Evaluation of the Next Birth After Caesarean (NBAC) clinic.

Developing, implementing and evaluating models of care that reduce the caesarean section (CS) rate have been a health care priority in Australia since the 1990’s. There is minimal evidence examining models of care that aim to nurture women’s emotional well-being after CS; as well as providing consistent evidence-based information and promoting safe and successful vaginal birth in the subsequent pregnancy. Furthermore the experiences of midwives working in these models have been overlooked

Responding to Vaccine Safety Signals during Pandemic Influenza: A Modeling Study

Background: Managing emerging vaccine safety signals during an influenza pandemic is challenging. Federal regulators must balance vaccine risks against benefits while maintaining public confidence in the public health system. Methods: We developed a multi-criteria decision analysis model to explore regulatory decision-making in the context of emerging vaccine safety signals during a pandemic. We simulated vaccine safety surveillance system capabilities and used an age-structured compartmental model to develop potential pandemic scenarios. We used an expert-derived multi-attribute utility function to evaluate potential regulatory responses by combining four outcome measures into a single measure of interest: 1) expected vaccination benefit from averted influenza; 2) expected vaccination risk from vaccine-associated febrile seizures; 3) expected vaccination risk from vaccine-associated Guillain-Barre Syndrome; and 4) expected change in vaccine-seeking behavior in future influenza seasons. Results: Over multiple scenarios, risk communication, with or without suspension of vaccination of high-risk persons, were the consistently preferred regulatory responses over no action or general suspension when safety signals were detected during a pandemic influenza. On average, the expert panel valued near-term vaccine-related outcomes relative to long-term projected outcomes by 3∶1. However, when decision-makers had minimal ability to influence near-term outcomes, the response was selected primarily by projected impacts on future vaccine-seeking behavior. Conclusions: The selected regulatory response depends on how quickly a vaccine safety signal is identified relative to the peak of the pandemic and the initiation of vaccination. Our analysis suggested two areas for future investment: efforts to improve the size and timeliness of the surveillance system and behavioral research to understand changes in vaccine-seeking behavior

What can we expect from navigating? Exploring navigation, wearables and data through critical design concepts

What is it to navigate or to be navigated? How, and through what, is information communicated to us? Do our interactions with space need to be limited to when we are moving through it? This paper describes a collection of design concepts generated as part of the initial stages of a research project that combines a critical design mindset and research through design process to explore these types of questions. The project seeks to problematise and diversify the discussion and understanding around pedestrian navigation, wearable technology, crowdsourcing and human data interaction. The goal is to develop one of the concepts using research through design as part of PhD research studies, leading to possible future applications

The Spitzer c2d Survey of Weak-line T Tauri Stars II: New Constraints on the Timescale for Planet Building

One of the central goals of the Spitzer Legacy Project ``From Molecular Cores to Planet-forming Disks'' (c2d) is to determine the frequency of remnant circumstellar disks around weak-line T Tauri stars (wTTs) and to study the properties and evolutionary status of these disks. Here we present a census of disks for a sample of over 230 spectroscopically identified wTTs located in the c2d IRAC (3.6, 4.5, 4.8, and 8.0 um) and MIPS (24 um) maps of the Ophiuchus, Lupus, and Perseus Molecular Clouds. We find that ~20% of the wTTs in a magnitude limited subsample have noticeable IR-excesses at IRAC wavelengths indicating the presence of a circumstellar disk. The disk frequencies we find in these 3 regions are ~3-6 times larger than that recently found for a sample of 83 relatively isolated wTTs located, for the most part, outside the highest extinction regions covered by the c2d IRAC and MIPS maps. The disk fractions we find are more consistent with those obtained in recent Spitzer studies of wTTs in young clusters such as IC 348 and Tr 37. From their location in the H-R diagram, we find that, in our sample, the wTTs with excesses are among the younger part of the age distribution. Still, up to ~50% of the apparently youngest stars in the sample show no evidence of IR excess, suggesting that the circumstellar disks of a sizable fraction of pre-main-sequence stars dissipate in a timescale of ~1 Myr. We also find that none of the stars in our sample apparently older than ~10 Myrs have detectable circumstellar disks at wavelengths < 24 um. Also, we find that the wTTs disks in our sample exhibit a wide range of properties (SED morphology, inner radius, L_DISK/L*, etc) which bridge the gaps observed between the cTTs and the debris disk regimes.Comment: 54 pages, 13 figures, Accepted by Ap

Bora event variability and the role of air-sea feedback

Author Posting. © American Geophysical Union, 2007. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 112 (2007): C03S18, doi:10.1029/2006JC003726.A two-way interacting high resolution numerical simulation of the Adriatic Sea using the Navy Coastal Ocean Model (NCOM) and Coupled Ocean/Atmosphere Mesoscale Prediction System (COAMPS®) was conducted to improve forecast momentum and heat flux fields, and to evaluate surface flux field differences for two consecutive bora events during February 2003. (COAMPS® is a registered trademark of the Naval Research Laboratory.) The strength, mean positions and extensions of the bora jets, and the atmospheric conditions driving them varied considerably between the two events. Bora 1 had 62% stronger heat flux and 51% larger momentum flux than bora 2. The latter displayed much greater diurnal variability characterized by inertial oscillations and the early morning strengthening of a west Adriatic barrier jet, beneath which a stronger west Adriatic ocean current developed. Elsewhere, surface ocean current differences between the two events were directly related to differences in wind stress curl generated by the position and strength of the individual bora jets. The mean heat flux bias was reduced by 72%, and heat flux RMSE reduced by 30% on average at four instrumented over-water sites in the two-way coupled simulation relative to the uncoupled control. Largest reductions in wind stress were found in the bora jets, while the biggest reductions in heat flux were found along the north and west coasts of the Adriatic. In bora 2, SST gradients impacted the wind stress curl along the north and west coasts, and in bora 1 wind stress curl was sensitive to the Istrian front position and strength. The two-way coupled simulation produced diminished surface current speeds of ∼12% over the northern Adriatic during both bora compared with a one-way coupled simulation.The research support for J. Pullen, J. D. Doyle, and T. Haack was provided by the Office of Naval Research (ONR) program elements 0602435N and 0601153N

High-spectral-resolution Observations of the Optical Filamentary Nebula Surrounding NGC 1275

We present new high-spectral-resolution observations (R = λ/Δλ = 7000) of the filamentary nebula surrounding NGC 1275, the central galaxy of the Perseus cluster. These observations have been obtained with SITELLE, an imaging Fourier transform spectrometer installed on the Canada–France–Hawai Telescope with a field of view of 11′×11′ , encapsulating the entire filamentary structure of ionized gas despite its large size of 80 kpc × 50 kpc. Here, we present renewed fluxes, velocities, and velocity dispersion maps that show in great detail the kinematics of the optical nebula at [S ii] λ6716, [S ii] λ6731, [N ii] λ6584, Hα (6563 Å), and [N ii] λ6548. These maps reveal the existence of a bright flattened disk-shaped structure in the core extending to r ∼10 kpc and dominated by a chaotic velocity field. This structure is located in the wake of X-ray cavities and characterized by a high mean velocity dispersion of 134 km s−1. The disk-shaped structure is surrounded by an extended array of filaments spread out to r ∼ 50 kpc that are 10 times fainter in flux, remarkably quiescent, and have a uniform mean velocity dispersion of 44 km s−1. This stability is puzzling given that the cluster core exhibits several energetic phenomena. Based on these results, we argue that there are two mechanisms that form multiphase gas in clusters of galaxies: a first triggered in the wake of X-ray cavities leading to more turbulent multiphase gas and a second, distinct mechanism, that is gentle and leads to large-scale multiphase gas spreading throughout the core

Immunochip analysis identifies multiple susceptibility loci for systemic sclerosis

In this study, 1,833 systemic sclerosis (SSc) cases and 3,466 controls were genotyped with the Immunochip array. Classical alleles, amino acid residues, and SNPs across the human leukocyte antigen (HLA) region were imputed and tested. These analyses resulted in a model composed of six polymorphic amino acid positions and seven SNPs that explained the observed significant associations in the region. In addition, a replication step comprising 4,017 SSc cases and 5,935 controls was carried out for several selected non-HLA variants, reaching a total of 5,850 cases and 9,401 controls of European ancestry. Following this strategy, we identified and validated three SSc risk loci, including DNASE1L3 at 3p14, the SCHIP1-IL12A locus at 3q25, and ATG5 at 6q21, as well as a suggested association of the TREH-DDX6 locus at 11q23. The associations of several previously reported SSc risk loci were validated and further refined, and the observed peak of association in PXK was related to DNASE1L3. Our study has increased the number of known genetic associations with SSc, provided further insight into the pleiotropic effects of shared autoimmune risk factors, and highlighted the power of dense mapping for detecting previously overlooked susceptibility loci

A cost-effectiveness analysis of early detection and bundled treatment of postpartum haemorrhage alongside the E-MOTIVE trial

Timely detection and treatment of postpartum haemorrhage (PPH) are crucial to prevent complications or death. A calibrated blood-collection drape can help provide objective, accurate, and early diagnosis of PPH and a treatment bundle can address delays or inconsistencies in the use of effective interventions. We conducted an economic evaluation alongside the E-MOTIVE trial, an international, parallel cluster-randomised trial with a baseline control phase involving 210,132 women undergoing vaginal delivery across 78 secondary-level hospitals in Kenya, Nigeria, South Africa, and Tanzania. We aimed to assess the cost-effectiveness of the E-MOTIVE intervention, which included a calibrated blood-collection drape for early detection of PPH and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), compared with usual care. We used multilevel modelling to estimate incremental cost-effectiveness ratios from the perspective of the public healthcare system for outcomes of cost per severe PPH (blood loss ≥1000 mL) avoided and cost per disability-adjusted life-year averted. Our findings suggest that use of a calibrated blood-collection drape for early detection of PPH and bundled first-response treatment is cost-effective and should be perceived by decision makers as a worthwhile use of healthcare budgets

A cost-effectiveness analysis of early detection and bundled treatment of postpartum haemorrhage alongside the E-MOTIVE trial

Timely detection and treatment of postpartum haemorrhage (PPH) are crucial to prevent complications or death. A calibrated blood-collection drape can help provide objective, accurate, and early diagnosis of PPH and a treatment bundle can address delays or inconsistencies in the use of effective interventions. We conducted an economic evaluation alongside the E-MOTIVE trial, an international, parallel cluster-randomised trial with a baseline control phase involving 210,132 women undergoing vaginal delivery across 78 secondary-level hospitals in Kenya, Nigeria, South Africa, and Tanzania. We aimed to assess the cost-effectiveness of the E-MOTIVE intervention, which included a calibrated blood-collection drape for early detection of PPH and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), compared with usual care. We used multilevel modelling to estimate incremental cost-effectiveness ratios from the perspective of the public healthcare system for outcomes of cost per severe PPH (blood loss ≥1000 mL) avoided and cost per disability-adjusted life-year averted. Our findings suggest that use of a calibrated blood-collection drape for early detection of PPH and bundled first-response treatment is cost-effective and should be perceived by decision makers as a worthwhile use of healthcare budgets

The Baryon Oscillation Spectroscopic Survey of SDSS-III

The Baryon Oscillation Spectroscopic Survey (BOSS) is designed to measure the scale of baryon acoustic oscillations (BAO) in the clustering of matter over a larger volume than the combined efforts of all previous spectroscopic surveys of large scale structure. BOSS uses 1.5 million luminous galaxies as faint as i=19.9 over 10,000 square degrees to measure BAO to redshifts z<0.7. Observations of neutral hydrogen in the Lyman alpha forest in more than 150,000 quasar spectra (g<22) will constrain BAO over the redshift range 2.15<z<3.5. Early results from BOSS include the first detection of the large-scale three-dimensional clustering of the Lyman alpha forest and a strong detection from the Data Release 9 data set of the BAO in the clustering of massive galaxies at an effective redshift z = 0.57. We project that BOSS will yield measurements of the angular diameter distance D_A to an accuracy of 1.0% at redshifts z=0.3 and z=0.57 and measurements of H(z) to 1.8% and 1.7% at the same redshifts. Forecasts for Lyman alpha forest constraints predict a measurement of an overall dilation factor that scales the highly degenerate D_A(z) and H^{-1}(z) parameters to an accuracy of 1.9% at z~2.5 when the survey is complete. Here, we provide an overview of the selection of spectroscopic targets, planning of observations, and analysis of data and data quality of BOSS.Comment: 49 pages, 16 figures, accepted by A