Evidence for a Record of Possible Paleo-Tsunami or Storm Deposits in the Fluviatile Neoproterozoic Malagarasi Supergroup of North-Western Tanzania

Two different localities within the fluviatile Neoproterozoic Malagarasi Supergroup of north-western Tanzania show striking evidence for tsunami related clastic sedimentary deposits. In each locality, the outcrops are characterised by the association of fine grained, thinly laminated shales at the bottom that are overlain by thick deposits of sandstones and conglomerates whose clasts and pebbles vary in size and angularity/roundness. In each case, the two rock units are separated by an erosional surface. The basal shale layers are consistent with deposition in deep shelf environments which are in stark contrast to the immediately overlying conglomerates/sandstones that suggest reworking under high energy conditions. The consistent association of erosional surfaces coupled with the deposition of adjacent low and high energy facies are interpreted as a result of an ancient earthquake triggered tsunami or storm that abruptly changed the depositional energy at the two localities. We propose that a backwash wave transported pebbles and sediments from the shore setting towards the basin interior depositing them on the shale units. Given the limited preservation of such unusual sedimentological deposits in ancient terranes, these two localities in the Neoproterozoic Malagarasi basin provide information on the effects of tsunami or storm impacts in Precambrian basins of Tanzania. Keywords: Malagarasi Supergroup; Tsunami deposits; Shales; Sandstones; Conglomerate

Doxorubicin-Based Chemotherapy for the Palliative Treatment of Adult Patients with Locally Advanced or Metastatic Soft-Tissue Sarcoma: A Meta-Analysis and Clinical Practice Guideline

Purpose. To make recommendations for the use of doxorubicin-based chemotherapy in patients with soft-tissue sarcoma

The Brahmaputra tale of tectonics and erosion:early Miocene river capture in the Eastern Himalaya

The Himalayan orogen provides a type example on which a number of models of the causes and consequences of crustal deformation are based and it has been suggested that it is the site of a variety of feedbacks between tectonics and erosion. Within the broader orogen, fluvial drainages partly reflect surface uplift, different climatic zones and a response to crustal deformation. In the eastern Himalaya, the unusual drainage configuration of the Yarlung Tsangpo–Brahmaputra River has been interpreted either as antecedent drainage distorted by the India–Asia collision (and as such applied as a passive strain marker of lateral extrusion), latest Neogene tectonically-induced river capture, or glacial damming-induced river diversion events. Here we apply a multi-technique approach to the Neogene paleo-Brahmaputra deposits of the Surma Basin (Bengal Basin, Bangladesh) to test the long-debated occurrence and timing of river capture of the Yarlung Tsangpo by the Brahmaputra River. We provide U–Pb detrital zircon and rutile, isotopic (Sr–Nd and Hf) and petrographic evidence consistent with river capture of the Yarlung Tsangpo by the Brahmaputra River in the Early Miocene. We document influx of Cretaceous–Paleogene zircons in Early Miocene sediments of the paleo-Brahmaputra River that we interpret as first influx of material from the Asian plate (Transhimalayan arc) indicative of Yarlung Tsangpo contribution. Prior to capture, the predominantly Precambrian–Paleozoic zircons indicate that only the Indian plate was drained. Contemporaneous with Transhimalayan influx reflecting the river capture, we record arrival of detrital material affected by Cenozoic metamorphism, as indicated by rutiles and zircons with Cenozoic U–Pb ages and an increase in metamorphic grade of detritus as recorded by petrography. We interpret this as due to a progressively increasing contribution from the erosion of the metamorphosed core of the orogen. Whole rock Sr–Nd isotopic data from the same samples provide further support to this interpretation. River capture may have been caused by a change in relative base level due to uplift of the Tibetan plateau. Assuming such river capture occurred via the Siang River in the Early Miocene, we refute the “tectonic aneurysm” model of tectonic–erosion coupling between river capture and rapid exhumation of the eastern syntaxis, since a time interval of at least 10 Ma between these two events is now demonstrated. This work is also the first to highlight U–Pb dating on detrital rutile as a powerful approach in provenance studies in the Himalaya in combination with zircon U–Pb chronology

Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among black men who have sex with men in 6 U.S. cities

Background American Black men who have sex with men (MSM) are disproportionately affected by HIV, but the factors associated with this concentrated epidemic are not fully understood. Methods Black MSM were enrolled in 6 US cities to evaluate a multi-component prevention intervention, with the current analysis focusing on the correlates of being newly diagnosed with HIV compared to being HIV-uninfected or previously diagnosed with HIV. Results HPTN 061 enrolled 1553 Black MSM whose median age was 40; 30% self-identified exclusively as gay or homosexual, 29% exclusively as bisexual, and 3% as transgender. About 1/6th(16.2%) were previously diagnosed with HIV (PD); of 1263 participants without a prior HIV diagnosis 7.6% were newly diagnosed (ND). Compared to PD, ND Black MSM were younger (p Conclusions ND HIV-infected Black MSM were more likely to be unemployed, have bacterial STIs and engage in URAI than other Black MSM. Culturally-tailored programs that address economic disenfranchisement, increase engagement in care, screen for STIs, in conjunction with safer sex prevention interventions, may help to decrease further transmission in this heavily affected community

Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers\u27 Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care

Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers\u27 adoption of PrEP into clinical practice. This qualitative study explored PrEP providers\u27 firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered a wide range of suggestions regarding content, strategy, and logistics surrounding PrEP training, highlighting sexual history-taking and sexual minority competence as areas to prioritize. These insights from early-adopting PrEP providers may facilitate adoption of PrEP into clinical practice by PrEP-inexperienced providers, thereby improving access for individuals at risk for HIV

Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: A nationwide retrospective cohort study

BACKGROUND: In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya. METHODS: We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Completeness refers to the presence of the appropriate amount of data. Consistency refers to uniformity of data across multiple indicators. Discrepancy (measured on a Z-scale) refers to the degree of alignment (or lack thereof) of data with rules that defined the possible valid values for the data. RESULTS: A total of 5,610 unique facility-quarters were extracted from KHIS. The mean completeness score was 61.1% [standard deviation (SD) = 27%]. The mean consistency score was 80% (SD = 16.4%). The mean discrepancy score was 0.07 (SD = 0.22). A strong and positive correlation was identified between the consistency score and discrepancy score (correlation coefficient = 0.77), whereas the correlation of either score with the completeness score was low with a correlation coefficient of -0.12 (with consistency score) and -0.36 (with discrepancy score). General HIV indicators were more complete, but less consistent, and less plausible than PMTCT indicators. CONCLUSION: We observed a lack of correlation between the completeness score and the other two scores. As such, for a holistic DQA, completeness assessment should be paired with the measurement of either consistency or discrepancy to reflect distinct dimensions of data quality. Given the complexity of the discrepancy score, we recommend the simpler consistency score, since they were highly correlated. Routine use of composite scores on KHIS data could enhance efficiencies in DQA at scale as digitization of health information expands and could be applied to other health sectors beyondHIV clinics

Adjuvant Chemotherapy Following Complete Resection of Soft Tissue Sarcoma in Adults: A Clinical Practice Guideline

Purpose. To review the literature and make recommendations for the use of anthracycline-based adjuvant chemotherapy in adult patients with soft tissue sarcoma (STS)

Incidence and correlates of STIs among black men who have sex with men participating in a US PrEP study

Abstract : Please refer to full text to view abstract

Walker-Warburg syndrome

Walker-Warburg Syndrome (WWS) is a rare form of autosomal recessive congenital muscular dystrophy associated with brain and eye abnormalities. WWS has a worldwide distribution. The overall incidence is unknown but a survey in North-eastern Italy has reported an incidence rate of 1.2 per 100,000 live births. It is the most severe form of congenital muscular dystrophy with most children dying before the age of three years. WWS presents at birth with generalized hypotonia, muscle weakness, developmental delay with mental retardation and occasional seizures. It is associated with type II cobblestone lissencephaly, hydrocephalus, cerebellar malformations, eye abnormalities and congenital muscular dystrophy characterized by hypoglycosylation of α-dystroglycan. Several genes have been implicated in the etiology of WWS, and others are as yet unknown. Several mutations were found in the Protein O-Mannosyltransferase 1 and 2 (POMT1 and POMT2) genes, and one mutation was found in each of the fukutin and fukutin-related protein (FKRP) genes. Laboratory investigations usually show elevated creatine kinase, myopathic/dystrophic muscle pathology and altered α-dystroglycan. Antenatal diagnosis is possible in families with known mutations. Prenatal ultrasound may be helpful for diagnosis in families where the molecular defect is unknown. No specific treatment is available. Management is only supportive and preventive

Concomitant Socioeconomic, Behavioral, and Biological Factors Associated with the Disproportionate HIV Infection Burden among Black Men Who Have Sex with Men in 6 U.S. Cities

Background: American Black men who have sex with men (MSM) are disproportionately affected by HIV, but the factors associated with this concentrated epidemic are not fully understood. Methods: Black MSM were enrolled in 6 US cities to evaluate a multi-component prevention intervention, with the current analysis focusing on the correlates of being newly diagnosed with HIV compared to being HIV-uninfected or previously diagnosed with HIV. Results: HPTN 061 enrolled 1553 Black MSM whose median age was 40; 30% self-identified exclusively as gay or homosexual, 29% exclusively as bisexual, and 3% as transgender. About 1/6th (16.2%) were previously diagnosed with HIV (PD); of 1263 participants without a prior HIV diagnosis 7.6% were newly diagnosed (ND). Compared to PD, ND Black MSM were younger (p<0.001); less likely to be living with a primary partner (p<0.001); more likely to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.011) or chlamydia (p = 0.020). Compared to HIV-uninfected Black MSM, ND were more likely to report unprotected receptive anal intercourse (URAI) with a male partner in the last 6 months (p<0.001); and to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.004), and urethral (p = 0.025) or rectal chlamydia (p<0.001). They were less likely to report female (p = 0.002) or transgender partners (p = 0.018). Multivariate logistic regression analyses found that ND Black MSM were significantly more likely than HIV-uninfected peers to be unemployed; have STIs, and engage in URAI. Almost half the men in each group were poor, had depressive symptoms, and expressed internalized homophobia. Conclusions: ND HIV-infected Black MSM were more likely to be unemployed, have bacterial STIs and engage in URAI than other Black MSM. Culturally-tailored programs that address economic disenfranchisement, increase engagement in care, screen for STIs, in conjunction with safer sex prevention interventions, may help to decrease further transmission in this heavily affected community