Remoteness and maternal and child health service utilization in rural Liberia: A population–based survey

Background: This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa. Methods: Cluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data. Findings: Living in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers. Conclusions: Within a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further dissemination of providers and greater use of community health workers should be prioritized

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

A FEM-BEM multiphysics coupling for the modeling of magnetoelectric composite structures

International audienceThis study concerns the modeling of structures made of composite materials with magnetoelectric effects arising from the combination of magnetostrictive and piezoelectric materials. Modeling these effects requires consideringan electro-magneto-mechanical problem derived bycoupling equations describing active materialssuch asTerfenol-D for the magnetostrictive phaseand PZT for the piezoelectric phase. A typicalmethod used for the resolution of this kind of problemis the finite element method(FEM). Although this method is general and has proven to be effective in many instances, it can becomecomputationally expensive, particularlyfor electromagnetic problems whereactive materials and coils are distantfromeach otherthus necessitating a huge mesh of air. In our case, the FEMis well adapted to the modeling of electro-mechanical coupling. Indeed, the large permittivity of piezoelectric materials makes the electric field leaks negligible.For magneto-mechanical coupling involving a small volume of active magnetic materials compared to air, FEM becomes expensive. Coupling between finite element method and boundary element method offers the possibility to not have to mesh the air while still providing excellent results(G. Meunier, J. Coulomb, S. Salon, and L. Krahenbul, “Hybrid finite element boundary element solutions for three dimensional scalar potential problems,” IEEE Transactions on Magnetics, vol. 22, no. 5, pp. 1040–1042, Sep. 1986). In this work an approach coupling FEM, for the electric and mechanicalfields, and BEM, for the magnetic field, is proposed to solve problems involving a reduced volume of active materials.The magnetostrictive phenomenon is strongly nonlinear, but it will be consideredlinear as a first approximation.Two dual formulations of the magneto-mechanical problemwill be presented, based on total magnetic vector potential and reduced magnetic scalar potential formulations respectively.The electro-mechanical problem is solvedby a classical FEM formulation. The electro-magneto-mechanical coupling isthen expressed by a matrix block system with sparse matrices for the mechanical and electrical problemsand full matrices for the magnetic problem. The resulting system is solved using theblockGauss-Seidel methodwith linear solvers adapted to the type of matrix, i.e, MUMPS used for sparse matrices and GMRES used for full matrices.Results of the two formulations and their performance will be compared

FEM-BEM modeling of nonlinear magnetoelectric effects in heterogeneous composite structures

This paper proposes a multiphysics multi-method model for 3D nonlinear magnetoelectric effects in heterogeneous composite structures made of the association of piezoelectric and magnetostrictive materials. Through the coupling of the Finite Element Method with the Boundary Element Method, only the active material is explicitly considered, and thus a single mesh is used for the resolution of all the physics. A mixed formulation combining the vector potential in the volume and a scalar potential in the free space is used to model magnetic phenomena. Non-linear constitutive laws for the magnetostrictive phase are derived from partial derivatives of a scalar invariant's formulation of the Helmholtz free energy, while linear relations are used to describe piezoelectric behavior. The coupled problem is solved by iteratively solving single-physics problems, and the full algorithm is used to model a rotating coilless ME device which can operate as an energy harvester or as an actuator

T-Cell Receptor Sequencing of Kaposi Sarcoma Tumors to Identify Candidate Tumor-Reactive T Cells

Abstract 60 Background: Development of Kaposi sarcoma (KS) is strongly associated with immune dysfunction in the context of HIV infection, but little is known about T-lymphocyte responses against KS tumor cells or human herpesvirus-8, the viral cause of KS. Increasing evidence suggests that treatment response in KS is attributable in part to an antitumor immune response that is mediated by tumor-infiltrating lymphocytes (TIL). The aim of this work was to identify TIL characteristics that are associated with tumor regression in patients with KS who were treated with antiretroviral therapy and chemotherapy as well as to identify a molecular signature of response. Methods: High-throughput sequencing of the T-cell receptor β chain ( TRB) was used to define the repertoire of T cells that infiltrate up to two pretreatment and two post-treatment KS tumors and matched normal skin obtained from HIV-infected adults with KS who received care at the Uganda Cancer Institute. We compared TRB repertoire in serially collected tumors to identify TRB sequences carried in candidate tumor-reactive T cells. Results: TRB sequencing was performed on KS tumor and matched normal skin samples from 12 HIV-infected adults with KS who collectively demonstrated a range of treatment responses. Unique populations of T cells were identified in pretreatment tumors but not in normal skin in all patients, which suggested the presence of KS-specific T-cell responses. Durable complete response to treatment in one patient was associated with significant expansion of a small number of T-cell clones, one of which carried a TRB sequence that was associated with a public CD8 + Epstein-Barr virus–associated T-cell receptor. Conclusion: Understanding the immune response to KS through cellular and molecular dissection of TIL will provide important insights into KS biology and may ultimately guide new immune-based strategies to stage and treat this often-refractory cancer. Funding: Solid Tumor Translational Research Transformative Team Grant, Fred Hutchinson Cancer Research Center; National Institutes of Health/National Cancer Institute Grant No. K23-CA150931. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors

Naves (2009) Subordination following Biber et al. (2002, 1999), Greenbaum & Quirk (1985), Quirk et al. (1985) Carter & McCarthy (2006) and Selection of Definitions from Oxford Reference Online

Subordination following Biber et al. (2002, 1999), Greenbaum & Quirk (1985),Quirk et al. (1985) Carter & McCarthy (2006)and Selection of Definitions from Oxford Reference Online by T.Nave