Implementing an internet-based capacity building program for interdisciplinary midwifery-lead teams in Ethiopia, Kenya Malawi and Somalia.

The Swedish care model MIDWIZE defined as midwife-led interdisciplinary care and zero separation between mother and newborn, was implemented in 2020-21 in Ethiopia, Kenya, Malawi, and Somalia in a capacity building programme funded by the Swedish Institute. OBJECTIVE: To determine the feasibility of using an internet-based capacity building programme contributing to effective midwifery practices in the labour rooms through implementation of dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of newborns in the immediate postnatal period. METHODS: The design is inspired by process evaluation. Focus group discussions with policy leaders, academicians, and clinicians who participated in the capacity building programme were carried out. Before and after the intervention, the numbers for dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of the newborn in the immediate postnatal period were detected. RESULTS: Participants believed the internet-based programme was appropriate for their countries' contexts based on their need for improved leadership and collaboration, the need for strengthened human resources, and the vast need for improved outcomes of maternal and newborn health. CONCLUSION: The findings provide insight into the feasibility to expand similar online capacity building programmes in collaboration with onsite policy leaders, academicians, and clinicians in sub-Saharan African countries with an agenda for improvements in maternal and child health.

The importance of clinical and labour market histories in psychiatric disability retirement: analysis of the comprehensive Finnish national-level RETIRE data.

OBJECTIVES: Despite the stable incidence of mental disorders in Finland and Europe, mental health-related occupational disability has been increasing. We unveiled the paths to permanent psychiatric disability, recovery, or death, by analysing sequences of labour market participation. METHODS: The RETIRE register database includes information regarding all persons (n = 42,170) awarded an ICD-10 psychiatric disability pension between 2010 and 2015 in Finland. We identified clusters of typical paths of pre-retirement labour market history. Controlling for major mental disorders, age, and sex, we evaluated factors associated with returning to work (RTW), or death, over a 5-year follow-up period. RESULTS: Only 10.5% of the disabled subjects returned to work within the follow-up. Half of them ended up with a permanent disability pension. Seven distinguishable paths to disability were identified. Subjects in the cluster characterized by steady employment were relatively often females, lost their work ability due to affective disorders, and had the highest rate of returning to work (16.3%). Mortality was highest (9%) among the cluster characterized by long-term unemployment. Distributions of major diagnostic groups, as well as age and sex, differed between clusters. After their adjustment in the analysis of RTW or death, the identified labour market history paths prior to losing work ability remained as important independent prognostic factors for both outcomes. CONCLUSIONS: The complex retirement process involves identifiable clinical and contextual associating factors. Labour market history patterns associate with varying prognoses after psychiatric retirement. Prolonged unemployment appears as a predictor of relatively poor prognoses, whereas employment indicates the opposite.

Design and implementation of a low temperature, inductance based high frequency alternating current susceptometer.

We report on the implementation of an induction based, low temperature, high frequency ac susceptometer capable of measuring at frequencies up to 3.5 MHz and at temperatures between 2 K and 300 K. Careful balancing of the detection coils and calibration allow a sample magnetic moment resolution of 5 × 10-10 Am2 at 1 MHz. We discuss the design and characterization of the susceptometer and explain the calibration process. We also include some example measurements on the spin ice material CdEr2S4 and iron oxide based nanoparticles to illustrate functionality.

Dipolar Spin Ice States with a Fast Monopole Hopping Rate in CdEr_{2}X_{4} (X=Se, S).

Excitations in a spin ice behave as magnetic monopoles, and their population and mobility control the dynamics of a spin ice at low temperature. CdEr_{2}Se_{4} is reported to have the Pauling entropy characteristic of a spin ice, but its dynamics are three orders of magnitude faster than the canonical spin ice Dy_{2}Ti_{2}O_{7}. In this Letter we use diffuse neutron scattering to show that both CdEr_{2}Se_{4} and CdEr_{2}S_{4} support a dipolar spin ice state-the host phase for a Coulomb gas of emergent magnetic monopoles. These Coulomb gases have similar parameters to those in Dy_{2}Ti_{2}O_{7}, i.e., dilute and uncorrelated, and so cannot provide three orders faster dynamics through a larger monopole population alone. We investigate the monopole dynamics using ac susceptometry and neutron spin echo spectroscopy, and verify the crystal electric field Hamiltonian of the Er^{3+} ions using inelastic neutron scattering. A quantitative calculation of the monopole hopping rate using our Coulomb gas and crystal electric field parameters shows that the fast dynamics in CdEr_{2}X_{4} (X=Se, S) are primarily due to much faster monopole hopping. Our work suggests that CdEr_{2}X_{4} offer the possibility to study alternative spin ice ground states and dynamics, with equilibration possible at much lower temperatures than the rare earth pyrochlore examples.

