Search

Introduction: Insulin pumps and continuous glucose monitors (CGM) have many benefits in the management of type 1 diabetes. Unfortunately disparities in technology access occur in groups with increased risk for adverse effects (eg, low socioeconomic status [SES], public insurance). Research Design & Methods: Using 2015 to 2016 data from 4,895 participants from the T1D Exchange Registry, a structural equation model (SEM) was fit to explore the hypothesized direct and indirect relationships between SES, insurance features, access to diabetes technology, and adverse clinical outcomes (diabetic ketoacidosis, hypoglycemia). SEM was estimated using the maximum likelihood method and standardized path coefficients are presented. Results: Higher SES and more generous insurance coverage were directly associated with CGM use (β = 1.52, SE = 0.12, P < .0001 and β = 1.21, SE = 0.14, P < .0001, respectively). Though SES displayed a small inverse association with pump use (β = -0.11, SE = 0.04, P = .0097), more generous insurance coverage displayed a stronger direct association with pump use (β = 0.88, SE = 0.10, P < .0001). CGM use and pump use were both directly associated with fewer adverse outcomes (β = -0.23, SE = 0.06, P = .0002 and β = -0.15, SE = 0.04, P = .0002, respectively). Both SES and insurance coverage demonstrated significant indirect effects on adverse outcomes that operated through access to diabetes technology (β = -0.33, SE = 0.09, P = .0002 and β = -0.40, SE = 0.09, P < .0001, respectively). Conclusions: The association between SES and insurance coverage and adverse outcomes was primarily mediated through diabetes technology use, suggesting that disparities in diabetes outcomes have the potential to be mitigated by addressing the upstream disparities in technology use.

Background and Objectives Diabetic ketoacidosis (DKA) rates in the United States are rising. Prior studies suggest higher rates in younger populations, but no studies have evaluated national trends in pediatric populations and differences by subgroups. As such, we sought to examine national trends in pediatric DKA. Methods We used the 2006, 2009, 2012, and 2016 Kids’ Inpatient Database to identify pediatric DKA admissions among a nationally representative sample of admissions of youth ≤20 years old. We estimate DKA admission per 10 000 admissions and per 10 000 population, charges, length of stay (LOS), and trends over time among all hospitalizations and by demographic subgroups. Regression models were used to evaluate differences in DKA rates within subgroups overtime. Results Between 2006 and 2016, there were 149 535 admissions for DKA. Unadjusted DKA rate per admission increased from 120.5 (95% CI, 115.9-125.2) in 2006 to 217.7 (95% CI, 208.3-227.5) in 2016. The mean charge per admission increased from $14 548 (95% CI, $13 971-$15 125) in 2006 to $20 997 (95% CI, $19 973-$22 022) in 2016, whereas mean LOS decreased from 2.51 (95% CI, 2.45-2.57) to 2.28 (95% CI, 2.23-2.33) days. Higher DKA rates occurred among 18- to 20-year-old females, Black youth, without private insurance, with lower incomes, and from nonurban areas. Young adults, men, those without private insurance, and from nonurban areas had greater increases in DKA rates across time. Conclusions Pediatric DKA admissions have risen by 40% in the United States and vulnerable subgroups remain at highest risk. Further studies should characterize the challenges experienced by these groups to inform interventions to mitigate their DKA risk and to address the rising DKA rates nationally.

To reach global immunization goals, national programs need to balance routine immunization at health facilities with vaccination campaigns and other outreach activities (e.g. vaccination weeks), which boost coverage at particular times and help reduce geographic inequalities. However, where routine immunization is weak, an overreliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunization and outreach activities to reach immunization goals in rural Madagascar.We obtained data from health centers in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, DTP and Polio) delivered to children, during 2014-2018. We also analyzed data from a district-representative cohort carried out every two years in over 1500 households in 2014-2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographic and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions. The HSS intervention was associated with a significant increase in immunization rates (Odds Ratio between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunization rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (Odds Ratio between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographic coverage, which prevented achieving international coverage targets. Investment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunizations.Key questionsWhat is already known?-Reaching the minimum recommended vaccination coverage of 90% for childhood illnesses remains a substantial challenge for low and middle income countries (LMICs).-Understanding how vaccine delivery strategies can be improved to achieve coverage targets in rural areas of LMICs is essential due to the fragility of health systems and associated health budgets.-While evidence exists on the impact of outreach activities and other targeted interventions aimed at improving immunization coverage, it is unclear how strengthening local health systems can help improve key indicators of vaccination coverage, via its different impacts on routine and outreach immunizations.What are the new findings?-A health systems strengthening (HSS) intervention in a rural district of Madagascar improved overall vaccination coverage, reduced economic inequalities in vaccination coverage, and increased the proportion of timely vaccinations via an increase in routine immunizations.-The contribution of outreach activities was lower in the HSS catchment area than in the rest of the district, which was associated with a persistence of geographic inequalities in vaccination coverage.What do the new findings imply?-Strengthening local health systems can help improve key indicators of vaccination coverage in rural, low resource settings, even when those interventions do not target specifically vaccine improvements themselves.-Explicit efforts are still necessary in areas undergoing HSS to vaccinate children in remote areas so that immunization goals can be reached.

