Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial

Background Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Methods Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation

Roman Exempla and Situation Ethics: Valerius Maximus and Cicero de Officiis

Copyright © The Author(s) 2011. Published by The Society for the Promotion of Roman StudiesWhen reading exempla and applying them to ethical decisions, Romans had to bear in mind the principle of situational variability: whether an action can be judged to be right depends on the circumstances in which it is performed; what is right for one person in a given situation may not be right for another. This principle and its ramifications are articulated by Valerius Maximus, Facta et Dicta Memorabilia. Comparison with Cicero, de Officiis suggests that situation ethics was a key feature of Roman ethics and that, within this framework, exempla may be understood as moral tools mediating between universal and particular

Ungulates rely less on visual cues, but more on adapting movement behaviour, when searching for forage

© 2017 The Author(s). This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Venter et al. (2017), Ungulates rely less on visual cues, but more on adapting movement behaviour, when searching for forage. PeerJ 5:e3178; DOI 10.7717/peerj.3178.Finding suitable forage patches in a heterogeneous landscape, where patches change dynamically both spatially and temporally could be challenging to large herbivores, especially if they have no a priori knowledge of the location of the patches. We tested whether three large grazing herbivores with a variety of different traits improve their efficiency when foraging at a heterogeneous habitat patch scale by using visual cues to gain a priori knowledge about potential higher value foraging patches. For each species (zebra (Equus burchelli), red hartebeest (Alcelaphus buselaphus subspecies camaa) and eland (Tragelaphus oryx)), we used step lengths and directionality of movement to infer whether they were using visual cues to find suitable forage patches at a habitat patch scale. Step lengths were significantly longer for all species when moving to nonvisible patches than to visible patches, but all movements showed little directionality. Of the three species, zebra movements were the most directional. Red hartebeest had the shortest step lengths and zebra the longest. We conclude that these large grazing herbivores may not exclusively use visual cues when foraging at a habitat patch scale, but would rather adapt their movement behaviour, mainly step length, to the heterogeneity of the specific landscape.Peer reviewedFinal Published versio

Keeping tradition alive: just war and historical imagination

The just war tradition is one of the key constituencies of international political theory, and its vocabulary plays a prominent role in how political and military leaders frame contemporary conflicts. Yet, it stands in danger of turning in on itself and becoming irrelevant. This article argues that scholars who wish to preserve the vitality of this tradition must think in a more open-textured fashion about its historiography. One way to achieve this is to problematize the boundaries of the tradition. This article pursues this objective by treating one figure that stands in a liminal relation to the just war tradition. Despite having a lot to say about the ethics of war, Xenophon is seldom acknowledged as a bona fide just war thinker. The analysis presented here suggests, however, that his writings have much to tell us, not only about how he and his contemporaries thought about the ethics of war, but about how just war thinking is understood (and delimited) today and how it might be revived as a pluralistic critical enterprise

Mammary molecular portraits reveal lineage-specific features and progenitor cell vulnerabilities.

The mammary epithelium depends on specific lineages and their stem and progenitor function to accommodate hormone-triggered physiological demands in the adult female. Perturbations of these lineages underpin breast cancer risk, yet our understanding of normal mammary cell composition is incomplete. Here, we build a multimodal resource for the adult gland through comprehensive profiling of primary cell epigenomes, transcriptomes, and proteomes. We define systems-level relationships between chromatin-DNA-RNA-protein states, identify lineage-specific DNA methylation of transcription factor binding sites, and pinpoint proteins underlying progesterone responsiveness. Comparative proteomics of estrogen and progesterone receptor-positive and -negative cell populations, extensive target validation, and drug testing lead to discovery of stem and progenitor cell vulnerabilities. Top epigenetic drugs exert cytostatic effects; prevent adult mammary cell expansion, clonogenicity, and mammopoiesis; and deplete stem cell frequency. Select drugs also abrogate human breast progenitor cell activity in normal and high-risk patient samples. This integrative computational and functional study provides fundamental insight into mammary lineage and stem cell biology

The Red Sea, Coastal Landscapes, and Hominin Dispersals

This chapter provides a critical assessment of environment, landscape and resources in the Red Sea region over the past five million years in relation to archaeological evidence of hominin settlement, and of current hypotheses about the role of the region as a pathway or obstacle to population dispersals between Africa and Asia and the possible significance of coastal colonization. The discussion assesses the impact of factors such as topography and the distribution of resources on land and on the seacoast, taking account of geographical variation and changes in geology, sea levels and palaeoclimate. The merits of northern and southern routes of movement at either end of the Red Sea are compared. All the evidence indicates that there has been no land connection at the southern end since the beginning of the Pliocene period, but that short sea crossings would have been possible at lowest sea-level stands with little or no technical aids. More important than the possibilities of crossing the southern channel is the nature of the resources available in the adjacent coastal zones. There were many climatic episodes wetter than today, and during these periods water draining from the Arabian escarpment provided productive conditions for large mammals and human populations in coastal regions and eastwards into the desert. During drier episodes the coastal region would have provided important refugia both in upland areas and on the emerged shelves exposed by lowered sea level, especially in the southern sector and on both sides of the Red Sea. Marine resources may have offered an added advantage in coastal areas, but evidence for their exploitation is very limited, and their role has been over-exaggerated in hypotheses of coastal colonization

Developing effective policy strategies to retain health workers in rural Bangladesh: a policy analysis

This article was published in Human Resources for Health [ © 2015 Rawal et al.; licensee BioMed Central] and the definite version is available at: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0030-6Introduction: Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to develop appropriate rural retention strategies in Bangladesh. Methods: We conducted a document review, thorough search and review of relevant literature published from 1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers, etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health Organization's (WHO's) guidelines as an analytical matrix to examine the rural retention policies under 4 domains, i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains. Results: Over the past four decades, Bangladesh has developed and implemented a number of health-related policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to improve geographical representation of the students. Students of special background including children of freedom fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further, in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive enough, and such provision is absent for those working in other rural areas. Although the government has career development and promotion plans for doctors and nurses, these plans are often not clearly specified and not implemented effectively. Conclusion: The government is committed to address the rural retention problem as shown through the formulation and implementation of related policies and strategies. However, Bangladesh needs more effective policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and the execution of these policies and provisions must be monitored and evaluated effectivelyPublishe