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Background: People with disabilities frequently experience barriers in seeking healthcare that lead to poorer health outcomes compared to people without disabilities. To overcome this, it is important to assess the accessibility of primary health facilities – broadly defined to include a disability-inclusive service provision – so as to document present status and identify areas for improvement. We aimed to identify, adapt and pilot test an appropriate tool to assess the accessibility of primary health facilities in Luuka District, Uganda. Methods: We conducted a rapid literature review to identify appropriate tools, selecting the Disability Awareness Checklist (DAC) on account of its relative brevity and development as a sensitization and action tool. We undertook three rounds of adaptation, working together with youth researchers (aged 18–35) with disabilities who then underwent 2 days of training as DAC facilitators. The adapted tool comprised 71 indicators across four domains and 12 sub-domains. We also developed a structured feedback form for facilitators to complete with healthcare workers. We calculated median accessibility scores overall, per domain and per sub-domain, and categorised feedback form suggestions by type and presumed investment level. We pilot-tested the adapted tool in 5 primary health facilities in one sub-district of Luuka, nested within a pilot healthcare worker training on disability. Results: The median overall facility accessibility score was 17.8% (range 12.3–28.8). Facility scores were highest in the universal design and accessibility domain (25.8%, 22.6–41.9), followed by reasonable accommodation (20.0%, 6.7–33.3). Median scores for capacity of facility staff (6.67%, 6.7–20.0), and linkages to other services were lower (0.0%, 0–25.0). Within the feedback forms, there were a median of 21 suggestions (range 14–26) per facility. Most commonly, these were categorised as minor structural changes (20% of suggestions), with a third categorised as no (2%) or low (33%) cost, and the majority (40%) medium cost. Conclusions: Overall accessibility scores were low, with many opportunities for low-cost improvement at the facility level. We did not identify any issues with the implementation of the tool, suggesting few further adaptations are required for its future use in this setting. [ABSTRACT FROM AUTHOR]

Since March 2020, Uganda has confirmed cases of COVID-19 and implemented a response to curb the spread, which included over 12 months of school closure for most children. In this study we investigated parents' perspectives of the impact of the COVID-19 response on education of children with disabilities enrolled in primary schools in Central Uganda during the first 12 months of the outbreak. We conducted four rounds of interviews with 27 parents of children with disabilities, which were analysed thematically. Parents described a lack of financial resources, food, learning materials, and teaching skills necessary to provide meaningful home education. Parents were concerned about the long-term impact school closure may have on their child's development, behaviour, and social life. Although parents were happy about the phased school re-opening, they expressed concerns about the financial costs involved in sending children back to school, and wondered how children would cope with prevention measures. School closure has greatly impacted the education of children with disabilities in Uganda. There is a need to consider inequality, poverty, and culture when studying children with disabilities during the COVID-19 outbreak, and prioritise and include this group in designing COVID-19 responses, prolonged home learning and school reopening plans. [ABSTRACT FROM AUTHOR]

Purpose: This research aimed to develop an innovative method for designing and fabricating nasal prostheses that reduces anaplastologist expertise dependency while maintaining quality and appearance, allowing patients to regain their normal facial appearance. Methods: The method involved statistical shape modeling using a morphable face model and 3D data acquired through optical scanning or CT. An automated design process generated patient-specific fits and appearances using regular prosthesis materials and 3D printing of molds. Manual input was required for specific case-related details. Results: The developed method met all predefined requirements, replacing analog impression-making and offering compatibility with various data acquisition methods. Prostheses created through this method exhibited equivalent aesthetics to conventionally fabricated ones while reducing the skill dependency typically associated with prosthetic design and fabrication. Conclusions: This method provides a promising approach for both temporary and definitive nasal prostheses, with the potential for remote prosthesis fabrication in areas lacking anaplastology care. While new skills are required for data acquisition and algorithm control, these technologies are increasingly accessible. Further clinical studies will help validate its effectiveness, and ongoing technological advancements may lead to even more advanced and skill-independent prosthesis fabrication methods in the future. [ABSTRACT FROM AUTHOR]

Background: There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda. Methods: We conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework. Results: Our findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices. Conclusion: The multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities. [ABSTRACT FROM AUTHOR]

In this introductory article to our PPA special issue we argue that the relation between wicked problems and collaborative governance is fraught with difficulties. Doing so, we take four steps: we maintain that wicked problems are better understood as wicked actor constellations; we delve into the collaborative governance-approach and posit that it is mainly concerned with wicked problems; we then argue that collaborative governance might not be the most feasible response to wicked problems; and after that we argue that an assumption instead of actors being engaged in actor positioning processes allows a clearer understanding of policy processes in wicked actor constellations. Following this discussion, we introduce the articles featured in the special issue and discuss implications for research. [ABSTRACT FROM AUTHOR]

