Evaluation of HIV counseling and testing in ANC settings and adherence to short course antiretroviral prophylaxis for PMTCT in Francistown, Botswana

Worldwide, it is estimated that two million children are infected with HIV (USAID 2005). The vast majority of these infections are the result of mother-to-child transmission (MTCT) of the virus during pregnancy, labor, or breastfeeding. However, there are effective methods for prevention of mother-to-child transmission (PMTCT). Botswana is one of the first countries in the developing world with a national PMTCT program that uses an efficacious and complex regimen to reduce vertical transmission. At the time of this evaluation (August - December 2005), the standard of care for prevention of MTCT of HIV in Botswana included three-drug antiretroviral therapy for HIV-infected women with a CD4 count of 200 (300 mg AZT in the morning and 300 mg AZT in the evening); four weeks of AZT for their infants; single-dose maternal and infant nevirapine (NVP); and 12 months of free infant formula. Botswana's PMTCT program also provided routine HIV testing for all pregnant women during antenatal care (ANC) to identify HIV-positive women for prophylaxis or treatment. While programs often report the number of individuals beginning AZT and receiving nevirapine for PMTCT, effectiveness is dependent on the level of adherence of individuals to these regimens. To describe adherence of pregnant women to the current PMTCT regimen, the Horizons Program of the Population Council, in collaboration with the Centers for Disease Control and Prevention (CDC) and Premiere Personnel in Botswana, conducted an evaluation to describe HIV-related services provided to women during their pregnancies, document the content of post-test counseling sessions for HIV-positive pregnant women, whether HIV-positive women remembered what had been discussed, the extent of AZT adherence based on self-reports, and the operational successes and barriers to adherence to AZT for PMTCT

Norse Animal Husbandry in Liminal Environments: Stable Isotope Evidence from the Scottish North Atlantic Islands

This paper employs ?13C and ?15N analysis of bone collagen to explore animal management at large Norse settlement sites in the liminal environments of the Scottish North Atlantic Islands. The Norse period was a time of social, cultural and economic change; the need to feed an expanding population and the demand for trade meant that domestic stock were a crucial resource. Our results indicate that rearing animals in these challenging insular environments required careful management. At all sites, the diet and movement of domestic cattle and sheep were highly similar and carefully controlled and, despite many of the analysed settlements lying close to the coast, there was no use of shorefront grazing or fodder resources. In contrast, pig rearing strategies varied across the island groups. In the Western Isles pig diets were diverse, indicative of household or ad hoc management, whilst on Orkney all pigs consumed a more restricted diet based primarily on terrestrial protein. A comparison of red deer with domestic stock on the Western Isles indicates that both groups were exploiting similar grazing niches.This research was undertaken by the authors at Cardiff University as part of a PhD project. The authors would like to thank Natural Environment Research Council (NERC) for funding this research [grant number NE/ F021054/1, PI Richard Evershed], and the NERC Life Sciences Mass Spectrometry Facility in East Kilbride [grant number EK158-03/10] for their financial assistance to analyse these specimens

A case study of school age female minority athletes who became pregnant

The purpose of this study is to provide an in-depth understanding of \u27\u27What had happened to the urban minority female athletes who became pregnant while playing high school basketball?\u27\u27 The study wanted to provide a qualitative analysis of rich narrative data collected from questionnaire interviews of two separate groups (one in Pittsburgh, the other in New York City). The findings of this study suggest that in fact urban female African-Americans athletes still received benefits from sports participation

Vascular remodeling of the mouse yolk sac requires hemodynamic force

The embryonic heart and vessels are dynamic and form and remodel while functional. Much has been learned about the genetic mechanisms underlying the development of the cardiovascular system, but we are just beginning to understand how changes in heart and vessel structure are influenced by hemodynamic forces such as shear stress. Recent work has shown that vessel remodeling in the mouse yolk sac is secondarily effected when cardiac function is reduced or absent. These findings indicate that proper circulation is required for vessel remodeling, but have not defined whether the role of circulation is to provide mechanical cues, to deliver oxygen or to circulate signaling molecules. Here, we used time-lapse confocal microscopy to determine the role of fluid-derived forces in vessel remodeling in the developing murine yolk sac. Novel methods were used to characterize flows in normal embryos and in embryos with impaired contractility (Mlc2a^(–/–)). We found abnormal plasma and erythroblast circulation in these embryos, which led us to hypothesize that the entry of erythroblasts into circulation is a key event in triggering vessel remodeling. We tested this by sequestering erythroblasts in the blood islands, thereby lowering the hematocrit and reducing shear stress, and found that vessel remodeling and the expression of eNOS (Nos3) depends on erythroblast flow. Further, we rescued remodeling defects and eNOS expression in low-hematocrit embryos by restoring the viscosity of the blood. These data show that hemodynamic force is necessary and sufficient to induce vessel remodeling in the mammalian yolk sa

Multidecadal increase in plastic particles in coastal ocean sediments.

