A bright γ-ray flare interpreted as a giant magnetar flare in NGC 253.

Soft γ-ray repeaters exhibit bursting emission in hard X-rays and soft γ-rays. During the active phase, they emit random short (milliseconds to several seconds long), hard-X-ray bursts, with peak luminosities1 of 1036 to 1043 erg per second. Occasionally, a giant flare with an energy of around 1044 to 1046 erg is emitted2. These phenomena are thought to arise from neutron stars with extremely high magnetic fields (1014 to 1015 gauss), called magnetars1,3,4. A portion of the second-long initial pulse of a giant flare in some respects mimics short γ-ray bursts5,6, which have recently been identified as resulting from the merger of two neutron stars accompanied by gravitational-wave emission7. Two γ-ray bursts, GRB 051103 and GRB 070201, have been associated with giant flares2,8-11. Here we report observations of the γ-ray burst GRB 200415A, which we localized to a 20-square-arcmin region of the starburst galaxy NGC 253, located about 3.5 million parsecs away. The burst had a sharp, millisecond-scale hard spectrum in the initial pulse, which was followed by steady fading and softening over 0.2 seconds. The energy released (roughly 1.3 × 1046 erg) is similar to that of the superflare5,12,13 from the Galactic soft γ-ray repeater SGR 1806-20 (roughly 2.3 × 1046 erg). We argue that GRB 200415A is a giant flare from a magnetar in NGC 253.

Older patients' preferences and views related to non-face-to-face diabetes chronic care management: a qualitative study from southeast Louisiana.

Background: Management of diabetes may be uniquely challenging for older individuals with multiple chronic conditions. Health systems and policymakers have attempted to reduce barriers to chronic care management (CCM) through incentives to provide non-face-to-face care. This qualitative study aimed to investigate and present views on non-face-to-face care management held by elderly patients with diabetes and other chronic conditions in order to contribute to improved programming for this population. Materials and methods: Semi-structured interviews were conducted with patients over the age of 64 who have been diagnosed with diabetes and at least one other chronic health condition. Interview recordings were transcribed and analyzed by experienced researchers using a thematic analytic approach, and an illustrative case study was developed. Results: Thirty individuals participated in this study. Participants were drawn from three health systems in south Louisiana, an area with high rates of morbidity and mortality related to chronic diseases. We identified themes related to lived experiences with diabetes and other medical conditions, perception of personal health status, perceived value of non-face-to-face programs, and support needs for future programming. Additionally, we present one case study describing in detail an individual patient's experience with non-face-to-face CCM. Conclusion: Health systems should consider intentionally recruiting participants who would benefit most from non-face-to-face care, including higher-need, less self-sufficient patients with resource constraints, while continuing to offer in-person services. Future research should examine whether tailoring non-face-to-face programming and support to address unique barriers can further enhance diabetes care at the population level.

Neonatal deaths in Cambodia: findings from a community-based mortality review.

OBJECTIVES: The aim of this study was to describe potential factors contributing to neonatal mortality in Takeo, Cambodia through assessment of verbal autopsies collected following newborn deaths in the community. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial, within the study setting. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. RESULTS: Thirteen newborn deaths of infants born in health facilities participating in a community based, behavioral intervention were reported during February 2015-November 2016. Ten deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of deaths were attributed to asphyxia. The study highlights the continuing need to improve quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.

Early initiation of breast-feeding in Ghana: barriers and facilitators.

To explore why women in Ghana initiate breast-feeding early or late, who gives advice about initiation and what foods or fluids are given to babies when breast-feeding initiation is late. Qualitative data were collected through 52 semistructured interviews with recent mothers, 8 focus group discussions with women of child-bearing age and 13 semistructured interviews with health workers, policy makers and implementers. The major reasons for delaying initiation of breast-feeding were the perception of a lack of breast milk, performing postbirth activities such as bathing, perception that the mother and the baby need rest after birth and the baby not crying for milk. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding, and the belief in some ethnic groups that putting the baby to the breast encourages the milk. Policy makers tended to focus on exclusive breast-feeding rather than early initiation. Most activities for the promotion of early initiation of breast-feeding were focused on health facilities with very few community activities. It is important to raise awareness about early initiation of breast-feeding in communities and in the policy arena. Interventions should focus on addressing barriers to early initiation and should include a community component.

Polarized gamma-ray emission from the crab.

Pulsar systems accelerate particles to immense energies. The detailed functioning of these engines is still poorly understood, but polarization measurements of high-energy radiation may allow us to locate where the particles are accelerated. We have detected polarized gamma rays from the vicinity of the Crab pulsar using data from the spectrometer on the International Gamma-Ray Astrophysics Laboratory satellite. Our results show polarization with an electric vector aligned with the spin axis of the neutron star, demonstrating that a substantial fraction of the high-energy electrons responsible for the polarized photons are produced in a highly ordered structure close to the pulsar.

Compact sources as the origin of the soft gamma-ray emission of the Milky Way.

The Milky Way is known to be an abundant source of gamma-ray photons, now determined to be mainly diffuse in nature and resulting from interstellar processes. In the soft gamma-ray domain, point sources are expected to dominate, but the lack of sensitive high-resolution observations did not allow for a clear estimate of the contribution from such sources. Even the best imaging experiment revealed only a few point sources, accounting for about 50% of the total Galactic flux. Theoretical studies were unable to explain the remaining intense diffuse emission. Investigating the origin of the soft gamma-rays is therefore necessary to determine the dominant particle acceleration processes and to gain insights into the physical and chemical equilibrium of the interstellar medium. Here we report observations in the soft gamma-ray domain that reveal numerous compact sources. We show that these sources account for the entirety of the Milky Way's emission in soft gamma-rays, leaving at most a minor role for diffuse processes.

Dolor articular y artritis reumatoidea: calidad de atencion / Rheumatoid arthritis and articular pain: quality health care

Una de cada seis visitas al primer nivel son motivadas por un problema musculoesqueletico. Se analizo la Artritis Reumatoidea (AR) por su prevalencia. La relacion mujer/ varon es de 3/1; entre 30 y 60 años. Produce incapacidad laboral con alto impacto socioeconomico. La terapeutica adecuada se basa en el diagnostico, seguimiento y tratamiento oportuno. Objetivos: caracterizacion epidemiologica de la poblacion con dolor articular (DA) y sospecha de AR. Analizar el tratamiento segun la calidad de atencion. Material y metodos: investigacion descriptiva de corte transversal. La poblacion pertenece a nueve zonas rurales de Tucuman. Se encuestaron personas con DA mayores de 18 años. Se excluyeron personas con enfermedad neurologica y oncologica. Resultados: 342/2807 presentaron DA. Con sospecha de AR 2,2 por ciento, 84 por ciento fue poliarticular, el 70 por ciento consulto menos de 3 veces, 40 por ciento toma DAINES, 14 por ciento drogas de segunda linea y ninguno tratamiento no farmacologico. Conclusion: la prevalencia de DA y AR es considerable. La escasa respuesta de los servicios se evidencia por: bajo numero de consultas, tratamiento farmacologico sintomatico y ausencia de tratamiento no farmacologico; agravandose el pronostico con deterioro de la calidad de vida. La reumatologia debe plantearse estrategias poblacionales para no consentir un desarrollo cientifico limitado a unos pocos

Dolor articular y artritis reumatoidea: calidad de atencion / Rheumatoid arthritis and articular pain: quality health care

Una de cada seis visitas al primer nivel son motivadas por un problema musculoesqueletico. Se analizo la Artritis Reumatoidea (AR) por su prevalencia. La relacion mujer/ varon es de 3/1; entre 30 y 60 años. Produce incapacidad laboral con alto impacto socioeconomico. La terapeutica adecuada se basa en el diagnostico, seguimiento y tratamiento oportuno. Objetivos: caracterizacion epidemiologica de la poblacion con dolor articular (DA) y sospecha de AR. Analizar el tratamiento segun la calidad de atencion. Material y metodos: investigacion descriptiva de corte transversal. La poblacion pertenece a nueve zonas rurales de Tucuman. Se encuestaron personas con DA mayores de 18 años. Se excluyeron personas con enfermedad neurologica y oncologica. Resultados: 342/2807 presentaron DA. Con sospecha de AR 2,2 por ciento, 84 por ciento fue poliarticular, el 70 por ciento consulto menos de 3 veces, 40 por ciento toma DAINES, 14 por ciento drogas de segunda linea y ninguno tratamiento no farmacologico. Conclusion: la prevalencia de DA y AR es considerable. La escasa respuesta de los servicios se evidencia por: bajo numero de consultas, tratamiento farmacologico sintomatico y ausencia de tratamiento no farmacologico; agravandose el pronostico con deterioro de la calidad de vida. La reumatologia debe plantearse estrategias poblacionales para no consentir un desarrollo cientifico limitado a unos pocos (AU)

Prevalencia de las enfermedades reumaticas en servicios de salud de Tucuman / Prevalence of rheumatic diseases in Tucuman is health services

Actualmente las enfermedades reumaticas constituyen un verdadero desafio, tanto para la sociedad, como para los sistemas de salud, por lo que representan: alta prevalencia, gran discapacidad de adultos jovenes, no respeta grupos etareos, y alto costo para el enfermo, la sociedad y la economia. El objetivo del presente trabajo fue analizar la prevalencia de las enfermedades reumaticas, su distribucion por edad, sexo y procedencia de los servicios de referencia de Tucuman y generar nuevas lineas de investigacion y elaborar un programa de investigacion y control. Material y metodo: estudio descriptivo transversal. Se analizo la demanda de tres centros de referencia que cuentan con servicio de reumatologia. Fuentes de datos, historias clinicas y registros institucionales. Variables analizadas. Resultados: El total de pacientes asistidos fue de 2179 lo que representaba el 2.5 por ciento de la consulta total. El 77 por ciento de los pacientes fueron del sexo fememino. La totalidad de datos disponibles y confiables para el estudio fue de: 1020 pacientes (registros de consultorio externo y de internacion ). Todos los grupos etareos de adultos estaban afectados. El grupo de los 20-40 y 40-60 años concentraban el 50 por ciento del total. Los diagnosticos mas frecuentes fueron: artrosis, artritis reumatoidea, y sin diagnostico 11.41 por ciento. Segun procedencia: la mayor parte pertenecian al departamento capital (79 por ciento) y el 21 restante se distribuyo entre los departamentos de la provincia. Conclusion: Las enfermedades reumaticas representan el 2 por ciento del total de la demanda. Entre 20 y 60 años se concentra el 50 por ciento del total de la consulta. La artrosis fue la causa mas frecuente, seguida de artritis reumatoidea. Hay un importante porcentaje sin diagnostico sobre lo cual debemos trabajar. El subregistro detectado pone en evidencia la precariedad de la informacion ya que estos resultados nos muestran la verdadera produccion de los servicios y por lo tanto no podemos cuantificar el daño. Todo esto pone en evidencia la necesidad de realizar estudios epidemiologicos con enfoque nacional y regional. El saber cuantos se enferman y mueren, de que y donde, nos permitira elaborar estrategias a fin de lograr eficiencia en la atencion de la poblacion reumatica en su conjunto

Prevalencia de las enfermedades reumaticas en servicios de salud de Tucuman / Prevalence of rheumatic diseases in Tucuman is health services

Actualmente las enfermedades reumaticas constituyen un verdadero desafio, tanto para la sociedad, como para los sistemas de salud, por lo que representan: alta prevalencia, gran discapacidad de adultos jovenes, no respeta grupos etareos, y alto costo para el enfermo, la sociedad y la economia. El objetivo del presente trabajo fue analizar la prevalencia de las enfermedades reumaticas, su distribucion por edad, sexo y procedencia de los servicios de referencia de Tucuman y generar nuevas lineas de investigacion y elaborar un programa de investigacion y control. Material y metodo: estudio descriptivo transversal. Se analizo la demanda de tres centros de referencia que cuentan con servicio de reumatologia. Fuentes de datos, historias clinicas y registros institucionales. Variables analizadas. Resultados: El total de pacientes asistidos fue de 2179 lo que representaba el 2.5 por ciento de la consulta total. El 77 por ciento de los pacientes fueron del sexo fememino. La totalidad de datos disponibles y confiables para el estudio fue de: 1020 pacientes (registros de consultorio externo y de internacion ). Todos los grupos etareos de adultos estaban afectados. El grupo de los 20-40 y 40-60 años concentraban el 50 por ciento del total. Los diagnosticos mas frecuentes fueron: artrosis, artritis reumatoidea, y sin diagnostico 11.41 por ciento. Segun procedencia: la mayor parte pertenecian al departamento capital (79 por ciento) y el 21 restante se distribuyo entre los departamentos de la provincia. Conclusion: Las enfermedades reumaticas representan el 2 por ciento del total de la demanda. Entre 20 y 60 años se concentra el 50 por ciento del total de la consulta. La artrosis fue la causa mas frecuente, seguida de artritis reumatoidea. Hay un importante porcentaje sin diagnostico sobre lo cual debemos trabajar. El subregistro detectado pone en evidencia la precariedad de la informacion ya que estos resultados nos muestran la verdadera produccion de los servicios y por lo tanto no podemos cuantificar el daño. Todo esto pone en evidencia la necesidad de realizar estudios epidemiologicos con enfoque nacional y regional. El saber cuantos se enferman y mueren, de que y donde, nos permitira elaborar estrategias a fin de lograr eficiencia en la atencion de la poblacion reumatica en su conjunto (AU)

Effect of retinoids on follicular cells.

It has been demonstrated that topical application of all-trans retinoic acid and other retinoids can alter the hair-growth cycle in the C3H mouse model. The anagen phase is prolonged and the telogen phase is shortened. This effect is similar to the effect of minoxidil on the hair-cycle dynamics in this animal model. The levels of cellular retinoic acid binding protein measured by radioreceptor assay in whole skin of C3H mice were higher during anagen and lower during telogen. Topical application of certain retinoids caused elevated levels of cellular retinoic acid-binding protein (cRABP) in the whole skin homogenates during both phases of the cycle. Of the retinoids tested, those most effective in altering the levels of cRABP in the skin of the mice were also capable of significantly altering the hair-cycle dynamics. There appeared to be a relationship between the ability of retinoid to increase cRABP, increase 3H-thymidine incorporation, and alter the dynamics of the hair cycle. Only cRABP-II is detectable in human cultured dermal fibroblasts and dermal papilla cells. Dermal fibroblasts showed higher amounts of cRABP-II as compared to dermal papilla cells. The difference in cRABP-II expression might explain a distinct response to RA by these two cell populations. Whether the difference in expression of cRABP-II might be of physiologic importance remains to be determined. Treatment of human dermal papilla cells in culture with retinoic acid does not appear to affect proliferation, at least at the doses tested.