Facility-level characteristics associated with family planning and child immunization services integration in urban areas of Nigeria: a longitudinal analysis

Background: Unmet need for postpartum contraception is high. Integration of family planning with routine child immunization services may help to satisfy unmet need. However, evidence about the determinants and effects of integration has been inconsistent, and more evidence is required to ascertain whether and how to invest in integration. In this study, facility-level family planning and immunization integration index scores are used to: (1) determine whether integration changes over time and (2) identify whether facility-level characteristics, including exposure to the Nigerian Urban Reproductive Health Initiative (NURHI), are associated with integration across facilities in six urban areas of Nigeria. Methods: This study utilizes health facility data collected at baseline (n = 400) and endline (n = 385) for the NURHI impact evaluation. Difference-in-differences models estimate the associations between facility-level characteristics, including exposure to NURHI, and Provider and Facility Integration Index scores. The two outcome measures, Provider and Facility Integration Index scores, reflect attributes that support integrated service delivery. These indexes, which range from 0 (low) to 10 (high), were constructed using principal component analysis. Scores were calculated for each facility. Independent variables are (1) time period, (2) whether the facility received the NURHI intervention, and (3) additional facility-level characteristics. Results: Within intervention facilities, mean Provider Integration Index scores were 6.46 at baseline and 6.79 at endline; mean Facility Integration Index scores were 7.16 (baseline) and 7.36 (endline). Within non-intervention facilities, mean Provider Integration Index scores were 5.01 at baseline and 6.25 at endline; mean Facility Integration Index scores were 5.83 (baseline) and 6.12 (endline). Provider Integration Index scores increased significantly (p = 0.00) among non-intervention facilities. Facility Integration Index scores did not increase significantly in either group. Results identify facility-level characteristics associated with higher levels of integration, including smaller family planning client load, family planning training among providers, and public facility ownership. Exposure to NURHI was not associated with integration index scores. Conclusion: Programs aiming to increase integration of family planning and immunization services should monitor and provide targeted support for the implementation of a well-defined integration strategy that considers the influence of facility characteristics and concurrent initiatives

Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria

Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration

MagAO Imaging of Long-period Objects (MILO). I. A Benchmark M Dwarf Companion Exciting a Massive Planet around the Sun-like Star HD 7449

We present high-contrast Magellan adaptive optics (MagAO) images of HD 7449, a Sun-like star with one planet and a long-term radial velocity (RV) trend. We unambiguously detect the source of the long-term trend from 0.6-2.15 \microns ~at a separation of \about 0\fasec 54. We use the object's colors and spectral energy distribution to show that it is most likely an M4-M5 dwarf (mass \about 0.1-0.2 \msun) at the same distance as the primary and is therefore likely bound. We also present new RVs measured with the Magellan/MIKE and PFS spectrometers and compile these with archival data from CORALIE and HARPS. We use a new Markov chain Monte Carlo procedure to constrain both the mass ($> 0.17$ \msun ~at 99$\%$ confidence) and semimajor axis (\about 18 AU) of the M dwarf companion (HD 7449B). We also refine the parameters of the known massive planet (HD 7449Ab), finding that its minimum mass is $1.09^{+0.52}_{-0.19}$ \mj, its semimajor axis is $2.33^{+0.01}_{-0.02}$ AU, and its eccentricity is $0.8^{+0.08}_{-0.06}$. We use N-body simulations to constrain the eccentricity of HD 7449B to $\lesssim$ 0.5. The M dwarf may be inducing Kozai oscillations on the planet, explaining its high eccentricity. If this is the case and its orbit was initially circular, the mass of the planet would need to be $\lesssim$ 1.5 \mj. This demonstrates that strong constraints on known planets can be made using direct observations of otherwise undetectable long-period companions.Comment: Corrected planet mass error (7.8 Mj --> 1.09 Mj, in agreement with previous studies

