Search

Abstract Background 98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models. Methods Our study was nested within a community-based survey of surgical conditions conducted in the Butajira Health and Demographic Surveillance Site, southern Ethiopia, and a follow-up study of people accessing surgical care in two local hospitals. We carried out 24 semi-structured interviews. Participants were community members who needed but did/did not access surgical care, community-based healthcare workers and traditional bone-setters. Interviews were conducted in Amharic, audio-recorded, transcribed, and translated into English. We initially carried out thematic analysis and we recognized that emerging themes were aligned with Kleinman’s explanatory models framework and decided to use this to guide the final stages of analysis. Results We found that community members primarily understood surgical conditions according to severity. We identified two categories: conditions you could live with and those which required urgent care, with the latter indicating a clear and direct path to surgical care whilst the former was associated with a longer, more complex and experimental pattern of help-seeking. Fear of surgery and poverty disrupted help-seeking, whilst community narratives based on individual experiences fed into the body of knowledge people used to inform decisions about care. Conclusions We found explanatory models to be flexible, responsive to new evidence about what might work best in the context of limited community resources. Our findings have important implications for future research and policy, suggesting that community-level barriers have the potential to be responsive to carefully designed interventions which take account of local knowledge and beliefs.

We present measurements of stellar populations properties of a z = 9.1 gravitationally lensed galaxy MACS1149-JD1 using deep James Webb Space Telescope NIRISS slitless spectroscopy as well as NIRISS and NIRCam imaging from the CAnadian NIRISS Unbiased Cluster Survey (CANUCS). The galaxy is split into four components. Three magnified ( μ ∼ 11) star-forming components are unresolved, giving intrinsic sizes of

We describe new ultradeep James Webb Space Telescope (JWST) NIRSpec PRISM and grating spectra for the galaxies JADES-GS-z11-0 ( ${z}_{\mathrm{spec}}={11.122}_{-0.003}^{+0.005}$ ) and JADES-GS-z13-0 ( ${z}_{\mathrm{spec}}={13.20}_{-0.04}^{+0.03}$ ), the most distant spectroscopically confirmed galaxy discovered in the first year of JWST observations. The extraordinary depth of these observations (75 hr and 56 hr, respectively) provides a unique opportunity to explore the redshifts, stellar properties, UV magnitudes, and slopes for these two sources. For JADES-GS-z11-0, we find evidence for multiple emission lines, including [O ii ] λ λ 3726, 3729 and [Ne iii ] λ 3869, resulting in a spectroscopic redshift we determine with 94% confidence. We present stringent upper limits on the emission-line fluxes and line equivalent widths for JADES-GS-z13-0. At this spectroscopic redshift, the Ly α break in JADES-GS-z11-0 can be fit with a damped Ly α absorber with $\mathrm{log}({N}_{\mathrm{HI}}/{\mathrm{cm}}^{-2})={22.42}_{-0.120}^{+0.093}$ . These results demonstrate how neutral hydrogen fraction and Lyman-damping wings may impact the recovery of spectroscopic redshifts for sources like these, providing insight into the overprediction of the photometric redshifts seen for distant galaxies observed with JWST. In addition, we analyze updated NIRCam photometry to calculate the morphological properties of these resolved sources, and find a secondary source 0.″3 south of JADES-GS-z11-0 at a similar photometric redshift, hinting at how galaxies grow through interactions in the early Universe.

We present a spatially resolved study of stellar populations in six galaxies with stellar masses M _* ∼ 10 ^10 M _☉ at z ∼ 3.7 using 14-filter James Webb Space Telescope (JWST)/NIRCam imaging from the JADES and JEMS surveys. The six galaxies are visually selected to have clumpy substructures with distinct colors over rest frame 3600−4100 Å, including a red, dominant stellar core that is close to their stellar-light centroids. With 23-filter photometry from the Hubble Space Telescope to JWST, we measure the stellar-population properties of individual structural components via spectral energy distribution fitting using Prospector . We find that the central stellar cores are ≳2 times more massive than the Toomre mass, indicating they may not form via single in situ fragmentation. The stellar cores have stellar ages of 0.4−0.7 Gyr that are similar to the timescale of clump inward migration due to dynamical friction, suggesting that they likely instead formed through the coalescence of giant stellar clumps. While they have not yet quenched, the six galaxies are below the star-forming main sequence by 0.2−0.7 dex. Within each galaxy, we find that the specific star formation rate is lower in the central stellar core, and the stellar-mass surface density of the core is already similar to quenched galaxies of the same masses and redshifts. Meanwhile, the stellar ages of the cores are either comparable to or younger than the extended, smooth parts of the galaxies. Our findings are consistent with model predictions of the gas-rich compaction scenario for the buildup of galaxies’ central regions at high redshifts. We are likely witnessing the coeval formation of dense central cores, along with the onset of galaxy-wide quenching at z > 3.

