ECP Handbook: Introducing and Mainstreaming the Provision of Emergency Contraceptive Pills in Developing Countries

For many women, emergency contraceptive pills (ECPs) offer an opportunity to prevent unintended pregnancy following contraceptive method failure, rape, or unprotected sex. Access to this safe, effective option remains an essential element of women’s quality reproductive health care. However, ECPs remain inaccessible across much of the world, particularly in developing countries where limited commodity supplies, provider competency, public awareness, and misinformation routinely coalesce to restrict availability. While ECPs have been introduced on a pilot basis in many countries, their effective integration into both the public and private sectors has lagged. Successful interventions are guided by the principle that provision of ECPs is not exclusively the responsibility of government family planning programs, and so seek to mainstream delivery of ECPs by developing links with private sector providers and pharmacies, the HIV/AIDS sector, and sexual assault services. Successfully introducing ECPs into a country’s health-care system is a complex undertaking. This handbook provides comprehensive guidance to reproductive health program managers and policymakers on introducing and mainstreaming ECPs, including needs assessments and operations research, drug registration, training and logistics, and introduction of ECP scale-up

Guide pour les pilules de contraception d\u27urgence : Introduire et développer l\u27offre des pilules de contraception d\u27urgence dans les pays en voie de développement

Pendant plus d\u27une décennie, les défenseurs ont cherché à améliorer l\u27accès à la contraception d\u27urgence (CU) dans le monde. Ces efforts ont été couronnés de succès en Europe et en Amérique du Nord, ont suscité de nombreux débats en Amérique latine et commencent à prendre racine en Asie. En Afrique, cependant, le succès des programmes communautaires reste limité. Même dans les pays où l\u27environnement réglementaire est favorable, les contraintes de ressources au sein du secteur public limitent la capacité de fournir des services de CU cohérents et de qualité à faible coût. Dans un nombre croissant de pays africains, le secteur privé a émergé pour combler ces lacunes, augmentant l\u27accès principalement parmi les jeunes citadins aisés. Les faibles niveaux de connaissances de la population générale sapent en fin de compte l\u27impact de telles stratégies de prestation. L\u27initiative décrite dans ce rapport comprend des activités visant à améliorer la connaissance globale de la CU à travers le Kenya et à renforcer la qualité des services de la CU dans les secteurs public et privé. Il était destiné à servir de modèle pour d\u27autres pays intéressés à améliorer l\u27accès à la CU et à générer des connaissances approfondies sur les stratégies des programmes de la CU et les caractéristiques d\u27utilisation en Afrique subsaharienne. Ce rapport final du projet détaille les résultats de cette initiative. --- For more than a decade, advocates have sought to improve access to emergency contraception (EC) around the world. These efforts have been highly successful in Europe and North America, have generated much debate in Latin America, and are beginning to take hold in Asia. In Africa, however, the success of EC programs remains limited. Even in countries where the regulatory environment is favorable, resource constraints within the public sector limit the ability to provide consistent and quality EC services at low cost. In a growing number of African countries, the private sector has emerged to fill these gaps, increasing access primarily among young, affluent urbanites. Low knowledge levels among the general population ultimately undermine the impact of such provision strategies. The initiative described in this report includes activities aimed at improving overall awareness of EC across Kenya and strengthening the quality of EC services in the public and private sectors. It was intended to serve as a model for other countries interested in improving access to EC, and to generate in-depth knowledge on EC program strategies and utilization characteristics in sub-Saharan Africa. This final project report details the outcomes of this initiative

Free Abelian 2-Form Gauge Theory: BRST Approach

We discuss various symmetry properties of the Lagrangian density of a four (3 + 1)-dimensional (4D) free Abelian 2-form gauge theory within the framework of Becchi-Rouet-Stora-Tyutin (BRST) formalism. The present free Abelian gauge theory is endowed with a Curci-Ferrari type condition which happens to be a key signature of the 4D non-Abelian 1-form gauge theory. In fact, it is due to the above condition that the nilpotent BRST and anti-BRST symmetries of the theory are found to be absolutely anticommuting in nature. For our present 2-form gauge theory, we discuss the BRST, anti-BRST, ghost and discrete symmetry properties of the Lagrangian densities and derive the corresponding conserved charges. The algebraic structure, obeyed by the above conserved charges, is deduced and the constraint analysis is performed with the help of the physicality criteria where the conserved and nilpotent (anti-)BRST charges play completely independent roles. These physicality conditions lead to the derivation of the above Curci-Ferrari type restriction, within the framework of BRST formalism, from the constraint analysis.Comment: LaTeX file, 21 pages, journal referenc

The experiences and needs of supporting individuals of young people who self-harm: A systematic review and thematic synthesis

Self-harm in young people is a serious international health concern that impacts on those providing informal support: the supporting individuals of young people. We aimed to highlight the experiences, views, and needs of these supporting individuals of young people. We conducted a systematic review and thematic synthesis: PROSPERO CRD42020168527. MEDLINE, PsycINFO, EMBASE, AMED, CINAHL, ASSIA, and Web of Science were searched from inception to 6 May 2020 with citation tracking of eligible studies done on 1 Oct 2021. Primary outcomes were experiences, perspectives, and needs of parents, carers, or other family members of young people aged 12-25. Searches found 6167 citations, of which 22 papers were included in synthesis. Supporting individuals seek an explanation for and were personally affected by self-harm in young people. It is important that these individuals are themselves supported, especially as they negotiate new identities when handling self-harm in young people, as they attempt to offer support. The GRADE-CERQual confidence in findings is moderate. Recommendations informed by the synthesis findings are made for the future development of interventions. Clinicians and health service providers who manage self-harm in young people should incorporate these identified unmet needs of supporting individuals in a holistic approach to self-harm care. Future research must co-produce and evaluate interventions for supporting individuals

