical findings. Results: Among the 23 seizures, two-thirds of the readers were able to delineate seizure-onset time in 10 of 23 using AR1, and 15 of 23 using AR2 (

Gas Accretion and Galactic Chemical Evolution: Theory and Observations

This chapter reviews how galactic inflows influence galaxy metallicity. The goal is to discuss predictions from theoretical models, but particular emphasis is placed on the insights that result from using models to interpret observations. Even as the classical G-dwarf problem endures in the latest round of observational confirmation, a rich and tantalizing new phenomenology of relationships between $M_*$, $Z$, SFR, and gas fraction is emerging both in observations and in theoretical models. A consensus interpretation is emerging in which star-forming galaxies do most of their growing in a quiescent way that balances gas inflows and gas processing, and metal dilution with enrichment. Models that explicitly invoke this idea via equilibrium conditions can be used to infer inflow rates from observations, while models that do not assume equilibrium growth tend to recover it self-consistently. Mergers are an overall subdominant mechanism for delivering fresh gas to galaxies, but they trigger radial flows of previously-accreted gas that flatten radial gas-phase metallicity gradients and temporarily suppress central metallicities. Radial gradients are generically expected to be steep at early times and then flattened by mergers and enriched inflows of recycled gas at late times. However, further theoretical work is required in order to understand how to interpret observations. Likewise, more observational work is needed in order to understand how metallicity gradients evolve to high redshifts.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springer. 29 pages, 2 figure

Mesoscopic 3D Charge Transport in Solution-Processed Graphene-Based Thin Films: A Multiscale Analysis

Graphene and related 2D material (GRM) thin films consist of 3D assembly of billions of 2D nanosheets randomly distributed and interacting via van der Waals forces. Their complexity and the multiscale nature yield a wide variety of electrical characteristics ranging from doped semiconductor to glassy metals depending on the crystalline quality of the nanosheets, their specific structural organization ant the operating temperature. Here, the charge transport (CT) mechanisms are studied that are occurring in GRM thin films near the metal-insulator transition (MIT) highlighting the role of defect density and local arrangement of the nanosheets. Two prototypical nanosheet types are compared, i.e., 2D reduced graphene oxide and few-layer-thick electrochemically exfoliated graphene flakes, forming thin films with comparable composition, morphology and room temperature conductivity, but different defect density and crystallinity. By investigating their structure, morphology, and the dependence of their electrical conductivity on temperature, noise and magnetic-field, a general model is developed describing the multiscale nature of CT in GRM thin films in terms of hopping among mesoscopic bricks, i.e., grains. The results suggest a general approach to describe disordered van der Waals thin films

Nonequilibrium Steady States and Fano-Kondo Resonances in an AB Ring with a Quantum Dot

Electron transport through a strongly correlated quantum dot (QD) embedded in an Aharonov-Bohm (AB) ring is investigated with the aid of the finite-U slave-boson mean-field (SBMF) approach extended to nonequilibrium regime. A nonequilibrium steady state (NESS) of the mean-field Hamiltonian is constructed with the aid of the C*-algebraic approach for studying infinitely extended systems. In the linear response regime, the Fano-Kondo resonances and AB oscillations of the conductance obtained from the SBMF approach are in good agreement with those from the numerical renormalization group technique (NRG) by Hofstetter et al. by using twice larger Coulomb interaction. At zero temperature and finite bias voltage, the resonance peaks of the differential conductance tend to split into two. At low bias voltage, the split of the asymmetric resonance can be observed as an increase of the conductance plateau. We also found that the differential conductance has zero-bias maximum or minimum depending on the background transmission via direct tunneling between the electrodes.Comment: 24 pages,17 figure

The <i>Castalia</i> mission to Main Belt Comet 133P/Elst-Pizarro

We describe Castalia, a proposed mission to rendezvous with a Main Belt Comet (MBC), 133P/Elst-Pizarro. MBCs are a recently discovered population of apparently icy bodies within the main asteroid belt between Mars and Jupiter, which may represent the remnants of the population which supplied the early Earth with water. Castalia will perform the first exploration of this population by characterising 133P in detail, solving the puzzle of the MBC’s activity, and making the first in situ measurements of water in the asteroid belt. In many ways a successor to ESA’s highly successful Rosetta mission, Castalia will allow direct comparison between very different classes of comet, including measuring critical isotope ratios, plasma and dust properties. It will also feature the first radar system to visit a minor body, mapping the ice in the interior. Castalia was proposed, in slightly different versions, to the ESA M4 and M5 calls within the Cosmic Vision programme. We describe the science motivation for the mission, the measurements required to achieve the scientific goals, and the proposed instrument payload and spacecraft to achieve these

Unusually long path length for a nearly scatter-free solar particle event observed by Solar Orbiter at 0.43 au

Context: After their acceleration and release at the Sun, solar energetic particles (SEPs) are injected into the interplanetary medium and are bound to the interplanetary magnetic field (IMF) by the Lorentz force. The expansion of the IMF close to the Sun focuses the particle pitch-angle distribution, and scattering counteracts this focusing. Solar Orbiter observed an unusual solar particle event on 9 April 2022 when it was at 0.43 astronomical units (au) from the Sun. // Aims: We show that the inferred IMF along which the SEPs traveled was about three times longer than the nominal length of the Parker spiral and provide an explanation for this apparently long path. // Methods: We used velocity dispersion analysis (VDA) information to infer the spiral length along which the electrons and ions traveled and infer their solar release times and arrival direction. // Results: The path length inferred from VDA is approximately three times longer than the nominal Parker spiral. Nevertheless, the pitch-angle distribution of the particles of this event is highly anisotropic, and the electrons and ions appear to be streaming along the same IMF structures. The angular width of the streaming population is estimated to be approximately 30 degrees. The highly anisotropic ion beam was observed for more than 12 h. This may be due to the low level of fluctuations in the IMF, which in turn is very probably due to this event being inside an interplanetary coronal mass ejection The slow and small rotation in the IMF suggests a flux-rope structure. Small flux dropouts are associated with very small changes in pitch angle, which may be explained by different flux tubes connecting to different locations in the flare region. // Conclusions: The unusually long path length along which the electrons and ions have propagated virtually scatter-free together with the short-term flux dropouts offer excellent opportunities to study the transport of SEPs within interplanetary structures. The 9 April 2022 solar particle event offers an especially rich number of unique observations that can be used to limit SEP transport models