Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa

Abstract Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally

A Locus on Chromosome 5 Is Associated with Dilated Cardiomyopathy in Doberman Pinschers

Dilated cardiomyopathy (DCM) is a heterogeneous group of heart diseases with a strong genetic background. Currently, many human DCM cases exist where no causative mutation can be identified. DCM also occurs with high prevalence in several large dog breeds. In the Doberman Pinscher a specific DCM form characterized by arrhythmias and/or echocardiographic changes has been intensively studied by veterinary cardiologists. We performed a genome-wide association study in Doberman Pinschers. Using 71 cases and 70 controls collected in Germany we identified a genome-wide significant association to DCM on chromosome 5. We validated the association in an independent cohort collected in the United Kingdom. There is no known DCM candidate gene under the association signal. Therefore, DCM in Doberman Pinschers offers the chance of identifying a novel DCM gene that might also be relevant for human health

Insight in modulation of inflammation in response to diclofenac intervention: a human intervention study

Background. Chronic systemic low-grade inflammation in obese subjects is associated with health complications including cardiovascular diseases, insulin resistance and diabetes. Reducing inflammatory responses may reduce these risks. However, available markers of inflammatory status inadequately describe the complexity of metabolic responses to mild anti-inflammatory therapy. Methods. To address this limitation, we used an integrative omics approach to characterize modulation of inflammation in overweight men during an intervention with the non-steroidal anti-inflammatory drug diclofenac. Measured parameters included 80 plasma proteins, >300 plasma metabolites (lipids, free fatty acids, oxylipids and polar compounds) and an array of peripheral blood mononuclear cells (PBMC) gene expression products. These measures were submitted to multivariate and correlation analysis and were used for construction of biological response networks. Results. A panel of genes, proteins and metabolites, including PGE2 and TNF-alpha, were identified that describe a diclofenac-response network (68 genes in PBMC, 1 plasma protein and 4 plasma metabolites). Novel candidate markers of inflammatory modulation included PBMC expression of annexin A1 and caspase 8, and the arachidonic acid metabolite 5,6-DHET. Conclusion. In this study the integrated analysis of a wide range of parameters allowed the development of a network of markers responding to inflammatory modulation, thereby providing insight into the complex process of inflammation and ways to assess changes in inflammatory status associated with obesity. Trial registration. The study is registered as NCT00221052 in clinicaltrials.gov database. © 2010 van Erk et al; licensee BioMed Central Ltd

Safety, tolerability, pharmacokinetics, and immunological activity ...

This phase 1 study showed the feasibility of combining anti-HIV bnAbs targeting different sites on the HIV envelope in people living without HIV. It also showed that the dual-antibody and triple-antibody combinations were as effective as the individual antibodies at neutralisation, thus justifying a combination approach going forward for additional monoclonal antibody studies for HIV prevention. The fact that modelling predicted the combination neutralisation titre on the basis of the single antibody titres will be valuable for future trial design of different antibody combinations

Quantifying crop pollinator-dependence and pollination deficits: the effects of experimental scale on yield and quality assessments

