Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities

BACKGROUND: The Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. METHODS: Four ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities’ infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations. RESULTS: Among 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28(th) week or later. Overall scores for providers’ PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers’ ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites. CONCLUSIONS: These findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early

Long‐term monitoring program reveals a mismatch between spatial distribution and reproductive success in an endangered raptor species in the Mediterranean area

Unmasking the ecological processes responsible for the dynamics of a population is a necessary step toward understanding its threats and viability. We examined a fitness proxy (reproductive success) of an endangered raptor in relation to its ecological niche and spatial distribution to provide insights into the dynamics and potential threats to the population. We first studied how biotic and abiotic conditions drive both the spatial distribution of Bonelli's eagle (Aquila fasciata) and its long-term reproductive success in a large area of northwestern Spain. We focused on the relationship between these two characteristics of the population. Our results showed that biotic factors (occurrence of competitors such as the golden eagle or prey availability) were more associated with the spatial distribution of the species than with its reproductive success. In contrast, abiotic factors describing climate were linked to reproductive success. Most interestingly, we found a mismatch between spatial suitability and reproductive success because reproduction was compromised in the areas that were more suitable for the occurrence of the species. The results suggest that productivity (less than one chick per year), measured as long-term reproductive success, may compromise the population viability and suggest the presence of an underlying mechanism in the population. Our results highlight the benefits of simultaneously considering both large-scale spatial distribution patterns and measures of fitness, which often require larger investments of time, for endangered species conservation programs

The prohibitin-binding compound fluorizoline induces apoptosis in chronic lymphocytic leukemia cells through the upregulation of NOXA and synergizes with ibrutinib, 5-aminoimidazole-4-carboxamide riboside or venetoclax

Fluorizoline is a new synthetic molecule that induces apoptosis by selectively targeting prohibitins. In the study herein, the pro-apoptotic effect of fluorizoline was assessed in 34 primary samples from patients with chronic lymphocytic leukemia. Fluorizoline induced apoptosis in chronic lymphocytic leukemia cells at concentrations in the low micromolar range. All primary samples were sensitive to fluorizoline irrespective of patients' clinical or genetic features, whereas normal T lymphocytes were less sensitive. Fluorizoline increased the protein levels of the pro-apoptotic B-cell lymphoma 2 family member NOXA in chronic lymphocytic leukemia cells. Furthermore, fluorizoline synergized with ibrutinib, 5-aminoimidazole-4-carboxamide riboside or venetoclax to induce apoptosis. These results suggest that targeting prohibitins could be a new therapeutic strategy for chronic lymphocytic leukemia

Adherence to the Western, Prudent, and Mediterranean dietary patterns and chronic lymphocytic leukemia in the MCC-Spain study.

Diet is a modifiable risk factor for several neoplasms but evidence for chronic lymphocytic leukemia (CLL) is sparse. Previous studies examining the association between single-food items and CLL risk have yielded mixed results, while few studies have been conducted on overall diet, reporting inconclusive findings. This study aimed to evaluate the association between adherence to three dietary patterns and CLL in the multicase-control study (MCC-Spain) study. Anthropometric, sociodemographic, medical and dietary information was collected for 369 CLL cases and 1605 controls. Three validated dietary patterns, Western, Prudent and Mediterranean, were reconstructed in the MCC-Spain data. The association between adherence to each dietary pattern and CLL was assessed, overall and by Rai stage, using mixed logistic regression models adjusted for potential confounders. High adherence to a Western dietary pattern (i.e. high intake of high-fat dairy products, processed meat, refined grains, sweets, caloric drinks, and convenience food) was associated with CLL [ORQ4 vs. Q1=1.63 (95%CI 1.11; 2.39); P-trend=0.02; OR 1-SD increase=1.19 (95%CI: 1.03; 1.37)], independently of Rai stages. No differences in the association were observed according to sex, Body Mass Index, energy intake, tobacco, physical activity, working on a farm, or family history of hematologic malignancies. No associations were observed for Mediterranean and Prudent dietary patterns and CLL. This study provides the first evidence for an association between a Western dietary pattern and CLL, suggesting that a proportion of CLL cases could be prevented by modifying dietary habits. Further research, especially with a prospective design, is warranted to confirm these findings