One of the more surprising findings after the first year of JWST observations is the large number of spatially extended galaxies (ultrared flattened objects, or UFOs) among the optically faint galaxy (OFG) population otherwise thought to be compact. Leveraging the depth and survey area of the JWST Advanced Deep Extragalactic Survey, we extend observations of the OFG population to an additional 112 objects, 56 of which are well-resolved in F444W with effective sizes, R _e > 0.″25, more than tripling previous UFO counts. These galaxies have redshifts around 2 < z < 4, high stellar masses ( $\mathrm{log}({M}_{* }/{M}_{\odot })\sim 10\mbox{--}11$ ), and star formation rates around ∼100–1000 M _⊙ yr ^−1 . Surprisingly, UFOs are red across their entire extents, which spatially resolved analysis of their stellar populations shows is due to large values of dust attenuation (typically A _V > 2 mag even at large radii). Morphologically, the majority of our UFO sample tends to have low Sérsic indices ( n ∼ 1) suggesting that these large, massive, OFGs have little contribution from a bulge in F444W. Further, a majority have axis ratios between 0.2 < q < 0.4, which Bayesian modeling suggests that their intrinsic shapes are consistent with being a mixture of inclined disks and prolate objects with little to no contribution from spheroids. While kinematic constraints will be needed to determine the true intrinsic shapes of UFOs, it is clear that an unexpected population of large, disky or prolate objects contributes significantly to the population of OFGs.

We conduct a systematic search for high-redshift galaxy overdensities at 4.9 < z _spec < 8.9 in both the Great Observatories Origins Deep Survey (GOODS)-N and GOODS-S fields using James Webb Space Telescope/Near-Infrared Camera (JWST/NIRCam) imaging from the JWST Advanced Deep Extragalactic Survey and JWST Extragalactic Medium-band Survey in addition to JWST/NIRCam wide field slitless spectroscopy from the First Reionization Epoch Spectroscopic Complete Survey. High-redshift galaxy candidates are identified using Hubble Space Telescope + JWST photometry spanning λ = 0.4–5.0 μ m. We confirmed the redshifts for roughly a third of these galaxies using JWST spectroscopy over λ = 3.9–5.0 μ m through identification of either H α or $\left[\mathrm{OIII}\right]\lambda 5008$ around the best-fit photometric redshift. The rest-ultraviolet magnitudes and continuum slopes of these galaxies were inferred from the photometry: the brightest and reddest objects appear in more dense environments and thus are surrounded by more galaxy neighbors than their fainter and bluer counterparts, suggesting accelerated galaxy evolution within overdense environments. We find 17 significant ( δ _gal ≥ 3.04, N _gal ≥ 4) galaxy overdensities across both fields (seven in GOODS-N and 10 in GOODS-S), including the two highest redshift spectroscopically confirmed galaxy overdensities to date at $\left\langle {z}_{\mathrm{spec}}\right\rangle =7.954$ and $\left\langle {z}_{\mathrm{spec}}\right\rangle =8.222$ (representing densities around ∼6 and ∼12 times that of a random volume). We estimate the total halo mass of these large-scale structures to be $11.5\leqslant {\mathrm{log}}_{10}\left({M}_{\mathrm{halo}}/{M}_{\odot }\right)\leqslant 13.4$ using an empirical stellar mass-to-halo mass relation, which are likely underestimates as a result of incompleteness. These protocluster candidates are expected to evolve into massive galaxy clusters with ${\mathrm{log}}_{10}\left({M}_{\mathrm{halo}}/{M}_{\odot }\right)\gtrsim 14$ by z = 0.

