A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants.

OBJECTIVE: To assess effects of a combined microfinance and training intervention on HIV risk behavior among young female participants in rural South Africa. DESIGN: : Secondary analysis of quantitative and qualitative data from a cluster randomized trial, the Intervention with Microfinance for AIDS and Gender Equity study. METHODS: Eight villages were pair-matched and randomly allocated to receive the intervention. At baseline and after 2 years, HIV risk behavior was assessed among female participants aged 14-35 years. Their responses were compared with women of the same age and poverty group from control villages. Intervention effects were calculated using adjusted risk ratios employing village level summaries. Qualitative data collected during the study explored participants' responses to the intervention including HIV risk behavior. RESULTS: After 2 years of follow-up, when compared with controls, young participants had higher levels of HIV-related communication (adjusted risk ratio 1.46, 95% confidence interval 1.01-2.12), were more likely to have accessed voluntary counseling and testing (adjusted risk ratio 1.64, 95% confidence interval 1.06-2.56), and less likely to have had unprotected sex at last intercourse with a nonspousal partner (adjusted risk ratio 0.76, 95% confidence interval 0.60-0.96). Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality. Although women noted challenges associated with acceptance of condoms by men, increased confidence and skills associated with participation in the intervention supported their introduction in sexual relationships. CONCLUSIONS: In addition to impacts on economic well being, women's empowerment and intimate partner violence, interventions addressing the economic and social vulnerability of women may contribute to reductions in HIV risk behavior

Voice and Agency: Empowering women and girls for shared prosperity

This document presents Voice and Agency: Empowering women and girls for shared prosperity is a major new report by the World Bank that shines a spotlight on the value of voice and agency, the patterns of constraints that limit their realization, and the associated costs, not only to individual women but to their families, communities, and societies. It highlights promising policies and interventions, and it identifies priority areas where further research and more and better data and evidence are needed. Underlining that agency has both intrinsic and instrumental, concrete value, this report puts advancing women's voice and agency squarely on the international development agenda

Reliability and importance of structural diversity of climate model ensembles

PublishedJournal ArticleWe investigate the performance of the newest generation multi-model ensemble (MME) from the Coupled Model Intercomparison Project (CMIP5). We compare the ensemble to the previous generation models (CMIP3) as well as several single model ensembles (SMEs), which are constructed by varying components of single models. These SMEs range from ensembles where parameter uncertainties are sampled (perturbed physics ensembles) through to an ensemble where a number of the physical schemes are switched (multi-physics ensemble). We focus on assessing reliability against present-day climatology with rank histograms, but also investigate the effective degrees of freedom (EDoF) of the fields of variables which makes the statistical test of reliability more rigorous, and consider the distances between the observation and ensemble members. We find that the features of the CMIP5 rank histograms, of general reliability on broad scales, are consistent with those of CMIP3, suggesting a similar level of performance for present-day climatology. The spread of MMEs tends towards being "over-dispersed" rather than "under-dispersed". In general, the SMEs examined tend towards insufficient dispersion and the rank histogram analysis identifies them as being statistically distinguishable from many of the observations. The EDoFs of the MMEs are generally greater than those of SMEs, suggesting that structural changes lead to a characteristically richer range of model behaviours than is obtained with parametric/physical-scheme-switching ensembles. For distance measures, the observations and models ensemble members are similarly spaced from each other for MMEs, whereas for the SMEs, the observations are generally well outside the ensemble. We suggest that multi-model ensembles should represent an important component of uncertainty analysis. © 2013 The Author(s).We acknowledge the World Climate Research Programme’s Working Group on Coupled Modelling, which is responsible for CMIP. For CMIP the US Department of Energy’s Pro- gram for Climate Model Diagnosis and Intercomparison provides coordinating support and led development of software infrastructure in partnership with the Global Organization for Earth System Science Portals. M.C. was partially supported by funding from NERC grants NE/I006524/1 and NE/I022841/1. MW is supported by the Joint DECC/Defra Met Office Hadley Centre Climate Programme (GA01101). T.Y., J.D.A, H.S., S.E., M.Y., J.C.H. were supported by the Global Environment Research Fund of the Ministry of the Environment of Japan (S-10, Integrated Climate Assessment – Risks,Uncertainties and Society, ICA-RUS)

Effectiveness and limitations of parameter tuning in reducing biases of top-of-atmosphere radiation and clouds in MIROC version 5

