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Background. There is a paucity of data on the risk factors for the hyperosmolar hyperglycemic state (HHS) compared with diabetic ketoacidosis (DKA) in pediatric type 2 diabetes (T2D). Methods. We used the national Kids' Inpatient Database to identify pediatric admissions for DKA and HHS among those with T2D in the years 2006, 2009, 2012, and 2019. Admissions were identified using ICD codes. Those aged <9yo were excluded. We used descriptive statistics to summarize baseline characteristics and Chi-squared test and logistic regression to evaluate factors associated with admission for HHS compared with DKA in unadjusted and adjusted models. Results. We found 8,961 admissions for hyperglycemic emergencies in youth with T2D, of which 6% were due to HHS and 94% were for DKA. These admissions occurred mostly in youth 17–20 years old (64%) who were non-White (Black 31%, Hispanic 20%), with public insurance (49%) and from the lowest income quartile (42%). In adjusted models, there were increased odds for HHS compared to DKA in males (OR 1.77, 95% CI 1.42–2.21) and those of Black race compared to those of White race (OR 1.81, 95% CI 1.34–2.44). Admissions for HHS had 11.3-fold higher odds for major or extreme severity of illness and 5.0-fold higher odds for mortality. Conclusion. While DKA represents the most admissions for hyperglycemic emergencies among pediatric T2D, those admitted for HHS had higher severity of illness and mortality. Male gender and Black race were associated with HHS admission compared to DKA. Additional studies are needed to understand the drivers of these risk factors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate changes in insulin pump use over two decades in a national U.S. sample. Research Design and Methods: We used data from the SEARCH for Diabetes in Youth study to perform a serial cross-sectional analysis to evaluate changes in insulin pump use in participants <20 years old with type 1 diabetes by race/ethnicity and markers of socioeconomic status across four time periods between 2001 and 2019. Multivariable generalized estimating equations were used to assess insulin pump use. Temporal changes by subgroup were assessed through interactions. Results: Insulin pump use increased from 31.7% to 58.8%, but the disparities seen in pump use persisted and were unchanged across subgroups over time. Odds ratio for insulin pump use in Hispanic (0.57, confidence interval [95% CI] 0.45–0.73), Black (0.28, 95% CI 0.22–0.37), and Other race (0.49, 95% CI 0.32–0.76) participants were significantly lower than White participants. Those with ≤high school degree (0.39, 95% CI 0.31–0.47) and some college (0.68, 95% CI 0.58–0.79) had lower use compared to those with ≥bachelor's degree. Those with public insurance (0.84, 95% CI 0.70–1.00) had lower use than those with private insurance. Those with an annual household income <$25K (0.43, 95% CI 0.35–0.53), $25K–$49K (0.52, 95% CI 0.43–0.63), and $50K–$74K (0.79, 95% CI 0.66–0.94) had lower use compared to those with income ≥$75,000. Conclusion: Over the past two decades, there was no improvement in the racial, ethnic, and socioeconomic inequities in insulin pump use, despite an overall increase in use. Studies that evaluate barriers or test interventions to improve technology access are needed to address these persistent inequities. [ABSTRACT FROM AUTHOR]

The main objective of this article is to assess the indicators of quality of working life (QWL) for academics and compare indicators of QWL in public universities in Brazil and Canada. The sample of this study consists of 205 professors of Minas Gerais and 269 from Quebec. Data were collected through an online questionnaire administered in February and March 2013.Three significant differences were found between the two samples: the meaning at work, affective commitment and continuance commitment. Brazilian professors seem to find more meaning in work than Canadian professors and they have more affective commitment with their institutions. [ABSTRACT FROM AUTHOR]

Objectives Febrile neutropenia (FN) creates concern in paediatrics due to the risk of serious bacterial infections (SBI). Protocols with empiric antibiotics designed for hematology and oncology are often applied in healthy children with FN despite lower rates of SBI in this population. This study quantifies rates of infections in presumed immunocompetent children hospitalized with suspected viral illnesses and FN. Methods This was a retrospective chart review of healthy children admitted to the Stollery Children's Hospital between 2007 and 2017 with fever, absolute neutrophil counts < 0.5 × 109/L, and viral symptoms. Primary outcomes were the incidence of SBI and bacterial pneumonia. Results Of 383 encounters reviewed, 96 admissions for 82 patients met inclusion criteria. Eighty-eight encounters (91.7%) were managed with empiric antibiotics. Viruses were identified in 42% of encounters. Three blood cultures were positive for coagulase-negative Staphylococcus and one for Coryneforms, all considered contaminants. There were three urinary tract infections and two pneumonias. Eighty-three per cent of patients had normalization of neutrophil counts, with a median neutropenia duration of 3.2 months. Follow-up diagnoses included chronic benign neutropenia of childhood (N = 17) and three rheumatologic/autoimmune conditions (N = 3). Conclusion Our results support previous findings of low rates of invasive bacterial infections in healthy children with FN. With an SBI rate of 3.1% and few patients found to have any pathologic etiology for their neutropenia, prospective studies would be valuable to evaluate the need for a practice change regarding antibiotic use in low-risk patients with suspected viral-induced neutropenia. [ABSTRACT FROM AUTHOR]

The Medical-Surgical Nursing Certification Board (MSNCB®) is a professional organization whose mission is to validate excellence in medical-surgical nursing. MSNCB administers the Certified Medical-Surgical Registered Nurse (CMSRN®) certification program because certification is the recognized path for registered nurses to build and demonstrate commitment, confidence, and credibility. Certification provides an added credential beyond licensure. It demonstrates, by examination, that the registered nurse adheres to specialized nursing standards and has acquired a core body of specialized knowledge in their practice or specialty. For more information about MSNCB, visit www.amsn.org. [ABSTRACT FROM AUTHOR]

Introduction: A global strategy of mass drug administration (MDA) has greatly reduced the burden of lymphatic filariasis (LF) in endemic countries. In Madagascar, the National Programme to eliminate LF has scaled-up annual MDA of albendazole and diethylcarbamazine across the country in the last decade, but its impact on LF transmission has never been reported. The objective of this study was to evaluate progress towards LF elimination in southeastern Madagascar. Methods: Three different surveys were carried out in parallel in four health districts of the Vatovavy Fitovinany region in 2016: i) a school-based transmission assessment survey (TAS) in the districts of Manakara Atsimo, Mananjary, and Vohipeno (following a successful pre-TAS in 2013); ii) a district-representative community prevalence survey in Ifanadiana district; and iii) a community prevalence survey in sentinel and spot-check sites of these four districts. LF infection was assessed using the Alere Filariasis Test Strips, which detect circulating filarial antigens (CFA) of adult worms. A brief knowledge, attitudes and practices questionnaire was included in the community surveys. Principal findings: None of the 1,825 children sampled in the TAS, and only one in 1,306 children from sentinel and spot-check sites, tested positive to CFA. However, CFA prevalence rate in individuals older than 15 years was still high in two of these three districts, at 3.5 and 9.7% in Mananjary and Vohipeno, respectively. Overall CFA prevalence in sentinel and spot-check sites of these three districts was 2.80% (N = 2,707), but only two individuals had detectable levels of microfilaraemia (0.06%). Prevalence rate estimates for Ifanadiana were substantially higher in the district-representative survey (15.8%; N = 545) than in sentinel and spot-check sites (0.8%; N = 618). Only 51.2% of individuals surveyed in these four districts reported taking MDA in the last year, and 42.2% reported knowing about LF. Conclusions: Although TAS results suggest that MDA can be stopped in three districts of southeastern Madagascar, the adult population still presents high CFA prevalence levels. This discordance raises important questions about the TAS procedures and the interpretation of their results. [ABSTRACT FROM AUTHOR]

