Evaluating the quality of routine data in primary health facilities for monitoring maternal and newborn care in Gombe State, northeastern Nigeria

Background. Accurate data are essential for monitoring progress and course correction. Good quality facility-based routine data can be used at the facility, district, national, and global levels to improve quality of care and care policies. However, poor routine data quality has been an ongoing challenge. This thesis aimed to evaluate the quality of routine data for monitoring maternal and newborn care in primary health facilities in Gombe State, Nigeria. Methods. To examine the quality of routine monitoring data, in Study 1 we assessed facility-reported data in the District Health Information Software, version 2 (DHIS 2) according to three routine data quality dimensions: completeness and timeliness, internal consistency, and external consistency. Using direct observations as a gold standard, in Study 2 we assessed the validity of data in facility registers as well as women’s recall of childbirth events. For 21 months (April 2017-December 2018), we implemented a data quality intervention, working with all 11 local government area (district-equivalent) monitoring and evaluation officers and maternal and child health program coordinators of Gombe State which oversee 492 primary health facilities. The intervention included regular self-assessment of data quality, learning workshops, and planning for improvement. In Study 3, we quantified the changes in data quality using before-and-after analyses, comparing the intervention period to the 21-month pre-intervention period (July 2015-March 2017). Results. Twelve of 14 priority facility-based indicators were available in Gombe’s health information system to monitor maternal and newborn care. However, the facility data were incomplete and showed inconsistencies over time, between related indicators, between internal and external data sources. Contact indicators had higher data quality than indicators reflecting the content of care. Though there were challenges with the quality of facility-reported data, the validity study demonstrated that health workers were able to record valid information for some aspects of maternal and newborn care. When compared to childbirth observations, health workers documented accurately in maternity registers for the following indicators: the cadre of main birth attendant; maternal background characteristics, and newborn outcomes. Lastly, the data quality intervention was associated with improved completeness, timeliness, consistency between related data, and accuracy of facility reporting. Conclusion. Facility-based routine data in Gombe State can monitor priority service provision indicators for mothers and newborns. To realize the potential of these data, opportunities to improve data quality include: expanding data quality assessments beyond completeness and accuracy; maximizing the reporting and specificity of existing data; refining supervision feedback on the data quality metrics; and optimizing the digitization of facility data in information systems such as DHIS 2. Further research opportunities include: deepening our understanding of how health workers directly engage with facility documentation to perform clinical care tasks; and developing a composite score to summarize the multi-dimensionality of routine data as a measure for continuous data quality monitoring and as an outcome for data quality interventions

Neural Correlates of Induced Light Experience during Meditation: A Pilot Hyperscanning Study

Certain individuals during deep meditative states can transmitt and give out an aura or ‘light, which is perceived by others through some unknown connections, visual, telepathic or other. Despite various anecdotal, historical accounts of such induced light experience (ILE), its underlying neural mechanism is not known. In this pilot study, we investigated the neural correlates of ILE by simultaneously recording the EEGs of an expert Teacher, who is claimed to elicit ILE, and his Pupil (N=2) during joint sessions under various instructions, given separately to the Teacher (transmit/ do not transmit) and to the Pupil (receive/ do not receive). In a further condition both teacher and pupil wear opaque goggles during transmit/receive instruction, limiting the visual/outputinput. We observed a robust increase in the high frequency beta (12-30 Hz) and gamma oscillations (30-70 Hz) in the Teacher’s brain whenever he was instructed to transmit. Electric field tomography analysis localized these effects over several brain regions including the fusiform gyrus, angular gyrus and the cerebellum. Finally, we found that the Teacher’s and Pupil’s brain responses were synchronized, especially in the alpha band (8-12 Hz) during transmit/receive condition, and the information flow was directional, i.e. from the Teacher to the Pupil; interestingly, this enhanced interbrain synchrony disappeared with opaque goggles. These results were interpreted in terms of heightened internally selective attention as manifested by high frequency beta-gamma oscillations and of joint attention as manifested by interbrain alpha synchrony. Altogether, our results provide the first neuroscientific evidence underlying the phenomenological experience of induced light

Gravitational collapse with tachyon field and barotropic fluid

A particular class of space-time, with a tachyon field, \phi, and a barotropic fluid constituting the matter content, is considered herein as a model for gravitational collapse. For simplicity, the tachyon potential is assumed to be of inverse square form i.e., V(\phi) \sim \phi^{-2}. Our purpose, by making use of the specific kinematical features of the tachyon, which are rather different from a standard scalar field, is to establish the several types of asymptotic behavior that our matter content induces. Employing a dynamical system analysis, complemented by a thorough numerical study, we find classical solutions corresponding to a naked singularity or a black hole formation. In particular, there is a subset where the fluid and tachyon participate in an interesting tracking behaviour, depending sensitively on the initial conditions for the energy densities of the tachyon field and barotropic fluid. Two other classes of solutions are present, corresponding respectively, to either a tachyon or a barotropic fluid regime. Which of these emerges as dominant, will depend on the choice of the barotropic parameter, \gamma. Furthermore, these collapsing scenarios both have as final state the formation of a black hole.Comment: 18 pages, 7 figures. v3: minor changes. Final version to appear in GR

