Emtonjeni—A structural intervention to integrate sexual and reproductive health into public sector HIV care in Cape Town, South Africa: results of a phase II study

Integration of sexual and reproductive health within HIV care services is a promising strategy for increasing access to family planning and STI services and reducing unwanted pregnancies, perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners. We conducted a Phase II randomized futility trial of a multi-level intervention to increase adherence to safer sex guidelines among those wishing to avoid pregnancy and adherence to safer conception guidelines among those seeking conception in newly-diagnosed HIV-positive persons in four public-sector HIV clinics in Cape Town. Clinics were pair-matched and the two clinics within each pair were randomized to either a three-session provider-delivered enhanced intervention (EI) (onsite contraceptive services and brief milieu intervention for staff) or standard-of-care (SOC) provider-delivered intervention. The futility analysis showed that we cannot rule out the possibility that the EI intervention has a 10 % point or greater success rate in improving adherence to safer sex/safer conception guidelines than does SOC (p = 0.573), indicating that the intervention holds merit, and a larger-scale confirmatory study showing whether the EI is superior to SOC has merit.IS

Population Dynamics Based on Resource Availability & Founding Effects: Live & Computational Models

With the looming global population crisis, it is more important now than ever that students understand what factors influence population dynamics. We present three learning modules with authentic, student-centered investigations that explore rates of population growth and the importance of resources. These interdisciplinary modules integrate biology, mathematics, and computer-literacy concepts aligned with the Next Generation Science Standards. The activities are appropriate for middle and high school science classes and for introductory college-level biology courses. The modules incorporate experimentation, data collection and analysis, drawing conclusions, and application of studied principles to explore factors affecting population dynamics in fruit flies. The variables explored include initial population structure, food availability, and space of the enclosed population. In addition, we present a computational simulation in which students can alter the same variables explored in the live experimental modules to test predictions on the consequences of altering the variables. Free web-based graphing (Joinpoint) and simulation software (NetLogo) allows students to work at home or at school

An assessment on the effect of collaborative groups on students’ problem-solving strategies and abilities

This paper reports the use of tools to probe the effectiveness of using small-group interaction to improve problem solving. We find that most students' problem-solving strategies and abilities can be improved by working in short-term, collaborative groups without any other intervention. This is true even for students who have stabilized on a problem-solving strategy and who have stabilized at a problem-solving ability level. Furthermore, we find that even though most students improve by a factor of about 10% in student ability, there are two exceptions: Female students who are classified as pre-formal on a test of logical thinking improve by almost 20% when paired with concrete students; however if two students at the concrete level are paired together no improvement is seen. It has been said that problem solving is the ultimate goal of education (1), and certainly this is true in any chemistry course (2). To be sure, most instructors value this skill and try to instill the ability to solve problems in their students. However, the term "problem solving" means different things to different audiences, from algorithmic problems to complex, open-ended problems that do not have one particular solution. A number of attempts have been made to define problem solving, including "any goal-directed sequence of cognitive operations" (3), and many now agree with the general definition: "what you do when you don't know what to do" (4). Problem solving can be closely allied to critical thinking (5), that other goal of most science courses, in that it involves the application of knowledge to unfamiliar situations. Problem solving also requires the solver to analyze the situation and make decisions about how to proceed, which critical thinking helps. A number of information processing models for problem solving have been developed (6-8) and attempts made to develop uniform theories of problem solving (9). However, many of these studies involve knowledge-lean, closed problems (2) that do not require any specific content knowledge to solve, and that have a specific path to the answer. The truth is that many types of problems exist and there is not one model that will be effective for all categories (10). For example, in teaching science we are ultimately concerned with knowledge-rich problems requiring scientific content knowledge. Studies on problem solving in chemistry have typically revolved around development of strategies derived from research on closed-ended problems, usually pinpointing areas of difficulty that students encounter in specific subject types, such as stoichiometry or equilibrium. A number of studies where students are given strategies or heuristics allowing them resolve word problems in order to produce a numerical answer by application of an algorithm Open-ended problem solving that requires students to use data to make inferences, or to use critical thinking skills, is much more difficult to incorporate into introductory (and even higher level) courses; it is even more difficult to assess, particularly when large numbers of students are involved. Traditional assessment methods, such as examinations and quizzes-including both short answer and multiple choice-give very little insight into the problem-solving process itself. If a student does not have a successful problem-solving strategy, these methods may not allow either the student or the instructor to see where the difficulty lies, or to find ways to improve. While other investigation methods such as think-aloud protocols and videotaped problem-solving sessions (14) give a more nuanced picture of the problem-solving process (15-17), these techniques are time consuming, expensive, and require specific expertise to analyze. These methods are certainly not applicable for the formative assessment of large numbers of students, and while they give a snapshot of a student's problem-solving ability at the time of observation, it is even more difficult to monitor students' development of problem-solving expertise over an extended period. The upshot of all this previous research is that while we know a great deal about the problem-solving process in an abstract environment, we do not in fact have much insight into how students solve many types of scientific problems. Since we lack this information about how students approach problems and how students achieve competence, it is not easy to address the difficulties that students encounter as they develop problemsolving abilities. Indeed, while instructors value problem-solving skills highly, it is often the case that the only explicit instruction that many students are exposed to is the modeling of the skill as the instructor solves problems for students. So we have a situation where a valued skill is often not fully developed in students, even though we implicitly expect that they will become competent problem solvers by the end of the course. The most common assessments give no real insight into student strategies for problem solving, and therefore there is little feedback the instructor can give in terms of how to improve. The traditional assessments also tend to measure and reward algorithmic problem-solving skills rather than critical thinking and application of knowledge to new situations. It seems clear that if we are serious about wanting to incorporate meaningful problem solving into our courses, then we must go beyond the traditional assessments and design systems that allow us t

