Seroepidemiology of <i>Trichomonas vaginalis</i> in rural women in Zimbabwe and patterns of association with HIV infection

Serological assays using dried blood spots from 5221 women in rural areas of eastern Zimbabwe were used to assess the epidemiology of Trichomonas vaginalis infection, and its association with HIV. Antibodies to T. vaginalis and to HIV were detected by enzyme immunoassays. Behavioural and demographic data were collected by confidential questionnaires. In total, 516 (9.9%) women were seropositive for T. vaginalis and seroprevalence increased with age among younger women. Divorced, widowed and single women were more likely to be seropositive. After controlling for age, seropositivity was significantly associated with being sexually active, having multiple sex partners, having a partner who had multiple sex partners, and having a new sex partner in the past year. Seropositivity was associated with a recent history of genital discharge. Overall, 208 (40.3%) T. vaginalis-positive samples were also positive for HIV, compared with 1106 (23.5%) T. vaginalis-negative samples (age and sex adjusted OR 2.11, 95% CI 1.74–2.55, P&lt;0.001). There was increased risk for being HIV-positive amongst T. vaginalis-seropositive women regardless of residence, employment or education. In a logistic regression controlling for common risk factors, the association remained significant. T. vaginalis-seropositive young women with a history of genital discharge were much more likely to be HIV-positive than women who were T. vaginalis-seronegative and had no history of discharge (OR 6.08, 95% CI 2.95–12.53). Although a causal relationship cannot be assumed, detection and treatment of trichomoniasis may be important in strategies to reduce HIV transmission through sexually transmitted infection control

Near-fatal misuse of medical tape around an endotracheal tube connector during inhalation anesthesia in a horse

A 7-year-old gelded Irish sports horse weighing 650 kg was anesthetized on 2 consecutive days for lavage of a septic right radio-carpal joint. On both occasions the endotracheal tube connector, which had been bound in medical tape to produce an airtight seal, functioned as a unidirectional valve during mechanical ventilation, retarding expiration, imposing positive end expiratory pressure (PEEP), and probably continuous positive airway pressure (CPAP). The equipment dysfunction was not identified on either occasion despite close inspection prompted by progressive increases in airway pressure and thoracic distension. Whilst the PEEP and CPAP exerted unexpectedly modest cardiovascular effects and the horse recovered uneventfully on both occasions, the improvisation may have proven fatal in a higher-risk subject

Local entrepreneurial resilience and culture: the role of social values in fostering economic recovery

This paper examines localities in terms of the impact of community culture on the resilience of their entrepreneurial activity. Drawing on a regression analysis of data covering localities in Britain for the period 2004-2011, it is found that an open and diverse culture is likely to aid the renewal and re-orientation of local entrepreneurial activity. Overall, the study indicates that local social values play an important role in fostering entrepreneurial resilience. It is suggested that future policy intervention may be best targeted at the education system, where the tolerance and skill-sets underpinning entrepreneurial resilience can be most effectively developed

Short communication: NKG2C+ NK cells contribute to increases in CD16+CD56- cells in HIV type 1+ individuals with high plasma viral load.

Chronic HIV-1 infection results in the expansion of both NKG2C+ and CD16+CD56- human natural killer cells. NKG2C+ cells proliferate in response to human cytomegalovirus (HCMV) and expansion of the dysfunctional CD56-CD16+ natural killer (NK) cells is associated with HIV-1 viremia. Here we report an association between increased proportions of CD56-CD16+ NK cells in viremic HIV-1+ individuals and an increased contribution of NKG2C+ cells to this subset. These data, in addition to anti-HCMV IgG serology, indicate a potential contribution of both HCMV and HIV-1 to NK cell dysfunction in HIV-1-infected individuals

Individual Level Injection History: A Lack of Association with HIV Incidence in Rural Zimbabwe

BACKGROUND: It has recently been argued that unsafe medical injections are a major transmission route of HIV infection in the generalised epidemics of sub-Saharan Africa. METHODS AND FINDINGS: We have analysed the pattern of injections in relation to HIV incidence in a population cohort in Manicaland in a rural area of Zimbabwe. In Poisson regression models, injections were not found to be associated with HIV in males (rate ratio = 0.33; 95% confidence interval: 0.07 to 1.46) or females (rate ratio = 1.04; 95% confidence interval: 0.59 to 1.85). CONCLUSION: It is important that unsafe medical injections can be confidently excluded as a major source of HIV infection. In rural Zimbabwe the evidence is that they can

The Future of Knowledge Sharing in a Digital Age: Exploring Impacts and Policy Implications for Development