Whole Exome Sequencing in Multi-Incident Families Identifies Novel Candidate Genes for Multiple Sclerosis

Multiple sclerosis (MS) is a degenerative disease of the central nervous system in which auto-immunity-induced demyelination occurs. MS is thought to be caused by a complex interplay of environmental and genetic risk factors. While most genetic studies have focused on identifying common genetic variants for MS through genome-wide association studies, the objective of the present study was to identify rare genetic variants contributing to MS susceptibility. We used whole exome sequencing (WES) followed by co-segregation analyses in nine multi-incident families with two to four affected individuals. WES was performed in 31 family members with and without MS. After applying a suite of selection criteria, co-segregation analyses for a number of rare variants selected from the WES results were performed, adding 24 family members. This approach resulted in 12 exonic rare variants that showed acceptable co-segregation with MS within the nine families, implicating the genes MBP, PLK1, MECP2, MTMR7, TOX3, CPT1A, SORCS1, TRIM66, ITPR3, TTC28, CACNA1F, and PRAM1. Of these, three genes (MBP, MECP2, and CPT1A) have been previously reported as carrying MS-related rare variants. Six additional genes (MTMR7, TOX3, SORCS1, ITPR3, TTC28, and PRAM1) have also been implicated in MS through common genetic variants. The proteins encoded by all twelve genes containing rare variants interact in a molecular framework that points to biological processes involved in (de-/re-)myelination and auto-immunity. Our approach provides clues to possible molecular mechanisms underlying MS that should be studied further in cellular and/or animal models

Genomic analysis of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli colonising adults in Blantyre, Malawi reveals previously undescribed diversity

Escherichia coli is one of the most prevalent Gram-negative species associated with drug resistant infections. Strains that produce extended-spectrum beta-lactamases (ESBLs) or carbapenemases are both particularly problematic and disproportionately impact resource limited healthcare settings where last-line antimicrobials may not be available. A large number of E. coli genomes are now available and have allowed insights into pathogenesis and epidemiology of ESBL E. coli but genomes from sub-Saharan Africa (sSA) are significantly underrepresented. To reduce this gap, we investigated ESBL-producing E. coli colonising adults in Blantyre, Malawi to assess bacterial diversity and AMR determinants and to place these isolates in the context of the wider population structure. We performed short-read whole-genome sequencing of 473 colonising ESBL E. coli isolated from human stool and contextualised the genomes with a previously curated multi-country collection of 10 146 E. coli genomes and sequence type (ST)-specific collections for our three most commonly identified STs. These were the globally successful ST131, ST410 and ST167, and the dominant ESBL genes were blaCTX-M, mirroring global trends. However, 37 % of Malawian isolates did not cluster with any isolates in the curated multicountry collection and phylogenies were consistent with locally spreading monophyletic clades, including within the globally distributed, carbapenemase-associated B4/H24RxC ST410 lineage. A single ST2083 isolate in this collection harboured a carbapenemase gene. Long read sequencing demonstrated the presence of a globally distributed ST410-associated carbapenemase carrying plasmid in this isolate, which was absent from the ST410 strains in our collection. We conclude there is a risk that carbapenem resistance in E. coli could proliferate rapidly in Malawi under increasing selection pressure, and that both ongoing antimicrobial stewardship and genomic surveillance are critical as local carbapenem use increases

Practical Pharmacist-Led Interventions to Improve Antimicrobial Stewardship in Ghana, Tanzania, Uganda and Zambia.