We characterize the earliest galaxy population in the JADES Origins Field, the deepest imaging field observed with JWST. We make use of ancillary Hubble Space Telescope optical images (five filters spanning 0.4–0.9 μ m) and novel JWST images with 14 filters spanning 0.8−5 μ m, including seven medium-band filters, and reaching total exposure times of up to 46 hr per filter. We combine all our data at >2.3 μ m to construct an ultradeep image, reaching as deep as ≈31.4 AB mag in the stack and 30.3–31.0 AB mag (5 σ , r = 0.″1 circular aperture) in individual filters. We measure photometric redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts z = 11.5−15. These objects show compact half-light radii of R _1/2 ∼ 50−200 pc, stellar masses of M _⋆ ∼ 10 ^7 −10 ^8 M _☉ , and star formation rates ∼ 0.1−1 M _☉ yr ^−1 . Our search finds no candidates at 15 < z < 20, placing upper limits at these redshifts. We develop a forward-modeling approach to infer the properties of the evolving luminosity function without binning in redshift or luminosity that marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the impact of nondetections. We find a z = 12 luminosity function in good agreement with prior results, and that the luminosity function normalization and UV luminosity density decline by a factor of ∼2.5 from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical models for evolution of the dark matter halo mass function.

We study 31 little red dots (LRD) detected by JADES/NIRCam and covered by the SMILES/MIRI survey, of which ∼70% are detected in the two bluest MIRI bands and 40% in redder MIRI filters. The median/quartiles redshifts are $z={6.9}_{5.9}^{7.7}$ (55% spectroscopic). The spectral slopes flatten in the rest-frame near-infrared, consistent with a 1.6 μ m stellar bump but bluer than direct pure emission from active galactic nuclei (AGN) tori. The apparent dominance of stellar emission at these wavelengths for many LRDs expedites stellar mass estimation: the median/quartiles are $\mathrm{log}{M}_{\star }/{M}_{\odot }={9.4}_{9.1}^{9.7}$ . The number density of LRDs is 10 ^−4.0±0.1 Mpc ^−3 , accounting for 14% ± 3% of the global population of galaxies with similar redshifts and masses. The rest-frame near-/mid-infrared (2–4 μ m) spectral slope reveals significant amounts of warm dust (bolometric attenuation ∼3–4 mag). Our spectral energy distribution modeling implies the presence of 10 mag. We find a wide variety in the nature of LRDs. However, the best-fitting models for many of them correspond to extremely intense and compact starburst galaxies with mass-weighted ages 5–10 Myr, very efficient in producing dust, with their global energy output dominated by the direct (in the flat rest-frame ultraviolet and optical spectral range) and dust-recycled emission from OB stars with some contribution from an obscured AGN (in the infrared).

We present a catalog of 717 candidate galaxies at z > 8 selected from 125 square arcmin of NIRCam imaging as part of the JWST Advanced Deep Extragalactic Survey (JADES). We combine the full JADES imaging data set with data from the JWST Extragalactic Medium Survey and First Reionization Epoch Spectroscopic COmplete Survey (FRESCO) along with extremely deep existing observations from Hubble Space Telescope (HST)/Advanced Camera for Surveys (ACS) for a final filter set that includes 15 JWST/NIRCam filters and five HST/ACS filters. The high-redshift galaxy candidates were selected from their estimated photometric redshifts calculated using a template-fitting approach, followed by visual inspection from seven independent reviewers. We explore these candidates in detail, highlighting interesting resolved or extended sources, sources with very red long-wavelength slopes, and our highest-redshift candidates, which extend to z _phot ∼ 18. Over 93% of the sources are newly identified from our deep JADES imaging, including 31 new galaxy candidates at z _phot > 12. We also investigate potential contamination by stellar objects, and do not find strong evidence from spectral energy distribution fitting that these faint high-redshift galaxy candidates are low-mass stars. Using 42 sources in our sample with measured spectroscopic redshifts from NIRSpec and FRESCO, we find excellent agreement to our photometric redshift estimates, with no catastrophic outliers and an average difference of 〈Δ z = z _phot − z _spec 〉 = 0.26. These sources comprise one of the most robust samples for probing the early buildup of galaxies within the first few hundred million years of the Universe’s history.

