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Bondza SA, Leopold T, Schwarz R, Lisdat C. Achromatic, planar Fresnel-reflector for a single-beam magneto-optical trap. Rev Sci Instrum 2024; 95:013202. [PMID: 38270499 DOI: 10.1063/5.0174674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
We present a novel achromatic, planar, periodic mirror structure for single-beam magneto-optical trapping and demonstrate its use in the first- and second-stage cooling and trapping for different isotopes of strontium. We refer to it as a Fresnel magneto-optical trap (MOT) as the structure is inspired by Fresnel lenses. By design, it avoids many of the problems that arise for multi-color cooling using planar structures based on diffraction gratings, which have been the dominant planar structures to be used for single-beam trapping thus far. In addition to a complex design process and cost-intensive fabrication, diffraction gratings suffer from their inherent chromaticity, which causes different axial displacements of trap volumes for different wavelengths and necessitates trade-offs in their diffraction properties and achievable trap depths. In contrast, the Fresnel-reflector structure presented here is a versatile, easy-to-manufacture device that combines achromatic beam steering with the advantages of a planar architecture. It enables miniaturizing trapping systems for alkaline-earth-like atoms with multiple cooling transitions as well as multi-species trapping in the ideal tetrahedral configuration and within the same volume above the structure. Our design presents a novel approach for the miniaturization of cold-atom systems based on single-beam MOTs and enables the widespread adoption of these systems.
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Affiliation(s)
- S A Bondza
- Physikalisch-Technische Bundesanstalt, Bundesallee 100, 38116 Braunschweig, Germany
- Deutsches Zentrum für Luft- und Raumfahrt e.V. (DLR), Institut für Satellitengeodäsie und Inertialsensorik, Callinstraße 30b, 30167 Hannover, Germany
| | - T Leopold
- Physikalisch-Technische Bundesanstalt, Bundesallee 100, 38116 Braunschweig, Germany
- Deutsches Zentrum für Luft- und Raumfahrt e.V. (DLR), Institut für Satellitengeodäsie und Inertialsensorik, Callinstraße 30b, 30167 Hannover, Germany
| | - R Schwarz
- Deutsches Zentrum für Luft- und Raumfahrt e.V. (DLR), Institut für Satellitengeodäsie und Inertialsensorik, Callinstraße 30b, 30167 Hannover, Germany
| | - C Lisdat
- Physikalisch-Technische Bundesanstalt, Bundesallee 100, 38116 Braunschweig, Germany
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Schwarz R, Hofmann B, Gergs U, Neumann J. Cantharidin increases the force of contraction and protein phosphorylation in isolated human atria. Naunyn Schmiedebergs Arch Pharmacol 2023; 396:2613-2625. [PMID: 37097333 PMCID: PMC10497697 DOI: 10.1007/s00210-023-02483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
Cantharidin, an inhibitor of protein phosphatase 1 (PP1) and protein phosphatase 2A (PP2A), is known to increase the force of contraction and shorten the time to relaxation in human ventricular preparations. We hypothesized that cantharidin has similar positive inotropic effects in human right atrial appendage (RAA) preparations. RAA were obtained during bypass surgery performed on human patients. These trabeculae were mounted in organ baths and electrically stimulated at 1 Hz. For comparison, we studied isolated electrically stimulated left atrial (LA) preparations and isolated spontaneously beating right atrial (RA) preparations from wild-type mice. Cumulatively applied (starting at 10 to 30 µM), cantharidin exerted a positive concentration-dependent inotropic effect that plateaued at 300 µM in the RAA, LA, and RA preparations. This positive inotropic effect was accompanied by a shortening of the time to relaxation in human atrial preparations (HAPs). Notably, cantharidin did not alter the beating rate in the RA preparations. Furthermore, cantharidin (100 µM) increased the phosphorylation state of phospholamban and the inhibitory subunit of troponin I in RAA preparations, which may account for the faster relaxation observed. The generated data indicate that PP1 and/or PP2A play a functional role in human atrial contractility.
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Affiliation(s)
- R. Schwarz
- Institute for Pharmacology and Toxicology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 4, 06112 Halle (Saale), Germany
| | - B. Hofmann
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle, Halle (Saale), Germany
| | - U. Gergs
- Institute for Pharmacology and Toxicology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 4, 06112 Halle (Saale), Germany
| | - J. Neumann
- Institute for Pharmacology and Toxicology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 4, 06112 Halle (Saale), Germany
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Nelson DB, Schwarz R, Dar M. Primary Care Sub-capitation in Medicaid: Improving Care Delivery in the Safety Net. J Gen Intern Med 2023; 38:1288-1290. [PMID: 36750508 PMCID: PMC9904520 DOI: 10.1007/s11606-023-08063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Daniel B Nelson
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
| | - Ryan Schwarz
- Massachusetts Medicaid (MassHealth), Boston, MA, USA
| | - Mohammad Dar
- Massachusetts Medicaid (MassHealth), Boston, MA, USA
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Tiwari A, Thapa A, Choudhury N, Khatri R, Sapkota S, Wu WJ, Halliday S, Citrin D, Schwarz R, Maru D, Rayamazi HJ, Paudel R, Bhatt LD, Bhandari V, Marasini N, Khadka S, Bogati B, Saud S, Kshetri YKB, Bhatta A, Magar KR, Shrestha R, Kafle R, Poudel R, Gautam S, Basnett I, Shrestha GN, Nirola I, Adhikari S, Thapa P, Kunwar L, Maru S. A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal. PLOS Glob Public Health 2023; 3:e0001512. [PMID: 36963046 PMCID: PMC10021605 DOI: 10.1371/journal.pgph.0001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/26/2022] [Indexed: 01/25/2023]
Abstract
Skilled care during pregnancy, childbirth, and postpartum is essential to prevent adverse maternal health outcomes, yet utilization of care remains low in many resource-limited countries, including Nepal. Community health workers (CHWs) can mitigate health system challenges and geographical barriers to achieving universal health coverage. Gaps remain, however, in understanding whether evidence-based interventions delivered by CHWs, closely aligned with WHO recommendations, are effective in Nepal's context. We conducted a type II hybrid effectiveness-implementation, mixed-methods study in two rural districts in Nepal to evaluate the effectiveness and the implementation of an evidence-based integrated maternal and child health intervention delivered by CHWs, using a mobile application. The intervention was implemented stepwise over four years (2014-2018), with 65 CHWs enrolling 30,785 families. We performed a mixed-effects Poisson regression to assess institutional birth rate (IBR) pre-and post-intervention. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the implementation during and after the study completion. There was an average 30% increase in IBR post-intervention, adjusting for confounding variables (p<0.0001). Study enrollment showed 35% of families identified as dalit, janjati, or other castes. About 78-89% of postpartum women received at least one CHW-counseled home visit within 60 days of childbirth. Ten (53% of planned) municipalities adopted the intervention during the study period. Implementation fidelity, measured by median counseled home visits, improved with intervention time. The intervention was institutionalized beyond the study period and expanded to four additional hubs, albeit with adjustments in management and supervision. Mechanisms of intervention impact include increased knowledge, timely referrals, and longitudinal CHW interaction. Full-time, supervised, and trained CHWs delivering evidence-based integrated care appears to be effective in improving maternal healthcare in rural Nepal. This study contributes to the growing body of evidence on the role of community health workers in achieving universal health coverage.
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Affiliation(s)
| | | | - Nandini Choudhury
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
| | | | - Sabitri Sapkota
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Possible, Kathmandu, Nepal
| | - Wan-Ju Wu
- Possible, New York, NY, United States of America
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, United States of America
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States of America
| | - Scott Halliday
- Possible, New York, NY, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - David Citrin
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Anthropology, University of Washington, Seattle, WA, United States of America
| | - Ryan Schwarz
- Possible, New York, NY, United States of America
- Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Duncan Maru
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | | | | | | | | | - Sonu Khadka
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | - Sita Saud
- Civil Service Hospital, Kathmandu, Nepal
| | | | | | - Kshitiz Rana Magar
- Department of Public Health and Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Ramesh Shrestha
- Department of Public Health and Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | | | | | | | | | - Goma Niroula Shrestha
- Department of Health Services, Nursing and Social Security Division (NSSD), Ministry of Health and Population, Nepal
| | - Isha Nirola
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Samrachana Adhikari
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Poshan Thapa
- University of New South Wales, School of Population Health, Sydney, Australia
| | | | - Sheela Maru
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Palmer-Young EC, Markowitz LM, Grubbs K, Zhang Y, Corona M, Schwarz R, Chen Y, Evans JD. Antiparasitic effects of three floral volatiles on trypanosomatid infection in honey bees. J Invertebr Pathol 2022; 194:107830. [PMID: 36174749 DOI: 10.1016/j.jip.2022.107830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/07/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Abstract
Trypanosomatid gut parasites are common in pollinators and costly for social bees. The recently described honey bee trypanosomatid Lotmaria passim is widespread, abundant, and correlated with colony losses in some studies. The potential for amelioration of infection by antimicrobial plant compounds has been thoroughly studied for closely related trypanosomatids of humans and is an area of active research in bumble bees, but remains relatively unexplored in honey bees. We recently identified several floral volatiles that inhibited growth of L. passim in vitro. Here, we tested the dose-dependent effects of four such compounds on infection, mortality, and food consumption in parasite-inoculated honey bees. We found that diets containing the monoterpenoid carvacrol and the phenylpropanoids cinnamaldehyde and eugenol at >10-fold the inhibitory concentrations for cell cultures reduced infection, with parasite numbers decreased by >90% for carvacrol and cinnamaldehyde and >99% for eugenol; effects of the carvacrol isomer thymol were non-significant. However, both carvacrol and eugenol also reduced bee survival, whereas parasite inoculation did not, indicating costs of phytochemical exposure that could exceed those of infection itself. To our knowledge, this is the first controlled screening of phytochemicals for effects on honey bee trypanosomatid infection, identifying potential treatments for managed bees afflicted with a newly characterized, cosmopolitan intestinal parasite.
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Affiliation(s)
| | - Lindsey M Markowitz
- USDA-ARS Bee Research Laboratory, Beltsville, MD, USA; Department of Biology, University of Maryland, College Park, MD, USA
| | - Kyle Grubbs
- USDA-ARS Bee Research Laboratory, Beltsville, MD, USA
| | - Yi Zhang
- USDA-ARS Bee Research Laboratory, Beltsville, MD, USA; Guangdong Key Laboratory of Animal Conservation and Resource Utilization, Guangdong Public Laboratory of Wild Animal Conservation and Utilization, Institute of Zoology, Guangdong Academy of Sciences, Guangzhou, PR China
| | - Miguel Corona
- USDA-ARS Bee Research Laboratory, Beltsville, MD, USA
| | - Ryan Schwarz
- Department of Biology, Fort Lewis College, Durango, CO, USA
| | - Yanping Chen
- USDA-ARS Bee Research Laboratory, Beltsville, MD, USA
| | - Jay D Evans
- USDA-ARS Bee Research Laboratory, Beltsville, MD, USA
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Choudhury N, Tiwari A, Wu WJ, Bhandari V, Bhatta L, Bogati B, Citrin D, Halliday S, Khadka S, Marasini N, Pandey S, Ballard M, Rayamazi HJ, Sapkota S, Schwarz R, Sullivan L, Maru D, Thapa A, Maru S. Comparing two data collection methods to track vital events in maternal and child health via community health workers in rural Nepal. Popul Health Metr 2022; 20:16. [PMID: 35897038 PMCID: PMC9327361 DOI: 10.1186/s12963-022-00293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/03/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Timely tracking of health outcomes is difficult in low- and middle-income countries without comprehensive vital registration systems. Community health workers (CHWs) are increasingly collecting vital events data while delivering routine care in low-resource settings. It is necessary, however, to assess whether routine programmatic data collected by CHWs are sufficiently reliable for timely monitoring and evaluation of health interventions. To study this, we assessed the consistency of vital events data recorded by CHWs using two methodologies-routine data collected while delivering an integrated maternal and child health intervention, and data from a birth history census approach at the same site in rural Nepal. METHODS We linked individual records from routine programmatic data from June 2017 to May 2018 with those from census data, both collected by CHWs at the same site using a mobile platform. We categorized each vital event over a one-year period as 'recorded by both methods,' 'census alone,' or 'programmatic alone.' We further assessed whether vital events data recorded by both methods were classified consistently. RESULTS From June 2017 to May 2018, we identified a total of 713 unique births collectively from the census (birth history) and programmatic maternal 'post-delivery' data. Three-fourths of these births (n = 526) were identified by both. There was high consistency in birth location classification among the 526 births identified by both methods. Upon including additional programmatic 'child registry' data, we identified 746 total births, of which 572 births were identified by both census and programmatic methods. Programmatic data (maternal 'post-delivery' and 'child registry' combined) captured more births than census data (723 vs. 595). Both methods consistently classified most infants as 'living,' while infant deaths and stillbirths were largely classified inconsistently or recorded by only one method. Programmatic data identified five infant deaths and five stillbirths not recorded in census data. CONCLUSIONS Our findings suggest that data collected by CHWs from routinely tracking pregnancies, births, and deaths are promising for timely program monitoring and evaluation. Despite some limitations, programmatic data may be more sensitive in detecting vital events than cross-sectional census surveys asking women to recall these events.
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Affiliation(s)
- Nandini Choudhury
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA
| | | | - Wan-Ju Wu
- grid.429937.2Possible, New York, USA ,grid.239424.a0000 0001 2183 6745Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | | | | | | | - David Citrin
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Anthropology, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - Scott Halliday
- grid.429937.2Possible, New York, USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | | | | | - Madeleine Ballard
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,Community Health Impact Coalition, New York, NY USA
| | | | | | - Ryan Schwarz
- grid.429937.2Possible, New York, USA ,grid.62560.370000 0004 0378 8294Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Harvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Lisa Sullivan
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Boston, MA USA
| | - Duncan Maru
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA ,grid.59734.3c0000 0001 0670 2351Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | - Sheela Maru
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA ,grid.59734.3c0000 0001 0670 2351Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Adhikari B, Mishra SR, Schwarz R. Transforming Nepal's primary health care delivery system in global health era: addressing historical and current implementation challenges. Global Health 2022; 18:8. [PMID: 35101073 PMCID: PMC8802254 DOI: 10.1186/s12992-022-00798-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
Nepal’s Primary Health Care (PHC) is aligned vertically with disease control programs at the core and a vast network of community health workers at the periphery. Aligning with the globalization of health and the factors affecting global burden of diseases, Nepal echoes the progressive increase in life expectancy, changes in diseases patterns, including the current impact of COVID-19. Nepal’s health system is also accommodating recent federalization, and thus it is critical to explore how the primary health care system is grappling the challenges amidst these changes. In this review, we conducted a narrative synthesis of literature to explore the challenges related to transformation of Nepal’s primary health care delivery system to meet the demands incurred by impact of globalization and recent federalization, covering following database: PubMED, Embase and Google Scholar. Of the 49 articles abstracted for full text review, 37 were included in the analyses. Existing theories were used for constructing the conceptual framework to explain the study findings. The results are divided into four themes. Additional searches were conducted to further support the narrative synthesis: a total of 46 articles were further included in the articulation of main findings. Transforming Nepal’s primary health care system requires a clear focus on following priority areas that include i) Revised efforts towards strengthening of community based primary health care units; ii) Adapting vertical programs to federal governance; iii) Reinforcing the health insurance scheme; and iv) Strengthening an existing network of community health workers and health human resources. This review discusses how these broad goals bear challenges and opportunities.
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Affiliation(s)
- Bipin Adhikari
- Nepal Community Health and Development Centre, Kathmandu, Nepal. .,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | | | - Ryan Schwarz
- Possible, New York, NY, USA.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA
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8
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Schioppo M, Kronjäger J, Silva A, Ilieva R, Paterson JW, Baynham CFA, Bowden W, Hill IR, Hobson R, Vianello A, Dovale-Álvarez M, Williams RA, Marra G, Margolis HS, Amy-Klein A, Lopez O, Cantin E, Álvarez-Martínez H, Le Targat R, Pottie PE, Quintin N, Legero T, Häfner S, Sterr U, Schwarz R, Dörscher S, Lisdat C, Koke S, Kuhl A, Waterholter T, Benkler E, Grosche G. Comparing ultrastable lasers at 7 × 10 -17 fractional frequency instability through a 2220 km optical fibre network. Nat Commun 2022; 13:212. [PMID: 35017500 PMCID: PMC8752831 DOI: 10.1038/s41467-021-27884-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/14/2021] [Indexed: 11/24/2022] Open
Abstract
Ultrastable lasers are essential tools in optical frequency metrology enabling unprecedented measurement precision that impacts on fields such as atomic timekeeping, tests of fundamental physics, and geodesy. To characterise an ultrastable laser it needs to be compared with a laser of similar performance, but a suitable system may not be available locally. Here, we report a comparison of two geographically separated lasers, over the longest ever reported metrological optical fibre link network, measuring 2220 km in length, at a state-of-the-art fractional-frequency instability of 7 × 10-17 for averaging times between 30 s and 200 s. The measurements also allow the short-term instability of the complete optical fibre link network to be directly observed without using a loop-back fibre. Based on the characterisation of the noise in the lasers and optical fibre link network over different timescales, we investigate the potential for disseminating ultrastable light to improve the performance of remote optical clocks.
