A mildly relativistic wide-angle outflow in the neutron-star merger event GW170817.

GW170817 was the first gravitational-wave detection of a binary neutron-star merger. It was accompanied by radiation across the electromagnetic spectrum and localized to the galaxy NGC 4993 at a distance of 40 megaparsecs. It has been proposed that the observed γ-ray, X-ray and radio emission is due to an ultra-relativistic jet being launched during the merger (and successfully breaking out of the surrounding material), directed away from our line of sight (off-axis). The presence of such a jet is predicted from models that posit neutron-star mergers as the drivers of short hard-γ-ray bursts. Here we report that the radio light curve of GW170817 has no direct signature of the afterglow of an off-axis jet. Although we cannot completely rule out the existence of a jet directed away from the line of sight, the observed γ-ray emission could not have originated from such a jet. Instead, the radio data require the existence of a mildly relativistic wide-angle outflow moving towards us. This outflow could be the high-velocity tail of the neutron-rich material that was ejected dynamically during the merger, or a cocoon of material that breaks out when a jet launched during the merger transfers its energy to the dynamical ejecta. Because the cocoon model explains the radio light curve of GW170817, as well as the γ-ray and X-ray emission (and possibly also the ultraviolet and optical emission), it is the model that is most consistent with the observational data. Cocoons may be a ubiquitous phenomenon produced in neutron-star mergers, giving rise to a hitherto unidentified population of radio, ultraviolet, X-ray and γ-ray transients in the local Universe.

A radio counterpart to a neutron star merger.

Gravitational waves have been detected from a binary neutron star merger event, GW170817. The detection of electromagnetic radiation from the same source has shown that the merger occurred in the outskirts of the galaxy NGC 4993, at a distance of 40 megaparsecs from Earth. We report the detection of a counterpart radio source that appears 16 days after the event, allowing us to diagnose the energetics and environment of the merger. The observed radio emission can be explained by either a collimated ultrarelativistic jet, viewed off-axis, or a cocoon of mildly relativistic ejecta. Within 100 days of the merger, the radio light curves will enable observers to distinguish between these models, and the angular velocity and geometry of the debris will be directly measurable by very long baseline interferometry.

Illuminating gravitational waves: A concordant picture of photons from a neutron star merger.

Merging neutron stars offer an excellent laboratory for simultaneously studying strong-field gravity and matter in extreme environments. We establish the physical association of an electromagnetic counterpart (EM170817) with gravitational waves (GW170817) detected from merging neutron stars. By synthesizing a panchromatic data set, we demonstrate that merging neutron stars are a long-sought production site forging heavy elements by r-process nucleosynthesis. The weak gamma rays seen in EM170817 are dissimilar to classical short gamma-ray bursts with ultrarelativistic jets. Instead, we suggest that breakout of a wide-angle, mildly relativistic cocoon engulfing the jet explains the low-luminosity gamma rays, the high-luminosity ultraviolet-optical-infrared, and the delayed radio and x-ray emission. We posit that all neutron star mergers may lead to a wide-angle cocoon breakout, sometimes accompanied by a successful jet and sometimes by a choked jet.

Herpes Zoster Infection Presenting with Urinary Retention and Constipation.

Herpes zoster is a sporadic disease that results from the reactivation of latent Varicella zoster virus infection (VZV) from the dorsal root ganglion. We report a case of herpes zoste of lumbosacral region presenting as acute retention of urine and constipation, an uncommon presentation.

A Case of Emphysematous Pyelonephritis.

Emphysematous pyelonephritis is a rare but dangerous condition in patients with D.M. and urinary tract infection. We report a case of emphysematous pyelonephritis who presented to us with acute abdomen and sepsis. Her CT abdomen showed air in the collecting system of left kidney. She was managed with, I. V. fluids, antibiotics, insulin, and percutaneous nephrostomy. But she died on the 3rd day of hospitalisation due to Multiorgan failure with sepsis.

Transformation of a star into a planet in a millisecond pulsar binary.

Millisecond pulsars are thought to be neutron stars that have been spun-up by accretion of matter from a binary companion. Although most are in binary systems, some 30% are solitary, and their origin is therefore mysterious. PSR J1719-1438, a 5.7-millisecond pulsar, was detected in a recent survey with the Parkes 64-meter radio telescope. We show that this pulsar is in a binary system with an orbital period of 2.2 hours. The mass of its companion is near that of Jupiter, but its minimum density of 23 grams per cubic centimeter suggests that it may be an ultralow-mass carbon white dwarf. This system may thus have once been an ultracompact low-mass x-ray binary, where the companion narrowly avoided complete destruction.

An integrated community based approach in undergraduate medical teaching of maternal and child health--an experiment.

