Access to Long Acting Reversible Contraceptives in Northeast TN: A Study of Reproductive Care in Hawkins County, TN

Unintended pregnancy leads to many public health consequences like lower educational attainment and diminished career opportunities, with higher rates of unintended pregnancies occurring in lower income communities and among women with drug addiction. Beyond preventing unintended pregnancies, effective contraception helps prevent poor birth spacing, thereby reducing the risk of both premature and low-weight births and maternal mortality and morbidity during the peripartum period. Long acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and implants, are considered the birth control of choice for women of reproductive potential as they possess a number of advantages: cost-effectiveness, minimal maintenance for 3 to 10 years, reversibility, and high efficacy and continuation rates. Despite these benefits, LARCs have been widely underused in rural communities as a result of many factors including hospital and gynecology department closures, workforce shortages, provider knowledge, and access to care challenges that arise from complex social determinants of health specific to rural US communities. We therefore investigated the knowledge and current practice of clinical providers regarding LARCs counseling and provision in Hawkins County of Northeast Tennessee. Hawkins County is a primarily rural county with clinics serving a large lower income population with a high prevalence of substance use, therefore making it at risk for higher rates of unintended pregnancies. An online survey was sent to all consenting medical providers (NPs, PAs, and physicians) (n=7) to collect information on their practices related to contraception, including LARCs. Following completion of online surveys, semi-structured interviews (n=2) were planned to qualitatively explore providers’ perspectives. Quantitative analysis of survey data and thematic analysis of interviews were conducted. Analysis of survey data shows that though non-OB/GYN primary care providers reported on being somewhat comfortable to comfortable in their ability to counsel patients on LARCs, they reported low levels of actually counseling on LARCs, compared with oral contraception. Furthermore, the survey data also shows low levels of LARC insertion/removal among non-OB/GYN primary care providers, with most noting preference to refer patients to a private OB/GYN provider within the community or the health department. Additionally, non-OB/GYN primary care providers reported little to no interest in including insertion/removal of LARCs within their scope of practice, citing clinic supply, no time for procedures, and low patient desire as reasons. All providers reported believing that there are little to no barriers to obtaining LARCs by patients within Hawkins County.The semi-structured interviews, including one with the county’s main OB/GYN provider, indicated that though there is access to LARCs within Hawkins County, there may still be multiple barriers including possible poor quality of counseling on LARCs by non-OB/GYN primary care providers and preference for counseling specific populations on LARCs rather than all patients of reproductive potential, both of which may contribute to low patient desire for LARCs. This work is a useful starting place for increasing utilization of LARCs within Hawkins County. By exploring current knowledge and practices of primary care providers, we can better address potential systematic barriers to improve access to and utilization of LARCs in rural communities

Shear strength behavior of geotextile/geomembrane interfaces

This paper aims to study the shear interaction mechanism of one of the critical geosynthetic interfaces, the geotextile/geomembrane, typically used for lined containment facilities such as landfills. A large direct shear machine is used to carry out 90 geosynthetic interface tests. The test results show a strain softening behavior with a very small dilatancy (<0.5 mm) and nonlinear failure envelopes at a normal stress range of 25-450 kPa. The influences of the micro-level structure of these geosynthetics on the macro-level interface shear behavior are discussed in detail. This study has generated several practical recommendations to help professionals to choose what materials are more adequate. From the three geotextiles tested, the thermally bonded monofilament exhibits the best interface shear strength under high normal stress. For low normal stress, however, needle-punched monofilaments are recommended. For the regular textured geomembranes tested, the space between the asperities is an important factor. The closer these asperities are, the better the result achieves. For the irregular textured geomembranes tested, the nonwoven geotextiles made of monofilaments produce the largest interface shear strength

Arthropod associates of Kenyan buffelgrass (Cenchrus ciliaris): a field survey for biological control candidates of a globally important invasive grass

Invasive species are the second largest contributor to biodiversity loss and drivers of ecosystem change. Buffelgrass is a C4, perennial grass native to Africa and Asia that was widely introduced across tropical and subtropical rangelands as livestock forage. Buffelgrass reduces native biodiversity and ecosystem stability in its introduced range when it escapes livestock pastures. Understanding the ecology of insects associated with buffelgrass in its native range may provide an understanding of invasion processes and biological control opportunities where buffelgrass has become an invasive challenge. Here, we present the results of a six-year survey of herbivorous arthropods of a native buffelgrass population from Kenya. Buffelgrass was examined for externally and internally feeding insects of vegetative and reproductive tissues. We also categorised buffelgrass detritivores and parasitoids that may use buffelgrass herbivores as hosts. The samples were photographed and Sanger sequenced to identify them to the lowest possible taxonomic ranking. We collected information on sample abundances, phenologies, tissues consumed, and putative diet breadths. We identified 25 morphospecies representing seven orders and 16 families. The putative host plant specialisation was as high as 67% for Diptera. Phenological variation in herbivore presence correlated with seasonal rainfall and provided a guide for when to conduct follow-up biological control agent searches. The most abundant herbivore was a gall midge (Diptera: Cecidomyiidae) that inhabits buffelgrass culms. Additional research should focus on bringing this species into containment where host choice trials can be conducted to determine if it is truly monophagous and assess its impact on buffelgrass growth

