139 research outputs found

    Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach

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    Background: The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. Methods: We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. Results: We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. Conclusions: The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0561-4) contains supplementary material, which is available to authorized users

    A generalist–specialist trade-off between switchgrass cytotypes impacts climate adaptation and geographic range

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    Polyploidy results from whole-genome duplication and is a unique form of heritable variation with pronounced evolutionary implications. Different ploidy levels, or cytotypes, can exist within a single species, and such systems provide an opportunity to assess how ploidy variation alters phenotypic novelty, adaptability, and fitness, which can, in turn, drive the development of unique ecological niches that promote the coexistence of multiple cytotypes. Switchgrass, Panicum virgatum, is a widespread, perennial C4 grass in North America with multiple naturally occurring cytotypes, primarily tetraploids (4×) and octoploids (8×). Using a combination of genomic, quantitative genetic, landscape, and niche modeling approaches, we detect divergent levels of genetic admixture, evidence of niche differentiation, and differential environmental sensitivity between switchgrass cytotypes. Taken together, these findings support a generalist (8×)–specialist (4×) trade-off. Our results indicate that the 8× represent a unique combination of genetic variation that has allowed the expansion of switchgrass’ ecological niche and thus putatively represents a valuable breeding resource

    Marine important bird and biodiversity areas for penguins in Antarctica: Targets for conservation action

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    Global targets for area-based conservation and management must move beyond threshold-based targets alone and must account for the quality of such areas. In the Southern Ocean around Antarctica, a region where key biodiversity faces unprecedented risks from climate change and where there is a growing demand to extract resources, a number of marine areas have been afforded enhanced conservation or management measures through two adopted marine protected areas (MPAs). However, evidence suggests that additional high quality areas could benefit from a proposed network of MPAs. Penguins offer a particular opportunity to identify high quality areas because these birds, as highly visible central-place foragers, are considered indicator species whose populations reflect the state of the surrounding marine environment. We compiled a comprehensive dataset of the location of penguin colonies and their associated abundance estimates in Antarctica. We then estimated the at-sea distribution of birds based on information derived from tracking data and through the application of a modified foraging radius approach with a density decay function to identify some of the most important marine areas for chick-rearing adult penguins throughout waters surrounding Antarctica following the Important Bird and Biodiversity Area (IBA) framework. Additionally, we assessed how marine IBAs overlapped with the currently adopted and proposed network of key management areas (primarily MPAs), and how the krill fishery likely overlapped with marine IBAs over the past five decades. We identified 63 marine IBAs throughout Antarctic waters and found that were the proposed MPAs to be adopted, the permanent conservation of high quality areas for penguin species would increase by between 49 and 100% depending on the species. Furthermore, our data show that, despite a generally contracting range of operation by the krill fishery in Antarctica over the past five decades, a consistently disproportionate amount of krill is being harvested within marine IBAs compared to the total area in which the fishery operates. Our results support the designation of the proposed MPA network and offer additional guidance as to where decision-makers should act before further perturbation occurs in the Antarctic marine ecosystem

    Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

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    Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

    Speciation and reactivity of uranium products formed during in situ bioremediation in a shallow alluvial aquifer

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    In this study, we report the results of in situ U(VI) bioreduction experiments at the Integrated Field Research Challenge site in Rifle, Colorado, USA. Columns filled with sediments were deployed into a groundwater well at the site and, after a period of conditioning with groundwater, were amended with a mixture of groundwater, soluble U(VI), and acetate to stimulate the growth of indigenous microorganisms. Individual reactors were collected as various redox regimes in the column sediments were achieved: (i) during iron reduction, (ii) just after the onset of sulfate reduction, and (iii) later into sulfate reduction. The speciation of U retained in the sediments was studied using X-ray absorption spectroscopy, electron microscopy and chemical extractions. Circa 90% of the total uranium was reduced to U(IV) in each reactor. Noncrystalline U(IV) comprised about two-thirds of the U(IV) pool, across large changes in microbial community structure, redox regime, total uranium accumulation, and reaction time. A significant body of recent research has demonstrated that noncrystalline U(IV) species are more suceptible to remobilization and reoxiation than crystalline U(IV) phases such as uraninite. Our results highlight the importance of considering noncrystalline U(IV) formation across a wide range of aquifer parameters when designing in situ remediation plans
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