The World Health Organisation (WHO) and others have identified, as a priority, the need to improve antimicrobial stewardship (AMS) interventions as part of the effort to tackle antimicrobial resistance (AMR). An international health partnership model, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, was established between selected countries in Africa (Ghana, Tanzania, Zambia and Uganda) and the UK to support AMS. This was funded by UK aid under the Fleming Fund and managed by the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET). The primary aims were to develop local AMS teams and generate antimicrobial consumption surveillance data, quality improvement initiatives, infection prevention and control (IPC) and education/training to reduce AMR. Education and training were key components in achieving this, with pharmacists taking a lead role in developing and leading AMS interventions. Pharmacist-led interventions in Ghana improved access to national antimicrobial prescribing guidelines via the CwPAMS mobile app and improved compliance with policy from 18% to 70% initially for patients with pneumonia in one outpatient clinic. Capacity development on AMS and IPC were achieved in both Tanzania and Zambia, and a train-the-trainer model on the local production of alcohol hand rub in Uganda and Zambia. The model of pharmacy health partnerships has been identified as a model with great potential to be used in other low and middle income countries (LMICs) to support tackling AMR

Contribución del anillamiento al conocimiento y conservación de las aves en España: pasado, presente y futuro

El anillamiento científico de aves es una técnica de estudio con más de un siglo de historia que, probablemente, ha contribuido como ninguna otra metodología al conocimiento de la biología de este grupo faunístico. A pesar del desarrollo de nuevas tecnologías, el marcaje individual de aves mediante anillamiento sigue siendo una técnica plenamente vigente y necesaria. Aunque la evidencia científica sobre los beneficios de la aplicación del anillamiento en la Ornitología moderna es abrumadora, hoy vivimos un proceso de creciente desinformación que cuestiona el anillamiento de aves y su utilidad. Este dosier se ha elaborado con el fin de ofrecer una visión actualizada de la utilidad del anillamiento científico de aves en España. Ha sido elaborado por un nutrido grupo de expertos asociados a universidades y centros de investigación que abarcan buena parte de las áreas del conocimiento implicadas en el estudio y conservación de las aves. El dosier se divide en cuatro grandes apartados. (1) En primer lugar se hace una introducción sobre el anillamiento como metodología y se resumen las grandes cifras del anillamiento en España donde, hasta la fecha, se han anillado algo más de 10.000.000 de aves y se han registrado 700.000 recuperaciones (en la actualidad se anillan unas 380.000 aves y se obtienen unas 30.000 recuperaciones anualmente). (2) En un segundo bloque se resume la aplicación del anillamiento en diferentes aproximaciones al estudio científico de las aves, que van apoyadas por numerosas referencias bibliográficas sobre trabajos llevados a cabo en España. Gracias al anillamiento se han podido abordar múltiples estudios sobre movimientos y migraciones, reproducción, demografía, enfermedades, morfología, muda e identificación y taxonomía. (3) Un tercer bloque se centra en la utilidad del anillamiento más allá de la investigación básica. Es el caso de la conservación, la gestión de especies cinegéticas y el estudio de los impactos del cambio global sobre las aves, por un lado, y la educación ambiental, formación y ciencia ciudadana, por otro. (4) Finalmente, se abordan algunas ideas sobre los retos actuales y perspectivas de futuro del anillamiento en España