High energy emission from microquasars

The microquasar phenomenon is associated with the production of jets by X-ray binaries and, as such, may be associated with the majority of such systems. In this chapter we briefly outline the associations, definite, probable, possible, and speculative, between such jets and X-ray, gamma-ray and particle emission.Comment: Contributing chapter to the book Cosmic Gamma-Ray Sources, K.S. Cheng and G.E. Romero (eds.), to be published by Kluwer Academic Publishers, Dordrecht, 2004. (19 pages

Power grip, pinch grip, manual muscle testing or thenar atrophy - which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review

<p>Abstract</p> <p>Background</p> <p>Objective assessment of motor function is frequently used to evaluate outcome after surgical treatment of carpal tunnel syndrome (CTS). However a range of outcome measures are used and there appears to be no consensus on which measure of motor function effectively captures change. The purpose of this systematic review was to identify the methods used to assess motor function in randomized controlled trials of surgical interventions for CTS. A secondary aim was to evaluate which instruments reflect clinical change and are psychometrically robust.</p> <p>Methods</p> <p>The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical interventions for CTS. Data on instruments used, methods of assessment and results of tests of motor function was extracted by two independent reviewers.</p> <p>Results</p> <p>Twenty-two studies were retrieved which included performance based assessments of motor function. Nineteen studies assessed power grip dynamometry, fourteen studies used both power and pinch grip dynamometry, eight used manual muscle testing and five assessed the presence or absence of thenar atrophy. Several studies used multiple tests of motor function. Two studies included both power and pinch strength and reported descriptive statistics enabling calculation of effect sizes to compare the relative responsiveness of grip and pinch strength within study samples. The study findings suggest that tip pinch is more responsive than lateral pinch or power grip up to 12 weeks following surgery for CTS.</p> <p>Conclusion</p> <p>Although used most frequently and known to be reliable, power and key pinch dynamometry are not the most valid or responsive tools for assessing motor outcome up to 12 weeks following surgery for CTS. Tip pinch dynamometry more specifically targets the thenar musculature and appears to be more responsive. Manual muscle testing, which in theory is most specific to the thenar musculature, may be more sensitive if assessed using a hand held dynamometer – the Rotterdam Intrinsic Handheld Myometer. However further research is needed to evaluate its reliability and responsiveness and establish the most efficient and psychometrically robust method of evaluating motor function following surgery for CTS.</p

Differential distribution of a SINE element in the Entamoeba histolytica and Entamoeba dispar genomes: Role of the LINE-encoded endonuclease

<p>Abstract</p> <p>Background</p> <p><it>Entamoeba histolytica </it>and <it>Entamoeba dispar </it>are closely related protistan parasites but while <it>E. histolytica </it>can be invasive, <it>E. dispar </it>is completely non pathogenic. Transposable elements constitute a significant portion of the genome in these species; there being three families of LINEs and SINEs. These elements can profoundly influence the expression of neighboring genes. Thus their genomic location can have important phenotypic consequences. A genome-wide comparison of the location of these elements in the <it>E. histolytica </it>and <it>E. dispar </it>genomes has not been carried out. It is also not known whether the retrotransposition machinery works similarly in both species. The present study was undertaken to address these issues.</p> <p>Results</p> <p>Here we extracted all genomic occurrences of full-length copies of EhSINE1 in the <it>E. histolytica </it>genome and matched them with the homologous regions in <it>E. dispar</it>, and vice versa, wherever it was possible to establish synteny. We found that only about 20% of syntenic sites were occupied by SINE1 in both species. We checked whether the different genomic location in the two species was due to differences in the activity of the LINE-encoded endonuclease which is required for nicking the target site. We found that the endonucleases of both species were essentially very similar, both in their kinetic properties and in their substrate sequence specificity. Hence the differential distribution of SINEs in these species is not likely to be influenced by the endonuclease. Further we found that the physical properties of the DNA sequences adjoining the insertion sites were similar in both species.</p> <p>Conclusions</p> <p>Our data shows that the basic retrotransposition machinery is conserved in these sibling species. SINEs may indeed have occupied all of the insertion sites in the genome of the common ancestor of <it>E. histolytica </it>and <it>E. dispar </it>but these may have been subsequently lost from some locations. Alternatively, SINE expansion took place after the divergence of the two species. The absence of SINE1 in 80% of syntenic loci could affect the phenotype of the two species, including their pathogenic properties, which needs to be explored.</p

