Family planning programs in sub-Saharan Africa

In the 1980s, signs that sub-Saharan Africans would welcome family planning in numbers sufficient to make a difference in fertility rates were scattered and weak. Pessimists cited formidable cultural and socioeconomic barriers; optimists provided resources for pilot projects, coupled with research to document results and to guide expansion and replication. Among projects with measurable achievements in acceptance of family planning in settings that were less than promising were the Ghana Registered Midwives Project, the Ruhengeri Project in Rwanda, and the Sudan Community-Based Family Health Project. All were associated with the Operations Research Program of Columbia University's Center for Population and Family Health. In Ghana, midwives in private practice were trained and given other support to initiate family planning services. In Rwanda, rural community development volunteers added family planning to their educational activities. In the Sudan, rural catchment areas and work assignments of rural primary health care personnel were changed to introduce family planning and strengthen other child survival services. Positive results were evident from quantitative measures of service delivery and, in Rwanda and the Sudan, from an increase in contraceptive prevalence in the project areas. Other criteria for success included improved management skills, motivation for replicating successful programmatic elements, and potential for continuity. Questions remain as to why attitudes changed, when contraceptive use for family limitation will be practiced widely, and how applicable the experiences reported here are to other locations. These projects do not provide the answers. They do, nonetheless, support an optimistic view for the future offamily planning in sub-Saharan Africa.Health Monitoring&Evaluation,Adolescent Health,ICT Policy and Strategies,Agricultural Knowledge&Information Systems,Early Child and Children's Health

A randomised controlled trial of supplemental oxygen versus medical air during exercise training in people with chronic obstructive pulmonary disease: Supplemental oxygen in pulmonary rehabilitation trial (SuppORT) (Protocol)

© 2016 Alison et al. Background: Oxygen desaturation during exercise is common in people with chronic obstructive pulmonary disease (COPD). The aim of the study is to determine, in people with COPD who desaturate during exercise, whether supplemental oxygen during an eight-week exercise training program is more effective than medical air (sham intervention) in improving exercise capacity and health-related quality of life both at the completion of training and at six-month follow up. Methods/Design: This is a multi-centre randomised controlled trial with concealed allocation, blinding of participants, exercise trainers and assessors, and intention-to-treat analysis. 110 people with chronic obstructive pulmonary disease who demonstrate oxygen desaturation lower than 90 % during the six-minute walk test will be recruited from pulmonary rehabilitation programs in seven teaching hospitals in Australia. People with chronic obstructive pulmonary disease on long term oxygen therapy will be excluded. After confirmation of eligibility and baseline assessment, participants will be randomised to receive either supplemental oxygen or medical air during an eight-week supervised treadmill and cycle exercise training program, three times per week for eight weeks, in hospital outpatient settings. Primary outcome measures will be endurance walking capacity assessed by the endurance shuttle walk test and health-related quality of life assessed by the Chronic Respiratory Disease Questionnaire. Secondary outcomes will include peak walking capacity measured by the incremental shuttle walk test, dyspnoea via the Dyspnoea-12 questionnaire and physical activity levels measured over seven days using an activity monitor. All outcomes will be measured at baseline, completion of training and at six-month follow up. Discussion: Exercise training is an essential component of pulmonary rehabilitation for people with COPD. This study will determine whether supplemental oxygen during exercise training is more effective than medical air in improving exercise capacity and health-related quality of life in people with COPD who desaturate during exercise. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12612000395831 , 5th Jan,201

Evidence for Reductive Genome Evolution and Lateral Acquisition of Virulence Functions in Two Corynebacterium pseudotuberculosis Strains

Ruiz JC, D'Afonseca V, Silva A, et al. Evidence for Reductive Genome Evolution and Lateral Acquisition of Virulence Functions in Two Corynebacterium pseudotuberculosis Strains. PLoS ONE. 2011;6(4): e18551.Background: Corynebacterium pseudotuberculosis, a Gram-positive, facultative intracellular pathogen, is the etiologic agent of the disease known as caseous lymphadenitis (CL). CL mainly affects small ruminants, such as goats and sheep; it also causes infections in humans, though rarely. This species is distributed worldwide, but it has the most serious economic impact in Oceania, Africa and South America. Although C. pseudotuberculosis causes major health and productivity problems for livestock, little is known about the molecular basis of its pathogenicity. Methodology and Findings: We characterized two C. pseudotuberculosis genomes (Cp1002, isolated from goats; and CpC231, isolated from sheep). Analysis of the predicted genomes showed high similarity in genomic architecture, gene content and genetic order. When C. pseudotuberculosis was compared with other Corynebacterium species, it became evident that this pathogenic species has lost numerous genes, resulting in one of the smallest genomes in the genus. Other differences that could be part of the adaptation to pathogenicity include a lower GC content, of about 52%, and a reduced gene repertoire. The C. pseudotuberculosis genome also includes seven putative pathogenicity islands, which contain several classical virulence factors, including genes for fimbrial subunits, adhesion factors, iron uptake and secreted toxins. Additionally, all of the virulence factors in the islands have characteristics that indicate horizontal transfer. Conclusions: These particular genome characteristics of C. pseudotuberculosis, as well as its acquired virulence factors in pathogenicity islands, provide evidence of its lifestyle and of the pathogenicity pathways used by this pathogen in the infection process. All genomes cited in this study are available in the NCBI Genbank database (http://www.ncbi.nlm.nih.gov/genbank/) under accession numbers CP001809 and CP001829

