Implementation of the SafeCare Model in Georgia for Preventing Child Maltreatment

Background: The SafeCare model is a behaviorally-based parenting model used in the prevention of child maltreatment. SafeCare targets three proximal risk factors for child neglect and abuse: parent-child interactions, home safety, and child health. SafeCare is one of only a few evidence-based practices for preventing child neglect, the dominant problem in child welfare, accounting for over 75% of child maltreatment cases. SafeCare has been broadly implemented in several states in the US, including Georgia, and is disseminated by the National SafeCare Training and Research Center (NSTRC) at Georgia State University. The presentation will (1) describe SafeCare and associated data, (2) describe the SafeCare implementation. Methods: SafeCare has been implemented in Georgia since 2008 using a rigorous implementation model, which includes ongoing quality assurance of SafeCare providers and skill acquisition evaluation in families. Providers of child welfare services have been trained to deliver SafeCare and have been coached by trainers from NSTRC. Evaluation data are regularly collected which include provider fidelity via observed sessions, family outcomes relating to completion of SafeCare, and skill acquisitions (i.e., changes in parenting behaviors, reductions in home hazards, and increases in knowledge and behaviors regarding child health care). Results: Recent evaluation data (2013-2015) indicate 115 families have been referred to a SafeCare provider and 100 families completed at least one session. Thirty-eight (38%) have completed the program in its entirety. Provider fidelity data collected monthly indicate high program fidelity (mean of 91% of desired behaviors performed). Family behavior data indicate excellent skill acquisition among families completing each SafeCare model. Parenting skills increased by 104%; home hazards were reduced by 85%, and child health care skills increased by 34%. Conclusions: The SafeCare model is an effective parenting program for reducing child maltreatment, and has been implemented successfully in Georgia. Broader impactof SafeCare will require increased implementation of the model to increase reach. Key words: child maltreatment, neglect, parenting, implementation, maternal-child healt

3D-HST: A wide-field grism spectroscopic survey with the Hubble Space Telescope

We present 3D-HST, a near-infrared spectroscopic Treasury program with the Hubble Space Telescope for studying the processes that shape galaxies in the distant Universe. 3D-HST provides rest-frame optical spectra for a sample of ~7000 galaxies at 1<z<3.5, the epoch when 60% of all star formation took place, the number density of quasars peaked, the first galaxies stopped forming stars, and the structural regularity that we see in galaxies today must have emerged. 3D-HST will cover 3/4 (625 sq.arcmin) of the CANDELS survey area with two orbits of primary WFC3/G141 grism coverage and two to four parallel orbits with the ACS/G800L grism. In the IR these exposure times yield a continuum signal-to-noise of ~5 per resolution element at H~23.1 and a 5sigma emission line sensitivity of 5x10-17 erg/s/cm2 for typical objects, improving by a factor of ~2 for compact sources in images with low sky background levels. The WFC3/G141 spectra provide continuous wavelength coverage from 1.1-1.6 um at a spatial resolution of ~0."13, which, combined with their depth, makes them a unique resource for studying galaxy evolution. We present the preliminary reduction and analysis of the grism observations, including emission line and redshift measurements from combined fits to the extracted grism spectra and photometry from ancillary multi-wavelength catalogs. The present analysis yields redshift estimates with a precision of sigma(z)=0.0034(1+z), or sigma(v)~1000 km/s. We illustrate how the generalized nature of the survey yields near-infrared spectra of remarkable quality for many different types of objects, including a quasar at z=4.7, quiescent galaxies at z~2, and the most distant T-type brown dwarf star known. The CANDELS and 3D-HST surveys combined will provide the definitive imaging and spectroscopic dataset for studies of the 1<z<3.5 Universe until the launch of the James Webb Space Telescope.Comment: Replacement reflects version now accepted by ApJS. A preliminary data release intended to provide a general illustration of the WFC3 grism data is available at http://3dhst.research.yale.edu

Assessing the impact of preventive mass vaccination campaigns on yellow fever outbreaks in Africa: A population-level self-controlled case series study.

