Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: a qualitative evaluation

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Few studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services. Methods: A qualitative study was conducted in 2010 and involved: (i) in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and (ii) focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five program sites in Kenya. Results: The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services. These include lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. Moreover, accreditation of only hospitals to offer GBVR services undermines access to the services in rural areas. Poor responsiveness from law enforcement agencies and fear of reprisal from perpetrators also undermine treatment options and access to medical services. Low provider knowledge on GBVR services and lack of supplies also affect effective provision and management of GBVR services. Conclusions: The above findings suggest that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA program to promote the GBVR services voucher, and conduct widespread community education programs aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.The Bill and Melinda Gates Foundatio

Multi-criteria dispatch optimization of a community energy network with desalination: Insights for trading off cost and security of supply.

The idea of community energy network is being advocated to enhance the elasticity of diverse energy systems required for efficiently integrating a substantial volume of distributed energy resources. On the other hand, the interest in renewables-based desalination systems has received significant interest recently to consider freshwater as an additional end-use product in the community energy network system. Within this context, this paper introduces a multifaceted method for community energy networks with a focus on desalination-capable systems. The central goals involve diminishing the cumulative long-term expenses of the configuration, all while concurrently augmenting the system's capacity to store electrothermal energy on a daily basis that varies - all aimed at enhancing the reliability and security of resource provisioning. Importantly, the model co-optimizes the community energy network expenditure and reserve capacities, whilst integrating electrical, thermal, and natural gas vectors, as well as providing a platform for supplying freshwater needs. The overall freshwater provisioning infrastructure incorporates a water storage system, a desalination unit, a water well component, and a water pumping system. Furthermore, for the purpose of enhancing the adaptability, the community energy network concept put forth here utilizes coordinated electrothermal responsive load initiatives. These are coupled with meticulously planned electrothermal reservoir setups to curtail the wastage of surplus renewable production amidst diverse origins of unpredictability. The normalized weighted sum method is employed to convert the proposed formulation to a single-objective problem that is amenable to commercially available solvers in GAMS software. Then, the modelling framework is adapted to a system populated for a hypothetical site. The results verify the validity of the model in yielding globally optimum results for complex community energy networks with intertwined vectors of energy and end-use products. They also indicate that relatively small raises in the size of the electric and thermal reservoirs - and insubstantial raises in the expenditure of the system - can have potentially significant impacts on the ability of the system in serving loads during contingency conditions. In particular, by implementing demand response programs a cost reduction of 2.07% is shown, which is significant in the day-ahead operational planning phase

Practical Challenges for Reliable RIS Deployment in Heterogeneous Multi-Operator Multi-Band Networks

Abstract Reconfigurable intelligent surfaces (RISs) have been introduced as arrays of nearly passive elements with software-tunable electromagnetic properties to dynamically manipulate the reflection/transmission of radio signals. Research in this area focuses on two applications, namely user-assist RIS aiming to tune the RIS to enhance the quality-of-service (QoS) of target users and malicious RIS aiming for an attacker to degrade the QoS at victim receivers through generating intended destructive interference. While both user-assist and malicious RIS applications have been explored extensively, the impact of RIS deployments on imposing unintended interference on various wireless user-equipments (UEs) remains underexplored. This article investigates the challenges of integrating RISs into multi-carrier, multi-user, and multi-operator wireless networks. We discuss how RIS deployments intended to benefit specific users can negatively impact other users served at various carrier frequencies through different network operators. While not an ideal solution, we discuss how ultra-narrowband metasurfaces can be incorporated into the manufacturing of RISs to mitigate some challenges of RIS deployment in wireless networks. We also present a simulation scenario to illustrate practical challenges associated with the deployment of RISs in shared public environments.Abstract Reconfigurable intelligent surfaces (RISs) have been introduced as arrays of nearly passive elements with software-tunable electromagnetic properties to dynamically manipulate the reflection/transmission of radio signals. Research in this area focuses on two applications, namely user-assist RIS aiming to tune the RIS to enhance the quality-of-service (QoS) of target users and malicious RIS aiming for an attacker to degrade the QoS at victim receivers through generating intended destructive interference. While both user-assist and malicious RIS applications have been explored extensively, the impact of RIS deployments on imposing unintended interference on various wireless user-equipments (UEs) remains underexplored. This article investigates the challenges of integrating RISs into multi-carrier, multi-user, and multi-operator wireless networks. We discuss how RIS deployments intended to benefit specific users can negatively impact other users served at various carrier frequencies through different network operators. While not an ideal solution, we discuss how ultra-narrowband metasurfaces can be incorporated into the manufacturing of RISs to mitigate some challenges of RIS deployment in wireless networks. We also present a simulation scenario to illustrate practical challenges associated with the deployment of RISs in shared public environments

Pharmacokinetic and exploratory exposure-response analysis of pertuzumab in patients with operable HER2-positive early breast cancer in the APHINITY study