This study discusses how much of the biases in top-of-atmosphere (TOA) radiation and clouds can be removed by parameter tuning in the present-day simulation of a climate model in the Coupled Model Inter-comparison Project phase 5 (CMIP5) generation. We used output of a perturbed parameter ensemble (PPE) experiment conducted with an atmosphere–ocean general circulation model (AOGCM) without flux adjustment. The Model for Interdisciplinary Research on Climate version 5 (MIROC5) was used for the PPE experiment. Output of the PPE was compared with satellite observation data to evaluate the model biases and the parametric uncertainty of the biases with respect to TOA radiation and clouds. The results indicate that removing or changing the sign of the biases by parameter tuning alone is difficult. In particular, the cooling bias of the shortwave cloud radiative effect at low latitudes could not be removed, neither in the zonal mean nor at each latitude–longitude grid point. The bias was related to the overestimation of both cloud amount and cloud optical thickness, which could not be removed by the parameter tuning either. However, they could be alleviated by tuning parameters such as the maximum cumulus updraft velocity at the cloud base. On the other hand, the bias of the shortwave cloud radiative effect in the Arctic was sensitive to parameter tuning. It could be removed by tuning such parameters as albedo of ice and snow both in the zonal mean and at each grid point. The obtained results illustrate the benefit of PPE experiments which provide useful information regarding effectiveness and limitations of parameter tuning. Implementing a shallow convection parameterization is suggested as a potential measure to alleviate the biases in radiation and clouds

Assessing household wealth in health studies in developing countries: a comparison of participatory wealth ranking and survey techniques from rural South Africa

BACKGROUND: Accurate tools for assessing household wealth are essential for many health studies in developing countries. Household survey and participatory wealth ranking (PWR) are two approaches to generate data for this purpose. METHODS: A household survey and PWR were conducted among eight villages in rural South Africa. We developed three indicators of household wealth using the data. One indicator used PWR data only, one used principal components analysis to combine data from the survey, while the final indicator used survey data combined in a manner informed by the PWR. We assessed internal consistency of the indices and assessed their level of agreement in ranking household wealth. RESULTS: Food security, asset ownership, housing quality and employment were important indicators of household wealth. PWR, consisting of three independent rankings of 9671 households, showed a high level of internal consistency (intraclass correlation coefficient 0.81, 95% CI 0.79-0.82). Data on 1429 households were available from all three techniques. There was moderate agreement in ranking households into wealth tertiles between the two indicators based on survey data (spearman rho = 0.69, kappa = 0.43), but only limited agreement between these techniques and the PWR data (spearman rho = 0.38 and 0.31, kappa = 0.20 and 0.17). CONCLUSION: Both PWR and household survey can provide a rapid assessment of household wealth. Each technique had strengths and weaknesses. Reasons for differences might include data inaccuracies or limitations in the methods by which information was weighted. Alternatively, the techniques may measure different things. More research is needed to increase the validity of measures of socioeconomic position used in health studies in developing countries

Socio-economic status is inversely related to bed net use in Gabon

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Monsoons: global energetics and local physics as drivers of past, present and future monsoons

Global constraints on momentum and energy govern the structure of the zonal mean tropical circulation and rainfall. The continental-scale monsoon systems are also facets of a momentum- and energy-constrained global circulation, but their modern and paleo variability deviates substantially from that of the longitudinal mean through mechanisms neither fully understood nor well simulated. A framework grounded in global constraints yet encompassing the complexities of monsoon dynamics is needed to identify the causes of mismatch between theory, models, and observations and, ultimately, improve regional climate projection. In a first step towards this goal, disparate regional processes must be distilled into gross measures of energy flow in and out of continents and from the surface to the tropopause, so that monsoon dynamics may be coherently diagnosed across modern and paleo observations and across idealized and comprehensive simulations. Accounting for zonal asymmetries in the circulation, land/ocean differences in surface fluxes, and the character of convective systems, such a monsoon framework would integrate our understanding at all relevant scales: from the fine details of how moisture and energy are lifted in the updrafts of thunderclouds, up to the global circulations

Large-scale features and evaluation of the PMIP4-CMIP6 midHolocene simulations

The mid-Holocene (6,000 years ago) is a standard experiment for the evaluation of the simulated response of global climate models using paleoclimate reconstructions. The latest mid-Holocene simulations are a contribution by the Palaeoclimate Model Intercomparison Project (PMIP4) to the current phase of the Coupled Model Intercomparison Project (CMIP6). Here we provide an initial analysis and evaluation of the results of the experiment for the mid-Holocene. We show that state-of-the-art models produce climate changes that are broadly consistent with theory and observations, including increased summer warming of the northern hemisphere and associated shifts in tropical rainfall. Many features of the PMIP4-CMIP6 simulations were present in the previous generation (PMIP3-CMIP5) of simulations. The PMIP4-CMIP6 ensemble for the mid-Holocene has a global mean temperature change of -0.3 K, which is -0.2 K cooler that the PMIP3-CMIP5 simulations predominantly as a result of the prescription of realistic greenhouse gas concentrations in PMIP4-CMIP6. Neither this difference nor the improvement in model complexity and resolution seems to improve the realism of the simulations. Biases in the magnitude and the sign of regional responses identified in PMIP3-CMIP5, such as the amplification of the northern African monsoon, precipitation changes over Europe and simulated aridity in mid-Eurasia, are still present in the PMIP4-CMIP6 simulations. Despite these issues, PMIP4-CMIP6 and the mid-Holocene provide an opportunity both for quantitative evaluation and derivation of emergent constraints on climate sensitivity and feedback strength

The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

Abstract: Background: Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods: Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results: Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion: There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery