The Effects of ERW Contamination in Sri Lanka

The Sri Lankan Civil War (July 1983–May 2009), between the government and the Tamil Tigers, was a conflict marked by the extensive use of explosive weapons. Predominantly affecting the majority-Tamil areas in the north and east (Tamil Eelam), the violence left deep scars upon the communities in these areas. The land is still heavily marked by the legacy of landmines, air-dropped bombs, and other explosive remnants of war (ERW)

Bedding Application and Increasing Dosage of Trenbolone Acetate and Estradiol in Implants for Beef Steers: Influence on Growth Performance, Carcass Characteristics, and Circulating Metabolite Responses

Three randomized complete block design feedlot experiments were conducted over the course of two years. Two experiments were conducted to investigate the effect of bedding use in confined beef steers. The third experiment evaluated the effects of implants containing increasing doses of trenbolone acetate (TBA) and estradiol benzoate (EB) in confined beef steers. Experiment 1 used Simmental × Angus steers (n = 240; initial body weight (BW) = 365 ± 22.5 kg). Experiment 2 used newly weaned Charolais × Red Angus steers (n = 162; initial BW = 278 ± 13.4 kg). Steers were allotted to 1 of 2 treatments: 1) no bedding (NO), or 2) 1.8 kg (Exp. 1) or 1.0 kg (Exp. 2) of wheat straw (as-is basis) bedding/steer·d-1 (BED). In Exp. 1 and Exp. 2 data were analyzed as a randomized complete block design with pen serving as the experimental unit for all analyses. In Exp.1, applying bedding improved (P ≤ 0.01) dry matter intake (DMI), gain:feed (G:F), and average daily gain (ADG). Bedding reduced (P = 0.01) the estimated maintenance coefficient (MQ). Dressing percentage, rib fat, marbling, and yield grade were increased (P ≤ 0.03) in NO. Bedding resulted in an increase (P = 0.01) in serum insulin-like growth factor I (IGF-I). In Exp. 2, a tendency (P = 0.06) for increased DMI for NO was noted. Bedding improved G:F (P = 0.01). MQ was elevated (P = 0.03) for NO and NO had an increase (P = 0.02) in serum concentration of urea-N (SUN). An increase (P = 0.01) in serum non-esterified fatty acid was noted for NO. These data indicate that bedding application should be considered to improve growth performance and feed efficiency by reducing maintenance energy requirements in beef steers during the feedlot receiving and finishing phase. In experiment 3, yearling Simmental × Angus crossbred beef steers (n = 240; allotment BW = 365 ± 22.5 kg) from a South Dakota auction facility were transported 117 km to Brookings, SD and used in a randomized complete block design feedlot study to evaluate the effects of implants (both from Zoetis, Parsippany, NJ) containing increasing doses of TBA and EB administered 124 d prior to harvest have on finishing phase growth performance, carcass characteristics, and serum concentrations of urea-N (SUN) and insulin-like growth factor I (IGF-I). Thirty pens (10 pens/treatment) were assigned to 1 of 3 treatments: 1) negative control given no implant (NI); 2) a steroidal implant containing 100 mg TBA and 14 mg EB administered subcutaneously in the center one-third of the ear on d 1 (Synovex Choice, Zoetis, Parsippany, NJ; CH); 3) a steroidal implant containing 200 mg TBA and 28 mg EB administered subcutaneously in the center one-third of the ear on d 1 (Synovex Plus, Zoetis; PL). Cattle were fed for 124 d post-implantation. Steers were fed a common diet throughout the study. Treatment effects were evaluated by the use of orthogonal polynomials. Pen was the experimental unit for all analyses; an α of 0.05 determined significance. There was a quadratic effect (P = 0.01) on carcass adjusted final BW. Increasing doses of TBA and EB resulted in a linear increase for both ADG (P = 0.01) and DMI (P = 0.02). A quadratic effect on G:F was observed (P = 0.01). No quadratic (P ≥ 0.40) or linear (P ≥ 0.14) effects were observed for dressing percentage, rib fat (RF), calculated yield grade, or marbling scores. A quadratic increase (P = 0.01) in hot carcass weight (HCW) and a linear increase (P = 0.01) in ribeye area (REA) was detected. No significant implant × day interaction (P ≥ 0.09) was noted for serum concentrations of urea-N or IGF-I. Implants decreased (P = 0.01) circulating SUN compared to NI. Serum concentration of IGF-I was increased (P = 0.04) in implanted steers compared to NI steers. In yearling crossbred beef steers the use of steroidal implants containing a combination of 100 mg TBA + 14 mg EB or 200 mg TBA + 28 mg EB increases growth performance, HCW, and REA at equal RF accumulation without detriment to marbling score compared to non-implanted steers