Background: Approximately 1.3 billion people worldwide face barriers in accessing inclusive healthcare due to disabilities, leading to worse health outcomes, particularly in low and middle-income countries (LMIC). However, there is a lack of training of healthcare workers about disability, both globally and in Uganda. Objectives: To use mixed research methods to develop a comprehensive training program with standardisedelements for healthcare workers in Uganda, focusing on improving their knowledge, attitudes, and skills inproviding care for people with disabilities. Methods: The Medical Research Council (MRC) approach was employed to guide the development of the training intervention. We conducted an umbrella review to gather relevant literature on disability training for healthcare workers. Interviews were conducted with international experts to gain insights and perspectives on the topic. Additionally, interviews were undertaken with people with disabilities and healthcare workers in Uganda to understand their experiences and needs. A participatory workshop was organised involving key stakeholders, to collaboratively design the training material based on the findings from these data sources. Results: Eight review articles examined training programs for healthcare workers on disability. Training settings ranged from specialised clinical settings to non-clinical settings, and the duration and evaluation methods of the training varied widely. Lectures and didactic methods were commonly used, often combined with other approaches such as case studies and simulations. The impact of the training was assessed through healthcare worker reports on attitudes, knowledge, and self-efficacy. Interviews emphasised the importance of involving people with disabilities in the training and improving communication and understanding between healthcare providers and people with disabilities. Five themes for a training on disability for healthcare workers were generated through the workshop, including responsibilities and rights, communication, informed consent, accommodation, and referral and connection, which were used to guide the development of the curriculum, training materials and training approach. Conclusion: This study presents a novel approach to develop a training program that aims to enhance healthcare services for people with disabilities in Uganda. The findings offer practical insights for the development of similar programs in LMICs. The effectiveness of the training program will be evaluated through a pilot test, and policy support is crucial for its successful implementation at scale. [ABSTRACT FROM AUTHOR]

Simple Summary: While the dosimetric advantages of proton therapy over conventional treatment for CSI are typically emphasized for spine fields, only lens dose reduction has been reported for brain fields. In this retrospective in silico planning study, the aim is to assess the potential gains of proton CSI for organs at risk in the whole-brain part of CSI. Different optimization techniques and beam arrangements as well as pencil beam spot editing were employed to determine the potential gains. The study shows that: (1) cochlear sparing is impractical, (2) improving the lens dose is possible mainly by adding a posterior field direction, and (3) an incremental scalp dose reduction is possible, particularly in adult patients. Proton therapy is a promising modality for craniospinal irradiation (CSI), offering dosimetric advantages over conventional treatments. While significant attention has been paid to spine fields, for the brain fields, only dose reduction to the lens of the eye has been reported. Hence, the objective of this study is to assess the potential gains and feasibility of adopting different treatment planning techniques for the entire brain within the CSI target. To this end, eight previously treated CSI patients underwent retrospective replanning using various techniques: (1) intensity modulated proton therapy (IMPT) optimization, (2) the modification/addition of field directions, and (3) the pre-optimization removal of superficially placed spots. The target coverage robustness was evaluated and dose comparisons for lenses, cochleae, and scalp were conducted, considering potential biological dose increases. The target coverage robustness was maintained across all plans, with minor reductions when superficial spot removal was utilized. Single- and multifield optimization showed comparable target coverage robustness and organ-at-risk sparing. A significant scalp sparing was achieved in adults but only limited in pediatric cases. Superficial spot removal contributed to scalp V30 Gy reduction at the expense of lower coverage robustness in specific cases. Lens sparing benefits from multiple field directions, while cochlear sparing remains impractical. Based on the results, all investigated plan types are deemed clinically adoptable. [ABSTRACT FROM AUTHOR]

Definitions and frameworks from high-income countries dominate tools used to measure impairment level, barriers and enablers to participation of children with disabilities in low-income countries. Disability scholars have argued that multiple perspectives and a different discourse are needed to study disability, participation, and inclusion in low-income countries. We examined the use, reliability, and cultural acceptability of the Child and Family Follow-up Survey's (CFFS) Child and Adolescent Scale of Participation CASP, Child and Adolescent Factors Inventory (CAFI), and the Child and Adolescent Scale of Environment (CASE) scales to measure participation of Ugandan children with disabilities and their peers. The tool testing and adaptation was conducted as part of a pilot and feasibility study of the 'Obuntu bulamu' intervention in five private and five public primary schools. Based on disability type, gender, age, and social class, 32 8-14-year-old children with disabilities were enrolled. The translated Luganda CFFS showed excellent internal consistency with CASE, CASP, and CAFI subscales showing good test re-test reliability. Our consistency and reliability results show the three tools are valid and effective to measure environmental issues, childhood social participation, impairment children with disabilities type and severity from a parental perspective in the Ugandan setting. To ensure more in-depth understanding of child participation in the cultural context, we suggest the CFFS scales are used in combination with qualitative child-inclusive methods such as drawings, participatory workshops, and Photo Voice. The study contributes to the existing literature that there need for more Afrocentric interventions and adaptions and development of culturally relevant measurement tools, which build on African cultural values and practices. [ABSTRACT FROM AUTHOR]

Copyright of Beleid en Maatschappij (1875712X) is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Methane (CH4) emissions from ruminants are of a significant environmental concern, necessitating accurate prediction for emission inventories. Existing models rely solely on dietary and host animal-related data, ignoring the predicting power of rumen microbiota, the source of CH4. To address this limitation, we developed novel CH4 prediction models incorporating rumen microbes as predictors, alongside animal- and feed-related predictors using four statistical/machine learning (ML) methods. These include random forest combined with boosting (RF-B), least absolute shrinkage and selection operator (LASSO), generalized linear mixed model with LASSO (glmmLasso), and smoothly clipped absolute deviation (SCAD) implemented on linear mixed models. With a sheep dataset (218 observations) of both animal data and rumen microbiota data (relative sequence abundance of 330 genera of rumen bacteria, archaea, protozoa, and fungi), we developed linear mixed models to predict CH4 production (g CH4/animal·d, ANIM-B models) and CH4 yield (g CH4/kg of dry matter intake, DMI-B models). We also developed models solely based on animal-related data. Prediction performance was evaluated 200 times with random data splits, while fitting performance was assessed without data splitting. The inclusion of microbial predictors improved the models, as indicated by decreased root mean square prediction error (RMSPE) and mean absolute error (MAE), and increased Lin's concordance correlation coefficient (CCC). Both glmmLasso and SCAD reduced the Akaike information criterion (AIC) and Bayesian information criterion (BIC) for both the ANIM-B and the DMI-B models, while the other two ML methods had mixed outcomes. By balancing prediction performance and fitting performance, we obtained one ANIM-B model (containing 10 genera of bacteria and 3 animal data) fitted using glmmLasso and one DMI-B model (5 genera of bacteria and 1 animal datum) fitted using SCAD. This study highlights the importance of incorporating rumen microbiota data in CH4 prediction models to enhance accuracy and robustness. Additionally, ML methods facilitate the selection of microbial predictors from high-dimensional metataxonomic data of the rumen microbiota without overfitting. Moreover, the identified microbial predictors can serve as biomarkers of CH4 emissions from sheep, providing valuable insights for future research and mitigation strategies. [ABSTRACT FROM AUTHOR]

