Provision of postpartum care to women giving birth in health facilities in sub-Saharan Africa: A cross-sectional study using Demographic and Health Survey data from 33 countries.

BACKGROUND: Postpartum care has the potential to avert a substantial proportion of maternal and perinatal mortality and morbidity. There is a crucial gap in understanding the quality of postpartum care for women giving birth in health facilities in low- and middle-income settings. This is particularly the case in sub-Saharan Africa (SSA), where the levels of maternal and neonatal mortality are highest globally despite rapid increases in facility-based childbirth. This study estimated the percentage of women receiving a postpartum health check following childbirth in a health facility in SSA and examined the determinants of receiving such check. METHODS AND FINDINGS: We used the most recent Demographic and Health Survey (DHS) conducted in 33 SSA countries between 2000-2016. We estimated the percentage of women receiving a postpartum check by a health professional while in the childbirth facility and the associated 95% confidence interval (CI) for each country. We analyzed determinants of receiving such checks using logistic regression of the pooled data. The analysis sample included 137,218 women whose most recent live birth in the 5- year period before the survey took place in a health facility. Of this pooled sample, 65.7% of women were under 30 years of age, 85.9% were currently married, and 57% resided in rural areas. Across countries, the median percentage of women who reported receiving a check was 71.7%, ranging from 26.6% in Eswatini (Swaziland) to 94.4% in Burkina Faso. The most fully adjusted model showed that factors from all four conceptual categories (obstetric/neonatal risk factors, care environment, and women's sociodemographic and child-related characteristics) were significant determinants of receiving a check. Women with a cesarean section had a significantly higher adjusted odds ratio (aOR) of 1.88 (95% CI 1.72-2.05, p < 0.001) of receiving a check. Women giving birth in lower-level public facilities had lower odds of receiving a check (aOR 0.94, 95% CI 0.90-0.98, p = 0.002) compared to those in public hospitals, as did women attended by a nurse/midwife (compared to doctor/nonphysician clinician) (aOR 0.74, 95% CI 0.69-0.78, p < 0.001). This study was limited by the accuracy of the respondent's recall of the provider, timing, and receipt of postpartum checks. The outcome of interest was measured using three slightly different question sets across the 33 included countries. CONCLUSIONS: The suboptimal levels of postpartum checks in health facilities in many of the included SSA countries partially reflect the lack of importance given to postpartum care in the global discourse on essential interventions and quality improvement in maternal health. Addressing disparities in access to both facility-based childbirth and good-quality postpartum care in SSA is critical to addressing stalling declines in maternal mortality and morbidity

Disk Evolution Study Through Imaging of Nearby Young Stars (DESTINYS): Diverse outcomes of binary-disk interactions

CONTEXT: Circumstellar disks play an essential role in the outcomes of planet formation. Disks do not evolve in isolation, as about half of solar-type stars were born in binary or multiple systems. The presence of stellar companions modifies the morphology and evolution of disks, potentially resulting in a different planet population. Resolving disks in binary systems provides the opportunity to examine the influence of stellar companions on the outcomes of planet formation. AIMS: We aim to investigate and compare disks in stellar multiple systems with near-infrared scattered-light imaging as part of the Disk Evolution Study Through Imaging of Nearby Young Stars (DESTINYS) large program. In particular, we present observations of circumstellar disks in three systems, namely, CHX 22, S CrA, and HP Cha. METHODS: We used polarimetric differential imaging with SPHERE/IRDIS at the VLT to search for scattered light from the circum-stellar disks in these multiple systems. We performed astrometric and orbit analyses for the stellar companions using archival HST, VLT/NACO, and SPHERE data to better understand the interplay between disks and companions. RESULTS: Combined with the age and orbital constraints, the observed disk structures in scattered light provide insights into the evolutionary history and the impact of the stellar companions. The small grains in CHX 22 form a tail-like structure surrounding the close binary, which likely results from a close encounter and capture of a cloudlet. S CrA shows intricate structures (tentative ringed and spiral features) in the circumprimary disk as a possible consequence of perturbations by companions. The circumsecondary disk is truncated and connected to the primary disk via a streamer, suggesting tidal interactions. In HP Cha, the primary disk is less disturbed and features a tenuous streamer, through which the material flows toward the companions. CONCLUSIONS: The comparison of the three systems spans a wide range of binary separation (50–500 au) and illustrates the decreasing influence on disk structures with the distance of companions. This agrees with the statistical analysis of the exoplanet population in binaries, that planet formation is likely obstructed around close binary systems, while it is not suppressed in wide binaries

