Relevance and feasibility of WHO recommendations for intimate partner violence care in South African primary health settings

The World Health Organization’s (WHO) clinical and policy guidelines for responding to intimate partner violence (IPV) against women focus on improving health service delivery of women-centred care. This publication is a watershed. It sounds a call to innovate and implement creative new directions for effective health service-driven, intersectoral responses to IPV. The commentary draws on experience derived from intermittent IPV research in the Western Cape primary health sector. It outlines the eight WHO guidelines which specifically address the health care needs of women experiencing IPV and reflects on their feasibility within the South African context. While these policy recommendations are undoubtedly welcome, the barriers to implementation are acknowledged and discussed. Where possible, innovative ways to move forward are suggested. If taken up, these could aid the alignment of South Africa’s standard of IPV care with that of the WHO recommendations. Now is the time for all sectors to mobilise and work together to improve IPV services in South Africa.Keywords: women-centred care, intimate partner violence, health service delivery, health systems, Western Cap

The epidemic of sexual violence in South Africa

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Sex Differences in Elite Swimming with Advanced Age Are Less Than Marathon Running

The sex difference in marathon performance increases with finishing place and age of the runner but whether this occurs among swimmers is unknown. The purpose was to compare sex differences in swimming velocity across world record place (1st–10th), age group (25–89 years), and event distance. We also compared sex differences between freestyle swimming and marathon running. The world\u27s top 10 swimming times of both sexes for World Championship freestyle stroke, backstroke, breaststroke, and butterfly events and the world\u27s top 10 marathon times in 5-year age groups were obtained. Men were faster than women for freestyle (12.4 ± 4.2%), backstroke (12.8 ± 3.0%), and breaststroke (14.5 ± 3.2%), with the greatest sex differences for butterfly (16.7 ± 5.5%). The sex difference in swimming velocity increased across world record place for freestyle (P \u3c 0.001), breaststroke, and butterfly for all age groups and distances (P  \u3c 0.001) because of a greater relative drop-off between first and 10th place for women. The sex difference in marathon running increased with the world record place and the sex difference for marathon running was greater than for swimming (P \u3c 0.001). The sex difference in swimming increased with world record place and age, but was less than for marathon running. Collectively, these results suggest more depth in women\u27s swimming than marathon running

Men Are More Likely than Women to Slow in the Marathon

Studies on nonelite distance runners suggest that men are more likely than women to slow their pace in a marathon. Purpose: This study determined the reliability of the sex difference in pacing across many marathons and after adjusting women\u27s performances by 12% to address men\u27s greater maximal oxygen uptake and also incorporating information on racing experience. Methods: Data were acquired from 14 US marathons in 2011 and encompassed 91,929 performances. For 2929 runners, we obtained experience data from a race-aggregating Web site. We operationalized pace maintenance as the percentage change in pace observed in the second half of the marathon relative to the first half. Pace maintenance was analyzed as a continuous variable and as two categorical variables, as follows: maintain the pace, defined as slowing=30%. Results: The mean change in pace was 15.6% and 11.7% for men and women, respectively (P \u3c 0.0001). This sex difference was significant for all 14 marathons. The odds for women were 1.46 (95% confidence interval, 1.41–1.50; P \u3c 0.0001) times higher than men to maintain the pace and 0.36 (95% confidence interval, 0.34–0.38; P \u3c 0.0001) times that of men to exhibit marked slowing. Slower finishing times were associated with greater slowing, especially in men (interaction, P \u3c 0.0001). However, the sex difference in pacing occurred across age and finishing time groups. Making the 12% adjustment to women’s performances lessened the magnitude of the sex difference in pacing but not its occurrence. Although greater experience was associated with less slowing, controlling for the experience variables did not eliminate the sex difference in pacing. Conclusions: The sex difference in pacing is robust. It may reflect sex differences in physiology, decision making, or both

Buckling without bending: a new paradigm in morphogenesis

A curious feature of organ and organoid morphogenesis is that in certain cases, spatial oscillations in the thickness of the growing "film" are out-of-phase with the deformation of the slower-growing "substrate," while in other cases, the oscillations are in-phase. The former cannot be explained by elastic bilayer instability, and contradict the notion that there is a universal mechanism by which brains, intestines, teeth, and other organs develop surface wrinkles and folds. Inspired by the microstructure of the embryonic cerebellum, we develop a new model of 2d morphogenesis in which system-spanning elastic fibers endow the organ with a preferred radius, while a separate fiber network resides in the otherwise fluid-like film at the outer edge of the organ and resists thickness gradients thereof. The tendency of the film to uniformly thicken or thin is described via a "growth potential". Several features of cerebellum, +blebbistatin organoid, and retinal fovea morphogenesis, including out-of-phase behavior and a film thickness amplitude that is comparable to the radius amplitude, are readily explained by our simple analytical model, as may be an observed scale-invariance in the number of folds in the cerebellum. We also study a nonlinear variant of the model, propose further biological and bio-inspired applications, and address how our model is and is not unique to the developing nervous system.Comment: version accepted by Physical Review

The Two-hour Marathon: What\u27s the Equivalent for Women?

The principal characteristic of the runner who may break the two-hour barrier in the marathon will be their sex: the person will be male. The fastest men outperform the fastest women because of sex differences in physiology including a higher VȮ2 max. This viewpoint addresses the questions of what is the two-hour equivalent for women, and who will break this barrier? The current sex difference in the world record for the marathon is ~10% which is slightly less than the mean sex difference in performance usually documented between elite men and women distance runners. Based on comparisons of the top 50 marathon times run by men and women, we argue that Paula Radcliffe\u27s world record of 2:15:25 (hr:min:s) set in 2003 is at least equivalent to a two-hour marathon for women. We also provide evidence that there is less depth in elite women\u27s distance running, in part, due to historical and social factors that have led to less opportunity for women than men

Human pathogen shown to cause disease in the threatened elkhorn coral Acropora palmata

Coral reefs are in severe decline. Infections by the human pathogen Serratia marcescens have contributed to precipitous losses in the common Caribbean elkhorn coral, Acropora palmata, culminating in its listing under the United States Endangered Species Act. During a 2003 outbreak of this coral disease, called acroporid serratiosis (APS), a unique strain of the pathogen, Serratia marcescens strain PDR60, was identified from diseased A. palmata, human wastewater, the non-host coral Siderastrea siderea and the corallivorous snail Coralliophila abbreviata. In order to examine humans as a source and other marine invertebrates as vectors and/or reservoirs of the APS pathogen, challenge experiments were conducted with A. palmata maintained in closed aquaria to determine infectivity of strain PDR60 from reef and wastewater sources. Strain PDR60 from wastewater and diseased A. palmata caused disease signs in elkhorn coral in as little as four and five days, respectively, demonstrating that wastewater is a definitive source of APS and identifying human strain PDR60 as a coral pathogen through fulfillment of Koch\u27s postulates. A. palmata inoculated with strain PDR60 from C. abbreviata showed limited virulence, with one of three inoculated fragments developing APS signs within 13 days. Strain PDR60 from non-host coral S. siderea showed a delayed pathogenic effect, with disease signs developing within an average of 20 days. These results suggest that C. abbreviata and non-host corals may function as reservoirs or vectors of the APS pathogen. Our results provide the first example of a marine “reverse zoonosis” involving the transmission of a human pathogen (S. marcescens) to a marine invertebrate (A. palmata). These findings underscore the interaction between public health practices and environmental health indices such as coral reef survival