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).

Background This study was part of a project funded under the Grand Challenges Explorations initiative to engage adolescent girls living in the main slums of Nairobi. This involved an innovative co-creation initiative through jointly designing and testing the feasibility of a toolkit of information, skill, and confidence-building, and coping mechanisms that can effectively shield them and their peers against the risks of mental stress during pregnancy and early motherhood. Methods Qualitative interviews and discussions from visual methodologies including Photovoice, digital storytelling, and public service announcements were conducted with 30 pregnant and adolescent mothers aged 14–19 years in four informal settlements either pregnant or having a child less than 2 years. The aims included; to generate an inventory of mental stressors during pregnancy and early motherhood; understand how mental stress affects the ability to seek care for themselves and their child, and understand individual coping strategies. Results The psychosocial challenges identified in order of importance included: chased from home by the parents; economic hardship; neglect and abandonment by the person responsible for the pregnancy; stigmatization by family, friends, and the community; feelings of shattered dreams; and daily stress related to living in poor and unhygienic conditions. During the pregnancy and early motherhood, the participants experienced feelings of embarrassment, shame, hopelessness, and to the extreme, suicidal thoughts clouded their minds. Main coping strategies included social isolation for some, socializing with other pregnant and adolescent mothers, and negative behaviors like the uptake of illicit drugs and alcohol and risky sexual relationships. Conclusion The unpreparedness for early motherhood infused with inadequate psychosocial support led to increased mental stress and risk of depression. The interconnection between the triggers to mental stress showed the need to focus on a multifaceted approach to address the wellbeing of pregnant and adolescent mothers.

International audience; There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district—community, primary care centers, hospital—including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.

People have prioritized even more the quality of life in the most diverse places of work. Quality of Working Life (QWL) can be analyzed from some indicators and factors that help to evaluate the workplace and the people who work on it. In addition, the personal characteristics also interfere in the QWL perception level. In this context, in this article, the objective is to analyze the emotional intelligence (EI) and Quality of Working Life factors in the professors’ work at federal institutions of higher education in Brazil. The data were collected by a questionnaire composed of scales to identify some variables of individual differences and QWL factors. The survey instrument was sent via Survey Monkey to university professors from 16 federal higher education institutions in the Southeast, Midwest, and Federal District. Once downloaded, the data were analyzed using SPSS software version 21. After the analysis, it is realized that EI can be analyzed from five components: well-being, self-control, emotionality, sociability and emotions recognition. It was observed that there are significant correlations between Emotional Intelligence and QWL factors. Furthermore, there are significant relations between the life events, EI and QWL factors.

International audience; This research assesses how low-income households in rural Kenya coped with the immediate economic consequences of the COVID-19 pandemic. It uses granular financial data from weekly household interviews covering six weeks before the first case was detected in Kenya to five weeks after during which various containment measures were implemented. Based on household-level fixed-effects regressions, our results suggest that income from work decreased with almost one-third and income from gifts and remittances reduced by more than one-third after the start of the pandemic. Nevertheless, household expenditures on food remained at pre-COVID levels. We do not find evidence that households coped with reduced income through increased borrowing, selling assets or withdrawing savings. Instead, they gave out less gifts and remittances themselves, lent less money to others and postponed loan repayments. Moreover, they significantly reduced expenditures on schooling and transportation, in line with the school closures and travel restrictions. Thus, despite their affected livelihoods, households managed to keep food expenditures at par, but this came at the cost of reduced informal risk-sharing and social support between households.