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Affiliation(s)
- M Schioppo
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK.
| | - J Kronjäger
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK.
| | - A Silva
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - R Ilieva
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - J W Paterson
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - C F A Baynham
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - W Bowden
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - I R Hill
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - R Hobson
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - A Vianello
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | | | - R A Williams
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - G Marra
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - H S Margolis
- National Physical Laboratory (NPL), Teddington, TW11 0LW, UK
| | - A Amy-Klein
- Laboratoire de Physique des Lasers (LPL), Université Paris 13, CNRS, Villetaneuse, France
| | - O Lopez
- Laboratoire de Physique des Lasers (LPL), Université Paris 13, CNRS, Villetaneuse, France
| | - E Cantin
- Laboratoire de Physique des Lasers (LPL), Université Paris 13, CNRS, Villetaneuse, France
- LNE-SYRTE, Observatoire de Paris - Université PSL, CNRS, Sorbonne Université, LNE, Paris, France
| | - H Álvarez-Martínez
- LNE-SYRTE, Observatoire de Paris - Université PSL, CNRS, Sorbonne Université, LNE, Paris, France
- Real Instituto y Observatorio de la Armada (ROA), 11100, San Fernando, Cádiz, Spain
| | - R Le Targat
- LNE-SYRTE, Observatoire de Paris - Université PSL, CNRS, Sorbonne Université, LNE, Paris, France
| | - P E Pottie
- LNE-SYRTE, Observatoire de Paris - Université PSL, CNRS, Sorbonne Université, LNE, Paris, France
| | | | - T Legero
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - S Häfner
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - U Sterr
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - R Schwarz
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - S Dörscher
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - C Lisdat
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - S Koke
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - A Kuhl
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - T Waterholter
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - E Benkler
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
| | - G Grosche
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116, Braunschweig, Germany
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9
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Ade PAR, Ahmed Z, Amiri M, Barkats D, Thakur RB, Bischoff CA, Beck D, Bock JJ, Boenish H, Bullock E, Buza V, Cheshire JR, Connors J, Cornelison J, Crumrine M, Cukierman A, Denison EV, Dierickx M, Duband L, Eiben M, Fatigoni S, Filippini JP, Fliescher S, Goeckner-Wald N, Goldfinger DC, Grayson J, Grimes P, Hall G, Halal G, Halpern M, Hand E, Harrison S, Henderson S, Hildebrandt SR, Hilton GC, Hubmayr J, Hui H, Irwin KD, Kang J, Karkare KS, Karpel E, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Lau K, Leitch EM, Lennox A, Megerian KG, Minutolo L, Moncelsi L, Nakato Y, Namikawa T, Nguyen HT, O'Brient R, Ogburn RW, Palladino S, Prouve T, Pryke C, Racine B, Reintsema CD, Richter S, Schillaci A, Schwarz R, Schmitt BL, Sheehy CD, Soliman A, Germaine TS, Steinbach B, Sudiwala RV, Teply GP, Thompson KL, Tolan JE, Tucker C, Turner AD, Umiltà C, Vergès C, Vieregg AG, Wandui A, Weber AC, Wiebe DV, Willmert J, Wong CL, Wu WLK, Yang H, Yoon KW, Young E, Yu C, Zeng L, Zhang C, Zhang S. Improved Constraints on Primordial Gravitational Waves using Planck, WMAP, and BICEP/Keck Observations through the 2018 Observing Season. Phys Rev Lett 2021; 127:151301. [PMID: 34678017 DOI: 10.1103/physrevlett.127.151301] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
We present results from an analysis of all data taken by the BICEP2, Keck Array, and BICEP3 CMB polarization experiments up to and including the 2018 observing season. We add additional Keck Array observations at 220 GHz and BICEP3 observations at 95 GHz to the previous 95/150/220 GHz dataset. The Q/U maps now reach depths of 2.8, 2.8, and 8.8 μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈600 square degrees at 95 GHz and ≈400 square degrees at 150 and 220 GHz. The 220 GHz maps now achieve a signal-to-noise ratio on polarized dust emission exceeding that of Planck at 353 GHz. We take auto- and cross-spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz and evaluate the joint likelihood of the spectra versus a multicomponent model of lensed ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and no longer requires a prior on the frequency spectral index of the dust emission taken from measurements on other regions of the sky. This model is an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.036 at 95% confidence. Running maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.009. These are the strongest constraints to date on primordial gravitational waves.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - Z Ahmed
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - M Amiri
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - D Barkats
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - R Basu Thakur
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - C A Bischoff
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - D Beck
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Bock
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - H Boenish
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - V Buza
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - J R Cheshire
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Connors
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - J Cornelison
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - M Crumrine
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Cukierman
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - E V Denison
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - M Dierickx
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - M Eiben
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - S Fatigoni
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - J P Filippini
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Department of Astronomy, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - S Fliescher
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - N Goeckner-Wald
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D C Goldfinger
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - J Grayson
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - P Grimes
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - G Hall
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - G Halal
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - M Halpern
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - E Hand
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - S Harrison
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - S Henderson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - S R Hildebrandt
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Hubmayr
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H Hui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Irwin
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Kang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K S Karkare
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - E Karpel
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Kefeli
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J M Kovac
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C L Kuo
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K Lau
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E M Leitch
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - A Lennox
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - K G Megerian
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - L Minutolo
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - L Moncelsi
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - Y Nakato
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - T Namikawa
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), UTIAS, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - H T Nguyen
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R O'Brient
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R W Ogburn
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Palladino
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - T Prouve
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Racine
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Aix-Marseille Université, CNRS/IN2P3, CPPM, Marseille 13288, France
| | - C D Reintsema
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Richter
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - A Schillaci
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R Schwarz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B L Schmitt
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - C D Sheehy
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Soliman
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - T St Germaine
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - B Steinbach
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R V Sudiwala
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - G P Teply
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K L Thompson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Tucker
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - A D Turner
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - C Umiltà
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - C Vergès
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - A G Vieregg
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
- Department of Physics, Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - A Wandui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - A C Weber
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - D V Wiebe
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - J Willmert
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C L Wong
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - W L K Wu
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - H Yang
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K W Yoon
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - E Young
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Yu
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - L Zeng
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - C Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
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10
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Rimal P, Choudhury N, Agrawal P, Basnet M, Bohara B, Citrin D, Dhungana SK, Gauchan B, Gupta P, Gupta TK, Halliday S, Kadayat B, Mahar R, Maru D, Nguyen V, Poudel S, Raut A, Rawal J, Sapkota S, Schwarz D, Schwarz R, Shrestha S, Swar S, Thapa A, Thapa P, White R, Acharya B. Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study. BMJ Open 2021; 11:e048481. [PMID: 34400456 PMCID: PMC8370561 DOI: 10.1136/bmjopen-2020-048481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings. METHODS We conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers' behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period. RESULTS Providers experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:-9, Q3:-2) decrease in PHQ-9 scores (p<0.0001). CONCLUSION Using the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers' positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.
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Affiliation(s)
- Pragya Rimal
- Nyaya Health Nepal, Kathmandu, Nepal
- Possible, Kathmandu, Nepal
| | - Nandini Choudhury
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Madhur Basnet
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | | | - David Citrin
- Possible, New York, New York, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | | | - Scott Halliday
- Possible, New York, New York, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Duncan Maru
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | - Viet Nguyen
- Health Services, Los Angeles County Department of Health Services, Los Angeles, California, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Anant Raut
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Sabitri Sapkota
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Ryan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Srijana Shrestha
- Possible, New York, New York, USA
- Department of Psychology, Wheaton College, Wheaton, Illinois, USA
| | | | | | - Poshan Thapa
- University of New South Wales School of Public Health and Community Medicine, Sydney, New South Wales, Australia
| | | | - Bibhav Acharya
- Possible, New York, New York, USA
- Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
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11
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Ballard M, Westgate C, Alban R, Choudhury N, Adamjee R, Schwarz R, Bishop J, McLaughlin M, Flood D, Finnegan K, Rogers A, Olsen H, Johnson A, Palazuelos D, Schechter J. Compensation models for community health workers: Comparison of legal frameworks across five countries. J Glob Health 2021; 11:04010. [PMID: 33692894 PMCID: PMC7916445 DOI: 10.7189/jogh.11.04010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications. Methods This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a review of the regulatory framework governing CHW compensation in each country was undertaken. Law firms in each of the five countries were engaged to support the identification and interpretation of relevant legal documents. To guide the search and aid in the creation of uniform country profiles, a standardized set of questions was developed, covering: (i) legal requirements for CHW compensation, (ii) CHW compensation mechanisms, and (iii) CHW legal protections and benefits. Results The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the health system, in terms of ease of implementation, are outlined. Conclusions While a strong legal framework does not necessarily translate into high-quality implementation of compensation practices, it is the first necessary step. Certain approaches to CHW compensation – particularly public-sector or models with public sector wage floors – best institutionalize recommended CHW protections. Political will and long-term financing often remain challenges; removing ecosystem barriers – such as multilateral and bilateral restrictions on the payment of salaries – can help governments institutionalize CHW payment.
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Affiliation(s)
- Madeleine Ballard
- Community Health Impact Coalition, New York, New York, USA.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carey Westgate
- Community Health Impact Coalition, New York, New York, USA
| | | | - Nandini Choudhury
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Possible, New York, New York, USA
| | | | - Ryan Schwarz
- Possible, New York, New York, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | | | | | - Helen Olsen
- Medic Mobile, San Francisco, California, USA
| | - Ari Johnson
- Muso, Bamako, Mali.,Department of Medicine, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Partners In Health, Boston, Massachusetts, USA
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12
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Nepal P, Schwarz R, Citrin D, Thapa A, Acharya B, Acharya Y, Aryal A, Baum A, Bhandari V, Bhatt L, Bhattarai D, Choudhury N, Dangal B, Dhimal M, Dhungana SK, Gauchan B, Halliday S, Kalaunee SP, Kunwar LB, Maru D, Nirola I, Paudel R, Raut A, Rayamazi HJ, Sapkota S, Schwarz D, Thapa P, Thapa P, Tiwari A, Tuitui R, Walter E, Maru S. Costing Analysis of a Pilot Community Health Worker Program in Rural Nepal. Glob Health Sci Pract 2020; 8:239-255. [PMID: 32606093 PMCID: PMC7326517 DOI: 10.9745/ghsp-d-19-00393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 05/19/2020] [Indexed: 01/01/2023]
Abstract
Data from a retrospective costing analysis offers insights and practical considerations for policy makers and locally elected officials for designing and implementing a new community health work cadre as a mechanism to achieve SDG targets in Nepal. Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60,000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74% is personnel cost. Service delivery and administrative costs and per beneficiary costs for all services are also described. To address the current discourse among Nepali policy makers at the local and federal levels, we also present 3 alternative implementation scenarios that policy makers may consider. Given the Government of Nepal’s commitment to increase health care spending (US$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets.
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Affiliation(s)
| | - Ryan Schwarz
- Possible, New York, NY, USA. .,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA
| | - David Citrin
- Possible, New York, NY, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | - Bibhav Acharya
- Possible, New York, NY, USA.,University of California, San Francisco, Department of Psychiatry, San Francisco, CA, USA
| | - Yubraj Acharya
- Pennsylvania State University, College of Health and Human Development, Department of Health Policy and Administration, University Park, PA, USA
| | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
| | - Aaron Baum
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | | | | | - Nandini Choudhury
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | | | | | - Bikash Gauchan
- Nyaya Health Nepal, Kathmandu, Nepal.,University of California, San Francisco, Health Equity Action Leadership Initiative, San Francisco, CA, USA
| | - Scott Halliday
- Possible, New York, NY, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - S P Kalaunee
- Nyaya Health Nepal, Kathmandu, Nepal.,Eastern University, College of Leadership and Development, St. Davids, PA, USA
| | | | - Duncan Maru
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY, USA
| | - Isha Nirola
- Possible, New York, NY, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | - Dan Schwarz
- Possible, New York, NY, USA.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA, USA.,Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA
| | - Poshan Thapa
- University of New South Wales, School of Public Health and Community Medicine, Sydney, NSW, Australia
| | | | | | - Roshani Tuitui
- Nursing and Social Security Division, Dept of Health Services, Kathmandu, Nepal
| | - Eric Walter
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.,University of Pennsylvania, The Wharton School, Healthcare Management Department, Philadelphia, PA, USA
| | - Sheela Maru
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Science, New York, NY, USA
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13
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Ballard M, Bancroft E, Nesbit J, Johnson A, Holeman I, Foth J, Rogers D, Yang J, Nardella J, Olsen H, Raghavan M, Panjabi R, Alban R, Malaba S, Christiansen M, Rapp S, Schechter J, Aylward P, Rogers A, Sebisaho J, Ako C, Choudhury N, Westgate C, Mbeya J, Schwarz R, Bonds MH, Adamjee R, Bishop J, Yembrick A, Flood D, McLaughlin M, Palazuelos D. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health 2020; 5:e002550. [PMID: 32503889 PMCID: PMC7298684 DOI: 10.1136/bmjgh-2020-002550] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/03/2022] Open
Abstract
COVID-19 disproportionately affects the poor and vulnerable. Community health workers are poised to play a pivotal role in fighting the pandemic, especially in countries with less resilient health systems. Drawing from practitioner expertise across four WHO regions, this article outlines the targeted actions needed at different stages of the pandemic to achieve the following goals: (1) PROTECT healthcare workers, (2) INTERRUPT the virus, (3) MAINTAIN existing healthcare services while surging their capacity, and (4) SHIELD the most vulnerable from socioeconomic shocks. While decisive action must be taken now to blunt the impact of the pandemic in countries likely to be hit the hardest, many of the investments in the supply chain, compensation, dedicated supervision, continuous training and performance management necessary for rapid community response in a pandemic are the same as those required to achieve universal healthcare and prevent the next epidemic.
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Affiliation(s)
- Madeleine Ballard
- Community Health Impact Coalition, New York, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Josh Nesbit
- Medic Mobile, San Francisco, California, USA
| | - Ari Johnson
- Muso, Bamako, Mali
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Isaac Holeman
- Medic Mobile, San Francisco, California, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | | | - Helen Olsen
- Medic Mobile, San Francisco, California, USA
| | | | - Raj Panjabi
- Last Mile Health, Monrovia, Liberia
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | - Nandini Choudhury
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- POSSIBLE, New York, New York, USA
| | - Carey Westgate
- Community Health Impact Coalition, New York, New York, USA
| | | | - Ryan Schwarz
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- POSSIBLE, New York, New York, USA
| | - Matthew H Bonds
- Harvard Medical School Department of Global Health and Social Medicine, Blavatnik Institute, Boston, Massachusetts, USA
- PIVOT, Ranomafana, Madagascar
| | | | | | | | - David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
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14
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Schwarz R, Thapa A, Sharma S, Kalaunee SP. At a crossroads: How can Nepal enhance its community health care system to achieve Sustainable Development Goal 3 and universal health coverage? J Glob Health 2020; 10:010309. [PMID: 32257137 PMCID: PMC7100858 DOI: 10.7189/jogh.10.010309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Sudha Sharma
- Former Secretary at Ministry of Health & Population, Nepal
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15
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Schwarz D, Dhungana S, Kumar A, Acharya B, Agrawal P, Aryal A, Baum A, Choudhury N, Citrin D, Dangal B, Dhimal M, Gauchan B, Gupta T, Halliday S, Karmacharya B, Kishore S, Koirala B, Kshatriya U, Levine E, Maru S, Rimal P, Sapkota S, Schwarz R, Shrestha A, Thapa A, Maru D. An integrated intervention for chronic care management in rural Nepal: protocol of a type 2 hybrid effectiveness-implementation study. Trials 2020; 21:119. [PMID: 31996250 PMCID: PMC6990567 DOI: 10.1186/s13063-020-4063-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/09/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Nepal, the burden of noncommunicable, chronic diseases is rapidly rising, and disproportionately affecting low and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontline providers, namely mid-level practitioners and community health workers, in chronic care management. Important operational questions remain, however, around the digital, training, and supervisory structures to support the implementation of effective, affordable, and equitable chronic care management programs. METHODS A 12-month, population-level, type 2 hybrid effectiveness-implementation study will be conducted in rural Nepal to evaluate an integrated noncommunicable disease care management intervention within Nepal's new municipal governance structure. The intervention will leverage the government's planned roll-out of the World Health Organization's Package of Essential Noncommunicable Disease Interventions (WHO-PEN) program in four municipalities in Nepal, with a study population of 80,000. The intervention will leverage both the WHO-PEN and its cardiovascular disease-specific technical guidelines (HEARTS), and will include three evidence-based components: noncommunicable disease care provision using mid-level practitioners and community health workers; digital clinical decision support tools to ensure delivery of evidence-based care; and training and digitally supported supervision of mid-level practitioners to provide motivational interviewing for modifiable risk factor optimization, with a focus on medication adherence, and tobacco and alcohol use. The study will evaluate effectiveness using a pre-post design with stepped implementation. The primary outcomes will be disease-specific, "at-goal" metrics of chronic care management; secondary outcomes will include alcohol and tobacco consumption levels. DISCUSSION This is the first population-level, hybrid effectiveness-implementation study of an integrated chronic care management intervention in Nepal. As low and middle-income countries plan for the Sustainable Development Goals and universal health coverage, the results of this pragmatic study will offer insights into policy and programmatic design for noncommunicable disease care management in the future. TRIAL REGISTRATION ClinicalTrials.gov, NCT04087369. Registered on 12 September 2019.
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Affiliation(s)
- Dan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA USA
| | - Santosh Dhungana
- Department of Internal Medicine, Hurley Medical Center, Flint, MI USA
| | - Anirudh Kumar
- Department of Medicine, NYU Langone Health, New York, NY USA
| | - Bibhav Acharya
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | | | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
| | - Aaron Baum
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Nandini Choudhury
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Anthropology, University of Washington, Seattle, WA USA
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | | | - Meghnath Dhimal
- Nepal Health Research Council, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Tula Gupta
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Scott Halliday
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Biraj Karmacharya
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
- Nepal Technology Innovation Center, Kathmandu University, Dhulikhel, Nepal
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Sandeep Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Young Professionals Chronic Disease Network, New York, NY USA
| | - Bhagawan Koirala
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Erica Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | | | - Sabitri Sapkota
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Archana Shrestha
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
- Yale School of Public Health, Center for Methods in Implementation and Prevention Science, New Haven, CT USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT USA
| | | | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
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16
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Harsha Bangura A, Nirola I, Thapa P, Citrin D, Belbase B, Bogati B, B K N, Khadka S, Kunwar L, Halliday S, Choudhury N, Schwarz R, Adhikari M, Kalaunee SP, Rising S, Maru D, Maru S. Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal. Reprod Health 2020; 17:5. [PMID: 31952543 PMCID: PMC6967133 DOI: 10.1186/s12978-019-0840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/02/2019] [Indexed: 12/04/2022] Open
Abstract
Background Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women’s groups suggests that group care models may both improve access to care and the quality of care delivered through women’s empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. Methods The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. Results A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. Conclusion Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. Trial registration ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.