Reproductive Outcomes Following Ectopic Pregnancy: Register-Based Retrospective Cohort Study

Using Scottish national registry data, Sohinee Bhattacharya and colleagues investigate pregnancy outcomes following ectopic pregnancy in comparison to livebirth, miscarriage, or termination in a first pregnancy

Natural convection in a square cavity with uniformly heated and/or insulated walls using marker-and-cell method

In this study, a numerical investigation has been performed using the computational Harlow-Welch MAC (Marker and Cell) finite difference method to analyse the unsteady state two-dimensional natural convection in lid-driven square cavity with left wall maintained at constant heat flux and remaining walls kept thermally insulated. The significant parameters in the present study are Reynolds number (Re), thermal Grashof number (Gr) and Prandtl number (Pr) and Peclét number (Pe =PrRe). The structure of thermal convection patterns is analysed via streamline, vorticity, pressure and temperature contour plots. The influence of the thermophysical parameters on these distributions is described in detail. Validation of solutions with earlier studies is included. Mesh independence is also conducted. It is observed that an increase in Prandtl number intensifies the primary circulation whereas it reduces the heat transfer rate. Increasing thermal Grashof number also decreases heat transfer rates. Furthermore the isotherms are significantly compressed towards the left (constant flux) wall with a variation in Grashof number while Peclét number is fixed. The study is relevant to solar collector heat transfer simulations and also crystal growth technologies

MicroRNA159 Can Act as a Switch or Tuning MicroRNA Independently of Its Abundance in Arabidopsis

The efficacy of gene silencing by plant microRNAs (miRNAs) is generally assumed to be predominantly determined by their abundance. In Arabidopsis the highly abundant miRNA, miR159, acts as a molecular “switch” in vegetative tissues completely silencing the expression of two GAMYB-like genes, MYB33 and MYB65. Here, we show that miR159 has a diminished silencing efficacy in the seed. Using reporter gene constructs, we determined that MIR159 and MYB33 are co-transcribed in the aleurone and embryo of germinating seeds. However in contrast to vegetative tissues, MYB33 is not completely silenced. Instead, miR159 appears to shape the spatio-temporal expression pattern of MYB33 during seed germination. Transcript profiling in a time course during seed germination in wild-type and a mir159 mutant in which miR159 is almost absent, revealed that transcript levels of the GAMYB-like genes were similar between these two genotypes during germination, but much higher in the mir159 mutant once germination had completed. This attenuation in the silencing of the GAMYB-like genes was not explained by a decrease in mature miR159 levels, which remained constant at all time points during seed germination. We propose that miR159 acts as a tuner of GAMYB-like levels in Arabidopsis germinating seeds and that the activity of this miRNA is attenuated in the seed compared to vegetative tissues. This implies that the efficacy of miRNA-mediated silencing is not solely determined by miRNA abundance and target transcript levels, but is being determined through additional mechanisms

Visceral Leishmaniasis in Muzaffarpur District, Bihar, India from 1990 to 2008

BACKGROUND: Visceral Leishmaniasis (VL) is a vector-borne disease transmitted by Phlebotomus argentipes. To understand the VL seasonality, annual and monthly variations of VL incidence and its relationship to meteorological variables, the numbers of VL cases reported in Muzaffarpur district, Bihar, India from 1990 to 2008 were studied. METHODS: Annual VL incidence per 10,000 and the total number of annual VL cases reported at block Community Health Centres (CHC), Public Hospitals or Non-Governmental Organisations (NGO) and the number of VL cases per month from 2000 to 2008 as well as the monthly average of cases for 2000-08, 2000-04 and 2005-08 periods along with the monthly averages of temperature, rainfall and relative humidity were plotted. VL Standardised Incidence Ratios per block were computed for the periods of 1990-1993, 1994-1998, 1999-2004 and 2005-2008 and month wise from 2002 to 2008. A negative binomial regression model was used to evaluate the association between meteorological variables and the number of VL cases per month from 2000 to 2008. RESULTS: A total of 68,358 VL cases were reported in Muzaffarpur district from 1990 to 2008, ranging from 1,2481 in 1992 to 1,161 in 2001. The blocks with the highest number of cases shifted from East (1990-98) to West (1999-2008). Monthly averages of cases ranged from 149 to 309, highest peak in March-April and another one in July. Monthly VL incidence was associated positively to rainfall and negatively to relative humidity and the numbers of VL cases in the previous month. INTERPRETATION: The number of cases reported to the public health sector allowed the describing of the spatial distribution and temporal variations in the Muzaffarpur from 1990 to 2008. However, to assess the actual VL burden, as well as the efficacy of the control measures applied in the district, reporting from private practices and NGOs should be encouraged