Copyright of Beleid en Maatschappij (1875712X) is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Beleid en Maatschappij (1875712X) is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Tijdschrift voor Bijzonder Strafrecht & Handhaving is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The rapid introduction of technical innovations in healthcare requires that professionals are adequately prepared for correct clinical use of medical technology. In response to the technological transformation of healthcare, a new type of professional, the Technical Physician (TP), was created and is trained to improve individual patient care using technology tailored to the needs of individual patients. This study investigates the TPs' impact on patient care in terms of innovation, effectiveness, efficiency, and patient safety. Method: Semi-structured, in-depth interviews were conducted with 30 TPs and 17 medical specialists (MSs) working in academic or teaching hospitals in the Netherlands. The pre-structured and open-ended interview questions focused on: 1) the perceived impact on innovation, effectiveness, efficiency, and safety, and 2) opportunities and challenges in daily work. Results: TPs and MSs unanimously experienced that TPs contributed to innovation. A majority indicated that effectiveness (TP 57%; MS 71%) and efficiency (TP 67%; MS 65%) of clinical practice had increased. For safety, 87% of TPs but only 47% of MSs reported an increase. The main explanation given for TPs positive impact was combining medical and technical knowledge. Mainly organizational barriers were mentioned as a potential cause for a less visible contribution of TPs. Conclusion and discussion: TPs and MSs unanimously agreed that TPs contributed to innovating patient care through their integrative medical and technical competencies. Most TPs and MSs also reported increased effectiveness, efficiency, and safety of patient care due to the TPs' work. TPs and MSs expected that the TPs' impact on direct and indirect patient care will be enhanced once organizational barriers are removed. [ABSTRACT FROM AUTHOR]

The word 'disability' does not exist in most African languages. There are words for impairments that describe the 'missing' or affected body parts, but no specific words to characterize, for instance, neurodevelopmental conditions. In this narrative review we focus on the different interpretations of neurodevelopmental conditions in Uganda and discuss the importance of cultural concepts and the intersectionality of family‐centred care, poverty, and neocolonialism when working with children with 'impairments of the brain'. We suggest that these concepts should be taken into consideration in health care service provision and public health awareness campaigns, and the need to rethink how disabled children can be included in a 'global' health approach. We explain how applying biomedical categories used in the Global North to diagnose children is only ethical if this information will benefit the child and is accompanied by supportive actions that are relevant to the child and family setting. We argue for the enhancement of community‐based structures of belonging and interdependence that are already in place and strengthening of family and community networks to continue the care and co‐responsibility for children with 'impairments of the brain'. What this paper adds: Cultural concepts, family‐centred care, poverty, and neocolonialism are key in defining disability in the Global South.Diagnosis of a neurodevelopmental condition should be accompanied by supportive actions relevant to the child's setting.Interventions need to build on family and community‐based structures of belonging and interdependence.Health care services and public health awareness campaigns should be made culturally relevant. [ABSTRACT FROM AUTHOR]

To understand the impact of the COVID-19 public health response on families of children with disabilities in Central Uganda we conducted phone interviews with parents and children during the first 5 months of the outbreak (March - July 2020). Most parents and children were well informed about COVID-19 and were keen to adhere to government prevention measures. The majority said lock-down measures had a negative effect on their mental and physical health, social life, finances, education and food security. Access to medical services and medication for chronic illness had been limited or absent due to restrictions in travel, some facilities restricting access, and limited financial resources. The majority of parents reported loss of work which resulted in difficulties in finding enough food and paying rent. Parents worried about children missing education and friends. We suggest greater attention to children with disabilities and their families when implementing mitigating and long-term responses. This paper reports a study with families of children with disabilities in Uganda during the Coronavirus pandemic in 2020, known as COVID-19. Families of children with disabilities in Uganda are well informed about COVID-19 and try to follow prevention measures. Families of children with disabilities have difficulties meeting daily basic needs as they were unable to work and had no income during the COVID-19 related lock down. The COVID-19 response affects access to health and rehabilitation services for children with disabilities in Uganda. Parents of children with disabilities struggle with home education and learning due to lack of access to accessible learning materials and learning support in Uganda. The COVID-19 response affects the peer support networks and social support for parents of children with disabilities in Uganda. Children with disabilities and their families should be involved and considered in the development and implementation of the COVID-19 response. [ABSTRACT FROM AUTHOR]