International audience; INTRODUCTION: Simulation training is an increasingly used method to train medical students in the use of ultrasound guidance for vascular access positioning. Although very efficient for basic training, commercial simulators for vascular access do not reproduce real-life conditions. We developed a biological training model, using porcine liver, and compared it with an existing commercial model. METHODS: Whole porcine livers were used by perfusing the portal vein system after inferior vena cava clamping. Thirty-three practitioners accustomed to ultrasound-guided procedure were enrolled to perform an ultrasound-guided vascular procedure on both biological and commercial models. Procedure duration was recorded and 10-point scales were used to compare the 2 models regarding image quality, procedure feeling, and similarity with the real-life procedure. RESULTS: Participants reported a better image quality with the biological model (8.8 ± 1 vs. 7.7 ± 2, P = 0.007) as well as a significant difference in the procedure feeling (8.0 ± 1 vs. 6.9 ± 1.9, P = 0.002). Real-life likeness was significantly better for the biological model (8.4 ± 1.1 vs. 4.5 ± 6, P < 0.0001). Procedure duration was almost 3 times longer using the biological model than the commercial model (209.6 ± 189.0 vs. 59.8 ± 50.1, P < 0.0001). CONCLUSIONS: This study validates our biological model of porcine’s liver as an interesting training model, allowing closer real-life perception than its commercial counterpart. This model could complement and enhance simulation learning.

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)

Background: Insulin pumps are valuable tools in diabetes management and their use has increased dramatically over the past decade. Unfortunately, insulin pump use has also been associated with diabetic ketoacidosis (DKA), relating to pump malfunctions that result in the disruption in insulin administration. Our objective was to examine the prevalence and characteristics of DKA admissions associated with pump failure among pediatric patients. Methods: We used the national Kids’ Inpatient Database to identify pediatric admissions with a primary diagnosis of DKA in years 2006, 2009, 2012, and 2016. We defined a DKA-pump failure admission as an admission with either a primary diagnosis of DKA plus a secondary diagnosis of pump failure/complication or conversely, a primary diagnosis of pump failure/complication with a secondary diagnosis of DKA. We used descriptive statistics and logistic regression to describe the annual trends and characteristics of children admitted for DKA with or without pump failure. Lastly, logistic regression was used to assess the impact of pump failure on length of stay and severity of illness during DKA admissions. Results: Our dataset included 166,583 DKA admissions, of which 2,291 (1.4%) were associated with a primary or secondary diagnosis of insulin pump failure. Between 2006 and 2016, the number of total DKA admissions increased by 58%. Admissions for DKA with pump failure increased from 387 to 665 admissions during this time. Among all children admitted with DKA, those with pump failure were primarily older (60% above age 12), mostly white (63%), female (57%), from urban areas (78%), and almost 2/3rds had private insurance (60%). Adjusted analyses revealed that compared to DKA admissions without pump failure, pump failure was associated with older age, white race, residing in a rural area, private insurance, and higher income. Pump failure admissions were more likely in western and southern hospitals, otherwise there were no significant differences with respect to hospital characteristics. Compared to DKA admissions without pump failure, DKA admissions associated with pump failure had a longer mean length of stay (2.6 vs 1.5 days) and were more likely to have a higher severity of illness category. Conclusion: In this national sample, DKA with pump failure was more often observed among white, privately insured and high income children; these patient characteristics likely reflect the population of youth with diabetes who are more likely prescribed pumps in the US. Admissions for DKA concurrent with insulin pump failure accounted for a minority of pediatric DKA admissions but these admissions were associated with longer lengths of stay and severity of illness. Pump failure has important implications for care and management of children with diabetes.

This research assesses how low-income households in Western Kenya coped with the immediate economic consequences of the COVID-19 outbreak. It uses granular financial data from weekly household interviews covering six weeks before the first case was detected in Kenya to five weeks after. Our results suggest that income from work decreased with almost one third and income from gifts and remittances reduced by more than one third since the start of the pandemic. Nevertheless, household expenditures on food remained at pre-outbreak levels after preventive measures were implemented. We do not find evidence that households coped with reduced income through increased borrowing, selling assets or withdrawing savings. Instead, they gave out less gifts and remittances themselves, lent less money to others and postponed loan repayments. Moreover, they significantly reduced expenditures on schooling and transportation, related to the school closures and travel restrictions. Taken together and despite their affected livelihoods, households managed to keep food consumption at par, but this came at the cost of reduced informal risk-sharing and social support between households.

Young women and girls in Kenya face challenges in access to abortion care services. Using in-depth and focus group interviews, we explored providers' constructions of these challenges. In general, providers considered abortion to be commonplace in Kenya; reported being regularly approached to offer abortion-related care and services; and articulated the structural, contextual, and personal challenges they faced in serving young post-abortion care (PAC) patients. They also considered induced abortion among young unmarried girls to be especially objectionable; stressed premarital fertility and out-of-union sexual activity among unmarried young girls as transgressive of respectable femininity and proper adolescence; blamed young women and girls for the challenges they reported in obtaining PAC services; and linked these challenges to young women's efforts to conceal their failures related to gender and adolescence, exemplified by pre-marital pregnancy and abortion. This study shows how providers' distinctive emphasis that young abortion care-seekers are to blame for their own difficulties in accessing PAC may add to the ongoing crisis of post-abortion care for young women and adolescent girls in Kenya.