Biodivulgación a través de podcasts

El presente proyecto pretende elaborar una serie de espacios de audio bajo demanda (podcast) relacionados con la difusión de las actividades del Programa de Seguimiento de Biodiviersidad y con cuestiones de actualidad relacionadas con la biodiversidad urbana y su interacción y efecto sobre el bienestar de los seres humanos que habitan en las ciudades. Debido a los recientes sucesos relacionados con la COVID-19, en la universidad ha surgido, la necesidad de desarrollar herramientas de aprendizaje relacionadas con las enseñanza semipresenciales o virtuales. Después de analizar las potencialidades y las carencias de estos elementos y de haber certificado en proyectos de innovación precedentes, el interés por las metodologías activas, con carácter innovador y orientado al desarrollo del conocimiento personal, este grupo ha decidido elaborar materiales que, sin disminuir su rigor científico y técnico, puedan ser accesibles no sólo a los estudiantes que los necesitan, sino también al público en general mediante formatos atractivos y accesibles. El uso de nuevas tecnologías se está imponiendo como una herramienta imprescindible tanto en la formación y desarrollo de nuestros estudiantes como en la difusión y transferencia de conocimientos a la sociedad en general, debido al impacto positivo en la adquisición de competencias técnicas y sociales. En un entorno universitario, la innovación metodológica debe estar presente especialmente en disciplinas empíricas como son las ciencias experimentales y más concretamente la Biología. A pesar de los beneficios comprobados con su aplicación, se necesitan conocimientos y esfuerzos extra por parte de los docentes para su diseño y aplicación. Resulta muy útil la existencia de herramientas que agilicen el proceso de aprendizaje y que predispongan al alumno a participar en determinadas actividades. En estudios recientes, se ha comprobado que los estudiantes realizan mejor sus tareas cuando se aplican metodologías cooperativas enriquecidas con recursos Tecnologías de la Información y Comunicación (TIC). En este sentido, las TIC pueden desempeñar un papel fundamental en la creación de entornos de aprendizaje que trasciendan al simple uso de las redes sociales. Se trata de que los estudiantes, desde una plataforma web, discutan, valoren y establezcan consensos sobre temas y datos relacionados con la biodiversidad. Tras la realización de la primera fase del Proyecto de Innovación y Mejora de la Calidad Docente durante la convocatoria 2011-12 (Ref: 88) que consiste en el uso de elementos como cajas nido para fijar poblaciones de aves y murciélagos al campus, la segunda fase durante la convocatoria 2012-13 (Ref: 288) dirigida a la elaboración de catálogos de la fauna específicos del CEI-Campus Moncloa de la UCM, la tercera fase en las convocatorias 2014-15 (Ref: 53) y 2019-2020 (Ref: 232) referidas a la percepción de la biodiversidad en la Ciudad Universitaria, al proyecto de LIFE-Campus (2016-2017) y la cuarta fase mediante los proyectos de la convocatoria 2017-2018 (Ref: 286) y 2018-2019 (Ref: 215) relacionados con la elaboración de microespacios de vídeo relacionados con la biodiversidad y su accesibilidad al mayor espectro de público posible, la consecuencia natural ha sido la presentación de este programa que correspondería con una quinta fase del programa de Seguimiento de Biodiversidad en el Campus Moncloa UCM. Con respecto a la viabilidad y transferencia del proyecto y desde la puesta en marcha de este programa en el año 2011, diversos alumnos y miembros de la comunidad educativa, especialmente de la Facultad de Ciencias Biológicas de la Universidad Complutense, han tenido la oportunidad de participar en actividades relacionadas con la planificación, ejecución y análisis de numerosas actividades relacionadas con el estudio de la biodiversidad del campus. Un siguiente paso natural para este programa consistió en ampliar los receptores de este tipo de actividades al resto de la comunidad universitaria, para lo que se identificó la percepción de la biodiversidad que tenían los usuarios del campus, teniendo en cuenta además que éste es compartido por diferentes universidades, facultades y, en cierto modo, distintas percepciones del entorno. Una vez identificadas esas apreciaciones y necesidades y tras elaborar los micro-espacios audiovisuales sobre biodiversidad y subtitularlos a diversos idiomas para hacerlos lo más accesibles posibles, el siguiente paso consistirá en realizar podcasts con una temática relacionada con la biodiversidad, pero que permitirán un diálogo más abierto y menos constreñido a guiones, y escaletas. La participación de grupos cada vez más amplios de personas hace necesario complementar la formación que reciben con aspectos adicionales que pueden resultar de interés no sólo para los participantes en el programa de seguimiento sino también para el público en general, contribuyendo a la educación informal de los usuarios del campus e interesados en su Biodiversidad