Cluster randomized evaluation of Adolescent Girls Empowerment Programme (AGEP): study protocol.

BACKGROUND: Adolescents in less developed countries such as Zambia often face multi-faceted challenges for achieving successful transitions through adolescence to early adulthood. The literature has noted the need to introduce interventions during this period, particularly for adolescent girls, with the perspective that such investments have significant economic, social and health returns to society. The Adolescent Girls Empowerment Programme (AGEP) was an intervention designed as a catalyst for change for adolescent girls through themselves, to their family and community. METHODS/DESIGN: AGEP was a multi-sectoral intervention targeting over 10,000 vulnerable adolescent girls ages 10-19 in rural and urban areas, in four of the ten provinces of Zambia. At the core of AGEP were mentor-led, weekly girls' group meetings of 20 to 30 adolescent girls participating over two years. Three curricula - sexual and reproductive health and lifeskills, financial literacy, and nutrition - guided the meetings. An engaging and participatory pedagogical approach was used. Two additional program components, a health voucher and a bank account, were offered to some girls to provide direct mechanisms to improve access to health and financial services. Embedded within AGEP was a rigorous multi-arm randomised cluster trial with randomization to different combinations of programme arms. The study was powered to assess the impact across a set of key longer-term outcomes, including early marriage and first birth, contraceptive use, educational attainment and acquisition of HIV and HSV-2. Baseline behavioural surveys and biological specimen collection were initiated in 2013. Impact was evaluated immediately after the program ended in 2015 and will be evaluated again after two additional years of follow-up in 2017. The primary analysis is intent-to-treat. Qualitative data are being collected in 2013, 2015 and 2017 to inform the programme implementation and the quantitative findings. An economic evaluation will evaluate the incremental cost-effectiveness of each component of the intervention. DISCUSSION: The AGEP program and embedded evaluation will provide detailed information regarding interventions for adolescent girls in developing country settings. It will provide a rich information and data source on adolescent girls and its related findings will inform policy-makers, health professionals, donors and other stakeholders. TRIAL REGISTRATION: ISRCTN29322231 . March 04 2016; retrospectively registered

Acquisition of pneumococci specific effector and regulatory Cd4+ T cells localising within human upper respiratory-tract mucosal lymphoid tissue

The upper respiratory tract mucosa is the location for commensal Streptococcus (S.) pneumoniae colonization and therefore represents a major site of contact between host and bacteria. The CD4(+) T cell response to pneumococcus is increasingly recognised as an important mediator of immunity that protects against invasive disease, with data suggesting a critical role for Th17 cells in mucosal clearance. By assessing CD4 T cell proliferative responses we demonstrate age-related sequestration of Th1 and Th17 CD4(+) T cells reactive to pneumococcal protein antigens within mucosal lymphoid tissue. CD25(hi) T cell depletion and utilisation of pneumococcal specific MHCII tetramers revealed the presence of antigen specific Tregs that utilised CTLA-4 and PDL-1 surface molecules to suppress these responses. The balance between mucosal effector and regulatory CD4(+) T cell immunity is likely to be critical to pneumococcal commensalism and the prevention of unwanted pathology associated with carriage. However, if dysregulated, such responses may render the host more susceptible to invasive pneumococcal infection and adversely affect the successful implementation of both polysaccharide-conjugate and novel protein-based pneumococcal vaccines

Über die Verteilung der Fermente des Nucleinstoffwechsels.

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Adolescent Girls Empowerment Programme: Endline technical report

The theory of change behind the Adolescent Girls Empowerment Program (AGEP) posited that adolescent girls are empowered by building social, health, and economic assets that they can then draw on to reduce vulnerabilities and expand opportunities. In the long term, they will then increase their likelihood of completing school, delaying sexual debut, and reducing risks of early marriages, unintended pregnancies, acquisition of HIV, and other possibly detrimental outcomes. This endline report indicates that, while there were some changes for the program participants in the medium and long term, they did not translate into longer-term effects on reproductive and demographic outcomes as hypothesized via the theory of change. However, interpretation of these results is constrained by two important factors: 1) a large proportion of the girls invited to the program did not participate, and 2) among those who did participate, only a subsegment of them participated actively in the safe-spaces sessions. The AGEP evaluation is an important contribution to the understanding of adolescent transitions and interventions in Zambia which should contribute to the improvement of current programs, as well as development of new programs and funding strategies

A point mutation in cpsE renders Streptococcus pneumoniae nonencapsulated and enhances its growth, adherence and competence.