Objective This study explored the acceptability and feasibility of the use of low-cost virtual reality (VR) glasses, and the Wong-Baker Faces Pain Scale and Children's Fear Scale scales, for pain and fear reduction in children admitted at the septic ward of CoRSU Rehabilitation Hospital in Uganda. Methods In total, 79 children aged 4–17 years of age were offered to watch cartoons using VR glasses while undergoing painful dressing procedures. Before and after the procedure, children were asked to index current pain; children and their caregivers were asked to rate anticipated fear. Focus group discussions with 13 children, 10 caregivers and 9 nurses explored acceptability and feasibility. Quantitative data were analyzed using STATA15, NVIVO12 was used for qualitative data analysis. Results The VR glasses were accepted by 76 (96%) of the children. Children, caregivers, and nurses mentioned the glasses were helpful in distracting children from the medical procedure and felt the use of the glasses helped reduce child fear and pain. Nurses felt it made their work easier. The Wong-Baker Faces Pain Scale was an acceptable and feasible method to measure pain, while the Children's Fear Scale was more difficult to interpret for our study population as they felt the faces on the scale were hard to read and identify with. Conclusions The use of VR glasses may offer an acceptable and effective pain and fear reduction method in resource-constrained settings and should be further explored in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Although network governance has become increasingly popular in both research and practice, its anticipated benefits do not always materialize. Although literature on network governance acknowledges the challenges that result from its introduction, scholars tend to assume these challenges can be managed and rarely analyze how the different participating actors (strategically) react to the tensions surrounding its establishment. As such, the process of how "networking" actors establish, maintain, and negotiate a network remains understudied. In light of these shortcomings, this article zooms in on how actors, in their collaboration efforts with network partners, navigate the tensions between (a) their discretionary space and the parameters set by a central policymaker, and (b) their pursuit of both integration and differentiation. This ethnographic case analysis contributes by, first, revealing how local actors demonstrate agency in maneuvering between these tensions in everyday practice by adopting three strategies—that is, overwhelmed deflection, situational segmentation, and strategic reappropriation—and, second, by revealing how these tensions interact and subsequently affect the implementation of policies in networks. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency.Design: Interventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each).Setting: Neonatal intensive care unit.Participants: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26-28) and postnatal age 17 (12-23) days.Intervention: Automated oxygen titration with the VDL1.1 algorithm, with the incoming SpO2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO2) adjustments actuated by a motorised blender. The desired SpO2 range was 90%-94%, with bedside clinicians able to make corrective manual FiO2 adjustments at all times.Main Outcome Measures: Target range (TR) time (SpO2 90%-94% or 90%-100% if in air), periods of SpO2 deviation, number of manual FiO2 adjustments and oxygen requirement were compared between automated and manual control periods.Results: In 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51-64)% vs automated 81 (72-85)%, p<0.001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25-32)% and automated 26 (24-32)%, p=0.13).Conclusion: The VDL1.1 algorithm was safe and effective in SpO2 targeting in preterm infants on non-invasive respiratory support.Trial Registration Number: ACTRN12616000300471. [ABSTRACT FROM AUTHOR]

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On the discursive construction of emotional problems in head-and-neck cancer follow-up consultations Cancer survivors often experience heightened emotional distress, resulting in reduced quality of life. However, previous research has shown that oncologists tend to avoid discussing emotional issues with these patients. In this paper we analyse doctor-patient interaction in follow-up head-and-neck cancer consultations in a major cancer centre in The Netherlands, comparing data from a Control group and a group that used the Distress Thermometer and Problem List (DT+PL) to stimulate the discussion of emotional concerns. We found that, although emotional problems were addressed in both conditions, the change in the doctors' epistemic status occasioned by the DT+PL caused there to be a marked difference in who first nominated the concerns as topics. When and how which issues were discussed was mutually, discursively, negotiated by the participants in the situation. Doctors were seen to rely in these negotiations on their bio-medical knowledge, while patients and companions used their own lived experience and the experiences of third parties. Detailed analysis of the data shows that when there was a disjunct between the knowledge that patients and doctors relied upon, both doctors and patients were very diffident when expressing disagreement. [ABSTRACT FROM AUTHOR]

Background: HIV status awareness is critical for HIV prevention and care but HIV testing rates remain low in Uganda, especially among men. One suggested approach to increase access and utilisation of HIV testing services is HIV self-testing. We explored perceptions of pregnant and lactating women and their male partners who attended antenatal care, and health care providers in a government hospital in Kampala, Uganda, about HIV self-testing for initial or repeat testing for women and their partners during pregnancy and postpartum We draw implications for scaling-up this new testing approach in Uganda. Methods: This was a qualitative study conducted at Mulago National Referral Hospital, Kampala, Uganda, between April and December 2017. We conducted in-depth interviews with five pregnant or lactating women and their five male partners; five focus group discussions (two with women, two with health workers and one with male partners of women attending antenatal care) and five key informant interviews with health workers providing prevention of mother-to-child HIV transmission (PMTCT) services. Data were analysed using content thematic approach. Results: There was limited awareness about HIV self-testing especially among pregnant or lactating women and their male partners. Study participants mentioned that HIV self-testing would enable people to know their HIV status faster, they thought the approach would be cost- and time-saving compared to health facility-based HIV testing, improve confidentiality and reduce stigma for those who test HIV positive. They expressed however, a general fear that HIV self-testing would lead to harm to self and others in case one tested HIV positive, including suicide, violence among couples, intentional transmission of HIV, and limited linkage to care due to lack of counselling. The likely misinterpretation of HIV test results especially among those with no or limited education, and possible coercion exerted by male partners on their wives were other potential concerns raised about the use of HIV self-testing. Conclusions: There was limited knowledge about HIV self-testing among pregnant and lactating women, their partners and health workers. While the self-testing modality was perceived to be critical for helping people, especially those in casual and distant relationships, to know their HIV status and that of their partners, most study participants believed that HIV self-testing could potentially result in a multitude of negative outcomes in the absence of pre- and post-test counselling. Successful scale-up and integration of self-testing in HIV programs requires community education, provision of information materials and making self-test kits accessible and affordable, especially in rural areas. [ABSTRACT FROM AUTHOR]

