“I beg you…breastfeed the baby, things changed”: Infant feeding experiences among Ugandan mothers living with HIV in the context of evolving PMTCT guidelines

For women living with HIV (WLWH) in low- and middle-income countries, breastfeedingrepresents both an HIV transmission risk and the best way to ensure infant survival. The 2013 World Health Organization (WHO)-led strategy for the Prevention of Mother to Child Transmission (PMTCT) recommends exclusive and continued breastfeeding alongside lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women to optimize maternal and infant health while reducing perinatal HIV transmission risk. There have been four major changes to WHO’s infant feeding guidelines since 1992, but few studies have explored how these evolving recommendations affect the pregnancy and postpartum experiences of WLWH. To address this gap, this study explores infant feeding experiences of twenty WLWH on ART in Uganda navigating new PMTCT guidelines. Findings reveal that women are making choices about infant feeding that run counter to current guidelines amid uncertainty about optimal infant feeding practices, fear of HIV transmission through breastfeeding, privileging of infant formula alongside fears about child survival and failure to-thrive while exclusively breastfeeding, and maternal stress related to breastfeeding duration. Results highlight an urgent need for clearer communication about guideline changes and supportive infant feeding care for WLWH, including training for healthcare providers

Psychosocial Challenges Facing Women Living with HIV During the Perinatal Period in Rural Uganda

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28± 35], a median of 3 living children [IQR: 2±5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community

Radio imaging of the Subaru/XMM-Newton Deep Field - III. Evolution of the radio luminosity function beyond z=1

We present spectroscopic and eleven-band photometric redshifts for galaxies in the 100-uJy Subaru/XMM-Newton Deep Field radio source sample. We find good agreement between our redshift distribution and that predicted by the SKA Simulated Skies project. We find no correlation between K-band magnitude and radio flux, but show that sources with 1.4-GHz flux densities below ~1mJy are fainter in the near-infrared than brighter radio sources at the same redshift, and we discuss the implications of this result for spectroscopically-incomplete samples where the K-z relation has been used to estimate redshifts. We use the infrared--radio correlation to separate our sample into radio-loud and radio-quiet objects and show that only radio-loud hosts have spectral energy distributions consistent with predominantly old stellar populations, although the fraction of objects displaying such properties is a decreasing function of radio luminosity. We calculate the 1.4-GHz radio luminosity function (RLF) in redshift bins to z=4 and find that the space density of radio sources increases with lookback time to z~2, with a more rapid increase for more powerful sources. We demonstrate that radio-loud and radio-quiet sources of the same radio luminosity evolve very differently. Radio-quiet sources display strong evolution to z~2 while radio-loud AGNs below the break in the radio luminosity function evolve more modestly and show hints of a decline in their space density at z>1, with this decline occurring later for lower-luminosity objects. If the radio luminosities of these sources are a function of their black hole spins then slowly-rotating black holes must have a plentiful fuel supply for longer, perhaps because they have yet to encounter the major merger that will spin them up and use the remaining gas in a major burst of star formation.Comment: Accepted for publication in MNRAS: 36 pages, including 13 pages of figures to appear online only. In memory of Stev

The XMM Cluster Survey: X-ray analysis methodology

The XMM Cluster Survey (XCS) is a serendipitous search for galaxy clusters using all publicly available data in the XMM-Newton Science Archive. Its main aims are to measure cosmological parameters and trace the evolution of X-ray scaling relations. In this paper we describe the data processing methodology applied to the 5,776 XMM observations used to construct the current XCS source catalogue. A total of 3,675 > 4-sigma cluster candidates with > 50 background-subtracted X-ray counts are extracted from a total non-overlapping area suitable for cluster searching of 410 deg^2. Of these, 993 candidates are detected with > 300 background-subtracted X-ray photon counts, and we demonstrate that robust temperature measurements can be obtained down to this count limit. We describe in detail the automated pipelines used to perform the spectral and surface brightness fitting for these candidates, as well as to estimate redshifts from the X-ray data alone. A total of 587 (122) X-ray temperatures to a typical accuracy of < 40 (< 10) per cent have been measured to date. We also present the methodology adopted for determining the selection function of the survey, and show that the extended source detection algorithm is robust to a range of cluster morphologies by inserting mock clusters derived from hydrodynamical simulations into real XMM images. These tests show that the simple isothermal beta-profiles is sufficient to capture the essential details of the cluster population detected in the archival XMM observations. The redshift follow-up of the XCS cluster sample is presented in a companion paper, together with a first data release of 503 optically-confirmed clusters.Comment: MNRAS accepted, 45 pages, 38 figures. Our companion paper describing our optical analysis methodology and presenting a first set of confirmed clusters has now been submitted to MNRA

