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Observations of a stellar occultation by (10199) Chariklo, a minor body that orbits the Sun between Jupiter and Neptune, reveal that it has a ring system, a property previously observed only for the four giant planets of the Solar System. Tiny Chariklo has its own ring system Observations of a stellar occultation by (10199) Chariklo, a Centaur-class outer-system asteroid orbiting between Saturn and Uranus, reveal that it has a ring system, a feature previously observed only for the four giant planets. Chariklo, with a diameter of about 250 km, has two narrow and dense rings separated by a small gap, probably due to the presence of a (yet-to-be-found) kilometre-sized satellite. The discovery of these rings raises questions about the formation and dynamical evolution of planetary rings. For one thing, it seems likely that planetary rings are much more common than previously thought. Hitherto, rings have been found exclusively around the four giant planets in the Solar System 1 . Rings are natural laboratories in which to study dynamical processes analogous to those that take place during the formation of planetary systems and galaxies. Their presence also tells us about the origin and evolution of the body they encircle. Here we report observations of a multichord stellar occultation that revealed the presence of a ring system around (10199) Chariklo, which is a Centaur—that is, one of a class of small objects orbiting primarily between Jupiter and Neptune—with an equivalent radius of 124   9 kilometres (ref. 2 ). There are two dense rings, with respective widths of about 7 and 3 kilometres, optical depths of 0.4 and 0.06, and orbital radii of 391 and 405 kilometres. The present orientation of the ring is consistent with an edge-on geometry in 2008, which provides a simple explanation for the dimming 3 of the Chariklo system between 1997 and 2008, and for the gradual disappearance of ice and other absorption features in its spectrum over the same period 4 , 5 . This implies that the rings are partly composed of water ice. They may be the remnants of a debris disk, possibly confined by embedded, kilometre-sized satellites.

We report the results of two multi-chord stellar occultations by the dwarf planet (1) Ceres that were observed from Brazil on 2010 August 17, and from the USA on 2013 October 25. Four positive detections were obtained for the 2010 occultation, and nine for the 2013 occultation. Elliptical models were adjusted to the observed chords to obtain Ceres' size and shape. Two limb fitting solutions were studied for each event. The first one is a nominal solution with an indeterminate polar aspect angle. The second one was constrained by the pole coordinates as given by Drummond et al. Assuming a Maclaurin spheroid, we determine an equatorial diameter of 972 \\(\\pm\\) 6 km and an apparent oblateness of 0.08 \\(\\pm\\) 0.03 as our best solution. These results are compared to all available size and shape determinations for Ceres made so far, and shall be confirmed by the NASA's Dawn space mission.

Until now, rings have been detected in the Solar System exclusively around the four giant planets. Here we report the discovery of the first minor-body ring system around the Centaur object (10199) Chariklo, a body with equivalent radius 124\\(\\pm\\)9 km. A multi-chord stellar occultation revealed the presence of two dense rings around Chariklo, with widths of about 7 km and 3 km, optical depths 0.4 and 0.06, and orbital radii 391 and 405 km, respectively. The present orientation of the ring is consistent with an edge-on geometry in 2008, thus providing a simple explanation for the dimming of Chariklo's system between 1997 and 2008, and for the gradual disappearance of ice and other absorption features in its spectrum over the same period. This implies that the rings are partially composed of water ice. These rings may be the remnants of a debris disk, which were possibly confined by embedded kilometre-sized satellites.

Somali refugees are resettling in large numbers in the US, but little is known about the Somali Bantu, an ethnic minority within this population. Refugee youth mental health is linked to the functioning of the larger family unit. Understanding how the process of culturally adjusting to life after resettlement relates to family functioning can help identify what kind of interventions might strengthen families and lead to better mental health outcomes for youth. This paper seeks to address the following research questions: (1) How do different groups of Somali Bantu refugees describe their experiences of culturally adapting to life in the US?; and (2) How, if at all, do processes of cultural adaptation in a new country affect Somali Bantu family functioning? We conducted 14 focus groups with a total of 81 Somali Bantu refugees in New England. Authors analyzed focus groups using principles of thematic analysis to develop codes and an overarching theoretical model about the relationship between cultural adaptation, parent–child relationships, and family functioning. Views and expectations of parent–child relationships were compared between Somali Bantu youth and adults. Cultural negotiation was dependent upon broader sociocultural contexts in the United States that were most salient to the experience of the individual. Adult and youth participants had conflicting views around negotiating Somali Bantu culture, which often led to strained parent–child relationships. In contrast, youth sibling relationships were strengthened, as they turned to each other for support in navigating the process of cultural adaptation.