We report the discovery of an extreme galaxy overdensity at z = 5.4 in the GOODS-S field using James Webb Space Telescope (JWST)/NIRCam imaging from JADES and JEMS alongside JWST/NIRCam wide-field slitless spectroscopy from FRESCO. We identified potential members of the overdensity using Hubble Space Telescope+JWST photometry spanning λ = 0.4–5.0 μ m. These data provide accurate and well-constrained photometric redshifts down to m ≈ 29–30 mag. We subsequently confirmed N = 81 galaxies at 5.2 < z < 5.5 using JWST slitless spectroscopy over λ = 3.9–5.0 μ m through a targeted line search for H α around the best-fit photometric redshift. We verified that N = 42 of these galaxies reside in the field, while N = 39 galaxies reside in a density around ∼10 times that of a random volume. Stellar populations for these galaxies were inferred from the photometry and used to construct the star-forming main sequence, where protocluster members appeared more massive and exhibited earlier star formation (and thus older stellar populations) when compared to their field galaxy counterparts. We estimate the total halo mass of this large-scale structure to be $12.6\lesssim {\mathrm{log}}_{10}\left({M}_{\mathrm{halo}}/{M}_{\odot }\right)\lesssim 12.8$ using an empirical stellar mass to halo mass relation, which is likely an underestimate as a result of incompleteness. Our discovery demonstrates the power of JWST at constraining dark matter halo assembly and galaxy formation at very early cosmic times.

HDF850.1 is the brightest submillimeter galaxy (SMG) in the Hubble Deep Field. It is known as a heavily dust-obscured star-forming galaxy embedded in an overdense environment at z = 5.18. With nine-band NIRCam images at 0.8–5.0 μ m obtained through the JWST Advanced Deep Extragalactic Survey, we detect and resolve the rest-frame UV–optical counterpart of HDF850.1, which splits into two components because of heavy dust obscuration in the center. The southern component leaks UV and H α photons, bringing the galaxy ∼100 times above the empirical relation between infrared excess and UV continuum slope (IRX– β _UV ). The northern component is higher in dust attenuation and thus fainter in UV and H α surface brightness. We construct a spatially resolved dust-attenuation map from the NIRCam images, well matched with the dust continuum emission obtained through millimeter interferometry. The whole system hosts a stellar mass of 10 ^10.8±0.1 M _⊙ and star formation rate (SFR) of 10 ^2.8±0.2 M _⊙ yr ^−1 , placing the galaxy at the massive end of the star-forming main sequence at this epoch. We further confirm that HDF850.1 resides in a complex overdense environment at z = 5.17–5.30, which hosts another luminous SMG at z = 5.30 (GN10). The filamentary structures of the overdensity are characterized by 109 H α -emitting galaxies confirmed through NIRCam slitless spectroscopy at 3.9–5 μ m, of which only eight were known before the JWST observations. Given the existence of a similar galaxy overdensity in the GOODS-S field, our results suggest that 50% ± 20% of the cosmic star formation at z = 5.1–5.5 occur in protocluster environments.

Minor mergers are thought to drive the structural evolution of massive quiescent galaxies; however, existing Hubble Space Telescope (HST) imaging is primarily sensitive to stellar mass ratios ≳1:10. Here, we report the discovery of a large population of low-mass companions within 35 kpc of known $\mathrm{log}{M}_{* }/{M}_{\odot }\gtrsim 10.5$ quiescent galaxies at 0.5 ≤ z ≤ 3. While massive companions like those identified by HST are rare, JWST imaging from the JWST Advanced Deep Extragalactic Survey reveals that the average massive quiescent galaxy hosts approximately five nearby companions with stellar mass ratios

We report the discovery of a low-mass z = 5.200 ± 0.002 galaxy that is in the process of ceasing its star formation. The galaxy, MACS0417-z5BBG, is multiply imaged with magnification factors ∼40 by the galaxy cluster MACS J0417.5-1154, observed as part of the CAnadian NIRISS Unbiased Cluster Survey (CANUCS). Using observations of MACS0417-z5BBG with a JWST/NIRSpec Prism spectrum and NIRCam imaging, we investigate the mechanism responsible for the cessation of star formation of the galaxy and speculate about possibilities for its future. Using spectrophotometric fitting, we find a remarkably low stellar mass of ${M}_{* }=4.3{\pm }_{0.8}^{0.9}\times {10}^{7}{M}_{\odot }$ , less than 1% of the characteristic stellar mass at z ∼ 5. We measure a delensed rest-UV half-light radius in the source plane of $30{\pm }_{5}^{7}$ pc and measure a star formation rate from H α of $0.14{\pm }_{0.12}^{0.17}$ M _⊙ yr ^−1 . We find that under the assumption of a double power-law star formation history, MACS0417-z5BBG has seen a recent rise in star formation, peaking ∼10–30 Myr ago and declining precipitously since then. Together, these measurements reveal a low-mass, extremely compact galaxy which is in the process of ceasing star formation. We investigate the possibilities of mechanisms that have led to the cessation of star formation in MACS0417-z5BBG, considering stellar and active galactic nuclei (AGN) feedback and environmental processes. We can likely rule out most environmental processes but leave open the possibility of a low-mass AGN that does not leave a broad-line imprint on the spectrum or that MACS0417-z5BBG could be a star-forming galaxy in the lull of a bursty star formation history.