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.

In this paper, we tackle the problem of action recognition using body skeletons extracted from video sequences. Our approach lies in the continuity of recent works representing video frames by Gramian matrices that describe a trajectory on the Riemannian manifold of positive-semidefinite matrices of fixed rank. In comparison with previous works, the manifold of fixed-rank positive-semidefinite matrices is here endowed with a different metric, and we resort to different algorithms for the curve fitting and temporal alignment steps. We evaluated our approach on three publicly available datasets (UTKinect-Action3D, KTH-Action and UAV-Gesture). The results of the proposed approach are competitive with respect to state-of-the-art methods, while only involving body skeletons., Comment: Updated version of the paper published in the workshop HBU2019. The differences with the published version are a few small corrections, mainly misleading notations for the distance function on p. 4, and missing square root in the expression for "d", in the Thm. on p. 4. Noticeable changes w. r. t. v1 and v2 on arxiv, please use this version instead

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., Author summary Lymphatic filariasis is a neglected disease with chronic disabling consequences. Endemic countries have reduced lymphatic filariasis transmission through a strategy of annual rounds of mass drug administration (MDA), but the impact of such strategy has not yet been reported for Madagascar. In this study we conducted three different surveys and used rapid diagnostic tests to evaluate lymphatic filariasis transmission in four health districts of southeastern Madagascar. This included a school-based transmission assessment survey (TAS), the international gold standard to help national programmes confirm that they have interrupted lymphatic filariasis transmission, and two complementary community-based surveys. Our TAS results suggested that MDA could be stopped in three districts, confirming the consistent decline in lymphatic filariasis observed in recent years. However, the other two surveys revealed that the adult population still had high prevalence levels. This discordance raises questions about the TAS procedures and the interpretation of their results in contexts where, like in Madagascar, implementation of MDA is different for school age children than for the rest of the population.

School-based comprehensive sexuality education (CSE) can help adolescents achieve their full potential and realize their sexual and reproductive health and rights. This is particularly pressing in low- and middle-income countries (LMICs), where high rates of unintended pregnancy and STIs among adolescents can limit countries' ability to capitalize on the demographic dividend. While many LMICs have developed CSE curricula, their full implementation is often hindered by challenges around program planning and roll-out at the national and local level. A better understanding of these barriers, and similarities and differences across countries, can help devise strategies to improve implementation; yet few studies have examined these barriers. This paper analyzes the challenges to the implementation of national CSE curricula in four LMICs: Ghana, Kenya, Peru and Guatemala. It presents qualitative findings from in-depth interviews with central and local government officials, civil society representatives, and community level stakeholders ranging from religious leaders to youth representatives. Qualitative findings are complemented by quantitative results from surveys of principals, teachers who teach CSE topics, and students aged 15-17 in a representative sample of 60-80 secondary schools distributed across three regions in each country, for a total of around 3000 students per country. Challenges encountered were strikingly similar across countries. Program planning-related challenges included insufficient and piecemeal funding for CSE; lack of coordination of the various efforts by central and local government, NGOs and development partners; and inadequate systems for monitoring and evaluating teachers and students on CSE. Curriculum implementation-related challenges included inadequate weight given to CSE when integrated into other subjects, insufficient adaptation of the curriculum to local contexts, and limited stakeholder participation in curriculum development. While challenges were similar across countries, the strategies used to overcome them were different, and offer useful lessons to improve implementation for these and other low- and middle-income countries facing similar challenges.

Sub-Saharan Africa (SSA) experiences an acute dearth of well-trained and skilled researchers. This dearth constrains the region’s capacity to identify and address the root causes of its poor social, health, development, and other outcomes. Building sustainable research capacity in SSA requires, among other things, locally led and run initiatives that draw on existing regional capacities as well as mutually beneficial global collaborations. This paper describes a regional research capacity strengthening initiative—the African Doctoral Dissertation Research Fellowship (ADDRF) program. This Africa-based and African-led initiative has emerged as a practical and tested platform for producing and nurturing research leaders, strengthening university-wide systems for quality research training and productivity, and building a critical mass of highly-trained African scholars and researchers. The program deploys different interventions to ensure the success of fellows. These interventions include research methods and scientific writing workshops, research and reentry support grants, post-doctoral research support and placements, as well as grants for networking and scholarly conferences attendance. Across the region, ADDRF graduates are emerging as research leaders, showing signs of becoming the next generation of world-class researchers, and supporting the transformations of their home-institutions. While the contributions of the ADDRF program to research capacity strengthening in the region are significant, the sustainability of the initiative and other research and training fellowship programs on the continent requires significant investments from local sources and, especially, governments and the private sector in Africa. The ADDRF experience demonstrates that research capacity building in Africa is possible through innovative, multifaceted interventions that support graduate students to develop different critical capacities and transferable skills and build, expand, and maintain networks that can sustain them as scholars and researchers.