• Organic micropollutant removal by aerobic methanotrophs was assessed. • CH 4 load positively correlated with sulfamethoxazole and 1H-benzotriazol removal. • Methylomonas was the main methanotroph and dominated the biofilm. • Microbial biomass accumulated protein as 39% CDW on average. Pharmaceuticals and other organic micropollutants (OMPs) present in wastewater effluents are of growing concern, as they threaten environmental and human health. Conventional biological treatments lead to limited removal of OMPs. Methanotrophic bacteria can degrade a variety of OMPs. By employing a novel bubble-free hybrid membrane biofilm bioreactor (hMBfR), we grew methanotrophic bacteria at three CH 4 loading rates. Biomass productivity and CH 4 loading showed a linear correlation, with a maximum productivity of 372 mg-VSS·L−1·d−1, with corresponding biomass concentration of 1117.6 ± 56.4 mg-VSS·L−1. Furthermore, the biodegradation of sulfamethoxazole and 1H-benzotriazole positively correlated with CH 4 oxidation rates, with highest biodegradation kinetic constants of 3.58 L·g−1·d−1 and 5.42 L·g−1·d−1, respectively. Additionally, the hMBfR recovered nutrients as microbial proteins, with an average content 39% DW. The biofilm community was dominated by Methylomonas , while the bulk was dominated by aerobic heterotrophic bacteria. The hMBfR removed OMPs, allowing for safer water reuse while valorising CH 4 and nutrients. [ABSTRACT FROM AUTHOR]

[Display omitted] • Short SRT denitrifying activated sludge system fully denitrified at 3 days SRT. • Low sludge volume index (<25 mL mg−1) was achieved after sludge degassing. • Sludge yields were comparable to the aerobic high rate activated sludge system. • Produced sludge had higher methane yield than conventional activated sludge. • Protein content was in the low range for aerobic high rate activated sludge systems. High rate activated sludge (HRAS) systems redirect organics into highly biodegradable sludge and nutrients into microbial proteins. This study evaluates anoxic HRAS for nitrogen and carbon recovery. The reactor treated synthetic wastewater at solids retention times (SRTs) of 5, 3 and 1 days. Denitrification rates varied between 0.15 and 0.19 g-NO 3 -N g-TSS-1 d-1 (total suspended solids per day) and all conditions showed favourable settling. The highest sludge yield, obtained at SRT 1 d, was 0.75 g-TSS g-COD removed -1, double that observed for aerobic HRAS. The highest methane yield (322 mL-CH 4 g-VS sludge -1) was obtained from sludge wasted at 3 d SRT. Both 1 d and 3 d SRTs showed favourable energy recovery, with 14 % of the organics recovered as methane. All conditions yielded sludge with protein content ranging between 24 and 27 % of dry weight and similar amino acid profile, comparable to traditional proteins. Thus, denitrifying HRAS recovers resources as its aerobic counterpart, allowing for nitrogen removal via denitrification, more stable compared to mainstream partial nitritation anammox typically combined with aerobic HRAS. [ABSTRACT FROM AUTHOR]

This study assesses quality of working life (QWL) factors among professors working in Brazil and Canada, and correlates them with the meaning of work. The sample consisted of 274 Brazilian professors and 252 Canadian professors. Data were collected through an online questionnaire sent to three public universities in Minas Gerais and three universities of Quebec, in the first half of 2013. Through the questionnaire, the following factors were evaluated: work purpose, autonomy, opportunities for professional development, relationship with colleagues, moral righteousness, recognition, job security, workload and working hours per day and per week; these were then correlated with the "meaning of work" and "meaning at work" indicators. Canadian professors perceived more autonomy, professional development opportunities and recognition in the workplace than Brazilian professors. On the other hand, mental workload and working hours per week were higher in the federal universities of Minas Gerais than in the universities in Québec. Factors describing the characteristics of work and work relations were positively related to the meaning of work, while physical and mental loads were negatively related to the meaning of work. [ABSTRACT FROM AUTHOR]

The main objective of this article is to assess the indicators of quality of working life (QWL) for academics and compare indicators of QWL in public universities in Brazil and Canada. The sample of this study consists of 205 professors of Minas Gerais and 269 from Quebec. Data were collected through an online questionnaire administered in February and March 2013.Three significant differences were found between the two samples: the meaning at work, affective commitment and continuance commitment. Brazilian professors seem to find more meaning in work than Canadian professors and they have more affective commitment with their institutions. [ABSTRACT FROM AUTHOR]

Objective: Verbal autopsies (VAs) are interviews with a relative or friend of the deceased; VAs are a technique used in surveillance sites in many countries with incomplete death certification. The goal of this study was to assess the accuracy and validity of data on HIV status and antiretroviral therapy (ART) usage reported in VAs and their influence on physician attribution of cause of death. Design: This was a prospective cohort study Methods: The Karonga Health and Demographic Surveillance Site monitors demographic events in a population in a rural area of northern Malawi; a VA is attempted on all deaths reported. VAs are reviewed by clinicians, who, with additional HIV test information collected pre-mortem, assign a cause of death. We linked HIV/ART information reported by respondents during adult VAs to database information on HIV testing and ART use and analysed agreement using chi-square and kappa statistics. We used multivariable logistic regression to analyse factors associated with agreement. Results: From 2003 to 2014, out of a total of 1,952 VAs, 80% of respondents reported the HIV status of the deceased. In 2013-2014, this figure was 99%. Of those with an HIV status known to the study, there was 89% agreement on HIV status between the VA and pre-mortem data, higher for HIV-negative people (92%) than HIV-positive people (83%). There was 84% agreement on whether the deceased had started ART, and 72% of ART initiation dates matched within 1 year. Conclusions: In this population, HIV/ART information was often disclosed during a VA and matched well with other data sources. Reported HIV/ART status appears to be a reliable source of information to help classification of cause of death. [ABSTRACT FROM AUTHOR]

Background: Sustaining a visual impairment may have a substantial impact on various life domains such as work, interpersonal relations, mobility and social and mental well-being. How to adjust to the loss of vision and its consequences might be a challenge for the visually impaired person. The purpose of the current study was to explore how younger male ex-Service personnel cope with becoming visually impaired and how this affects their daily life.Methods: Semi-structured interviews with 30 visually impaired male ex-Service personnel, all under the age of 55, were conducted. All participants are members of the charity organisation Blind Veterans UK. Interviews were analysed thematically.Results: Younger ex-Service personnel applied a number of different strategies to overcome their loss of vision and its associated consequences. Coping strategies varied from learning new skills, goal setting, integrating the use of low vision aids in their daily routine, to social withdrawal and substance misuse. Vision loss affected on all aspects of daily life and ex-Service personnel experienced an on-going struggle to accept and adjust to becoming visually impaired.Conclusions: Health care professionals, family and friends of the person with the visual impairment need to be aware that coping with a visual impairment is a continuous struggle; even after a considerable amount of time has passed, needs for emotional, social, practical and physical support may still be present. [ABSTRACT FROM AUTHOR]

