Professionalizing Healthcare Management: A Descriptive Case Study

Despite international recognition of the importance of healthcare management in the development of high-performing systems, the path by which countries may develop and sustain a professional healthcare management workforce has not been articulated. Accordingly, we sought to identify a set of common themes in the establishment of a professional workforce of healthcare managers in low- and middle-income country (LMIC) settings using a descriptive case study approach. We draw on a historical analysis of the development of this profession in the United States and Ethiopia to identify five common themes in the professionalization of healthcare management: (1) a country context in which healthcare management is demanded; (2) a national framework that elevates a professional management role; (3) standards for healthcare management, and a monitoring function to promote adherence to standards; (4) a graduatelevel educational path to ensure a pipeline of well-prepared healthcare managers; and (5) professional associations to sustain and advance the field. These five components can to inform the creation of a long-term national strategy for the development of a professional cadre of heathcare managers in LMIC settings

Atmospheric Retrievals Suggest the Presence of a Secondary Atmosphere and Possible Sulfur Species on L98-59 d from JWST Nirspec G395H Transmission Spectroscopy

L 98-59 d is a Super-Earth planet orbiting an M-type star. We performed retrievals on the transmission spectrum of L 98-59 d obtained using NIRSpec G395H during a single transit, from JWST Cycle 1 GTO 1224. The wavelength range of this spectrum allows us to detect the presence of several atmospheric species. We found that the spectrum is consistent with a high mean molecular weight atmosphere. The atmospheric spectrum indicates the possible presence of the sulfur-bearing species H2S and SO2, which could hint at active volcanism on this planet if verified by future observations. We also tested for signs of stellar contamination in the spectrum and found signs of unocculted faculae on the star. The tentative signs of an atmosphere on L 98-59 d presented in this work from just one transit bodes well for possible molecular detections in the future, particularly as it is one of the best targets among small exoplanets for atmospheric characterization using JWST

Hints of a Sulfur-rich Atmosphere around the 1.6 R ⊕ Super-Earth L98-59 d from JWST NIRspec G395H Transmission Spectroscopy

Detecting atmospheres around planets with a radius below 1.6 R ⊕, commonly referred to as rocky planets, has proven to be challenging. However, rocky planets orbiting M dwarfs are ideal candidates due to their favorable planet-to-star radius ratio. Here, we present one transit observation of the Super-Earth L98-59 d (1.58 R ⊕ and 2.31 M ⊕), at the limit of rocky/gas-rich, using the JWST NIRSpec G395H mode covering the 2.8–5.1 μm wavelength range. The extracted transit spectrum from a single transit observation deviates from a flat line by 2.6σ–5.6σ, depending on the data reduction and retrieval setup. The hints of an atmospheric detection are driven by a large absorption feature between 3.3 and 4.8 μm. A stellar contamination retrieval analysis rejected the source of this feature as being due to stellar inhomogeneities, making the best fit an atmospheric model including sulfur-bearing species, suggesting that the atmosphere of L98-59 d may not be at equilibrium. This result will need to be confirmed by the analysis of the second NIRSpec G395H visit in addition to the NIRISS SOSS transit observation