Introduction: Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear. Methods: Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion. Results: Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcus-based single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention. Conclusion: IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met. How to cite this article: Van Mierlo C, Abegao Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32.

Family planning services were introduced in Senegal in the early 1960s at the private Blue Cross Clinic in Dakar, but it was only in 1981 that the government developed an administrative structure capable of directing a national program and began to provide information, education and counseling support and family planning services. Wider provision of family planning prior to 1981 was prohibited by a law passed during the 1920s, when Senegal was a French colony, (1) and repealed only in 1980. In 1988, a national population policy was issued, giving official and political approval of the family planning program and paving the way for progress in family planning in Senegal. But despite changes in Senegal's legal and regulatory environment in regard to family planning, contraceptive prevalence has been slow to increase. According to the 2010-2011 Senegalese Demographic and Health Survey (DHS), only 12% of currently married women used a modern contraceptive method, compared with 8% in 1997 and 10% in 2005. (2) This slow change can be attributed to low demand for contraceptives, as well as to supply-side barriers. For instance, most African countries have been providing oral contraceptives and injectables through community-based distribution programs for decades; however, Senegal pilot-tested such a program only in 2012-2013, a delay caused by illogical restrictions on which types of providers can supply oral contraceptives and injectables. (3) Nearly 30% of currently married Senegalese women have an unmet need for family planning--that is, they want to either postpone their next birth for at least two years or stop childbearing altogether, but are not currently using a contraceptive method; (2) the current level is slightly lower than in 2005 (32%). The level of unmet need in Senegal--especially for spacing (29% among currently married women)--is higher than in other West African countries, such as Burkina Faso, Ghana, Mali and Nigeria. (4) Factors contributing to unmet need for family planning in developing countries include lack of contraceptive knowledge; poor quality of and access to family planning services; method cost; women's concerns about side effects; and women's, husbands' or family members' objections to contraceptive use. (4,5) According to a descriptive analysis of Urban Reproductive Health Initiative data, women's beliefs and misconceptions about contraceptives, husbands' objections to contraceptive use and the poor quality of family planning services are the most frequent reasons deterring women in urban Senegal from practicing contraception. (6) Youth constitute a key target in reproductive health strategies and, in Senegal, appear to have particularly low levels of contraceptive use. For example, in 2010-2011, only 2% of all 15-19-year-olds and 6% of all 20-24-yearolds reported using a modern method; (2) the proportions among currently married women in those age-groups were slightly higher (5% and 8%, respectively). Access to reproductive health services remains an issue for young women and men because of cultural, medical and financial barriers. (7-9) For example, although there are no legal restrictions to providing oral contraceptive pills to unmarried young women, results from simulated client studies suggest that providers are reluctant to do so and tend to promote abstinence instead. (7,9) Consequences among young women of lack of access to reproductive health services are increased risk of unplanned pregnancy; unsafe abortion; STIs, including HIV; and early school dropout due to pregnancy. (7) Previous research has stressed the importance of helping young people in developing countries to be effective contraceptive users. (10-12) As the medical mediators between clients' knowledge and fears and their use of contraceptives, health providers are also key to ensuring access to, and adoption and continued use of, contraceptive methods among youth. Health providers' knowledge and training influence access to specific contraceptives. …

International audience; The translation of brain activity into user command, through Brain-Computer Interfaces (BCI), is a very active topic in machine learning and signal processing. As commercial applications and out-of-the-lab solutions are proposed, there is an increased pressure to provide on-line algorithms and real-time implementations. Electroencephalography (EEG) systems offer lightweight and wearable solutions, at the expense of signal quality. Approaches based on covariance matrices have demonstrated good robustness to noise and provide a suitable representation for classification tasks, relying on advances in Riemannian geometry. We propose to equip the minimum distance to mean (MDM) classifier with a new family of means, based on the inductive mean, for block-online classification tasks and to embed the inductive mean in an incremental learning algorithm for online classification of EEG.

