Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia.

BACKGROUND: The evidence base for improving reproductive health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Little is known about the factors affecting the use of evidence by policy makers and clinicians, particularly in developing countries. The objective of this study was to examine the factors that might affect the translation of randomised controlled trial (RCT) findings into policies and practice in developing countries. METHODS: The recent publication of an important RCT on the use of magnesium sulphate to treat pre-eclampsia provided an opportunity to explore how research findings might be translated into policy. A range of research methods, including a survey, group interview and observations with RCT collaborators and a survey of WHO drug information officers, regulatory officials and obstetricians in 12 countries, were undertaken to identify barriers and facilitators to knowledge translation. RESULTS: It proved difficult to obtain reliable data regarding the availability and use of commonly used drugs in many countries. The perceived barriers to implementing RCT findings regarding the use of magnesium sulphate for pre-eclampsia include drug licensing and availability; inadequate and poorly implemented clinical guidelines; and lack of political support for policy change. However, there were significant regional and national differences in the importance of specific barriers. CONCLUSION: The policy changes needed to ensure widespread availability and use of magnesium sulphate are variable and complex. Difficulties in obtaining information on availability and use are combined with the wide range of barriers across settings, including a lack of support from policy makers. This makes it difficult to envisage any single intervention strategy that might be used to promote the uptake of research findings on magnesium sulphate into policy across the study settings. The publication of important trials may therefore not have the impacts on health care that researchers hope for

Stakeholder views on the incorporation of traditional birth attendants into the formal health systems of low-and middle-income countries: a qualitative analysis of the HIFA2015 and CHILD2015 email discussion forums.

BACKGROUND: Health workforce shortages are key obstacles to the achievement of the health-related Millennium Development Goals. Task shifting is seen as a way to improve access to pregnancy and childbirth care. However, the role of traditional birth attendants (TBAs) within task shifting initiatives remains contested. The objective of this study was to explore stakeholder views and justifications regarding the incorporation of TBAs into formal health systems. METHODS: Data were drawn from messages submitted to the HIFA2015 and CHILD2015 email discussion forums. The forums focus on the healthcare information needs of frontline health workers and citizens in low - and middle-income countries, and how these needs can be met, and also include discussion of diverse aspects of health systems. Messages about TBAs submitted between 2007-2011 were analysed thematically. RESULTS: We identified 658 messages about TBAs from a total of 193 participants. Most participants supported the incorporation of trained TBAs into primary care systems to some degree, although their justifications for doing so varied. Participant viewpoints were influenced by the degree to which TBA involvement was seen as a long-term or short-term solution and by the tasks undertaken by TBAs. CONCLUSIONS: Many forum members indicated that they were supportive of trained TBAs being involved in the provision of pregnancy care. Members noted that TBAs were already frequently used by women and that alternative options were lacking. However, a substantial minority regarded doing so as a threat to the quality and equity of healthcare. The extent of TBA involvement needs to be context-specific and should be based on evidence on effectiveness as well as evidence on need, acceptability and feasibility

Integrating HIV care into nurse-led primary health care services in South Africa: a synthesis of three linked qualitative studies

BACKGROUND: The integration of HIV care into primary care services is one of the strategies proposed to increase access to treatment for people living with HIV/AIDS in high HIV burden countries. However, how best to do this is poorly understood. This study documents different factors influencing models of integration within clinics.METHODS: Using methods based on the meta-ethnographic approach, we synthesised the findings from three qualitative studies of the factors that influenced integration of HIV care into all consultations in primary care. The studies were conducted amongst staff and patients in South Africa during a randomised trial of nurse initiation of antiretroviral therapy (ART) and integration of HIV care into primary care services - the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) trial. Themes from each study were identified and translated into each other to develop categories and sub-categories and then to inform higher level interpretations of the synthesised data.RESULTS: Clinics varied as to how HIV care was integrated. Existing administration systems, workload and support staff shortages tended to hinder integration. Nurses' wanted to be involved in providing HIV care and yet also expressed preferences for developing expertise in certain areas and for establishing good nurse patient relationships by specialising in certain services. Patients, in turn, were concerned about the stigma of separate HIV services and yet preferred to be seen by nurses with expertise in HIV care. These factors had conflicting effects on efforts to integrate HIV care.CONCLUSION: Local clinic factors and nurse and patient preferences in relation to care delivery should be taken into account in programmes to integrate HIV care into primary care services. The integration of medical records, monitoring and reporting systems would support clinic based efforts to integrate HIV care into primary care services.</p