To achieve universal health coverage, health system strengthening (HSS) is required to support the of delivery of high-quality care. The aim of the National Institute for Health Research Global Research Unit on HeAlth System StrEngThening in Sub-Saharan Africa (ASSET) is to address this need in a four-year programme, with three healthcare platforms involving eight work-packages. Key to effective health system strengthening (HSS) is the pre-implementation phase of research where efforts focus on applying participatory methods to embed the research programme within the existing health system. To conceptualise the approach, we provide an overview of the key methods applied across work-package to address this important phase of research conducted between 2017 and 2021. Work-packages are being undertaken in publicly funded health systems in rural and urban areas in Ethiopia, Sierra Leone, South Africa, and Zimbabwe. Stakeholders including patients and their caregivers, community representatives, clinicians, managers, administrators, and policymakers are the main research participants. In each work-package, initial activities engage stakeholders and build relationships to ensure co-production and ownership of HSSIs. A mixed-methods approach is then applied to understand and address determinants of high-quality care delivery. Methods such as situation analysis, cross-sectional surveys, interviews and focus group discussions are adopted to each work-package aim and context. At the end of the pre-implementation phase, findings are disseminated using focus group discussions and participatory Theory of Change workshops where stakeholders from each work package use findings to select HSSIs and develop a programme theory. ASSET places a strong emphasis of the pre-implementation phase in order to provide an in-depth and systematic diagnosis of the existing heath system functioning, needs for strengthening and stakeholder engagement. This common approach will inform the design and evaluation of the HSSIs to increase effectiveness across work packages and contexts, to better understand what works, for whom, and how.

Abstract Background The post-partum consumption of the placenta by the mother (placentophagy) has been practiced since the 1970s in the global North and is seemingly increasing in popularity. Maternal placentophagy is not known to have been practiced in any other time period or culture, despite being near-ubiquitous in other placental mammals. An in-depth qualitative exploration as to the reasons for the practice, its increasing popularity and how it is narratively incorporated into discourses surrounding “ideal” natural and medical births are given in this paper. Methods 1752 posts from 956 users across 85 threads from the parenting forums Mumsnet and Netmums were identified for inclusion. A thematic discourse analysis was performed using NVivo. Results Three main themes were identified: women recounted predominantly positive attitudes towards their own experiences of placentophagy, and they were respectful of others’ views and experiences; some had negative views, particularly around the concept of disgust, but again, they were respectful of others’ experiences. By far the most common method of consumption of the placenta was encapsulation. Conclusions This paper identifies the motivation for placentophagy to almost universally be for medical benefits, most commonly the prevention or treatment of post-natal depression (PND). Whilst disgust is a common reaction, discussion of risks is rare, and positive experiences outweigh negative ones. The increasing popularity of the practice is ascribed in part to the comparative palatability of encapsulation and the use of the internet to share resources and remove barriers. Parenting forums are important spaces to negotiate normative birth practices, including placentophagy, and act to build communities of women who value personal experience over medical evidence and highly value personal choice and bodily autonomy. Placentophagy is discussed in terms of its relation to natural and medical births with arguments being made using both discourses for and against the practice. This paper argues that placentophagy is practiced as a resistance to medicalisation as an assertion of control by the mother, whilst simultaneously being a medicalised phenomenon itself.

JWST has revolutionized the field of extragalactic astronomy with its sensitive and high-resolution infrared view of the distant Universe. Adding to the new legacy of JWST observations, we present the first NIRCam imaging data release from the JWST Advanced Deep Extragalactic Survey (JADES), providing nine filters of infrared imaging of ∼25 arcmin ^2 covering the Hubble Ultra Deep Field and portions of Great Observatories Origins Deep Survey South. Utilizing 87 on-sky dual-filter hours of exposure time, these images reveal the deepest ever near-infrared view of this iconic field. We supply carefully constructed nine-band mosaics of the JADES bands, as well as matching reductions of five additional bands from the JWST Extragalactic Medium-band Survey. Combining with existing Hubble Space Telescope imaging, we provide 23-band space-based photometric catalogs and photometric redshifts for ≈47,500 sources. To promote broad engagement with JADES, we have created an interactive FitsMap website to provide an interface for professional researchers and the public to experience these JWST data sets. Combined with the first JADES NIRSpec data release, these public JADES imaging and spectroscopic data sets provide a new foundation for discoveries of the infrared Universe by the worldwide scientific community.