“Being Straight in the Army Is Pretty Easy, Being Gay Is Not”: The Communicative Resilience of Lesbian and Gay Military Service Members

The U.S. Military has 1.9 million individuals serving across five branches, and official policy permits anyone to serve regardless of sexuality (Council on Foreign Relations, 2020). Despite the repeal of Don’t Ask Don’t Tell (DADT), the culture of the U.S. military remains unfriendly to Lesbian and Gay service members (McNamara et al., 2021b), which influences service members’ decisions to disclose sexuality or be “out” in the military (Evans et al., 2019; McNamara et al., 2021a). Lesbian and Gay service members are situated in a heteronormative and masculine culture in the U.S. military and as a result experience disruptions that may necessitate the enactment of resilience. Using the communication theory of resilience (CTR) this study identified post coming-out (in the military) triggers experienced by Lesbian and Gay service members and their communicative responses to such triggers that enact resilience. Through qualitative interviews (n = 12) this study’s findings illustrate the heteronormative culture experienced by LG service members and challenges they face related to their sexuality. This study also identified five communication processes of affirming identity anchors, maintain, and use communication networks, use alternative logics, and finally legitimize negative feelings and engage in positive actions

Olmesartan medoxomil-induced acute renal failure in a premature newborn following maternal exposure during pregnancy: A case report and review of the literature

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) are widely used antihypertensive with well-recognized renoprotective and cardioprotective effects. Although treatment with these agents generally does not result in adverse metabolic consequences, their use during human pregnancy has been associated with negative reactions. Here, we report a premature baby with a history of oligohydramnios and maternal exposure to the ARB olmesartan medoxomil who was transferred to our institution with acute renal failure

Evaluation of Bedding Application on Steroidal Ear Implant Abnormality Rate in Beef Steers

Objective: To evaluate the effects of bedding application on steroidal implant abnormalities (i.e. abscess, hard, knot, missing, partial, and soft inflammation)

"I don't see color, I only see behaviors" : Therapists' concerns in working with clients of color

Although there have been significant gains in the field of multicultural counseling, including the development of multicultural competencies for counseling clients of color, the importance of examining the role of therapists' racial attitudes and biases, as they relate to their level of concerns in counseling clients of color, has not received much attention in the multicultural research and counseling literature. Also, cross-cultural psychological capital and its influence on therapists' level of concern in working with clients of color is unknown. These aspects of cross-cultural capital include optimism and hope in working with clients of color, viewing them as resilient individuals, and believing in one's ability to help this group, otherwise known as self-efficacy. The purpose of this study was to explore therapists' general racial attitudes, their use of psychological capital in sessions with clients, and their levels of multicultural competence as potential predictors of their level of concern in working with clients of color in therapy. Therapists recruited from various fields of psychotherapy (e.g., clinical, counseling, school psychology, couples, and family therapists, social workers, counselors) participated in the study. A total of 177 participants completed an online survey, which included a demographic page as well as the following questionnaires: the Mental Health Practitioner's Racial Socialization Practices Measure, the Cross-Cultural Psychological Capital Scale, the California Brief Multicultural Competence Scale, and the Concerns about Counseling Racial Minority Clients Scale. Results indicated that therapists' general racial attitudes, cross-cultural psychological capital, and multicultural competence were significantly and linearly related to their level of concern in working with clients of color. However, cross-cultural psychological capital was the only significant individual predictor of therapists' level of concern in working with clients of color. Thus, helping mental health professionals be more hopeful, optimistic, and self-efficacious with this client population, and feeling resilient in their work with culturally diverse clients will help them feel more comfortable in working with clients of color