Evaluating the extent of a large-scale transformation in gateway science courses

We evaluate the impact of an institutional effort to transform undergraduate science courses using an approach based on course assessments. The approach is guided by A Framework for K-12 Science Education and focuses on scientific and engineering practices, crosscutting concepts, and core ideas, together called three-dimensional learning. To evaluate the extent of change, we applied the Three-dimensional Learning Assessment Protocol to 4 years of chemistry, physics, and biology course exams. Changes in exams differed by discipline and even by course, apparently depending on an interplay between departmental culture, course organization, and perceived course ownership, demonstrating the complex nature of transformation in higher education. We conclude that while transformation must be supported at all organizational levels, ultimately, change is controlled by factors at the course and departmental levels

Eliminating Preventable HIV-Related Maternal Mortality in Sub-Saharan Africa: What Do We Need to Know?

Introduction: HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum. Methods: This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature. Results: Priorities for improving the evidence about effective interventions to reduce maternal mortality and improve maternal health among WLWH include better quality data about causes of maternal death among WLWH, enhanced and harmonized program monitoring, and research and evaluation that contributes to improving: (1) clinical management of pregnant and postpartum WLWH, including assessment of the impact of expanded antiretroviral therapy on maternal mortality and morbidity, (2) integrated service delivery models, and (3) interventions to create an enabling social environment for women to begin and remain in care. Conclusions: As the global community evaluates progress and prepares for new maternal mortality and HIV targets, addressing the needs of WLWH must be a priority now and after 2015. Research and evaluation on maternal health and HIV can increase collaboration on these 2 global priorities, strengthen political constituencies and communities of practice, and accelerate progress toward achievement of goals in both areas

The burden and dynamics of hospital-acquired SARS-CoV-2 in England

Hospital-based transmission had a dominant role in Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) epidemics1,2, but large-scale studies of its role in the SARS-CoV-2 pandemic are lacking. Such transmission risks spreading the virus to the most vulnerable individuals and can have wider-scale impacts through hospital-community interactions. Using data from acute hospitals in England, we quantify within-hospital transmission, evaluate likely pathways of spread and factors associated with heightened transmission risk, and explore the wider dynamical consequences. We estimate that between June 2020 and March 2021 between 95,000 and 167,000 inpatients acquired SARS-CoV-2 in hospitals (1% to 2% of all hospital admissions in this period). Analysis of time series data provided evidence that patients who themselves acquired SARS-CoV-2 infection in hospital were the main sources of transmission to other patients. Increased transmission to inpatients was associated with hospitals having fewer single rooms and lower heated volume per bed. Moreover, we show that reducing hospital transmission could substantially enhance the efficiency of punctuated lockdown measures in suppressing community transmission. These findings reveal the previously unrecognized scale of hospital transmission, have direct implications for targeting of hospital control measures and highlight the need to design hospitals better equipped to limit the transmission of future high-consequence pathogens

