Experiences, Opportunities and Challenges of Implementing Task Shifting in Underserved Remote Settings: The Case of Kongwa District, Central Tanzania.

Tanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers' shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants' practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care. Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based

The Gaia-ESO Survey : Extracting diffuse interstellar bands from cool star spectra: DIB-based interstellar medium line-of-sight structures at the kpc scale

Date of Acceptance: 05/10/2014Aims. We study how diffuse interstellar bands (DIBs) measured toward distance-distributed target stars can be used to locate dense interstellar (IS) clouds in the Galaxy and probe a line-of-sight (LOS) kinematical structure, a potentially useful tool when gaseous absorption lines are saturated or not available in the spectral range. Cool target stars are numerous enough for this purpose. Methods. We devised automated DIB-fitting methods appropriate for cool star spectra and multiple IS components. The data were fitted with a combination of a synthetic stellar spectrum, a synthetic telluric transmission, and empirical DIB profiles. The initial number of DIB components and their radial velocity were guided by HI 21 cm emission spectra, or, when available in the spectral range, IS neutral sodium absorption lines. For NaI, radial velocities of NaI lines and DIBs were maintained linked during a global simultaneous fit. In parallel, stellar distances and extinctions were estimated self-consistently by means of a 2D Bayesian method from spectroscopically-derived stellar parameters and photometric data. Results. We have analyzed Gaia-ESO Survey (GES) spectra of 225 stars that probe between ∼2 and 10 kpc long LOS in five different regions of the Milky Way. The targets are the two CoRoT fields, two open clusters (NGC 4815 and γ Vel), and the Galactic bulge. Two OGLE fields toward the bulge observed before the GES are also included (205 target stars). Depending on the observed spectral intervals, we extracted one or more of the following DIBs: λλ 6283.8, 6613.6, and 8620.4. For each field, we compared the DIB strengths with the Bayesian distances and extinctions, and the DIB Doppler velocities with the HI emission spectra. Conclusions. For all fields, the DIB strength and the target extinction are well correlated. For targets that are widely distributed in distance, marked steps in DIBs and extinction radial distance profiles match each other and broadly correspond to the expected locations of spiral arms. For all fields, the DIB velocity structure agrees with HI emission spectra, and all detected DIBs correspond to strong NaI lines. This illustrates how DIBs can be used to locate the Galactic interstellar gas and to study its kinematics at the kpc scale, as illustrated by Local and Perseus Arm DIBs that differ by ≳∼30 km s-1, in agreement with HI emission spectra. On the other hand, if most targets are located beyond the main absorber, DIBs can trace the differential reddening within the field.Peer reviewedFinal Accepted Versio

Evolutionary stage of the spectral variable BD+48 1220=IRAS 05040+4820

Based on high-resolution observations (R=60000 and 75000), we have studied the optical spectral variability of the star BD+48 1220 (IRAS05040+4820). We have measured the equivalent widths of numerous absorption lines of neutral atoms and ions at wavelengths from 4500 to 6760 AA, as well as the corresponding radial velocities. We use model atmospheres to determine Teff=7900K, log g=0.0, microturbulence velocity xi_t=6.0, and the abundances for 16 elements. The star's metallicity differs little from the solar value: [Fe/H]=-0.10 dex. The main peculiarity of the chemical composition of the star is a large He-excess, derived from the HeI 5876 A absorption, [He/H]=+1.04, and the equally large O-excess, [O/Fe]=+0.72 dex. The C-excess is small, [C/Fe]=+0.09 dex, and the ratio [C/O]$\le$ 1. We obtained a revised relation for the light-metal abundances: [Na/Fe]=+0.87 with [Mg/Fe]=-0.31. The barium abundance is low, [Ba/Fe]=-0.84. The radial velocity of the star measured from photospheric absorption lines over three years of observations varies in the interval V_sun = -(7 - 15) km/s. Time variable differential line shifts have been revealed. The entire set of available data (the luminosity Mv~-5m, velocity V_lsr~-20 km/s, metallicity [Fe/H]=-0.10, and peculiarities of the optical spectrum and chemical composition) confirms the status of BD+48 1220 as a post-AGB star with He- and O-excesses belonging to the Galactic disk.Comment: 42 pages, 7 figures, 6 tables, accepted by Astronomy Report

