Beta: Bioprinting engineering technology for academia

Higher STEM education is a field of growing potential, but too many middle school and high school students are not testing proficiently in STEM subjects. The BETA team worked to improve biology classroom engagement through the development of technologies for high school biology experiments. The BETA project team expanded functionality of an existing product line to allow for better student and teacher user experience and the execution of more interesting experiments. The BETA project’s first goal was to create a modular incubating Box for the high school classroom. This Box, called the BETA Box was designed with a variety of sensors to allow for custom temperature and lighting environments for each experiment. It was completed with a clear interface to control the settings and an automatic image capture system. The team also conducted a feasibility study on auto calibration and dual-extrusion for SE3D’s existing 3D bioprinter. The findings of this study led to the incorporation of a force sensor for auto calibration and the evidence to support the feasibility of dual extrusion, although further work is needed. These additions to the current SE3D educational product line will increase effectiveness in the classroom and allow the target audience, high school students, to better engage in STEM education activities

Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Adherence is a necessary part of successful antiretroviral treatment (ART). We assessed risk factors for incomplete adherence among a cohort of HIV-infected women initiating ART and examined associations between adherence and virologic response to ART.</p> <p>Methods</p> <p>A secondary data analysis was conducted on a cohort of 154 women initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART at a single site in Johannesburg, South Africa. Ninety women had been enrolled in a prevention of mother-to-child transmission (pMTCT) program and were exposed to single-dose nevirapine (sdNVP) >18 months earlier. Women were interviewed pre-treatment and clinical, virologic and adherence data were collected during follow-up to 24 weeks. Incomplete adherence to ART was defined as returning >5% of medications, estimated by pill counts at scheduled visits. Multivariable logistic regression analysis and unadjusted odds ratio (95%CI) were performed, using STATA/SE (ver 10.1).</p> <p>Results</p> <p>About half of the women (53%) were <30 years of age, 63% had <11 years of schooling, 69% were unemployed and 37% lived in a shack. Seven percent of women had a viral load >400 copies/ml at 24 weeks and 37% had incomplete adherence at one or more visits. Incomplete adherence was associated with less education (p = 0.01) and lack of financial support from a partner (p = 0.02) after adjustment for confounders. Only when adherence levels dropped below 80% was there a significant association with viremia in the group overall (p = 0.02) although adherence <95% was associated with viremia in the sdNVP-exposed group (p = 0.03). The main reasons for incomplete adherence were being away from home, busy with other things and forgetting to take their medication.</p> <p>Conclusion</p> <p>Virologic response to NNRTI-treatment in the cohort was excellent. However, women who received sdNVP were at greater risk of virologic failure when adherence was <95%. Women exposed to sdNVP, and those with less education and less social support may benefit from additional adherence counseling to ensure the long-term success of ART. More than 80% adherence may be sufficient to maintain virologic suppression on NNRTI-based regimens in the short-term, however complete adherence should be encouraged.</p

Rapid antiretroviral therapy initiation in the Botswana Combination Prevention Project: a quasi-experimental before and after study.

BACKGROUND: Ensuring that individuals who are living with HIV rapidly initiate antiretroviral therapy (ART) is an essential step in meeting the 90-90-90 targets. We evaluated the feasibility and outcomes of rapid ART initiation in the Botswana Combination Prevention Project (BCPP). We aimed to establish whether simplified ART initiation with the offer of same-day treatment could increase uptake and reduce time from clinic linkage to treatment initiation, while maintaining rates of retention in care and viral suppression. METHODS: We did a quasi-experimental before and after study with use of data from the BCPP. The BCPP was a community-randomised HIV-prevention trial done in 30 communities across Botswana from Oct 1, 2013, to June 30, 2018. Participants in the 15 intervention clusters, who were HIV-positive and not already taking ART were offered universal HIV-treatment and same-day ART with a dolutegravir-based regimen at first clinic visit. This rapid ART intervention was implemented mid-way through the trial on June 1, 2016, enabling us to determine the effect of rapid ART guidelines on time to ART initiation and rates of retention in care and viral suppression at 1 year in the BCPP intervention group. FINDINGS: We assessed 1717 adults linked to study clinics before rapid ART introduction and 800 after rapid ART introduction. During the rapid ART period, 457 (57·1%, 95% CI 53·7-60·6) individuals initiated ART within 1 day of linkage, 589 (73·7%, 70·6-76·7) of 799 within 1 week, 678 (84·9%, 82·4-87·3) of 799 within 1 month, and 744 (93·5%, 91·6-95·1) of 796 within 1 year. Before the introduction of rapid ART, 163 (9·5%, 95% CI 8·2-11·0) individuals initiated ART within 1 day of linkage, 276 (16·1%, 14·4-17·9) within 1 week, 839 (48·9%, 46·5-51·3) within 1 month, and 1532 (89·2%, 87·7-90·6) within 1 year. 1 year after ART initiation, 1472 (90·5%, 87·4-92·8) of 1627 individuals who linked in the standard ART period were in care and had a viral load of less than 400 copies per mL, compared with 578 (91·6%, 88·1-94·1) of 631 in the rapid ART period (risk ratio 1·01, 95% CI 0·92-1·11). INTERPRETATION: Our findings provide support for the WHO recommendations for rapid ART initiation, and add to the accumulating evidence showing the feasibility, acceptability, and safety of rapid ART initiation in low-income and middle-income country settings. FUNDING: US President's Emergency Plan for AIDS Relief