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During the strong El Niño event of 2015–2016 large‐scale dieback of mangrove forests was observed in the Gulf of Carpentaria region of northern Australia. These and other intertidal communities are also extensive along the 7,400 km coastline of north‐eastern Australia. Determination of their floristic composition, potential carbon (C) store and sequestration capacity, and vulnerability to climate extremes is required for their effective conservation management and was the aim of this study.Standardized, state‐wide quantitative classification methods identified five mangrove forest and three saltmarsh communities covering 2,604 km2 along this coastline.Estuarine and oceanic mangrove forests were mapped separately. Carbon storage and sequestration capacity of the intertidal communities and their vulnerability to strong El Niño events were estimated using published data and GIS analyses.An estimated potential 126.2 (± 27.3 SEM) Tg C and 8.3 (±0.4 SD) Tg C were stored in the mangrove forests and saltmarshes, respectively. Comparatively, the rainforests of the region stored an estimated equivalent amount of C but covered three times the area, and the most widespread woodlands (Eucalyptus tetrodonta) of the region stored an estimated 1.5 times the C but covered 16 times the area. The C stored in the intertidal communities was estimated as equivalent to 493.47 Tg of CO2, valued at AU$6.8 billion on the Australian carbon market in December 2018. Annual C sequestration potential was 0.18–0.34 Tg C/year, valued between AU$8.9 and $17 million.Approximately 360 ha of mangrove forest was estimated as lost because of dieback during the 2015–16 El Niño event. Three types of mangrove forest were identified as potentially vulnerable to dieback from El Niño‐driven climate events.This study highlights the national and global significance of these intertidal systems and our findings need to be incorporated in future conservation and development planning of northern Australia. [ABSTRACT FROM AUTHOR]

Professionals' limited knowledge on mental health and their stigmatizing attitudes toward mental illness can delay the diagnosis of autism. We evaluated the knowledge on Autism Spectrum Disorder (ASD) and stigmatizing attitudes in 93 physicians at Dutch Youth and Family Centers (YFC). These physicians screen for psychiatric symptoms in children. We show that their general ASD knowledge scored 7.1 (SD 1.2), but their specific ASD knowledge was only 5.7 (SD 1.7) (weighted means on 1–10 scale, 1 = least knowledge, 10 = most knowledge). Our physicians had positive attitudes toward mental illness (CAMI scores 2.18 (SD 0.33) to 2.22 (SD 0.40) on a 5-point Likert scale) but they had higher levels of stigmatizing attitudes than other Western healthcare professionals. Their levels were considerably lower than in non-Western professionals. We found no relations between ASD knowledge, stigmatizing attitudes and demographic variables. In conclusion, ASD knowledge and stigmatizing attitudes toward mental illness in Dutch YFC physicians require attention. [ABSTRACT FROM AUTHOR]

In mitigating greenhouse gas (GHG) emissions and reducing the carbon footprint of dairy milk, the use of generic estimates in inventory and accounting methodology at farm level largely ignores variation of on-farm GHG emissions. The present study aimed to implement results of an extant dynamic, mechanistic Tier 3 model for enteric methane (CH4) (applied in Dutch national GHG inventory) in order to capture variation in enteric CH4 emission, and in faecal N and organic matter (OM) digestibility, ultimately required to predict manure CH4 and ammonia emission. Tier 3 model predictions were translated into calculation rules that could easily be implemented in an annual nutrient cycling assessment tool including GHG emissions, which is currently used by Dutch dairy farmers. Calculations focussed on (1) enteric CH4 emission, (2) apparent faecal OM digestibility and (3) apparent faecal N digestibility. Enteric CH4 was expressed in CH4 yield indicated with the term emission factor (EF; g CH4/kg DM) for individual dietary components and feedstuffs. Factors investigated to cover predicted variation in EF value included the level of feed intake, the type of roughage fed (proportions of grass silage and maize silage) and the quality of roughage fed. A minimum number of three classes of roughage type (i.e. 0. 40% and 80% maize silage in roughage DM) appeared necessary to obtain correspondence between interpolated EF values from EF lists and Tier 3 model predictions. A linear decline in EF value with 1% per kg increase in DM intake is adopted based on model simulations. The quality of roughage was represented by the effect of maturity of harvested grass or of the whole plant maize at cutting, based on a survey of modelling as well as experimental work. Also, predictions were assembled for apparent faecal OM digestibility which could be used in national inventory and in farm accounting. Apparent faecal N digestibility (as a major determinant of predicted urinary N excretion) was predicted, to support current Dutch national ammonia emission inventory and to correct the level of N digestibility in farm accounting. Compared to generic values or values retrieved from the Dutch feeding tables, predicted OM and N digestibility and enteric CH4 are better rooted in physiological principles and better reflect observed variation under experimental conditions. The present results apply for conditions with fairly intensive grassland management in temperate regions. [ABSTRACT FROM AUTHOR]

Copyright of Bestuurskunde is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inclusive education interventions in low-income countries are dominated by definitions and frameworks from disability studies and educational research scholars from high-income countries. Disability studies scholars have argued for valuing diverse understandings and a different discourse when studying disability and inclusion in low-income countries. In this paper, we explore the meaning of belonging and inclusion to parents of children with disabilities in central Uganda. Through case study analysis we aim to give alternative starting points for inclusive primary education programmes. We explore the themes 'missing parts', the 'ability to manage', 'belonging to a family', and 'being given a chance' as key concepts of disability and inclusion. We argue not to translate parents' descriptions into international categories and framework, but to reflect on the larger and underlying meaning of the concepts to form a more culturally embedded and relevant starting point of education for all. We propose to address the gaps of the postcolonial education system that has taken teachers' and families' away from the concept of 'obuntu bulamu', and focus interventions on re-creating this togetherness and value the strength of concepts of belonging and caring for each other. [ABSTRACT FROM AUTHOR]

