What could be influencing older Ghanaians outpatient care utilization rate?

Objectives: Ghana’s population is rapidly aging and there may be healthcare access and utilization issues. This study investigates some of the issues that may influence outpatient care utilization rate among older Ghanaians. Methods: Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health are used, and a sample of 1408 are analyzed. After multiple imputations of missing values, a negative binomial regression model is used to identify the association between outpatient care utilization rate and lifestyle activities. Results: The rate of outpatient care utilization is negatively associated with the rate of eating vegetables (β =0.0830, p < .001), fruits (β =0.0033, p < .05), moderate-exercise (β =0.4010, p < .001), moderate-work (β =0.2049, p < .001), walking/biking (β = 0.0436, p < .001), and positively associated with leisure hours ((β =0.0194, p < .001). Conclusion: To promote better aging situations of older adults in Ghana, poverty and poor education should be addressed as potential barriers to healthcare access. There is a need for policies that encourage healthier lifestyles for older Ghanaian’s health

CCR2⁺CD103⁻ intestinal dendritic cells develop from DC-committed precursors and induce interleukin-17 production by T cells

The identification of intestinal macrophages (m phi s) and dendritic cells (DCs) is a matter of intense debate. Although CD103(+) mononuclear phagocytes (MPs) appear to be genuine DCs, the nature and origins of CD103(-) MPs remain controversial. We show here that intestinal CD103(-)CD11b(+) MPs can be separated clearly into DCs and m phi s based on phenotype, gene profile, and kinetics. CD64(-)CD103(-)CD11b(+) MPs are classical DCs, being derived from Flt3 ligand-dependent, DC-committed precursors, not Ly6C hi monocytes. Surprisingly, a significant proportion of these CD103(-)CD11b(+) DCs express CCR2 and there is a selective decrease in CD103(-)CD11b(+) DCs in mice lacking this chemokine receptor. CCR2(+)CD103(-) DCs are present in both the murine and human intestine, drive interleukin (IL)-17a production by Tcells in vitro, and show constitutive expression of IL-12/IL-23p40. These data highlight the heterogeneity of intestinal DCs and reveal a bona fide population of CCR2(+) DCs that is involved in priming mucosal T helper type 17 (Th17) responses

Single-Exposure, Single-Mask, Edge-Illumination X-ray Phase-Contrast Imaging Using a 7.8-μm Pixel Pitch Direct Conversion X-ray Detector

Double-mask edge-illumination is a well-reported technique for phase-contrast x-ray imaging. Although phase retrieval using this technique is comparably easier than propagation-based phase-contrast x-ray imaging, edge-illumination can be inefficient in terms of dose efficiency and imaging time when it comes to computed tomography scanning. The illumination curve, which describes the beamlets' intensity profile impinging upon the detector, is a key parameter that contributes to retrieving phase and absorption information. To obtain the illumination curve, multiple exposures are typically required which decreases x-ray dose efficiency and, more importantly, increases imaging time. Moreover, sample motion can negatively impact the image and information retrieval process. In this research, we employ a single mask in conjunction with a 7.8-μm pixel pitch amorphous selenium-CMOS hybrid direct conversion x-ray detector to obtain the beamlets' intensity profile with only a single exposure. We demonstrate how using an ultra-high spatial resolution x-ray detector with a single-mask edge-illumination technique can potentially increase both dose efficiency and imaging time by at least a factor of 1.5X. Moreover, the resulting system using our approach is more compact with a source-to-detector distance of less than 30 cm. Single-exposure imaging can also help mitigate the impact of motion artifacts in the final image

Spotting the diffusion of New Psychoactive Substances over the Internet

Online availability and diffusion of New Psychoactive Substances (NPS) represent an emerging threat to healthcare systems. In this work, we analyse drugs forums, online shops, and Twitter. By mining the data from these sources, it is possible to understand the dynamics of drugs diffusion and their endorsement, as well as timely detecting new substances. We propose a set of visual analytics tools to support analysts in tackling NPS spreading and provide a better insight about drugs market and analysis

A Schur complement approach to preconditioning sparse linear least-squares problems with some dense rows

The effectiveness of sparse matrix techniques for directly solving large-scale linear least-squares problems is severely limited if the system matrix A has one or more nearly dense rows. In this paper, we partition the rows of A into sparse rows and dense rows (A s and A d ) and apply the Schur complement approach. A potential difficulty is that the reduced normal matrix AsTA s is often rank-deficient, even if A is of full rank. To overcome this, we propose explicitly removing null columns of A s and then employing a regularization parameter and using the resulting Cholesky factors as a preconditioner for an iterative solver applied to the symmetric indefinite reduced augmented system. We consider complete factorizations as well as incomplete Cholesky factorizations of the shifted reduced normal matrix. Numerical experiments are performed on a range of large least-squares problems arising from practical applications. These demonstrate the effectiveness of the proposed approach when combined with either a sparse parallel direct solver or a robust incomplete Cholesky factorization algorithm

Maximizing the impact of malaria funding through allocative efficiency: using the right interventions in the right locations.