We present JWST NIRCam nine-band near-infrared imaging of the luminous z = 10.6 galaxy GN-z11 from the JWST Advanced Deep Extragalactic Survey of the GOODS-N field. We find a spectral energy distribution (SED) entirely consistent with the expected form of a high-redshift galaxy: a clear blue continuum from 1.5 to 4 μ m with a complete dropout in F115W. The core of GN-z11 is extremely compact in JWST imaging. We analyze the image with a two-component model, using a point source and a Sérsic profile that fits to a half-light radius of 200 pc and an index n = 0.9. We find a low-surface-brightness haze about 0.″4 to the northeast of the galaxy, which is most likely a foreground object but might be a more extended component of GN-z11. At a spectroscopic redshift of 10.60 (Bunker et al. 2023 ), the comparison of the NIRCam F410M and F444W images spans the Balmer jump. From population-synthesis modeling, here assuming no light from an active galactic nucleus, we reproduce the SED of GN-z11, finding a stellar mass of ∼10 ^9 M _⊙ , a star formation rate of ∼20 M _⊙ yr ^−1 , and a young stellar age of ∼20 Myr. Since massive galaxies at high redshift are likely to be highly clustered, we search for faint neighbors of GN-z11, finding nine galaxies out to ∼5 comoving Mpc transverse with photometric redshifts consistent with z = 10.6, and a tenth more tentative dropout only 3″ away. This is consistent with GN-z11 being hosted by a massive dark-matter halo (≈8 × 10 ^10 M _⊙ ), though lower halo masses cannot be ruled out.

Abstract Background Most international electives in which medical students from high-income countries travel abroad are largely unstructured, and can lead to problematic outcomes for students as well as sending and receiving institutions. We analyse the problems of unstructured medical electives and describe the benefits of an elective experience that includes more organisation and oversight from the sending medical school. Results A number of structured elective programmes have been developed, including those at the Medical School for International Health, Israel and the University of Dundee, United Kingdom. These programmes provide significant pre-departure training in global health and the ethical dimensions of electives, support and monitoring during the elective, and post-elective debrief. Crucially, the programmes themselves are developed on the basis of long-term engagement between institutions, and have an element of reciprocity. We further identify two major problems in current medical electives: the different ethical contexts in which electives take place, and the problem of ‘voluntourism’, in which the primary beneficiary of the activity is the medical student, rather than the receiving institution or health system. These two issues should be seen in the light of unequal relations between sending and receiving institutions, which largely mirror unequal relations between the Global North and South. Conclusion We argue that more structured elective programmes could form a useful corrective to some of the problems identified with medical electives. We recommend that medical schools in countries such as the UK strongly consider developing these types of programmes, and if this is not possible, they should seek to further develop their pre-departure training curricula.

Abstract Background There is increasing interest in global health teaching among medical schools and their students. Schools in the UK and internationally are considering the best structure, methods and content of global health courses. Academic work in this area, however, has tended to either be normative (specifying what global health teaching ought to look like) or descriptive (of a particular intervention, new module, elective, etc.). Methods While a number of studies have explored student perspectives on global health teaching, these have often relied on tools such as questionnaires that generate little in-depth evidence. This study instead used qualitative methods to explore medical student perspectives on global health in the context of a new global health module established in the core medical curriculum at a UK medical school. Results Fifth year medical students participated in a structured focus group session and semi-structured interviews designed to explore their knowledge and learning about global health issues, as well as their wider perspectives on these issues and their relevance to professional development. While perspectives on global health ranged from global health ‘advocate’ to ‘sceptic’, all of the students acknowledged the challenges of prioritising global health within a busy curriculum. Conclusions Students are highly alert to the diverse epistemological issues that underpin global health. For some students, such interdisciplinarity is fundamental to understanding contemporary health and healthcare. For others, global health is merely a topic of geographic relevance. Furthermore, some students appeared to accept global health as a specialist area only relevant to professionals working overseas, while others considered it to be an essential part of working in the globalised world and therefore relevant to all medical professionals. Students also clearly noted that including ‘soft’ subjects and more discursive approaches to teaching and learning often sits awkwardly in a programme where ‘harder’ forms of knowledge and didactic methods tend to dominate. This suggests that more work needs to be done to explain the relevance of global health to medical students at the very beginning of their studies.