We live in a Digital Age that gives us instant access to information at greater and greater volumes. The rapid growth of digital content and tools is already changing how we create, consume and distribute knowledge. Even though globally participation in the Digital Age remains uneven, more and more people are accessing and contributing digital content every day. Over the next 15 years, developing countries are likely to experience sweeping changes in how states and societies engage with knowledge. These changes hold the potential to improve people’s lives by making information more available, increasing avenues for political and economic engagement, and making government more transparent and responsive. But they also carry dangers of a growing knowledge divide influenced by technology access, threats to privacy, and the potential loss of diversity of knowledge. Our research sets out with a 15-year horizon to look at the possible ways in which digital technologies might contribute to or damage development agendas, and how development practitioners and policymakers might best respond.UK Department for International Developmen

Knowledge Sharing and Development in a Digital Age

Digital technologies are reaching ever further into remote parts of the world, changing how people access, use, and create information and knowledge. These changes may improve people’s lives by making information more available, increasing avenues for political and economic engagement, and making governments more transparent and responsive. However, they also carry dangers of growing digital divides, threats to privacy, and the potential loss of diversity of knowledge. Governments, development agencies and civil society organisations need to work together to make knowledge more inclusive and open. This calls for investment in Information and Communications Technology (ICT) infrastructure, information professionals, and search and discovery tools.UK Department for International Developmen

Marketing Logistics Systems Analysis: The Development of Heuristic Guidelines to Aid Decision Making in the Pharmaceutical Manufacturing Industry

This thesis describes the development of heuristic guidelines to aid logistics management in manufacturing industry, in this case pharmaceutical manufacturers, to make decisions when faced with the appraisal of alternative methods of operation. A number of research suppositions are proposed which suggest that a more formalised approach to decision making than is current practice can be implemented in assessing the total logistics costs and customer service implications of operations. A study is made of existing research in logistics and related areas, the pharmaceutical industry in general, and in particular the logistics activities of pharmaceutical manufacturers and the service requirements of their customers. A research programme is devised whose primary purpose is to enable a comparison to be made between the implications of the research suppositions and the empirical data obtained by administering questionnaires to manufacturers and samples of customers. A model of the decision making process is presented around the framework of a cost-effectiveness analysis. A systems approach is used to analyse a manufacturer's logistics operation, highlighting as it does the interactive effects between logistics activities. The research suppositions provide heuristic guidelines which relate an activity's position on a manufacturer's material flow path to that of the proposed change, and which assign service priorities in terms of lead time to customer types. These guidelines serve to decrease the number of considered interactions and, subsequently, to reduce the complexity of the analysis. A number of implications of the findings for manufacturing industry in general, for pharmaceutical manufacturers in particular, and for logistics research, are presented. Suggestions are also made to aid any company wishing to apply its own logistics systems analysis along the lines pursued in this study.Ph

When Did HIV Incidence Peak in Harare, Zimbabwe? Back-Calculation from Mortality Statistics

HIV prevalence has recently begun to decline in Zimbabwe, a result of both high levels of AIDS mortality and a reduction in incident infections. An important component in understanding the dynamics in HIV prevalence is knowledge of past trends in incidence, such as when incidence peaked and at what level. However, empirical measurements of incidence over an extended time period are not available from Zimbabwe or elsewhere in sub-Saharan Africa. Using mortality data, we use a back-calculation technique to reconstruct historic trends in incidence. From AIDS mortality data, extracted from death registration in Harare, together with an estimate of survival post-infection, HIV incidence trends were reconstructed that would give rise to the observed patterns of AIDS mortality. Models were fitted assuming three parametric forms of the incidence curve and under nine different assumptions regarding combinations of trends in non-AIDS mortality and patterns of survival post-infection with HIV. HIV prevalence was forward-projected from the fitted incidence and mortality curves. Models that constrained the incidence pattern to a cubic spline function were flexible and produced well-fitting, realistic patterns of incidence. In models assuming constant levels of non-AIDS mortality, annual incidence peaked between 4 and 5% between 1988 and 1990. Under other assumptions the peak level ranged from 3 to 8% per annum. However, scenarios assuming increasing levels of non-AIDS mortality resulted in implausibly low estimates of peak prevalence (11%), whereas models with decreasing underlying crude mortality could be consistent with the prevalence and mortality data. HIV incidence is most likely to have peaked in Harare between 1988 and 1990, which may have preceded the peak elsewhere in Zimbabwe. This finding, considered alongside the timing and location of HIV prevention activities, will give insight into the decline of HIV prevalence in Zimbabwe