Nitrogen hydrides in interstellar gas II. Analysis of Herschel/HIFI observations towards W49N and G10.6-0.4 (W31C)

We have used the Herschel-HIFI instrument to observe interstellar nitrogen hydrides along the sight-lines towards W49N and G10.6-0.4 in order to elucidate the production pathways leading to nitrogen-bearing species in diffuse gas. All detections show absorption by foreground material over a wide range of velocities, as well as absorption associated directly with the hot-core source itself. As in the previously published observations towards G10.6-0.4, the NH, NH2 and NH3 spectra towards W49N show strikingly similar and non-saturated absorption features. We decompose the absorption of the foreground material towards W49N into different velocity components in order to investigate whether the relative abundances vary among the velocity components, and, in addition, we re-analyse the absorption lines towards G10.6-0.4 in the same manner. Abundances, with respect to molecular hydrogen, in each velocity component are estimated using CH. The analysis points to a co-existence of the nitrogen hydrides in diffuse or translucent interstellar gas with a high molecular fraction. Towards both sources, we find that NH is always at least as abundant as both o-NH2 and o-NH3, in sharp contrast to previous results for dark clouds. We find relatively constant N(NH)/N(o-NH3) and N(o-NH2)/N(o-NH3) ratios with mean values of 3.2 and 1.9 towards W49N, and 5.4 and 2.2 towards G10.6-0.4, respectively. The mean abundance of o-NH3 is ~2x10^-9 towards both sources. The nitrogen hydrides also show linear correlations with CN and HNC towards both sources, and looser correlations with CH. The upper limits on the NH+ abundance indicate column densities < 2 - 14 % of N(NH). Surprisingly low values of the ammonia ortho-to-para ratio are found in both sources, ~0.5 - 0.7 +- 0.1. This result cannot be explained by current models as we had expected to find a value of unity or higher.Comment: 35 pages, 74 figure

The Interstellar Environment of our Galaxy

We review the current knowledge and understanding of the interstellar medium of our galaxy. We first present each of the three basic constituents - ordinary matter, cosmic rays, and magnetic fields - of the interstellar medium, laying emphasis on their physical and chemical properties inferred from a broad range of observations. We then position the different interstellar constituents, both with respect to each other and with respect to stars, within the general galactic ecosystem.Comment: 39 pages, 12 figures (including 3 figures in 2 parts

Control of star formation by supersonic turbulence

Understanding the formation of stars in galaxies is central to much of modern astrophysics. For several decades it has been thought that stellar birth is primarily controlled by the interplay between gravity and magnetostatic support, modulated by ambipolar diffusion. Recently, however, both observational and numerical work has begun to suggest that support by supersonic turbulence rather than magnetic fields controls star formation. In this review we outline a new theory of star formation relying on the control by turbulence. We demonstrate that although supersonic turbulence can provide global support, it nevertheless produces density enhancements that allow local collapse. Inefficient, isolated star formation is a hallmark of turbulent support, while efficient, clustered star formation occurs in its absence. The consequences of this theory are then explored for both local star formation and galactic scale star formation. (ABSTRACT ABBREVIATED)Comment: Invited review for "Reviews of Modern Physics", 87 pages including 28 figures, in pres

The sub-mm J=6-5 line of 13CO in Orion

We present a fully sampled map covering the Orion Hot Core and dense molecular ridge, in the sub-millimeter J=6-5 rotational transition of 13CO, at 0.45 mm with a resolution of 13 arcsec and 0.5 km s^-1. The map covers 3 arc min by 2arc min . The profile centered on the Hot Core peaks at 8.5 km s^-1 and has a peak intensity of 40 K, corrected antenna temperature. It shows line wings from 30 km s^-1 to -20 km s^-1. The map of intensity, integrated from 0 to +18 km s^-1, shows a prominent maximum <5 arcsec from the center of the Orion Hot Core. The FWHP is 3 arcsec, larger than the regions containing complex molecules. Single dish measurements of lines from the J=2-1 or J=1-0 transitions of CO isotopes show no such distinct maximum. Correcting for optical depth 1.5 in the J=6-5 line of 13CO, and assuming that the level populations are thermalized at 150 K, the beam averaged column density between 0 to +18 km s^-1 is N(13CO )=6.8 10^17 cm^-2 and N(CO)=5.2 10^19 cm-2. When combined with published dust emission data, the CO/ H2 number ratio is 2 {\cdot} 10^-5, a factor of ~5 lower than the canonical value, 10^-4. For the Orion South and Orion Ridge region, the column density of CO is <25% of that found for the Hot Core but CO/H2 ratios are similar. Models of Photodissociation Regions, PDRs, predict that CO lines from PDRs are only marginally optically thick. Thus our map traces warm and dense molecular gas rather than PDRs.Comment: 23 pages total, including 5 figure