The Eliminate Yellow fever Epidemics (EYE) strategy was launched in 2017 in response to the resurgence of yellow fever in Africa and the Americas. The strategy relies on several vaccination activities, including preventive mass vaccination campaigns (PMVCs). However, to what extent PMVCs are associated with a decreased risk of outbreak has not yet been quantified. We used the self-controlled case series (SCCS) method to assess the association between the occurrence of yellow fever outbreaks and the implementation of PMVCs at the province level in the African endemic region. As all time-invariant confounders are implicitly controlled for in the SCCS method, this method is an alternative to classical cohort or case-control study designs when the risk of residual confounding is high, in particular confounding by indication. The locations and dates of outbreaks were identified from international epidemiological records, and information on PMVCs was provided by coordinators of vaccination activities and international funders. The study sample consisted of provinces that were both affected by an outbreak and targeted for a PMVC between 2005 and 2018. We compared the incidence of outbreaks before and after the implementation of a PMVC. The sensitivity of our estimates to a range of assumptions was explored, and the results of the SCCS method were compared to those obtained through a retrospective cohort study design. We further derived the number of yellow fever outbreaks that have been prevented by PMVCs. The study sample consisted of 33 provinces from 11 African countries. Among these, the first outbreak occurred during the pre-PMVC period in 26 (79%) provinces, and during the post-PMVC period in 7 (21%) provinces. At the province level, the post-PMVC period was associated with an 86% reduction (95% CI 66% to 94%, p < 0.001) in the risk of outbreak as compared to the pre-PMVC period. This negative association between exposure to PMVCs and outbreak was robustly observed across a range of sensitivity analyses, especially when using quantitative estimates of vaccination coverage as an alternative exposure measure, or when varying the observation period. In contrast, the results of the cohort-style analyses were highly sensitive to the choice of covariates included in the model. Based on the SCCS results, we estimated that PMVCs were associated with a 34% (95% CI 22% to 45%) reduction in the number of outbreaks in Africa from 2005 to 2018. A limitation of our study is the fact that it does not account for potential time-varying confounders, such as changing environmental drivers of yellow fever and possibly improved disease surveillance. In this study, we provide new empirical evidence of the high preventive impact of PMVCs on yellow fever outbreaks. This study illustrates that the SCCS method can be advantageously applied at the population level in order to evaluate a public health intervention

LibrettOS: A Dynamically Adaptable Multiserver-Library OS

We present LibrettOS, an OS design that fuses two paradigms to simultaneously address issues of isolation, performance, compatibility, failure recoverability, and run-time upgrades. LibrettOS acts as a microkernel OS that runs servers in an isolated manner. LibrettOS can also act as a library OS when, for better performance, selected applications are granted exclusive access to virtual hardware resources such as storage and networking. Furthermore, applications can switch between the two OS modes with no interruption at run-time. LibrettOS has a uniquely distinguishing advantage in that, the two paradigms seamlessly coexist in the same OS, enabling users to simultaneously exploit their respective strengths (i.e., greater isolation, high performance). Systems code, such as device drivers, network stacks, and file systems remain identical in the two modes, enabling dynamic mode switching and reducing development and maintenance costs. To illustrate these design principles, we implemented a prototype of LibrettOS using rump kernels, allowing us to reuse existent, hardened NetBSD device drivers and a large ecosystem of POSIX/BSD-compatible applications. We use hardware (VM) virtualization to strongly isolate different rump kernel instances from each other. Because the original rumprun unikernel targeted a much simpler model for uniprocessor systems, we redesigned it to support multicore systems. Unlike kernel-bypass libraries such as DPDK, applications need not be modified to benefit from direct hardware access. LibrettOS also supports indirect access through a network server that we have developed. Applications remain uninterrupted even when network components fail or need to be upgraded. Finally, to efficiently use hardware resources, applications can dynamically switch between the indirect and direct modes based on their I/O load at run-time. [full abstract is in the paper]Comment: 16th ACM SIGPLAN/SIGOPS International Conference on Virtual Execution Environments (VEE '20), March 17, 2020, Lausanne, Switzerlan

Two Remarkably Luminous Galaxy Candidates at z≈11−13z\approx11-13 Revealed by JWST

The first few hundred Myrs at $z>10$ mark the last major uncharted epoch in the history of the Universe, where only a single galaxy (GNz11 at $z\approx11$) is currently spectroscopically confirmed. Here we present a search for luminous $z>10$ galaxies with $JWST$/NIRCam photometry spanning $\approx1-5\mu$m and covering 49 arcmin$^{2}$ from the public $JWST$ Early Release Science programs (CEERS and GLASS). Our most secure candidates are two $M_{\rm{UV}}\approx-21$ systems: GLASS-z13 and GLASS-z11. These galaxies display abrupt $\gtrsim2.5$ mag breaks in their spectral energy distributions, consistent with complete absorption of flux bluewards of Lyman-$\alpha$ that is redshifted to $z\approx13$ and $z\approx11$. Lower redshift interlopers such as dusty quiescent galaxies with strong Balmer breaks would be comfortably detected at $>5\sigma$ in multiple bands where instead we find no flux. From SED modeling we infer that these galaxies have already built up $\sim 10^9$ solar masses in stars over the $\lesssim300-400$ Myrs after the Big Bang. The brightness of these sources enable morphological constraints. Tantalizingly, GLASS-z11 shows a clearly extended exponential light profile, potentially consistent with a disk galaxy of $r_{\rm{50}}\approx0.7$ kpc. These sources, if confirmed, join GNz11 in defying number density forecasts for luminous galaxies based on Schechter UV luminosity functions, which require a survey area $>10\times$ larger than we have studied here to find such luminous sources at such high redshifts. They extend evidence from lower redshifts for little or no evolution in the bright end of the UV luminosity function into the cosmic dawn epoch, with implications for just how early these galaxies began forming. This, in turn, suggests that future deep $JWST$ observations may identify relatively bright galaxies to much earlier epochs than might have been anticipated.Comment: Submitted to ApJL. Figs. 1 and 2 summarize the candidates, Fig. 3 places the brightness of these systems in context, Fig. 4 shows the morphology, Fig. 5 explores implications for the UVLF. Comments warmly welcome