Aims Since the start of the conflicts in Iraq and Afghanistan, the numbers of young service personnel who have sustained a combat-related visual impairment have increased. This cross-sectional study examined the mental well-being of ex-servicemen (aged 22-55 years) with a visual impairment and determined if the mental health of those with a combat-related visual impairment differed from those whose visual impairment is not combat-related. Methods Male ex-service personnel with a visual impairment completed a telephone interview assessing the presence of depressive symptomatology, probable anxiety disorder, post-traumatic stress disorder (PTSD) symptomatology and alcohol misuse. Data were analysed using descriptive statistics. Results 77 participants were included in the study, reflecting a response rate of 76.2%. Of those with complete data (n=74), 20 ex-servicemen had a combatrelated visual impairment. Among ex-service personnel with a combat-related visual impairment, 10.0% (95% CI 0 to 23.2) screened positive for a probable depression, 25.0% (95% CI 6.0 to 44.0) for probable anxiety and 10.0% (95% CI 0 to 23.2) for probable PTSD. The prevalence of probable depression and probable PTSD differed among those with a non-combatrelated visual impairment, namely 18.5% (95% CI 8.1 to 28.9) and 16.7% (95% CI 6.8 to 26.7), respectively. Probable anxiety was 18.5% (95% CI 8.1 to 28.9) among non-combat-related visually impaired ex-service personnel. 45.0% (95% CI 23.2 to 66.8) of combatrelated visually impaired personnel reported hazardous drinking, compared with 20.4% (95% CI 9.7 to 31.2) of those with a non-combat-related visual impairment. Conclusions Mental health problems were prevalent among visually impaired younger ex-servicemen. No statistically significant differences were found in the prevalence of mental health problems among exservicemen with a combat-related visual impairment compared with those with a non-combat-related visual impairment. [ABSTRACT FROM AUTHOR]

Universal access to reproductive health services entails strengthening health systems, but requires significant resource commitments as well as efficient and effective use of those resources. A number of international organizations and governments in developing countries are putting efforts into tracking the flow of health resources in order to inform resource mobilization and allocation, strategic planning, priority setting, advocacy and general policy making. The UNFPA/NIDI-led Resource Flows Project ("The UNFPA/NIDI RF Project") has conducted annual surveys since 1997 to monitor progress achieved by developing countries in implementing reproductive health financial targets. This commentary summarizes the Project experiences and challenges in gathering data on allocation of resources for reproductive health at the domestic level in sub-Saharan African countries. One key lesson learnt from the Project experience is the need for strengthening tracking mechanisms in sub-Saharan African countries and making information on reproductive health resources and expenditures available, in particular the private sector resources. [ABSTRACT FROM AUTHOR]

CONTEXT: Contraceptive prevalence is very low in Senegal, particularly among young women. Greater knowledge is needed about the barriers young women face to using contraceptives, including barriers imposed by health providers. METHODS: Survey data collected in 2011 for the evaluation of the Urban Reproductive Health Initiative in Senegal were used to examine contraceptive use, method mix, unmet need and method sources among urban women aged 15-29 who were either currently married or unmarried but sexually active. Data from a sample of family planning providers were used to examine the prevalence of contraceptive eligibility restrictions based on age and marital status, and differences in such restrictions by method, facility type and provider characteristics. RESULTS: Modern contraceptive prevalence was 20% among young married women and 27% among young sexually active unmarried women; the levels of unmet need for contraception—mostly for spacing—were 19% and 11 %, respectively. Providers were most likely to set minimum age restrictions for the pill and the injectable—two o f the methods most often used by young women in urban Senegal. The median minimum age for contraceptive provision was typically 18. Restrictions based on marital status were less common than those based on age. CONCLUSIONS: Training and education programs for health providers should aim to remove unnecessary barriers to contraceptive access. [ABSTRACT FROM AUTHOR]

Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the resource-tracking process. Data are drawn from Kenyan budget estimates, reproductive health accounts, and the Resource Flows Project database and compare budgets and spending in 2005–06 with 2009–10. Despite policies and programmes in place since 1994, services for family planning, maternity care and infant and child health face serious challenges. As regards health financing, the government spends less than the average in sub-Saharan Africa, while donor assistance and out-of-pocket expenditure for health are high. Donor assistance to Kenya has increased over the years, but the percentage of funds devoted to reproductive health is lower than it was in 2005. We recommend an increase in the budget and spending for reproductive health in order to achieve MDG targets on maternal mortality and universal access to reproductive health in Kenya. Safety nets for the poor are also needed to reduce the burden of spending by households. Lastly, we recommend the generation of more comprehensive reproductive health accounts on a regular basis. Pour financer efficacement la santé génésique, il est essentiel de comprendre le flux de ressources destinées, au niveau national, à cet élément clé de la santé. L'article brosse un tableau complet de l'allocation de ressources à la santé génésique au Kenya et les difficultés rencontrées dans le suivi des fonds. Les données sont tirées des estimations budgétaires kényanes, des comptes de la santé génésique et de la base de données sur le projet de flux de ressources. L'article compare les budgets et les dépenses de 2005–06 avec 2009–10. Bien que des politiques et programmes soient en place depuis 1994, les services de planification familiale, de soins maternels et de santé juvéno-infantile se heurtent à de sérieux écueils. S'agissant du financement de la santé, le Gouvernement dépense moins que la moyenne en Afrique subsaharienne, alors que l'assistance des donateurs et la participation des patients aux frais de santé sont élevées. L'aide des donateurs au Kenya a augmenté au fil des années, mais le pourcentage de fonds consacré à la santé génésique est inférieur à son niveau de 2005. Nous recommandons de relever le budget et les dépenses de santé génésique afin de réaliser les OMD sur la mortalité maternelle et l'accès généralisé à la santé génésique au Kenya. Des filets de sécurité pour les pauvres sont aussi requis afin de réduire la charge financière des ménages. Enfin, nous préconisons de créer régulièrement des comptes de santé génésique plus complets. Entender el flujo de recursos a nivel nacional en el área de salud reproductiva es esencial para la financiación eficaz de este elemento fundamental para la salud. En este artículo se ofrece una visión integral de la asignación de recursos para salud reproductiva en Kenia y los retos en el proceso de dar seguimiento a los recusos. Se obtuvieron datos de estimaciones presupuestarias, cuentas de salud reproductiva y la base de datos del Proyecto del Flujo de Recursos, y se compararon los presupuestos y los gastos en 2005–06 con los del 2009–10. A pesar de políticas y programas establecidos desde 1994, los servicios de planificación familiar, atención materna y salud de lactantes y de niños enfrentan retos difíciles. En la financiación de servicios de salud, el gobierno gasta menos del promedio en Ãfrica subsahariana, mientras que la asistencia de donantes y desembolsos varios para la salud son altos. En los últimos años, los donantes han aumentado su ayuda financiera a Kenia, pero el porcentaje de fondos dedicados a la salud reproductiva es menor que en 2005. Recomendamos un aumento en el presupuesto y los gastos en salud reproductiva a fin de lograr las metas de los ODM respecto a la mortalidad materna y el acceso universal a servicios de salud reproductiva en Kenia. Además, es necesario proteger a la gente pobre reduciendo la carga de gastos por vivienda. Por último, recomendamos generar con regularidad cuentas más integrales de salud reproductiva. [ABSTRACT FROM AUTHOR]