Saber:module-LWR based key exchange, CPA-secure encryption and CCA-secure KEM

© Springer International Publishing AG, part of Springer Nature 2018. In this paper, we introduce Saber, a package of cryptographic primitives whose security relies on the hardness of the Module Learning With Rounding problem (Mod-LWR). We first describe a secure Diffie-Hellman type key exchangeprotocol, which is then transformed into an IND-CPA encryption scheme and finally into an IND-CCA secure key encapsulation mechanism using a post-quantum version of the Fujisaki-Okamoto transform. The design goals of this package were simplicity, efficiency and flexibility resulting in the following choices: all integer moduli are powers of 2 avoiding modular reduction and rejection sampling entirely; the use of LWR halves the amount of randomness required compared to LWE-based schemes and reduces bandwidth; the module structure provides flexibility by reusing one core component for multiple security levels. A constant-time AVX2 optimized software implementation of the KEM with parameters providing more than 128 bits of post-quantum security, requires only 101K, 125K and 129K cycles for key generation, encapsulation and decapsulation respectively on a Dell laptop with an Intel i7-Haswell processor

(One) Failure Is Not an Option:Bootstrapping the Search for Failures in Lattice-Based Encryption Schemes

Lattice-based encryption schemes are often subject to the possibility of decryption failures, in which valid encryptions are decrypted incorrectly. Such failures, in large number, leak information about the secret key, enabling an attack strategy alternative to pure lattice reduction. Extending the failure boosting\u27\u27 technique of D\u27Anvers et al. in PKC 2019, we propose an approach that we call directional failure boosting\u27\u27 that uses previously found failing ciphertexts\u27\u27 to accelerate the search for new ones. We analyse in detail the case where the lattice is defined over polynomial ring modules quotiented by and demonstrate it on a simple Mod-LWE-based scheme parametrized à la Kyber768/Saber. We show that, using our technique, for a given secret key (single-target setting), the cost of searching for additional failing ciphertexts after one or more have already been found, can be sped up dramatically. We thus demonstrate that, in this single-target model, these schemes should be designed so that it is hard to even obtain one decryption failure. Besides, in a wider security model where there are many target secret keys (multi-target setting), our attack greatly improves over the state of the art

Haptoglobin Phenotype, Preeclampsia Risk and the Efficacy of Vitamin C and E Supplementation to Prevent Preeclampsia in a Racially Diverse Population

Haptoglobin's (Hp) antioxidant and pro-angiogenic properties differ between the 1-1, 2-1, and 2-2 phenotypes. Hp phenotype affects cardiovascular disease risk and treatment response to antioxidant vitamins in some non-pregnant populations. We previously demonstrated that preeclampsia risk was doubled in white Hp 2-1 women, compared to Hp 1-1 women. Our objectives were to determine whether we could reproduce this finding in a larger cohort, and to determine whether Hp phenotype influences lack of efficacy of antioxidant vitamins in preventing preeclampsia and serious complications of pregnancy-associated hypertension (PAH). This is a secondary analysis of a randomized controlled trial in which 10,154 low-risk women received daily vitamin C and E, or placebo, from 9-16 weeks gestation until delivery. Hp phenotype was determined in the study prediction cohort (n = 2,393) and a case-control cohort (703 cases, 1,406 controls). The primary outcome was severe PAH, or mild or severe PAH with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclampsia, fetal growth restriction, medically indicated preterm birth or perinatal death. Preeclampsia was a secondary outcome. Odds ratios were estimated by logistic regression. Sampling weights were used to reduce bias from an overrepresentation of women with preeclampsia or the primary outcome. There was no relationship between Hp phenotype and the primary outcome or preeclampsia in Hispanic, white/other or black women. Vitamin supplementation did not reduce the risk of the primary outcome or preeclampsia in women of any phenotype. Supplementation increased preeclampsia risk (odds ratio 3.30; 95% confidence interval 1.61-6.82, p<0.01) in Hispanic Hp 2-2 women. Hp phenotype does not influence preeclampsia risk, or identify a subset of women who may benefit from vitamin C and E supplementation to prevent preeclampsia