Systematic reduction of natural enemies and competition across variable precipitation approximates buffelgrass invasiveness (Cenchrus ciliaris) in its native range

Invasive grasses cause devastating losses to biodiversity and ecosystem function directly and indirectly by altering ecosystem processes. Escape from natural enemies, plant–plant competition, and variable resource availability provide frameworks for understanding invasion. However, we lack a clear understanding of how natural stressors interact in their native range to regulate invasiveness. In this study, we reduced diverse guilds of natural enemies and plant competitors of the highly invasive buffelgrass across a precipitation gradient throughout major climatic shifts in Laikipia, Kenya. To do this, we used a long-term ungulate exclosure experiment design across a precipitation gradient with nested treatments that (1) reduced plant competition through clipping, (2) reduced insects through systemic insecticide, and (3) reduced fungal associates through fungicide application. Additionally, we measured the interaction of ungulates on two stem-boring insect species feeding on buffelgrass. Finally, we measured a multiyear smut fungus outbreak. Our findings suggest that buffelgrass exhibits invasive qualities when released from a diverse group of natural stressors in its native range. We show natural enemies interact with precipitation to alter buffelgrass productivity patterns. In addition, interspecific plant competition decreased the basal area of buffelgrass, suggesting that biotic resistance mediates buffelgrass dominance in the home range. Surprisingly, systemic insecticides and fungicides did not impact buffelgrass production or reproduction, perhaps because other guilds filled the niche space in these highly diverse systems. For example, in the absence of ungulates, we showed an increase in host-specific stem-galling insects, where these insects compensated for reduced ungulate use. Finally, we documented a smut outbreak in 2020 and 2021, corresponding to highly variable precipitation patterns caused by a shifting Indian Ocean Dipole. In conclusion, we observed how reducing natural enemies and competitors and certain interactions increased properties related to buffelgrass invasiveness

Systematic reduction of natural enemies and competition across variable precipitation approximates buffelgrass invasiveness ( Cenchrus ciliaris ) in its native range

Invasive grasses cause devastating losses to biodiversity and ecosystem function directly and indirectly by altering ecosystem processes. Escape from natural enemies, plant–plant competition, and variable resource availability provide frameworks for understanding invasion. However, we lack a clear understanding of how natural stressors interact in their native range to regulate invasiveness. In this study, we reduced diverse guilds of natural enemies and plant competitors of the highly invasive buffelgrass across a precipitation gradient throughout major climatic shifts in Laikipia, Kenya. To do this, we used a long‐term ungulate exclosure experiment design across a precipitation gradient with nested treatments that (1) reduced plant competition through clipping, (2) reduced insects through systemic insecticide, and (3) reduced fungal associates through fungicide application. Additionally, we measured the interaction of ungulates on two stem‐boring insect species feeding on buffelgrass. Finally, we measured a multiyear smut fungus outbreak. Our findings suggest that buffelgrass exhibits invasive qualities when released from a diverse group of natural stressors in its native range. We show natural enemies interact with precipitation to alter buffelgrass productivity patterns. In addition, interspecific plant competition decreased the basal area of buffelgrass, suggesting that biotic resistance mediates buffelgrass dominance in the home range. Surprisingly, systemic insecticides and fungicides did not impact buffelgrass production or reproduction, perhaps because other guilds filled the niche space in these highly diverse systems. For example, in the absence of ungulates, we showed an increase in host‐specific stem‐galling insects, where these insects compensated for reduced ungulate use. Finally, we documented a smut outbreak in 2020 and 2021, corresponding to highly variable precipitation patterns caused by a shifting Indian Ocean Dipole. In conclusion, we observed how reducing natural enemies and competitors and certain interactions increased properties related to buffelgrass invasiveness

Waterborne and on-land electrical surveys to suggest the geological evolution of a glacial lake in NW Italy

Geophysical surveys on and around the Candia Lake, located NE of Turin (NW Italy), in the internal depression of the Ivrea Morainic Amphitheatre (IMA) right frontal sector, are reported in this paper. The surveys were intended to obtain a geophysical characterization of the lakebed, to investigate the interconnection paths between surface water and groundwater and to be used as a first general survey for suggesting the geological processes which lead to the actual morphology. An extensive waterborne Continuous Vertical Electrical Soundings (CVES) survey consisting of 15 profiles, with a total length of about 19 km of acquisition, was carried out on the lake surface. The processing of the acquired profiles with a Laterally Constrained Inversion (LCI) approach lead to the reconstruction of the lakebed sediments distribution, down to 10 meters depth. Self Potential (SP) data recorded on the lake surface have also been analyzed. Moreover, to verify the areal distribution of the deposits, three Electrical Resistivity Tomographies (ERT) were carried out on land near the northern and southern shore of the lake. The combination of the geophysical surveys results with hydrogeological information and geological observations and interpretations allowed the characterization of the submerged deposits, the probable identification of the main areas of groundwater recharge and the preliminary reconstruction of the lake genesis

NOTCH blockade combined with radiation therapy and temozolomide prolongs survival of orthotopic glioblastoma.

Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults. The current standard of care includes surgery followed by radiotherapy (RT) and chemotherapy with temozolomide (TMZ). Treatment often fails due to the radiation resistance and intrinsic or acquired TMZ resistance of a small percentage of cells with stem cell-like behavior (CSC). The NOTCH signaling pathway is expressed and active in human glioblastoma and NOTCH inhibitors attenuate tumor growth in vivo in xenograft models. Here we show using an image guided micro-CT and precision radiotherapy platform that a combination of the clinically approved NOTCH/γ-secretase inhibitor (GSI) RO4929097 with standard of care (TMZ + RT) reduces tumor growth and prolongs survival compared to dual combinations. We show that GSI in combination with RT and TMZ attenuates proliferation, decreases 3D spheroid growth and results into a marked reduction in clonogenic survival in primary and established glioma cell lines. We found that the glioma stem cell marker CD133, SOX2 and Nestin were reduced following combination treatments and NOTCH inhibitors albeit in a different manner. These findings indicate that NOTCH inhibition combined with standard of care treatment has an anti-glioma stem cell effect which provides an improved survival benefit for GBM and encourages further translational and clinical studies

The influence of ground ice distribution on geomorphic dynamics since the Little Ice Age in proglacial areas of two cirque glacier systems

International audienceHolocene glaciers have contributed to an abundance of unstable sediments in mountainous environments. In permafrostenvironments, these sediments can contain ground ice and are subject to rapid geomorphic activity and evolution undercondition of a warming climate. To understand the influence of ground ice distribution on this activity since the Little Ice Age(LIA), we have investigated the Pierre Ronde and Rognes proglacial areas, two cirque glacier systems located in the periglacial beltof the Mont Blanc massif. For the first time, electrical resistivity tomography, temperature data loggers and differential global positioningsystems (dGPS) are combined with historical documents and glaciological data analysis to produce a complete study of evolutionin time and space of these small landsystems since the LIA. This approach allows to explain spatial heterogeneity of current internalstructure and dynamics. The studied sites are a complex assemblage of debris-covered glacier, ice-rich frozen debris and unfrozendebris. Ground ice distribution is related to former glacier thermal regime, isolating effect of debris cover, water supply to specificzones, and topography. In relation with this internal structure, present dynamics are dominated by rapid ice melt in the debriscoveredupper slopes, slow creep processes in marginal glacigenic rock glaciers, and weak, superficial reworking in deglaciatedmoraines. Since the LIA, geomorphic activity is mainly spatially restricted within the proglacial areas. Sediment exportation hasoccurred in a limited part of the former Rognes Glacier and through water pocket outburst flood and debris flows in Pierre Ronde.Both sites contributed little sediment supply to the downslope geomorphic system, rather by episodic events than by constant supply.In that way, during Holocene and even in a paraglacial context as the recent deglaciation, proglacial areas of cirque glaciers actmostly as sediment sinks, when active geomorphic processes are unable to evacuate sediment downslope, especially because ofthe slope angle weakness

Role of corticotropin-releasing hormone in the impact of chronic stress during pregnancy on inducing depression in male offspring mice

This is an accepted manuscript of an article published by Elsevier in Brain Research on 30/07/2020, available online: https://doi.org/10.1016/j.brainres.2020.147029 The accepted version of the publication may differ from the final published version.This work was supported by the National Natural Science Foundation of China (grant no. 81773452).Published versio

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie