The epidemiology of HIV among young people in sub-Saharan Africa: know your local epidemic and its implications for prevention.

BACKGROUND: Broad patterns of HIV epidemiology are frequently used to design generic HIV programs in sub-Saharan Africa. METHODS: We reviewed the epidemiology of HIV among young people in sub-Saharan Africa, and explored the unique dynamics of infection in its different regions. RESULTS: In 2009, HIV prevalence among youth in sub-Saharan Africa was an estimated 1.4% in males and 3.4% in females, but these values mask wide variation at regional and national levels. Within countries there are further major differences in HIV prevalence, such as by sex, urban/rural location, economic status, education, or ethnic group. Within this highly nuanced context, HIV prevention programs targeting youth must consider both where new infections are occurring and where they are coming from. CONCLUSIONS: Given the epidemiology, one-size-fits-all HIV prevention programs are usually inappropriate at regional and national levels. Consideration of local context and risk associated with life transitions, such as leaving school or getting married, is imperative to successful programming for young people

Palliative outpatient parenteral antibiotic therapy: a review of 5 years of patient data

Objectives: A review of patients requiring lifelong antibiotics to control, rather than cure, infection was performed [‘palliative outpatient parenteral antibiotic therapy (OPAT)’]. This was to evaluate emerging themes and complications. The aim was to aid in the management of such patients.Methods: A retrospective review of the OPAT database over 5 years (2013–17) was performed. Of the 1438 patients, 9 were deemed to have received palliative OPAT.Results: The palliative cohort represented 0.6% of the total number of patients on OPAT and 8.6% of the bed days saved. Patients fell into two main groups: those with multiple comorbidities that precluded surgical management and those with a terminal condition. Both groups received IV antibiotics with no clear endpoint. The themes to emerge were: patients often had multiple comorbidities with a high operative risk to control the source of infection; a trial of no or oral antibiotics led to resurgence of the infection; vascular patients appeared to tolerate long-term antibiotics well; and conversely, antibiotic side effects were a significant issue in others. Patients with incurable cancer and a coincident infection can be given additional quality of life with the judicious use of appropriate therapy.Conclusions: There are significant issues surrounding antimicrobial stewardship in the palliative OPAT group that should be considered. Excellent communication is required to deal with these often very complicated patients. There are considerable gains to be made both for patients and the number of bed days saved. The small number of patients accounted for a disproportionate number of bed days saved

Developing an app to provide physical and mental health benefits for menopausal women

Background: Menopause is the end of a women’s menstrual cycle and reproductive years. For some women the transition is without major problems; others struggle with various psychological and physical symptoms. Regular walking exercise can be an easy way to maintain physical and mental health. Previous focus groups revealed that women enjoy and want the social aspect of walking groups.    Objectives: The goal of this study is to test use and effectiveness of a walking app platform specific for menopausal women that allows them to connect with each other to schedule walks in Edmonton, and track the effect of walking on their symptom changes.   Methods: Women will be recruited from the Edmonton Menopause clinics and by word of mouth. Interested and consented women receive login information to use the app to schedule and sign-up for walks. Women will complete menopause-specific QOL and symptom questionnaires at their first login and will be prompted to complete them monthly thereafter. Women will also be asked to record their walking durations and intensities. Participating women will be invited to focus groups to discuss their experience using the app. Descriptive statistics will be applied to analyze data collected at the backend from questionnaires and surveys, and qualitative content analysis will be applied to analyze the audio-recorded focus groups.    Results: A prototypic online application has been created including a user manual. Access is restricted and all potential participants will be screened after their first login by the research team prior to gaining full access. Women will then be able to use the app features for schedules and surveys. Data collected at the back end by the researchers will determine the use and effectiveness of the app and explore the impact of social walking on menopause symptom changes.   Conclusion: This is the first social platform of this kind created specifically for menopausal women. Ultimately we hope that this platform will empower women to seek lifestyle changes such as walking exercises and connect with each other on the communality of menopause. Testing the use and effectiveness of the app will help us to improve and further develop the app

Implementing Community-Engaged Participatory Research Methods in a Study of Cree Women’s Wellness: Describing Recruitment Processes and Outcomes

Background: In 2017, the Sohkitehew Group was funded to undertake research to identify wellness strategies adopted by mature women as they age in the rural Cree community of Maskwacis, Alberta. We describe our recruitment processes and outcomes for events from July 2017 to June 2018, the first phase of this research. Methodology: Data gathered from minutes of 36 Sohkitehew Working Group and two Elders Advisory Committee meetings were used to identify recruitment strategies, event characteristics and recruitment outcomes for two large community events and three Sharing Circles. Results:1. Recruitment strategies: Strategies were similar for community events and Sharing Circles: event posters were displayed throughout Maskwacis, and advertisements were broadcast by Hawk Radio and appeared in Band newsletters.2. Event Characteristics: Settings included a large community gymnasium for large events, and smaller community venues in different Bands for Sharing Circles. Traditional/cultural protocols were addressed by smudging meeting spaces, inviting community Elders to attend all events, and saying prayers. Healthy lunches were provided.3. Event attendance: The two larger community events attracted 96, and 37 participants, respectively. Sharing Circle attendance ranged from 8 to 23 participants. Conclusion: Recruitment strategies succeeded for the Sohkitehew events in Maskwacis. Prior trusting and respectful relationships with the community established over several years provided a firm basis for this research. Successful recruitment efforts required time, planning, flexibility, and careful attention to culture and tradition to meet objectives to attract participants. Similar strategies may be successful in other rural Indigenous communities if tailored for the specific needs and expectations of individual communities