Background: There is scanty evidence regarding the impact of parenting practices on young people's sexual risk-taking in sub-Saharan Africa. Moreover, the extent to which such practices have enduring consequences on adolescents and young adults is little documented. This study uses repeated measures of parent-child relationships, parental monitoring, and parent-child communication about sexual matters to shed some light in these two areas. Methods: The analysis is based on time-dependent retrospective data on parenting practices which were retrieved from the Cameroon Family and Health Survey (CFHS). The study sample includes 447 sexually active and unmarried individuals aged 15-24 years old. Correlation analysis and multivariate logistic regressions are used. Results: Young males and females reported high levels of parental monitoring, moderate quality of parent-child relationships and low levels of parent-child communication on sexual matters. This study substantiates that the higher the quality of parent-child relationships, the lower the odds of young males having multiple sexual partners (0.63, p < 0.05), and the lower the odds of young females being sexually active (0.52, p < 0.10) or of having multiple sexual partners (0.64, p < 0.10) or of having occasional sexual partners (0.51, p < 0.05). Living with the biological father only was associated with higher odds of having multiple sexual partners (3.21, p < 0.10) and higher odds of occasional concurrent sexual partners (3.26, p < 0.10) among young males. Compared with their out-of-school counterparts, young males still enrolled in school were less likely to be sexually active in the last 12 months (0.33, p < 0.05) and less likely to have occasional concurrent sexual partners (0.57, p < 0.10), whereas young females still enrolled in school were more likely to be sexually active (2.25, p < 0.10) and less likely to use contraceptive consistently (0.36, p < 0.001). Conclusions: Reproductive health programs and interventions for preventing young people's risky sexual behaviors in sub-Saharan African settings must take into account the protective effects of parent-child relationships and the significance of parental monitoring over time. [ABSTRACT FROM AUTHOR]

In most organisms, including humans, meiotic recombination occurs preferentially at a limited number of sites in the genome known as hotspots. There has been substantial progress recently in elucidating the factors determining the location of meiotic recombination hotspots, and it is becoming clear that simple sequence motifs play a significant role. In S. pombe, there are at least five unique sequence motifs that have been shown to produce hotspots of recombination, and it is likely that there are more. In S. cerevisiae, simple sequence motifs have also been shown to produce hotspots or show significant correlations with hotspots. Some of the hotspot motifs in both yeasts are known or suspected to bind transcription factors (TFs), which are required for the activity of those hotspots. Here we show that four of the five hotspot motifs identified in S. pombe also create hotspots in the distantly related budding yeast S. cerevisiae. For one of these hotspots, M26 (also called CRE), we identify TFs, Cst6 and Sko1, that activate and inhibit the hotspot, respectively. In addition, two of the hotspot motifs show significant correlations with naturally occurring hotspots. The conservation of these hotspots between the distantly related fission and budding yeasts suggests that these sequence motifs, and others yet to be discovered, may function widely as hotspots in many diverse organisms. [ABSTRACT FROM AUTHOR]

This study aimed to determine the ability of a specific group of adolescents with hearing loss to access and use academic information in order to establish the kind of support that might be required for adolescents with hearing loss. Adolescents with hearing loss who have a language delay because of this loss experience problems with access to formal as well as informal academic material. Children with severe hearing loss need special education and the teacher should receive in-service training. This is necessary because children with this degree of hearing loss have a serious language delay, and need special help in all language skills, language-based academic subjects, vocabulary, grammar, pragmatism, reading and writing (HMIE 2007:16). They also have a lack of prior knowledge to assist them in all their language skills (HMIE 2007:26). The participants of this study were adolescents with hearing loss, and teachers and media teachers at special schools that cater for adolescents with hearing loss. Questionnaires were distributed to 326 adolescents with hearing loss, 19 teachers, and six media teachers. In addition, the researcher observed 48 adolescents with hearing loss while they completed an assignment in a media centre. The results indicated that these young people found it difficult to access and use academic information. They used academic information mainly during class and after school when they needed to, and there was not much consensus as to the purpose for which they used it. Over 50% of the participants were not able to trace other sources. Various factors were identified which influenced their ability to access and to use academic information, such as degree of hearing loss, literacy skills and information literacy skills, communication and poor cognitive skills. In the media centre the adolescents were not able to execute an assignment on academic information with ease. This was because they had difficulties with bibliographical details and a lack of knowledge about finding and accessing information (HMIE 2007:26). Suggestions are made for an information literacy programme for adolescents with hearing loss so that they could develop the relevant skills to access and use academic information. [ABSTRACT FROM AUTHOR]

In many organisms, including yeasts and humans, meiotic recombination is initiated preferentially at a limited number of sites in the genome referred to as recombination hotspots. Predicting precisely the location of most hotspots has remained elusive. In this study, we tested the hypothesis that hotspots can result from multiple different sequence motifs. We devised a method to rapidly screen many short random oligonucleotide sequences for hotspot activity in the fission yeast Schizosaccharomyces pombe and produced a library of ~500 unique 15- and 30-bp sequences containing hotspots. The frequency of hotspots found suggests that there may be a relatively large number of different sequence motifs that produce hotspots. Within our sequence library, we found many shorter 6- to 10-bp motifs that occurred multiple times, many of which produced hotspots when reconstructed in vivo. On the basis of sequence similarity, we were able to group those hotspots into five different sequence families. At least one of the novel hotspots we found appears to be a target for a transcription factor, as it requires that factor for its hotspot activity. We propose that many hotspots in S. pombe, and perhaps other organisms, result from simple sequence motifs, some of which are identified here. [ABSTRACT FROM AUTHOR]

The potential energy surface for the interaction of a coronene molecule, as a model for a graphitic sheet, with a water molecule over its central ring has been calculated at the DFT and MP2 levels. The lowest energy orientation has both hydrogen atoms of the water pointing down symmetrically towards the coronene surface; this is also the preferred geometry for circumcoronene, C54H18. This is different from the water-benzene system, where the minimum is asymmetric, with one hydrogen pointing towards one of the carbon atoms in the ring. The coronene-water interaction energies were parameterized as a function of the Euler angles that describe the orientation of the water molecule and the distance between the oxygen atom and the coronene plane. The symmetry and distance dependence of the angular components were used to determine the physical origin of each term. [ABSTRACT FROM AUTHOR]

Abstract: Chemical rescue of site-modified amino acids using externally supplied organic molecules represents a powerful method to investigate structure–function relationships in proteins. Here we provide definitive evidence that aryl and alkyl thiolates, reagents typically used for in vitro iron–sulfur cluster reconstitutions, serve as rescue ligands to a site-specifically modified [4Fe–4S]1+,2+ cluster in PsaC, a bacterial dicluster ferredoxin-like subunit of Photosystem I. PsaC binds two low-potential [4Fe–4S]1+,2+ clusters termed FA and FB. In the C13G/C33S variant of PsaC, glycine has replaced cysteine at position 13 creating a protein that is missing one of the ligating amino acids to iron–sulfur cluster FB. Using a variety of analytical techniques, including non-heme iron and acid-labile sulfur assays, and EPR, resonance Raman, and Mössbauer spectroscopies, we showed that the C13G/C33S variant of PsaC binds two [4Fe–4S]1+,2+ clusters, despite the absence of one of the biological ligands. 19F NMR spectroscopy indicated that the external thiolate replaces cysteine 13 as a substitute ligand to the FB cluster. The finding that site-modified [4Fe–4S]1+,2+ clusters can be chemically rescued with external thiolates opens new opportunities for modulating their properties in proteins. In particular, it provides a mechanism to attach an additional electron transfer cofactor to the protein via a bound, external ligand. [Copyright &y& Elsevier]

