Prospective Phase II trial of drug-eluting bead chemoembolization for liver transplant candidates with hepatocellular carcinoma and marginal hepatic reserve.

Purpose: To determine whether chemoembolization using drug-eluting beads (DEB-TACE) is safe and effective for liver transplantation candidates with liver-limited hepatocellular carcinoma (HCC) without vascular invasion and baseline hepatic dysfunction. Materials and methods: Seventeen adult liver transplantation candidates (median age 66 years, range 58-73 years; 13 men) with HCC were treated with DEB-TACE as a part of Stage 1 of a prospective single-institution Phase II trial. All patients had marginal hepatic reserve based on at least one of the following criteria: ascites (n=14), bilirubin between 3 and 6 mg/dL (n=5), AST 5-10 times upper normal limit (n=1), INR between 1.6 and 2.5 (n=4), portal vein thrombosis (n=2), and/or portosystemic shunt (n=2). Primary study objectives were safety and best observed radiographic response. Results: Thirty-seven DEB-TACE procedures were performed. Objective response rate and disease control rate were 63% and 88%, respectively. HCC progression was observed in 12 patients. Median time to progression was 5.6 months (range 0.9-13.6 months). Within 1 month following DEB-TACE, 13 patients (76%) developed grade 3 or 4 AE attributable to the procedure. Four patients (all within Milan Criteria) were transplanted (2.7-6.9 months after DEB-TACE), and 12 patients died (1.8-32 months after DEB-TACE). All deaths were due to liver failure that was either unrelated to HCC (n=5), in the setting of metastatic HCC (n=5), or in the setting of locally advanced HCC (n=2). Mortality rate at 1 month was 0%. Conclusions: DEB-TACE achieves tumor responses but carries a high risk of hepatotoxicity for liver transplant candidates with HCC and marginal hepatic reserve

Measuring HIV stigma for PLHAs and nurses over time in five African countries

The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a 1-year period. HIV stigma has been shown to negatively affect the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardised scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a 1-year period in a three-wave longitudinal design. The average age of people living with HIV/AIDS (PLHAs) (N=948) was 36.15 years (SD=8.69), and 67.1% (N=617) were female. The average age of nurses (N=887) was 38.44 years (SD=9.63), and 88.6% (N=784) were females. Eighty-four per cent of all PLHAs reported one or more HIV-stigma events at baseline. This declined, but was still significant 1 year later, when 64.9% reported experiencing at least one HIV-stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV-stigma events and this increased to 83.7% 1 year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association

Experimental Validation of Specialised Questioning Techniques in Conservation

Conservation increasingly relies on social science tools to understand human behavior. Specialized questioning techniques (SQTs) are a suite of methods designed to reduce bias in social surveys and are widely used to collect data on sensitive topics, including compliance with conservation rules. Most SQTs have been developed in Western, industrialized, educated, rich, and democratic countries, meaning their suitability in other contexts may be limited. Whether these techniques perform better than conventional direct questioning is important for those considering their use. We designed an experiment to validate the performance of four SQTs (unmatched count technique, randomized response technique, crosswise model, and bean method) against direct questions when asking about a commonly researched sensitive behavior in conservation, wildlife hunting. We developed fictional characters, and for each method asked respondents to report the answers that each fictional character should give when asked if they hunt wildlife. We collected data from 609 individuals living close to protected areas in two different cultural and socioeconomic contexts (Indonesia and Tanzania) to quantify the extent to which respondents understood and followed SQT instructions and to explore the sociodemographic factors that influenced a correct response. Data were modeled using binomial general linear mixed models. Participants were more likely to refuse to answer questions asked using SQTs compared with direct questions. Model results suggested that SQTs were harder for participants to understand. Demographic factors (e.g., age and education level) significantly influenced response accuracy. When sensitive responses to sensitive questions were required, all SQTs (excluding the bean method) outperformed direct questions, demonstrating that SQTs can successfully reduce sensitivity bias. However, when reviewing each method, most respondents (59–89%) reported they would feel uncomfortable using them to provide information on their own hunting behavior, highlighting the considerable challenge of encouraging truthful reporting on sensitive topics. Our results demonstrate the importance of assessing the suitability of social science methods prior to their implementation in conservation contexts

Why Give Birth in Health Facility? Users' and Providers' Accounts of Poor Quality of Birth Care in Tanzania.