Objective: More people with cystic fibrosis (pwCF) are reaching adulthood and considering their reproductive futures. Unfortunately, many pwCF report gaps in their reproductive healthcare. We describe measures of stakeholder engagement in developing a reproductive goals decision aid for women with CF called MyVoice:CF. Methods: Stakeholders reviewed the content, design, and usability of the tool, which was informed by prior research related to CF family planning experiences and preferences as well as a conceptual understanding of reproductive decision making. We evaluated stakeholder engagement via process measures and outcomes of stakeholder involvement. We collected data via recorded stakeholder recommendations and surveys. Results: Fourteen stakeholders participated and the majority described their role on the project as “collaborator”, “advisor”, or “expert.” Most felt their expectations for the project were met or exceeded, that they had contributed significantly, and that they received sufficient and frequent information about the process. All stakeholders provided recommen­dations and clarified aims for a CF-specific family planning tool, including its content and focus on facilitating shared decision making. Discussion: Utilizing meaningful stakeholder contributions, we developed MyVoice:CF, a novel web-based decision aid to help women with CF engage in shared decision-making regarding their reproductive goals. Practical Value: Our findings from working with stakeholders for MyVoice:CF indicate that disease-specific reproductive health resources can and should be designed with input from individuals in the relevant communities.

Background Access to integrated services for individuals with co-occurring substance use and mental health disorders is a long-standing public health issue. Receiving integrated treatment services are both more effective and preferred by patients and families versus parallel or fragmented care. National policy statements and expert consensus guidelines underscore the benefits of integrated treatment. Despite decades of awareness, adequate treatment for individuals with co-occurring substance use and mental health disorders occurs infrequently. The underlying disease burden associated with alcohol, illicit and prescription drug problems, as well as mental health disorders, such as depression, posttraumatic stress disorder and schizophrenia, is substantial. Methods This cluster randomized controlled trial (RCT) is designed to determine if the multi-component Network for the Improvement of Addiction Treatment (NIATx) strategies are effective in implementing integrated services for persons with co-occurring substance use and mental health disorders. In this study, 50 behavioral health programs in Washington State will be recruited and then randomized into one of two intervention arms: 1) NIATx implementation strategies, including coaching and learning sessions over a 12-month intervention period to implement changes targeting integrated treatment services; or 2) wait-list control. Primary outcome measures include: 1) fidelity - a standardized organizational assessment of integrated services (Dual Diagnosis in Addiction Treatment [DDCAT] Index); and 2) penetration - proportion of patients screened and diagnosed with co-occurring disorders, proportion of eligible patients receiving substance use and mental health services, and psychotropic or substance use disorder medications. Barriers and facilitators, as determinants of implementation outcomes, will be assessed using the Consolidated Framework for Implementation Research (CFIR) Index. Fidelity to and participation in NIATx strategies will be assessed utilizing the NIATx Fidelity Scale and Stages of Implementation Completion (SIC). Discussion This study addresses an issue of substantial public health significance: the gap in access to an evidence-based practice for integrated treatment for individuals with co-occurring mental health and substance use disorders. The study utilizes rigorous and reproducible quantitative approaches to measuring implementation determinants and strategies, and may address a longstanding gap in the quality of care for persons with co-occurring disorders. Trial registration ClinicalTrials.gov NCT03007940 . Registered 02 January 2017 – Retrospectively Registered

BackgroundUse of local data for health system planning and decision-making in maternal, newborn and child health services is limited in low-income and middle-income countries, despite decentralisation and advances in data gathering. An improved culture of data-sharing and collaborative planning is needed. The Data-Informed Platform for Health is a system-strengthening strategy which promotes structured decision-making by district health officials using local data. Here, we describe implementation including process evaluation at district level in Ethiopia, and evaluation through a cluster-randomised trial.MethodsWe supported district health teams in 4-month cycles of data-driven decision-making by: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritising; and (e) a consultative process to develop, commit to and follow up on action plans. 12 districts were randomly selected from 24 in the North Shewa zone of Ethiopia between October 2020 and June 2022. The remaining districts formed the trial’s comparison arm. Outcomes included health information system performance and governance of data-driven decision-making. Analysis was conducted using difference-in-differences.Results58 4-month cycles were implemented, four or five in each district. Each focused on a health service delivery challenge at district level. Administrators’ practice of, and competence in, data-driven decision-making showed a net increase of 77% (95% CI: 40%, 114%) in the regularity of monthly reviews of service performance, and 48% (95% CI: 9%, 87%) in data-based feedback to health facilities. Statistically significant improvement was also found in administrators’ use of information to appraise services. Qualitative findings also suggested that district health staff reported enhanced data use and collaborative decision-making.ConclusionsThis study generated robust evidence that 20 months’ implementation of the Data-Informed Platform for Health strengthened health management through better data use and appraisal practices, systemised problem analysis to follow up on action points and improved stakeholder engagement.Trial registration numberNCT05310682.

