Remoteness and maternal and child health service utilization in rural Liberia: A population–based survey

Background: This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa. Methods: Cluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data. Findings: Living in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers. Conclusions: Within a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further dissemination of providers and greater use of community health workers should be prioritized

The aminosterol antibiotic squalamine permeabilizes large unilamellar phospholipid vesicles.

AbstractThe ability of the shark antimicrobial aminosterol squalamine to induce the leakage of polar fluorescent dyes from large unilamellar phospholipid vesicles (LUVs) has been measured. Micromolar squalamine causes leakage of carboxyfluorescein (CF) from vesicles prepared from the anionic phospholipids phosphatidylglycerol (PG), phosphatidylserine (PS), and cardiolipin. Binding analyses based on the leakage data show that squalamine has its highest affinity to phosphatidylglycerol membranes, followed by phosphatidylserine and cardiolipin membranes. Squalamine will also induce the leakage of CF from phosphatidylcholine (PC) LUVs at low phospholipid concentrations. At high phospholipid concentrations, the leakage of CF from PC LUVs deviates from a simple dose–response relationship, and it appears that some of the squalamine can no longer cause leakage. Fluorescent dye leakage generated by squalamine is graded, suggesting the formation of a discrete membrane pore rather than a generalized disruption of vesicular membranes. By using fluorescently labeled dextrans of different molecular weight, material with molecular weight ≤4000 g/mol is released from vesicles by squalamine, but material with molecular weight ≥10,000 is retained. Negative stain electron microscopy of squalamine-treated LUVs shows that squalamine decreases the average vesicular size in a concentration-dependent manner. Squalamine decreases the size of vesicles containing anionic phospholipid at a lower squalamine/lipid molar ratio than pure PC LUVs. In a centrifugation assay, squalamine solubilizes phospholipid, but only at significantly higher squalamine/phospholipid ratios than required for either dye leakage or vesicle size reduction. Squalamine solubilizes PC at lower squalamine/phospholipid ratios than PG. We suggest that squalamine complexes with phospholipid to form a discrete structure within the bilayers of LUVs, resulting in the transient leakage of small encapsulated molecules. At higher squalamine/phospholipid ratios, these structures release from the bilayers and aggregate to form either new vesicles or squalamine/phospholipid mixed micelles

Interrelationship of structure and function in maxillofacial fractures

© 2016 American Osteopathic Association. Surgical fixation of maxillofacial fractures can be associated with a myriad of surgical complications. Specific complications correlate with the type of fracture. The authors present a case of multiple maxillofacial fractures, briefly review various types of fractures, and discuss the operative decisionmaking process. This case report serves as an important reminder that the operative decision-making process should take into account a patient’s entire clinical condition

Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization

Background: Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span. Methods: We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization. Results: Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001). Conclusions: Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users

Spectral Isolation and Measurement of Surface-Trapped State Multidimensional Nonlinear Susceptibility in Colloidal Quantum Dots

Multiresonant coherent multidimensional spectroscopy (CMDS) is a powerful new method for probing the coupling between vibrational modes and their dynamics. The line narrowing that occurs because of the multidimensional nature of CMDS allows the separation of homogeneous and inhomogeneous broadening and enhances spectral resolution. Recent work has extended multiresonant CMDS to electronic resonances in quantum confined nanostructures. Vibrational modes of the solvent also appear in the CMDS spectra. The phase oscillations of the vibrational and electronic coherences interfere and change the line shapes. Since the form of the vibrational third-order susceptibility and hyperpolarizability are well-known and since they can be measured against known standards, it becomes possible to use the interference effects as a probe of the absolute magnitude and phase of the electronic resonances. This approach is demonstrated using PbSe quantum dots where incomplete capping causes ultrafast relaxation to a new electronic state that appears directly in the CMDS spectra. The new state is believed to be a mixed core/surface exciton. Closed-form expressions for the electronic nonlinearities are used to analyze the frequency dependence of the fully resonant complex hyperpolarizability of the 1S exciton and the surface-trapped state. The ability of mixed frequency/time domain multiresonant CMDS methods to spectrally resolve surface states promises to be an important new way to characterize the interface states in complex heterostructures and the surface states that define the stability of nanostructures resulting from different synthetic strategies

Spectral Isolation and Measurement of Surface-Trapped State Multidimensional Nonlinear Susceptibility in Colloidal Quantum Dots

Multiresonant coherent multidimensional spectroscopy (CMDS) is a powerful new method for probing the coupling between vibrational modes and their dynamics. The line narrowing that occurs because of the multidimensional nature of CMDS allows the separation of homogeneous and inhomogeneous broadening and enhances spectral resolution. Recent work has extended multiresonant CMDS to electronic resonances in quantum confined nanostructures. Vibrational modes of the solvent also appear in the CMDS spectra. The phase oscillations of the vibrational and electronic coherences interfere and change the line shapes. Since the form of the vibrational third-order susceptibility and hyperpolarizability are well-known and since they can be measured against known standards, it becomes possible to use the interference effects as a probe of the absolute magnitude and phase of the electronic resonances. This approach is demonstrated using PbSe quantum dots where incomplete capping causes ultrafast relaxation to a new electronic state that appears directly in the CMDS spectra. The new state is believed to be a mixed core/surface exciton. Closed-form expressions for the electronic nonlinearities are used to analyze the frequency dependence of the fully resonant complex hyperpolarizability of the 1S exciton and the surface-trapped state. The ability of mixed frequency/time domain multiresonant CMDS methods to spectrally resolve surface states promises to be an important new way to characterize the interface states in complex heterostructures and the surface states that define the stability of nanostructures resulting from different synthetic strategies

Multiresonant Coherent Multidimensional Electronic Spectroscopy of Colloidal PbSe Quantum Dots

We demonstrate the use of multiresonant coherent multidimensional spectroscopy (CMDS) for obtaining 2D spectra of the diagonal and cross-peaks of the 1S and 1P excitons and biexcitons in PbSe quantum dots and their coherent and incoherent dynamics. We show that multiresonant CMDS line narrows the inhomogeneous broadening and resolves the excitonic peaks from the background that often obscures peaks. We develop theoretical methods that extract details of the homogeneous and inhomogeneous broadening, the Coulombic coupling within the biexciton, and the relative exciton and biexciton transition moments. The population dynamics are measured by scanning the excitation pulse time delays over all time orderings. Phase modulations of individual coherences are observed because of heterodyning between scattered light and the four-wave mixing signal. The experiments demonstrate that CMDS can be used to obtain quantum state resolved dynamics of the electronic states in complex nanostructures and other important materials

Additional file 1: Table S1. of Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization

Receipt of Maternal and Child Health Services (Adjusted): Percent of the population receiving maternal and child health services in the rural subsection of DHS 2007, DHS 2013 and the Konobo survey, with 95 % confidence intervals. (DOCX 96 kb