Objectives Prevalence of cardiovascular disease risk factors (CVDRF) is increasing, especially in low-income countries. In Sierra Leone, there are no previous studies on the knowledge and the awareness of these conditions in the community. This study aimed to explore the knowledge and understanding of CVDRF, as well as the perceptions of the barriers and facilitators to accessing care for these conditions, among patients and community leaders in Sierra Leone.Design Qualitative study employing semistructured interviews and focus group discussions.Setting Urban and rural Bo District, Sierra Leone.Participants Interviews with a purposive sample of 37 patients and two focus groups with six to nine community leaders.Results While participants possessed general knowledge of their conditions, the level and complexity of this knowledge varied widely. There were clear gaps in knowledge regarding the coexistence of CVDRF and their consequences, as well as the link between behavioural factors and CVDRF. An overarching theme from the data was the need to create an understanding and awareness of CVDRF in the community in order to prevent and improve management of these conditions. Cost was also seen as a major barrier to accessing care for CVDRFs.Conclusions The knowledge gaps identified in this study highlight the need to design strategies and interventions that improve knowledge and recognition of CVDRF in the community. Interventions should specifically consider how to develop and enhance awareness about CVDRF and their consequences. They should also consider how patients seek help and where they access it.

Objectives: Our aim was to develop a sustainable continuing education model for nurses in maternal and child health through examining the outcomes of a distance education intervention. Methods: An online anonymous survey was conducted to evaluate a web-based continuing education program used by nurses in Mongolia. Results: 356 people out of 699 (50.9%) of the people responded. Over 80% were nurses with average clinical experience 13.9 ± 9.9 years. The major reasons for participation were to broaden knowledge and skills (50.3%). Participants’ pride in being a nurse, and job satisfaction after the program increased (4.3/ 5.0) and they enjoyed interacting with foreign lecturers and participants by using IT technology (4.2/ 5.0). From analysis of their free text descriptions, the nurses who used the continuing education program hope to that the topics expand to include nursing ethics, nursing theories, and international standards, among others. The needs for hands-on skill training and improving teaching and technical skills were noted. Conclusion: Results revealed that the web-based continuing education program was well received. New knowledge and skills were widely shared and adapted into local contexts, including developing new clinical guidelines and manuals, enhanced revision of undergraduate curricular content and improved teaching methods. Job satisfaction amongst participants was increased after the intervention.

This article examines the methods students use to gain access to a university in Nigeria’s elite federal sector. It explains the relationships between three “currencies” – merit, personal connections and money – that are utilised by students to achieve their goals. I argue that influences representing the official rules – merit – and those representing semi-official or unofficial processes – personal connections and money – intersect in ways that reveal the complexity of the relationship between state and society in contemporary Nigeria. This analysis reveals that in this case the hybrid interpretation of the neopatrimonial state, which views official and unofficial norms as existing in parallel and suffusing one another, has more analytical value than its counterpart, the wholesale state privatisation thesis.Dieser Aufsatz untersucht, welche Möglichkeiten Studierende nutzen, um die Aufnahme an einer (bundes)staatlichen Eliteuniversität in Nigeria zu erreichen. Der Autor beschreibt das Verhältnis von drei unterschiedlichen Zugangs-„Währungen“ – Leistung, persönliche Verbindungen und Geld –, die zu diesem Zweck eingesetzt werden. Er argumentiert, dass sich Zugangsmöglichkeiten nach offiziellen Regelungen, die vor allem auf Leistung beruhen, mit halb- oder inoffiziellen Wegen überschneiden, wie dem Einsatz von persönlichen Verbindungen und/oder Geld. In dieser Interdependenz sieht er einen Ausdruck der Komplexität der Beziehung zwischen Staat und Gesellschaft im heutigen Nigeria. Seine Analyse deckt auf, dass in diesem Fall die hybride Interpretation des neopatrimonialen Staates, wonach offizielle und inoffizielle Normen parallel existieren und einander durchdringen, größeren analytischen Wert besitzt als ihr Gegenstück, die These von der umfassenden Privatisierung staatlicher Strukturen.