The aim of this study was to test whether women who conceived after a period of subfertility are less likely to undergo invasive prenatal testing (IPT) and determine factors of influence in that decision. We conducted a retrospective study at the Maastricht University Medical Centre (MUMC+) to compare the rates of IPT following abnormal results of combined first trimester screening (cFTS) or second trimester screening (STS), or because of advanced maternal age among women tested for the effect of type and duration of subfertility and history of fertility investigations and/or treatment. We included 977 women who underwent IPT between January 2010 and December 2013. The women who conceived after fertility investigations and/or treatment had lower rates of IPT following abnormal STS (12.6% vs. 20.0%, OR = 0.58, 95% CI; 0.34–0.97). The difference was not statistically significant after correction for maternal age and severity of the foetal anomaly. Maternal age was, in contrast to fertility treatment or duration of subfertility, related to the choice of IPT among formerly subfertile women. Therefore, the lower uptake of IPT in women conceiving after a period of subfertility is dependent on the indication for IPT and maternal age and less on the type and duration of subfertility. [ABSTRACT FROM AUTHOR]

Background: Characterising the regulation of milk component synthesis in response to macronutrient supply is critical for understanding the implications of nutritional interventions on milk production. Gene expression in mammary gland secretory cells was measured using RNA isolated from milk fat globules from 6 Holstein-Friesian cows receiving 5-d abomasal infusions of saline, essential amino acids (AA), or glucose (GG) or palm olein (LG) without (LAA) or with (HAA) essential AA, according to a 6 × 6 Latin square design. RNA was isolated from milk fat samples collected on d 5 of infusion and subjected to real-time quantitative PCR. We hypothesised that mRNA expression of genes involved in de novo milk fatty acid (FA) synthesis would be differently affected by GG and LG, and that expression of genes regulating transfer of tricarboxylic acid cycle intermediates would increase at the HAA level. We also hypothesised that the HAA level would affect genes regulating endoplasmic reticulum (ER) homeostasis but would not affect genes related to the mechanistic target of rapamycin complex 1 (mTORC1) or the integrated stress response (ISR) network. Results: Infusion of GG did not affect de novo milk FA yield but decreased expression of FA synthase (FASN). Infusion of LG decreased de novo FA yield and tended to decrease expression of acetyl-CoA carboxylase 1 (ACC1). The HAA level increased both de novo FA yield and expression of ACC1, and tended to decrease expression of mitochondrial phosphoenolpyruvate carboxykinase (PCK2). mRNA expression of mTORC1 signaling participants was not affected by GG, LG, or AA level. Expression of the ε subunit of the ISR constituent eukaryotic translation initiation factor 2B (EIF2B5) tended to increase at the HAA level, but only in the presence of LG. X-box binding protein 1 (XBP1) mRNA was activated in response to LG and the HAA level. Conclusions: Results show that expression of genes involved in de novo FA synthesis responded to glucogenic, lipogenic, and aminogenic substrates, whereas genes regulating intermediate flux through the tricarboxylic acid cycle were not majorly affected. Results also suggest that after 5 d of AA supplementation, milk protein synthesis is supported by enhanced ER biogenesis instead of signaling through the mTORC1 or ISR networks. [ABSTRACT FROM AUTHOR]

Copyright of Beleid en Maatschappij (1875712X) is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The standard process for starting anamnesis in the follow-up cancer consultation is for the doctor to ask a 'How are you?' question. This question gives the patient the opportunity to give a gloss of their general condition and offer the first topic of discussion. Findings in earlier analyses of US and UK data in a broad array of medical contexts show that the question is ambiguous and hence patients may interpret it as social rather than medical. A discourse analysis of a corpus of 28 video-taped consultations shows that the 'How are you?' question in the context of Dutch follow-up cancer consultations is consistently interpreted by both doctor and patients as a holistic medical question, making relevant a – frequently complex and nuanced – medically oriented response. We suggest that this difference may have to do with the interactional norms of hospital visits in the Netherlands, and with the specific contextual parameters of return visits, more specifically with follow-up cancer consultations, which affect the way the HAY question is placed, intended and understood. [ABSTRACT FROM AUTHOR]

On-farm nutrition and management interventions to reduce enteric CH4 (eCH4) emission, the most abundant greenhouse gas from cattle, may also affect volatile solids and N excretion. The objective was to jointly quantify eCH4 emissions, digestible volatile solids (dVS) excretion and N excretion from dairy cattle, based on dietary variables and animal characteristics, and to evaluate relationships between these emissions and excreta. Univariate and Bayesian multivariate mixed-effects models fitted to 520 individual North American dairy cow records indicated dry matter (DM) intake and dietary ADF and CP to be the main predictors for production of eCH4 emissions and dVS and N excreta (g/day). Yields (g/kg DM intake) of eCH4 emissions and dVS and N excreta were best predicted by dietary ADF, dietary CP, milk yield and milk fat content. Intensities (g/kg fat- and protein-corrected milk) of eCH4, dVS and N excreta were best predicted by dietary ADF, dietary CP, days in milk and BW. A K -fold cross-validation indicated that eCH4 and urinary N variables had larger root mean square prediction error (RMSPE; % of observed mean) than dVS, fecal N and total N production (on average 24.3% and 26.5% v. 16.7%, 15.5% and 16.2%, respectively), whereas intensity variables had larger RMSPE than production and yields (29.4%, 14.7% and 14.6%, respectively). Univariate and multivariate equations performed relatively similar (18.8% v. 19.3% RMSPE). Mutual correlations indicated a trade-off for eCH4 v. dVS yield. The multivariate model indicated a trade-off between eCH4 and dVS v. total N production, yield and intensity induced by dietary CP content. [ABSTRACT FROM AUTHOR]

