| 1. |
- Gurung, Rejina, et al.
(author)
-
Predictors for timely initiation of breastfeeding after birth in the hospitals of Nepal- a prospective observational study.
- 2021
-
In: International breastfeeding journal. - : Springer Science and Business Media LLC. - 1746-4358. ; 16:1
-
Journal article (peer-reviewed)abstract
- Timely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal.A prospective observational study was conducted in four public hospitals between July and October 2018. All women admitted in the hospital for childbirth and who consented were included in the study. An independent researchers observed whether the neonates were placed in skin-to-skin contact, delay cord clamping and timely initiation of breastfeeding. Sociodemographic variables, obstetric and neonate information were extracted from the maternity register. We analysed predictors for timely initiation of breastfeeding with Pearson chi-square test and multivariate logistic regression.Among the 6488 woman-infant pair observed, breastfeeding was timely initiated in 49.5% neonates. The timely initiation of breastfeeding was found to be higher among neonates who were placed skin-to-skin contact (34.9% vs 19.9%, p - value < 0.001). The timely initiation of breastfeeding was higher if the cord clamping was delayed than early cord clamped neonates (44.5% vs 35.3%, p - value < 0.001). In multivariate analysis, a mother with no obstetric complication during admission had 57% higher odds of timely initiation of breastfeeding (aOR 1.57; 95% CI 1.33, 1.86). Multiparity was associated with less timely initiation of breastfeeding (aOR 1.56; 95% CI 1.35, 1.82). Similarly, there was more common practice of timely initiation of breastfeeding among low birthweight neonates (aOR 1.46; 95% CI 1.21, 1.76). Neonates who were placed skin-to-skin contact with mother had more than two-fold higher odds of timely breastfeeding (aOR 2.52; 95% CI 2.19, 2.89). Likewise, neonates who had their cord intact for 3 min had 37% higher odds of timely breastfeeding (aOR 1.37; 95% CI 1.21, 1.55).The rate of timely initiation of breastfeeding practice is low in the health facilities of Nepal. Multiparity, no obstetric complication at admission, neonates placed in skin-to-skin contact and delay cord clamping were strong predictors for timely initiation of breastfeeding. Quality improvement intervention can improve skin-to-skin contact, delayed cord clamping and timely initiation of breastfeeding.
|
|
| 2. |
- Andreoni, Igor, et al.
(author)
-
Fast-transient Searches in Real Time with ZTFReST : Identification of Three Optically Discovered Gamma-Ray Burst Afterglows and New Constraints on the Kilonova Rate
- 2021
-
In: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 918:2
-
Journal article (peer-reviewed)abstract
- The most common way to discover extragalactic fast transients, which fade within a few nights in the optical, is via follow-up of gamma-ray burst and gravitational-wave triggers. However, wide-field surveys have the potential to identify rapidly fading transients independently of such external triggers. The volumetric survey speed of the Zwicky Transient Facility (ZTF) makes it sensitive to objects as faint and fast fading as kilonovae, the optical counterparts to binary neutron star mergers, out to almost 200 Mpc. We introduce an open-source software infrastructure, the ZTF REaltime Search and Triggering, ZTFReST, designed to identify kilonovae and fast transients in ZTF data. Using the ZTF alert stream combined with forced point-spread-function photometry, we have implemented automated candidate ranking based on their photometric evolution and fitting to kilonova models. Automated triggering, with a human in the loop for monitoring, of follow-up systems has also been implemented. In 13 months of science validation, we found several extragalactic fast transients independently of any external trigger, including two supernovae with post-shock cooling emission, two known afterglows with an associated gamma-ray burst (ZTF20abbiixp, ZTF20abwysqy), two known afterglows without any known gamma-ray counterpart (ZTF20aajnksq, ZTF21aaeyldq), and three new fast-declining sources (ZTF20abtxwfx, ZTF20acozryr, ZTF21aagwbjr) that are likely associated with GRB200817A, GRB201103B, and GRB210204A. However, we have not found any objects that appear to be kilonovae. We constrain the rate of GW170817-like kilonovae to R < 900 Gpc(-3) yr(-1) (95% confidence). A framework such as ZTFReST could become a prime tool for kilonova and fast-transient discovery with the Vera Rubin Observatory.
|
|
| 3. |
- Bruch, Rachel J., et al.
(author)
-
A Large Fraction of Hydrogen-rich Supernova Progenitors Experience Elevated Mass Loss Shortly Prior to Explosion
- 2021
-
In: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 912:1
-
Journal article (peer-reviewed)abstract
- Spectroscopic detection of narrow emission lines traces the presence of circumstellar mass distributions around massive stars exploding as core-collapse supernovae. Transient emission lines disappearing shortly after the supernova explosion suggest that the material spatial extent is compact and implies an increased mass loss shortly prior to explosion. Here, we present a systematic survey for such transient emission lines (Flash Spectroscopy) among Type II supernovae detected in the first year of the Zwicky Transient Facility survey. We find that at least six out of ten events for which a spectrum was obtained within two days of the estimated explosion time show evidence for such transient flash lines. Our measured flash event fraction (>30% at 95% confidence level) indicates that elevated mass loss is a common process occurring in massive stars that are about to explode as supernovae.
|
|
| 4. |
- Fremling, Christoffer, et al.
(author)
-
SNIascore : Deep-learning Classification of Low-resolution Supernova Spectra
- 2021
-
In: Astrophysical Journal Letters. - : American Astronomical Society. - 2041-8205 .- 2041-8213. ; 917:1
-
Journal article (peer-reviewed)abstract
- We present SNIascore, a deep-learning-based method for spectroscopic classification of thermonuclear supernovae (SNe Ia) based on very low-resolution (R similar to 100) data. The goal of SNIascore is the fully automated classification of SNe Ia with a very low false-positive rate (FPR) so that human intervention can be greatly reduced in large-scale SN classification efforts, such as that undertaken by the public Zwicky Transient Facility (ZTF) Bright Transient Survey (BTS). We utilize a recurrent neural network architecture with a combination of bidirectional long short-term memory and gated recurrent unit layers. SNIascore achieves a SNIascore simultaneously performs binary classification and predicts the redshifts of secure SNe Ia via regression (with a typical uncertainty of z = 0.01 to z = 0.12). For the magnitude-limited ZTF BTS survey (approximate to 70% SNe Ia), deploying SNIascore reduces the amount of spectra in need of human classification or confirmation by approximate to 60%. Furthermore, SNIascore allows SN Ia classifications to be automatically announced in real time to the public immediately following a finished observation during the night.
|
|
| 5. |
- Gurung, Rejina, et al.
(author)
-
Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal.
- 2021
-
In: BMC pregnancy and childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 21:Suppl 1
-
Journal article (peer-reviewed)abstract
- Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns.At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017-July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health - ethnicity, age, sex, mode of birth - as possible predictors for reporting poor care.Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = - 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = - 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01-0.05) of receiving skin-to-skin contact than those with vaginal births.Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women's age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.
|
|
| 6. |
- Karambelkar, Viraj R., et al.
