Characterizing a community health partnership in Dominican Republic: Network mapping and analysis of stakeholder perceptions

Background: Medical trainees complete learning experiences abroad to fulfil global health curricular elements, but this participation has been steadily criticized as fulfilling learner objectives at the cost of host communities. This study uses network and qualitative analyses in characterizing a community coalition in order to better understand its various dimensions and to explore the perceived benefits it provided towards optimizing community outcomes.Methods: Data from a semi-structured survey was used for network and qualitative analyses. Partner linkages were assessed using network analysis tool UCINET 6 (version 6.6). Thematic analysis was conducted on qualitative responses around the perceived coalition strengths and weaknesses.Results: Network analysis confirmed that local member organizations were key network influencers based on reported formal agreements, general interactions, and information shared. While sharing of resources was rare, qualitative analysis suggested that information sharing contributed to engagement, enthusiasm, and communication that allowed visiting partners to expand their understanding of community needs and shift their focus beyond learner objectives.Conclusion: Global health programs for medical students should consider the use of community health coalitions to optimally align the work undertaken by learners on global health experiences abroad. Network mapping can help educators and coalition partners visualize interactions and identify value

Evidence of Gunn-Peterson damping wings in high-z quasar spectra: strengthening the case for incomplete reionization

The spectra of several high-redshift (z>6) quasars have shown evidence for a Gunn-Peterson (GP) damping wing, indicating a substantial mean neutral hydrogen fraction (x_HI > 0.03) in the z ~ 6 intergalactic medium (IGM). However, previous analyses assumed that the IGM was uniformly ionized outside of the quasar's HII region. Here we relax this assumption and model patchy reionization scenarios for a range of IGM and quasar parameters. We quantify the impact of these differences on the inferred x_HI, by fitting the spectra of three quasars: SDSS J1148+5251 (z=6.419), J1030+0524 (z=6.308), and J1623+3112 (z=6.247). We find that the best-fit values of x_HI in the patchy models agree well with the uniform case. More importantly, we confirm that the observed spectra favor the presence of a GP damping wing, with peak likelihoods decreasing by factors of > few - 10 when the spectra are modeled without a damping wing. We also find that the Ly alpha absorption spectra, by themselves, cannot distinguish the damping wing in a relatively neutral IGM from a damping wing in a highly ionized IGM, caused either by an isolated neutral patch, or by a damped Ly alpha absorber (DLA). However, neutral patches in a highly ionized universe (x_HI < 0.01), and DLAs with the large required column densities (N_HI > few x 10^{20} cm^{-2}) are both rare. As a result, when we include reasonable prior probabilities for the line of sight (LOS) to intercept either a neutral patch or a DLA at the required distance of ~ 40-60 comoving Mpc away from the quasar, we find strong lower limits on the neutral fraction in the IGM, x_HI > 0.1 (at 95% confidence). This strengthens earlier claims that a substantial global fraction of hydrogen in the z~6 IGM is in neutral form.Comment: 18 pages, 7 figures, version accepted for publication in the MNRA

A strong redshift dependence of the broad absorption line quasar fraction

We describe the application of non-negative matrix factorisation to generate compact reconstructions of quasar spectra from the Sloan Digital Sky Survey (SDSS), with particular reference to broad absorption line quasars (BALQSOs). BAL properties are measured for SiIV lambda1400, CIV lambda1550, AlIII lambda1860 and MgII lambda2800, resulting in a catalogue of 3547 BALQSOs. Two corrections, based on extensive testing of synthetic BALQSO spectra, are applied in order to estimate the intrinsic fraction of CIV BALQSOs. First, the probability of an observed BALQSO spectrum being identified as such by our algorithm is calculated as a function of redshift, signal-to-noise ratio and BAL properties. Second, the different completenesses of the SDSS target selection algorithm for BALQSOs and non-BAL quasars are quantified. Accounting for these selection effects the intrinsic CIV BALQSO fraction is 41+/-5 per cent. Our analysis of the selection effects allows us to measure the dependence of the intrinsic CIV BALQSO fraction on luminosity and redshift. We find a factor of 3.5+/-0.4 decrease in the intrinsic fraction from the highest redshifts, z~4.0, down to z~2.0. The redshift dependence implies that an orientation effect alone is not sufficient to explain the presence of BAL troughs in some but not all quasar spectra. Our results are consistent with the intrinsic BALQSO fraction having no strong luminosity dependence, although with 3-sigma limits on the rate of change of the intrinsic fraction with luminosity of -6.9 and 7.0 per cent dex^-1 we are unable to rule out such a dependence.Comment: MNRAS in press; 28 pages, 28 figures; full data table is available until Sep 2011 at www.ast.cam.ac.uk/~jta/papers/bal_nmf_table1.da

The influence of in-pregnancy smoking cessation programmes on partner quitting and women's social support mobilization: a randomized controlled trial [ISRCTN89131885]

BACKGROUND: Smoking cessation interventions in pregnancy could influence a woman's social behaviour and her partner's smoking behaviour, but this has not been examined in any published randomized trials. METHOD: 918 women smoking at booking for antenatal care were enrolled in a cluster-randomized trial of three interventions: standard care, self-help manual and enhanced stage-based counselling, or self-help manual, enhanced stage-based counselling and use of an interactive computer program. The outcomes were change in social support received by women between booking for maternity care and 30 weeks gestation and 10 days postpartum and reported cessation in the woman's partner at these times. RESULTS: Few pregnant women's partners stopped smoking (4.1% at 30 weeks of gestation and 5.8% at 10 days postpartum) and the probability of quitting did not differ significantly by trial arm. Women's scores on the Inventory of Socially Supportive Behaviors showed a slight decline from booking to 30 weeks gestation, and a slight increase to 10 days postpartum, but these changes did not differ significantly by trial arm. CONCLUSION: The stage-based interventions tested in this trial aimed partly to influence women's mobilization of support and might have influenced partners' quitting, but there was no evidence that they did so. Given that women and their partners often stopped smoking together, future interventions to prevent smoking in pregnant women could encourage both partners to quit together