Pädiatrische Referenzintervalle und Zusammenhänge soziodemographischer Kenngrößen zu Serumkonzentrationen von Lipoproteinen

Background: Serumlipid concentrations are thought to be risk factors for the development of cardiovascular disease. The present study aims to investigate the prevalence of dyslipidemia and provide sex- and age-related reference values for triglycerides, total cholesterol, LDL and HDL cholesterol as well as apolipoproteins A1 and B by using modern analytical approaches. Materials and methods: Venous blood and anthropometric data were collected from 2571 subjects of the LIFE Child study, aged between 0.5 and 16 years. Age- and gender-related reference intervals (3rd and 97th percentiles) were established by using Cole's LMS method. Results: Serumconcentrations of TC, LDL-C, TG and ApoBwere higher in girls than in boys. In girls TC reached peak levels two years earlier than in boys. Triglyceride levels initially declined until the school age.Until early adolescence there was a steady increase. The LDL-C concentrations in girls and boys followed similar patterns to that of TC. Up to the age of 8 years, a continuous increase in HDL levels for both sexeswas found. Due to the strong correlation between HDL-C and ApoA1 (r=0.87) or rather between LDL-C and ApoB (r=0.93), the respective percentiles showed very similar patterns. Dyslipidemia prevalence were as follows: increased TC 7.8%, increased LDL 6.1%, increased TG 0–9 years 22.1%, increased TG 10–16 years 11.7%, and decreased HDL 8.0%. Conclusion: Age- and sex-related trends for all parameters are similar to those of the German KIGGS study. With the exception of HDL cholesterol, the prevalence of dyslipidemias in the German LIFE Child cohort are similar to the US-American prevalence.:I Abkürzungsverzeichnis - 03 - 1 Bibliographische Beschreibung - 04 - 2 Einleitung - 05 - 2.1 Hintergrund - 05 - 2.2 Serumlipide, Apolipoproteine und Dyslipidämien - 05 - 2.3 Referenzintervalle - 08 - 2.4 Soziodemographische Faktoren - 10 - 2.5 Die LIFE-Child Studie - 12 - 2.6 Hypothesen, Frage- und Zielstellungen - 13 - 3 Publikationen - 14 - 3.1 Pediatric reference data of serum lipids and prevalence of dyslipidemia: results from a population-based cohort in Germany - 15 - 3.2 Serum lipid levels were related to socio-demographic characteristics in a German population-based child cohort. Serum lipid levels and social class - 25 - 4 Zusammenfassung - 33 - 5 Literaturverzeichnis - 36 - II Anhang - 45 - III Erklärung über die eigenständige Abfassung der Arbeit - 64 - IV Curriculum vitae - 65 - V Danksagung - 66 -Aim: Socio-demographic factors affect the development and lives of children and adolescents. We examined links between serum lipids and apolipoproteins and sociodemographic factors in the Leipzig Research Centre for Civilization Diseases Child (LIFE Child) study. Methods: The Winkler index and the Family Affluence Scale were used to define characteristics of the social status of 938 boys and 860 girls aged from birth to 19 years. We then used univariate and multivariate regression analyses to examine the sociodemographic impact on total cholesterol, low-density lipoprotein (LDL) cholesterol, highdensity lipoprotein (HDL), cholesterol triglycerides and apolipoproteins A1 (ApoA1) and B (ApoB). Results: No significant influences on the Winkler index or the Family Affluence Scale were observed regarding the concentrations of serum lipids for total cholesterol or LDL cholesterol. However, and most importantly, children and adolescents with high social status and high family affluence showed significantly higher HDL cholesterol and ApoA1 levels than those with lower individual totals. A higher Winkler index was associated with significantly lower values for triglycerides and ApoB. Conclusion: Adolescents with higher family wealth and social status showed a lower cardiovascular risk profile, as measured by the concentrations of HDL cholesterol and triglycerides as well as ApoA1 and B.:I Abkürzungsverzeichnis - 03 - 1 Bibliographische Beschreibung - 04 - 2 Einleitung - 05 - 2.1 Hintergrund - 05 - 2.2 Serumlipide, Apolipoproteine und Dyslipidämien - 05 - 2.3 Referenzintervalle - 08 - 2.4 Soziodemographische Faktoren - 10 - 2.5 Die LIFE-Child Studie - 12 - 2.6 Hypothesen, Frage- und Zielstellungen - 13 - 3 Publikationen - 14 - 3.1 Pediatric reference data of serum lipids and prevalence of dyslipidemia: results from a population-based cohort in Germany - 15 - 3.2 Serum lipid levels were related to socio-demographic characteristics in a German population-based child cohort. Serum lipid levels and social class - 25 - 4 Zusammenfassung - 33 - 5 Literaturverzeichnis - 36 - II Anhang - 45 - III Erklärung über die eigenständige Abfassung der Arbeit - 64 - IV Curriculum vitae - 65 - V Danksagung - 66

Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium

OBJECTIVE To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. METHODS Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. RESULTS Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. CONCLUSION Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation.

BackgroundHypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]-although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions.MethodsWe sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013-2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH's assessment of each participant's HTN status against measured blood pressure and HTN history.FindingsSEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and 42% of persons with HTN linked to subsequent care. At follow-up, 82% of SEARCH clinic participants received blood pressure checks; 75% received medication appropriate for their blood pressure; 66% remained in care; and 46% had normal blood pressure at their most recent visit.ConclusionThe SEARCH study's consistency in delivering screening and treatment services for HTN was generally high, but SEARCH could improve effectiveness in linking patients to care and achieving HTN control. Its model for implementing population-scale HTN testing and care through an existing HIV test-and-treat program-and protocol for evaluating the intervention's stepwise fidelity and care outcomes-may be adapted, strengthened, and scaled up for use across multiple resource-limited settings

Impact of a mobile phone-based interactive voice response software on tuberculosis treatment outcomes in Uganda (CFL-TB): a protocol for a randomized controlled trial.

BACKGROUND: Throughout the last decade, tuberculosis (TB) treatment success has not surpassed 90%, the global target. The impact of mobile health interventions (MHIs) on TB treatment outcomes is unknown, especially in low- and middle-income countries (LMICs). MHIs, including interactive voice response technology (IVRT), may enhance adherence and retention in the care of patients with tuberculosis and improve TB treatment outcomes. This study seeks to determine the impact of IVRT-based MHI on TB treatment success (treatment completion and cure rates) in patients with TB receiving care at five public health facilities in Uganda. METHODS: We used a theory-based and human-centered design (HCD) to adapt an already piloted software to design "Call for life-TB" (CFL-TB), an MHI that utilizes IVRT to deliver adherence and appointment reminders and allows remote symptom reporting. This open-label, multicenter, randomized controlled trial (RCT), with nested qualitative and economic evaluation studies, will determine the impact of CFL-TB on TB treatment success in patients with drug-susceptible TB in Uganda. Participants (n = 274) at the five study sites will be randomized (1:1 ratio) to either control (standard of care) or intervention (adherence and appointment reminders, and health tips) arms. Multivariable regression models will be used to compare treatment success, adherence to treatment and clinic appointments, and treatment completion at 6 months post-enrolment. Additionally, we will determine the cost-effectiveness, acceptability, and perceptions of stakeholders. The study received national ethical approval and was conducted in accordance with the international ethical guidelines. DISCUSSION: This randomized controlled trial aims to evaluate interactive voice response technology in the context of resource-limited settings with a high burden of TB and high illiteracy rates. The software to be evaluated was developed using HCD and the intervention was based on the IMB model. The software is tailored to the local context and is interoperable with the MHI ecosystem. The HCD approach ensures higher usability of the MHI by integrating human factors in the prototype development. This research will contribute towards the understanding of the implementation and impact of the MHI on TB treatment outcomes and the health system, especially in LMICs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04709159 . Registered on January 14, 2021