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Qualitative methods in operations research on contraceptive distribution systems: A case study from Nigeria

This article discusses the application of qualitative methods in operations research on a family planning service delivery system. Market traders in Ibadan, Nigeria were trained to sell oral contraceptives, condoms, and spermicidal foaming tablets in a collaborative research project of the Fertility Research Unit of the University College Hospital, Ibadan, and the Center for Population and Family Health of Columbia University. Focus group discussion, participant observation, and semi-structured interviews were used to investigate the cultural acceptability of distribution of contraceptives in the market places and the motivations of participating traders. The strength of the market associations was a factor influencing acceptance of the project and the number of customers for the traders' other wares were found to positively influence the volume of sales of contraceptives. Traders were motivated by the status associated with participating in a program of a well-known health institution. Findings from qualitive research suggest areas for quantitative studies and vice versa in an interactive process.qualitative methods operations research contraceptive sales Yoruba markets

Spatial and temporal variability in CH4 and N2O fluxes from a Scottish ombrotrophic peatland: implications for modeling and upscaling

Peatlands typically exhibit significant spatial heterogeneity which can lead to large uncertainties when catchment scale greenhouse gas fluxes are extrapolated from chamber measurements (generally <1 m2). Here we examined the underlying environmental and vegetation characteristics which led to within-site variability in both CH4 and N2O emissions and the importance of such variability in up-scaling. We also consider within-site variation in the controls of temporal dynamics. Net annual emissions (and coefficients of variation) for CH4 and N2O were 1.06 kg ha−1 y−1 (300%) and 0.02 kg ha−1 y−1 (410%), respectively. The riparian zone was a significant CH4 hotspot contributing 12% of the total catchment emissions whilst covering only 0.5% of the catchment area. In contrast to many other studies we found smaller CH4 emissions and greater uptake in chambers containing either sedges or rushes. We also found clear differences in the drivers of temporal CH4 dynamics across the site, e.g. water table was important only in chambers which did not contain aerenchymous plants. We suggest that depending on the heterogeneity of the site, flux models could be improved by incorporating a number of spatially distinct sub-models, rather than a single model parameterized using whole-catchment averages

People attending pulmonary rehabilitation demonstrate a substantial engagement with technology and willingness to use telerehabilitation: a survey

Questions: What is the level of technology engagement by people attending pulmonary rehabilitation? Are participant demographics and level of technology engagement associated with willingness to use telerehabilitation? Design: A cross-sectional, multicentre study involving quantitative survey analysis. Participants: Convenience sample of people with chronic respiratory disease attending a pulmonary rehabilitation program, maintenance exercise class or support group. Outcome measures: The survey assessed the participants’ level of technology engagement (access to and use of devices), self-rated skill competence, access to online health information and willingness to use telerehabilitation. Results: Among the 254 people who were invited, all agreed to complete the survey (100% response rate). Among these 254 respondents, 41% were male, the mean age was 73 years (SD 10), and the mean forced expiratory volume in 1 second (FEV1) was 59% predicted (SD 23). Ninety-two percent (n = 233) of participants accessed at least one technological device, of whom 85% (n = 198) reported regularly using mobile phones and 70% (n = 164) regularly used a computer or tablet. Fifty-seven percent (n = 144) of participants self-rated their technology skill competence as good and 60% (n = 153) of all participants were willing to use telerehabilitation. The multivariate regression model found regular computer use (OR 3.14, 95% CI 1.72 to 5.71) and regular mobile phone use (OR 2.83, 95% CI 1.32 to 6.09) were most associated with a willingness to use telerehabilitation. Conclusion: People attending metropolitan pulmonary rehabilitation, maintenance exercise classes and support groups had substantial technology engagement, with high device access and use, and good self-rated technology competence. The majority of participants were willing to use telerehabilitation, especially if they were regular users of technology devices. [Seidman Z, McNamara R, Wootton S, Leung R, Spencer L, Dale M, Dennis S, McKeough Z (2017) People attending pulmonary rehabilitation demonstrate a substantial engagement with technology and willingness to use telerehabilitation: a survey. Journal of Physiotherapy 63: 175–181