In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go

Stock assessment of freshwater crayfish (Astacus leptodactylus) in Aras reservoir

360 funnel traps were prepared as 30 in one row. They were bitted and located in different depths in sampling sites. Two rows each composed of 30 traps were located by stone, linking rope and boat with 50 m distance in sampling stations. The results showed that the average of total length of caught crayfish was 106.26±12.89 mm and their mean weight was 38.79 ± 15.54 gr. The largest crayfish had 171 mm length and 216 g weight. Also mean of total CPUE was 9.72±4.49 individuals in the study period. The evaluation by Schnabel approach indicated that fluctuation range of freshwater crayfish biomass with more than 120mm length was 131-313 with an average of 212.59 ±30.23 kilograms per ha. In this study freshwater crayfish biomass with more than 120mm length was 247 × 10^3 kilograms. The Maximum Sustainable Yield (MSY) was estimated 83 × 10^3 kilograms. In this study ّFecundity and biometry of crayfish (Astacus leptodactylus) was investigated during 2012-2013. The results showed that the average of total length of caught crayfish was 106.26±12.89 mm and their mean weight was 38.79 ± 15.54 gr. The largest crayfish had 171 mm length and 216 g weight. Mean number of ovarian and pleopodal eggs were estimated at 286 ± 82 and 246.31 ± 80.41 eggs (with 95% confidence limits), respectively. In this research, male to female ratio was obtained 1.21:1. The time of male moulting at 16°C was started from April and was ended in the late May, when the water temperature reached to 18° C. The second moulting of males and the first moulting of females was performed simultaneously in 18°C water temperature at September. Reproduction of freshwater crayfish was started from November and continued to May of the next year. Harvesting period was from May to late November

Cysteinyl leukotrienes: multi-functional mediators in allergic rhinitis

Cysteinyl leukotrienes (CysLTs) are a family of inflammatory lipid mediators synthesized from arachidonic acid by a variety of cells, including mast cells, eosinophils, basophils, and macrophages. This article reviews the data for the role of CysLTs as multi-functional mediators in allergic rhinitis (AR). We review the evidence that: (1) CysLTs are released from inflammatory cells that participate in AR, (2) receptors for CysLTs are located in nasal tissue, (3) CysLTs are increased in patients with AR and are released following allergen exposure, (4) administration of CysLTs reproduces the symptoms of AR, (5) CysLTs play roles in the maturation, as well as tissue recruitment, of inflammatory cells, and (6) a complex inter-regulation between CysLTs and a variety of other inflammatory mediators exists.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75432/1/j.1365-2222.2006.02498.x.pd

Large herbivores may alter vegetation structure of semi-arid savannas through soil nutrient mediation

In savannas, the tree–grass balance is governed by water, nutrients, fire and herbivory, and their interactions. We studied the hypothesis that herbivores indirectly affect vegetation structure by changing the availability of soil nutrients, which, in turn, alters the competition between trees and grasses. Nine abandoned livestock holding-pen areas (kraals), enriched by dung and urine, were contrasted with nearby control sites in a semi-arid savanna. About 40 years after abandonment, kraal sites still showed high soil concentrations of inorganic N, extractable P, K, Ca and Mg compared to controls. Kraals also had a high plant production potential and offered high quality forage. The intense grazing and high herbivore dung and urine deposition rates in kraals fit the accelerated nutrient cycling model described for fertile systems elsewhere. Data of a concurrent experiment also showed that bush-cleared patches resulted in an increase in impala dung deposition, probably because impala preferred open sites to avoid predation. Kraal sites had very low tree densities compared to control sites, thus the high impala dung deposition rates here may be in part driven by the open structure of kraal sites, which may explain the persistence of nutrients in kraals. Experiments indicated that tree seedlings were increasingly constrained when competing with grasses under fertile conditions, which might explain the low tree recruitment observed in kraals. In conclusion, large herbivores may indirectly keep existing nutrient hotspots such as abandoned kraals structurally open by maintaining a high local soil fertility, which, in turn, constrains woody recruitment in a negative feedback loop. The maintenance of nutrient hotspots such as abandoned kraals by herbivores contributes to the structural heterogeneity of nutrient-poor savanna vegetation