(author)
-
Faintest of Them All : ZTF 21aaoryiz/SN 2021fcg-Discovery of an Extremely Low Luminosity Type Iax Supernova
- 2021
-
In: Astrophysical Journal Letters. - : American Astronomical Society. - 2041-8205 .- 2041-8213. ; 921:1
-
Journal article (peer-reviewed)abstract
- We present the discovery of ZTF 21aaoryiz/SN 2021fcg-an extremely low luminosity Type Tax supernova. SN 2021fcg was discovered by the Zwicky Transient Facility in the star-forming galaxy IC0512 at a distance of approximate to 27 Mpc. It reached a peak absolute magnitude of M-r = -12.66 +/- 0.20 mag, making it the least luminous thermonuclear supernova discovered to date. The E(B - V) contribution from the underlying host galaxy is unconstrained. However, even if it were as large as 0.5 mag, the peak absolute magnitude would be M-r = -13.78 +/- 0.20 mag-still consistent with being the lowest-luminosity SN. Optical spectra of SN 2021fcg taken at 37 and 65 days post-maximum show strong [Ca II], Ca II, and Na I D emission and several weak [Fe II] emission lines. The [Ca II] emission in the two spectra has extremely low velocities of approximate to 1300 and 1000 km s(-1), respectively. The spectra very closely resemble those of the very low luminosity Type Tax supernovae SN 2008 ha, SN 2010ae, and SN 2019gsc taken at similar phases. The peak bolometric luminosity of SN 2021fcg is approximate to 2.5(-0.3)(+1.5) x 10(40) erg s(-1), which is a factor of 3 lower than that for SN 2008 ha. The bolometric lightcurve of SN 2021fcg is consistent with a very low ejected nickel mass (M-Ni approximate to 0.8(-0.5)(+0.4) x 10(-3) M-circle dot). The low luminosity and nickel mass of SN 2021fcg pose a challenge to the picture that low-luminosity SNe Tax originate from deflagrations of near-M-ch hybrid carbon-oxygen-neon white dwarfs. Instead, the merger of a carbon-oxygen and oxygen-neon white dwarf is a promising model to explain SN 2021fcg.
|
|
| 7. |
- KC, Ashish, 1982, et al.
(author)
-
Mistreatment of newborns after childbirth in health facilities in Nepal: Results from a prospective cohort observational study.
- 2021
-
In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 16:2
-
Journal article (peer-reviewed)abstract
- Patient experience of care reflects the quality of health care in health facilities. While there are multiple studies documenting abuse and disrespect to women during childbirth, there is limited evidence on the mistreatment of newborns immediately after childbirth. This paper addresses the evidence gap by assessing the prevalence and risk factors associated with mistreatment of newborns after childbirth in Nepal, based on a large-scale observational study.This is a prospective observational cohort study conducted over a period of 18 months in 4 public referral hospitals in Nepal. All newborns born at the facilities during the study period, who breathed spontaneously and were observed, were included. A set of indicators to measure mistreatment for newborns was analysed. Principal component analysis was used to construct a single newborn mistreatment index. Uni-variate, multi-variate, and multi-level analysis was done to measure the association between the newborn mistreatment index and demographic, obstetric, and neonatal characteristics. A total of 31,804 births of newborns who spontaneously breathed were included. Among the included newborns, 63.0% (95% CI, 62.5-63.5) received medical interventions without taking consent from the parents, 25.0% (95% CI, 24.5-25.5) were not treated with kindness and respect (roughly handled), and 21.4% (95% CI, 20.9-21.8) of them were suctioned with no medical need. Among the newborns, 71.7% (95% CI, 71.2-72.3) had the cord clamped within 1 minute and 77.6% (95% CI, 77.1-78.1) were not breast fed within 1 hour of birth. Only 3.5% (95% CI, 3.2-3.8) were kept in skin to skin contact in the delivery room after birth. The mistreatment index showed maximum variation in mistreatment among those infants born to women of relatively disadvantaged ethnic groups and infants born to women with 2 or previous births. After adjusting for hospital heterogeneity, infants born to women aged 30-34 years (β, -0.041; p value, 0.01) and infants born to women aged 35 years or more (β, -0.064; p value, 0.029) were less mistreated in reference to infants born to women aged 18 years or less. Infants born to women from the relatively disadvantaged (chhetri) ethnic groups (β, 0.077; p value, 0.000) were more likely to be mistreated than the infants born to relatively advantaged (brahmin) ethnic groups. Female newborns (β, 0.016; p value, 0.015) were more likely to be mistreated than male newborns.The mistreatment of spontaneously breathing newborns is high in public hospitals in Nepal. Mistreatment varied by hospital, maternal ethnicity, maternal age, and sex of the newborn. Reducing mistreatment of newborns will require interventions at policy, health system, and individual level. Further, implementation studies will be required to identify effective interventions to reduce inequity and mistreatment of newborns at birth.
|
|
| 8. |
- KC, Ashish, 1982, et al.