MIMAC : a micro-TPC detector for non-baryonic dark matter search

The MIMAC project is multi-chamber detector for Dark Matter search, aiming at measuring both track and ionization with a matrix of micromegas micro-TPC filled with He3 and CF4. Recent experimental results on the first measurements of the Helium quenching factor at low energy (1 keV recoil) are presented.Comment: 7 pages, Proc of Dark Energy and Dark Matter conference, Lyon : France (2008

Making it real: exploring the potential of Augmented Reality for teaching primary school science

The use of Augmented Reality (AR) in formal education could prove a key component in future learning environments that are richly populated with a blend of hardware and software applications. However, relatively little is known about the potential of this technology to support teaching and learning with groups of young children in the classroom. Analysis of teacher-child dialogue in a comparative study between use of an AR virtual mirror interface and more traditional science teaching methods for 10-year-old children, revealed that the children using AR were less engaged than those using traditional resources. We suggest four design requirements that need to be considered if AR is to be successfully adopted into classroom practice. These requirements are: flexible content that teachers can adapt to the needs of their children, guided exploration so learning opportunities can be maximised, in a limited time, and attention to the needs of institutional and curricular requirements

Eclipse Timings of the Transient Low Mass X-ray Binary EXO0748-676. IV. The Rossi X-Ray Timing Explorer Eclipses

We report our complete database of X-ray eclipse timings of the low mass X-ray binary EXO0748-676 observed by the Rossi X-Ray Timing Explorer (RXTE) satellite. As of this writing we have accumulated 443 full X-ray eclipses, 392 of which have been observed with the Proportional Counter Array on RXTE. These include both observations where an eclipse was specifically targeted and those eclipses found in the RXTE data archive. Eclipse cycle count has been maintained since the discovery of the EXO0748-676 system in February 1985. We describe our observing and analysis techniques for each eclipse and describe improvements we have made since the last compilation by Wolff et al. (2002). The principal result of this paper is the database containing the timing results from a seven-parameter fit to the X-ray light curve for each observed eclipse along with the associated errors in the fitted parameters. Based on the standard O-C analysis, EXO0748-676 has undergone four distinct orbital period epochs since its discovery. In addition, EXO0748-676 shows small-scale events in the O-C curve that are likely due to short-lived changes in the secondary star.Comment: Accepted for publication in The Astrophysical Journal Supplement Series, 5 figures. Analysis revised. Tables 1 & 3 update

The Web of Human Sexual Contacts

Many ``real-world'' networks are clearly defined while most ``social'' networks are to some extent subjective. Indeed, the accuracy of empirically-determined social networks is a question of some concern because individuals may have distinct perceptions of what constitutes a social link. One unambiguous type of connection is sexual contact. Here we analyze data on the sexual behavior of a random sample of individuals, and find that the cumulative distributions of the number of sexual partners during the twelve months prior to the survey decays as a power law with similar exponents $\alpha \approx 2.4$ for females and males. The scale-free nature of the web of human sexual contacts suggests that strategic interventions aimed at preventing the spread of sexually-transmitted diseases may be the most efficient approach.Comment: 7 pages with 2 eps figures. Latex file. For more details or for downloading the PDF file of the published article see http://polymer.bu.edu/~amaral/WebofContacts.html . For more results on teh structure of complex networks see http://polymer.bu.edu/~amaral/Networks.htm

Stiefel and Grassmann manifolds in Quantum Chemistry

We establish geometric properties of Stiefel and Grassmann manifolds which arise in relation to Slater type variational spaces in many-particle Hartree-Fock theory and beyond. In particular, we prove that they are analytic homogeneous spaces and submanifolds of the space of bounded operators on the single-particle Hilbert space. As a by-product we obtain that they are complete Finsler manifolds. These geometric properties underpin state-of-the-art results on existence of solutions to Hartree-Fock type equations.Comment: 23 page

Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries.