Variable sensitivity to the glucocorticoid activity of cortisol in patients with primary adrenal insufficiency: assessment with ACTH profiles.

Our aim was to investigate the usefulness of circulating levels of adrenocorticotropic hormone (ACTH) and also salivary cortisol to monitor cortisone substitution in patients with Addison's disease. 13 patients with primary adrenal insufficiency (8 women and 5 men, age 44 ± 11 years) received 12.5 mg cortisone acetate orally at 16:00 h and 25 mg at 07:00 h. Blood samples for cortisol and ACTH analysis were drawn every hour for 24 h, and also every half hour between 07:00 and 12:00 h. Samples for salivary cortisol were collected in parallel. Total ACTH levels showed large inter-individual variations and a diurnal rhythm with a nadir in the early evening at 19:00 (median 19 ng/l, range 2-434 ng/l) and high levels in the early morning, with a peak around 07:30 (median 844 ng/l, range 45-2,249 ng/l). Plasma cortisol concentrations showed 2 peaks distinct in time, but variable in height, 1-2 h after intake of cortisone. Plasma cortisol correlated significantly with ln(ACTH) at 17:00 h (r=-0.56), at 10:00 h (r=-0.51), and at 10.30 h (r=-0.57). When tested at different time points, ln(ACTH) at 10:00 to 12:00 h was negatively correlated with plasma cortisol between 08:30 and 12:00 h. Plasma cortisol was highly correlated to ln(salivary cortisol) most of the time points measured, but 30-60 min after intake of cortisone acetate the correlation disappeared. In conclusion, the large interindividual variation in ACTH levels most likely indicates varying sensitivity to cortisol with a need for individualized dosing schemes. Furthermore ACTH-determinations may be useful for dose titration of cortisol.

Precision measurements of the np scattering differential cross section in the intermediate energy region.

In fast neutron cancer therapy, approximately 50% of the cell damage is caused by recoil protons from neutron-proton (np) scattering. In the intermediate energy region, there is a need for unambiguous np scattering data with good precision in both the shape of the angular distribution and the absolute normalisation. The normalisation techniques have been reviewed for np scattering measurements as well as recent experimental results, particularly the data obtained at The Svedberg Laboratory at 96 and 162 MeV. In addition, to what extent systematic uncertainties in the np differential cross section might affect the determination of proton recoil kerma coefficients is investigated.

Kerma coefficients for neutron scattering on 12C and 16O at 96 MeV.

Recently, many new applications of fast neutrons are emerging or under development, like dose effects due to cosmic ray neutrons for airplane crew, fast neutron cancer therapy, studies of electronics failure induced by cosmic ray neutrons and accelerator-driven incineration of nuclear waste and energy production technologies. In radiation treatment, the kerma (Kinetic energy release in matter) coefficient, which describes the average energy transferred from neutrons to charged particles, is widely used. The kerma coefficient can be calculated from microscopic nuclear data. Nuclear data above 20 MeV are rather scarce, and more complete nuclear data libraries are needed in order to improve the understanding of the processes occurring on a cellular level. About half the dose in human tissue due to fast neutrons comes from proton recoils in neutron-proton (np) scattering, 10-15% from nuclear recoils due to elastic and inelastic neutron scattering and the remaining 35-40% from neutron-induced emission of light ions. Experimental data on elastic and inelastic neutron scattering at 96 MeV from (12)C and (16)O have been obtained recently at The Svedberg Laboratory in Uppsala, Sweden. These data are shown to be relevant for the determination of nuclear recoil kerma coefficients from elastic and inelastic neutron scattering at intermediate energies.

Fast neutron beams--prospects for the coming decade.

The present status of neutron beam production techniques above 20 MeV is discussed. Presently, two main methods are used; white beams and quasi-monoenergetic beams. The performances of these two techniques are discussed, as well as the use of such facilities for measurements of nuclear data for fundamental and applied research. Recently, two novel ideas on how to produce extremely intense neutron beams in the 100-500 MeV range have been proposed. Decay in flight of beta delayed neutron-emitting nuclei could provide beam intensities five orders of magnitudes larger than present facilities. A typical neutron energy spectrum would be essentially monoenergetic, i.e., the energy spread is about 1 MeV with essentially no low-energy tail. A second option would be to produce beams of (6)He and dissociate the (6)He nuclei into alpha particles and neutrons. The basic features of these concepts are outlined, and the potential for improved nuclear data research is discussed.

The problems associated with the monitoring of complex workplace radiation fields at European high-energy accelerators and thermonuclear fusion facilities.