Identification of multiple risk loci and regulatory mechanisms influencing susceptibility to multiple myeloma

Genome-wide association studies (GWAS) have transformed our understanding of susceptibility to multiple myeloma (MM), but much of the heritability remains unexplained. We report a new GWAS, a meta-analysis with previous GWAS and a replication series, totalling 9974 MM cases and 247,556 controls of European ancestry. Collectively, these data provide evidence for six new MM risk loci, bringing the total number to 23. Integration of information from gene expression, epigenetic profiling and in situ Hi-C data for the 23 risk loci implicate disruption of developmental transcriptional regulators as a basis of MM susceptibility, compatible with altered B-cell differentiation as a key mechanism. Dysregulation of autophagy/apoptosis and cell cycle signalling feature as recurrently perturbed pathways. Our findings provide further insight

Linking hydrogeochemistry to nitrate abundance in groundwater in agricultural settings in Ireland

peer-reviewedNitrate (NO3-–N) contamination of groundwater and associated surface waters is an increasingly important global issue with multiple impacts on terrestrial, aquatic and atmospheric environments. Investigation of the distribution of hydrogeochemical variables and their connection with the occurrence of NO3-–N provides better insights into the prediction of the environmental risk associated with nitrogen use within agricultural systems. The research objective was to evaluate the effect of hydrogeological setting on agriculturally derived groundwater NO3-–N occurrence. Piezometers (n = 36) were installed at three depths across four contrasting agricultural research sites. Groundwater was sampled monthly for chemistry and dissolved gases, between February 2009 and January 2011. Mean groundwater NO3-–N ranged 0.7–14.6 mg L−1, with site and groundwater depth being statistically significant (p < 0.001). Unsaturated zone thickness and saturated hydraulic conductivity (Ksat) were significantly correlated with dissolved oxygen (DO) and redox potential (Eh) across sites. Groundwater NO3-–N occurrence was significantly negatively related to DOC and methane and positively related with Eh and Ksat. Reduction of NO3-–N started at Eh potentials <150 mV while significant nitrate reduction occurred <100 mV. Indications of heterotrophic and autotrophic denitrification were observed through elevated dissolved organic carbon (DOC) and oxidation of metal bound sulphur, as indicated by sulphate (SO42-). Land application of waste water created denitrification hot spots due to high DOC losses. Hydrogeological settings significantly influenced groundwater nitrate occurrence and suggested denitrification as the main control.Department of Agriculture, Food and the Marine Ireland - Research Stimulus Fund Programme (Grant RSF 06383); Department of Civil, Structural and Environmental Engineering, Trinity College Dublin

The DNA damage response and immune signaling alliance: Is it good or bad? Nature decides when and where

The characteristic feature of healthy living organisms is the preservation of homeostasis. Compelling evidence highlight that the DNA damage response and repair (DDR/R) and immune response (ImmR) signaling networks work together favoring the harmonized function of (multi)cellular organisms. DNA and RNA viruses activate the DDR/R machinery in the host cells both directly and indirectly. Activation of DDR/R in turn favors the immunogenicity of the incipient cell. Hence, stimulation of DDR/R by exogenous or endogenous insults triggers innate and adaptive ImmR. The immunogenic properties of ionizing radiation, a prototypic DDR/R inducer, serve as suitable examples of how DDR/R stimulation alerts host immunity. Thus, critical cellular danger signals stimulate defense at the systemic level and vice versa. Disruption of DDR/R-ImmR cross talk compromises (multi)cellular integrity, leading to cell-cycle-related and immune defects. The emerging DDR/R-ImmR concept opens up a new avenue of therapeutic options, recalling the Hippocrates quote &quot;everything in excess is opposed by nature. © 2015 Elsevier Inc. All rights reserved

Denitrification and indirect N2O emissions in groundwater: Hydrologic and biogeochemical influences

peer-reviewedIdentification of specific landscape areas with high and low groundwater denitrification potential is critical for improved management of agricultural nitrogen (N) export to ground and surface waters and indirect nitrous oxide (N2O) emissions. Denitrification products together with concurrent hydrogeochemical properties were analysed over two years at three depths at two low (L) and two high (H) permeability agricultural sites in Ireland. Mean N2O–N at H sites were significantly higher than L sites, and decreased with depth. Conversely, excess N2–N were significantly higher at L sites than H sites and did not vary with depth. Denitrification was a significant pathway of nitrate (NO3−–N) reduction at L sites but not at H sites, reducing 46–77% and 4–8% of delivered N with resulting mean NO3−–N concentrations of 1–4 and 12–15 mg N L− 1 at L and H sites, respectively. Mean N2O–N emission factors (EF5g) were higher than the most recent Intergovernmental Panel on Climate Change (IPCC, 2006) default value and more similar to the older IPCC (1997) values. Recharge during winter increased N2O but decreased excess dinitrogen (excess N2–N) at both sites, probably due to increased dissolved oxygen (DO) coupled with low groundwater temperatures. Denitrifier functional genes were similar at all sites and depths. Data showed that highly favourable conditions prevailed for denitrification to occur — multiple electron donors, low redox potential (Eh < 100 mV), low DO (< 2 mg L− 1), low permeability (ks < 0.005 m·d− 1) and a shallow unsaturated zone (< 2 m). Quantification of excess N2–N in groundwater helps to close N balances at the local, regional and global scales.Department of Agriculture, Food and Marine, Ireland - Research Stimulus Fund Programme (Grant RSF 06383); The University of Dublin, Trinity College Dublin