BACKGROUND: Many people with mental, neurological and substance-use disorders (MNS) do not receive health care. Non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) are a key strategy for closing the treatment gap. OBJECTIVES: To assess the effect of NSHWs and OPHRs delivering MNS interventions in primary and community health care in low- and middle-income countries. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 21 June 2012); MEDLINE, OvidSP; MEDLINE In Process & Other Non-Indexed Citations, OvidSP; EMBASE, OvidSP (searched 15 June 2012); CINAHL, EBSCOhost; PsycINFO, OvidSP (searched 18 and 19 June 2012); World Health Organization (WHO) Global Health Library (searched 29 June 2012); LILACS; the International Clinical Trials Registry Platform (WHO); OpenGrey; the metaRegister of Controlled Trials (searched 8 and 9 August 2012); Science Citation Index and Social Sciences Citation Index (ISI Web of Knowledge) (searched 2 October 2012) and reference lists, without language or date restrictions. We contacted authors for additional studies. SELECTION CRITERIA: Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted-time-series studies of NSHWs/OPHR-delivered interventions in primary/community health care in low- and middle-income countries, and intended to improve outcomes in people with MNS disorders and in their carers. We defined an NSHW as any professional health worker (e.g. doctors, nurses and social workers) or lay health worker without specialised training in MNS disorders. OPHRs included people outside the health sector (only teachers in this review). DATA COLLECTION AND ANALYSIS: Review authors double screened, double data-extracted and assessed risk of bias using standard formats. We grouped studies with similar interventions together. Where feasible, we combined data to obtain an overall estimate of effect. MAIN RESULTS: The 38 included studies were from seven low- and 15 middle-income countries. Twenty-two studies used lay health workers, and most addressed depression or post-traumatic stress disorder (PTSD). The review shows that the use of NSHWs, compared with usual healthcare services: 1. may increase the number of adults who recover from depression or anxiety, or both, two to six months after treatment (prevalence of depression: risk ratio (RR) 0.30, 95% confidence interval (CI) 0.14 to 0.64; low-quality evidence); 2. may slightly reduce symptoms for mothers with perinatal depression (severity of depressive symptoms: standardised mean difference (SMD) -0.42, 95% CI -0.58 to -0.26; low-quality evidence); 3. may slightly reduce the symptoms of adults with PTSD (severity of PTSD symptoms: SMD -0.36, 95% CI -0.67 to -0.05; low-quality evidence); 4. probably slightly improves the symptoms of people with dementia (severity of behavioural symptoms: SMD -0.26, 95% CI -0.60 to 0.08; moderate-quality evidence); 5. probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia (carer burden: SMD -0.50, 95% CI -0.84 to -0.15; moderate-quality evidence); 6. may decrease the amount of alcohol consumed by people with alcohol-use disorders (drinks/drinking day in last 7 to 30 days: mean difference -1.68, 95% CI -2.79 to -0.57); low-quality evidence).It is uncertain whether lay health workers or teachers reduce PTSD symptoms among children. There were insufficient data to draw conclusions about the cost-effectiveness of using NSHWs or teachers, or about their impact on people with other MNS conditions. In addition, very few studies measured adverse effects of NSHW-led care - such effects could impact on the appropriateness and quality of care. AUTHORS' CONCLUSIONS: Overall, NSHWs and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, PTSD and alcohol-use disorders, and patient- and carer-outcomes for dementia. However, this evidence is mostly low or very low quality, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific NSHW-led interventions are more effective

A dozen colliding wind X-ray binaries in the star cluster R136 in the 30Doradus region

We analyzed archival Chandra X-ray observations of the central portion of the 30 Doradus region in the Large Magellanic Cloud. The image contains 20 X-ray point sources with luminosities between $5 \times 10^{32}$ and $2 \times 10^{35}$ erg s$^{-1}$ (0.2 -- 3.5 keV). A dozen sources have bright WN Wolf-Rayet or spectral type O stars as optical counterparts. Nine of these are within $\sim 3.4$pc of R136, the central star cluster of NGC2070. We derive an empirical relation between the X-ray luminosity and the parameters for the stellar wind of the optical counterpart. The relation gives good agreement for known colliding wind binaries in the Milky Way Galaxy and for the identified X-ray sources in NGC2070. We conclude that probably all identified X-ray sources in NGC2070 are colliding wind binaries and that they are not associated with compact objects. This conclusion contradicts Wang (1995) who argued, using ROSAT data, that two earlier discovered X-ray sources are accreting black-hole binaries. Five of the eighteen brightest stars in R136 are not visible in our X-ray observations. These stars are either single, have low mass companions or very wide orbits. The resulting binary fraction among early type stars is then unusually high (at least 70%).Comment: 23 pages, To appear in August in Ap