The European Commission is funding within its Sixth Framework Programme a three-year project (2005-2007) called CONRAD, COordinated Network for RAdiation Dosimetry. The organisational framework for this project is provided by the European Radiation Dosimetry Group EURADOS. One task within the CONRAD project, Work Package 6 (WP6), was to provide a report outlining research needs and research activities within Europe to develop new and improved methods and techniques for the characterisation of complex radiation fields at workplaces around high-energy accelerators, but also at the next generation of thermonuclear fusion facilities. The paper provides an overview of the report, which will be available as CERN Yellow Report.

Light charged-particle production in 96 MeV neutron-induced reactions on carbon and oxygen.

In recent years, an increasing number of applications involving fast neutrons have been developed or are under consideration, e.g. radiation treatment of cancer, neutron dosimetry at commercial aircraft altitudes, soft-error effects in computer memories, accelerator-driven transmutation of nuclear waste and energy production and determination of the response of neutron detectors. Data on light-ion production in light nuclei such as carbon, nitrogen and oxygen are particularly important in calculations of dose distributions in human tissue for radiation therapy at neutron beams, and for dosimetry of high-energy neutrons produced by high-energy cosmic radiation interacting with nuclei (nitrogen and oxygen) in the atmosphere. When studying neutron dose effects, it is especially important to consider carbon and oxygen, since they are, by weight, the most abundant elements in human tissue. Preliminary experimental double-differential cross sections of inclusive light-ion (p, d, t, (3)He and alpha) production in carbon induced by 96-MeV neutrons have been presented. Energy spectra were measured at eight laboratory angles: 20, 40, 60, 80, 100, 120, 140 and 160 degrees. Measurements were performed at The Svedberg Laboratory (TSL), Uppsala, using the dedicated MEDLEY experimental setup. The authors have earlier reported experimental double-differential cross sections of inclusive light-ion production in oxygen. In this paper, the deduced kerma coefficients for oxygen has been presented and compared with reaction model calculations.

A monitor for neutron flux measurements up to 20 MeV.

A liquid scintillation detector aimed for neutron energy and fluence measurements in the energy region <20 MeV has been calibrated using monoenergetic and white spectrum neutron fields. Careful measurements of the proton light output function and the response matrix have been performed allowing for the application of unfolding techniques using existing codes. The response matrix is used to characterise monoenergetic neutron fields produced by the T(d,n) at a low-energy deuteron accelerator installed at the Swedish Defense Research Agency (FOI).

The TSL neutron beam facility.

A new quasi-monoenergetic neutron beam facility has been constructed at The Svedberg Laboratory (TSL) in Uppsala, Sweden. Key features include a neutron energy range of 11-175 MeV, high fluxes, user flux control, flexible neutron field size and shape, and spacious and easily accessible user area. The first results of the beam characterisation measurements are reported.

Neutron-induced light-ion production from Fe, Pb and U at 96 MeV.

Double-differential cross-sections for light-ion production (up to A = 4) induced by 96 MeV neutrons have been measured for Fe, Pb and U. The experiments have been performed at The Svedberg Laboratory in Uppsala, using two independent devices, MEDLEY and SCANDAL. The recorded data cover a wide angular range (20 degrees -160 degrees ) with low energy thresholds. The data have been normalised to obtain cross-sections using np elastic scattering events. The latter have been recorded with the same setup, and results for this measurement are reported. The work was performed within the HINDAS collaboration with the primary aim of improving the database for three of the most important nuclei for incineration of nuclear waste with accelerator-driven systems. The obtained cross-section data are of particular interest for the understanding of the so-called pre-equilibrium stage in a nuclear reaction and will be compared with model calculations.

Elastic neutron scattering studies at 96 MeV for transmutation.

Elastic neutron scattering from (12)C, (14)N, (16)O, (28)Si, (40)Ca, (56)Fe, (89)Y and (208)Pb has been studied at 96 MeV in the10-70 degrees interval, using the SCANDAL (SCAttered Nucleon Detection AssembLy) facility. The results for (12)C and (208)Pb have recently been published, while the data on the other nuclei are under analysis. The achieved energy resolution, 3.7 MeV, is about an order of magnitude better than for any previous experiment above 65 MeV incident energy. A novel method for normalisation of the absolute scale of the cross section has been used. The estimated normalisation uncertainty, 3%, is unprecedented for a neutron-induced differential cross section measurement on a nuclear target. Elastic neutron scattering is of utmost importance for a vast number of applications. Besides its fundamental importance as a laboratory for tests of isospin dependence in the nucleon-nucleon, and nucleon-nucleus, interaction, knowledge of the optical potentials derived from elastic scattering come into play in virtually every application where a detailed understanding of nuclear processes is important. Applications for these measurements are dose effects due to fast neutrons, including fast neutron therapy, as well as nuclear waste incineration and single event upsets in electronics. The results at light nuclei of medical relevance ((12)C, (14)N and (16)O) are presented separately. In the present contribution, results on the heavier nuclei are presented, among which several are of relevance to shielding of fast neutrons.