Rumen sensors provide specific information to help understand rumen functioning in relation to health disorders and to assist in decision-making for farm management. This review focuses on the use of rumen sensors to measure ruminal pH and discusses variation in pH in both time and location, pH-associated disorders and data analysis methods to summarize and interpret rumen pH data. Discussion on the use of rumen sensors to measure redox potential as an indication of the fermentation processes is also included. Acids may accumulate and reduce ruminal pH if acid removal from the rumen and rumen buffering cannot keep pace with their production. The complexity of the factors involved, combined with the interactions between the rumen and the host that ultimately determine ruminal pH, results in large variation among animals in their pH response to dietary or other changes. Although ruminal pH and pH dynamics only partially explain the typical symptoms of acidosis, it remains a main indicator and may assist to optimize rumen function. Rumen pH sensors allow continuous monitoring of pH and of diurnal variation in pH in individual animals. Substantial drift of non-retrievable rumen pH sensors, and the difficulty to calibrate these sensors, limits their application. Significant within-day variation in ruminal pH is frequently observed, and large distinct differences in pH between locations in the rumen occur. The magnitude of pH differences between locations appears to be diet dependent. Universal application of fixed conversion factors to correct for absolute pH differences between locations should be avoided. Rumen sensors provide high-resolution kinetics of pH and a vast amount of data. Commonly reported pH characteristics include mean and minimum pH, but these do not properly reflect severity of pH depression. The area under the pH × time curve integrates both duration and extent of pH depression. The use of this characteristic, as well as summarizing parameters obtained from fitting equations to cumulative pH data, is recommended to identify pH variation in relation to acidosis. Some rumen sensors can also measure the redox potential. This measurement helps to understand rumen functioning, as the redox potential of rumen fluid directly reflects the microbial intracellular redox balance status and impacts fermentative activity of rumen microorganisms. Taken together, proper assessment and interpretation of data generated by rumen sensors requires consideration of their limitations under various conditions. [ABSTRACT FROM AUTHOR]

In this microanalytical study, designed as part of an interdisciplinary and intercultural virtual exchange project for undergraduate students, the authors investigate the correlation between task design on the one hand and participant interaction during task performance on the other. The task created for this study consisted of 12 low‐frequency vocabulary terms nonnative speakers (NNS) were expected to negotiate with their native speaker (NS) counterparts in order to reach mutual understanding and to complete the task successfully. Six NS‐NNS dyads (N = 12) carried out the task, each using both videoconferencing (Skype) and text‐based real‐time chat during the same session in a counterbalanced design. It was found that (a) if a task consists of multiple items to be exchanged, with multiple triggers of potential nonunderstanding, the NNS response gradually moves from task‐appropriate response to face‐appropriate response during the course of an ongoing task session; (b) in order to ensure successful task completion, the NS tends to respond to NNS face‐appropriate behaviour with responses that are both face‐ and task‐appropriate; and (c) NNS nonunderstanding of a particular target item shapes the expectations of both NS and NNS concerning the next task item. [ABSTRACT FROM AUTHOR]

There is need to learn from indigenous knowledge and concepts when studying disability and inclusion in resource-constrained settings. We describe the development and testing of the 'Obuntu bulamu' intervention, a peer-to-peer support disability inclusion intervention, starting from indigenous interpretations of belonging and humanity. 'Obuntu bulamu' is an accepted and consistent behaviour that signifies a shared set of values that promote well-being, togetherness, and unity. The intervention was co-created and tested by a team of children, parents, teachers, disability rehabilitation workers, and academics in Uganda. It consists of training sessions, peer support meetings, and activities for children, parents, and teachers around the themes 'peer support', 'disability', and 'belonging'. Through qualitative participatory methods the feasibility and acceptability of the intervention was evaluated with 64 children, 64 parents, and 33 teachers in 10 communities in Wakiso district, Central Uganda. [ABSTRACT FROM AUTHOR]

We consider a class of random processes on graphs that include the discrete Bak–Sneppen process and several versions of the contact process, with a focus on the former. These processes are parametrized by a probability 0 ≤ p ≤ 1 that controls a local update rule, and often exhibit a phase transition in this parameter. In general, analyzing properties of the phase transition is challenging, even for one-dimensional chains. In this article we consider a power-series approach based on representing certain quantities, such as the survival probability or the expected number of steps per site to reach the steady state, as a power series in p. We prove that the coefficients of those power series stabilize for various families of graphs, including the family of chain graphs. This phenomenon has been used in the physics community but was not yet proven. We also show that for local events A, B of which the support is a distance d apart we have cor (A , B) = O (p d) . The stabilization allows for the (exact) computation of coefficients for arbitrary large systems which can then be analyzed using the wide range of existing methods of power series analysis. [ABSTRACT FROM AUTHOR]