Multifarious Transnational Engagements of Contemporary Diaspora Members: From Revolving-door Universalists to Multi-nationals and Site-Hopping Vagabonds

Drawing on recent studies of diaspora and its members’ transnational engagements, which treat the former as fuzzy-boundary, context-dependent groupings, and the latter as multi-faceted (rather than two-pronged) relationships, in this paper I explore the notion of diasporans’ polymorphous and multi-directional transnational commitments; identify different types of such involvements; and propose a preliminary list of macro- and micro-level circumstances contributing to multifarious transnationalism. In conclusion, I consider the implications of the notion of diaspora members’ multifarious transnational engagements for the study of (im)migrant transnationalism in general and suggest some interesting questions for future research on this phenomenon generated by this discussion

Community wildfire protection plans in the American West

2 pagesLarge wildfires are increasingly common in the American West. The federal government is responsible for the majority of suppression costs, and has a significant interest in policies that can improve resilience at the community level. The Healthy Forests Restoration Act (HFRA) of 2003 encourages communities to complete Community Wildfire Protection Plans (CWPPs). While not mandatory, CWPPs give communities access to federal and state funding for activities highlighted in plans. HFRA allows flexibility to adapt plans to local contexts; however, little is known about whether communities have capitalized on the opportunity to develop site-specific plans that meet the needs of individual communities. This research analyzed CWPP structure and content to better understand variability between plans.This research was supported by funding from the USDA National Institute for Food and Agriculture, Grant #2011- 67023-30695

Re-Envisioning Community-Wildfire Relations in the U.S. West as Adaptive Governance

Prompted by a series of increasingly destructive, expensive, and highly visible wildfire crises in human communities across the globe, a robust body of scholarship has emerged to theorize, conceptualize, and measure community-level resilience to wildfires. To date, however, insufficient consideration has been given to wildfire resilience as a process of adaptive governance mediated by institutions at multiple scales. Here we explore the possibilities for addressing this gap through an analysis of wildfire resilience among wildland-urban interface communities in the western region of the United States. We re-engage important but overlooked components of social-ecological system resilience by situating rural communities within their state-to national-level institutional contexts; we then analyze two communities in Nevada and New Mexico in terms of their institutional settings and responses to recent wildfire events. We frame our analysis around the concepts of scale matching, linking within and across scales, and institutional flexibility

A randomized trial of multivitamin supplements and HIV disease progression and mortality.

BACKGROUND: Results from observational studies suggest that micronutrient status is a determinant of the progression of human immunodeficiency virus (HIV) disease. METHODS: We enrolled 1078 pregnant women infected with HIV in a double-blind, placebo-controlled trial in Dar es Salaam, Tanzania, to examine the effects of daily supplements of vitamin A (preformed vitamin A and beta carotene), multivitamins (vitamins B, C, and E), or both on progression of HIV disease, using survival models. The median follow-up with respect to survival was 71 months (interquartile range, 46 to 80). RESULTS: Of 271 women who received multivitamins, 67 had progression to World Health Organization (WHO) stage 4 disease or died--the primary outcome--as compared with 83 of 267 women who received placebo (24.7 percent vs. 31.1 percent; relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.98; P=0.04). This regimen was also associated with reductions in the relative risk of death related to the acquired immunodeficiency syndrome (0.73; 95 percent confidence interval, 0.51 to 1.04; P=0.09), progression to WHO stage 4 (0.50; 95 percent confidence interval, 0.28 to 0.90; P=0.02), or progression to stage 3 or higher (0.72; 95 percent confidence interval, 0.58 to 0.90; P=0.003). Multivitamins also resulted in significantly higher CD4+ and CD8+ cell counts and significantly lower viral loads. The effects of receiving vitamin A alone were smaller and for the most part not significantly different from those produced by placebo. Adding vitamin A to the multivitamin regimen reduced the benefit with regard to some of the end points examined. CONCLUSIONS: Multivitamin supplements delay the progression of HIV disease and provide an effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women