Many crops are known to be dependent on biotic pollination, but knowledge gaps remain regarding the extent of this dependence, how it varies between crop varieties, and the implications of biotic pollination for crop quality. Data is also lacking on the prevalence and extent of pollination deficits and the ability of the surrounding pollinator community to provide pollination services. Robust and standardised methodologies are crucial for pollination studies. However, there has been only limited research into the critical question of the appropriate scale to apply these methods. Here, we use a commercially important UK apple Malus domestica variety (Gala) to address the questions of pollinator-dependence and pollination deficits, quality benefits arising from pollination, and the implications of conducting pollination experiments at three different scales: the inflorescence, the branch, and the whole plant. We found that Gala apple production was highly dependent on biotic pollination: overall, pollinator exclusion reduced fruit set at harvest to 55% of open pollination levels, whilst supplementary pollination led to fruit set of 167%. However, significant differences were found between the inflorescence, branch, and tree experiments; with increasing scale of observation leading to a lower measure of pollinator-dependence and pollination deficit. At the inflorescence scale, fruit set at harvest was just 13% of normal levels following pollinator exclusion, whilst at the branch and tree scales it was 75% and 79% of normal levels respectively. Supplementary pollination led to fruit set of 218%, 172%, and 117% of normal rates at the inflorescence, branch, and tree scales respectively. Apple seed set was also significantly affected by pollination treatment and the extent of this effect also depended on experimental scale. These differences due to experimental scale are likely a combination of methodological, biological and crop management factors. Seed numbers were shown to be a very good indicator of a number of fruit quality parameters, with greater seed numbers resulting in greater production of Class 1 (i.e. top commercial value) fruit. It is recommended that to measure pollinator-dependence and pollination deficits, experiments are conducted at the largest scale practicable and that treatment effects are monitored until harvest to more accurately reflect final yield outcomes. For apples, growers are recommended to record seed number as part of their fruit quality monitoring programmes to give a rapid and easy to measure indication of potential pollination deficit

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Becoming bird : creative pedagogies for future-making education?

This chapter explores the mattering of science and art creativities for futuremaking education through the transnational project Naming the world: Enhancing early years literacy and sustainability learning. Set in the context of the new geological age of the Anthropocene, the project was informed by posthuman and new materialist theorising, and the proliferation of ways these have been applied in early years learning. It is based on the belief that children of the Anthropocene will grow into a different future than the one we now know, so we need to learn with them and from them, in their everyday worlds. Through researching in collaboration with these children Naming the world seeks new ways of being, knowing and doing, and emergent creative pedagogies for future-making education. It troubles power politics and policy by transforming the power dynamics between university and practitioner researchers and through engaging with young children as a source of knowledge production and decision making. The project was implemented in two phases: in the first phase university researchers collaborated with young children (0–5 years), through a process of deep hanging out. In the second phase children and educator researchers developed creative pedagogies in response. The chapter outlines the methodological and theoretical underpinnings of Phase 1, in “posthuman” and “new materialist approaches”, and Despret’s “curious practice”. The difficult transition in between is explored as a liminal space of unknowing, a necessary space to enable transformative practices to emerge. The chapter also explores the emergent creative pedagogies that came into being through one of the projects from Phase 2: What can we see outside? (Becoming Bird Project). Through this project, new configurings emerged when Australian Indigenous ecophilosophies came into play, emphasising the necessity of emergence from unknowing for future-making education

Xylem Anatomy and Hydraulic Conductivity of Psuedotsuga menziesii var. glauca Along an Elevation Gradient

The causes of lower treelines in the Intermountain West are not entirely understood. Little is known about how conifer trees adjust their structural morphology at lower treeline as they experience increased drought-conditions with decreasing elevation. We hypothesized that as elevation decreases, hydraulic transport capability decreases, because trees design their xylem structure more for safety against cavitation rather than for transport efficiency under drier conditions. To test this hypothesis, branch samples were collected from Rocky Mountain Douglas-fir trees (Pseudotsuga menziesii var. glauca) along an elevation gradient from 1700 m elevation to 2100 m elevation. Cross sections were then sliced off of the Douglas-fir tree branches and placed onto microscope slides. The cross sections were then imaged with a confocal microscope and uploaded to an image analysis program (ImageJ) . Using ImageJ, the number of growth rings, ring width (mm), number of trachieds, trachied area (mm), and trachied density were determined for each cross section. We found that Rocky Mountain Douglas-fir make adjustments in various hydraulic and morphological parameters at the branch-level with decreasing elevation. Branches at lower treeline had structural characteristics that suggested greater resistance to hydraulic dysfunction created by increasing xylem tension, but also exhibit trade-offs in decreased water transport efficiency. These elevation gradients had a clear effect on branch hydraulic transport ability and morphological traits