(author)
-
The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal.
- 2021
-
In: Journal of global health. - : International Global Health Society. - 2047-2986 .- 2047-2978. ; 11
-
Journal article (peer-reviewed)abstract
- The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal.We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women's residence in a COVID-19 hotspot area.The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% (P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women's residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P = 0.001).The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a "building-back-better" approach in post-pandemic period.
|
|
| 9. |
- Khare, Shweta, et al.
(author)
-
Determinants and pathways of healthcare-seeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing : a cohort study in rural India
- 2021
-
In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:12
-
Journal article (peer-reviewed)abstract
- Objectives To explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India.Study design Prospective cohort study.Study setting and study sample The cohort included 270 U-5 children from selected six villages in rural demographic surveillance site, of the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. A community-based cohort was visited two times weekly for over 113 weeks (August 2014 to October 2016) to record the HSB of caregivers using HSB diaries. Sociodemographic information was also solicited.Primary and secondary outcome measures Primary outcomes: first point of care, healthcare-seeking pathway and quantify antibiotic prescribing for the common acute illnesses.Secondary outcome HSB risk factors were determined using mixed-effects multinomial logistic regression.Results A total of 60 228 HSB follow-up time points for 270 children were recorded with a total of 2161 acute illness episodes. The most common illnesses found were respiratory tract infections (RTI) (69%) and gastrointestinal tract infections (8%). No healthcare was sought in 33% of illness episodes, mostly for RTIs. The most common healthcare-seeking pathway was to informal healthcare providers (IHCPs, 49% of illness episodes). The adjusted relative risk for obtaining no treatment, home treatment and treatment by IHCPs was higher for RTIs (aRR=11.54, 1.82 and 1.29, respectively), illiterate mothers (aRR=2.86, 2.38 and 1.93, respectively), and mothers who were homemakers (aRR=2.90, 4.17 and 2.10, respectively). Socioeconomic status was associated with HSB, with the highest aRR for no treatment in the lowest two socioeconomic quintiles (aRR=6.59 and 6.39, respectively). Antibiotics were prescribed in 46% (n=670/1450) illness episodes and the majority (85%, n=572/670) were broad spectrum.Conclusion In our rural cohort for many acute episodes of illnesses, no treatment or home treatment was done, which resulted in overall reduced antibiotic prescribing. The most common healthcare-seeking pathway was to visit IHCPs, which indicates that they are major healthcare providers in rural areas. Most of the antibiotics were prescribed by IHCPs and were commonly prescribed for illnesses where they were not indicated.
|
|
| 10. |
- Purdum, Josiah N., et al.
(author)
-
Time-series and Phase-curve Photometry of the Episodically Active Asteroid (6478) Gault in a Quiescent State Using APO, GROWTH, P200, and ZTF
- 2021
-
In: Astrophysical Journal Letters. - : American Astronomical Society. - 2041-8205 .- 2041-8213. ; 911:2
-
Journal article (peer-reviewed)abstract
- We observed the episodically active asteroid (6478) Gault in 2020 with multiple telescopes in Asia and North America and found that it is no longer active after its recent outbursts at the end of 2018 and the start of 2019. The inactivity during this apparition allowed us to measure the absolute magnitude of Gault of H ( r ) = 14.63 +/- 0.02, G ( r ) = 0.21 +/- 0.02 from our secular phase-curve observations. In addition, we were able to constrain Gault's rotation period using time-series photometric lightcurves taken over 17 hr on multiple days in 2020 August, September, and October. The photometric lightcurves have a repeating less than or similar to 0.05 mag feature suggesting that (6478) Gault has a rotation period of similar to 2.5 hr and may have a semispherical or top-like shape, much like the near-Earth asteroids Ryugu and Bennu. The rotation period of similar to 2.5 hr is near the expected critical rotation period for an asteroid with the physical properties of (6478) Gault, suggesting that its activity observed over multiple epochs is due to surface mass shedding from its fast rotation spin-up by the Yarkovsky-O'Keefe-Radzievskii-Paddack effect.
|
|