Is it possible to estimate the minimal clinically important treatment effect needed to change practice in preterm birth prevention? Results of an obstetrician survey used to support the design of a trial

<p>Abstract</p> <p>Background</p> <p>Sample sizes for obstetrical trials are often based on the opinion of investigators about clinically important effect size. We surveyed Canadian obstetricians to investigate clinically important effect sizes required before introducing new treatments into practice to prevent preterm birth.</p> <p>Methods</p> <p>Questionnaires were mailed to practicing obstetricians, asking the magnitude of pregnancy prolongation required to introduce treatments into practice. The three prophylactic treatments were of increasing invasiveness: vaginal progesterone, intramuscular progesterone, and cervical cerclage. We also asked about the perceived most relevant outcome measures for obstetrical trials and current obstetrical practice in preterm birth prevention.</p> <p>Results</p> <p>544/1293(42.1%) completed questionnaires were received. The majority of respondents required one or two weeks' increase in length of gestation before introducing vaginal (372,77.1%), and intramuscular progesterone(354,67.9%). At least three weeks increase was required before introducing prophylactic cervical cerclage(326,62.8%). Clinicians who already used a treatment required a smaller difference before introducing it into practice. Decreasing neonatal morbidity was cited as the most important outcome for obstetrical trials (349,72.2%).</p> <p>Conclusion</p> <p>Obstetricians would require a larger increase in treatment effect before introducing more invasive treatments into practice. Although infant morbidity was perceived as a more important outcome, clinicians appeared willing to change practice on the basis of prolongation of pregnancy, a surrogate outcome. We found that there is not a single minimum clinically important treatment effect that will influence all practising clinicians: rather the effect size that will influence physicians is affected by the nature of the treatment, the reported outcome measure and the clinician's own current clinical practice.</p

Profound Differences in Virus Population Genetics Correspond to Protection from CD4 Decline Resulting from Feline Lentivirus Coinfection

CD4 decline is a hallmark of disease onset in individuals infected with Feline Immunodeficiency Virus (FIV) or Human Immunodeficiency Virus type 1 (HIV-1). Cats that are infected with a poorly replicating, apathogenic FIV (PLV) prior to exposure to a virulent FIV strain (FIVC) maintain CD4 numbers by mechanisms that are not correlated with a measurable adaptive immune response or reduction in circulating viral load. We employed population genetic approaches based on the 3′ portion of the viral genome to estimate the population structure of FIVC from single and dual infected cats. In dual infected cats, FIVC effective population size was decreased during the initial viral expansion phase, and after three weeks of infection, the population declined sharply. The FIVC population recovered to pre-bottleneck levels approximately seven weeks post-FIVC infection. However, the population emerging from the bottleneck in dual infected cats was distinct based on estimates of temporal population structure and substitution profiles. The transition to transversion rate ratio (κ) increased from early to late phases in dual infected cats due primarily to a decrease in transversions whereas in single infected cats, κ declined over time. Although one clone with extensive G to A substitutions, indicative of host cytidine deaminase editing, was recovered from a dual infected cat during the bottleneck, the post bottleneck population had an overall reduction in G to A substitutions. These data are consistent with a model of PLV-induced host restriction, putatively involving host DNA editing, that alters the dynamics of FIVC throughout the course of infection leading to disease attenuation

Collective futures: cultivating creative collectives.

Collective Futures was a partnership project between three highly regarded institutions operating in the creative industries: Gray's School of Art, University of The West of Scotland (UWS) and the Glasgow School of Art. The partners undertook a unique exploration of creative collectives as a route to economic success and talent development for designer-makers. The collaborative nature of the partnership working throughout the project was recognised by the partners as a form of Creative Academic Collective. The aims of the project were consistent with Creative Scotland's strategic intention to support talent hubs for creative practitioners, and also aligned with recent reports (EKOS) and initiatives such as the South of Scotland Social Enterprise Initiative (SOSCEI), Creative Arts Business Network (CABN) and Emergents, that reinforced the importance of scale, networking, collaboration and the notion of creative places around the country to support creative industries. Central to the success of the project was a meaningful connection and engagement of designer/maker communities and creative practitioners in several parts of Scotland. This project sought to explore effective models of collective working that support designer/makers in the development of their own talent and to sustain and grow their creative businesses