The Carbon-Rich Gas in the Beta Pictoris Circumstellar Disk

The edge-on disk surrounding the nearby young star Beta Pictoris is the archetype of the "debris disks", which are composed of dust and gas produced by collisions and evaporation of planetesimals, analogues of Solar System comets and asteroids. These disks provide a window on the formation and early evolution of terrestrial planets. Previous observations of Beta Pic concluded that the disk gas has roughly solar abundances of elements [1], but this poses a problem because such gas should be rapidly blown away from the star, contrary to observations of a stable gas disk in Keplerian rotation [1, 2]. Here we report the detection of singly and doubly ionized carbon (CII, CIII) and neutral atomic oxygen (OI) gas in the Beta Pic disk; measurement of these abundant volatile species permits a much more complete gas inventory. Carbon is extremely overabundant relative to every other measured element. This appears to solve the problem of the stable gas disk, since the carbon overabundance should keep the gas disk in Keplerian rotation [3]. New questions arise, however, since the overabundance may indicate the gas is produced from material more carbon-rich than the expected Solar System analogues.Comment: Accepted for publication in Nature. PDF document, 12 pages. Supplementary information may be found at http://www.dtm.ciw.edu/akir/Documents/roberge_supp.pdf *** Version 2 : Removed extraneous publication information, per instructions from the Nature editor. No other changes mad

On the Morphology and Chemical Composition of the HR 4796A Debris Disk

[abridged] We present resolved images of the HR 4796A debris disk using the Magellan adaptive optics system paired with Clio-2 and VisAO. We detect the disk at 0.77 \microns, 0.91 \microns, 0.99 \microns, 2.15 \microns, 3.1 \microns, 3.3 \microns, and 3.8 \microns. We find that the deprojected center of the ring is offset from the star by 4.76$\pm$1.6 AU and that the deprojected eccentricity is 0.06$\pm$0.02, in general agreement with previous studies. We find that the average width of the ring is 14$^{+3}_{-2}$, also comparable to previous measurements. Such a narrow ring precludes the existence of shepherding planets more massive than \about 4 \mj, comparable to hot-start planets we could have detected beyond \about 60 AU in projected separation. Combining our new scattered light data with archival HST/STIS and HST/NICMOS data at \about 0.5-2 \microns, along with previously unpublished Spitzer/MIPS thermal emission data and all other literature thermal data, we set out to constrain the chemical composition of the dust grains. After testing 19 individual root compositions and more than 8,400 unique mixtures of these compositions, we find that good fits to the scattered light alone and thermal emission alone are discrepant, suggesting that caution should be exercised if fitting to only one or the other. When we fit to both the scattered light and thermal emission simultaneously, we find mediocre fits (reduced chi-square \about 2). In general, however, we find that silicates and organics are the most favored, and that water ice is usually not favored. These results suggest that the common constituents of both interstellar dust and solar system comets also may reside around HR 4796A, though improved modeling is necessary to place better constraints on the exact chemical composition of the dust.Comment: Accepted to ApJ on October 27, 2014. 21 pages, 12 figures, 4 table

A new type of superelastic and shape memory materials: ThCr2Si2- structured novel intermetallic compounds at small length scales

Crystalline, superelastic materials typically exhibit large recoverable strains due to the ability of the material to undergo a reversible phase transition between martensite and austenite phases. Applicable to various alloys, ceramics and intermetallic compounds, this reversible transition serves as a general mechanism for superelasticity and shape memory effect. Recently, we noticed that ThCr2Si2-structured intermetallic compounds exhibit a reversible phase transition between a tetragonal (or orthorhombic) phase to a collapsed tetragonal phase under compression along c-axis of the unit cell by making and breaking Si-Si type bonds. This process has nothing to do with martensitic transformation. This unique reversible phase transformation process motivated us to investigate their potential as a superelastic and shape memory material. Please click Additional Files below to see the full abstract

Outcomes in patients with gunshot wounds to the brain.

Introduction:Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods:We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation. Results:825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation. Conclusion:We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. Level of evidence:Level II

Macrophages directly contribute collagen to scar formation during zebrafish heart regeneration and mouse heart repair

Canonical roles for macrophages in mediating the fibrotic response after a heart attack include extracellular matrix turnover and activation of cardiac fibroblasts to initiate collagen deposition. Here we reveal that macrophages directly contribute collagen to the forming post-injury scar. Unbiased transcriptomics shows an upregulation of collagens in both zebrafish and mouse macrophages following heart injury. Adoptive transfer of macrophages, from either collagen-tagged zebrafish or adult mouse GFPtpz-collagen donors, enhances scar formation via cell autonomous production of collagen. In zebrafish, the majority of tagged collagen localises proximal to the injury, within the overlying epicardial region, suggesting a possible distinction between macrophage-deposited collagen and that predominantly laid-down by myofibroblasts. Macrophage-specific targeting of col4a3bpa and cognate col4a1 in zebrafish significantly reduces scarring in cryoinjured hosts. Our findings contrast with the current model of scarring, whereby collagen deposition is exclusively attributed to myofibroblasts, and implicate macrophages as direct contributors to fibrosis during heart repair