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Affiliation(s)
| | - Isha Nirola
- Harvard T.H, Chan School of Public Health, Boston, MA, USA
| | - Poshan Thapa
- University of New South Wales, School of Public Health and Community Medicine, Sydney, NSW, Australia
| | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue Fifth Floor, Room 556, New York, NY, 10029, USA.,Possible, New York, NY, USA
| | | | - Bhawana Bogati
- Nyaya Health Nepal, Kathmandu, Nepal.,Possible, New York, NY, USA
| | - Nirmala B K
- Om Health Science Campus, Purbanchal University, Kathmandu, VA, Nepal
| | - Sonu Khadka
- Nyaya Health Nepal, Kathmandu, Nepal.,Possible, New York, NY, USA
| | - Lal Kunwar
- Nyaya Health Nepal, Kathmandu, Nepal.,Possible, New York, NY, USA
| | - Scott Halliday
- Nyaya Health Nepal, Kathmandu, Nepal.,Department of Global Health, University of Washington, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue Fifth Floor, Room 556, New York, NY, 10029, USA.,Possible, New York, NY, USA
| | - Nandini Choudhury
- Nyaya Health Nepal, Kathmandu, Nepal.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue Fifth Floor, Room 556, New York, NY, 10029, USA.,Possible, New York, NY, USA
| | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal.,Department of Medicine, Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Possible, New York, NY, USA
| | | | - S P Kalaunee
- Nyaya Health Nepal, Kathmandu, Nepal.,Eastern University, College of Business and Leadership, St. Davids, PA, USA.,Possible, New York, NY, USA
| | | | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal.,Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue Fifth Floor, Room 556, New York, NY, 10029, USA.,Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, New York, NY, USA.,Possible, New York, NY, USA
| | - Sheela Maru
- Nyaya Health Nepal, Kathmandu, Nepal. .,Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue Fifth Floor, Room 556, New York, NY, 10029, USA. .,Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Science, New York, NY, USA. .,Possible, New York, NY, USA.
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17
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Agarwal S, Sripad P, Johnson C, Kirk K, Bellows B, Ana J, Blaser V, Kumar MB, Buchholz K, Casseus A, Chen N, Dini HSF, Deussom RH, Jacobstein D, Kintu R, Kureshy N, Meoli L, Otiso L, Pakenham-Walsh N, Zambruni JP, Raghavan M, Schwarz R, Townsend J, Varpilah B, Weiss W, Warren CE. A conceptual framework for measuring community health workforce performance within primary health care systems. Hum Resour Health 2019; 17:86. [PMID: 31747947 PMCID: PMC6868857 DOI: 10.1186/s12960-019-0422-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/24/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND With the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries. METHODS A review of peer-reviewed articles, reports, and global data collection tools was conducted to identify key measurement domains in monitoring CHW performance. Three consultations were successively convened with global stakeholders, community health implementers, advocates, measurement experts, and Ministry of Health representatives using a modified Delphi approach to build consensus on priority indicators. During this process, a structured, web-based survey was administered to identify the importance and value of specific measurement domains, sub-domains, and indicators determined through the literature reviews and initial stakeholder consultations. Indicators with more than 75% support from participants were further refined with expert qualitative input. RESULTS Twenty-one sub-domains for measurement were identified including measurement of incentives for CHWs, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referral/counter-referral, credibility/trust, and programmatic costs. Forty-six indicators were agreed upon to measure the sub-domains. In the absence of complete population enumeration and digitized health information systems, the quality of metrics to monitor CHW programs is limited. CONCLUSIONS Better data collection approaches at the community level are needed to strengthen management of CHW programs and community health systems. The proposed list of metrics balances exhaustive and pragmatic measurement of CHW performance within primary healthcare systems. Adoption of the proposed framework and associated indicators by CHW program implementors may improve programmatic effectiveness, strengthen their accountability to national community health systems, drive programmatic quality improvement, and plausibly improve the impact of these programs.
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Affiliation(s)
- Smisha Agarwal
- Population Council, Washington, DC USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | | | | | - Joseph Ana
- Healthcare Information For All (HIFA), Oxford, UK
| | | | - Meghan Bruce Kumar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | | | | | | | | | | | - Lilian Otiso
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Brigham and Women’s Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA USA
| | | | | | - William Weiss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- USAID, Washington, DC USA
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18
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Thapa P, Bangura AH, Nirola I, Citrin D, Belbase B, Bogati B, Nirmala BK, Khadka S, Kunwar L, Halliday S, Choudhury N, Ozonoff A, Tenpa J, Schwarz R, Adhikari M, Kalaunee SP, Rising S, Maru D, Maru S. The power of peers: an effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal. Reprod Health 2019; 16:150. [PMID: 31640770 PMCID: PMC6805428 DOI: 10.1186/s12978-019-0820-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing the maternal mortality ratio to less than 70 per 100,000 live births globally is one of the Sustainable Development Goals. Approximately 830 women die from pregnancy- or childbirth-related complications every day. Almost 99% of these deaths occur in developing countries. Increasing antenatal care quality and completion, and institutional delivery are key strategies to reduce maternal mortality, however there are many implementation challenges in rural and resource-limited settings. In Nepal, 43% of deliveries do not take place in an institution and 31% of women have insufficient antenatal care. Context-specific and evidence-based strategies are needed to improve antenatal care completion and institutional birth. We present an assessment of effectiveness outcomes for an adaptation of a group antenatal care model delivered by community health workers and midwives in close collaboration with government staff in rural Nepal. METHODS The study was conducted in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized, cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allowed for iterative improvement in design by making changes to improve the quality of the intervention. We evaluated effectiveness through a difference in difference analysis of institutional birth rates between groups prior to implementation of the intervention and 1 year after implementation. Additionally, we assessed the change in knowledge of key danger signs and the acceptability of the group model compared with individual visits in a nested cohort of women receiving home visit care and home visit care plus group antenatal care. Using a directed content and thematic approach, we analyzed qualitative interviews to identify major themes related to implementation. RESULTS At baseline, there were 457 recently-delivered women in the six village clusters receiving home visit care and 214 in the seven village clusters receiving home visit care plus group antenatal care. At endline, there were 336 and 201, respectively. The difference in difference analysis did not show a significant change in institutional birth rates nor antenatal care visit completion rates between the groups. There was, however, a significant increase in both institutional birth and antenatal care completion in each group from baseline to endline. We enrolled a nested cohort of 52 participants receiving home visit care and 62 participants receiving home visit care plus group antenatal care. There was high acceptability of the group antenatal care intervention and home visit care, with no significant differences between groups. A significantly higher percentage of women who participated in group antenatal care found their visits to be 'very enjoyable' (83.9% vs 59.6%, p = 0.0056). In the nested cohort, knowledge of key danger signs during pregnancy significantly improved from baseline to endline in the intervention clusters only (2 to 31%, p < 0.001), while knowledge of key danger signs related to labor and childbirth, the postpartum period, and the newborn did not in either intervention or control groups. Qualitative analysis revealed that women found that the groups provided an opportunity for learning and discussion, and the groups were a source of social support and empowerment. They also reported an improvement in services available at their village clinic. Providers noted the importance of the community health workers in identifying pregnant women in the community and linking them to the village clinics. Challenges in birth planning were brought up by both participants and providers. CONCLUSION While there was no significant change in institutional birth and antenatal care completion at the population level between groups, there was an increase of these outcomes in both groups. This may be secondary to the primary importance of community health worker involvement in both of these groups. Knowledge of key pregnancy danger signs was significantly improved in the home visit plus group antenatal care cohort compared with the home visit care only group. This initial study of Nyaya Health Nepal's adapted group care model demonstrates the potential for impacting women's antenatal care experience and should be studied over a longer period as an intervention embedded within a community health worker program. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02330887 , registered 01/05/2015, retroactively registered.
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Affiliation(s)
- Poshan Thapa
- University of New South Wales, School of Public Health and Community Medicine, Sydney, NSW Australia
| | | | - Isha Nirola
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Anthropology, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
- University of Washington, Henry M. Jackson School of International Studies, Seattle, WA USA
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue, Fifth Floor, Room 556, New York, NY 10029 USA
| | | | | | - B. K. Nirmala
- Om Health Science Campus, Purbanchal University, Kathmandu, Nepal
| | | | | | - Scott Halliday
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Global Health, University of Washington, Seattle, WA USA
- University of Washington, Henry M. Jackson School of International Studies, Seattle, WA USA
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue, Fifth Floor, Room 556, New York, NY 10029 USA
| | - Nandini Choudhury
- Nyaya Health Nepal, Kathmandu, Nepal
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue, Fifth Floor, Room 556, New York, NY 10029 USA
| | - Al Ozonoff
- Center for Patient Safety and Quality Research, Boston Children’ Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
| | - Jasmine Tenpa
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA USA
| | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
| | | | - S. P. Kalaunee
- Nyaya Health Nepal, Kathmandu, Nepal
- Eastern University, College of Leadership and Development, St. Davids, PA USA
| | | | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue, Fifth Floor, Room 556, New York, NY 10029 USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, 1216 Fifth Avenue, Fifth Floor, Room 556, New York, NY 10029 USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY USA
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19
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Stromer W, Messerer B, Crevenna R, Hemberger SH, Jauk B, Schwarz R, Streif W, Thom K, Wagner B, Zwiauer K, Likar R. [Pain therapy for children and adolescents with hemophilia : Recommendations by an expert panel]. Schmerz 2019; 32:404-418. [PMID: 30191308 DOI: 10.1007/s00482-018-0321-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated. OBJECTIVES This paper discusses how to improve pain management for children and adolescents (0-18 years) with hemophilia and which specific features in this population should influence decisions in pain management. MATERIALS AND METHODS An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience. RESULT Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.
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Affiliation(s)
- W Stromer
- Abteilung für Anästhesie und allg. Intensivmedizin, Landesklinikum Waldviertel Horn, Spitalgasse 8/7/9, 3580, Horn, Österreich.
| | - B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, LKH-Univ.-Klinikum Graz, Graz, Österreich
| | - R Crevenna
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin Wien, Wien, Österreich
| | - S H Hemberger
- Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich
| | - B Jauk
- Abteilung für Kinder- und Jugendheilkunde, Klinikum Klagenfurt, Klagenfurt, Österreich
| | - R Schwarz
- Abteilung für Kinder- und Jugendheilkunde, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - W Streif
- Departement für Kinder und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - K Thom
- Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich
| | - B Wagner
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin Wien, Wien, Österreich
| | - K Zwiauer
- Klinische Abteilung für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - R Likar
- Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich
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20
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Kumar A, Schwarz D, Acharya B, Agrawal P, Aryal A, Choudhury N, Citrin D, Dangal B, Deukmedjian G, Dhimal M, Dhungana S, Gauchan B, Gupta T, Halliday S, Jha D, Kalaunee SP, Karmacharya B, Kishore S, Koirala B, Kunwar L, Mahar R, Maru S, Mehanni S, Nirola I, Pandey S, Pant B, Pathak M, Poudel S, Rajbhandari I, Raut A, Rimal P, Schwarz R, Shrestha A, Thapa A, Thapa P, Thapa R, Wong L, Maru D. Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal. BMJ Glob Health 2019; 4:e001343. [PMID: 31139453 PMCID: PMC6509610 DOI: 10.1136/bmjgh-2018-001343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022] Open
Abstract
Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care-first-contact access, care coordination, comprehensiveness and continuity-offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non-communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular 'at-goal' metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6 and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to-follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community visits. 'At-goal' status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions.
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Affiliation(s)
- Anirudh Kumar
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Ariadne Labs, Harvard T H Chan Schoo of Public Health and Brigham and Women's Hospital, Boston, MA, United States
| | - Bibhav Acharya
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
| | | | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Anthropology, University of Washington, Seattle, WA, United States
- Henry M Jackson School of International Studies, University of Washington, Seattle, WA, United States
| | | | - Grace Deukmedjian
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, Natividad Medical Center, Salinas, CA, United States
| | | | | | - Bikash Gauchan
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Scott Halliday
- Nyaya Health Nepal, Kathmandu, Nepal
- Henry M Jackson School of International Studies, University of Washington, Seattle, WA, United States
| | - Dhiraj Jha
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - SP Kalaunee
- Nyaya Health Nepal, Kathmandu, Nepal
- College of Business and Leadership, Eastern University, St Davids, PA, USA
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
- Nepal Technology Innovation Center, Kathmandu University, Dhulikhel, Nepal
- Sun Yat-sen Global Health Insititute, Sun Yat-sen University, Guangzhou, China
| | - Sandeep Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Young Professionals Chronic Disease Network, New York, NY, United States
| | - Bhagawan Koirala
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Lal Kunwar
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Sheela Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen Mehanni
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Gallup Indian Medical Center, Gallup, NM, United States
| | - Isha Nirola
- Harvard University T H Chan School of Public Health, Boston, MA, USA
| | | | - Bhaskar Pant
- Department of Orthopedic and Trauma, Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal
| | | | | | | | | | - Pragya Rimal
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Archana Shrestha
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, USA
- Division of Research and Development, Dhulikhel Hospital, Dhulikhel, Nepal
| | | | - Poshan Thapa
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Lena Wong
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Tuba City Regional Health Care, Tuba City, AZ, United States
| | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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21
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Mehanni S, Jha D, Kumar A, Choudhury N, Dangal B, Deukmedjian G, Dhungana SK, Gauchan B, Gupta TK, Halliday S, Kalaunee SP, Mahar R, Poudel S, Raut A, Schwarz R, Singh DR, Thapa A, Thapa R, Wong L, Maru D, Schwarz D. Implementing a quality improvement initiative for the management of chronic obstructive pulmonary disease in rural Nepal. BMJ Open Qual 2019; 8:e000408. [PMID: 31259269 PMCID: PMC6567951 DOI: 10.1136/bmjoq-2018-000408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 12/14/2018] [Accepted: 12/27/2018] [Indexed: 12/01/2022] Open
Abstract
Background Chronic obstructive pulmonary disease accounts for a significant portion of the world’s morbidity and mortality, and disproportionately affects low/middle-income countries. Chronic obstructive pulmonary disease management in low-resource settings is suboptimal with diagnostics, medications and high-quality, evidence-based care largely unavailable or unaffordable for most people. In early 2016, we aimed to improve the quality of chronic obstructive pulmonary disease management at Bayalpata Hospital in rural Achham, Nepal. Given that quality improvement infrastructure is limited in our setting, we also aimed to model the use of an electronic health record system for quality improvement, and to build local quality improvement capacity. Design Using international chronic obstructive pulmonary disease guidelines, the quality improvement team designed a locally adapted chronic obstructive pulmonary disease protocol which was subsequently converted into an electronic health record template. Over several Plan-Do-Study-Act cycles, the team rolled out a multifaceted intervention including educational sessions, reminders, as well as audits and feedback. Results The rate of oral corticosteroid prescriptions for acute exacerbations of chronic obstructive pulmonary disease increased from 14% at baseline to >60% by month 7, with the mean monthly rate maintained above this level for the remainder of the initiative. The process measure of chronic obstructive pulmonary disease template completion rate increased from 44% at baseline to >60% by month 2 and remained between 50% and 70% for the remainder of the initiative. Conclusion This case study demonstrates the feasibility of robust quality improvement programmes in rural settings and the essential role of capacity building in ensuring sustainability. It also highlights how individual quality improvement initiatives can catalyse systems-level improvements, which in turn create a stronger foundation for continuous quality improvement and healthcare system strengthening.
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Affiliation(s)
- Stephen Mehanni
- Possible, Kathmandu, Nepal.,Health Equity Action Leadership Initiative, University of California San Francisco, San Francisco, California, USA.,Gallup Indian Medical Center, Gallup, New Mexico, USA
| | - Dhiraj Jha
- Possible, Kathmandu, Nepal.,Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Anirudh Kumar
- Possible, Kathmandu, Nepal.,Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Grace Deukmedjian
- Possible, Kathmandu, Nepal.,Health Equity Action Leadership Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Pediatrics, Natividad Medical Center, Salinas, California, USA
| | | | - Bikash Gauchan
- Possible, Kathmandu, Nepal.,Health Equity Action Leadership Initiative, University of California San Francisco, San Francisco, California, USA
| | | | - Scott Halliday
- Possible, Kathmandu, Nepal.,Henry M. Jackson School of International Studies, University of Washington, Seattle, Washington, USA
| | - S P Kalaunee
- Possible, Kathmandu, Nepal.,College of Business and Leadership, Eastern University, St. Davids, Pennsylvania, USA
| | | | | | | | - Ryan Schwarz
- Possible, Kathmandu, Nepal.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dipendra Raman Singh
- Public Health Monitoring and Evaluation Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | | | | | - Lena Wong
- Possible, Kathmandu, Nepal.,Health Equity Action Leadership Initiative, University of California San Francisco, San Francisco, California, USA.,Tuba City Indian Medical Center, Tuba City, Arizona, USA
| | - Duncan Maru
- Possible, Kathmandu, Nepal.,Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dan Schwarz
- Possible, Kathmandu, Nepal.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
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22
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Mehanni S, Wong L, Acharya B, Agrawal P, Aryal A, Basnet M, Citrin D, Dangal B, Deukmedjian G, Dhungana SK, Gauchan B, Gupta TK, Halliday S, Kalaunee SP, Kshatriya U, Kumar A, Maru D, Maru S, Nguyen V, Paudel JS, Rimal P, Saleh M, Schwarz R, Swar SB, Thapa A, Tiwari A, White R, Wu WJ, Schwarz D. Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model. BMC Med Educ 2019; 19:61. [PMID: 30786884 PMCID: PMC6383231 DOI: 10.1186/s12909-019-1492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning. METHODS The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted. RESULTS Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site. CONCLUSION We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.