An exploration of lifestyle beliefs and lifestyle behaviour following stroke: findings from a focus group study of patients and family members

<p>Abstract</p> <p>Background</p> <p>Stroke is a major cause of disability and family disruption and carries a high risk of recurrence. Lifestyle factors that increase the risk of recurrence include smoking, unhealthy diet, excessive alcohol consumption and physical inactivity. Guidelines recommend that secondary prevention interventions, which include the active provision of lifestyle information, should be initiated in hospital, and continued by community-based healthcare professionals (HCPs) following discharge. However, stroke patients report receiving little/no lifestyle information.</p> <p>There is a limited evidence-base to guide the development and delivery of effective secondary prevention lifestyle interventions in the stroke field. This study, which was underpinned by the Theory of Planned Behaviour, sought to explore the beliefs and perceptions of patients and family members regarding the provision of lifestyle information following stroke. We also explored the influence of beliefs and attitudes on behaviour. We believe that an understanding of these issues is required to inform the content and delivery of effective secondary prevention lifestyle interventions.</p> <p>Methods</p> <p>We used purposive sampling to recruit participants through voluntary sector organizations (29 patients, including 7 with aphasia; 20 family members). Using focus group methods, data were collected in four regions of Scotland (8 group discussions) and were analysed thematically.</p> <p>Results</p> <p>Although many participants initially reported receiving no lifestyle information, further exploration revealed that most had received written information. However, it was often provided when people were not receptive, there was no verbal reinforcement, and family members were rarely involved, even when the patient had aphasia. Participants believed that information and advice regarding healthy lifestyle behaviour was often confusing and contradictory and that this influenced their behavioural intentions. Family members and peers exerted both positive and negative influences on behavioural patterns. The influence of HCPs was rarely mentioned. Participants' sense of control over lifestyle issues was influenced by the effects of stroke (e.g. depression, reduced mobility) and access to appropriate resources.</p> <p>Conclusions</p> <p>For secondary prevention interventions to be effective, HCPs must understand psychological processes and influences, and use appropriate behaviour change theories to inform their content and delivery. Primary care professionals have a key role to play in the delivery of lifestyle interventions.</p

Self-management interventions for type 2 diabetes in adult people with severe mental illness (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of diabetes self-management (DSM) interventions for people with type 2 diabetes with severe mental illness (SMI)

Study protocol for the evaluation of an Infant Simulator based program delivered in schools: a pragmatic cluster randomised controlled trial

Background: This paper presents the study protocol for a pragmatic randomised controlled trial to evaluate the impact of a school based program developed to prevent teenage pregnancy. The program includes students taking care of an Infant Simulator; despite growing popularity and an increasing global presence of such programs, there is no published evidence of their long-term impact. The aim of this trial is to evaluate the Virtual Infant Parenting (VIP) program by investigating pre-conceptual health and risk behaviours, teen pregnancy and the resultant birth outcomes, early child health and maternal health. Methods and Design: Fifty-seven schools (86% of 66 eligible secondary schools) in Perth, Australia were recruited to the clustered (by school) randomised trial, with even randomisation to the intervention and control arms. Between 2003 and 2006, the VIP program was administered to 1,267 participants in the intervention schools, while 1,567 participants in the non-intervention schools received standard curriculum. Participants were all female and aged between 13-15 years upon recruitment. Pre and post-intervention questionnaires measured short-term impact and participants are now being followed through their teenage years via data linkage to hospital medical records, abortion clinics and education records. Participants who have a live birth are interviewed by face-to-face interview. Kaplan-Meier survival analysis and proportional hazards regression will test for differences in pregnancy, birth and abortion rates during the teenage years between the study arms.Discussion: This protocol paper provides a detailed overview of the trial design as well as initial results in the form of participant flow. The authors describe the intervention and its delivery within the natural school setting and discuss the practical issues in the conduct of the trial, including recruitment. The trial is pragmatic and will directly inform those who provide Infant Simulator based programs in school settings

Evidence of patchy hydrogen reionization from an extreme Lyα trough below redshift six

We report the discovery of an extremely long (∼110 Mpc/h) and dark (τeff≳7) Lyα trough extending down to z≃5.5 towards the zem≃6.0 quasar ULAS J0148+0600. We use these new data in combination with Lyα forest measurements from 42 quasars at 4.5≤zem≤6.4 to conduct an updated analysis of the line-of-sight variance in the intergalactic Lyα opacity over 4≤z≤6. We find that the scatter in transmission among lines of sight near z∼6 significantly exceeds theoretical expectations for either a uniform ultraviolet background (UVB) or simple fluctuating UVB models in which the mean free path to ionizing photons is spatially invariant. The data, particularly near z≃5.6-5.8, instead require fluctuations in the volume-weighted hydrogen neutral fraction that are a factor of 3 or more beyond those expected from density variations alone. We argue that these fluctuations are most likely driven by large-scale variations in the mean free path, consistent with expectations for the final stages of inhomogeneous hydrogen reionization. Even by z≃5.6, however, a large fraction of the data are consistent with a uniform UVB, and by z∼5 the data are fully consistent with opacity fluctuations arising solely from the density field. This suggests that while reionization may be ongoing at z∼6, it has fully completed by z∼5