Health financing reform in Kenya- assessing the social health insurance proposal

Kenya has had a history of health financing policy changes since its   independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a tr&amp;nsition period. Questions of economic  feasibility and political acceptability continue to be discussed, with   stakeholders voicing concerns on design features of the new proposal   submitted to the  Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be  necessary, which is likely to last more than a decade. However, important objectives such as access to health care  and avoiding impoverishment due to direct health care payments should be recognised from the start so that  steady progress towards effective universal coverage can be planned and achieved

The architecture of clonal expansions in morphologically normal tissue from cancerous and non-cancerous prostates

Background: Up to 80% of cases of prostate cancer present with multifocal independent tumour lesions leading to the concept of a field effect present in the normal prostate predisposing to cancer development. In the present study we applied Whole Genome DNA Sequencing (WGS) to a group of morphologically normal tissue (n = 51), including benign prostatic hyperplasia (BPH) and non-BPH samples, from men with and men without prostate cancer. We assess whether the observed genetic changes in morphologically normal tissue are linked to the development of cancer in the prostate. Results: Single nucleotide variants (P = 7.0 × 10–03, Wilcoxon rank sum test) and small insertions and deletions (indels, P = 8.7 × 10–06) were significantly higher in morphologically normal samples, including BPH, from men with prostate cancer compared to those without. The presence of subclonal expansions under selective pressure, supported by a high level of mutations, were significantly associated with samples from men with prostate cancer (P = 0.035, Fisher exact test). The clonal cell fraction of normal clones was always higher than the proportion of the prostate estimated as epithelial (P = 5.94 × 10–05, paired Wilcoxon signed rank test) which, along with analysis of primary fibroblasts prepared from BPH specimens, suggests a stromal origin. Constructed phylogenies revealed lineages associated with benign tissue that were completely distinct from adjacent tumour clones, but a common lineage between BPH and non-BPH morphologically normal tissues was often observed. Compared to tumours, normal samples have significantly less single nucleotide variants (P = 3.72 × 10–09, paired Wilcoxon signed rank test), have very few rearrangements and a complete lack of copy number alterations. Conclusions: Cells within regions of morphologically normal tissue (both BPH and non-BPH) can expand under selective pressure by mechanisms that are distinct from those occurring in adjacent cancer, but that are allied to the presence of cancer. Expansions, which are probably stromal in origin, are characterised by lack of recurrent driver mutations, by almost complete absence of structural variants/copy number alterations, and mutational processes similar to malignant tissue. Our findings have implications for treatment (focal therapy) and early detection approaches

UNCOVER: Candidate Red Active Galactic Nuclei at 3<z<7 with JWST and ALMA

The James Webb Space Telescope (JWST) is revolutionizing our knowledge of $z>5$ galaxies and their actively accreting black holes. Using the JWST Cycle 1 Treasury program Ultradeep NIRSpec and NIRCam ObserVations before the Epoch of Reionization (UNCOVER) in the lensing field Abell 2744, we report the identification of a sample of little red dots at $3 < z_{\rm{phot}} < 7$ that likely contain highly-reddened accreting supermassive black holes. Using a NIRCam-only selection to F444W$<27.7$ mag, we find 26 sources over the $\sim45$ arcmin$^{2}$ field that are blue in F115W$-$F200W$\sim0$ (or $\beta_{\rm UV}\sim-2.0$ for $f_{\lambda} \propto \lambda^\beta$), red in F200W$-$F444W = $1-4$ ($\beta_{\rm opt} \sim +2.0$), and are dominated by a point-source like central component. Of the 20 sources with deep ALMA 1.2-mm coverage, none are detected individually or in a stack. For the majority of the sample, SED fits to the JWST+ALMA observations prefer models with hot dust rather than obscured star-formation to reproduce the red NIRCam colors and ALMA 1.2-mm non-detections. While compact dusty star formation can not be ruled out, the combination of extremely small sizes ($\langle r_e \rangle\approx50$ pc after correction for magnification), red rest-frame optical slopes, and hot dust can by explained by reddened broad-line active galactic nuclei (AGNs). Our targets have faint $M_{\rm 1450} \approx -14\ \, {\rm to} -18$ mag but inferred bolometric luminosities of $L_{\rm bol} = 10^{43}-10^{46}$ erg/s, reflecting their obscured nature. If the candidates are confirmed as AGNs with upcoming UNCOVER spectroscopy, then we have found an abundant population of reddened luminous AGN that are at least ten times more numerous than UV-luminous AGN at the same intrinsic bolometric luminosity.Comment: submitted to Ap