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Affiliation(s)
- Stephen Mehanni
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Gallup Indian Medical Center, Gallup, NM USA
| | - Lena Wong
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Tuba City Regional Health Care, Tuba City, AZ USA
| | - Bibhav Acharya
- Possible, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | | | | | - Madhur Basnet
- Possible, Kathmandu, Nepal
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - David Citrin
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Anthropology, University of Washington, Seattle, WA USA
| | | | - Grace Deukmedjian
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Department of Pediatrics, Natividad Medical Center, Salinas, CA USA
| | | | - Bikash Gauchan
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | | | - Scott Halliday
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - S. P. Kalaunee
- Possible, Kathmandu, Nepal
- College of Business and Leadership, Eastern University, St. Davids, PA USA
| | | | - Anirudh Kumar
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Duncan Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Viet Nguyen
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Jhalak Sharma Paudel
- National Health Training Center, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Pragya Rimal
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Marwa Saleh
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Ryan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Sikhar Bahadur Swar
- Possible, Kathmandu, Nepal
- Department of Psychiatry, Kathmandu Medical College, Kathmandu, Nepal
| | | | | | - Rebecca White
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Wan-Ju Wu
- Possible, Kathmandu, Nepal
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Dan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
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23
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Ade PAR, Ahmed Z, Aikin RW, Alexander KD, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Bowens-Rubin R, Brevik JA, Buder I, Bullock E, Buza V, Connors J, Cornelison J, Crill BP, Crumrine M, Dierickx M, Duband L, Dvorkin C, Filippini JP, Fliescher S, Grayson J, Hall G, Halpern M, Harrison S, Hildebrandt SR, Hilton GC, Hui H, Irwin KD, Kang J, Karkare KS, Karpel E, Kaufman JP, Keating BG, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Larsen NA, Lau K, Leitch EM, Lueker M, Megerian KG, Moncelsi L, Namikawa T, Netterfield CB, Nguyen HT, O'Brient R, Ogburn RW, Palladino S, Pryke C, Racine B, Richter S, Schillaci A, Schwarz R, Sheehy CD, Soliman A, St Germaine T, Staniszewski ZK, Steinbach B, Sudiwala RV, Teply GP, Thompson KL, Tolan JE, Tucker C, Turner AD, Umiltà C, Vieregg AG, Wandui A, Weber AC, Wiebe DV, Willmert J, Wong CL, Wu WLK, Yang H, Yoon KW, Zhang C. Constraints on Primordial Gravitational Waves Using Planck, WMAP, and New BICEP2/Keck Observations through the 2015 Season. Phys Rev Lett 2018; 121:221301. [PMID: 30547645 DOI: 10.1103/physrevlett.121.221301] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/28/2018] [Indexed: 06/09/2023]
Abstract
We present results from an analysis of all data taken by the bicep2/Keck CMB polarization experiments up to and including the 2015 observing season. This includes the first Keck Array observations at 220 GHz and additional observations at 95 and 150 GHz. The Q and U maps reach depths of 5.2, 2.9, and 26 μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈400 square degrees. The 220 GHz maps achieve a signal to noise on polarized dust emission approximately equal to that of Planck at 353 GHz. We take auto and cross spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz. We evaluate the joint likelihood of the spectra versus a multicomponent model of lensed-ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and we impose priors on some of these using external information from Planck and WMAP derived from larger regions of sky. The model is shown to be an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.07 at 95% confidence, which tightens to r_{0.05}<0.06 in conjunction with Planck temperature measurements and other data. The lensing signal is detected at 8.8σ significance. Running a maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.020. These are the strongest constraints to date on primordial gravitational waves.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - Z Ahmed
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - R W Aikin
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Alexander
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - D Barkats
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - S J Benton
- Department of Physics, Princeton University, Princeton, New Jersey 08544, USA
| | - C A Bischoff
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - J J Bock
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R Bowens-Rubin
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J A Brevik
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - I Buder
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - V Buza
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J Connors
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J Cornelison
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - B P Crill
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - M Crumrine
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Dierickx
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - C Dvorkin
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J P Filippini
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Department of Astronomy, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - S Fliescher
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Grayson
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - G Hall
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Halpern
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - S Harrison
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - S R Hildebrandt
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H Hui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Irwin
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Kang
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K S Karkare
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - E Karpel
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J P Kaufman
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - B G Keating
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - S Kefeli
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J M Kovac
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C L Kuo
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - N A Larsen
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - K Lau
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E M Leitch
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - M Lueker
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K G Megerian
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - L Moncelsi
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - T Namikawa
- Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei 10617, Taiwan
| | - C B Netterfield
- Department of Physics, University of Toronto, Toronto, Ontario, M5S 1A7, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario, M5G 1Z8, Canada
| | - H T Nguyen
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R O'Brient
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R W Ogburn
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Palladino
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Racine
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - S Richter
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - A Schillaci
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R Schwarz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C D Sheehy
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Soliman
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - T St Germaine
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - Z K Staniszewski
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - B Steinbach
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R V Sudiwala
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - G P Teply
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - K L Thompson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Tucker
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - A D Turner
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - C Umiltà
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - A G Vieregg
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
- Department of Physics, Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - A Wandui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - A C Weber
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - D V Wiebe
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - J Willmert
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C L Wong
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - W L K Wu
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - H Yang
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K W Yoon
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
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Citrin D, Mehanni S, Acharya B, Wong L, Nirola I, Sherchan R, Gauchan B, Karki KB, Singh DR, Shamasunder S, Le P, Schwarz D, Schwarz R, Dangal B, Dhungana SK, Maru S, Mahar R, Thapa P, Raut A, Adhikari M, Basnett I, Kaluanee SP, Deukmedjian G, Halliday S, Maru D. Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal. Glob Health Action 2018; 10:1367161. [PMID: 28914185 PMCID: PMC5645653 DOI: 10.1080/16549716.2017.1367161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.
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Affiliation(s)
- David Citrin
- a Possible , Kathmandu , Nepal.,b Department of Anthropology , University of Washington , Seattle , WA , USA.,c Department of Global Health , University of Washington , Seattle , WA , USA.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Stephen Mehanni
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,g Gallup Indian Medical Center , Gallup , NM , USA
| | - Bibhav Acharya
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,h Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,i Shared Minds , Boston , MA , USA
| | - Lena Wong
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,j Tuba City Regional Health Care , Tuba City , AZ , USA
| | - Isha Nirola
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Rekha Sherchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Bikash Gauchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Khem Bahadur Karki
- k Nepal Health Research Council , Ministry of Health , Kathmandu , Nepal
| | - Dipendra Raman Singh
- l Public Health Monitoring & Evaluation Division , Ministry of Health , Kathmandu , Nepal
| | - Sriram Shamasunder
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Phuoc Le
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Dan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA
| | - Ryan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,o Department of Medicine, Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA
| | | | | | - Sheela Maru
- a Possible , Kathmandu , Nepal.,q Department of Obstetrics and Gynecology , Boston Medical Center , Boston , MA , USA.,r Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA , USA.,s Department Medicine, Division of Women's Health , Brigham and Women's Hospital , Boston , MA , USA
| | | | | | | | - Mukesh Adhikari
- t District Health Office, Department of Health Services , Ministry of Health , Mangalsen , Achham , Nepal
| | | | - Shankar Prasad Kaluanee
- a Possible , Kathmandu , Nepal.,u School of Leadership and Development , Eastern University , St. Davids , PA , USA
| | - Grace Deukmedjian
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,v Tséhootsooí Medical Center , Fort Defiance , AZ , USA
| | - Scott Halliday
- a Possible , Kathmandu , Nepal.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Duncan Maru
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA.,w Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
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Citrin D, Thapa P, Nirola I, Pandey S, Kunwar LB, Tenpa J, Acharya B, Rayamazi H, Thapa A, Maru S, Raut A, Poudel S, Timilsina D, Dhungana SK, Adhikari M, Khanal MN, Pratap Kc N, Acharya B, Karki KB, Singh DR, Bangura AH, Wacksman J, Storisteanu D, Halliday S, Schwarz R, Schwarz D, Choudhury N, Kumar A, Wu WJ, Kalaunee SP, Chaudhari P, Maru D. Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal. Healthc (Amst) 2018; 6:197-204. [PMID: 29880283 PMCID: PMC7739377 DOI: 10.1016/j.hjdsi.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/12/2018] [Accepted: 05/02/2018] [Indexed: 01/25/2023]
Abstract
Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems.
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Affiliation(s)
- David Citrin
- Possible, Kathmandu, Nepal; University of Washington, Department of Anthropology, Seattle, WA, USA; University of Washington, Department of Global Health, Seattle, WA, USA; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | | | | | | | | | | | - Bibhav Acharya
- Possible, Kathmandu, Nepal; University of California, San Francisco, Department of Psychiatry, San Francisco, CA, USA
| | | | | | - Sheela Maru
- Possible, Kathmandu, Nepal; Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA; Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA; Brigham and Women's Hospital, Department Medicine, Division of Women's Health, Boston, MA, USA
| | | | | | | | | | - Mukesh Adhikari
- Ministry of Health, Department of Health Services, Kathmnadu, Nepal
| | - Mukti Nath Khanal
- Nepal Health Sector Programme, Kathmandu, Nepal; Ministry of Health, Department of Health Services, Health Management Information Section, Kathmandu, Nepal
| | - Naresh Pratap Kc
- Ministry of Health, Department of Health Services, Management Division, Kathmandu, Nepal
| | - Bhim Acharya
- Ministry of Health, Department of Health Services, Epidemiology and Disease Control Division, Kathmandu, Nepal
| | - Khem Bahadur Karki
- Tribhuvan University, Institute of Medicine, Department of Community Health, Kathmandu, Nepal
| | - Dipendra Raman Singh
- Ministry of Health, Public Health Administration, Monitoring and Evaluation Division, Kathmandu, Nepal
| | - Alex Harsha Bangura
- Contra Costa Regional Medical Center, Contra Costa Family Medicine Residency, Martinez, CA, USA
| | | | | | - Scott Halliday
- Possible, Kathmandu, Nepal; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - Ryan Schwarz
- Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA
| | - Dan Schwarz
- Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA
| | | | - Anirudh Kumar
- Possible, Kathmandu, Nepal; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Wan-Ju Wu
- Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department Medicine, Division of Women's Health, Boston, MA, USA
| | - S P Kalaunee
- Possible, Kathmandu, Nepal; Eastern University, College of Business and Leadership, St. Davids, PA, USA
| | - Pushpa Chaudhari
- Ministry of Health, Department of Health Services, Kathmnadu, Nepal
| | - Duncan Maru
- Possible, Kathmandu, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, USA; Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
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26
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Ballard M, Schwarz R. Employing practitioner expertise in optimizing community healthcare systems. Healthc (Amst) 2018; 7:100334. [PMID: 30146473 DOI: 10.1016/j.hjdsi.2018.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 11/27/2022]
Abstract
To harness the potential of community health workers (CHWs) to extend health services to poor and marginalized populations and avoid the pitfalls of the post-Alma-Ata period, there is an urgent need to better understand how CHW programs can be optimized. Understanding that several operational questions are unresolved by current academic evidence, this viewpoint considers the role of practitioner expertise in optimizing community health systems and highlights findings from a recently published report that captures implementation experience from 15 countries. The viewpoint considers applications of the report's suggested community health design principles and implications for implementers, philanthropists, policymakers, and academic researchers.
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Affiliation(s)
| | - Ryan Schwarz
- Community Health Impact Coalition, Berlin, Germany; Possible, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA
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27
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Gargioni E, Domanski S, Schwarz R. EP-2011: Accuracy of NTCP models for rectum and bladder toxicity in prostate cancer patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Maru S, Nirola I, Thapa A, Thapa P, Kunwar L, Wu WJ, Halliday S, Citrin D, Schwarz R, Basnett I, Kc N, Karki K, Chaudhari P, Maru D. An integrated community health worker intervention in rural Nepal: a type 2 hybrid effectiveness-implementation study protocol. Implement Sci 2018; 13:53. [PMID: 29598824 PMCID: PMC5875011 DOI: 10.1186/s13012-018-0741-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Evidence-based medicines, technologies, and protocols exist to prevent many of the annual 300,000 maternal, 2.7 million neonatal, and 9 million child deaths, but they are not being effectively implemented and utilized in rural areas. Nepal, one of South Asia’s poorest countries with over 80% of its population living in rural areas, exemplifies this challenge. Community health workers are an important cadre in low-income countries where human resources for health and health care infrastructure are limited. As local women, they are uniquely positioned to understand and successfully navigate barriers to health care access. Recent case studies of large community health worker programs have highlighted the importance of training, both initial and ongoing, and accountability through structured management, salaries, and ongoing monitoring and evaluation. A gap in the evidence regarding whether such community health worker systems can change health outcomes, as well as be sustainably adopted at scale, remains. In this study, we plan to evaluate a community health worker system delivering an evidence-based integrated reproductive, maternal, newborn, and child health intervention as it is scaled up in rural Nepal. Methods We will conduct a type 2 hybrid effectiveness-implementation study to test both the effect of an integrated reproductive, maternal, newborn, and child health intervention and the implementation process via a professional community health worker system. The intervention integrates five evidence-based approaches: (1) home-based antenatal care and post-natal care counseling and care coordination; (2) continuous surveillance of all reproductive age women, pregnancies, and children under age 2 years via a mobile application; (3) Community-Based Integrated Management of Newborn and Childhood Illness; (4) group antenatal and postnatal care; and 5) the Balanced Counseling Strategy to post-partum contraception. We will evaluate effectiveness using a pre-post quasi-experimental design with stepped implementation and implementation using the RE-AIM framework. Discussion This is the first hybrid effectiveness-implementation study of an integrated reproductive, maternal, newborn, and child health intervention in rural Nepal that we are aware of. As Nepal takes steps towards achieving the Sustainable Development Goals, the data from this three-year study will be useful in the detailed planning of a professionalized community health worker cadre delivering evidence-based reproductive, maternal, newborn, and child health interventions to the country’s rural population. Trial registration ClinicalTrials.gov Identifier: NCT03371186, registered 04 December 2017, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13012-018-0741-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheela Maru
- Possible, Kathmandu, Nepal.,Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Isha Nirola
- Possible, Kathmandu, Nepal.,Department Medicine, Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Wan-Ju Wu
- Possible, Kathmandu, Nepal.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott Halliday
- Possible, Kathmandu, Nepal.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - David Citrin
- Possible, Kathmandu, Nepal.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ryan Schwarz
- Possible, Kathmandu, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Indira Basnett
- Department of Health Services, Nepal Health Sector Programme, Ministry of Health, Kathmandu, Nepal
| | - Naresh Kc
- Department of Health Services, Family Health Division, Ministry of Health, Kathmandu, Nepal
| | - Khem Karki
- Department of Community Medicine, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Pushpa Chaudhari
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Duncan Maru
- Possible, Kathmandu, Nepal. .,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Abstract
BACKGROUND Resistance of uropathogenic bacteria against the common antibiotics is considerable-especially in the elderly. OBJECTIVES In Germany nitroxoline is licensed for the treatment of acute urinary tract infections and for prophylaxis of recurrent infections. What is the actual resistance pattern of uropathogenic bacteria? MATERIALS AND METHODS The in vitro susceptibility of 477 uropathogenic bacteria from patients in 2015 was determined by means of the agar diffusion method. RESULTS Obviously, this agent is still active against the vast majority of uropathogenic bacteria and in particular against strains of Escherichia coli (E. coli). Pseudomonas aeruginosa and enterococci are not really within the spectrum of nitroxoline. One has to keep in mind, however, that even among E. coli and other enterobacteriaceae there are single resistant isolates. This applies in particular to problem strains resistant to many other antibiotics. DISCUSSION Nitroxoline is a reasonable alternative and a promising option for calculated treatment of urinary tract infections-especially of the elderly, although this drug is not recommended in the current guideline. Laboratory testing of clinical isolates should be requested-at least when treatment fails.
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Affiliation(s)
- H Hof
- MVZ Labor Limbach, Im Breitspiel 15, 69126, Heidelberg, Deutschland.
| | - D Bertsch
- MVZ Labor Limbach, Im Breitspiel 15, 69126, Heidelberg, Deutschland
| | - D Passek
- Praxis für Urologie, Hanau, Deutschland
| | - R Schwarz
- MVZ Labor Limbach, Im Breitspiel 15, 69126, Heidelberg, Deutschland
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30
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Fleming M, King C, Rajeev S, Baruwal A, Schwarz D, Schwarz R, Khadka N, Pande S, Khanal S, Acharya B, Benton A, Rogers SO, Panizales M, Gyorki D, McGee H, Shaye D, Maru D. Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal. BMC Health Serv Res 2017; 17:676. [PMID: 28946885 PMCID: PMC5613391 DOI: 10.1186/s12913-017-2624-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 09/15/2017] [Indexed: 11/11/2022] Open
Abstract
Background Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. Methods We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization’s Health Systems Framework. Results We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district’s per capita income. We identified and mapped challenges according to the World Health Organization’s Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. Conclusion The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization. Electronic supplementary material The online version of this article (10.1186/s12913-017-2624-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew Fleming
- Department of Surgery, Yale-New Haven Hospital, New Haven, CT, USA
| | - Caroline King
- Oregon Health & Sciences University, Portland, OR, USA
| | - Sindhya Rajeev
- Bellevue Hospital Center, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | | | - Dan Schwarz
- Possible, Sanfebagar-10, Achham, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Ryan Schwarz
- Possible, Sanfebagar-10, Achham, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Sami Pande
- United Nations Population Fund, Kathmandu, Nepal
| | - Sumesh Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Bibhav Acharya
- Possible, Sanfebagar-10, Achham, Nepal.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Adia Benton
- Department of Anthropology, Northwestern University, Evanston, IL, USA.,Program of African Studies, Northwestern University, Evanston, IL, USA
| | - Selwyn O Rogers
- Biological Sciences Division, Department of Surgery, University of Chicago, Chicago, IL, USA
| | | | - David Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Heather McGee
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Shaye
- Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duncan Maru
- Possible, Sanfebagar-10, Achham, Nepal. .,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Raut A, Yarbrough C, Singh V, Gauchan B, Citrin D, Verma V, Hawley J, Schwarz D, Harsha Bangura A, Shrestha B, Schwarz R, Adhikari M, Maru D. Design and implementation of an affordable, public sector electronic medical record in rural Nepal. J Innov Health Inform 2017; 24:862. [PMID: 28749321 DOI: 10.14236/jhi.v24i2.862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 02/02/2017] [Accepted: 12/15/2016] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. APPLICATION For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.
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Kaeding TS, Karch A, Schwarz R, Flor T, Wittke TC, Kück M, Böselt G, Tegtbur U, Stein L. Whole-body vibration training as a workplace-based sports activity for employees with chronic low-back pain. Scand J Med Sci Sports 2017; 27:2027-2039. [PMID: 28185300 DOI: 10.1111/sms.12852] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/26/2022]
Abstract
The goal of this randomized and controlled study was to examine whether whole-body vibration (WBV) training is able to reduce back pain and physical disability in seated working office employees with chronic low-back pain in a real-world setting. A total of 41 subjects (68.3% female/mean age 45.5±9.1 years/mean BMI 26.6±5.2) were randomly allocated to an intervention group (INT [n=21]) or a control group (CON [n=20]). The INT participated in WBV training 2.5 times per week for 3 months. The primary outcome was the change in the Roland and Morris disability questionnaire (RMQ) score over the study period. In addition, secondary outcomes included changes in the Oswestry Disability Index (ODI), the Work Ability Index Questionnaire, the quality of life questionnaire SF-36, the Freiburger activity questionnaire, and an isokinetic test of the musculature of the trunk. Compliance with the intervention in the INT reached a mean of 81.1%±31.2% with no long-lasting unwanted side effects. We found significant positive effects of 3 months of WBV training in the INT compared to the CON regarding the RMQ (P=.027), the ODI (P=.002), the SF-36 (P=.013), the Freiburger activity questionnaire (P=.022), the post-interventional sick-leave in the INT (P=.008), and trends regarding a positive effect of the intervention on the muscular capacity of the muscles of the trunk in flexion. WBV training seems to be an effective, safe, and suitable intervention for seated working employees with chronic low-back pain.
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Affiliation(s)
- T S Kaeding
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - A Karch
- Institute for Biostatistics, Hannover Medical School (MHH), Hannover, Germany
| | - R Schwarz
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - T Flor
- Institute for Biostatistics, Hannover Medical School (MHH), Hannover, Germany
| | - T-C Wittke
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - M Kück
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - G Böselt
- Deutsche Rentenversicherung Braunschweig-Hannover, Laatzen, Germany
| | - U Tegtbur
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - L Stein
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
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Acharya B, Maru D, Schwarz R, Citrin D, Tenpa J, Hirachan S, Basnet M, Thapa P, Swar S, Halliday S, Kohrt B, Luitel NP, Hung E, Gauchan B, Pokharel R, Ekstrand M. Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal. Global Health 2017; 13:2. [PMID: 28086925 PMCID: PMC5237195 DOI: 10.1186/s12992-016-0226-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation. PARTNERSHIPS NETWORK We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community. CONCLUSIONS We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.
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Affiliation(s)
- Bibhav Acharya
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal. .,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA, 94143, USA. .,Shared Minds, Boston, MA, USA.
| | - Duncan Maru
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ryan Schwarz
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David Citrin
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Jasmine Tenpa
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal
| | - Soniya Hirachan
- Shared Minds, Boston, MA, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Madhur Basnet
- Shared Minds, Boston, MA, USA.,Faculty of Medicine, Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Poshan Thapa
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal
| | - Sikhar Swar
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Psychiatric Department, Kathmandu Medical College, Kathmandu, Nepal
| | - Scott Halliday
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Brandon Kohrt
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,Global Health Institute, Duke University, Durham, NC, USA.,Department of Cultural Anthropology, Duke University, Durham, NC, USA
| | - Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Erick Hung
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA, 94143, USA
| | - Bikash Gauchan
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal
| | - Rajeev Pokharel
- Policy Planning & International Cooperation Division, Ministry of Health, Kathmandu, Nepal
| | - Maria Ekstrand
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Harsha Bangura A, Ozonoff A, Citrin D, Thapa P, Nirola I, Maru S, Schwarz R, Raut A, Belbase B, Halliday S, Adhikari M, Maru D. Practical issues in the measurement of child survival in health systems trials: experience developing a digital community-based mortality surveillance programme in rural Nepal. BMJ Glob Health 2016; 1:e000050. [PMID: 28588974 PMCID: PMC5321370 DOI: 10.1136/bmjgh-2016-000050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022] Open
Abstract
Child mortality measurement is essential to the impact evaluation of maternal and child healthcare systems interventions. In the absence of vital statistics systems, however, assessment methodologies for locally relevant interventions are severely challenged. Methods for assessing the under-5 mortality rate for cross-country comparisons, often used in determining progress towards development targets, pose challenges to implementers and researchers trying to assess the population impact of targeted interventions at more local levels. Here, we discuss the programmatic approach we have taken to mortality measurement in the context of delivering healthcare via a public–private partnership in rural Nepal. Both government officials and the delivery organisation, Possible, felt it was important to understand child mortality at a fine-grain spatial and temporal level. We discuss both the short-term and the long-term approach. In the short term, the team chose to use the under-2 mortality rate as a metric for mortality measurement for the following reasons: (1) as overall childhood mortality declines, like it has in rural Nepal, deaths concentrate among children under the age of 2; (2) 2-year cohorts are shorter and thus may show an impact more readily in the short term of intervention trials; and (3) 2-year cohorts are smaller, making prospective census cohorts more feasible in small populations. In the long term, Possible developed a digital continuous surveillance system to capture deaths as they occur, at which point under-5 mortality assessment would be desirable, largely owing to its role as a global standard.
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Affiliation(s)
- Alex Harsha Bangura
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Al Ozonoff
- Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, Center for Patient Safety and Quality Research, Boston, MA, USA
| | - David Citrin
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - Poshan Thapa
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Isha Nirola
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Sheela Maru
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA.,Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA.,Brigham and Women's Hospital, Department Medicine, Division of Women's Health, Boston, MA, USA
| | - Ryan Schwarz
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA
| | - Anant Raut
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Bishal Belbase
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Scott Halliday
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - Mukesh Adhikari
- Ministry of Health, Department of Health Services, District Health Office, Mangalsen, Achham, Nepal
| | - Duncan Maru
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, USA
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Karkare KS, Ade PAR, Ahmed Z, Alexander KD, Amiri M, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Boenish H, Bowens-Rubin R, Buder I, Bullock E, Buza V, Connors J, Filippini JP, Fliescher ST, Grayson JA, Halpern M, Harrison SA, Hilton GC, Hristov VV, Hui H, Irwin KD, Kang JH, Karpel E, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Leitch EM, Lueker M, Megerian KG, Monticue V, Namikawa T, Netterfield CB, Nguyen HT, O'Brient R, Ogburn RW, Pryke CL, Reintsema CD, Richter S, St. Germaine MT, Schwarz R, Sheehy CD, Staniszewski ZK, Steinbach B, Teply GP, Thompson KL, Tolan JE, Tucker C, Turner AD, Vieregg AG, Wandui A, Weber A, Willmert J, Wong CL, Wu WLK, Yoon KW. Optical characterization of the BICEP3 CMB polarimeter at the South Pole. ACTA ACUST UNITED AC 2016. [DOI: 10.1117/12.2231747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- K. S. Karkare
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | | | | | - M. Amiri
- The Univ. of British Columbia (Canada)
| | - D. Barkats
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | - C. A. Bischoff
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | - J. J. Bock
- California Institute of Technology (United States)
| | - H. Boenish
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | - I. Buder
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | - V. Buza
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | - J. Connors
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | | | | | | | - S. A. Harrison
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | - G. C. Hilton
- National Institute of Standards and Technology (United States)
| | | | - H. Hui
- California Institute of Technology (United States)
| | | | | | | | - S. Kefeli
- California Institute of Technology (United States)
| | | | - J. M. Kovac
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | | | - M. Lueker
- California Institute of Technology (United States)
| | | | | | | | | | | | | | | | | | - C. D. Reintsema
- National Institute of Standards and Technology (United States)
| | - S. Richter
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | - R. Schwarz
- Univ. of Minnesota, Twin Cities (United States)
| | | | | | - B. Steinbach
- California Institute of Technology (United States)
| | - G. P. Teply
- California Institute of Technology (United States)
| | | | | | | | | | - A. G. Vieregg
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | | | - A. Weber
- Jet Propulsion Lab. (United States)
| | | | - C. L. Wong
- Harvard-Smithsonian Ctr. for Astrophysics (United States)
| | - W. L. K. Wu
- Univ. of California, Berkeley (United States)
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Ade PAR, Ahmed Z, Aikin RW, Alexander KD, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Bowens-Rubin R, Brevik JA, Buder I, Bullock E, Buza V, Connors J, Crill BP, Duband L, Dvorkin C, Filippini JP, Fliescher S, Grayson J, Halpern M, Harrison S, Hilton GC, Hui H, Irwin KD, Karkare KS, Karpel E, Kaufman JP, Keating BG, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Leitch EM, Lueker M, Megerian KG, Netterfield CB, Nguyen HT, O'Brient R, Ogburn RW, Orlando A, Pryke C, Richter S, Schwarz R, Sheehy CD, Staniszewski ZK, Steinbach B, Sudiwala RV, Teply GP, Thompson KL, Tolan JE, Tucker C, Turner AD, Vieregg AG, Weber AC, Wiebe DV, Willmert J, Wong CL, Wu WLK, Yoon KW. Improved Constraints on Cosmology and Foregrounds from BICEP2 and Keck Array Cosmic Microwave Background Data with Inclusion of 95 GHz Band. Phys Rev Lett 2016; 116:031302. [PMID: 26849583 DOI: 10.1103/physrevlett.116.031302] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Indexed: 06/05/2023]
Abstract
We present results from an analysis of all data taken by the BICEP2 and Keck Array cosmic microwave background (CMB) polarization experiments up to and including the 2014 observing season. This includes the first Keck Array observations at 95 GHz. The maps reach a depth of 50 nK deg in Stokes Q and U in the 150 GHz band and 127 nK deg in the 95 GHz band. We take auto- and cross-spectra between these maps and publicly available maps from WMAP and Planck at frequencies from 23 to 353 GHz. An excess over lensed ΛCDM is detected at modest significance in the 95×150 BB spectrum, and is consistent with the dust contribution expected from our previous work. No significant evidence for synchrotron emission is found in spectra such as 23×95, or for correlation between the dust and synchrotron sky patterns in spectra such as 23×353. We take the likelihood of all the spectra for a multicomponent model including lensed ΛCDM, dust, synchrotron, and a possible contribution from inflationary gravitational waves (as parametrized by the tensor-to-scalar ratio r) using priors on the frequency spectral behaviors of dust and synchrotron emission from previous analyses of WMAP and Planck data in other regions of the sky. This analysis yields an upper limit r_{0.05}<0.09 at 95% confidence, which is robust to variations explored in analysis and priors. Combining these B-mode results with the (more model-dependent) constraints from Planck analysis of CMB temperature plus baryon acoustic oscillations and other data yields a combined limit r_{0.05}<0.07 at 95% confidence. These are the strongest constraints to date on inflationary gravitational waves.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - Z Ahmed
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - R W Aikin
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Alexander
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - D Barkats
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - S J Benton
- Department of Physics, University of Toronto, Toronto, Ontario, M5S 1A7, Canada
| | - C A Bischoff
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J J Bock
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R Bowens-Rubin
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J A Brevik
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - I Buder
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - V Buza
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J Connors
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - B P Crill
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - C Dvorkin
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J P Filippini
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - S Fliescher
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Grayson
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - M Halpern
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - S Harrison
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H Hui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Irwin
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - K S Karkare
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - E Karpel
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J P Kaufman
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - B G Keating
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - S Kefeli
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J M Kovac
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C L Kuo
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - E M Leitch
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - M Lueker
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K G Megerian
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - C B Netterfield
- Department of Physics, University of Toronto, Toronto, Ontario, M5S 1A7, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario M5G 1Z8, Canada
| | - H T Nguyen
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R O'Brient
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R W Ogburn
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - A Orlando
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - S Richter
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - R Schwarz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C D Sheehy
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - Z K Staniszewski
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - B Steinbach
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R V Sudiwala
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - G P Teply
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - K L Thompson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Tucker
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - A D Turner
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - A G Vieregg
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
- Department of Physics, Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - A C Weber
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - D V Wiebe
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - J Willmert
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C L Wong
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - W L K Wu
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K W Yoon
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
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Hamre H, Glockmann A, Schwarz R, Riley D, Baars E, Kiene H, Kienle G. Antibiotikaverbrauch bei Kindern mit akuten Atemwegs- oder Ohrinfekten: eine prospektive Beobachtungsstudie zum Vergleich zwischen anthroposophischer und konventioneller Behandlung in der hausärztlichen Routineversorgung. ACTA ACUST UNITED AC 2016. [DOI: 10.14271/dms-20637-de] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Weiss S, Van Egmond-Fröhlich A, Hofer N, Pfleger A, Rath R, Schwarz R, Kurz H, Waibel V, Kenzian H, Kommer E, Wadlegger F, Stelzl W, Keck B, Grigorow I, Kerbl R, Sauseng W, Frischer T, Eber E, Bernert G. Long-Term Respiratory Support for Children and Adolescents in Austria: A National Survey. Klin Padiatr 2015; 228:42-6. [PMID: 26697738 DOI: 10.1055/s-0035-1565240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Population-based data on pediatric patients on long-term respiratory support (LTRS) in Austria are lacking. This study aimed to record the pediatric departments active in this field, as well as number and characteristics of patients on LTRS. METHODS A national cross-sectional study was carried out by means of questionnaires sent to all pediatric departments in Austria. RESULTS All departments answered to the questionnaires. On June 1st, 2013, the reference day for this study, 12 of the 41 pediatric departments in Austria were active in the field. At this time, these centers were caring for 143 patients, 111 (77.6%) of them under 18 years, which corresponds to a prevalence of 7.4 per 100 000. The patients suffered from neuromuscular disorders (44%), other neurological disorders (18.9%), disorders of respiratory drive (9.1%), obstructive sleep apnea (8.4%), thoracal and spinal diseases (8.4%), pulmonary disorders (4.9%) and other diseases (6.3%). Continuous positive airway pressure was used in 6.3%, non-invasive ventilation in 60.1% and invasive ventilation in 33.6% of the patients, respectively. LTRS was performed at home in 92.3%. CONCLUSION LTRS represents a common management strategy in children and adolescents with a variety of disorders. Census reports such as this one provide the basis for appropriate planning of resource allocation. The age distribution of our patients shows the need for structured transition into adult care.
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Affiliation(s)
- S Weiss
- Department of Pediatrics, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - N Hofer
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - A Pfleger
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - R Rath
- Department of Pediatrics, Hospital Moedling, Moedling, Austria
| | - R Schwarz
- Department of Pediatrics, Women's and Children's Hospital Linz, Linz, Austria
| | - H Kurz
- Department of Pediatrics, SMZ Ost Danube Hospital, Vienna, Austria
| | - V Waibel
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - H Kenzian
- Department of Pediatrics, Hospital Villach, Villach, Austria
| | - E Kommer
- Department of Pediatrics, Hospital Mistelbach, Mistelbach, Austria
| | - F Wadlegger
- Department of Pediatrics, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - W Stelzl
- Department of Pediatrics, Hospital Feldkirch, Feldkirch, Austria
| | - B Keck
- St. Anna Children's Hospital, Vienna, Austria
| | - I Grigorow
- Department of Pediatrics, Hospital Leoben, Leoben, Austria
| | - R Kerbl
- Department of Pediatrics, Wilhelminenspital, Vienna, Austria
| | - W Sauseng
- Medical Services, Youth and Child Welfare Services, City of Graz, Austria
| | - T Frischer
- Department of Pediatrics, Wilhelminenspital, Vienna, Austria
| | - E Eber
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - G Bernert
- Department of Pediatrics, Kaiser Franz Josef Hospital, Vienna, Austria
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Raut A, Thapa P, Citrin D, Schwarz R, Gauchan B, Bista D, Tamrakar B, Halliday S, Maru D, Schwarz D. Design and implementation of a patient navigation system in rural Nepal: Improving patient experience in resource-constrained settings. Healthc (Amst) 2015; 3:251-7. [PMID: 26699353 DOI: 10.1016/j.hjdsi.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/18/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
Patient navigation programs have shown to be effective across multiple settings in guiding patients through the care delivery process. Limited experience and literature exist, however, for such programs in rural and resource-constrained environments. Patients living in such settings frequently have low health literacy and substantially lower social status than their providers. They typically have limited experiences interfacing with formalized healthcare systems, and, when they do, their experience can be unpleasant and confusing. At a district hospital in rural far-western Nepal, we designed and implemented a patient navigation system that aimed to improve patients' subjective care experience. First, we hired and trained a team of patient navigators who we recruited from the local area. Their responsibility is exclusively to demonstrate compassion and to guide patients through their care process. Second, we designed visual cues throughout our hospital complex to assist in navigating patients through the buildings. Third, we incorporated the patient navigators within the management and communications systems of the hospital care team, and established standard operating procedures. We describe here our experiences and challenges in designing and implementing a patient navigator program. Such patient-centered systems may be relevant at other facilities in Nepal and globally where patient health literacy is low, patients come from backgrounds of substantial marginalization and disempowerment, and patient experience with healthcare facilities is limited.
