Quality of Neonatal Health Care: Learning From Health Workers’ Experiences in Critical Care in Kilimanjaro Region, Northeast Tanzania

Neonatal deaths are generally attributed to suboptimal standards of health care. Health care worker motivation and adherence to existing guidelines are rarely studied. To assess the performance of health workers for neonatal health care in the hospitals of Kilimanjaro region. A descriptive study using a semi-structured interview for health care workers at a tertiary referral hospital and peripheral health facilities (regional referral, district hospitals and health centres).was used. Health Care Workers (HCW) were asked to recall a scenario of a critically ill neonate admitted in the wards and the treatment that was provided. The WHO Emergency Triage Assessment and Treatment (ETAT) guidelines were used as a standard reference for knowledge of critical care. Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% of 120 HCW at both peripheral hospitals and by 46.4% of 28 health workers in tertiary referral centres. Half of the HCW commented on their own performance (47.5%, n=140). HCW presented with low to moderate levels of knowledge for critical care were at 92%. Supplementary training was associated with a higher levels of knowledge of neonatal critical care (p value = 0.05). HCW in peripheral hospital had lower levels of knowledge (only 44.7% at peripheral hospitals had sufficient ratings compared to 82.1% at the referral centre). [Pearson χ2 (2) = 12.10, p value = 0.002]. Guided Practical-Competence Diagnostic Specific neonatal health care training is highly needed in the peripheral facilities of rural Kilimanjaro region

Government Insurance Program Design, Incentive Effects, and Technology Adoption: The Case of Skip-Row Crop Insurance

Can the availability of poorly-designed government insurance alter technology adoption decisions? A theoretical model of technology adoption and insurance incentive effects for a high- and low-risk technology is developed and explored empirically using a unique dataset of skip-row agronomic trial data. A multivariate nonparametric resampling technique is developed, which augments the trial data with a larger dataset of conventional yields to improve estimation efficiency. Skip-row adoption is found to increase mean yields and reduce risk in areas prone to drought. RMA insurance rules have incentive-distorting impacts which disincentivize skip-row adoption

Empirical Constraints on the Oblateness of an Exoplanet

We show that the gas giant exoplanet HD 189733b is less oblate than Saturn, based on Spitzer Space Telescope photometry of seven transits. The observable manifestations of oblatenesswould have been slight anomalies during the ingress and egress phases, as well as variations in the transit depth due to spin precession. Our nondetection of these effects gives the first empirical constraints on the shape of an exoplanet. The results are consistent with the theoretical expectation that the planetary rotation period and orbital period are synchronized, in which case the oblateness would be an order of magnitude smaller than our upper limits. Conversely, if HD 189733b is assumed to be in a synchronous, zero-obliquity state, then the data give an upper bound on the quadrupole moment of the planet (J2 < 0.068 with 95% confidence) that is too weak to constrain the interior structure of the planet. An Appendix describes a fast algorithm for computing the transit light curve of an oblate planet, which was necessary for our analysis.Comment: 14 pages, accepted for publication in The Astrophysical Journa

Passion, craving, and affect in online gaming: Predicting how gamers feel when playing and when prevented from playing

According to the Dualistic Model of Passion, two forms of passion can motivate a behavior: harmonious passion and obsessive passion. Across various life activities, studies have found that the two forms of passion show different relationships with affect, linking harmonious passion to positive affect and obsessive passion to negative affect. To investigate if this pattern also holds for online gaming, the present study investigated 160 gamers involved in playing massively multiplayer online role-playing games (MMOs) and examined positive and negative affect (a) when playing and (b) when prevented from playing. In addition, the effects of general affect and craving for playing MMOs were controlled for. Results were as expected from the Dualistic Model of Passion: Harmonious passion for online gaming predicted positive affect when playing whereas obsessive passion predicted negative affect when playing and when prevented from playing. Moreover, these effects remained unchanged when general affect and craving were controlled for. With this, the present research shows that individual differences in passion for online gaming explain unique variance in gaming-related emotions. Moreover, the present findings suggests that craving is a variable that future research on positive and negative affect in online gaming should pay closer attention to

Physical Activity and Quality of Life in Retinitis Pigmentosa

Purpose. Aerobic exercise has been found to be neuroprotective in animal models of retinal degeneration. This study aims to report physical activity levels in patients with RP and investigate the relationship between physical activity and vision-related quality-of-life (QOL). Materials and Methods. A retrospective study of adult patients with RP examined in 2005–2014. Physical activity levels were assessed using the Godin Exercise Questionnaire. The NEI-Visual Function Questionaire-25 (VFQ-25), SF-36 General Health survey, and Pepper Assessment Tool for Disability (PAT-D) were administered. Results. 143 patients participated. 81 (56.6%) patients were classified as “active” and 62 (43.4%) as “insufficiently active” by Godin score. VFQ-25 revealed statistically significant differences between the active and insufficiently active patients, including overall visual function (53.3 versus 45.1, p=0.010), color vision (73.8 versus 52.9, p<0.001), and peripheral vision (34.3 versus 23.8, p=0.021). The physical component of the SF-36 and the PAT-D survey also demonstrated statistically significant differences (47.2 versus 52.9, p=0.002; 24.3 versus 30.0, p=0.010). Active patients had a higher initial Goldmann visual field (GVF) score (74.8 versus 60.1 degrees, p=0.255) and final GVF score (78.7 versus 47.1 degrees, p=0.069) but did not reach statistical significance. Conclusions. In RP, increased physical activity is associated with greater self-reported visual function and QOL