Nitrophorin 4 (NP4), a nitric oxide (NO)-transport protein from the blood-sucking insect Rhodnius prolixus, uses a ferric (Fe3+) heme to deliver NO to its victims. NO binding to NP4 induces a large conformational change and complete desolvation of the distal pocket. The heme is markedly nonplanar, displaying a ruffling distortion postulated to contribute to stabilization of the ferric iron. Here, we report the ferrous (Fe2+) complexes of NP4 with NO, CO, and H2O formed after chemical reduction of the protein and the characterization of these complexes by absorption spectroscopy, flash photolysis, and ultrahigh-resolution crystallography (resolutions vary from 0.9 to 1.08 A). The absorption spectra, both in solution and in the crystal, are typical for six-coordinated ferrous complexes. Closure and desolvation of the distal pocket occurs upon binding CO or NO to the iron regardless of the heme oxidation state, confirming that the conformational change is driven by distal ligand polarity. The degree of heme ruffling is coupled to the nature of the ligand and the iron oxidation state in the following order: (Fe3+)-NO > (Fe2+)-NO > (Fe2+)-CO > (Fe3+)-H2O > (Fe2+)-H2O. The ferrous coordination geometry is as expected, except for the proximal histidine bond, which is shorter than typically found in model compounds. These data are consistent with heme ruffling and coordination geometry serving to stabilize the ferric state of the nitrophorins, a requirement for their physiological function. Possible roles for heme distortion and NO bending in heme protein function are discussed. [ABSTRACT FROM AUTHOR]

Certain bloodsucking insects deliver nitric oxide (NO) while feeding, to induce vasodilation and inhibit blood coagulation. We have expressed, characterized, and determined the crystal structure of the Cimexiectularius (bedbug) nitrophorin, the protein responsible for NO storage and delivery, to understand how the insect successfully handles this reactive molecule. Surprisingly, NO binds not only to the ferric nitrophorin heme, but it can also be stored as an S-nitroso (SNO) conjugate of the proximal heme cysteine (Cys-60) when present at higher concentrations. EPR- and UV-visible spectroscopies, and a crystallographic structure determination to 1.75-A resolution, reveal SNO formation to proceed with reduction of the heme iron, yielding an Fe-NO complex. Stopped-flow kinetic measurements indicate that an ordered reaction mechanism takes place: initial NO binding occurs at the ferric heme and is followed by heme reduction, Cys-60 release from the heme iron, and SNO formation. Release of NO occurs through a reversal of these steps. These data provide, to our knowledge, the first view of reversible metal-assisted SNO formation in a protein and suggest a mechanism for its role in NO release from ferrous heme. This mechanism and Cimex nitrophorin structure are completely unlike those of the nitrophorins from Rhodnius prolixus, where NO protection is provided by a large conformational change that buries the heme nitrosyl complex, highlighting the remarkable evolution of proteins that assist insects in blood feeding. [ABSTRACT FROM AUTHOR]

Nitrophorin 4 (NP4) is one of seven nitric oxide (NO) transporting proteins in the blood-sucking insect Rhodnius prolixus. In its physiological function, NO binds to a ferric iron centered in a highly ruffled heme plane. Carbon monoxide (CO) also binds after reduction of the heme iron. Here we have used Fourier transform infrared spectroscopy at cryogenic temperatures to study CO and NO binding and migration in NP4, complemented by x-ray cryo-crystallography on xenon-containing NP4 crystals to identify cavities that may serve as ligand docking sites. Multiple infrared stretching bands of the heme-bound ligands indicate different active site conformations with varying degrees of hydrophobicity. Narrow infrared stretching bands are observed for photodissociated CO and NO; temperature-derivative spectroscopy shows that these bands are associated with ligand docking sites close to the extremely reactive heme iron. No rebinding from distinct secondary sites was detected, although two xenon binding cavities were observed in the x-ray structure. Photolysis studies at ∼200 K show efficient NO photoproduct formation in the more hydrophilic, open NP4 conformation. This result suggests that ligand escape is facilitated in this conformation, and blockage of the active site by water hinders immediate reassociation of NO to the ferric iron. In the closed, low-pH conformation, ligand escape from the active site of NP4 is prevented by an extremely reactive heme iron and the absence of secondary ligand docking sites. [ABSTRACT FROM AUTHOR]

Nitrophorins are ferric heme proteins that transport nitric oxide (NO) from blood-sucking insects to victims. NO binding is tighter at lower pH values, as found in the insect salivary gland, and weaker at the pH of the victim's tissue, facilitating NO release and subsequent vasodilation. Previous structural analyses of nitrophorin 4 (NP4) from Rhodnius prolixus revealed a substantial NO-induced conformational change involving the A-B and G-H loops, which rearrange to desolvate the distal pocket and pack nonpolar residues against the heme-ligated NO. Previous kinetic analyses revealed a slow, biphasic, and pH-dependent NO release, which was proposed to be associated with loop movements. In this study, we created NP4 mutants D30A and D30N (A-B loop), D129A/L130A (G-H loop), and T121V (distal pocket). Eight crystal structures were determined, including complexes with NO, NH3, and imidazole, to resolutions as high as 1.0 Å. The NO-induced conformational change is largely abolished in the loop mutants, but retained in T121V. Kinetic analyses using stopped-flow spectroscopy revealed the pH dependence for NO release is eliminated for D129A/L1 30A, considerably reduced for D30A and D30N, but retained for T121V. NO association rates were increased 2-5-fold for T121V, but were unchanged in the loop mutants. Taken together, our findings demonstrate that the pH dependency for NO release is linked to loop dynamics and that solvent reorganization is apparently rate-limiting for formation of the initial iron-nitrosyl bond. Interestingly, the multiphasic kinetic behavior of rNPs was not affected by mutations, and its cause remains unclear. [ABSTRACT FROM AUTHOR]

Examines the Arabidopsis CDPL-SnRK superfamily of protein kinases. Accounts on the types of kinases that decode calcium signals in animals; Mechanisms for the membrane binding of CDPK; Emphasis on the pattern of intron placement.

Examines the resonance Raman spectroscopic study of Nitrophorin 1 (NP1), a nitric oxide (NO)-binding heme protein from Rhodnius prolixus. Identification of nitrosyl NP1 vibrational frequencies; Evaluation on the bond strength of NP1 nitrosyl; Assessment on the NO and cyanide binding geometries.