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 (2004–2012) 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. Keywords : fertility intention; contraception; HIV status; women; sub-Saharan Africa (Published: 23 October 2014) Citation : Glob Health Action 2014, 7 : 25579 - http://dx.doi.org/10.3402/gha.v7.25579

KEYWORDSBrand, Repositioning.Positioning Strategy.Market Research. Innovation ABSTRACT This paper reports on an exploratory qualitative study of the re-branding 'process' at one of the largest Fast Moving Consumer Goods(FMCG) company in the world, by shedding light on the decisions and processes which pre-cede and follow, a re-branding exercise. The primary reason for re-branding is to 'innovate' and meet consumer expectations, and the marketing team especially the brand managers, are solely responsible for initiating changes to the package design. Furthermore, marketing research is not necessarily conducted before, during or after re-branding, and no attempts are made to assess the impact of re-branding on turnover.The implication of the findings for marketers of FMCGs is that they need to pay close attention to the consumer purchasing behavior post re-branding, by making useof inter-alia, social media and also to integrate re-branding with any package design changes requiredto comply with legislation.

It is important to understand the extent to which project involvement affects mental health. As projects and project management expand beyond traditional fields, it is also important to compare project involvement and mental health across settings that vary in terms of management structure. This study is the first to validate a Project Involvement Index (PII) useful in various settings to understand how workload relates to mental health defined as high psychological well-being and low psychological distress. Our results demonstrate that the PII is parsimonious measure showing reliability, predictive validity, and discriminant validity. Furthermore, results show that people involved in projects from a non-projectized organization show less mental health than those from a projectized organization.

From 2004 to 2008, in four U.S. test markets, Planned Parenthood Federation of America implemented Real Life. Real Talk.®, an initiative designed to foster open, honest, and balanced communication about sex and health among parents/caregivers, their children, and the general public. Funded by private donors and foundations, including the Ford Foundation, Real Life. Real Talk, combined community organizing and collaboration, education, community events, and promotion in an intervention that addressed the entire marketing mix. Through building local grassroots partnerships and providing a host of coordinated local educational events, including repeated offerings of Sex Ed for Parents™, Real Life. Real Talk. sought to reduce the public's level of shame, intolerance, and avoidance and, subsequently, to increase openness, acceptance, and engagement about issues of sexual health. Parents who participated in Sex Ed for Parents reported that these events were useful, and nearly all participating parents said they would recommend Sex Ed for Parents to a friend. Results from community-wide surveys show modest program awareness and several promising trends that correspond with the goals of the initiative. Real Life. Real Talk. is an example of community-level social marketing that evolved for continual improvement. Real Life. Real Talk. maintained an iterative design and implementation process. It allowed each community to embrace engagement on its own terms, and, as a result, each community contributed unique cultural elements.

Attrition for Black men is a serious problem in higher education. While researchers have explored factors of retention for Black men attending historically White institutions (HWIs), less research explains factors underlying the success of Black men attending historically Black colleges and universities (HBCUs), particularly those men who are academically unprepared. Eleven Black men, who entered a public, urban HBCU through its pre-college program and persisted to graduation, provided a retrospective view of factors promoting their success. The result from this study may help universities enhance retention for Black men by understanding salient variables in their academic achievement and retention.

Late graft loss (LGL) and late mortality (LM) following liver transplantation (LT) in children were analyzed from the studies of pediatric liver transplantation (SPLIT) database. Univariate and multivariate associations between pre- and postoperative factors and LGL and LM in 872 patients alive with their primary allografts 1 year after LT were reviewed. Thirty-four patients subsequently died (LM) and 35 patients underwent re-LT (LGL). Patients who survive the first posttransplant year had 5-year patient and graft survival rates of 94.2% and 89.2%, respectively. Graft loss after the first year was caused by rejection in 49% of the cases with sequelae of technical complications accounting for an additional 20% of LGL. LT for tumor, steroid resistant rejection, reoperation in the first 30 days and >5 admissions during the first posttransplant year were independently associated with LGL in multivariate analysis. Malignancy, infection, multiple system organ failure and posttransplant lymphoproliferative disease accounted for 61.8% of all late deaths after LT. LT performed for FHF and tumor were associated with LM. Patients who are at or below the mean for weight at the time of transplant were also at an increased risk of dying. Frequent readmission was also found to be associated with LM.

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.

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.