Dysfunction of the Intestinal Microbiome in Inflammatory Bowel Disease and Treatment

Background: The inflammatory bowel diseases (IBD) Crohn's disease and ulcerative colitis result from alterations in intestinal microbes and the immune system. However, the precise dysfunctions of microbial metabolism in the gastrointestinal microbiome during IBD remain unclear. We analyzed the microbiota of intestinal biopsies and stool samples from 231 IBD and healthy subjects by 16S gene pyrosequencing and followed up a subset using shotgun metagenomics. Gene and pathway composition were assessed, based on 16S data from phylogenetically-related reference genomes, and associated using sparse multivariate linear modeling with medications, environmental factors, and IBD status. Results: Firmicutes and Enterobacteriaceae abundances were associated with disease status as expected, but also with treatment and subject characteristics. Microbial function, though, was more consistently perturbed than composition, with 12% of analyzed pathways changed compared with 2% of genera. We identified major shifts in oxidative stress pathways, as well as decreased carbohydrate metabolism and amino acid biosynthesis in favor of nutrient transport and uptake. The microbiome of ileal Crohn's disease was notable for increases in virulence and secretion pathways. Conclusions: This inferred functional metagenomic information provides the first insights into community-wide microbial processes and pathways that underpin IBD pathogenesis

Bioactivation of isoxazole-containing bromodomain and extra-terminal domain (BET) inhibitors

The 3,5-dimethylisoxazole motif has become a useful and popular acetyl-lysine mimic employed in isoxazole-containing bromodomain and extra-terminal (BET) inhibitors but may introduce the potential for bioactivations into toxic reactive metabolites. As a test, we coupled deep neural models for quinone formation, metabolite structures, and biomolecule reactivity to predict bioactivation pathways for 32 BET inhibitors and validate the bioactivation of select inhibitors experimentally. Based on model predictions, inhibitors were more likely to undergo bioactivation than reported non-bioactivated molecules containing isoxazoles. The model outputs varied with substituents indicating the ability to scale their impact on bioactivation. We selected OXFBD02, OXFBD04, and I-BET151 for more in-depth analysis. OXFBD\u27s bioactivations were evenly split between traditional quinones and novel extended quinone-methides involving the isoxazole yet strongly favored the latter quinones. Subsequent experimental studies confirmed the formation of both types of quinones for OXFBD molecules, yet traditional quinones were the dominant reactive metabolites. Modeled I-BET151 bioactivations led to extended quinone-methides, which were not verified experimentally. The differences in observed and predicted bioactivations reflected the need to improve overall bioactivation scaling. Nevertheless, our coupled modeling approach predicted BET inhibitor bioactivations including novel extended quinone methides, and we experimentally verified those pathways highlighting potential concerns for toxicity in the development of these new drug leads

ALMA Discovery of a Disk around the Planetary-Mass Companion Sr 12 C

We report an Atacama Large Millimeter/submillimeter Array 0.88 mm (Band 7) continuum detection of the accretion disk around SR 12 c, an ∼11 M Jup planetary-mass companion (PMC) orbiting its host binary at 980 au. This is the first submillimeter detection of a circumplanetary disk around a wide PMC. The disk has a flux density of 127 ± 14 μJy and is not resolved by the ∼0.″1 beam, so the dust disk radius is likely less than 5 au and can be much smaller if the dust continuum is optically thick. If, however, the dust emission is optically thin, then the SR 12 c disk has a comparable dust mass to the circumplanetary disk around PDS 70 c but is about five times lower than that of the ∼12 M Jup free-floating OTS 44. This suggests that disks around bound and unbound planetary-mass objects can span a wide range of masses. The gas mass estimated with an accretion rate of 10-11 M ⊙ yr-1 implies a gas-to-dust ratio higher than 100. If cloud absorption is not significant, a nondetection of 12CO(3-2) implies a compact gas disk around SR 12 c. Future sensitive observations may detect more PMC disks at 0.88 mm flux densities of ≲ 100 μJy

Solstice: An Electronic Journal of Geography and Mathematics: Vol. 29, No. 1

This particular issue of Solstice is a Special Issue devoted to Meridian MS renaissance.Contains journal articles and one supporting animation for the cover to Volume XXIX, Number 1, of Solstice: An Electronic Journal of Geography and Mathematics.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144499/1/SolsticeJune2018Final.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144499/3/QRcover.gif284Description of SolsticeJune2018Final.pdf : Solstice, Vol. XXIX, No. 1.Description of QRcover.gif : Animation attached in pdf.Description of SolsticeJune2018Final.docx : Word file; base for pdf.Description of SolsticeJune2018Final.docx : Word file; base for pdf