Purpose: To characterize the pharmacokinetics (PK) of, and perform an exploratory exposure–response (E–R) analysis for, pertuzumab in patients with HER2-positive early breast cancer (EBC) within the APHINITY study (NCT01358877, BIG 4–11/BO25126/TOC4939G). Methods: A previously developed pertuzumab two-compartment linear population pharmacokinetic (popPK) model was subjected to external validation to examine appropriateness for describing pertuzumab concentrations from the APHINITY study. Pharmacokinetic drug–drug interactions (DDIs) between pertuzumab, trastuzumab, and chemotherapy were assessed by comparing observed serum or plasma Cmax, Cmin, and AUClast geometric mean ratios with 90% CIs. Predictions of pertuzumab Cmax,ss, Cmin,ss, and AUCss were derived from individual parameter estimates and used in an exploratory E–R analysis. Results: Using data from 72 patients, based on goodness-of-fit, the popPK model was deemed appropriate for predictions of individual exposures for subsequent comparisons to historical data, assessment of DDIs, and E–R analyses. No evidence of DDIs for pertuzumab on trastuzumab, trastuzumab on pertuzumab, or pertuzumab on chemotherapy PK was observed. Analyses of differences in exposure between patients with and without invasive disease-free survival events did not indicate improved efficacy with increased exposure. Overall Grade ≥ 3 diarrhea prevalence was higher with pertuzumab versus placebo, but was not greater with increasing pertuzumab exposure. No apparent E–R relationship was suggested with respect to other grade ≥ 3 AEs. Conclusion: Overall, the limited available data from this exploratory study suggest that no dose adjustments are needed for pertuzumab when administered in combination with trastuzumab and an EBC chemotherapy regimen

DNA sequence variants in the LOXL1 gene are associated with pseudoexfoliation glaucoma in a U.S. clinic-based population with broad ethnic diversity

<p>Abstract</p> <p>Background</p> <p>Pseudoexfoliation syndrome is a major risk factor for glaucoma in many populations throughout the world. Using a U.S. clinic-based case control sample with broad ethnic diversity, we show that three common SNPs in LOXL1 previously associated with pseudoexfoliation in Nordic populations are significantly associated with pseudoexfoliation syndrome and pseudoexfoliation glaucoma.</p> <p>Methods</p> <p>Three LOXL1 SNPs were genotyped in a patient sample (206 pseudoexfoliation, 331 primary open angle glaucoma, and 88 controls) from the Glaucoma Consultation Service at the Massachusetts Eye and Ear Infirmary. The SNPs were evaluation for association with pseudeoexfoliation syndrome, pseudoexfoliation glaucoma, and primary open angle glaucoma.</p> <p>Results</p> <p>The strongest association was found for the G allele of marker rs3825942 (G153D) with a frequency of 99% in pseudoexfoliation patients (with and without glaucoma) compared with 79% in controls (p = 1.6 × 10^-15; OR = 20.93, 95%CI: 8.06, 54.39). The homozygous GG genotype is also associated with pseudoexfoliation when compared to controls (p = 1.2 × 10^-12; OR = 23.57, 95%CI: 7.95, 69.85). None of the SNPs were significantly associated with primary open angle glaucoma.</p> <p>Conclusion</p> <p>The pseudoexfoliation syndrome is a common cause of glaucoma. These results indicate that the G153D LOXL1 variant is significantly associated with an increased risk of pseudoexfoliation and pseudoexfoliation glaucoma in an ethnically diverse patient population from the Northeastern United States. Given the high prevalence of pseudooexfoliation in this geographic region, these results also indicate that the G153D LOXL1 variant is a significant risk factor for adult-onset glaucoma in this clinic based population.</p

Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh

<p>Abstract</p> <p>Background</p> <p>There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring's growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes.</p> <p>Methods</p> <p>In the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab), Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F) or MMS combined with either an early (immediately after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community) program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54 months, and 2735 children were available for analysis at 54 months.</p> <p>Results</p> <p>There were no differences in characteristics of mothers and households among the different intervention groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the proportion of stunting from early infancy up to 54 months for boys (p = 0.01), but not for girls (p = 0.31). MMS resulted in more stunting than standard Fe60F (p = 0.02). There was no interaction between the food and micronutrient supplementation on the growth outcome.</p> <p>Conclusions</p> <p>Early food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal growth suggest programming effects in early fetal life.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN16581394">ISRCTN16581394</a></p

Are we ready for genetic testing for primary open-angle glaucoma?

Following a dramatic reduction in the cost of genotyping technology in recent years, there have been significant advances in the understanding of the genetic basis of glaucoma. Glaucoma patients represent around a quarter of all outpatient activity in the UK hospital eye service and are a huge burden for the National Health Service. A potential benefit of genetic testing is personalised glaucoma management, allowing direction of our limited healthcare resources to the glaucoma patients who most need it. Our review aims to summarise recent discoveries in the field of glaucoma genetics and to discuss their potential clinical utility. While genome-wide association studies have now identified over ten genes associated with primary open-angle glaucoma (POAG), individually, variants in these genes are not predictive of POAG in populations. There are data suggesting some of these POAG variants are associated with conversion from ocular hypertension to POAG and visual field progression among POAG patients. However, these studies have not been replicated yet and such genetic testing is not currently justified in clinical care. In contrast, genetic testing for inherited early-onset disease in relatives of POAG patients with a known genetic mutation is of clear benefit; this can support either regular review to commence early treatment when the disease develops, or discharge from ophthalmology services of relatives who do not carry the mutation. Genetic testing for POAG at a population level is not currently justified