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The article focuses on the evolution of Irish traditional music over the past twenty-five years, detailing its historical significance and ongoing development. Topics include the transformation of traditional music from a social dance form to a performance art aimed at culturally appreciative audiences, the increasing variety of music practices and the pivotal role of organizations and initiatives that support the preservation and promotion of Irish traditional music.

The self-collection of vaginal swabs and point-of-care testing and treatment of sexually transmitted infections (STIs) is reported from several low-and middle-income countries. However, the reporting on women's experiences of self-collection and same-day testing and treatment of STIs is less well described. In this paper, we present the acceptability of self-collected vaginal swabs and point-of-care testing and treatment among pregnant women enrolled in a clinical trial (Women and Newborn Trial of Antenatal Intervention and Management – WANTAIM) in Papua New Guinea. Semi-structured interviews were conducted among 54 women enrolled into WANTAIM to identify the acceptability of the test and treat approach. Analysis of qualitative data used deductive and inductive thematic analysis applying Sekhon, Cartwright and Francis' acceptability theoretical framework. Most women reported that they understood that the vaginal swab was to identify infections that may affect their unborn baby; however, some were unsure about the specific infections they were being tested for. Among women who tested positive for an STI, some were unsure what they had been treated for. Overall, the self-collection of vaginal swabs for STI testing during pregnancy was highly acceptable. [ABSTRACT FROM AUTHOR]

Papua New Guinea's health system faces ongoing challenges in the provision of maternal and child health and has some of the poorest health indicators in the world. In this paper, we describe the impact of COVID-19 on maternal and child health, as examples of primary health care services. We conducted 131 semi-structured interviews with different population groups in seven provinces (Jul–Nov 2021). A deductive analysis focused on identifying the impact of COVID-19 using the World Health Organization building blocks framework. An inductive analysis explored these impacts for maternal and child health services specifically. We identified three broad themes: service disruption, challenges in access to care and service provision. Service disruption included the closure, suspension and relocation of services and workforce challenges due to healthcare worker absences, redeployment and working within an already constrained health system. Access to care was difficult due to lockdowns and restricted movement. Service provision continued despite the fear staff had of COVID-19. Investing in pandemic preparedness, including an adequately trained and resourced healthcare workforce and facilities able to withstand sustained provision of essential services should be integrated with locally appropriate, and timely community-based information to allay fears and mistrust within the healthcare system. [ABSTRACT FROM AUTHOR]

We present 307 type Ia supernova (SN) light curves from the first 4 yr of the Transiting Exoplanet Survey Satellite mission. We use this sample to characterize the shapes of the early-time light curves, measure the rise times from first light to peak, and search for companion star interactions. Using simulations, we show that light curves must have noise <10% of the peak flux to avoid biases in the early-time light-curve shape, restricting our quantitative analysis to 74 light curves. We find that the mean power-law index t β 1 of the early-time light curves is β 1 = 1.93 ± 0.57, and the mean rise time to peak is 15.7 ± 3.5 days. The underlying population distribution for β 1 may instead consist of a Gaussian component with mean 2.29, width 0.34, and a long tail extending to values less than 1.0. We find that the data can rarely distinguish between models with and without companion interaction models. Nevertheless, we find three high-quality light curves that tentatively prefer the addition of a companion interaction model, but the statistical evidence for the companion interactions is not robust. We also find two SNe that disfavor the addition of a companion interaction model to a curved power-law model. Taking the 74 SNe together, we calculate 3 σ upper limits on the presence of companion signatures to control for orientation effects that can hide companions in individual light curves. Our results rule out common progenitor systems with companions having Roche lobe radii >31 R ⊙ (separations >5.7 × 1012 cm, 99.9% confidence level) and disfavor companions having Roche lobe radii >10 R ⊙ (separations >1.9 × 1012 cm, 95% confidence level). Lastly, we discuss the implications of our results for the intrinsic fraction of single degenerate progenitor systems. [ABSTRACT FROM AUTHOR]