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Affiliation(s)
- Anant Raut
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal
| | - Poshan Thapa
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal
| | - David Citrin
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; University of Washington, Department of Anthropology, Seattle, WA, United States; University of Washington, Department of Global Health, Seattle, WA, United States; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, United States
| | - Ryan Schwarz
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, United States
| | - Bikash Gauchan
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal
| | - Deepak Bista
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal
| | - Bibhu Tamrakar
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal
| | - Scott Halliday
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States
| | - Duncan Maru
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, United States; Harvard Medical School, Department of Medicine, Boston, MA, United States
| | - Dan Schwarz
- Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, United States
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Ade PAR, Ahmed Z, Aikin RW, Alexander KD, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Brevik JA, Buder I, Bullock E, Buza V, Connors J, Crill BP, Dowell CD, Dvorkin C, Duband L, Filippini JP, Fliescher S, Golwala SR, Halpern M, Harrison S, Hasselfield M, Hildebrandt SR, Hilton GC, Hristov VV, Hui H, Irwin KD, Karkare KS, Kaufman JP, Keating BG, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Leitch EM, Lueker M, Mason P, Megerian KG, Netterfield CB, Nguyen HT, O’Brient R, Ogburn IV RW, Orlando A, Pryke C, Reintsema CD, Richter S, Schwarz R, Sheehy CD, Staniszewski ZK, Sudiwala RV, Teply GP, Thompson KL, Tolan JE, Turner AD, Vieregg AG, Weber AC, Willmert J, Wong CL, Yoon KW. BICEP2/KECK ARRAY V: MEASUREMENTS OFB-MODE POLARIZATION AT DEGREE ANGULAR SCALES AND 150 GHz BY THE KECK ARRAY. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/811/2/126] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kittel-Schneider S, Schreck S, Ziegler C, Weißflog L, Hilscher M, Schwarz R, Schnetzler L, Neuner M, Reif A. Lithium-induced Clock Gene Expression in Lymphoblastoid Cells of Bipolar Affective Patients. Pharmacopsychiatry 2015; 48:145-9. [PMID: 26011568 DOI: 10.1055/s-0035-1549946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Disturbances of circadian rhythms occur in all episodes of bipolar disorder (BD). Lithium, as gold-standard in the maintenance treatment of BD, is known to influence circadian processes. METHODS In a pilot study lymphoblastoid cell lines (LCLs) were generated from 8 BD patients and 6 healthy controls. The LCLs were treated with lithiumchloride (LiCl) for 3 weeks. Cell cycles were then synchronized and expressional analysis by quantitative Real Time PCR was done. RESULTS BD and controls differed in the period length regarding DBP (albumin D-box binding protein) expression and DBP expression was also influenced by lithium treatment. Furthermore, baseline DBP expression was significantly different between non-treated BD and healthy controls. None of the other analyzed circadian genes showed to be influenced by chronic lithium treatment or to be differentially regulated due to the diagnosis. DISCUSSION We here show that chronic lithium treatment of LCLs leads to decreased expression of the clock gene DBP, rendering DBP a lithium-regulated gene. We could confirm the role of the circadian clock as well in lithium mode of action as in the pathomechanisms of BD although future studies with a greater number of participants and cell lines are needed.
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Affiliation(s)
- S Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - S Schreck
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - C Ziegler
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - L Weißflog
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - M Hilscher
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - R Schwarz
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - L Schnetzler
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - M Neuner
- Department of Psychiatry, Community Hospital of Lohr, Lohr am Main, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
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Meyer W, Schwarz R, Neurand K. The skin of domestic mammals as a model for the human skin, with special reference to the domestic pig. Curr Probl Dermatol 2015; 7:39-52. [PMID: 752456 DOI: 10.1159/000401274] [Citation(s) in RCA: 287] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Gargioni E, Mehta P, Jäckel M, Raabe A, Schwarz R. PO-0893: Robustness of biologically-based treatment planning for prostate cancer patients. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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Ade PAR, Aghanim N, Ahmed Z, Aikin RW, Alexander KD, Arnaud M, Aumont J, Baccigalupi C, Banday AJ, Barkats D, Barreiro RB, Bartlett JG, Bartolo N, Battaner E, Benabed K, Benoît A, Benoit-Lévy A, Benton SJ, Bernard JP, Bersanelli M, Bielewicz P, Bischoff CA, Bock JJ, Bonaldi A, Bonavera L, Bond JR, Borrill J, Bouchet FR, Boulanger F, Brevik JA, Bucher M, Buder I, Bullock E, Burigana C, Butler RC, Buza V, Calabrese E, Cardoso JF, Catalano A, Challinor A, Chary RR, Chiang HC, Christensen PR, Colombo LPL, Combet C, Connors J, Couchot F, Coulais A, Crill BP, Curto A, Cuttaia F, Danese L, Davies RD, Davis RJ, de Bernardis P, de Rosa A, de Zotti G, Delabrouille J, Delouis JM, Désert FX, Dickinson C, Diego JM, Dole H, Donzelli S, Doré O, Douspis M, Dowell CD, Duband L, Ducout A, Dunkley J, Dupac X, Dvorkin C, Efstathiou G, Elsner F, Enßlin TA, Eriksen HK, Falgarone E, Filippini JP, Finelli F, Fliescher S, Forni O, Frailis M, Fraisse AA, Franceschi E, Frejsel A, Galeotta S, Galli S, Ganga K, Ghosh T, Giard M, Gjerløw E, Golwala SR, González-Nuevo J, Górski KM, Gratton S, Gregorio A, Gruppuso A, Gudmundsson JE, Halpern M, Hansen FK, Hanson D, Harrison DL, Hasselfield M, Helou G, Henrot-Versillé S, Herranz D, Hildebrandt SR, Hilton GC, Hivon E, Hobson M, Holmes WA, Hovest W, Hristov VV, Huffenberger KM, Hui H, Hurier G, Irwin KD, Jaffe AH, Jaffe TR, Jewell J, Jones WC, Juvela M, Karakci A, Karkare KS, Kaufman JP, Keating BG, Kefeli S, Keihänen E, Kernasovskiy SA, Keskitalo R, Kisner TS, Kneissl R, Knoche J, Knox L, Kovac JM, Krachmalnicoff N, Kunz M, Kuo CL, Kurki-Suonio H, Lagache G, Lähteenmäki A, Lamarre JM, Lasenby A, Lattanzi M, Lawrence CR, Leitch EM, Leonardi R, Levrier F, Lewis A, Liguori M, Lilje PB, Linden-Vørnle M, López-Caniego M, Lubin PM, Lueker M, Macías-Pérez JF, Maffei B, Maino D, Mandolesi N, Mangilli A, Maris M, Martin PG, Martínez-González E, Masi S, Mason P, Matarrese S, Megerian KG, Meinhold PR, Melchiorri A, Mendes L, Mennella A, Migliaccio M, Mitra S, Miville-Deschênes MA, Moneti A, Montier L, Morgante G, Mortlock D, Moss A, Munshi D, Murphy JA, Naselsky P, Nati F, Natoli P, Netterfield CB, Nguyen HT, Nørgaard-Nielsen HU, Noviello F, Novikov D, Novikov I, O'Brient R, Ogburn RW, Orlando A, Pagano L, Pajot F, Paladini R, Paoletti D, Partridge B, Pasian F, Patanchon G, Pearson TJ, Perdereau O, Perotto L, Pettorino V, Piacentini F, Piat M, Pietrobon D, Plaszczynski S, Pointecouteau E, Polenta G, Ponthieu N, Pratt GW, Prunet S, Pryke C, Puget JL, Rachen JP, Reach WT, Rebolo R, Reinecke M, Remazeilles M, Renault C, Renzi A, Richter S, Ristorcelli I, Rocha G, Rossetti M, Roudier G, Rowan-Robinson M, Rubiño-Martín JA, Rusholme B, Sandri M, Santos D, Savelainen M, Savini G, Schwarz R, Scott D, Seiffert MD, Sheehy CD, Spencer LD, Staniszewski ZK, Stolyarov V, Sudiwala R, Sunyaev R, Sutton D, Suur-Uski AS, Sygnet JF, Tauber JA, Teply GP, Terenzi L, Thompson KL, Toffolatti L, Tolan JE, Tomasi M, Tristram M, Tucci M, Turner AD, Valenziano L, Valiviita J, Van Tent B, Vibert L, Vielva P, Vieregg AG, Villa F, Wade LA, Wandelt BD, Watson R, Weber AC, Wehus IK, White M, White SDM, Willmert J, Wong CL, Yoon KW, Yvon D, Zacchei A, Zonca A. Joint analysis of BICEP2/keck array and Planck Data. Phys Rev Lett 2015; 114:101301. [PMID: 25815919 DOI: 10.1103/physrevlett.114.101301] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Indexed: 06/04/2023]
Abstract
We report the results of a joint analysis of data from BICEP2/Keck Array and Planck. BICEP2 and Keck Array have observed the same approximately 400 deg^{2} patch of sky centered on RA 0 h, Dec. -57.5°. The combined maps reach a depth of 57 nK deg in Stokes Q and U in a band centered at 150 GHz. Planck has observed the full sky in polarization at seven frequencies from 30 to 353 GHz, but much less deeply in any given region (1.2 μK deg in Q and U at 143 GHz). We detect 150×353 cross-correlation in B modes at high significance. We fit the single- and cross-frequency power spectra at frequencies ≥150 GHz to a lensed-ΛCDM model that includes dust and a possible contribution from inflationary gravitational waves (as parametrized by the tensor-to-scalar ratio r), using a prior on the frequency spectral behavior of polarized dust emission from previous Planck analysis of other regions of the sky. We find strong evidence for dust and no statistically significant evidence for tensor modes. We probe various model variations and extensions, including adding a synchrotron component in combination with lower frequency data, and find that these make little difference to the r constraint. Finally, we present an alternative analysis which is similar to a map-based cleaning of the dust contribution, and show that this gives similar constraints. The final result is expressed as a likelihood curve for r, and yields an upper limit r_{0.05}<0.12 at 95% confidence. Marginalizing over dust and r, lensing B modes are detected at 7.0σ significance.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Queens Buildings, The Parade, Cardiff, CF24 3AA, United Kingdom
| | - N Aghanim
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - Z Ahmed
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - R W Aikin
- California Institute of Technology, Pasadena, California, USA
| | - K D Alexander
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - M Arnaud
- Laboratoire AIM, IRFU/Service d'Astrophysique-CEA/DSM-CNRS-Université Paris Diderot, Bâtiment 709, CEA-Saclay, F-91191 Gif-sur-Yvette Cedex, France
| | - J Aumont
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - C Baccigalupi
- SISSA, Astrophysics Sector, via Bonomea 265, 34136, Trieste, Italy
| | - A J Banday
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - D Barkats
- Joint ALMA Observatory, Vitacura, Santiago, Chile
| | - R B Barreiro
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
| | - J G Bartlett
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - N Bartolo
- Dipartimento di Fisica e Astronomia G. Galilei, Università degli Studi di Padova, via Marzolo 8, 35131 Padova, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, via Marzolo 8, I-35131 Padova, Italy
| | - E Battaner
- University of Granada, Departamento de Física Teórica y del Cosmos, Facultad de Ciencias, Granada, Spain
- University of Granada, Instituto Carlos I de Física Teórica y Computacional, Granada, Spain
| | - K Benabed
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- UPMC Université de Paris 06, UMR7095, 98 bis Boulevard Arago, F-75014, Paris, France
| | - A Benoît
- Institut Néel, CNRS, Université Joseph Fourier Grenoble I, 25 rue des Martyrs, Grenoble, France
| | - A Benoit-Lévy
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- UPMC Université de Paris 06, UMR7095, 98 bis Boulevard Arago, F-75014, Paris, France
- Department of Physics and Astronomy, University College London, London WC1E 6BT, United Kingdom
| | - S J Benton
- Department of Physics, University of Toronto, Toronto, Ontario, M5S 1A7, Canada
| | - J-P Bernard
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - M Bersanelli
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria, 16, Milano, Italy
- INAF/IASF Milano, Via E. Bassini 15, Milano, Italy
| | - P Bielewicz
- SISSA, Astrophysics Sector, via Bonomea 265, 34136, Trieste, Italy
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - C A Bischoff
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J J Bock
- California Institute of Technology, Pasadena, California, USA
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - A Bonaldi
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - L Bonavera
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
| | - J R Bond
- CITA, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 3H8, Canada
| | - J Borrill
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, California, USA
- Space Sciences Laboratory, University of California, Berkeley, California, USA
| | - F R Bouchet
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- Sorbonne Université-UPMC, UMR7095, Institut d'Astrophysique de Paris, 98 bis Boulevard Arago, F-75014, Paris, France
| | - F Boulanger
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - J A Brevik
- California Institute of Technology, Pasadena, California, USA
| | - M Bucher
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - I Buder
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C Burigana
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
- Dipartimento di Fisica e Scienze della Terra, Università di Ferrara, Via Saragat 1, 44122 Ferrara, Italy
- INFN, Sezione di Bologna, Via Irnerio 46, I-40126, Bologna, Italy
| | - R C Butler
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - V Buza
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - E Calabrese
- Sub-Department of Astrophysics, University of Oxford, Keble Road, Oxford OX1 3RH, United Kingdom
| | - J-F Cardoso
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- Laboratoire Traitement et Communication de l'Information, CNRS (UMR 5141) and Télécom ParisTech, 46 rue Barrault F-75634 Paris Cedex 13, France
| | - A Catalano
- Laboratoire de Physique Subatomique et Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3, 53, rue des Martyrs, 38026 Grenoble Cedex, France
- LERMA, CNRS, Observatoire de Paris, 61 Avenue de l'Observatoire, Paris, France
| | - A Challinor
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, United Kingdom
- Kavli Institute for Cosmology Cambridge, Madingley Road, Cambridge, CB3 0HA, United Kingdom
- Centre for Theoretical Cosmology, DAMTP, University of Cambridge, Wilberforce Road, Cambridge CB3 0WA, United Kingdom
| | - R-R Chary
- Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, California 91125, USA
| | - H C Chiang
- Department of Physics, Princeton University, Princeton, New Jersey, USA
- Astrophysics & Cosmology Research Unit, School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
| | - P R Christensen
- Niels Bohr Institute, Blegdamsvej 17, Copenhagen, Denmark
- Discovery Center, Niels Bohr Institute, Blegdamsvej 17, Copenhagen, Denmark
| | - L P L Colombo
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
- Department of Physics and Astronomy, Dana and David Dornsife College of Letter, Arts and Sciences, University of Southern California, Los Angeles, California 90089, USA
| | - C Combet
- Laboratoire de Physique Subatomique et Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3, 53, rue des Martyrs, 38026 Grenoble Cedex, France
| | - J Connors
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - F Couchot
- LAL, Université Paris-Sud, CNRS/IN2P3, Orsay, France
| | - A Coulais
- LERMA, CNRS, Observatoire de Paris, 61 Avenue de l'Observatoire, Paris, France
| | - B P Crill
- California Institute of Technology, Pasadena, California, USA
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - A Curto
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
- Astrophysics Group, Cavendish Laboratory, University of Cambridge, J J Thomson Avenue, Cambridge CB3 0HE, United Kingdom
| | - F Cuttaia
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - L Danese
- SISSA, Astrophysics Sector, via Bonomea 265, 34136, Trieste, Italy
| | - R D Davies
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - R J Davis
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - P de Bernardis
- Dipartimento di Fisica, Università La Sapienza, Piazzale Aldo Moro 2, Roma, Italy
| | - A de Rosa
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - G de Zotti
- SISSA, Astrophysics Sector, via Bonomea 265, 34136, Trieste, Italy
- INAF-Osservatorio Astronomico di Padova, Vicolo dell'Osservatorio 5, Padova, Italy
| | - J Delabrouille
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - J-M Delouis
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- UPMC Université de Paris 06, UMR7095, 98 bis Boulevard Arago, F-75014, Paris, France
| | - F-X Désert
- IPAG: Institut de Planétologie et d'Astrophysique de Grenoble, Université Grenoble Alpes, IPAG, F-38000 Grenoble, France, CNRS, IPAG, F-38000 Grenoble, France
| | - C Dickinson
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - J M Diego
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
| | - H Dole
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
- Institut Universitaire de France, 103, bd Saint-Michel, 75005, Paris, France
| | - S Donzelli
- INAF/IASF Milano, Via E. Bassini 15, Milano, Italy
| | - O Doré
- California Institute of Technology, Pasadena, California, USA
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - M Douspis
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - C D Dowell
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - A Ducout
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- Imperial College London, Astrophysics group, Blackett Laboratory, Prince Consort Road, London, SW7 2AZ, United Kingdom
| | - J Dunkley
- Sub-Department of Astrophysics, University of Oxford, Keble Road, Oxford OX1 3RH, United Kingdom
| | - X Dupac
- European Space Agency, ESAC, Planck Science Office, Camino bajo del Castillo, s/n, Urbanización Villafranca del Castillo, Villanueva de la Cañada, Madrid, Spain
| | - C Dvorkin
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - G Efstathiou
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, United Kingdom
| | - F Elsner
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- UPMC Université de Paris 06, UMR7095, 98 bis Boulevard Arago, F-75014, Paris, France
- Department of Physics and Astronomy, University College London, London WC1E 6BT, United Kingdom
| | - T A Enßlin
- Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Strasse 1, 85741 Garching, Germany
| | - H K Eriksen
- Institute of Theoretical Astrophysics, University of Oslo, Blindern, Oslo, Norway
| | - E Falgarone
- LERMA, CNRS, Observatoire de Paris, 61 Avenue de l'Observatoire, Paris, France
| | - J P Filippini
- California Institute of Technology, Pasadena, California, USA
- Department of Physics, University of Illinois at Urbana-Champaign, 1110 West Green Street, Urbana, Illinois, USA
| | - F Finelli
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
- INFN, Sezione di Bologna, Via Irnerio 46, I-40126, Bologna, Italy
| | - S Fliescher
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - O Forni
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - M Frailis
- INAF-Osservatorio Astronomico di Trieste, Via G.B. Tiepolo 11, Trieste, Italy
| | - A A Fraisse
- Department of Physics, Princeton University, Princeton, New Jersey, USA
| | - E Franceschi
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - A Frejsel
- Niels Bohr Institute, Blegdamsvej 17, Copenhagen, Denmark
| | - S Galeotta
- INAF-Osservatorio Astronomico di Trieste, Via G.B. Tiepolo 11, Trieste, Italy
| | - S Galli
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
| | - K Ganga
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - T Ghosh
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - M Giard