BACKGROUND: The polysaccharide capsule is a major virulence factor of the important human pathogen Streptococcus pneumoniae. However, S. pneumoniae strains lacking capsule do occur. RESULTS: Here, we report a nasopharyngeal isolate of Streptococcus pneumoniae composed of a mixture of two phenotypes; one encapsulated (serotype 18C) and the other nonencapsulated, determined by serotyping, electron microscopy and fluorescence isothiocyanate dextran exclusion assay.By whole genome sequencing, we demonstrated that the phenotypes differ by a single nucleotide base pair in capsular gene cpsE (C to G change at gene position 1135) predicted to result in amino acid change from arginine to glycine at position 379, located in the cytoplasmic, enzymatically active, region of this transmembrane protein. This SNP is responsible for loss of capsule production as the phenotype is transferred with the capsule operon. The nonencapsulated variant is superior in growth in vitro and is also 117-fold more adherent to and more invasive into Detroit 562 human epithelial cells than the encapsulated variant.Expression of six competence pathway genes and one competence-associated gene was 11 to 34-fold higher in the nonencapsulated variant than the encapsulated and transformation frequency was 3.7-fold greater. CONCLUSIONS: We identified a new single point mutation in capsule gene cpsE of a clinical S. pneumoniae serotype 18C isolate sufficient to cause loss of capsule expression resulting in the co-existence of the encapsulated and nonencapsulated phenotype. The mutation caused phenotypic changes in growth, adherence to epithelial cells and transformability. Mutation in capsule gene cpsE may be a way for S. pneumoniae to lose its capsule and increase its colonization potential

Applied Use of Safety Performance Monitoring in Global Aviation Operations

For decades, aviation has been at the leading edge of safety and human factors data collection. These data have provided valuable insights into emerging trends and human-system performance needs. As industry continues to improve its data collection capabilities, stakeholders must develop a common understanding and use of safety performance monitoring (SPM) practices and terms governed by ICAO (ICAO Annex 19, ICAO Doc 9859). SPM is a critical component of Safety Management Systems and State Safety Programs. To understand industry’s awareness and use of SPM in current operations, an SPM Survey was administered. Responses were received from 161 domain representatives in six ICAO global regions. Response data revealed the current state of industry SPM practices, SPM variability across domains and regions, and generalizable best practices. This paper will present top safety performance targets (SPTs), safety data analysis methods, and safety data sources utilized by respondents to track, analyze, and measure risk across five areas: Maintenance (n=120), Near Mid-Air Collision (n=95), Runway Safety (n=124), Loss of Control-Inflight (n=92), Controlled Flight into Terrain (n=109). Survey data revealed that the top SPTs set by respondents are: Unstable approaches (83.5%), Runway Excursions (70.1%). The top analysis methods used are: Causal Factor Analysis (68.1%), FDM/FOQA Software (59.7). The top data sources are: Voluntary Reports (93.8%), Mandatory Reports (86.2%). This paper will describe how SPM survey results may be used to develop a supplemental Safety Performance Monitoring Handbook in 2019, which will be intended to drive an industry-wide shift towards proactive and predictive safety risk management

Adolescent Girls Empowerment Programme: Research and evaluation mid-term technical report

The Adolescent Girls Empowerment Programme (AGEP) was a social, health, and economic asset-building program targeting vulnerable adolescent girls aged 10–19. The Population Council, in partnership with the Young Women’s Christian Association of Zambia, successfully implemented the AGEP program from late 2013 to early 2016. The results presented in this midterm report have implications for recommendations on future programming for adolescent girls in Zambia and elsewhere and should be coupled with burgeoning evidence from AGEP and the literature to adapt programming for vulnerable adolescent girls in order to improve impact. While the underlying root causes of girls’ vulnerabilities are interrelated, it is possible that a more direct focus on a particular outcome, driven by a more targeted intervention, would have led to greater impact in the shorter term. For older adolescents, it may imply a direct focus on livelihoods and entrepreneurship, whereas younger adolescents may need more focus on educational support. Also, providing direct resources through incentivized activities may be a constructive approach to increasing engagement with the program

The Role of Northeast Ohio Central Cities in the Regional Economy, 2000-2007

This report examines the four central cities in Northeast Ohio – Akron, Canton, Cleveland, and Youngstown — in the context of their metropolitan areas. A central city is the largest or most important city of a metropolitan area. A metropolitan area combines a large city with adjacent urbanized areas and peripheral areas that are closely bound to the center with strong ties to commuting, commerce, and a common labor market