The field of psychedelic studies is expanding at a rapid pace and the need for academic institutions to engage more directly with this emergent field is growing. There have been some initial moves within the academy to begin tackling this evolving landscape, but these efforts have been relatively siloed along traditional disciplinary lines. Academic inquiry helps shape our collective engagement with – and understanding of – the world around us. An interdisciplinary approach to psychedelic studies is essential for building our understanding of the potential of psychedelics for human healing and flourishing, and for ensuring an inclusive, holistic and sustainable evolution of this field. This paper explores the intersection of psychedelic studies and interdisciplinarity, and calls for more interdisciplinarity in academia's institutional and cultural approach to engaging with this complex and dynamic field. [ABSTRACT FROM AUTHOR]

A more individualised donor selection policy was implemented in the UK in 2021, which replaced the previous 3‐month deferral for men who have sex with men (MSM). Other blood services have a variety of policies in place to ensure the virological safety of blood components, ranging from an indefinite ban on MSM, to a defined period of exclusion, or to an individualised risk assessment that is not based on gender or sexual orientation. Justification of these policies should be based on scientific evidence including assessment of lengths of virological window periods, infectious disease epidemiology within donor populations and donation screening assay sensitivities. Developments in molecular technology and assays which can detect both antibodies and antigens in the very early stages of infection have significantly reduced the risk in most developed countries. However, the increasing usage of pre‐exposure prophylaxis (PrEP) to prevent acquisition of HIV infection after possible high‐risk sexual contact within the UK blood donor population has been recently noted. It has brought with it new diagnostic challenges within blood screening, notably possible non‐detection of HIV RNA and serological markers following PrEP use despite potential infectivity. The use of other testing strategies such as detection of HIV DNA and screening for non‐declared PrEP usage should be investigated further. [ABSTRACT FROM AUTHOR]

There is a considerable body of work that describes the scaling of diblock copolymer micelle dimensions in dilute and semi‐dilute solution based upon block degrees of polymerization and copolymer concentration. However, there is a lack of analogous information for semi‐dilute ABA triblock copolymer gels, which consist of ABA triblock copolymer dissolved in midblock‐selective (B‐selective) solvent. The present study uses small angle X‐ray scattering to extract micelle dimensions for numerous triblock copolymer gels that vary in copolymer identity (and hence block lengths) and copolymer concentration, as well as gels that contain various ratios of two unique triblock copolymers. Analysis of micelle structural data subsequently translates to universal scaling expressions for the micelle core radius – rA ≈ NA0.53NB−0.14ϕABA0.16 where NA and NB are the endblock and midblock degrees of polymerization, respectively, and ϕABA is the volume fraction of triblock copolymer in the gel – and for the intermicelle spacing – lAA ≈ NA0.09NB0.29ϕABA−0.35. Each scaling expression describes the full collection of experimental data very well. Additionally, these scaling expressions are partially in line with expectations from semi‐dilute diblock copolymer solution theory. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive direct coronary artery bypass has enabled coronary artery bypass graft to compete with the appeal of less invasive percutaneous coronary procedures. Favorable results of coronary artery bypass surgery performed without the use of cardiopulmonary bypass and without touching the aorta (anOPCAB) have enabled the development and use of minimally invasive methods. Methods: Between 2016 and 2021, 112 patients underwent multivessel coronary bypass surgery performed using a minimally invasive method through a small thoracotomy in the left chest with off‐pump, anaortic, and all‐arterial grafts (Minimally Invasive Off‐Pump Anaortic Coronary Artery Bypass [MACAB]). Patient data were collected and retrospectively analyzed. Eight series from the literature using the multivessel mini‐OPCAB and MACAB technique were also evaluated. Results: Collectively, from the literature, 2729 patients underwent an average of 2.4 bypasses with an early mortality rate of 0.7% and a stroke rate of 0.16%. In our MACAB case series, 112 patients underwent an average of 2.9 bypasses with a mortality rate of 1.8% and a stroke rate of 0%. Conclusion: MACAB can be performed safely by experienced surgeons and reduces neurological injury and surgical trauma and may be a good alternative for multivessel stenting. Simulation systems are essential for its dissemination, and teams dedicated to coronary surgery—with subspecialty expertise—are necessary to achieve good outcomes. [ABSTRACT FROM AUTHOR]