JWST-TST DREAMS: Quartz Clouds in the Atmosphere of WASP-17b

Clouds are prevalent in many of the exoplanet atmospheres that have been observed to date. For transiting exoplanets, we know if clouds are present because they mute spectral features and cause wavelength-dependent scattering. While the exact composition of these clouds is largely unknown, this information is vital to understanding the chemistry and energy budget of planetary atmospheres. In this work, we observe one transit of the hot Jupiter WASP-17b with JWST's MIRI LRS and generate a transmission spectrum from 5-12 $\rm{\mu}$m. These wavelengths allow us to probe absorption due to the vibrational modes of various predicted cloud species. Our transmission spectrum shows additional opacity centered at 8.6 $\rm{\mu}$m, and detailed atmospheric modeling and retrievals identify this feature as SiO$_2$(s) (quartz) clouds. The SiO$_2$(s) clouds model is preferred at 3.5-4.2$\sigma$ versus a cloud-free model and at 2.6$\sigma$ versus a generic aerosol prescription. We find the SiO$_2$(s) clouds are comprised of small ${\sim}0.01$ $\rm{\mu}$m particles, which extend to high altitudes in the atmosphere. The atmosphere also shows a depletion of H$_2$O, a finding consistent with the formation of high-temperature aerosols from oxygen-rich species. This work is part of a series of studies by our JWST Telescope Scientist Team (JWST-TST), in which we will use Guaranteed Time Observations to perform Deep Reconnaissance of Exoplanet Atmospheres through Multi-instrument Spectroscopy (DREAMS).Comment: 19 pages, 7 figures, accepted for publication in ApJ

Early Release Science of the exoplanet WASP-39b with JWST NIRCam

Measuring the metallicity and carbon-to-oxygen (C/O) ratio in exoplanet atmospheres is a fundamental step towards constraining the dominant chemical processes at work and, if in equilibrium, revealing planet formation histories. Transmission spectroscopy provides the necessary means by constraining the abundances of oxygen- and carbon-bearing species; however, this requires broad wavelength coverage, moderate spectral resolution, and high precision that, together, are not achievable with previous observatories. Now that JWST has commenced science operations, we are able to observe exoplanets at previously uncharted wavelengths and spectral resolutions. Here we report time-series observations of the transiting exoplanet WASP-39b using JWST's Near InfraRed Camera (NIRCam). The long-wavelength spectroscopic and short-wavelength photometric light curves span 2.0 - 4.0 $\mu$m, exhibit minimal systematics, and reveal well-defined molecular absorption features in the planet's spectrum. Specifically, we detect gaseous H$_2$O in the atmosphere and place an upper limit on the abundance of CH$_4$. The otherwise prominent CO$_2$ feature at 2.8 $\mu$m is largely masked by H$_2$O. The best-fit chemical equilibrium models favour an atmospheric metallicity of 1-100$\times$ solar (i.e., an enrichment of elements heavier than helium relative to the Sun) and a sub-stellar carbon-to-oxygen (C/O) ratio. The inferred high metallicity and low C/O ratio may indicate significant accretion of solid materials during planet formation or disequilibrium processes in the upper atmosphere.Comment: 35 pages, 13 figures, 3 tables, Nature, accepte

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Identification of carbon dioxide in an exoplanet atmosphere

Carbon dioxide (CO2) is a key chemical species that is found in a wide range of planetary atmospheres. In the context of exoplanets, CO2 is an indicator of the metal enrichment (that is, elements heavier than helium, also called ‘metallicity’), and thus the formation processes of the primary atmospheres of hot gas giants. It is also one of the most promising species to detect in the secondary atmospheres of terrestrial exoplanets. Previous photometric measurements of transiting planets with the Spitzer Space Telescope have given hints of the presence of CO2, but have not yielded definitive detections owing to the lack of unambiguous spectroscopic identification. Here we present the detection of CO2 in the atmosphere of the gas giant exoplanet WASP-39b from transmission spectroscopy observations obtained with JWST as part of the Early Release Science programme. The data used in this study span 3.0–5.5 micrometres in wavelength and show a prominent CO2 absorption feature at 4.3 micrometres (26-sigma significance). The overall spectrum is well matched by one-dimensional, ten-times solar metallicity models that assume radiative–convective–thermochemical equilibrium and have moderate cloud opacity. These models predict that the atmosphere should have water, carbon monoxide and hydrogen sulfide in addition to CO2, but little methane. Furthermore, we also tentatively detect a small absorption feature near 4.0 micrometres that is not reproduced by these models

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Acceptability and Barriers of the Home-Based Voluntary Counseling and Testing Model in the First Six Months of Service in Three Rural Sites in Amhara, Ethiopia

