Leveraging Farmer Field Days to Provide Family Planning and Other Health Services in Rural Kenya

Background: Access to family planning (FP) and other reproductive health (RH) services is difficult in much of rural Africa. Distance to health facilities, staff shortages, stock-outs, and other barriers impede the uptake and continued use of contraception. One way to improve FP access in rural areas is to deliver FP services at non-health events. FHI and Land O’Lakes collaborated to assess a model for providing health services through existing farmer-education events.  This study examined the introduction of Family Planning/Reproductive Health services through Land O’Lakes-supported dairy cooperatives. Methods: The study was conducted at seven events in Central and Rift Valley provinces between August and December 2010. Typical field days draw attendees from across the dairy sector: farmers, processors, development partners and officials from the Ministry of Livestock Development and the Kenya Dairy Board. At each study site, local Land O Lakes and dairy cooperative staff helped to incorporate a “family health camp” where attendees could consult with clinicians. The package included FP services, child immunizations, antenatal care, sexually transmitted infection screening and treatment, and HIV counseling and testing. All women, 18 to 49 years old, who received services from an on-site provider, were invited to participate in a survey about the health camp and the offered services. A total of 319 women were interviewed. Key findings: Use of health services at the seven field days was high; more than 80% of the 2,344 attendees received consultations. The services provided most frequently during the field-days were non-reproductive health exams (66%), FP counseling (18%), and HIV counseling and testing (13%). Of the women interviewed, 40% were affiliated with a dairy cooperative. One-quarter of current FP users acquired additional supplies of contraceptives at the event.  Knowledge contributions: This study contributes to the scant data regarding the provision of health services in the non-health sector. . This model provides a convenient way for rural people to access health services. Key Words: FP services, non-health sector, rural area, farmer

Dopamine in nucleus accumbens: salience modulation in latent inhibition and overshadowing

Latent inhibition (LI) is demonstrated when non-reinforced pre-exposure to a to-be-conditioned stimulus retards later learning. Learning is similarly retarded in overshadowing, in this case using the relative intensity of competing cues to manipulate associability. Electrolytic/excitotoxic lesions to shell accumbens (NAc) and systemic amphetamine both reliably abolish LI. Here a conditioned emotional response procedure was used to demonstrate LI and overshadowing and to examine the role of dopamine (DA) within NAc. Experiment 1 showed that LI but not overshadowing was abolished by systemic amphetamine (1.0 mg/kg i.p.). In Experiment 2, 6-hydroxydopamine (6-OHDA) was used to lesion DA terminals within NAc: both shell- and core- (plus shell-)lesioned rats showed normal LI and overshadowing. Experiment 3 compared the effects of amphetamine microinjected at shell and core coordinates prior to conditioning: LI, but not overshadowing, was abolished by 10.0 but not 5.0 µg/side amphetamine injected in core but not shell NAc. These results suggest that the abolition of LI produced by NAc shell lesions is not readily reproduced by regionally restricted DA depletion within NAc; core rather than shell NAc mediates amphetamine-induced abolition of LI; overshadowing is modulated by different neural substrates

Implementation of the LANS-alpha turbulence model in a primitive equation ocean model

This paper presents the first numerical implementation and tests of the Lagrangian-averaged Navier-Stokes-alpha (LANS-alpha) turbulence model in a primitive equation ocean model. The ocean model in which we work is the Los Alamos Parallel Ocean Program (POP); we refer to POP and our implementation of LANS-alpha as POP-alpha. Two versions of POP-alpha are presented: the full POP-alpha algorithm is derived from the LANS-alpha primitive equations, but requires a nested iteration that makes it too slow for practical simulations; a reduced POP-alpha algorithm is proposed, which lacks the nested iteration and is two to three times faster than the full algorithm. The reduced algorithm does not follow from a formal derivation of the LANS-alpha model equations. Despite this, simulations of the reduced algorithm are nearly identical to the full algorithm, as judged by globally averaged temperature and kinetic energy, and snapshots of temperature and velocity fields. Both POP-alpha algorithms can run stably with longer timesteps than standard POP. Comparison of implementations of full and reduced POP-alpha algorithms are made within an idealized test problem that captures some aspects of the Antarctic Circumpolar Current, a problem in which baroclinic instability is prominent. Both POP-alpha algorithms produce statistics that resemble higher-resolution simulations of standard POP. A linear stability analysis shows that both the full and reduced POP-alpha algorithms benefit from the way the LANS-alpha equations take into account the effects of the small scales on the large. Both algorithms (1) are stable; (2) make the Rossby Radius effectively larger; and (3) slow down Rossby and gravity waves.Comment: Submitted to J. Computational Physics March 21, 200

Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus

Objective To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies. Method We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK. Results In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains - (1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4. Conclusion We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies

Origins of the Ambient Solar Wind: Implications for Space Weather

The Sun's outer atmosphere is heated to temperatures of millions of degrees, and solar plasma flows out into interplanetary space at supersonic speeds. This paper reviews our current understanding of these interrelated problems: coronal heating and the acceleration of the ambient solar wind. We also discuss where the community stands in its ability to forecast how variations in the solar wind (i.e., fast and slow wind streams) impact the Earth. Although the last few decades have seen significant progress in observations and modeling, we still do not have a complete understanding of the relevant physical processes, nor do we have a quantitatively precise census of which coronal structures contribute to specific types of solar wind. Fast streams are known to be connected to the central regions of large coronal holes. Slow streams, however, appear to come from a wide range of sources, including streamers, pseudostreamers, coronal loops, active regions, and coronal hole boundaries. Complicating our understanding even more is the fact that processes such as turbulence, stream-stream interactions, and Coulomb collisions can make it difficult to unambiguously map a parcel measured at 1 AU back down to its coronal source. We also review recent progress -- in theoretical modeling, observational data analysis, and forecasting techniques that sit at the interface between data and theory -- that gives us hope that the above problems are indeed solvable.Comment: Accepted for publication in Space Science Reviews. Special issue connected with a 2016 ISSI workshop on "The Scientific Foundations of Space Weather." 44 pages, 9 figure

Assessing the ecological impacts of invasive species based on their functional responses and abundances

Invasive species management requires allocation of limited resources towards the proactive mitigation of those species that could elicit the highest ecological impacts. However, we lack predictive capacity with respect to the identities and degree of ecological impacts of invasive species. Here, we combine the relative per capita effects and relative field abundances of invader as compared to native species into a new metric, “Relative Impact Potential” (RIP), and test whether this metric can reliably predict high impact invaders. This metric tests the impact of invaders relative to the baseline impacts of natives on the broader ecological community. We first derived the functional responses (i.e. per capita effects) of two ecologically damaging invasive fish species in Europe, the Ponto-Caspian round goby (Neogobius melanostomus) and Asian topmouth gudgeon (Pseudorasbora parva), and their native trophic analogues, the bullhead (Cottus gobio; also C. bairdi) and bitterling (Rhodeus amarus), towards several prey species. This establishes the existence and relative strengths of the predator-prey relationships. Then, we derived ecologically comparable field abundance estimates of the invader and native fish from surveys and literature. This establishes the multipliers for the above per capita effects. Despite both predators having known severe detrimental field impacts, their functional responses alone were of modest predictive power in this regard; however, incorporation of their abundances relative to natives into the RIP metric gave high predictive power. We present invader/native RIP biplots that provide an intuitive visualisation of comparisons among the invasive and native species, reflecting the known broad ecological impacts of the invaders. Thus, we provide a mechanistic understanding of invasive species impacts and a predictive tool for use by practitioners, for example, in risk assessments

Theoretical Framework for Retrospective Studies of the Effectiveness of SARS-CoV-2 Vaccines.

Observational studies of the effectiveness of vaccines to prevent COVID-19 are needed to inform real-world use. Such studies are now underway amid the ongoing rollout of SARS-CoV-2 vaccines globally. Although traditional case-control and test-negative design studies feature prominently among strategies used to assess vaccine effectiveness, such studies may encounter important threats to validity. Here, we review the theoretical basis for estimation of vaccine direct effects under traditional case-control and test-negative design frameworks, addressing specific natural history parameters of SARS-CoV-2 infection and COVID-19 relevant to these designs. Bias may be introduced by misclassification of cases and controls, particularly when clinical case criteria include common, nonspecific indicators of COVID-19. When using diagnostic assays with high analytical sensitivity for SARS-CoV-2 detection, individuals testing positive may be counted as cases even if their symptoms are due to other causes. The traditional case-control design may be particularly prone to confounding due to associations of vaccination with healthcare-seeking behavior or risk of infection. The test-negative design reduces but may not eliminate this confounding, for instance, if individuals who receive vaccination seek care or testing for less-severe illness. These circumstances indicate the two study designs cannot be applied naively to datasets gathered through public health surveillance or administrative sources. We suggest practical strategies to reduce bias in vaccine effectiveness estimates at the study design and analysis stages

Astrophysical Origins of Ultrahigh Energy Cosmic Rays

In the first part of this review we discuss the basic observational features at the end of the cosmic ray energy spectrum. We also present there the main characteristics of each of the experiments involved in the detection of these particles. We then briefly discuss the status of the chemical composition and the distribution of arrival directions of cosmic rays. After that, we examine the energy losses during propagation, introducing the Greisen-Zaptsepin-Kuzmin (GZK) cutoff, and discuss the level of confidence with which each experiment have detected particles beyond the GZK energy limit. In the second part of the review, we discuss astrophysical environments able to accelerate particles up to such high energies, including active galactic nuclei, large scale galactic wind termination shocks, relativistic jets and hot-spots of Fanaroff-Riley radiogalaxies, pulsars, magnetars, quasar remnants, starbursts, colliding galaxies, and gamma ray burst fireballs. In the third part of the review we provide a brief summary of scenarios which try to explain the super-GZK events with the help of new physics beyond the standard model. In the last section, we give an overview on neutrino telescopes and existing limits on the energy spectrum and discuss some of the prospects for a new (multi-particle) astronomy. Finally, we outline how extraterrestrial neutrino fluxes can be used to probe new physics beyond the electroweak scale.Comment: Higher resolution version of Fig. 7 is available at http://www.angelfire.com/id/dtorres/down3.html. Solicited review article prepared for Reports on Progress in Physics, final versio