The batch of 147 undergraduate medical students (Group I) were trained in maternal and child health (MCH) by allotting them families study wherein either pregnant lady or a new born child was present. The students were made to follow up these mothers and their children for three years on periodic basis by paying home visits and motivating the mothers to attend under five clinic in the community. The students educated the mother regarding child rearing with the help of medical teacher. Another batch of 140 undergraduate medical students (Group II) who did not undergo such community based training but only didactic lectures in MCH were studied as control. The knowledge and attitudes of students in both the groups were tested and compared and significantly higher knowledge and favourable attitude were found in Group I. The attendance of patients of Group I in under five clinics was compared with other children who were not adopted by medical students. The comparison was made between their weight gain, immunizational status and episodes of illness. The beneficiaries in students families had better, attendance and immunizational coverage, more weight gain and less episodes of illness. The difference was found to be statistically significant.

Role of the family in drug abuse.

A simple random survey of 9863 population out of the total 70,000 population is one slum pocket of Bombay revealed drug dependence in 104 persons. Out of 104, 83.65% smoked 'brown sugar' 10.68% used cannabis and 5.77% opium. Most of the addicts (95.2%) belonged to large families. Family history of alcoholism and drug abuse was present in 41.35%. Parental deprivation was additional contributing factor in 30.7%.

Exposition of the status of girl child in urban area.

A study was undertaken to determine the sex discrimination in child rearing in an urban low socio-economic chawl type of community. Totally 1101 children in the age group of 0-14 years (631 females and 470 males) in 346 families selected at random were studied. It was found that educational and nutritional status of both the sexes were comparable but partial coverage or non-coverage of immunisation was observed in more girls as compared to boys. Majority of parents (93.9%) expressed that they would get their daughter married after 18 years of age.

[Community participation improves vaccination coverage]. / La participation communautaire ameliore la couverture vaccinale.

PIP: Since 1979 in India, the health center in Malavani, a Bombay slum, has tried different methods to vaccinate the largest possible number of newborns and children. Methods used to vaccinate infants and children included clinic visits to subcenters or to a health center, vaccination of siblings of students at primary schools, visits in a designated place in the community, and home visits by a health center team with the participation of local leaders and benevolent organizations, with the participation of medical and paramedical students, by a health center team with no community participation, or by primary school students who persuaded mothers to take their children to the mobile vaccination unit. A review of the vaccination records shows that, in the case of first vaccinations for DPT (diphtheria-pertussis-tetanus) and polio conducted by door-to-door visits, follow-up vaccinations had been better and the costs lower when primary school students made home visits encouraging mothers to take their children to a mobile vaccination unit and with participation of local benevolent organizations. Overall, third dose coverage for these two vaccinations was higher with community participation (regardless of type of community participation) than without it (78% vs. 67%). Without doubt, community participation has a favorable effect on vaccination coverage.^ieng

[Community participation promotes immunization]. / La participacion comunitaria impulsa la cobertura vacunal.

PIP: In 1979, the immunization coverage of children under 5 was 40% in Malavani, a slum of Bombay with 100,000 inhabitants. During the period 1980-87 the percentage of children receiving a 3rd vaccination dose against diphtheria-pertussis-tetanus (DPT) and poliomyelitis increased from 66% in 1980 to 82% in 1983, and dropped again to 74% in 1987 resulting in an almost zero incidence of polio. Since 1979 various methods have been used to involve nursing mothers and their infants to reduce the rate of discontinuation between the 1st DPT and polio vaccination. 5 subcenters serve the weekly health care of children under 5 with vaccination, weighing, as well as the education of mothers about nutrition, immunization and family planning. 971 children obtained their vaccination with their older brothers in 3 phases in the course of 3 months. Community consultation for children under 5 and their mothers was also organized. 563 nursing infants were identified, of whom 502 received health care in the course of 6 months. 89% received DPT and antipolio vaccination. Under a scheme funded by the Aga Khan Foundation 200 children volunteers also paid door-to-door visits to 1200 families that comprised 6000 persons distributing UNICEF flyers and providing instruction in oral rehydration for diarrhea management. They achieved an 85% rate of 3rd vaccination dose completion. This grassroots community approach improved coverage at reduced costs indicating the value of voluntary community action.^ieng

Impact of community-based immunization services.

PIP: The knowledge, attitude and practice of mothers toward childhood immunization was surveyed in 2 neighborhoods in greater Bombay, India. The areas were a slum of 75,000 called Malavani, and a nearby area called Kharodi. Measles and triple (DPT or DPV) vaccines were available at local health centers, 1.5 km away at the most; oral polio vaccines were given by field workers to the Malavani community to children in their homes, but only in the center for those in Kharodi. BCG tuberculosis vaccinations were available to all, but from a center 5 km away. Malavani mothers had significantly better knowledge of triple and measles vaccines, but knowledge about BCG was similar in the 2 groups. Slightly more women from Kharodi expressed negative attitudes toward immunization. Coverage of children, established from clinic records, was significantly better in the Malavani area: 91% vs. 58% for polio; 71% vs 61% for BCG (n.s.); 85% vs. 55% for triple vaccine; and 21% vs 1% for measles. Evidently, visitation by field teams with polio vaccinations affected mothers' knowledge and practice for other immunizations available only at the center.^ieng

Effectiveness of polio vaccination coverage in reducing the incidence of paralytic poliomyelitis in a highly endemic area of Bombay city.

