Catalysing scale-up of maternal and newborn health innovations in Ethiopia

Scaling-up the innovation across a large geographical area as part of the Community Based Newborn Care package produced challenges, yet there have also been positive and enabling factors in Ethiopia. IDEAS wanted to understand what helps and what hinders the scale-up of community-based maternal and newborn health (MNH) innovations, both within and beyond implementation partner areas, and how scale-up can be catalysed. IDEAS and its partners carried out a case study of an MNH innovation in Ethiopia with its roots in the Community Based Interventions for Newborns in Ethiopia (COMBINE) project which enables Health Extension Workers (HEWs) to administer antibiotics to manage neonatal sepsis at community level. This was evaluated through a randomised controlled trial. The innovation was facilitated by Save the Children USA, through Saving Newborn Lives (SNL), and was initially implemented by HEWs and the Health Development Army in 19 districts ('woredas') of Ethiopia. From late 2013, the innovation was being scaled-up to 92 woredas as one of nine components of Phase One of the Ethiopian Government’s Community Based Newborn Care (CBNC) package. This summary presents evidence from the study and identifies both enablers and barriers to scale up and key actions needed to catalyse scale up

Primary nodal anthracosis identified by EBUS-TBNA as a cause of FDG PET/CT positive mediastinal lymphadenopathy.

Isolated mediastinal lymphadenopathy can result from a number of potentially serious aetiologies. Traditionally those presenting with mediastinal lymphadenopathy would undergo mediastinoscopy to elucidate a final diagnosis or receive empirical treatment. There is now increased utilization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in this setting. Five cases of mediastinal lymphadenopathy are presented here in which lymph node anthracosis was identified as the primary diagnosis using EBUS-TBNA. They were female, non-smokers presenting with non-specific symptoms, who retrospectively reported cooking over wood fires. Four were from South Asia. Three were investigated by F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning and increased signal was identified in the anthracotic nodes sampled. With expansion of PET/CT and EBUS-TBNA services it is likely that primary nodal anthracosis will be encountered more frequently and should be considered in the differential diagnosis of those with PET/CT positive lymphadenopathy. It may mimic pathologies including tuberculosis and malignancy, thus accurate sampling and follow-up are essential

A content analysis of district level health data in Uttar Pradesh, India

The study aimed to conduct a content analysis of the different types of public health data maintained by the Health Department, the Department of Women and Child Development, and the private for profit and not for profit health sectors and the links that exist between them in terms of data sharing. Method: In two districts, Sitapur and Unnao, an IDEAS/PHFI study team visited district, sub-district and village level health facilities (public and private) as well as NRHM programme management units, and Women and Child Development offices. The team collected all available forms and interviewed facility staff and programme managers to understand the types of data collected, their flow and data sharing. Case studies of three not-for-profit non-governmental organisations were developed to understand how they maintain and share data with the public health system. Findings: The public health system collects a large volume of health data; Data exist for all of WHO’s health system building blocks, but it is unevenly distributed. There are fewer data on contextual information, e.g. village infrastructure and demographic profile, compared to service delivery; There is little formal or institutional routine data sharing between the public and private health sectors, and between the health department and other related departments such as Women and Child Development

Evaluation of serum inflammatory biomarkers as predictors of treatment outcome in pulmonary tuberculosis

Objective: To evaluate C-reactive protein (CRP), globulin and white blood cell (WBC) count as predictors of treatment outcome in pulmonary tuberculosis (PTB).Methods: An observational study of patients with active PTB was conducted at a tertiary centre. All patients had serum CRP, globulin and WBC measured at baseline and at 2 months following commencement of treatment. The outcome of interest was requirement for extension of treatment beyond 6 months.Results: There were 226 patients included in the study. Serum globulin 45 g/l was the only baseline biomarker evaluated that independently predicted requirement for treatment extension (OR 3.42, 95%CI 1.597.32, P 0.001). An elevated globulin level that failed to normalise at 2 months was also associated with increased requirement for treatment extension (63.9% vs. 5.1%, P 0.001), and had a low negative likelihood ratio (0.07) for exclusion of requirement for treatment extension. On multivariable analysis, an elevated globulin that failed to normalise at 2 months was independently associated with requirement for treatment extension (OR 6.13, 95%CI 2.2316.80, P 0.001).Conclusions: Serum globulin independently predicts requirement for treatment extension in PTB and outperforms CRP and WBC as a predictive biomarker. Normalisation of globulin at 2 months following treatment commencement is associated with low risk of requirement for treatment extension.</p

Self-assembling multidomain peptides tailor biological responses through biphasic release

Delivery of small molecules and drugs to tissues is a mainstay of several tissue engineering strategies. Next generation treatments focused on localized drug delivery offer a more effective means in dealing with refractory healing when compared to systemic approaches. Here we describe a novel multidomain peptide hydrogel that capitalizes on synthetic peptide chemistry, supramolecular self-assembly and cytokine delivery to tailor biological responses. This material is biomimetic, shows shear stress recovery and offers a nanofibrous matrix that sequesters cytokines. The biphasic pattern of cytokine release results in the spatio-temporal activation of THP-1 monocytes and macrophages. Furthermore, macrophage–material interactions are promoted without generation of a proinflammatory environment. Subcutaneous implantation of injectable scaffolds showed a marked increase in macrophage infiltration and polarization dictated by cytokine loading as early as 3 days, with complete scaffold resorption by day 14. Macrophage interaction and response to the peptide composite facilitated the (i) recruitment of monocytes/macrophages, (ii) sustained residence of immune cells until degradation, and (iii) promotion of a pro-resolution M2 environment. Our results suggest the potential use of this injectable cytokine loaded hydrogel scaffold in a variety of tissue engineering applications

Informed Decisions for Actions in Maternal and Newborn Health 2010–17 Report What works, why and how in maternal and newborn health

IDEAS is a measurement, learning and evaluation project based at the London School of Hygiene & Tropical Medicine (LSHTM). The project aims to find out “what works, why, and how” for maternal and newborn health in three low-resource settings in Nigeria, India, and Ethiopia. The IDEAS team includes 20 research and professional support staff, living in Abuja, Addis Ababa, London, and New Delhi, who have been working since 2010 with the Bill & Melinda Gates Foundation (the foundation) and with the foundation’s implementation partners

First Measurement of Monoenergetic Muon Neutrino Charged Current Interactions

We report the first measurement of monoenergetic muon neutrino charged current interactions. MiniBooNE has isolated 236 MeV muon neutrino events originating from charged kaon decay at rest ($K^+ \rightarrow \mu^+ \nu_\mu$) at the NuMI beamline absorber. These signal $\nu_\mu$-carbon events are distinguished from primarily pion decay in flight $\nu_\mu$ and $\overline{\nu}_\mu$ backgrounds produced at the target station and decay pipe using their arrival time and reconstructed muon energy. The significance of the signal observation is at the 3.9$\sigma$ level. The muon kinetic energy, neutrino-nucleus energy transfer ($\omega=E_\nu-E_\mu$), and total cross section for these events is extracted. This result is the first known-energy, weak-interaction-only probe of the nucleus to yield a measurement of $\omega$ using neutrinos, a quantity thus far only accessible through electron scattering.Comment: 6 pages, 4 figure

Measurement of the antineutrino neutral-current elastic differential cross section

arXiv:1309.7257v1 [hep-ex