We analyzed coastal sediments of the Santa Barbara Basin, California, for historical changes in microplastic deposition using a box core that spanned 1834-2009. The sediment was visually sorted for plastic, and a subset was confirmed as plastic polymers via FTIR (Fourier transform infrared) spectroscopy. After correcting for contamination introduced during sample processing, we found an exponential increase in plastic deposition from 1945 to 2009 with a doubling time of 15 years. This increase correlated closely with worldwide plastic production and southern California coastal population increases over the same period. Increased plastic loading in sediments has unknown consequences for deposit-feeding benthic organisms. This increase in plastic deposition in the post-World War II years can be used as a geological proxy for the Great Acceleration of the Anthropocene in the sedimentary record

2013 Applied Projects Evaluation Organizational Impact Report

University of San Diego’s Nonprofit Leadership and Management (NLM) master’s degree program places a special focus on experiential learning, requiring students to complete multiple applied projects as part of the program’s curriculum. Applied projects give students various opportunities to work in teams to provide real-world consulting services to nonprofit and philanthropic organizations. In developing this curriculum, the NLM program serves both the students who are given these real-world consulting opportunities, as well as the client organizations who benefit from the services provided by the students. In Fall 2010, the University of San Diego’s NLM program initiated an Applied Projects Evaluation to better understand and continuously track the effectiveness of these applied student projects, as perceived by the nonprofit and philanthropic client organizations. Thus, the Applied Projects Evaluation serves as a client-feedback mechanism for monitoring how well the client organizations feel the applied projects program is functioning overall. This ongoing evaluation study is designed and managed by The Caster Center for Nonprofit and Philanthropic Research at the University of San Diego. This Organizational Impact Report summarizes the results of the past five semesters (Spring 2011 to Spring 2013), in which 131 applied projects were completed. Online surveys were sent to the client representative from each of the 131 participating organizations approximately four to six months following the completion of the applied project. A cumulative total of 82 organizations responded, representing a cumulative response rate of 63%.https://digital.sandiego.edu/npi-appliedprojects/1000/thumbnail.jp

Proportional Consistency of Apportionment Methods

We analyze a little-known property of apportionment methods that captures how allocations scale with the size of the house: specifically, if, for a fixed population distribution, the house size and allocation can be scaled down within the set of integers, then the apportionment should be correspondingly scaled down. Balinski and Young (2001) include this property among the minimal requirements for a "reasonable" apportionment method. We argue that this property is better understood as a consistency requirement since quota-based apportionments that are "less proportional" meet this requirement while others that are "more proportional" do not. We also show that the family of quotatone methods based on stationary divisors (including the quota method) do not satisfy this property

Success for People with Disabilities after Postsecondary Education

Success may be defined in numerous ways and may be linked to quality of life. Individuals with disabilities often find success difficult to achieve. Postsecondary education has been shown to improve individual quality of life. Does a professional life obtained through postsecondary education provide individuals with disabilities entree to a better quality of life? How does this play out in the life of a person with a disability? This study reports on interviews with both people with and without disabilities and their perceptions of both success and quality of life. The findings stress how important it is to facilitate access and support in the pursuit of a postsecondary education for individuals with disabilities

Cost-Effectiveness of an Emergency Department Based Early Sepsis Resuscitation Protocol

Background Guidelines recommend that sepsis be treated with an early resuscitation protocol, such as early goal directed therapy (EGDT). Our objective was to assess the cost-effectiveness of implementing EGDT as a routine protocol. Design Prospective before and after study. Setting Large urban hospital ED with >110,000 visits/year. Patients The target population was patients with consensus criteria for septic shock. We excluded those with age <18 yrs, no aggressive care desired, or need for immediate surgery. Interventions Clinical and cost data were prospectively collected on two groups: 1) patients from 1 yr before and 2) 2 yrs after implementing EGDT as standard-of-care. Before phase patients received nonprotocolized care at attending discretion. The primary outcomes were one year mortality, discounted life expectancy, and quality adjusted life years (QALYs). Using costs and QALYs, we constructed an incremental cost-effectiveness ratio and performed a net monetary benefit (NMB) analysis, producing the probability that the intervention was cost-effective given different values for the willingness to pay for a QALY. Results 285 subjects, 79 in the before and 206 in the after phases, were enrolled. Treatment with EGDT was associated with an increased hospital cost of $7028 and an increase in both discounted sepsis-adjusted life expectancy and QALYs of 1.5 and 1.3 yrs, respectively. EGDT use was associated with a cost of$5397 per QALY gained and the NMB analysis indicates a 98% probability (p = .038) that EGDT is cost-effective at a willingness to pay of $50,000 per QALY. Conclusion Implementation of EGDT in the ED care of severe sepsis patients is cost effective