[Display omitted] • Competition for electrons suppresses N 2 O reduction rates regardless of EA supply. • Co-enrichment with NO 3 – and N 2 O favours NOS activity under conditions of electron competition. • Co-enrichment with NO 3 – and N 2 O increases nosZ I type N 2 O-reducers. • Flavobacterium may favour N 2 O reduction on conditions of electron competition. The reduction rate of nitrous oxide (N 2 O) is affected by the electron competition among the four denitrifying steps, limiting the mitigation of N 2 O emissions during wastewater treatment. We foresee essential to understand how combinations of electron acceptors (EAs) affect the microbial composition and reduction mechanisms of denitrifying communities. We enriched three denitrifying communities from activated sludge biomass with equivalent loads of different EAs: NO 3 – (R1), N 2 O (R2), and NO 3 – + N 2 O (R3). The resulting enrichments were compared in terms of (1) reduction of nitrogen oxides in absence/presence of other EAs (NO 3 –, NO 2 –, N 2 O), (2) their denitrification gene composition and (3) their microbial community composition. Batch results showed the presence of NO 3 – and NO 2 – suppressed N 2 O reduction rates in all three reactors. The effect was lower in the mixed-substrate feed community than in the single-substrate feed under infinite sludge retention time and chemostat operation modes. N 2 O-reducers of type nosZ II were enriched when N 2 O serves as the sole EA, whereas nosZ I type N 2 O-reducers were more prone to enrichment with NO 3 – as EA. The EA composition rather than the sludge retention mode differentiated the microbial communities. The genus Flavobacterium seems to play a significant role in alleviating the suppression of the N 2 O reduction rate caused by electron competition. Limited conditions of electron supply are the norm independently of high C/N levels, and a community co-enriched with NO 3 – and N 2 O alleviates more the competition for electrons in the nitrous oxide reductase enzyme than communities enriched with NO 3 – or N 2 O individually. [ABSTRACT FROM AUTHOR]

Presents information on a study regarding the modification of Arabidopsis cullin by the ubiquitin-like protein RUB1. Experimental procedures; Results; Discussion on the results.

Focuses on studies of postgraduate collaborative or support groups and studies of gender-related communication patterns. Implications for postgraduate groups.

Peking or Beijing Opera, the theatre of the capital, as it is literally translated, has dominated China for the past 100 years. All the others, being regional in nature, reflects adaptations of music, content, acting style and dialect. Despite variations, which are important to scholars, performers and regions, all forms of Chinese Opera shares so many similarities that we can consider Peking Opera as generic. It was said that the persistence of theatrical and cultural traditions which reflect the national identity of Mainland China can be seen in Peking Opera. The surface strangeness of Peking Opera to most foreigners indicates their imperfect knowledge and understanding of the Chinese, who in turn cannot comprehend what excites others in films and theatre. Every aspect of Peking Opera reflects the psychological makeup of the Chinese people. At first the foreigner believes that Peking Opera must function as grand spectacle. The glorious costumes and makeup of stage dress imitate Chinese court dress ranging from the seventh-century Tang dynasty to the twentieth-century Ch'ing. Only occasionally would a bright color show up, just as it might stand out today amid the standard communist navy blue or black costume. To the outsider, this contrast between the brilliant, magnificently costumed stage creatures and the drably clothed audience implies that the performance functions as pure spectacle and escape. It was said that nowhere is the persistence of this theatrical tradition seen more vividly than during the cultural revolution of 1966-76, China's holocaust years.

Answers to long-standing questions concerning the molecular mechanism of auxin action and auxin's exact functions in plant growth and development are beginning to be uncovered through studies using mutant and transgenic plants. We review recent work in this area in vascular plants. A number of conclusions can be drawn from these studies. First, auxin appears essential for cell division and viability, as auxin auxotrophs isolated in tissue culture are dependent on auxin for growth and cannot be regenerated into plants even when auxin is supplied exogenously. Secondly, plants with transgenes that alter auxin levels are able to regulate cellular auxin concentrations by synthesis and conjugation; wild-type plants are probably also capable of such regulation. Thirdly, the phenotypes of transgenic plants with altered auxin levels and of mutant plants with altered sensitivity to auxin confirm earlier physiological studies which indicated a role for auxin in regulation of apical dominance, in development of roots and vascular tissue, and in the gravitropic response. Finally, the cloning of a mutationally identified gene important for auxin action, along with accumulating biochemical evidence, hints at a major role for protein degradation in the auxin response pathway. [ABSTRACT FROM AUTHOR]

Background: Rates of diabetic ketoacidosis (DKA) have been rising despite many medical advances. National studies in the U.S. describe higher rates in younger populations, although studies have not closely characterized U.S. trends in pediatrics. Methods: We conducted a study using the national Kids' Inpatient Database to identify pediatric admissions for DKA in years 2006, 2009, 2012, and 2016. Newborn admissions were excluded. We used descriptive statistics to describe prevalence of DKA admissions, DKA rates and trends among all pediatric admissions. Logistic regression was used to evaluate differences in DKA rates overtime within subgroups and determine factors associated with DKA trends. Results: We identified 12,271,107 admissions of which 149,713 were for DKA. Among those with DKA, there was a high prevalence of those 15-20yo (58%), female sex (54%), white race (50%), and publicly insured (44%). Most were from urban areas (81%), the bottom two income quartiles (58%) and hospitalized in large (60%), private hospitals (71%), and in southern states (40%). When compared to all pediatric admissions, rates of DKA were highest in those 12-14yo, of male sex, black race, second income quartile and with charity care. Patients from non-urban areas and those hospitalized in private and small hospitals also had higher rates. There was a large rise in DKA admissions rates per 10,000 admissions from 94.6 in 2006 to 184.6 in 2016. The rate of change was similar within most subgroups. The characteristics positively associated with DKA admission after adjustment were age 12-14yo, male sex, black race, publicly insured or self-pay, lower income, and hospitals that were private, small, or located outside the northeast. Conclusions: Rates of DKA admission have increased from 2006 to 2016. Although there were disparities among subgroups admitted, the rise in rate overtime was similar within most subgroups. Further studies are needed to understand drivers of admission in this population. Disclosure: E.M. Everett: None. T. Copeland: None. T. Moin: None. L.E. Wisk: None. Funding: National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01) [ABSTRACT FROM AUTHOR]

Introduction: Transition of care to adult endocrinology is associated with clinical deterioration in young adults with diabetes. We characterized the young adult patient population with diabetes at our institution's adult endocrinology clinics to identify patients' characteristics associated with poor glycemic control. Methods: We completed a retrospective cohort study of patients aged 16-25 with diabetes, whose first visit with an adult endocrinologist at any of 4 sites within our medical system occurred between July 1st, 2011 and June 30th, 2015. The following factors were analyzed: visits with pediatric endocrinology at our center, age, race, ethnicity, gender, social deprivation index, and age of diabetes onset. The primary outcome was mean hemoglobin A1c ≥ 10% in the 2 years after establishing care with adult endocrinology. Results: We identified 264 patients who met inclusion criteria. Our preliminary analysis shows that 107 (40%) had a mean A1c ≥ 10%, which was associated with the following patient characteristics: male gender (OR 1.95 95% CI 1.02-3.74), younger age, with every year placing patient at a 5% increased risk (OR 1.3; 95% CI 1.1-1.5), black race (OR 9.03; 95% CI 3.43-28.2) and being seen in pediatric endocrinology clinic at the same institution (OR 2.34; 95% CI 1.12-4.87). Interestingly, there was no increased risk associated with diabetes type, diagnosis age, ethnicity and area social deprivation tertile. Conclusion: We found a high prevalence of mean A1c ≥ 10% in our population. Preliminary analysis of data suggests certain patient groups are at high risk of poor control. Additional analysis is needed to determine factors associated with this clinical deterioration. In the future, intervention strategies maybe targeted to high risk populations to improve overall outcomes in our population of young adults with diabetes. Disclosure: E.M. Everett: None. J.T. Lee: None. A. Sidhaye: None. [ABSTRACT FROM AUTHOR]