1. Understand currently described pediatric palliative care quality metrics within the context of pediatric oncology psychosocial standards of care. 2. Apply pediatric palliative care quality metrics and psychosocial standards of care to their own end of life team processes to facilitate equity and improved communication through the development of their own palliative care roadmaps specific to their local institution. Focused on pediatric oncology psychosocial standards of care for palliative care, bereavement, and interdisciplinary communication, our team sought to ensure adherence with quality care metrics through the development of a palliative care "roadmap". Through chart review we identified areas of growth, developed a targeted intervention (roadmap), and continue to modify and evaluate improvement over time. Focused on pediatric oncology psychosocial standards of care for palliative care, bereavement, and interdisciplinary communication, our pediatric palliative oncology team sought to standardize and ensure adherence with quality care metrics across the continuum of care delivery. Our literature review identified fifteen quality measures to evaluate our current practice. We performed a retrospective chart review focused on end of life (EoL) for all patients who died from progressive disease. By evaluating our current practice gaps compared to quality metrics, we created a multidisciplinary group to draft a "Pediatric Oncology Palliative Care Roadmap" (PCR). The PCR is a physical document that travels in tandem with the patient's treatment roadmap. We chose the term "roadmap" to align ourselves with the oncology team members who reflexively look at treatment roadmaps. The PCR was then distributed to key stakeholders to include inpatient, outpatient, and home-based multidisciplinary teams for feedback. A second draft is currently being trialed in a pilot group of eight patients. Iterative feedback in both informal and formal focus groups are in progress. A more extended chart review to include three additional years is ongoing. Preliminary results are based on our first year of chart review, 2022. Twelve patients died due to progressive disease. From this group, we quantified each quality measures. 6(50%) reached EoL in preferred location, 10(83%) were not intubated within last 14 days, 9(75%) referred to hospice, 7(58%) legacy documented, 7(58%) DNR, 11(92%) disclosed nearing EoL, 5(42%) spiritual beliefs documented, 4(33%) EoL date documented, 3(25%) home visit documented, 8(67%) wish documented, and 1(8%) documented tumor donation.10(83%) had at least 5 quality measures documented. Based on published metrics and standards we identified areas of growth for our program, developed a customized intervention, and continue to evaluate our improvement over time through the implementation of our PCR. Interdisciplinary Teamwork / Professionalism; Communication [ABSTRACT FROM AUTHOR]

Aim: To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster‐randomised crossover trial in Papua New Guinea. Methods: Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system. Results: There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty‐seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29%; 10/35). Extreme multi‐organ immaturity (23%; 8/35) and hypoxic ischaemic encephalopathy (17%; 6/35) were the most common final causes of neonatal death. Forty‐six avoidable factors were identified among 26 deaths, including delays in care‐seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation. Conclusion: In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community. [ABSTRACT FROM AUTHOR]