BACKGROUND: The high burden of malaria and limited funding means there is a necessity to maximize the allocative efficiency of malaria control programmes. Quantitative tools are urgently needed to guide budget allocation decisions. METHODS: A geospatial epidemic model was coupled with costing data and an optimization algorithm to estimate the optimal allocation of budgeted and projected funds across all malaria intervention approaches. Interventions included long-lasting insecticide-treated nets (LLINs), indoor residual spraying (IRS), intermittent presumptive treatment during pregnancy (IPTp), seasonal mass chemoprevention in children (SMC), larval source management (LSM), mass drug administration (MDA), and behavioural change communication (BCC). The model was applied to six geopolitical regions of Nigeria in isolation and also the nation as a whole to minimize incidence and malaria-attributable mortality. RESULTS: Allocative efficiency gains could avert approximately 84,000 deaths or 15.7 million cases of malaria in Nigeria over 5 years. With an additional US$300 million available, approximately 134,000 deaths or 37.3 million cases of malaria could be prevented over 5 years. Priority funding should go to LLINs, IPTp and BCC programmes, and SMC should be expanded in seasonal areas. To minimize mortality, treatment expansion is critical and prioritized over some LLIN funding, while to minimize incidence, LLIN funding remained a priority. For areas with lower rainfall, LSM is prioritized over IRS but MDA is not recommended unless all other programmes are established. CONCLUSIONS: Substantial reductions in malaria morbidity and mortality can be made by optimal targeting of investments to the right malaria interventions in the right areas

Predicting live birth, preterm and low birth weight infant after in-vitro fertilisation: a prospective study of 144018 treatment cycles

Background The extent to which baseline couple characteristics affect the probability of live birth and adverse perinatal outcomes after assisted conception is unknown. Methods and Findings We utilised the Human Fertilisation and Embryology Authority database to examine the predictors of live birth in all in vitro fertilisation (IVF) cycles undertaken in the UK between 2003 and 2007 (n = 144,018). We examined the potential clinical utility of a validated model that pre-dated the introduction of intracytoplasmic sperm injection (ICSI) as compared to a novel model. For those treatment cycles that resulted in a live singleton birth (n = 24,226), we determined the associates of potential risk factors with preterm birth, low birth weight, and macrosomia. The overall rate of at least one live birth was 23.4 per 100 cycles (95% confidence interval [CI] 23.2–23.7). In multivariable models the odds of at least one live birth decreased with increasing maternal age, increasing duration of infertility, a greater number of previously unsuccessful IVF treatments, use of own oocytes, necessity for a second or third treatment cycle, or if it was not unexplained infertility. The association of own versus donor oocyte with reduced odds of live birth strengthened with increasing age of the mother. A previous IVF live birth increased the odds of future success (OR 1.58, 95% CI 1.46–1.71) more than that of a previous spontaneous live birth (OR 1.19, 95% CI 0.99–1.24); p-value for difference in estimate &#60;0.001. Use of ICSI increased the odds of live birth, and male causes of infertility were associated with reduced odds of live birth only in couples who had not received ICSI. Prediction of live birth was feasible with moderate discrimination and excellent calibration; calibration was markedly improved in the novel compared to the established model. Preterm birth and low birth weight were increased if oocyte donation was required and ICSI was not used. Risk of macrosomia increased with advancing maternal age and a history of previous live births. Infertility due to cervical problems was associated with increased odds of all three outcomes—preterm birth, low birth weight, and macrosomia. Conclusions Pending external validation, our results show that couple- and treatment-specific factors can be used to provide infertile couples with an accurate assessment of whether they have low or high risk of a successful outcome following IVF