Reference genome assemblies have been created from multiple lineages within the Canidae family; however, despite its phylogenetic relevance as a basal genus within the clade, there is currently no reference genome for the gray fox (Urocyon cinereoargenteus). Here, we present a chromosome-level assembly for the gray fox (U. cinereoargenteus), which represents the most contiguous, non-domestic canid reference genome available to date, with 90% of the genome contained in just 34 scaffolds and a contig N50 and scaffold N50 of 59.4 and 72.9 Megabases, respectively. Repeat analyses identified an increased number of simple repeats relative to other canids. Based on mitochondrial DNA, our Vermont sample clusters with other gray fox samples from the northeastern United States and contains slightly lower levels of heterozygosity than gray foxes on the west coast of California. This new assembly lays the groundwork for future studies to describe past and present population dynamics, including the delineation of evolutionarily significant units of management relevance. Importantly, the phylogenetic position of Urocyon allows us to verify the loss of PRDM9 functionality in the basal canid lineage, confirming that pseudogenization occurred at least 10 million years ago. [ABSTRACT FROM AUTHOR]

We provide novel representations of strategy-proof voting rules applicable when voters have uni-dimensional single-peaked preferences. In particular, we introduce a 'grading curve' representation which is particularly useful when introducing variable electorates. Our analysis recovers, links and unifies existing results in the literature, and provides new characterizations when strategy-proofness is combined with other desirable properties such as ordinality, participation, consistency, and proportionality. Finally, the new representations are used to compute the strategy-proof methods that maximize the ex-ante social welfare for the L 2 -norm and a uniform prior. The resulting strategy-proof welfare maximizer is the linear median (or 'uniform median'), that we also characterize as the unique proportional strategy-proof voting rule. [ABSTRACT FROM AUTHOR]

Background: There is scanty evidence regarding the impact of parenting practices on young people's sexual risk-taking in sub-Saharan Africa. Moreover, the extent to which such practices have enduring consequences on adolescents and young adults is little documented. This study uses repeated measures of parent-child relationships, parental monitoring, and parent-child communication about sexual matters to shed some light in these two areas.Methods: The analysis is based on time-dependent retrospective data on parenting practices which were retrieved from the Cameroon Family and Health Survey (CFHS). The study sample includes 447 sexually active and unmarried individuals aged 15-24 years old. Correlation analysis and multivariate logistic regressions are used.Results: Young males and females reported high levels of parental monitoring, moderate quality of parent-child relationships and low levels of parent-child communication on sexual matters. This study substantiates that the higher the quality of parent-child relationships, the lower the odds of young males having multiple sexual partners (0.63, p < 0.05), and the lower the odds of young females being sexually active (0.52, p < 0.10) or of having multiple sexual partners (0.64, p < 0.10) or of having occasional sexual partners (0.51, p < 0.05). Living with the biological father only was associated with higher odds of having multiple sexual partners (3.21, p < 0.10) and higher odds of occasional concurrent sexual partners (3.26, p < 0.10) among young males. Compared with their out-of-school counterparts, young males still enrolled in school were less likely to be sexually active in the last 12 months (0.33, p < 0.05) and less likely to have occasional concurrent sexual partners (0.57, p < 0.10), whereas young females still enrolled in school were more likely to be sexually active (2.25, p < 0.10) and less likely to use contraceptive consistently (0.36, p < 0.001).Conclusions: Reproductive health programs and interventions for preventing young people's risky sexual behaviors in sub-Saharan African settings must take into account the protective effects of parent-child relationships and the significance of parental monitoring over time. [ABSTRACT FROM AUTHOR]

The original purpose of this study was to conduct an exploratory analysis of the meaning of work to nursing professionals, comparing meanings by hierarchical level (non-degree and college-degreed levels) and by characteristics of the work environment. We applied a structured questionnaire containing scales for the meaning of work, affective commitment, and work stress. Results were treated with descriptive statistics, exploratory factor analysis, correlation analysis, and mean comparison, and confirmed that hierarchical level and work environment define differences in the perception of work meaning and related constructs. Since our field work demanded long hours of permanence in hospitals, the study was enriched with observations and conversations. This combination of methods allowed expanding the knowledge about the factors that elicit experiencing the meaning of work in nursing. Meaning can emerge from factors such as increase in employability, social distinction, work-family harmonization, and the nature of the relationship with managers and leaders. Loss of meaning can cause a drop in productivity and be associated with resistance behaviors or even retaliatory behaviors in the form of absenteeism and changing jobs. [ABSTRACT FROM AUTHOR]

Determining the structural organisation of viral replication complexes and unravelling the impact of infection on cellular homeostasis represent important challenges in virology. This may prove particularly useful when confronted with viruses that pose a significant threat to human health, that appear unique within their family, or for which knowledge is scarce. Among Mononegavirales, bornaviruses (family Bornaviridae) stand out due to their compact genomes and their nuclear localisation for replication. The recent recognition of the zoonotic potential of several orthobornaviruses has sparked a surge of interest in improving our knowledge on this viral family. In this work, we provide a complete analysis of the structural organisation of Borna disease virus 1 (BoDV-1) phosphoprotein (P), an important cofactor for polymerase activity. Using X-ray diffusion and diffraction experiments, we revealed that BoDV-1 P adopts a long coiled-coil α-helical structure split into two parts by an original β-strand twist motif, which is highly conserved across the members of whole Orthobornavirus genus and may regulate viral replication. In parallel, we used BioID to determine the proximal interactome of P in living cells. We confirmed previously known interactors and identified novel proteins linked to several biological processes such as DNA repair or mRNA metabolism. Altogether, our study provides important structure/function cues, which may improve our understanding of BoDV-1 pathogenesis. [ABSTRACT FROM AUTHOR]

Background: Over six million induced abortions were reported in Africa in 2008 with over two million induced abortions occurring in Eastern Africa. Although a significant proportion of women in the region procure more than one abortion during their reproductive period, there is a dearth of research on factors associated with repeat abortion.Methods: Data for this study come from the Magnitude and Incidence of Unsafe Abortion Study conducted by the African Population and Health Research Center in Kenya in 2012. The study used a nationally-representative sample of 350 facilities (level II to level VI) that offer post-abortion services for complications following induced and spontaneous abortions. A prospective morbidity survey tool was used by health providers in 328 facilities to collect information on socio-demographic charateristics, reproductive health history and contraceptive use at conception for all patients presenting for post-abortion services. Our analysis is based on data recorded on 769 women who were classified as having had an induced abortion.Results: About 16 % of women seeking post abortion services for an induced abortion reported to have had a previous induced abortion. Being separated or divorced or widowed, having no education, having unwanted pregnancy, having 1-2 prior births and using traditional methods of contraception were associated with a higher likelihood of a repeat induced abortion.Conclusions: The findings point to the need to address the reasons why women with first time induced abortion do not have the necessary information to prevent unintended pregnancies and further induced abortions. Possible explanations linked to the quality of post-abortion family planning and coverage of long-acting methods should be explored. [ABSTRACT FROM AUTHOR]