Thesis (Master's)--University of Washington, 2012 Specific Aims: The objective of this research was to evaluate a home-based HIV counseling and testing (HBVCT) pilot implemented in three Ethiopian sites during the first six month of implementation (January 1, 2011 to June 30, 2011). This study sought to document the experiences and challenges from the community voluntary counseling and testing (VCT) counselors providing the HBVCT service as well as specific challenges and barriers faced by ever-married community members. Setting: The pilot HBVCT program was implemented in eight sites in four regions of Ethiopia. The three sites in the Amhara Region were selected for this study. These sites (and rural kebeles) are Bahir Dar (Tis Abay, Andasa), Dessie (Addis Mender, Habru 01), and Gondar (Loza Mariam, Tekele Hymenot). These sites were selected because they are in the Amhara National Regional State. Methods: Secondary counseling and testing reports were collected from each site to analyze the clients' demographic information and testing results. In-depth interviews were conducted with the community VCT counselors and the senior VCT counselors in all three sites. Male and female focus group discussions were held in each community for ever-married men and women age 18 to 59 years old. Counselors were asked about the challenges of providing home-based services and their experience during the first six months of implementation. The focus group participants were asked about the community's perception of the HBVCT program, benefits, and barriers to acceptance. Results: 6,757 clients were tested in the Amhara Region during the first six months of implementation. In all sites, 59.26 percent of clients were female, the age of clients ranged from less than one year to over 99 years of age, 45.37 percent were illiterate, and 79.38 percent reported never before being tested. The qualitative interview and focus group data revealed three major themes: acceptance, challenges and barriers to testing, and benefits of HBVCT. Acceptance included both the general acceptance of the service and the acceptance of the locally selected VCT counselors. Challenges faced by clients were primarily related to understanding and fear of stigma or discrimination. Challenges faced by the counselors were mostly regarding the logistical challenges of providing home-to-home service and the technical challenges of providing counseling service. Benefits of the home-based service included reduction of traditional barriers to counseling and testing and normalization of VCT, making it easier and more socially acceptable to receive testing. Conclusions: HBVCT may provide an important avenue for testing Ethiopia's rural population. In this pilot, 79.38 percent of the Amhara clients had never before been tested for HIV, higher than other reported findings highlighting the need for an alternate testing model (1). Through this study, the HBVCT model was found to be accepted by community members in the three Amhara sites. In addition, community members were comfortable and reported a sense of increased confidentiality when receiving VCT services in their homes, even with a local community VCT counselor. Acceptability and normalization of counseling and testing were strengthened by community-based HIV and VCT education or promotion activities. This occurred by reducing some challenges faced by the HBVCT counselors as well as increasing acceptability among the community. The logistics and discussion of HIV counseling and testing remains a barrier for couples. However, HBVCT can act as a catalyst for couples to discuss and receive testing, especially for couples with low levels of education and for those who reside in rural communities. As the only qualitative and quantitative evaluation of a HBVCT program in Ethiopia, further research is needed to better understand the cost and prevention benefits of home-based service

Professionalizing Healthcare Management: A Descriptive Case Study

Despite international recognition of the importance of healthcare management in the development of high-performing systems, the path by which countries may develop and sustain a professional healthcare management workforce has not been articulated. Accordingly, we sought to identify a set of common themes in the establishment of a professional workforce of healthcare managers in low- and middle-income country (LMIC) settings using a descriptive case study approach. We draw on a historical analysis of the development of this profession in the United States and Ethiopia to identify five common themes in the professionalization of healthcare management: (1) a country context in which healthcare management is demanded; (2) a national framework that elevates a professional management role; (3) standards for healthcare management, and a monitoring function to promote adherence to standards; (4) a graduatelevel educational path to ensure a pipeline of well-prepared healthcare managers; and (5) professional associations to sustain and advance the field. These five components can to inform the creation of a long-term national strategy for the development of a professional cadre of heathcare managers in LMIC settings