The Complete Star Formation History of the Universe

The determination of the star-formation history of the Universe is a key goal of modern cosmology, as it is crucial to our understanding of how structure in the Universe forms and evolves. A picture has built up over recent years, piece-by-piece, by observing young stars in distant galaxies at different times in the past. These studies indicated that the stellar birthrate peaked some 8 billion years ago, and then declined by a factor of around ten to its present value. Here we report on a new study which obtains the complete star formation history by analysing the fossil record of the stellar populations of 96545 nearby galaxies. Broadly, our results support those derived from high-redshift galaxies elsewhere in the Universe. We find, however, that the peak of star formation was more recent - around 5 billion years ago. Our study also shows that the bigger the stellar mass of the galaxy, the earlier the stars were formed. This striking result indicates a very different formation history for high- and low-mass formation.Comment: Accepted by Nature. Press embargo until publishe

Optima Nutrition: an allocative efficiency tool to reduce childhood stunting by better targeting of nutrition-related interventions.

BACKGROUND: Child stunting due to chronic malnutrition is a major problem in low- and middle-income countries due, in part, to inadequate nutrition-related practices and insufficient access to services. Limited budgets for nutritional interventions mean that available resources must be targeted in the most cost-effective manner to have the greatest impact. Quantitative tools can help guide budget allocation decisions. METHODS: The Optima approach is an established framework to conduct resource allocation optimization analyses. We applied this approach to develop a new tool, 'Optima Nutrition', for conducting allocative efficiency analyses that address childhood stunting. At the core of the Optima approach is an epidemiological model for assessing the burden of disease; we use an adapted version of the Lives Saved Tool (LiST). Six nutritional interventions have been included in the first release of the tool: antenatal micronutrient supplementation, balanced energy-protein supplementation, exclusive breastfeeding promotion, promotion of improved infant and young child feeding (IYCF) practices, public provision of complementary foods, and vitamin A supplementation. To demonstrate the use of this tool, we applied it to evaluate the optimal allocation of resources in 7 districts in Bangladesh, using both publicly available data (such as through DHS) and data from a complementary costing study. RESULTS: Optima Nutrition can be used to estimate how to target resources to improve nutrition outcomes. Specifically, for the Bangladesh example, despite only limited nutrition-related funding available (an estimated $0.75 per person in need per year), even without any extra resources, better targeting of investments in nutrition programming could increase the cumulative number of children living without stunting by 1.3 million (an extra 5%) by 2030 compared to the current resource allocation. To minimize stunting, priority interventions should include promotion of improved IYCF practices as well as vitamin A supplementation. Once these programs are adequately funded, the public provision of complementary foods should be funded as the next priority. Programmatic efforts should give greatest emphasis to the regions of Dhaka and Chittagong, which have the greatest number of stunted children. CONCLUSIONS: A resource optimization tool can provide important guidance for targeting nutrition investments to achieve greater impact

The ISM properties and gas kinematics of a redshift 3 massive dusty star-forming galaxy

We present CO (J = 1 → 0; 3 → 2; 5 → 4; 10 → 9) and 1.2 kpc resolution [C II] line observations of the dusty star-forming galaxy (SFG) HXMM05—carried out with the Karl G. Jansky Very Large Array, the Combined Array for Research in Millimeter-wave Astronomy, the Plateau de Bure Interferometer, and the Atacama Large Millimeter/submillimeter Array, measuring an unambiguous redshift of z = 2.9850 ± 0.0009. We find that HXMM05 is a hyperluminous infrared galaxy (LIR = (4 ± 1) × 1013 Le) with a total molecular gas mass of (2.1 ± 0.7) × 1011(aCO/0.8) Me. The CO (J = 1 → 0) and [C II] emission are extended over ∼9 kpc in diameter, and the CO line FWHM exceeds 1100 km s−1 . The [C II] emission shows a monotonic velocity gradient consistent with a disk, with a maximum rotation velocity of vc = 616 ± 100 km s−1 and a dynamical mass of (7.7 ± 3.1) × 1011 Me. We find a star formation rate of 2900- + 595 750 Me yr−1 . HXMM05 is thus among the most intensely SFGs known at high redshift. Photodissociation region modeling suggests physical conditions similar to nearby SFGs, showing extended star formation, which is consistent with our finding that the gas emission and dust emission are cospatial. Its molecular gas excitation resembles the local major merger Arp 220. The broad CO and [C II] lines and a pair of compact dust nuclei suggest the presence of a late-stage major merger at the center of the extended disk, again reminiscent of Arp 220. The observed gas kinematics and conditions, together with the presence of a companion and the pair of nuclei, suggest that HXMM05 is experiencing multiple mergers as a part of the evolution