O principal objetivo deste artigo é testar a aplicabilidade de um modelo de Qualidade de Vida no Trabalho (QVT). Especificamente, buscou-se descrever o modelo de QVT adotado, analisar os indicadores e fatores de QVT na perspectiva dos professores universitários de instituições públicas, e verificar a adequabilidade do referido modelo para avaliar QVT em instituições do setor público. Aplicou-se um questionário online em dois momentos distintos, sendo que a amostra foi constituída inicialmente por 354 professores de Minas Gerais e 317 professores do Quebec. No segundo momento, respectivamente, 274 e 252 professores participaram da pesquisa. Os dados foram coletados entre janeiro e maio de 2013. A análise de correlação mostrou que, tanto os indicadores quanto os fatores que foram analisados apresentaram resultados consistentes com os do modelo de referência. Os resultados mostram que os construtos complementares relacionados ao sentido do trabalho, também foram consistentes com as pesquisas anteriores que subsidiaram a construção do modelo sistêmico de análise da QVT.

This study investigated the associations between parent–child connectedness and sexual behaviors among adolescents living in informal settlements in Nairobi, Kenya, a vulnerable group with respect to reproductive health outcomes. The study was based on data from the Transition to Adulthood project, a study designed to follow adolescents aged 12–22 for 3 years in the informal settlements of Korogocho and Viwandani. Direct face-to-face questions were asked to adolescents about parenting variables and sexual behaviors. This study used a subsample of 689 sexually experienced 12–22-years-olds at Wave 2. Bivariate analysis compared gender differences for three outcomes–sexual activity in the 12 months prior to the survey and, among those who had had sex in this period, multiple sexual partners and condom use at last sex. Multivariate logistic regressions were used to identify associations between these outcomes and the quality of parent–child connectedness. About 60 % of adolescent females and males were sexually active in the 12 months prior to the survey. The multivariate results showed a strong association between the quality of parent–child connectedness and condom use among adolescent males. Living with related or unrelated guardians (versus living with biological parents) was also associated with higher odds of multiple sexual partners and lower odds of condom use at last sex among adolescent females and with higher odds of sexual activity among adolescent males. Sexual and reproductive health programs targeting adolescents living in Nairobi informal settlements would benefit from attention to assisting parents to improve their ability to play the connectedness role.

Low level of funding for reproductive health (RH) is a cause for concern, given that RH service utilization in the vast majority of the developing world is well below the desired level. Though there is an urgent need to track the domestic and international financial resource flows for RH, the instruments through which financial resources are tracked in developing countries are limited. In this paper we examined the methodological and conceptual challenges of monitoring financial resources for RH services at international and national level. At the international level, there are a number of estimates that highlights the need for financial resources for RH programmes but the estimates vary significantly. At the national level, Reproductive Health Accounts (RHA) in the framework of National Health Accounts (NHA) is considered to be the ideal source to track domestic financial flows for RH activities. However, the weak link between data production by the RHA and its application by the stakeholders as well as lack of political will impedes the institutionalization of RHA at the country level.

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.

The accuracy and acceptability of saliva human immunodeficiency virus type 1 (HIV-1) antibody testing were compared with serum testing in a study of paired specimens from HIV-1-seropositive and HIV-1-seronegative Ugandan adults attending a clinic for sexually transmitted diseases. Saliva collection was performed with the Omni-sal device (Saliva Diagnostic Systems, Vancouver, Wash.), and antibody testing was performed by a rapid filter paper assay (Test-Pack; Abbott Laboratories, Abbott Park, Ill.). Relative to serum testing, the sensitivity of saliva testing was 95% (195 of 205) and the specificity was 99% (295 of 297). The sensitivity of saliva testing was higher for patients with elevated levels of beta-2 microglobulin in sera and greater numbers of HIV-1-related symptoms. Pre- and poststudy interviews indicated that saliva testing did not foster inordinate fears of saliva exposure. The development of saliva tests that are inexpensive and do not require electricity is needed.

Social or intellectual isolation has been identified as a problem for many postgraduate students, particularly among subgroups in which women predominate. Newly developing collaborative postgraduate student groups complement the supervisor's role as an advisor and counteract the effects of isolation. However, the very method that may reduce isolation for women also entails risks. Research into gender and communication suggests that groups, often dominated by men, may not adequately serve the educational needs of women. This article brings together two separate strands of research: (a) studies of support groups, collaborative groups, or supervisory groups for thesis-writers; and (b) studies of gender-related communication patterns. The intersection of these areas of research provides a basis for suggesting how arrangements for, and research into, collaborative support groups for thesis writers can help to ensure that the potential of such groups for enhancing educational opportunities for all students—womens as well as men—is tapped and possible risks minimized.

Discusses Australian postgraduate management training needs in the light of the obsolescence of current management development technology. Reports on a pilot study into perceptions within industry and higher education of what is needed for future courses. Academics emphasized content, and managers′ practical and process skills. Advocates a shift from content to process because of the rapidity of change in management′s environment.