A downturn in intergalactic CIV as redshift 6 is approached

We present the results of the largest survey to date for intergalactic metals at redshifts z > 5, using near-IR spectra of nine QSOs with emission redshifts z(em) > 5.7. We find, for the first time, a change in the comoving mass density of C IV ions as we look back to redshifts z > 5. At a mean = 5.76, we deduce Omega(C IV)=(4.4+/-2.6)x10^(-9) which implies a drop by a factor of about 3.5 compared to the value at z < 4.7, after accounting for the differing sensitivities of different surveys. The observed number of C IV doublets is also lower by a similar factor, compared to expectations for a non-evolving column density distribution of absorbers. These results point to a rapid build-up of intergalactic C IV over a period of only 300 Myr; such a build-up could reflect the accumulation of metals associated with the rising levels of star formation activity from z = 9 indicated by galaxy counts, and/or an increasing degree of ionisation of the intergalactic medium (IGM), following the overlap of ionisation fronts from star-forming regions. If the value of Omega(C IV) we derive is typical of the IGM at large, it would imply a metallicity Z(IGM) = 10^(-4) Z(Sun). The early-type stars responsible for synthesising these metals would have emitted only about one Lyman continuum photon per baryon prior to z = 5.8; such a background is insufficient to keep the IGM ionised and we speculate on possible factors which could make up the required shortfall.Comment: 15 pages, 8 Figures, Accepted for publication in Monthly Notices of the Royal Astronomical Society. Typo in astro-ph abstract fixed. Paper unchange

The community-based prevention of diabetes (ComPoD) study: A randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme

© 2019 The Author(s). Objective: This two-site randomised trial compared the effectiveness of a voluntary sector-led, community-based diabetes prevention programme to a waiting-list control group at 6 months, and included an observational follow-up of the intervention arm to 12 months. Methods: Adults aged 18-75 years at increased risk of developing type 2 diabetes due to elevated blood glucose and being overweight were recruited from primary care practices at two UK sites, with data collected in participants' homes or community venues. Participants were randomised using an online central allocation service. The intervention, comprising the prototype "Living Well, Taking Control" (LWTC) programme, involved four weekly two-hour group sessions held in local community venues to promote changes in diet and physical activity, plus planned follow-up contacts at two, three, six, nine and 12 months alongside 5 hours of additional activities/classes. Waiting list controls received usual care for 6 months before accessing the programme. The primary outcome was weight loss at 6 months. Secondary outcomes included glycated haemoglobin (HbA1c), blood pressure, physical activity, diet, health status and well-being. Only researchers conducting analyses were blinded. Results: The target sample of 314 participants (157 each arm) was largely representative of local populations, including 44% men, 26% from ethnic minorities and 33% living in deprived areas. Primary outcome data were available for 285 (91%) participants (141 intervention, 144 control). Between baseline and 6 months, intervention participants on average lost more weight than controls (- 1.7 kg, 95% CI - 2.59 to - 0.85). Higher attendance was associated with greater weight loss (- 3.0 kg, 95% CI - 4.5 to - 1.5). The prototype LWTC programme more than doubled the proportion of participants losing > 5% of their body weight (21% intervention vs. 8% control, OR 2.83, 95% CI 1.36 to 5.90) and improved self-reported dietary behaviour and health status. There were no impacts on HbA1c, blood pressure, physical activity and well-being at 6 months and, amongst intervention participants, few further changes from six to 12-months (e.g. average weight re-gain 0.36 kg, 95% CI - 0.20 to 0.91). There were no serious adverse events but four exercise-related injuries were reported in the intervention arm. Conclusions: This voluntary sector-led diabetes prevention programme reached a broad spectrum of the population and had modest effects on weight-related outcomes, but limited impacts on other diabetes risk factors. Trial registration: Trial registration number: ISRCTN70221670, 5 September 2014 Funder (National Institute for Health Research School for Public Health Research) project reference number: SPHR-EXE-PES-COM

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

“I beg you…breastfeed the baby, things changed”: infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission

Abstract Background For women living with HIV (WLWH) in low- and middle-income countries, World Health Organization (WHO) infant feeding guidelines now recommend exclusive breastfeeding until six months followed by mixed feeding until 24 months, alongside lifelong maternal antiretroviral therapy (ART). These recommendations represent the sixth major revision to WHO infant feeding guidelines since 1992. We explored how WLWH in rural Uganda make infant feeding decisions in light of evolving recommendations. Methods We conducted semi-structured interviews with 20 postpartum Ugandan WLWH accessing ART, who reported pregnancy < 2 years prior to recruitment. Interviews were conducted between February–August 2014 with babies born between March 2012–October 2013, over which time, the regional HIV treatment clinic recommended lifelong ART for all pregnant and breastfeeding women (Option B+). Content analysis was used to identify major themes. Infant feeding experiences was an emergent theme. NVivo 10 software was used to organize analyses. Results Among 20 women, median age was 33 years [IQR: 28–35], number of livebirths was 3 [IQR: 2–5], years on ART was 2.3 [IQR: 1.5–5.1], and 95% were virally suppressed. Data revealed that women valued opportunities to reduce postnatal transmission. However, women made infant feeding choices that differed from recommendations due to: (1) perception of conflicting recommendations regarding infant feeding; (2) fear of prolonged infant HIV exposure through breastfeeding; and (3) social and structural constraints shaping infant feeding decision-making. Conclusions WLWH face layered challenges navigating evolving infant feeding recommendations. Further research is needed to examine guidance and decision-making on infant feeding choices to improve postpartum experiences and outcomes. Improved communication about changes to recommendations is needed for WLWH, their partners, community members, and healthcare providers