PIP: 100% oral polio vaccine coverage was sought through household visits by health center personnel in a slum area in northwestern Bombay. Children up to and including 3 years of age comprised the target population. In the 2 1/2-year period following initiation of the vaccination campaign in September 1980, 83% of children in the target population were covered and no cases of paralytic poliomyelitis were reported from the area. This coverage rate of 83% stands in contrast with the 64% rate obtained in Bombay's Ward B, a residential area for middle and upper-income people, and the 70% rate in Ward E, another slum district where household visits were not conducted. This experience demonstrates that it is possible to abolish paralytic poliomyelitis through adequate vaccination coverage even in slum areas located in the middle of highly endemic areas. Experience further demonstrated that it is not necessary to withhold oral polio vaccine from children with minor illnesses such as diarrhea or immediately before or after breastfeeding. These 2 contraindications have in the past increased the difficulty of obtaining adequate vaccine coverage rates among young children.^ieng

Contribution of the education of the prospective fathers to the success of maternal health care programme.

PIP: The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need for their husbands coming and meeting the doctor at the Center. The outcome of the maternal health care program for the 270 women whose husbands were invited and came (Group 1) was compared with the outcome of the same program, under the same roof, for 405 women whose husbands could not be invited (Group 2). The husbands who attended the center were educated individually and in groups about their role in nutrition and health of their wives during pregnancy and their responsibility in subsequent child rearing. The physiology of pregnancy, complications of pregnancy, and the possible ways and means of preventing the complications were explained in detail. The husbands were also told to encourage their wives to attend the antenatal clinic of the center as often as possible. There was no difference in the socioeconomic, educational, cultural, and religious background of the 2 groups of women who were similar in parity distribution. The main difference between the 2 groups was a significantly lower perinatal mortality in Group 1. Only 60 of the 405 Group 2 women were considered eligible for postpartum sterilization (para 3 and higher). In contrast, 41 of the 270 Group 1 women were considered eligible for postpartum sterilization and 110 women accepted. The excess of those who accepted over those who were eligible came form the lower paras. This effort confirms that the involvement of prospective fathers is possible and pays good dividends even in an uneducated and low socioeconomic connumity such as that in Malavani.^ieng

Experience with Under Fives' Clinic in Malavani, a slum area near Bombay.

PIP: 3 models of Under Fives Clinics were tried successively at the Malavani Health Center beginning in 1978. Malavani is a village with a population of abourt 70,000 near the city of Bombay (India). In each model mothers were given a Road to Health Card for each child. Model I was a center-based model. The venue was the same center where outpatient departments were located for the convenience of the mothers. The staff comprised 1 pediatrician from the staff of the K.E.M. Hospital and rotating interns posted for 1 month at a time. Enrollment and follow-up of the children were done in the outpatient department. Model II, a subcenter-based model established in 1980, 5 satellite subcenters located in the community were established. The permanent staff consisted of a medical officer, a medico-social worker, and a records assistan. A detailed record of each child was maintained at the subcenter. The medico-social worker held group discussions with the attending mothers and an attempt was made to understand their views and beliefs about child care before trying to educate them. Model III, a community-based model, was established in April 1983. The staff was partly permanent (a medico-social worker, a student nurse, and local community health volunteer) and partly temporary (rotating interns). The staff visited different areas of Malavani village by rotation. An attempt was made to visit each area at least once in 2 months. Detailed recors were maintained as in Model II. In all models, the children were weighed at each visit. They were given oral polio and triple vaccines. Mothers were advised on foods to feed the children to improve nutrition and were given simple recipes and cooking demonstrations. An attempt was made to evaluate the regularity of attendance, weight gain in children, and immuniation coverage. With Model I 450 babies were registered in 6 months but only 48 of them were brought for further follow-up; only 21 of them completed primary immunization. 2034 babies were registered under Model II over a 2-year period. Of these, 1280 attended the clinic regularly for follow-up and completed the course of primary immunization. A striking feature was the weight gain in 1011 children. The number of family planning users increased significantly from 237 at the time of clinic registration to 384 after a few months. 856 babies were registered in 6 months under Model III and 764 attended regularly for follow-up. 613 of the 764 children gained weight and all 764 completed the primary course of immunization. The deficiencies of the center-based model, Model I, are evident. Models II and III proved effective in improving the care of children under 5.^ieng