Recent discussions on the HUMANIST conference on Binet are but one manifestation of concern over the relations between humanists and technologists (including scientists and business people who use technology, especially computers). Focusing on the computer as an object that both unifies and separates these two communities, the discussants have broached a number of key topics, all more or less related to C. P. Show's dichotomy of the «Two Cultures». Much the same question underlies this review essay of the three books: Turing's Man (1984) by J. David Bolter, The Second Self (1984) by Sherry Turkle, and Alan Turing: The Enigma (1983) by Andrew Hodges

The use of multibody simulation programs for the study of large displacement motions of systems of flexible bodies adds another dimension to the model reduction problem. In general, straightforward criteria are available for performing model reduction at the system level; however, simulation codes normally require modal data input for each component body of a system rather than for the system as a whole. It is thus always necessary to determine the modes to be retained for each component based on knowledge of the system modes of interest. The method presented in this report for component model reduction utilizes submatrices of the system modal matrix as transformation matrices used to accomplish the first phase of a two phase matrix diagonalization process. This method is systematic and, as demonstrated above using simple mass-spring systems, the method gives very accurate results. The method has also been tested on a model of the Galileo spacecraft, and gave excellent results.

Reincubation and subsequent subculture at 72 h of previously positive blood cultures failed to demonstrate an increase in detection of polymicrobial bacteremia as has been previously reported. These procedures increased the cost of blood cultures between 140–192% without yielding new organisms. No new information was gained in 94.7% of cultures and, in 11.1% of the cultures, less information was obtained either because the cultures were sterile or because the original organisms could not be reisolated.

This paper sets out the current situation in a number of schools and institutions of higher education with departments of design. A case is presented for the design curriculum to be regarded as a serious academic subject which makes a unique contribution to pupils' cognitive, emotional, psycho-motor and social development. It is argued that design teachers should shift the focus of their lessons from the product to the person, and that they should receive training which would help them to understand why they do what they do in terms of the contribution they are making to the psychological development of their pupils. The special character of design education means that it has certain opportunities to offer children that other subjects do not. Activities such as modelling and making objects facilitate the expression of pent-up emotions, while also encouraging an intuitive, holistic approach to problem solving. It is suggested that design education be used to help children think more flexibly and c...

Immunologic, morphologic, and functional evaluations were performed in beagle dogs with single lung allografts surviving 3-13 years after transplantation. Immunosuppressive treatment included lethal total-body irradiation, autologous bone marrow reconstitution, and three doses of methotrexate. Three beagle recipients with full DLA-haplotype-matched grafts and five recipients with one-haplotype-mismatched grafts were studied. Evidence of rejection--i.e., infiltrates on chest roentgenograms, hypoperfusion on radionuclide lung scans, and histopathologic changes--were absent in the matched recipients and in three of the five mismatched recipients. Two of the mismatched recipients had decreased perfusion to their allografted lungs, and open-lung biopsy specimens revealed diffuse fibrotic blood vessels with narrowed lumina but no other abnormalities. Decreased fractional blood flow to the lung allograft of the five one-haplotype-mismatched recipients was correlated (r = -0.92) with the level of donor-specific cytolytic lymphocyte activity generated in mixed lymphocyte cultures (MLC). In contrast, the level of proliferative activity in donor-specific MLC did not correlate well with graft function. These findings suggest that the mechanism of tolerance to these lung allografts (with particular regard to vascular integrity) involves attenuation of the response against major histocompatibility complex (MHC) class I alloantigen since the induction of cytolytic T lymphocytes in MLC is directed primarily against these molecules. Though all of the mismatched recipients had the ability to react against MHC class II alloantigens in vitro (as demonstrated by proliferative responses in MLC), in vivo responses to class II gene products may not occur because of the lack of expression of these molecules on long-term surviving grafts.

Men and women seldom do the same job. The segregation of role according to sex is a continuing phenomenon throughout the western world: it occurs in occupations, in families, and in education, and it results in a loss of potential development for both men and women, as well as a serious loss of human resources for organizations.

This paper discusses the design of remedial measures that can be taken to achieve reasonable nutation damping of the Galileo spacecraft in the event of failure of its boom damper in flight. One scheme exploits the effects of payload motion on the nutational stability of a spinning spacecraft. This scheme demands that the spacecraft motion compensation algorithm be enabled with the scan platform bore sight pointed in a well chosen direction to produce rapid damping of spacecraft nutation. A second method suggested for nutation damping is a thruster-based open loop control algorithm, utilizing a pair of thrusters as actuators.

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