Facility-based delivery in the context of Zimbabwe's HIV epidemic--missed opportunities for improving engagement with care: a community-based serosurvey.

BackgroundIn developing countries, facility-based delivery is recommended for maternal and neonatal health, and for prevention of mother-to-child HIV transmission (PMTCT). However, little is known about whether or not learning one's HIV status affects one's decision to deliver in a health facility. We examined this association in Zimbabwe.MethodsWe analyzed data from a 2012 cross-sectional community-based serosurvey conducted to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women (≥16 years old and mothers of infants born 9-18 months before the survey) were randomly sampled from the catchment areas of 157 health facilities in five of ten provinces. Participants were interviewed about where they delivered and provided blood samples for HIV testing.ResultsOverall 8796 (77 %) mothers reported facility-based delivery; uptake varied by community (30-100%). The likelihood of facility-based delivery was not associated with maternal HIV status. Women who self-reported being HIV-positive before delivery were as likely to deliver in a health facility as women who were HIV-negative, irrespective of when they learned their status - before (adjusted prevalence ratio (PRa) = 1.04, 95% confidence interval (CI) = 1.00-1.09) or during pregnancy (PRa = 1.05, 95% CI = 1.01-1.09). Mothers who had not accessed antenatal care or tested for HIV were most likely to deliver outside a health facility (69%). Overall, however 77% of home deliveries occurred among women who had accessed antenatal care and were HIV-tested.ConclusionsUptake of facility-based delivery was similar among HIV-infected and HIV-uninfected mothers, which was somewhat unexpected given the substantial technical and financial investment aimed at retaining HIV-positive women in care in Zimbabwe

Using a Flipped Classroom to Teach Evidence-Based Practice to Entry-Level Occupational Therapy Students

Constructivist teaching approaches rely on students to be active participants in their learning. A flipped classroom is a constructivist approach that requires the students to complete pre-learning activities outside of class. Thus, in class the students can practice and engage in team-based discussions and teacher guided learning. We delivered evidence-based practice (EBP) concepts to entry level occupational therapy (OT) students in a doctoral program using a constructivist approach, that included a flipped classroom model and reliance on team-based strategies. We used the Evidence Based Practice Confidence (EPIC) Scale to assess the change in students’ confidence in EBP. Students demonstrated statistically significant differences in their confidence for EBP after the course. Evaluation of the changes in EPIC Scale scores indicates that a flipped classroom and team-based activities are effective approaches to teach EBP for entry level OT doctoral students

Dr. Mary Edwards Walker: years ahead of her time.

Women phsycians in the United States were virtually nonexistent in the early to mid-1800s. Traditional medical schools still did not accept women, and few secretarian or eclectic medical schools were beginning to open their doors to female students. In 1849 at Geneva College, Elizabeth Blackwell became the first woman to achieve a medical degree in the United States.1 At the time of the Civil War, the few women who had managed to obtain medical degrees mainly served as nurses in the war, because society was not yet ready to accept the female physician.2 Dr. Mary Edwards Walker would help change the role of women physicians, becoming not only a valuable surgeon for the Union Army, but also a catalyst for the introduction and advancement of women in medicine

Whole genome sequencing for mutation discovery in a single case of lysosomal storage disease (MPS type 1) in the dog.

Mucopolysaccharidosis (MPS) is a metabolic storage disorder caused by the deficiency of any lysosomal enzyme required for the breakdown of glycosaminoglycans. A 15-month-old Boston Terrier presented with clinical signs consistent with lysosomal storage disease including corneal opacities, multifocal central nervous system disease and progressively worsening clinical course. Diagnosis was confirmed at necropsy based on histopathologic evaluation of multiple organs demonstrating accumulation of mucopolysaccharides. Whole genome sequencing was used to uncover a frame-shift insertion affecting the alpha-L-iduronidase (IDUA) gene (c.19_20insCGGCCCCC), a mutation confirmed in another Boston Terrier presented 2 years later with a similar clinical picture. Both dogs were homozygous for the IDUA mutation and shared coat colors not recognized as normal for the breed by the American Kennel Club. In contrast, the mutation was not detected in 120 unrelated Boston Terriers as well as 202 dogs from other breeds. Recent inbreeding to select for recessive and unusual coat colors may have concentrated this relatively rare allele in the breed. The identification of the variant enables ante-mortem diagnosis of similar cases and selective breeding to avoid the spread of this disease in the breed. Boston Terriers carrying this variant represent a promising model for MPS I with neurological abnormalities in humans

The agronomic performance and nutritional content of oat and barley varieties grown in a northern maritime environment depends on variety and growing conditions

Funding for this research came from the Scottish Government's Rural and Environment Science and Analytical Services Division (RESAS) through their support for this Strategic Partnership project. We are also grateful to Ingvar Andersson at Lantmännen SW Seed AB for supplying seed of the Scandinavian varieties for the trials each year and to the seed merchant William Shearer (Kirkwall) for importing it. We are indebted to Grietje Holtrop from Biomathematics and Statistics Scotland for her help with statistical analysis. Andy Beer (The Royal Zoological Society, Edinburgh) performed all NIRS analysis and Gill Campbell (Rowett Institute of Nutrition and Health) performed the mineral content analysis. The Centre for Sustainable Cropping platform is supported through Scottish Government Underpinning Capacity funding. The Agronomy Institute acknowledges support from the Northern Periphery and Arctic Programme's Northern Cereals project in preparing this publication.Peer reviewedPostprin

CAP/ACMG proficiency testing for biochemical genetics laboratories: a summary of performance

Testing for inborn errors of metabolism is performed by clinical laboratories worldwide, each utilizing laboratory-developed procedures. We sought to summarize performance in the College of American Pathologists’ (CAP) proficiency testing (PT) program and identify opportunities for improving laboratory quality. When evaluating PT data, we focused on a subset of laboratories that have participated in at least one survey since 2010