Cross-Generational Relationships in Kenya: Couples' Motivations, Risk Perception for STIs/HIV and Condom Use

Objectives: To understand women's and men's motivations for entering into cross-generational relationships and to examine how their risk perception for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) affects sexual decision-making and condom use.Methods: A total of eight focus groups were conducted with women aged 15 -- 19 and 28 indepth interviews were carried out with men aged 30 years and older in Nairobi, Mombasa, Kisumu, and Meru. Participants discussed motivations for entering into non-marital, crossgenerational relationships, perceived risks, relationship dynamics, and circumstances under which older men and younger women meet. Data analysis highlighted common and divergent themes on cross-generational relationships and the risks associated with them. Results: According to study participants, Kenyan men who pursue younger women do not fit a "sugar daddy" stereotype; rather they come from a variety of social and professional backgrounds. Young women actively seek partners who are willing to spend money on them whereas men look for partners who are well mannered, need money and have certain physical attributes. Women's primary incentive for engaging in cross-generational relationships is financial and material gain while men seek younger partners for sexual gratification. Pressure from peers to fit in and some family members to secure financial assistance from older partners can compel women to engage in cross-generational relationships. Although some peer groups support and encourage such relationships, other groups, especially wives, same-aged boyfriends and parents, disapprove of them. As a result, cross-generational couples are often preoccupied by the threat of discovery. Risk perception for STIs/HIV is low and couples rarely use condoms.Conclusions: Most cross-generational couples underestimate their risk for infection from STIs/ HIV. Young women believe that older men are low-risk partners because they are less likely to be promiscuous and more likely to remain faithful to younger partners and wives. Men believe that young partners are innocent and sexually inexperienced. Material gain, emotional factors, sexual gratification, and recognition from peers override the risk for STIs and HIV infection. Condom use is low and young women's ability to negotiate use is compromised by age disparities and economic dependence. Study findings suggest several programmatic strategies for targeting young women and older men. Behavior change communication campaigns should educate women and men about the increased risk of STIs/HIV associated with cross-generational relationships. Programs should also promote safer sexual practices, such as consistent condom use, within relationships. Campaigns could employ positive role models to encourage young women to seek safer alternatives to cross-generational relationships and decrease peer pressure among men to pursue such relationships. Long-term interventions include improving young women's access to educational and career opportunities, and working with communities to determine the best approach for changing social norms and the acceptability of cross-generational relationships

Bartholin's gland cyst and abscess treatment

This issue of eMedRef provides information to clinicians on resolving Bartholin's gland cysts and treatment of Bartholin's gland abscess

Informed about Informed Consent: A Qualitative Study of Ethics Education

Informed consent is a foundational concept in modern medicine. Despite physicians’ ethical and legal obligations to obtain informed consent, no standard curriculum exists to teach residents relevant knowledge and skills. This paper presents a qualitative study of residents at one academic medical center. The authors conducted focus groups with trainees in the Departments of Internal Medicine, Emergency Medicine, and Ob/Gyn and analyzed their responses using rigorous qualitative methods. Four themes emerged: First, participants agreed that informed consent and decision-making capacity were relevant in many clinical situations. Second, participants varied widely in their understandings of consent. Third, current resident training was insufficient. Fourth, more training was needed. These results add to the growing literature that ethics education in residency is desired and useful. The findings will help educators craft instruments assessing the prevalence and degree of deficiencies related to informed consent competencies and aid in the development of a model curriculum

Hepatic Proprotein Convertases Modulate HDL Metabolism

SummaryThe risk of atherosclerosis is inversely associated with plasma levels of high-density lipoprotein cholesterol (HDL-C). However, HDL metabolism is incompletely understood, and there are few effective approaches to modulate HDL-C levels. Here we show that inhibition in the liver of the classical proprotein convertases (PCs), but not the atypical PCs S1P and PCSK9, decreases plasma HDL-C levels. This metabolic effect of hepatic PCs is critically dependent on expression of endothelial lipase (EL), an enzyme that directly hydrolyzes HDL phospholipids and promotes its catabolism. Hepatic PCs reduce EL function through direct inactivating cleavage of EL as well as through activating cleavage of angiopoietin-like protein 3 (ANGPTL3), an endogenous inhibitor of EL. Thus, inhibition of hepatic PCs results in increased EL activity, leading to reduced HDL-C as well as impaired reverse cholesterol transport. The hepatic PC–ANGPTL3–EL–HDL pathway is therefore a novel mechanism controlling HDL metabolism and cholesterol homeostasis

Efficient Intra-Rack Resource Disaggregation for HPC Using Co-Packaged DWDM Photonics

The diversity of workload requirements and increasing hardware heterogeneity in emerging high performance computing (HPC) systems motivate resource disaggregation. Resource disaggregation allows compute and memory resources to be allocated individually as required to each workload. However, it is unclear how to efficiently realize this capability and cost-effectively meet the stringent bandwidth and latency requirements of HPC applications. To that end, we describe how modern photonics can be co-designed with modern HPC racks to implement flexible intra-rack resource disaggregation and fully meet the bit error rate (BER) and high escape bandwidth of all chip types in modern HPC racks. Our photonic-based disaggregated rack provides an average application speedup of 11% (46% maximum) for 25 CPU and 61% for 24 GPU benchmarks compared to a similar system that instead uses modern electronic switches for disaggregation. Using observed resource usage from a production system, we estimate that an iso-performance intra-rack disaggregated HPC system using photonics would require 4x fewer memory modules and 2x fewer NICs than a non-disaggregated baseline.Comment: 15 pages, 12 figures, 4 tables. Published in IEEE Cluster 202

BNip3 regulates mitochondrial function and lipid metabolism in the liver

BNip3 localizes to the outer mitochondrial membrane, where it functions in mitophagy and mitochondrial dynamics. While the BNip3 protein is constitutively expressed in adult liver from fed mice, we have shown that its expression is superinduced by fasting of mice, consistent with a role in responses to nutrient deprivation. Loss of BNip3 resulted in increased lipid synthesis in the liver that was associated with elevated ATP levels, reduced AMP-regulated kinase (AMPK) activity, and increased expression of lipogenic enzymes. Conversely, there was reduced β-oxidation of fatty acids in BNip3 null liver and also defective glucose output under fasting conditions. These metabolic defects in BNip3 null liver were linked to increased mitochondrial mass and increased hepatocellular respiration in the presence of glucose. However, despite elevated mitochondrial mass, an increased proportion of mitochondria exhibited loss of mitochondrial membrane potential, abnormal structure, and reduced oxygen consumption. Elevated reactive oxygen species, inflammation, and features of steatohepatitis were also observed in the livers of BNip3 null mice. These results identify a role for BNip3 in limiting mitochondrial mass and maintaining mitochondrial integrity in the liver that has consequences for lipid metabolism and disease

2014 Ruby Yearbook

A digitized copy of the 2014 Ruby, the Ursinus College yearbook.https://digitalcommons.ursinus.edu/ruby/1117/thumbnail.jp