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - E Gjerløw
- Institute of Theoretical Astrophysics, University of Oslo, Blindern, Oslo, Norway
| | - S R Golwala
- California Institute of Technology, Pasadena, California, USA
| | - J González-Nuevo
- SISSA, Astrophysics Sector, via Bonomea 265, 34136, Trieste, Italy
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
| | - K M Górski
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
- Warsaw University Observatory, Aleje Ujazdowskie 4, 00-478 Warszawa, Poland
| | - S Gratton
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, United Kingdom
- Kavli Institute for Cosmology Cambridge, Madingley Road, Cambridge, CB3 0HA, United Kingdom
| | - A Gregorio
- INAF-Osservatorio Astronomico di Trieste, Via G.B. Tiepolo 11, Trieste, Italy
- Dipartimento di Fisica, Università degli Studi di Trieste, via Alfonso Valerio 2, Trieste, Italy
- INFN/National Institute for Nuclear Physics, Via Valerio 2, I-34127 Trieste, Italy
| | - A Gruppuso
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - J E Gudmundsson
- Department of Physics, Princeton University, Princeton, New Jersey, USA
| | - M Halpern
- Department of Physics & Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, British Columbia, Canada
| | - F K Hansen
- Institute of Theoretical Astrophysics, University of Oslo, Blindern, Oslo, Norway
| | - D Hanson
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
- CITA, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 3H8, Canada
- McGill Physics, Ernest Rutherford Physics Building, McGill University, 3600 rue University, Montréal, Quebec, H3A 2T8, Canada
| | - D L Harrison
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, United Kingdom
- Kavli Institute for Cosmology Cambridge, Madingley Road, Cambridge, CB3 0HA, United Kingdom
| | - M Hasselfield
- Department of Physics & Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, British Columbia, Canada
| | - G Helou
- California Institute of Technology, Pasadena, California, USA
| | | | - D Herranz
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
| | - S R Hildebrandt
- California Institute of Technology, Pasadena, California, USA
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - E Hivon
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- UPMC Université de Paris 06, UMR7095, 98 bis Boulevard Arago, F-75014, Paris, France
| | - M Hobson
- Astrophysics Group, Cavendish Laboratory, University of Cambridge, J J Thomson Avenue, Cambridge CB3 0HE, United Kingdom
| | - W A Holmes
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - W Hovest
- Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Strasse 1, 85741 Garching, Germany
| | - V V Hristov
- California Institute of Technology, Pasadena, California, USA
| | - K M Huffenberger
- Department of Physics, Florida State University, Keen Physics Building, 77 Chieftan Way, Tallahassee, Florida, USA
| | - H Hui
- California Institute of Technology, Pasadena, California, USA
| | - G Hurier
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - K D Irwin
- Department of Physics, Stanford University, Stanford, California 94305, USA
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - A H Jaffe
- Imperial College London, Astrophysics group, Blackett Laboratory, Prince Consort Road, London, SW7 2AZ, United Kingdom
| | - T R Jaffe
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - J Jewell
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - W C Jones
- Department of Physics, Princeton University, Princeton, New Jersey, USA
| | - M Juvela
- Department of Physics, Gustaf Hällströmin katu 2a, University of Helsinki, Helsinki, Finland
| | - A Karakci
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - K S Karkare
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J P Kaufman
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - B G Keating
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - S Kefeli
- California Institute of Technology, Pasadena, California, USA
| | - E Keihänen
- Department of Physics, Gustaf Hällströmin katu 2a, University of Helsinki, Helsinki, Finland
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - R Keskitalo
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - T S Kisner
- Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - R Kneissl
- European Southern Observatory, ESO Vitacura, Alonso de Cordova 3107, Vitacura, Casilla 19001, Santiago, Chile
- Atacama Large Millimeter/submillimeter Array, ALMA Santiago Central Offices, Alonso de Cordova 3107, Vitacura, Casilla 763 0355, Santiago, Chile
| | - J Knoche
- Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Strasse 1, 85741 Garching, Germany
| | - L Knox
- Department of Physics, University of California, One Shields Avenue, Davis, California, USA
| | - J M Kovac
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - N Krachmalnicoff
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria, 16, Milano, Italy
| | - M Kunz
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
- Département de Physique Théorique, Université de Genève, 24, Quai E. Ansermet, 1211 Genève 4, Switzerland
- African Institute for Mathematical Sciences, 6-8 Melrose Road, Muizenberg, Cape Town, South Africa
| | - C L Kuo
- Department of Physics, Stanford University, Stanford, California 94305, USA
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - H Kurki-Suonio
- Department of Physics, Gustaf Hällströmin katu 2a, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Physics, Gustaf Hällströmin katu 2, University of Helsinki, Helsinki, Finland
| | - G Lagache
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
- Aix Marseille Université, CNRS, LAM (Laboratoire d'Astrophysique de Marseille) UMR 7326, 13388, Marseille, France
| | - A Lähteenmäki
- Helsinki Institute of Physics, Gustaf Hällströmin katu 2, University of Helsinki, Helsinki, Finland
- Aalto University Metsähovi Radio Observatory and Department of Radio Science and Engineering, P.O. Box 13000, FI-00076 AALTO, Finland
| | - J-M Lamarre
- LERMA, CNRS, Observatoire de Paris, 61 Avenue de l'Observatoire, Paris, France
| | - A Lasenby
- Kavli Institute for Cosmology Cambridge, Madingley Road, Cambridge, CB3 0HA, United Kingdom
- Astrophysics Group, Cavendish Laboratory, University of Cambridge, J J Thomson Avenue, Cambridge CB3 0HE, United Kingdom
| | - M Lattanzi
- Dipartimento di Fisica e Scienze della Terra, Università di Ferrara, Via Saragat 1, 44122 Ferrara, Italy
| | - C R Lawrence
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - E M Leitch
- University of Chicago, Chicago, Illinois 60637, USA
| | - R Leonardi
- European Space Agency, ESAC, Planck Science Office, Camino bajo del Castillo, s/n, Urbanización Villafranca del Castillo, Villanueva de la Cañada, Madrid, Spain
| | - F Levrier
- LERMA, CNRS, Observatoire de Paris, 61 Avenue de l'Observatoire, Paris, France
| | - A Lewis
- Department of Physics and Astronomy, University of Sussex, Brighton BN1 9QH, United Kingdom
| | - M Liguori
- Dipartimento di Fisica e Astronomia G. Galilei, Università degli Studi di Padova, via Marzolo 8, 35131 Padova, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, via Marzolo 8, I-35131 Padova, Italy
| | - P B Lilje
- Institute of Theoretical Astrophysics, University of Oslo, Blindern, Oslo, Norway
| | - M Linden-Vørnle
- DTU Space, National Space Institute, Technical University of Denmark, Elektrovej 327, DK-2800 Kongens Lyngby, Denmark
| | - M López-Caniego
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
- European Space Agency, ESAC, Planck Science Office, Camino bajo del Castillo, s/n, Urbanización Villafranca del Castillo, Villanueva de la Cañada, Madrid, Spain
| | - P M Lubin
- Department of Physics, University of California, Santa Barbara, California, USA
| | - M Lueker
- California Institute of Technology, Pasadena, California, USA
| | - J F Macías-Pérez
- Laboratoire de Physique Subatomique et Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3, 53, rue des Martyrs, 38026 Grenoble Cedex, France
| | - B Maffei
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - D Maino
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria, 16, Milano, Italy
- INAF/IASF Milano, Via E. Bassini 15, Milano, Italy
| | - N Mandolesi
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
- Dipartimento di Fisica e Scienze della Terra, Università di Ferrara, Via Saragat 1, 44122 Ferrara, Italy
| | - A Mangilli
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
- LAL, Université Paris-Sud, CNRS/IN2P3, Orsay, France
| | - M Maris
- INAF-Osservatorio Astronomico di Trieste, Via G.B. Tiepolo 11, Trieste, Italy
| | - P G Martin
- CITA, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 3H8, Canada
| | - E Martínez-González
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
| | - S Masi
- Dipartimento di Fisica, Università La Sapienza, Piazzale Aldo Moro 2, Roma, Italy
| | - P Mason
- California Institute of Technology, Pasadena, California, USA
| | - S Matarrese
- Dipartimento di Fisica e Astronomia G. Galilei, Università degli Studi di Padova, via Marzolo 8, 35131 Padova, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, via Marzolo 8, I-35131 Padova, Italy
- Gran Sasso Science Institute, INFN, viale F. Crispi 7, 67100L'Aquila, Italy
| | - K G Megerian
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - P R Meinhold
- Department of Physics, University of California, Santa Barbara, California, USA
| | - A Melchiorri
- Dipartimento di Fisica, Università La Sapienza, Piazzale Aldo Moro 2, Roma, Italy
- INFN, Sezione di Roma 1, Università di Roma Sapienza, Piazzale Aldo Moro 2, 00185, Roma, Italy
| | - L Mendes
- European Space Agency, ESAC, Planck Science Office, Camino bajo del Castillo, s/n, Urbanización Villafranca del Castillo, Villanueva de la Cañada, Madrid, Spain
| | - A Mennella
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria, 16, Milano, Italy
- INAF/IASF Milano, Via E. Bassini 15, Milano, Italy
| | - M Migliaccio
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, United Kingdom
- Kavli Institute for Cosmology Cambridge, Madingley Road, Cambridge, CB3 0HA, United Kingdom
| | - S Mitra
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
- IUCAA, Post Bag 4, Ganeshkhind, Pune University Campus, Pune 411 007, India
| | - M-A Miville-Deschênes
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
- CITA, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 3H8, Canada
| | - A Moneti
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
| | - L Montier
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - G Morgante
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - D Mortlock
- Imperial College London, Astrophysics group, Blackett Laboratory, Prince Consort Road, London, SW7 2AZ, United Kingdom
| | - A Moss
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - D Munshi
- School of Physics and Astronomy, Cardiff University, Queens Buildings, The Parade, Cardiff, CF24 3AA, United Kingdom
| | - J A Murphy
- National University of Ireland, Department of Experimental Physics, Maynooth, County Kildare, Ireland
| | - P Naselsky
- Niels Bohr Institute, Blegdamsvej 17, Copenhagen, Denmark
- Discovery Center, Niels Bohr Institute, Blegdamsvej 17, Copenhagen, Denmark
| | - F Nati
- Department of Physics, Princeton University, Princeton, New Jersey, USA
| | - P Natoli
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
- Dipartimento di Fisica e Scienze della Terra, Università di Ferrara, Via Saragat 1, 44122 Ferrara, Italy
- Agenzia Spaziale Italiana Science Data Center, Via del Politecnico snc, 00133, Roma, Italy
| | - C B Netterfield
- Department of Astronomy and Astrophysics, University of Toronto, 50 Saint George Street, Toronto, Ontario, Canada
| | - H T Nguyen
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - H U Nørgaard-Nielsen
- DTU Space, National Space Institute, Technical University of Denmark, Elektrovej 327, DK-2800 Kongens Lyngby, Denmark
| | - F Noviello
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - D Novikov
- Lebedev Physical Institute of the Russian Academy of Sciences, Astro Space Centre, 84/32 Profsoyuznaya st., Moscow, GSP-7, 117997, Russia
| | - I Novikov
- Niels Bohr Institute, Blegdamsvej 17, Copenhagen, Denmark
- Lebedev Physical Institute of the Russian Academy of Sciences, Astro Space Centre, 84/32 Profsoyuznaya st., Moscow, GSP-7, 117997, Russia
| | - R O'Brient
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - R W Ogburn
- Department of Physics, Stanford University, Stanford, California 94305, USA
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - A Orlando
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - L Pagano
- Dipartimento di Fisica, Università La Sapienza, Piazzale Aldo Moro 2, Roma, Italy
- INFN, Sezione di Roma 1, Università di Roma Sapienza, Piazzale Aldo Moro 2, 00185, Roma, Italy
| | - F Pajot
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - R Paladini
- Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, California 91125, USA
| | - D Paoletti
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
- INFN, Sezione di Bologna, Via Irnerio 46, I-40126, Bologna, Italy
| | - B Partridge
- Haverford College Astronomy Department, 370 Lancaster Avenue, Haverford, Pennsylvania, USA
| | - F Pasian
- INAF-Osservatorio Astronomico di Trieste, Via G.B. Tiepolo 11, Trieste, Italy
| | - G Patanchon
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - T J Pearson
- California Institute of Technology, Pasadena, California, USA
- Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, California 91125, USA
| | - O Perdereau
- LAL, Université Paris-Sud, CNRS/IN2P3, Orsay, France
| | - L Perotto
- Laboratoire de Physique Subatomique et Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3, 53, rue des Martyrs, 38026 Grenoble Cedex, France
| | - V Pettorino
- HGSFP and University of Heidelberg, Theoretical Physics Department, Philosophenweg 16, 69120, Heidelberg, Germany
| | - F Piacentini
- Dipartimento di Fisica, Università La Sapienza, Piazzale Aldo Moro 2, Roma, Italy
| | - M Piat
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - D Pietrobon
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | | | - E Pointecouteau
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - G Polenta
- Agenzia Spaziale Italiana Science Data Center, Via del Politecnico snc, 00133, Roma, Italy
- INAF-Osservatorio Astronomico di Roma, via di Frascati 33, Monte Porzio Catone, Italy
| | - N Ponthieu
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
- IPAG: Institut de Planétologie et d'Astrophysique de Grenoble, Université Grenoble Alpes, IPAG, F-38000 Grenoble, France, CNRS, IPAG, F-38000 Grenoble, France
| | - G W Pratt
- Laboratoire AIM, IRFU/Service d'Astrophysique-CEA/DSM-CNRS-Université Paris Diderot, Bâtiment 709, CEA-Saclay, F-91191 Gif-sur-Yvette Cedex, France
| | - S Prunet
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- UPMC Université de Paris 06, UMR7095, 98 bis Boulevard Arago, F-75014, Paris, France
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J-L Puget
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - J P Rachen
- Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Strasse 1, 85741 Garching, Germany
- Department of Astrophysics/IMAPP, Radboud University Nijmegen, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - W T Reach
- Universities Space Research Association, Stratospheric Observatory for Infrared Astronomy, MS 232-11, Moffett Field, California 94035, USA
| | - R Rebolo
- Instituto de Astrofísica de Canarias, C/Vía Láctea s/n, La Laguna, Tenerife, Spain
- Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
- Departamento Astrofísica, Universidad de La Laguna (ULL), E-38206 La Laguna, Tenerife, Spain
| | - M Reinecke
- Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Strasse 1, 85741 Garching, Germany
| | - M Remazeilles
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - C Renault
- Laboratoire de Physique Subatomique et Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3, 53, rue des Martyrs, 38026 Grenoble Cedex, France
| | - A Renzi
- Dipartimento di Matematica, Università di Roma Tor Vergata, Via della Ricerca Scientifica, 1, Roma, Italy
- INFN, Sezione di Roma 2, Università di Roma Tor Vergata, Via della Ricerca Scientifica, 1, Roma, Italy
| | - S Richter
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - I Ristorcelli
- Université de Toulouse, UPS-OMP, IRAP, F-31028 Toulouse cedex 4, France
- CNRS, IRAP, 9 Avenue colonel Roche, BP 44346, F-31028 Toulouse cedex 4, France
| | - G Rocha
- California Institute of Technology, Pasadena, California, USA
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - M Rossetti
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria, 16, Milano, Italy
- INAF/IASF Milano, Via E. Bassini 15, Milano, Italy
| | - G Roudier
- APC, AstroParticule et Cosmologie, Université Paris Diderot, CNRS/IN2P3, CEA/lrfu, Observatoire de Paris, Sorbonne Paris Cité, 10, rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
- LERMA, CNRS, Observatoire de Paris, 61 Avenue de l'Observatoire, Paris, France
| | - M Rowan-Robinson
- Imperial College London, Astrophysics group, Blackett Laboratory, Prince Consort Road, London, SW7 2AZ, United Kingdom
| | - J A Rubiño-Martín
- Instituto de Astrofísica de Canarias, C/Vía Láctea s/n, La Laguna, Tenerife, Spain
- Departamento Astrofísica, Universidad de La Laguna (ULL), E-38206 La Laguna, Tenerife, Spain
| | - B Rusholme
- Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, California 91125, USA
| | - M Sandri
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - D Santos
- Laboratoire de Physique Subatomique et Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3, 53, rue des Martyrs, 38026 Grenoble Cedex, France
| | - M Savelainen
- Department of Physics, Gustaf Hällströmin katu 2a, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Physics, Gustaf Hällströmin katu 2, University of Helsinki, Helsinki, Finland
| | - G Savini
- Optical Science Laboratory, University College London, Gower Street, London, United Kingdom
| | - R Schwarz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - D Scott
- Department of Physics & Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, British Columbia, Canada
| | - M D Seiffert
- California Institute of Technology, Pasadena, California, USA
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - C D Sheehy
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - L D Spencer
- School of Physics and Astronomy, Cardiff University, Queens Buildings, The Parade, Cardiff, CF24 3AA, United Kingdom
| | - Z K Staniszewski
- California Institute of Technology, Pasadena, California, USA
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - V Stolyarov
- Kavli Institute for Cosmology Cambridge, Madingley Road, Cambridge, CB3 0HA, United Kingdom
- Astrophysics Group, Cavendish Laboratory, University of Cambridge, J J Thomson Avenue, Cambridge CB3 0HE, United Kingdom
- Special Astrophysical Observatory, Russian Academy of Sciences, Nizhnij Arkhyz, Zelenchukskiy region, Karachai-Cherkessian Republic, 369167, Russia
| | - R Sudiwala
- School of Physics and Astronomy, Cardiff University, Queens Buildings, The Parade, Cardiff, CF24 3AA, United Kingdom
| | - R Sunyaev
- Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Strasse 1, 85741 Garching, Germany
- Space Research Institute (IKI), Russian Academy of Sciences, Profsoyuznaya Street, 84/32, Moscow, 117997, Russia
| | - D Sutton
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, United Kingdom
- Kavli Institute for Cosmology Cambridge, Madingley Road, Cambridge, CB3 0HA, United Kingdom
| | - A-S Suur-Uski
- Department of Physics, Gustaf Hällströmin katu 2a, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Physics, Gustaf Hällströmin katu 2, University of Helsinki, Helsinki, Finland
| | - J-F Sygnet
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
| | - J A Tauber
- European Space Agency, ESTEC, Keplerlaan 1, 2201 AZ Noordwijk, The Netherlands
| | - G P Teply
- California Institute of Technology, Pasadena, California, USA
| | - L Terenzi
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
- Facoltà di Ingegneria, Università degli Studi e-Campus, Via Isimbardi 10, Novedrate (CO), 22060, Italy
| | - K L Thompson
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - L Toffolatti
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
- Departamento de Física, Universidad de Oviedo, Avda. Calvo Sotelo s/n, Oviedo, Spain
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - M Tomasi
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria, 16, Milano, Italy
- INAF/IASF Milano, Via E. Bassini 15, Milano, Italy
| | - M Tristram
- LAL, Université Paris-Sud, CNRS/IN2P3, Orsay, France
| | - M Tucci
- Département de Physique Théorique, Université de Genève, 24, Quai E. Ansermet, 1211 Genève 4, Switzerland
| | - A D Turner
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
- University of Chicago, Chicago, Illinois 60637, USA
| | - L Valenziano
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - J Valiviita
- Department of Physics, Gustaf Hällströmin katu 2a, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Physics, Gustaf Hällströmin katu 2, University of Helsinki, Helsinki, Finland
| | - B Van Tent
- Laboratoire de Physique Théorique, Université Paris-Sud 11 & CNRS, Bâtiment 210, 91405 Orsay, France
| | - L Vibert
- Institut d'Astrophysique Spatiale, CNRS (UMR8617) Université Paris-Sud 11, Bâtiment 121, Orsay, France
| | - P Vielva
- Instituto de Física de Cantabria (CSIC-Universidad de Cantabria), Avenida de los Castros s/n, Santander, Spain
| | - A G Vieregg
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
- Department of Physics, Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - F Villa
- INAF/IASF Bologna, Via Gobetti 101, Bologna, Italy
| | - L A Wade
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - B D Wandelt
- Institut d'Astrophysique de Paris, CNRS (UMR7095), 98 bis Boulevard Arago, F-75014, Paris, France
- UPMC Université de Paris 06, UMR7095, 98 bis Boulevard Arago, F-75014, Paris, France
- Department of Physics, University of Illinois at Urbana-Champaign, 1110 West Green Street, Urbana, Illinois, USA
| | - R Watson
- Jodrell Bank Centre for Astrophysics, Alan Turing Building, School of Physics and Astronomy, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - A C Weber
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - I K Wehus
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, California, USA
| | - M White
- Department of Physics, University of California, Berkeley, California, USA
| | - S D M White
- Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Strasse 1, 85741 Garching, Germany
| | - J Willmert
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C L Wong
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - K W Yoon
- Department of Physics, Stanford University, Stanford, California 94305, USA
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - D Yvon
- DSM/Irfu/SPP, CEA-Saclay, F-91191 Gif-sur-Yvette Cedex, France
| | - A Zacchei
- INAF-Osservatorio Astronomico di Trieste, Via G.B. Tiepolo 11, Trieste, Italy
| | - A Zonca
- Department of Physics, University of California, Santa Barbara, California, USA
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Filkins M, Halliday S, Daniels B, Bista R, Thapa S, Schwarz R, Schwarz D, Gauchan B, Maru D. Implementing Diagnostic Imaging Services in a Rural Setting of Extreme Poverty: Five Years of X-ray and Ultrasound Service Delivery in Achham, Nepal. JGR 2015. [DOI: 10.7191/jgr.2015.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Whelan JS, Bielack SS, Marina N, Smeland S, Jovic G, Hook JM, Krailo M, Anninga J, Butterfass-Bahloul T, Böhling T, Calaminus G, Capra M, Deffenbaugh C, Dhooge C, Eriksson M, Flanagan AM, Gelderblom H, Goorin A, Gorlick R, Gosheger G, Grimer RJ, Hall KS, Helmke K, Hogendoorn PCW, Jundt G, Kager L, Kuehne T, Lau CC, Letson GD, Meyer J, Meyers PA, Morris C, Mottl H, Nadel H, Nagarajan R, Randall RL, Schomberg P, Schwarz R, Teot LA, Sydes MR, Bernstein M. EURAMOS-1, an international randomised study for osteosarcoma: results from pre-randomisation treatment. Ann Oncol 2014; 26:407-14. [PMID: 25421877 PMCID: PMC4304379 DOI: 10.1093/annonc/mdu526] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Four international study groups undertook a large study in resectable osteosarcoma, which included two randomised controlled trials, to determine the effect on survival of changing post-operative chemotherapy based on histological response. PATIENTS AND METHODS Patients with resectable osteosarcoma aged ≤40 years were treated with the MAP regimen, comprising pre-operatively of two 5-week cycles of cisplatin 120 mg/m(2), doxorubicin 75 mg/m(2), methotrexate 12 g/m(2) × 2 (MAP) and post-operatively two further cycles of MAP and two cycles of just MA. Patients were randomised after surgery. Those with ≥10% viable tumour in the resected specimen received MAP or MAP with ifosfamide and etoposide. Those with <10% viable tumour were allocated to MAP or MAP followed by pegylated interferon. Longitudinal evaluation of quality of life was undertaken. RESULTS Recruitment was completed to the largest osteosarcoma study to date in 75 months. Commencing March 2005, 2260 patients were registered from 326 centres across 17 countries. About 1334 of 2260 registered patients (59%) were randomised. Pre-operative chemotherapy was completed according to protocol in 94%. Grade 3-4 neutropenia affected 83% of cycles and 59% were complicated by infection. There were three (0.13%) deaths related to pre-operative chemotherapy. At definitive surgery, 50% of patients had at least 90% necrosis in the resected specimen. CONCLUSIONS New models of collaboration are required to successfully conduct trials to improve outcomes of patients with rare cancers; EURAMOS-1 demonstrates achievability. Considerable regulatory, financial and operational challenges must be overcome to develop similar studies in the future. The trial is registered as NCT00134030 and ISRCTN 67613327.
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Affiliation(s)
- J S Whelan
- Department of Oncology, University College Hospital, London, UK
| | - S S Bielack
- Cooperative Osteosarcoma Study Group (COSS), Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - N Marina
- Stanford University Medical Center, Pediatric Hematology/Oncology, Palo Alto, USA
| | - S Smeland
- Division of Cancer, Surgery and Transplantation, and Scandinavian Sarcoma Group, Oslo University Hospital, Oslo Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - G Jovic
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - J M Hook
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - M Krailo
- Children's Oncology Group, Arcadia, USA
| | - J Anninga
- Department of Pediatrics and Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - T Böhling
- University of Helsinki and HUSLAB, Helsinki, Finland
| | - G Calaminus
- University Hospital of Muenster, Muenster, Germany
| | - M Capra
- Our Lady's Children's Hospital, Dublin, Ireland
| | - C Deffenbaugh
- Lucile Salter Packard Childrens Hospital Stanford, Palo Alto, USA
| | - C Dhooge
- University Hospital Ghent, Gent, Belgium
| | - M Eriksson
- Skane University Hospital, Lund University, Lund, Sweden
| | - A M Flanagan
- Royal National Orthopaedic Hospital, Stanmore Cancer Institute, University College London, London, UK
| | - H Gelderblom
- Department of Pediatrics and Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Goorin
- Dana-Farber Cancer Institute, Boston
| | - R Gorlick
- Section of Pediatric Hematology/Oncology, Montefiore Medical Center, Bronx, USA
| | - G Gosheger
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, Muenster, Germany
| | - R J Grimer
- Royal Orthopaedic Hospital, Birmingham, UK
| | - K S Hall
- Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, Scandinavian Sarcoma Group, Oslo, Norway
| | - K Helmke
- Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P C W Hogendoorn
- Department of Pediatrics and Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - G Jundt
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - L Kager
- St Anna Children's Hospital, Vienna, Austria
| | - T Kuehne
- University Children's Hospital Basel, Basel, Switzerland
| | - C C Lau
- Texas Children's Cancer Centre, Baylor College of Medicine, Houston
| | - G D Letson
- H. Lee Moffit Cancer Centre & Research Institute, Tampa
| | - J Meyer
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia
| | - P A Meyers
- Memorial Sloan-Kettering Cancer Center, New?York
| | - C Morris
- Memorial Sloan-Kettering Cancer Center, New?York Orthopedic Surgery, Johns Hopkins, Baltimore, USA
| | - H Mottl
- Department of Pediatric Hematology Oncology, University Hospital, Prague, Czech Republic
| | - H Nadel
- British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - R Nagarajan
- Cincinnati Children's Hospital Medical Center, Cincinnati
| | - R L Randall
- Primary Children's Hospital and Huntsman Cancer Institute, University of Utah, Salt Lake City
| | | | - R Schwarz
- Department of Radiation Oncology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L A Teot
- Department of Pathology, Boston Children's Hospital, Boston, USA
| | - M R Sydes
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - M Bernstein
- IWK Health Center, Dalhousie University, Halifax, Canada
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Schwarz D, Sharma R, Bashyal C, Schwarz R, Baruwal A, Karelas G, Basnet B, Khadka N, Brady J, Silver Z, Mukherjee J, Andrews J, Maru DSR. Strengthening Nepal's Female Community Health Volunteer network: a qualitative study of experiences at two years. BMC Health Serv Res 2014; 14:473. [PMID: 25301105 PMCID: PMC4282192 DOI: 10.1186/1472-6963-14-473] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 09/26/2014] [Indexed: 11/12/2022] Open
Abstract
Background Nepal’s Female Community Health Volunteer (FCHV) program has been described as an exemplary public-sector community health worker program. However, despite its merits, the program still struggles to provide high-quality, accessible services nation-wide. Both in Nepal and globally, best practices for community health worker program implementation are not yet known: there is a dearth of empiric research, and the research that has been done has shown inconsistent results. Methods Here we evaluate a pilot program designed to strengthen the Nepali government’s FCHV network. The program was structured with five core components: 1) improve local FCHV leadership; 2) facilitate structured weekly FCHV meetings and 3) weekly FCHV trainings at the village level; 4) implement a monitoring and evaluation system for FCHV patient encounters; and 5) provide financial compensation for FCHV work. Following twenty-four months of program implementation, a retrospective programmatic evaluation was conducted, including qualitative analysis of focus group discussions and semi-structured interviews. Results Qualitative data analysis demonstrated that the program was well-received by program participants and community members, and suggests that the five core components of this program were valuable additions to the pre-existing FCHV network. Analysis also revealed key challenges to program implementation including geographic limitations, literacy limitations, and limitations of professional respect from healthcare workers to FCHVs. Descriptive statistics are presented for programmatic process metrics and costs throughout the first twenty four months of implementation. Conclusions The five components of this pilot program were well-received as a mechanism for strengthening Nepal’s FCHV program. To our knowledge, this is the first study to present such data, specifically informing programmatic design and management of the FCHV program. Despite limitations in its scope, this study offers tangible steps forward for further research and community health worker program improvement, both within Nepal and globally.
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Affiliation(s)
- Dan Schwarz
- Possible, Bayalpata Hospital, Ridikot, Achham, USA.
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Meyer J, Foster R, Lev-Cohain N, Yokoo T, Schwarz R, Rule W, Solberg T, Timmerman R. Toxicity and Efficacy Results From a Phase I Dose-Escalation Study of Single-Fraction Stereotactic Radiation Therapy for Liver Metastases. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ade PAR, Aikin RW, Amiri M, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Brevik JA, Buder I, Bullock E, Davis G, Day PK, Dowell CD, Duband L, Filippini JP, Fliescher S, Golwala SR, Halpern M, Hasselfield M, Hildebrandt SR, Hilton GC, Irwin KD, Karkare KS, Kaufman JP, Keating BG, Kernasovskiy SA, Kovac JM, Kuo CL, Leitch EM, Llombart N, Lueker M, Netterfield CB, Nguyen HT, O'Brient R, Ogburn RW, Orlando A, Pryke C, Reintsema CD, Richter S, Schwarz R, Sheehy CD, Staniszewski ZK, Story KT, Sudiwala RV, Teply GP, Tolan JE, Turner AD, Vieregg AG, Wilson P, Wong CL, Yoon KW. BICEP2. II. EXPERIMENT AND THREE-YEAR DATA SET. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/792/1/62] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ade PAR, Aikin RW, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Brevik JA, Buder I, Bullock E, Dowell CD, Duband L, Filippini JP, Fliescher S, Golwala SR, Halpern M, Hasselfield M, Hildebrandt SR, Hilton GC, Hristov VV, Irwin KD, Karkare KS, Kaufman JP, Keating BG, Kernasovskiy SA, Kovac JM, Kuo CL, Leitch EM, Lueker M, Mason P, Netterfield CB, Nguyen HT, O'Brient R, Ogburn RW, Orlando A, Pryke C, Reintsema CD, Richter S, Schwarz R, Sheehy CD, Staniszewski ZK, Sudiwala RV, Teply GP, Tolan JE, Turner AD, Vieregg AG, Wong CL, Yoon KW. Detection of B-mode polarization at degree angular scales by BICEP2. Phys Rev Lett 2014; 112:241101. [PMID: 24996078 DOI: 10.1103/physrevlett.112.241101] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Indexed: 06/03/2023]
Abstract
We report results from the BICEP2 experiment, a cosmic microwave background (CMB) polarimeter specifically designed to search for the signal of inflationary gravitational waves in the B-mode power spectrum around ℓ∼80. The telescope comprised a 26 cm aperture all-cold refracting optical system equipped with a focal plane of 512 antenna coupled transition edge sensor 150 GHz bolometers each with temperature sensitivity of ≈300 μK(CMB)√s. BICEP2 observed from the South Pole for three seasons from 2010 to 2012. A low-foreground region of sky with an effective area of 380 square deg was observed to a depth of 87 nK deg in Stokes Q and U. In this paper we describe the observations, data reduction, maps, simulations, and results. We find an excess of B-mode power over the base lensed-ΛCDM expectation in the range 30 < ℓ < 150, inconsistent with the null hypothesis at a significance of >5σ. Through jackknife tests and simulations based on detailed calibration measurements we show that systematic contamination is much smaller than the observed excess. Cross correlating against WMAP 23 GHz maps we find that Galactic synchrotron makes a negligible contribution to the observed signal. We also examine a number of available models of polarized dust emission and find that at their default parameter values they predict power ∼(5-10)× smaller than the observed excess signal (with no significant cross-correlation with our maps). However, these models are not sufficiently constrained by external public data to exclude the possibility of dust emission bright enough to explain the entire excess signal. Cross correlating BICEP2 against 100 GHz maps from the BICEP1 experiment, the excess signal is confirmed with 3σ significance and its spectral index is found to be consistent with that of the CMB, disfavoring dust at 1.7σ. The observed B-mode power spectrum is well fit by a lensed-ΛCDM+tensor theoretical model with tensor-to-scalar ratio r = 0.20_(-0.05)(+0.07), with r = 0 disfavored at 7.0σ. Accounting for the contribution of foreground, dust will shift this value downward by an amount which will be better constrained with upcoming data sets.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - R W Aikin
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - D Barkats
- Joint ALMA Observatory, Vitacura, Santiago, Chile
| | - S J Benton
- Department of Physics, University of Toronto, Toronto, Ontario, M5S 1A7, Canada
| | - C A Bischoff
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J J Bock
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA and Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - J A Brevik
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - I Buder
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C D Dowell
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - J P Filippini
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S Fliescher
- Department of Physics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - S R Golwala
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - M Halpern
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - M Hasselfield
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - S R Hildebrandt
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA and Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - V V Hristov
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Irwin
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA and Department of Physics, Stanford University, Stanford, California 94305, USA and Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - K S Karkare
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J P Kaufman
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - B G Keating
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J M Kovac
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - C L Kuo
- Department of Physics, Stanford University, Stanford, California 94305, USA and Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - E M Leitch
- University of Chicago, Chicago, Illinois 60637, USA
| | - M Lueker
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - P Mason
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - C B Netterfield
- Department of Physics, University of Toronto, Toronto, Ontario, M5S 1A7, Canada and Canadian Institute for Advanced Research, Toronto, Ontario, M5G 1Z8, Canada
| | - H T Nguyen
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R O'Brient
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R W Ogburn
- Department of Physics, Stanford University, Stanford, California 94305, USA and Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - A Orlando
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA and Department of Physics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C D Reintsema
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Richter
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - R Schwarz
- Department of Physics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C D Sheehy
- Department of Physics, University of Minnesota, Minneapolis, Minnesota 55455, USA and University of Chicago, Chicago, Illinois 60637, USA
| | - Z K Staniszewski
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA and Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R V Sudiwala
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - G P Teply
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - A D Turner
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - A G Vieregg
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA and University of Chicago, Chicago, Illinois 60637, USA
| | - C L Wong
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - K W Yoon
- Department of Physics, Stanford University, Stanford, California 94305, USA and Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
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