Background: Expanding access to antiretroviral therapy (ART) means that HIV is no longer a death sentence. This change has implications for reproductive decisions and behaviors of HIV-infected individuals. Design: Using multiple rounds of biomarker data from Demographic and Health Surveys (20042012) in nine sub-Saharan African countries, we compare patterns of associations between HIV status and fertility intention and between current use of modern contraception and HIV status in the context of expanding ART coverage. Results: Generally, results show that knowledge of HIV status and proportion of women ever tested for HIV increased substantially between the two surveys for almost all countries. Whereas modern contraceptive use slightly increased, fertility intentions remained relatively stable, except for Rwanda, where they decreased. Results from the two surveys for the nine countries do however indicate that there is no clear consistent pattern of fertility intention and modern contraceptive use behavior by HIV status, with variations observed across countries. However, multivariate analyses show that for Rwanda and Zimbabwe women who were HIV positive, with knowledge of their status, had lower odds of wanting more children. Similarly only in Rwanda (both surveys) were HIV-positive women who knew their status more likely to be current users of contraception compared with women who were HIV negative. The reverse was observed for Zimbabwe. Conclusions: Generally, the results point to the fact that the assumption that reproductive intention and behavior of HIV-positive women will differ compared with that of HIV-negative women may only hold true to the extent that women know their HIV status. Continuous expansion of voluntary counseling and testing services and integration of HIV treatment and care services with reproductive health services are thus warranted. [ABSTRACT FROM AUTHOR]

Ticks vector a greater variety of pathogens than any other arthropod group, making them a significant threat to the public, companion animals and wildlife. Surveying wildlife habitats and areas commonly used for recreation for the presence of ticks and the pathogens that they carry is essential to the prevention of tick-borne diseases. Tick behaviour also plays an active role in transmission dynamics. We set out to study the host-seeking behaviour of Amblyomma americanum , the lone star tick, at the population level and at the individual level by collecting ticks in public parks in Gainesville, Florida, U.S.A., and by conducting behavioural assays on host-seeking behaviour (questing). We assayed a subset of the collected ticks for 3 consecutive days to determine whether ticks displayed repeatable, individual level differences in questing behaviour. Afterward, we screened ticks for two human pathogens, Rickettsia spp. and Ehrlichia spp. While we did not find differences in pathogen prevalence among the populations, we found that nymphal ticks infected with Rickettsia amblyommatis spent less time questing than uninfected nymphs. However, across all populations, we found a greater prevalence of R. amblyommatis in adult ticks. Additionally, nymphs were more likely to engage in questing behaviours than adults. Lastly, we found significant repeatability in the average height that a tick quests and the questing likelihood of a tick. These findings could fill a gap in the knowledge about trends in disease dynamics. • Ticks displayed repeatability in average heights quested and the likelihood to quest. • Infected nymphal ticks spent less time questing than uninfected nymphs. • Nymphs were more likely to engage in questing behaviours than adult ticks. • Ticks from rural sites quested higher on average compared to ticks from city parks. [ABSTRACT FROM AUTHOR]

Background: Universal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women's health including their knowledge, behavior, and uptake of respective services, as well as women's empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing community health volunteers' health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake.Methods: This is a study protocol for a cluster randomized controlled trial (RCT) study that uses a four-pronged approach-including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study, and behavioral lab-in-the-field experiments-in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures, and enrolment in health insurance over time. Half of the households live in villages randomly assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board. Research permits were obtained from the National Commission for Science, Technology and Innovation agency of Kenya.Discussion: People in low-and middle-income countries often suffer from high out-of-pocket healthcare expenditures, which, in turn, impede access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels-individuals, families, and communities. Notably, i-PUSH fosters savings for health care through the mobile-phone based "health wallet," it enhances enrolment in subsidized health insurance through the mobile platform-M-TIBA-developed by PAF, and it seeks to improve health knowledge and behavior through community health volunteers (CHVs) who are trained using the LEAP tool-AMREF's mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to Universal Health Coverage in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children.Trial Registration: Registered with Protocol Registration and Results System (protocol ID: AfricanPHRC; trial ID: NCT04068571 : AEARCTR-0006089 ; date: 29 August 2019) and The American Economic Association's registry for randomized controlled trials (trial ID: AEARCTR-0006089; date: 26 June 2020). [ABSTRACT FROM AUTHOR]

Background People who inject drugs (PWID) living with HIV experience inadequate access to antiretroviral treatment (ART) and medication for opioid use disorders (MOUD). HPTN 074 showed that an integrated intervention increased ART use and viral suppression over 52 weeks. To examine durability of ART, MOUD, and HIV viral suppression, participants could re-enroll for an extended follow-up period, during which standard-of-care (SOC) participants in need of support were offered the intervention. Methods Participants were recruited from Ukraine, Indonesia and Vietnam and randomly allocated 3:1 to SOC or intervention. Eligibility criteria included: HIV-positive; active injection drug use; 18-60 years of age; ≥1 HIV-uninfected injection partner; and viral load ≥1,000 copies/mL. Re-enrollment was offered to all available intervention and SOC arm participants, and SOC participants in need of support (off-ART or off-MOUD) were offered the intervention. Results The intervention continuation group re-enrolled 89 participants, and from week 52 to 104, viral suppression (<40 copies/mL) declined from 41% to 29% (estimated 9.4% decrease per year, 95% CI -17.0%; -1.8%). The in need of support group re-enrolled 94 participants and had increased ART (re-enrollment: 55%, week 26: 69%) and MOUD (re-enrollment: 16%, week 26: 25%) use, and viral suppression (re-enrollment: 40%, week 26: 49%). Conclusions Viral suppression declined in year 2 for those who initially received the HPTN 074 intervention and improved maintenance support is warranted. Viral suppression and MOUD increased among in need participants who received intervention during the study extension. Continued efforts are needed for widespread implementation of this scalable, integrated intervention. [ABSTRACT FROM AUTHOR]

Precision health mapping is a technique that uses spatial relationships between socio-ecological variables and disease to map the spatial distribution of disease, particularly for diseases with strong environmental signatures, such as diarrhoeal disease (DD). While some studies use GPS-tagged location data, other precision health mapping efforts rely heavily on data collected at coarse-spatial scales and may not produce operationally relevant predictions at fine enough spatio-temporal scales to inform local health programmes. We use two fine-scale health datasets collected in a rural district of Madagascar to identify socio-ecological covariates associated with childhood DD. We constructed generalized linear mixed models including socio-demographic, climatic and landcover variables and estimated variable importance via multi-model inference. We find that socio-demographic variables, and not environmental variables, are strong predictors of the spatial distribution of disease risk at both individual and commune-level (cluster of villages) spatial scales. Climatic variables predicted strong seasonality in DD, with the highest incidence in colder, drier months, but did not explain spatial patterns. Interestingly, the occurrence of a national holiday was highly predictive of increased DD incidence, highlighting the need for including cultural factors in modelling efforts. Our findings suggest that precision health mapping efforts that do not include socio-demographic covariates may have reduced explanatory power at the local scale. More research is needed to better define the set of conditions under which the application of precision health mapping can be operationally useful to local public health professionals. [ABSTRACT FROM AUTHOR]