Measuring the impact of contraceptive use on unintended pregnancy and other health outcomes

This brief describes several statistical models that have been developed to estimate the number of health outcomes that will be averted because of contraceptive use. Concerns have been expressed that this range of approaches—which overlap in the impacts they estimate, but sometimes use different inputs, mathematical algorithms, and assumptions, and may produce different results—may be confusing for policymakers, managers, and donors who want to measure or evaluate these impacts. To address these concerns, the STEP UP consortium convened two expert meetings to review the estimation methods used; come to consensus on methodologies and assumptions, where possible; and provide guidance to those wanting to measure such impacts. As a result of this consensus-building process, decisionmakers and managers using the different models can more clearly understand the assumptions behind each model so as to make informed choices between them

Second consultation on developing standards for identifying evidence-based practices in reproductive health

The STEP UP consortium and the High Impact Practices initiative, together with other partners, supported three consultation meetings to inform the use of appropriate standards of evidence for recommending best practices in reproductive health (RH). The second consultation, reported here, brought together researchers and funders to review the research designs and methodologies that can be used to generate evidence on the impact of FP/RH interventions and on their implementation; the mechanisms and structures through which such evidence is reviewed and translated into recommendations; and the implications for organizing and funding evidence generation to maximize its quality and utility. Drawing from the presentations, three plenary discussions were held which reflected a diversity of views on what constitutes high-quality evidence, which type of evidence is appropriate for which type of recommendations, and which approaches should be followed to translate evidence into practice recommendations. Recommendations for consolidating standards of evidence and formulating guidelines for high-impact practices in FP/RH programming and policymaking are presented in this report

The consumer perspective: A consultation with senior health officials from developing countries on standards of evidence for reproductive and maternal health care

The Population Council (through the STEP UP consortium and the Evidence Project) and the High Impact Practices (HIP) Collaboration, together with other partners, held a series of three consultative meetings around the topic of standards of evidence in reproductive and maternal health. This report details the third and final meeting held in Bellagio, Italy in February 2016. The meeting brought together developing-country decisionmakers to vet, from the research “consumer” perspective, the recommendations that emerged from the second consultation and to elicit further recommendations on how to better generate and package evidence to meet the needs of decisionmakers. Also in attendance were donors, multilateral organizations, and researchers from the second consultation, so that they could better understand the decisionmakers’ perspectives and forge connections between “producers” and “consumers” of evidence

Effective scale-up: avoiding the same old traps

Despite progress in developing more effective training methodologies, training initiatives for health workers continue to experience common pitfalls that have beset the overall success and cost-effectiveness of these programs for decades. These include lack of country-level coordination of health training, inequitable access to training, interrupted services, and failure to reinforce skills and knowledge training by addressing other performance factors. These pitfalls are now seen as aggravating the current crisis in human resources for health and impeding the effective scale-up of training and the potential impact of promising strategies such as task shifting to address health worker shortages. Drawing on IntraHealth International's lessons learned in designing reproductive health and HIV/AIDS training and performance improvement programmes, this commentary discusses promising practices for strengthening human resources for health through more efficient and effective training and learning programmes that avoid the same old traps. These promising practices include the following

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Multi-messenger Observations of a Binary Neutron Star Merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of $\sim$1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg$^2$ at a luminosity distance of $40^{+8}_{-8}$ Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Msun. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at $\sim$40 Mpc) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over $\sim$10 days. Following early non-detections, X-ray and radio emission were discovered at the transient's position $\sim$9 and $\sim$16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. (Abridged

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

Study Protocol of the Ten Years Up Project: Mapping the Development of Self-Regulation Strategies in Young Adults Over Time

Self-regulation is an important predictor of many outcomes relating to health and well-being. Research thus far has not systematically addressed the development of self-regulation strategies during young adulthood, but instead has focused on the predictive value of childhood self-regulation competence for outcomes later in life. The present study protocol describes the Ten Years Up (10YUP) project, a longitudinal cohort of young adults who will be followed for Ten years. By adopting a dynamic approach, we aim to examine how the nature and frequency of self-regulation strategies develop over time, document to what extent the use of strategies is affected by contextual and personal factors, and determine how these strategies affect health and well-being over the course of ten years. The 10YUP project employs a prospective longitudinal design to map the development of self-regulation strategies over time. A sample of 3,000 participants will be recruited by random selection from the general population of 16-year olds to retain a final sample of 1,000 participants after Ten years (accounting for an estimated drop-out rate of 10% each year). A mobile app will be used to collect data every 3 months. Self-regulation strategies will be assessed by means of the Goal Setting and Striving Inventory that asks participants to list their personal goals and then choose their most important goal to answer items about goal perception and strategy use. The resulting composite self-regulation index will be related to a wide range of contextual and personal factors that may act as either antecedents or consequences of self-regulation, depending on their specific time of assessment (either prior to or following self-regulation assessment) by means of cross-lagged panel analyses and other analyses allowing for establishing causal relationships over time. The 10YUP project is likely to generate novel insights into the development of self-regulation in young adulthood, how this development is affected by personal and contextual factors, and how these in turn may be influenced by how young people self-regulate—which is important for public policies aimed at guiding young people's choices and how they affect their health and well-being

La planification familiale postpartum au Burkina Faso - résumé en français

Ce résumé décrit une étude sur la planification familiale post-partum (PFPP) au Burkina Faso. L’étude avait pour but: de donner un aperçu de la disponibilité et la qualité des services prénatals, du post-partum, et de planification familiale au niveau des soins primaires, et d’évaluer la mesure dans laquelle ils fournissent des services efficaces de PFPP; d’évaluer l\u27accessibilité des services PFPP; d’explorer l’effet de facteurs sociaux, économiques, et culturels sur la demande et l\u27adoption de la PFPP; d’estimer l’impact, la pertinence, et la mise en œuvre de la politique nationale et des protocoles cliniques par rapport à la PFPP; et d’identifier les principaux obstacles qui empêchent une réponse efficace aux besoins non satisfaits en matière de PPFP aux niveaux de l’offre, de l\u27accès, et de la demande, et de proposer des domaines d’amélioration potentiels. --- This summary describes a study on postpartum family planning (PPFP) in Burkina Faso. The purpose of the study was: to provide an overview of the availability and quality of prenatal, postpartum, and family planning services at the primary care level, and to assess the extent to which they provide effective PPFP health services; to assess the accessibility of PPFP services; to explore the effect of social, economic, and cultural factors on the demand and adoption of PPFP; to estimate the impact, relevance, and implementation of the national policy and clinical protocols in relation to PPFP; and to identify the main barriers to an effective response to unmet PPFP needs at the supply, access, and demand levels, and to suggest areas for improvement