Adults with low literacy may encounter informational obstacles on the Internet when searching for health information, in part because most health Web sites require at least a high-school reading proficiency for optimal access. The purpose of this study was to 1) determine how low-literacy adults independently access and evaluate health information on the Internet, 2) identify challenges and areas of proficiency in the Internet-searching skills of low-literacy adults. Subjects (n=8) were enrolled in a reading assistance program at Bidwell Training Center in Pittsburgh, PA, and read at a 3rd to 8th grade level. Subjects conducted self-directed Internet searches for designated health topics while utilizing a think-aloud protocol. Subjects' keystrokes and comments were recorded using Camtasia Studio screen-capture software. The search terms used to find health information, the amount of time spent on each Web site, the number of Web sites accessed, the reading level of Web sites accessed, and the responses of subjects to questionnaires were assessed. Subjects collectively answered 8 out of 24 questions correctly. Seven out of 8 subjects selected \"sponsored sites\"-paid Web advertisements-over search engine-generated links when answering health questions. On average, subjects accessed health Web sites written at or above a 10th grade reading level. Standard methodologies used for measuring health literacy and for promoting subjects to verbalize responses to Web-site form and content had limited utility in this population. This study demonstrates that Web health information requires a reading level that prohibits optimal access by some low-literacy adults. These results highlight the low-literacy adult population as a potential audience for Web health information, and indicate some areas of difficulty that these individuals face when using the Internet and health Web sites to find information on specific health topics.

Objective Although women with rheumatic and musculoskeletal diseases (RMDs) are at an elevated risk for adverse pregnancy and perinatal outcomes, some report that they lack access to resources that support informed reproductive decision‐making. We developed MyVoice:Rheum, a web‐based decision aid to support women with RMDs in reproductive decision‐making. We conducted a pilot trial to assess feasibility and acceptability of MyVoice:Rheum and to assess its preliminary effectiveness compared to a freely available online pamphlet about reproductive and RMDs. Methods Using a parallel‐arm randomized pilot trial design, we assigned women aged 18 to 44 years with RMDs in a 3:1 ratio to receive either MyVoice:Rheum or the control pamphlet immediately before a rheumatology clinical encounter. Quantitative and qualitative measures of feasibility, acceptability, and usability were assessed among MyVoice:Rheum users. We evaluated the preliminary effectiveness of MyVoice:Rheum in prompting family planning discussions as compared to pamphlet users, as well as its effects on users’ reproductive knowledge and/or communication self‐efficacy with rheumatologists. Results We enrolled MyVoice:Rheum users (n = 31) and controls (n = 9) in the pilot study. MyVoice:Rheum users scored the tool as feasible, acceptable, and easy to use. Approximately 61% of MyVoice:Rheum users and 44% of controls had family planning discussions with their rheumatologists. MyVoice:Rheum users demonstrated increases in self‐efficacy and knowledge scores after the intervention. Conclusion In pilot testing, MyVoice:Rheum was feasible, acceptable, and usable to women with RMDs. Preliminary findings suggest that MyVoice:Rheum may increase family planning discussions in the rheumatology context and augment patients’ reproductive knowledge and self‐efficacy; these findings should be confirmed in a future full‐scale study.

Dyspnea, a debilitating symptom of COPD, worsens health‐related quality of life (HRQL), reduces daily physical activity, increases health care utilization, and is more closely associated with survival than airflow limitation. Thus, having treatments that reduce dyspnea in COPD is important. Pulmonary hypertension (PH) is a common complication of COPD that is associated with severe dyspnea, more frequent COPD exacerbations, and increased mortality. Multiple causes of PH, including a reduction in bioavailable vasodilator nitric oxide (NO), are associated with COPD (COPD‐PH). Phosphodiesterase type‐5 inhibitor (PDE5i) therapy restores NO signaling and improves hemodynamics and dyspnea in patients with Group 1 Pulmonary Arterial Hypertension, but has not been proven effective in COPD‐PH. In a prior study (ClinicalTrials. gov identifier: NCT01862536), we investigated effects of 12 months of oral PDE5i therapy with tadalafil on 6‐min walk distance (6MWD) in a multi‐center, randomized, placebo‐controlled trial funded by the Department of Veterans Affairs. While tadalafil did not change 6MWD at 12 months, the treatment group experienced clinically meaningful improvements in patient‐reported dyspnea and HRQL at 6 months. Because of the importance of mitigating dyspnea in COPD‐PH, we developed a new study protocol examining the effect of PDE‐5i therapy in COPD‐PH, with a reduction in dyspnea the primary outcome. In the current study (NCT05937854), we will conduct a prospective, randomized, double‐blind, multi‐center clinical trial to evaluate the effects of 6 months of maximally tolerated therapy with tadalafil (target dose 40 mg/day) versus placebo on dyspnea, as measured by University of California San Diego Shortness of Breath Questionnaire.