Doubling of marine dinitrogen-fixation rates based on direct measurements

Biological dinitrogen fixation provides the largest input of nitrogen to the oceans, therefore exerting important control on the ocean’s nitrogen inventory and primary productivity. Nitrogen-isotope data fromocean sediments suggest that the marine-nitrogen inventory has been balanced for the past 3,000 years (ref. 4). Producing a balanced marine-nitrogenbudget based on direct measurements has proved difficult, however, with nitrogen loss exceeding the gain from dinitrogen fixation by approximately 200 TgNyr-1 (refs 5, 6). Here we present data from the Atlantic Ocean and show that the most widely used method of measuring oceanic N2-fixation rates underestimates the contribution of N2-fixing microorganisms (diazotrophs) relative to a newly developed method. Using molecular techniques to quantify the abundance of specific clades of diazotrophs in parallel with rates of 15N2 incorporation into particulate organic matter, we suggest that the difference between N2-fixation rates measured with the established method and those measured with the new method8 can be related to the composition of the diazotrophic community. Our data show that in areas dominated by Trichodesmium, the established method underestimatesN2-fixation rates by an averageof 62%. We also find that the newly developed method yields N2-fixation rates more than six times higher than those from the established method when unicellular, symbiotic cyanobacteria and c-proteobacteria dominate the diazotrophic community. On the basis of average areal rates measured over the Atlantic Ocean, we calculated basin-wide N2-fixation rates of 14+/-1TgNyr-1 and 24+/-1TgNyr-1 for the established and new methods, respectively. If our findings can be extrapolated to other ocean basins, this suggests that the global marine N2-fixation rate derived from direct measurements may increase from 103+/-8TgNyr-1 to 177+/-8TgNyr-1, and that the contribution of N2 fixers other than Trichodesmium is much more significant than was previously thought

Standardized ultrasound evaluation of carotid stenosis for clinical trials: University of Washington Ultrasound Reading Center

<p>Abstract</p> <p>Introduction</p> <p>Serial monitoring of patients participating in clinical trials of carotid artery therapy requires noninvasive precision methods that are inexpensive, safe and widely available. Noninvasive ultrasonic duplex Doppler velocimetry provides a precision method that can be used for recruitment qualification, pre-treatment classification and post treatment surveillance for remodeling and restenosis. The University of Washington Ultrasound Reading Center (UWURC) provides a uniform examination protocol and interpretation of duplex Doppler velocity measurements.</p> <p>Methods</p> <p>Doppler waveforms from 6 locations along the common carotid and internal carotid artery path to the brain plus the external carotid and vertebral arteries on each side using a Doppler examination angle of 60 degrees are evaluated. The UWURC verifies all measurements against the images and waveforms for the database, which includes pre-procedure, post-procedure and annual follow-up examinations. Doppler angle alignment errors greater than 3 degrees and Doppler velocity measurement errors greater than 0.05 m/s are corrected.</p> <p>Results</p> <p>Angle adjusted Doppler velocity measurements produce higher values when higher Doppler examination angles are used. The definition of peak systolic velocity varies between examiners when spectral broadening due to turbulence is present. Examples of measurements are shown.</p> <p>Discussion</p> <p>Although ultrasonic duplex Doppler methods are widely used in carotid artery diagnosis, there is disagreement about how the examinations should be performed and how the results should be validated. In clinical trails, a centralized reading center can unify the methods. Because the goals of research examinations are different from those of clinical examinations, screening and diagnostic clinical examinations may require fewer velocity measurements.</p