Measurement of the absolute n p scattering differential cross section at 194 MeV.

We describe a double-scattering experiment with a novel tagged neutron beam to measure differential cross sections for np backscattering to better than +/-2% absolute precision. The measurement focuses on angles and energies where the cross section magnitude and angle dependence constrain the charged pion-nucleon coupling constant, but existing data show serious discrepancies among themselves and with energy-dependent partial-wave analyses. The present results are in good accord with the partial-wave analyses, but deviate systematically from other recent measurements.

Non-physiological levels of circulating cortisol in growth hormone-treated hypopituitary adults after conventional cortisone substitution.

OBJECTIVE: To assess the usefulness of measuring plasma cortisol profiles in growth hormone-treated hypopituitary adults and to compare these with cortisol levels in healthy controls. METHODS: Eleven ACTH-deficient adult patients received 12.5 mg cortisone-acetate orally at 16.00 h and 25 mg at 07.00 h. The patients arrived in the ward at 12.00 h. After tablet intake at 16.00 h, samples for serum cortisol were taken at hourly intervals for the next 24 h, except between 07.00 and 12.00 h when samples were drawn every half hour; 24-h urinary free cortisol (24-h-UFC) excretion was collected simultaneously. For comparison, 8 healthy controls were investigated. RESULTS: The patients had circulating cortisol levels with very low plasma cortisol at 07.00 h before their morning dose of cortisone acetate. At the same time period, controls had their highest plasma cortisol levels. After tablet intake the patients had a rapid initial absorption of cortisol, but a marked variability in the morning peak levels (Cmax), and the Cmax was in general higher and occurred 90 min later than the Cmax in the controls. The 24-h-UFC excretion and 24-h area under the curve (24-h-AUC) did not differ between patients and controls. The female patients had higher 24-h-AUC for plasma cortisol (p=0.032) and tended to have higher plasma cortisol peaks in the morning, but had levels of 24-h-UFC similar to those of the male patients. CONCLUSIONS: Conventional cortisone substitution with a twice-daily replacement regimen in hypopituitary adults results in abnormal circulating cortisol profiles with low or non-measurable morning values and variable individual peaks. This suggests that the present dosing schemes have to be improved and that cortisone substitution should be individualized.

Beyond kerma--neutron data for biomedical applications.

Presently, many new applications of fast neutrons are emerging or under development, like dose effects due to cosmic-ray neutrons for airplane crew, fast-neutron cancer therapy, studies of electronics failures induced by cosmic-ray neutrons, and accelerator-driven incineration of nuclear waste and energy production technologies. All these areas would benefit from improved neutron dosimetry. In this paper, the present rapid progress on measurements of double-differential neutron-induced nuclear reaction data are described. With such data at hand, the full response of, in principle, any system, including human tissue, can be calculated in detail. This could potentially revolutionise our understanding of biological effects in tissue due to fast neutrons.

Mechanism of topical glucocorticoid treatment of hay fever: IL-5 and eosinophil activation during natural allergen exposure are suppressed, but IL-4, IL-6, and IgE antibody production are unaffected.

BACKGROUND: Allergic rhinitis is traditionally defined as an IgE- and mast cell-mediated hypersensitivity reaction. Allergen challenge models suggest that cytokines and eosinophil mediators may also play roles. However, the causal relationship among inflammatory cells, their products, and patients' symptoms during natural allergen exposure has not been established. OBJECTIVE: We sought to elucidate the mechanisms of seasonal allergic rhinitis and the beneficial effects of topical glucocorticoids. METHODS: Thirty patients with ragweed-induced hay fever and a strongly positive serologic test response for ragweed IgE antibody received budesonide nasal spray or placebo in a randomized, parallel, double-blind study. Nasal wash fluids and sera were collected before and during the hay fever season. The levels of inflammatory mediators and allergen-specific immunoglobulins were measured by immunoassay. The activation markers on blood eosinophils were quantitated by flow cytometry. RESULTS: Compared with placebo-treated patients, budesonide-treated patients had strikingly reduced symptoms. In the placebo group, nasal symptoms correlated with nasal lavage fluid eosinophil-derived neurotoxin and IL-5 levels. At the season peak, the budesonide-treated group had significantly lower nasal fluid eosinophil-derived neurotoxin, IL-5, and soluble intracellular adhesion molecule-1 levels. In the treated group eosinophil expression of CD11b was suppressed at the season peak. In contrast, levels of IL-4 and IL-6 in nasal fluid and the seasonal increases in serum ragweed-specific IgE and nasal fluid IgA antibodies did not differ between groups. CONCLUSION: Eosinophilic inflammation plays a critical role in seasonal allergic rhinitis symptoms. One of the therapeutic effects of glucocorticoids is to suppress this inflammation.