Fermi-LAT Search for Pulsar Wind Nebulae around gamma-ray Pulsars

The high sensitivity of the Fermi-LAT (Large Area Telescope) offers the first opportunity to study faint and extended GeV sources such as pulsar wind nebulae (PWNe). After one year of observation the LAT detected and identified three pulsar wind nebulae: the Crab Nebula, Vela-X and the PWN inside MSH 15-52. In the meantime, the list of LAT detected pulsars increased steadily. These pulsars are characterized by high energy loss rates from ~3 \times 10^{33} erg s$^{-1}$ to 5 \times 10$^{38}$ erg s$^{-1}$ and are therefore likely to power a PWN. This paper summarizes the search for PWNe in the off-pulse windows of 54 LAT-detected pulsars using 16 months of survey observations. Ten sources show significant emission, seven of these likely being of magnetospheric origin. The detection of significant emission in the off-pulse interval offers new constraints on the gamma-ray emitting regions in pulsar magnetospheres. The three other sources with significant emission are the Crab Nebula, Vela-X and a new pulsar wind nebula candidate associated with the LAT pulsar PSR J1023-5746, coincident with the TeV source HESS J1023-575. We further explore the association between the H.E.S.S. and the Fermi source by modeling its spectral energy distribution. Flux upper limits derived for the 44 remaining sources are used to provide new constraints on famous PWNe that have been detected at keV and/or TeV energies.Comment: Accepted for publication in Astrophysical Journal, 42 pages, 17 figure

Borrelia burgdorferi EbfC defines a newly-identified, widespread family of bacterial DNA-binding proteins

The Lyme disease spirochete, Borrelia burgdorferi, encodes a novel type of DNA-binding protein named EbfC. Orthologs of EbfC are encoded by a wide range of bacterial species, so characterization of the borrelial protein has implications that span the eubacterial kingdom. The present work defines the DNA sequence required for high-affinity binding by EbfC to be the 4 bp broken palindrome GTnAC, where ‘n’ can be any nucleotide. Two high-affinity EbfC-binding sites are located immediately 5′ of B. burgdorferi erp transcriptional promoters, and binding of EbfC was found to alter the conformation of erp promoter DNA. Consensus EbfC-binding sites are abundantly distributed throughout the B. burgdorferi genome, occurring approximately once every 1 kb. These and other features of EbfC suggest that this small protein and its orthologs may represent a distinctive type of bacterial nucleoid-associated protein. EbfC was shown to bind DNA as a homodimer, and site-directed mutagenesis studies indicated that EbfC and its orthologs appear to bind DNA via a novel α-helical ‘tweezer’-like structure

Planck Intermediate Results. IX. Detection of the Galactic haze with Planck

Using precise full-sky observations from Planck, and applying several methods of component separation, we identify and characterize the emission from the Galactic "haze" at microwave wavelengths. The haze is a distinct component of diffuse Galactic emission, roughly centered on the Galactic centre, and extends to |b| ~35 deg in Galactic latitude and |l| ~15 deg in longitude. By combining the Planck data with observations from the WMAP we are able to determine the spectrum of this emission to high accuracy, unhindered by the large systematic biases present in previous analyses. The derived spectrum is consistent with power-law emission with a spectral index of -2.55 +/- 0.05, thus excluding free-free emission as the source and instead favouring hard-spectrum synchrotron radiation from an electron population with a spectrum (number density per energy) dN/dE ~ E^-2.1. At Galactic latitudes |b|<30 deg, the microwave haze morphology is consistent with that of the Fermi gamma-ray "haze" or "bubbles," indicating that we have a multi-wavelength view of a distinct component of our Galaxy. Given both the very hard spectrum and the extended nature of the emission, it is highly unlikely that the haze electrons result from supernova shocks in the Galactic disk. Instead, a new mechanism for cosmic-ray acceleration in the centre of our Galaxy is implied.Comment: 15 pages, 9 figures, submitted to Astronomy and Astrophysic