Early-onset and classical forms of type 2 diabetes show impaired expression of genes involved in muscle branched-chain amino acids metabolism

The molecular mechanisms responsible for the pathophysiological traits of type 2 diabetes are incompletely understood. Here we have performed transcriptomic analysis in skeletal muscle, and plasma metabolomics from subjects with classical and early-onset forms of type 2 diabetes (T2D). Focused studies were also performed in tissues from ob/ob and db/db mice. We document that T2D, both early and late onset, are characterized by reduced muscle expression of genes involved in branched-chain amino acids (BCAA) metabolism. Weighted Co-expression Networks Analysis provided support to idea that the BCAA genes are relevant in the pathophysiology of type 2 diabetes, and that mitochondrial BCAA management is impaired in skeletal muscle from T2D patients. In diabetic mice model we detected alterations in skeletal muscle proteins involved in BCAA metabolism but not in obese mice. Metabolomic analysis revealed increased levels of branched-chain keto acids (BCKA), and BCAA in plasma of T2D patients, which may result from the disruption of muscle BCAA management. Our data support the view that inhibition of genes involved in BCAA handling in skeletal muscle takes place as part of the pathophysiology of type 2 diabetes, and this occurs both in early-onset and in classical type 2 diabetes

Clinical and genetic characterisation of dystrophin-deficient muscular dystrophy in a family of Miniature Poodle dogs

Four full-sibling intact male Miniature Poodles were evaluated at 4–19 months of age. One was clinically normal and three were affected. All affected dogs were reluctant to exercise and had generalised muscle atrophy, a stiff gait and a markedly elevated serum creatine kinase activity. Two affected dogs also showed poor development, learning difficulties and episodes of abnormal behaviour. In these two dogs, investigations into forebrain structural and metabolic diseases were unremarkable; electromyography demonstrated fibrillation potentials and complex repetitive discharges in the infraspinatus, supraspinatus and epaxial muscles. Histopathological, immunohistochemical and immunoblotting analyses of muscle biopsies were consistent with dystrophin-deficient muscular dystrophy. DNA samples were obtained from all four full-sibling male Poodles, a healthy female littermate and the dam, which was clinically normal. Whole genome sequencing of one affected dog revealed a >5 Mb deletion on the X chromosome, encompassing the entire DMD gene. The exact deletion breakpoints could not be experimentally ascertained, but we confirmed that this region was deleted in all affected males, but not in the unaffected dogs. Quantitative polymerase chain reaction confirmed all three affected males were hemizygous for the mutant X chromosome, while the wildtype chromosome was observed in the unaffected male littermate. The female littermate and the dam were both heterozygous for the mutant chromosome. Forty-four Miniature Poodles from the general population were screened for the mutation and were homozygous for the wildtype chromosome. The finding represents a naturally-occurring mutation causing dystrophin-deficient muscular dystrophy in the dog

Characterizing college science instruction: The Three-Dimensional Learning Observation Protocol

The importance of improving STEM education is of perennial interest, and to this end, the education community needs ways to characterize transformation efforts. Three-dimensional learning (3DL) is one such approach to transformation, in which core ideas of the discipline, scientific practices, and crosscutting concepts are combined to support student development of disciplinary expertise. We have previously reported on an approach to the characterization of assessments, the Three-Dimensional Learning Assessment Protocol (3D-LAP), that can be used to identify whether assessments have the potential to engage students in 3DL. Here we present the development of a companion, the Three-Dimensional Learning Observation Protocol (3D-LOP), an observation protocol that can reliably distinguish between instruction that has potential for engagement with 3DL and instruction that does not. The 3D-LOP goes beyond other observation protocols, because it is intended not only to characterize the pedagogical approaches being used in the instructional environment, but also to identify whether students are being asked to engage with scientific practices, core ideas, and crosscutting concepts. We demonstrate herein that the 3D-LOP can be used reliably to code for the presence of 3DL; further, we present data that show the utility of the 3D-LOP in differentiating between instruction that has the potential to promote 3DL from instruction that does not. Our team plans to continue using this protocol to evaluate outcomes of instructional transformation projects. We also propose that the 3D-LOP can be used to support practitioners in developing curricular materials and selecting instructional strategies to promote engagement in three-dimensional instruction