Background: Although conceptualisation of addiction varies with time and culture, literature on intercultural studies between high and low income countries is scarce. This article uses Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 guidelines on diagnosis of Alcohol Use Disorder (AUD) and the Capability Opportunity Motivation - Behaviour (COM-B) model to explore perspectives on alcohol addiction and its facilitating factors in Uganda and Belgium. Method: Sixty qualitative interviews (40 with service providers and 20 service users) were administered in four alcohol treatment centres, two in Uganda and two in Belgium. Interviews were transcribed and analysed thematically using Nvivo software. Result: While addiction was primarily regarded as a disease enabled by capability factors (affordability and the absence of life and social skills) by Belgian respondents, many Ugandans viewed it as a moral or criminal issue; motivated by the varied roles of informal alcohol use amidst weak restrictions. Opportunity-related factors including; acceptability, availability, media influence, cultural/religious beliefs and practices and peer influence were recognised as facilitating factors in both countries, while stigma was equally prevalent. Conclusion: Interventions in Uganda could explore strengthening legislation and research on utilisation of the well-entrenched religious and cultural institutions to encourage alternatives to alcohol use. In Belgium, promotion of life and social skills, alcohol regulation in educational institutions and other demand reduction strategies seem essential to delay the onset of (mis)use. In both societies; general reduction of opportunities for access, early intervention, programmes for young persons and prevention of stigma through awareness-raising can be explored for mitigation of AUD. [ABSTRACT FROM AUTHOR]

Sampling uniform simple graphs with power-law degree distributions with degree exponent |$\tau\in(2,3)$| is a non-trivial problem. Firstly, we propose a method to sample uniform simple graphs that uses a constrained version of the configuration model together with a Markov Chain switching method. We test the convergence of this algorithm numerically in the context of the presence of small subgraphs and we estimate the mixing time to be at most |$\mathcal{O}(n \log^2n)$|⁠. Secondly, we compare the number of triangles in uniform random graphs with the number of triangles in the erased configuration model where double edges and self-loops of the configuration model are removed. Using simulations and heuristic arguments, we conjecture that the number of triangles in the erased configuration model is larger than the number of triangles in the uniform random graph, provided that the graph is sufficiently large. Lastly, we argue that certain switch-chain-based proof methods can not be used in the regime |$\tau\in(2,3)$| due to the possibility of creating many triangles with a single switch. [ABSTRACT FROM AUTHOR]

Background: The ‘Primary HIV Prevention among Pregnant and Lactating Ugandan Women’ (PRIMAL) study aimed to assess the effectiveness of an enhanced HIV counseling intervention for preventing HIV acquisition among HIV-uninfected mothers during pregnancy and throughout the breastfeeding period. Methods: We conducted an unblinded randomized control trial between 22 February 2013 and 22 April 2016 to assess the effectiveness of an extended repeat HIV testing and enhanced counseling (ERHTEC) intervention aimed at preventing primary HIV infection among HIV-uninfected pregnant and lactating women in Uganda. HIV-uninfected pregnant women aged 15–49 were enrolled 1:1 individually or in couples together with their partner. Enrolled women and couples were randomized 1:1 to an intervention (ERHTEC) or control (extended repeat HIV testing and standard counseling) group and followed up to 24 months postpartum or six weeks past complete cessation of breastfeeding, whichever came first. Both groups were tested for sexually transmitted infections (STIs) and HIV at enrollment, delivery, 3 and 6 months postpartum and every 6 months thereafter until the end of follow-up. The intervention group received enhanced HIV prevention counseling every 3 months throughout follow-up. The control group received standard counseling at the time of HIV retesting. Both intervention and control couples were offered couple HIV testing and counseling at all study visits. Main outcome measures: Frequency of condom use and incidence of HIV, syphilis, gonorrhea, chlamydia and trichomoniasis over follow-up. Results: Between February 2013 and April 2014, we enrolled 820 HIV-uninfected pregnant women presenting for antenatal care individually (n = 410) or in couples (n = 410 women and 410 partners) in one urban and one rural public Ugandan hospital. Women’s median age was 24 years (IQR 20–28 years). At baseline, participants did not differ in any socio-demographic, reproductive health, HIV testing history, sexual behavior, medical history or STI status characteristics; 96% (386/402) of couples were tested and counseled for HIV together with their partners at enrolment, 2.1% (7/329) of whom were found to be HIV-infected. Six hundred twenty-five (76%) women completed follow-up as per protocol (). Women were followed for an average of 1.76 years and cumulated 1,439 women-years of follow-up or 81% of the maximum 1,779 women-years of follow-up assuming no dropouts. Men were followed for an average of 1.72 years. The frequency of consistent condom use and the proportion of women who used condoms over the last 3 months or at last vaginal sex increased substantially over follow-up in both arms, but there were no statistically significant differences in increases between the intervention and control arms. During follow-up, on average 42% (range 36%-46%) of couple partners were counseled together. Between 3.8% and 7.6% of women tested positive at any follow-up visit for any STI including syphilis, gonorrhea, C. trachomatis or T. vaginalis. Four women (two in each arm) and no enrolled men became infected with HIV, representing an overall HIV incidence rate of 0.186 per 100 person-years. Three of the women seroconverters had enrolled individually, one as a couple. At or before seroconversion, all four women reported their partners had extramarital relationships and/or had not disclosed their suspected HIV-infected status. There were no statistically significant differences between study arms for STI or HIV incidences. Conclusions: A sustained enhanced HIV prevention counseling intervention for up to 2 years postpartum among pregnant and breastfeeding women did not have a statistically significant effect on condom use or HIV incidence among these women. However, in both study arms, condom use increased over follow-up while STI and HIV incidence remained very low when compared to similar cohorts in and outside Uganda, suggesting that repeat HIV testing during breastfeeding, whether with enhanced or standard counseling, may have had an unintended HIV preventive effect among pregnant and lactating women in this setting. Further research is needed to verify this hypothesis. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Copyright of Beleid en Maatschappij (1875712X) is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)