Objective: To undertake a retrospective perinatal death audit and assessment of avoidable factors associated with stillbirths among a cohort of women in two provinces in Papua New Guinea. Methods: We used data from an ongoing cluster‐randomized crossover trial in 10 sites among 4600 women in Papua New Guinea (from 2017 to date). The overarching aim is to improve birth outcomes. All stillbirths from July 2017 to January 2020 were identified. The Perinatal Problem Identification Program was used to analyze each stillbirth and review associated avoidable factors. Results: There were 59 stillbirths among 2558 births (23 per 1000 births); 68% (40/59) were classified "fresh" and 32% as "macerated". Perinatal cause of death was identified for 63% (37/59): 30% (11/37) were due to intrapartum asphyxia and traumatic breech birth and 19% (7/37) were the result of pre‐eclampsia. At least one avoidable factor was identified for 95% (56/59) of stillbirths. Patient‐associated factors included lack of response to reduced fetal movements and delay in seeking care during labor. Health personnel‐associated factors included poor intrapartum care, late diagnosis of breech presentation, and prolonged second stage with no intervention. Conclusion: Factors associated with stillbirths in this setting could be avoided through a package of interventions at both the community and health‐facility levels. Among 59 stillbirths, we identified 127 possible avoidable factors, including poor response to reduced fetal movement, delay in seeking care in labor, and poor intrapartum monitoring. [ABSTRACT FROM AUTHOR]

We present the early-time light curves of Type Ia supernovae (SNe Ia) observed in the first six sectors of Transiting Exoplanet Survey Satellite (TESS) data. Ten of these SNe were discovered by ASAS-SN, seven by ATLAS, six by ZTF, and one by Gaia. For nine of these objects with sufficient dynamic range (>3.0 mag from detection to peak), we fit power-law models and searched for signatures of companion stars. We found a diversity of early-time light-curve shapes, although most of our sources are consistent with fireball models where the flux increases as ∝t2. Three SNe displayed a flatter rise with flux ∝t. We did not find any obvious evidence for additional structures, such as multiple power-law components, in the early rising light curves. For assumptions about the SN properties and the observer viewing angle (ejecta mass of 1.4 M⊙, expansion velocity of 104 km s−1, opacity of 0.2 cm2 g−1, and viewing angle of 45°) and a further assumption that any companion stars would be in Roche lobe overflow, it is possible to place upper limits on the radii of any companion stars. Six of the nine SNe had complete coverage of the early-time light curves, and we placed upper limits on the radii of companion stars of ≲32 R⊙ for these SNe, ≲20 R⊙ for five of the six, and ≲4 R⊙ for two of the six. The small sample size did not allow us to put limits on the occurrence rate of companion stars in the progenitors of SNe Ia. However, we expect that TESS observed enough SNe in its two-year primary mission (26 sectors) to either detect the signature of a large companion (R > 20 R⊙) or constrain the occurrence rate of such systems, at least for the fiducial SN properties adopted here. We also show that TESS is capable of detecting emission from a 1 R⊙ companion for an SN Ia within 50 Mpc and has a reasonable chance of doing so after about six years. [ABSTRACT FROM AUTHOR]

Jainism's renowned compassion toward nonhuman animals is derived from the vulnerability and finitude we share with them. The tradition recognizes the impetus to avoid suffering and preserve life as basic to all living beings and emphasizes our shared existential condition. Nevertheless, Jainism treats the condition of being human as privileged because of its capacity for radical bodily detachment. This article, based on long-term ethnographic work among Jain communities in India, brings Jainism's traditional understandings of the human/nonhuman distinction into discussion with contemporary philosophical and anthropological reflections on the category of the "animal." [ABSTRACT FROM AUTHOR]

One observational prediction for Type Ia supernovae (SNe Ia) explosions produced through white dwarf–white dwarf collisions is the presence of bimodal velocity distributions for the 56Ni decay products, although this signature can also be produced by an off-centre ignition in a delayed detonation explosion. These bimodal velocity distributions can manifest as double-peaked or flat-topped spectral features in late-time spectroscopic observations for favourable viewing angles. We present nebular-phase spectroscopic observations of 17 SNe Ia obtained with the Large Binocular Telescope. Combining these observations with an extensive search of publicly available archival data, we collect a total sample of 48 SNe Ia and classify them based on whether they show compelling evidence for bimodal velocity profiles in three features associated with 56Ni decay products: the [Fe  ii ] and [Fe  iii ] feature at ∼5300 Å, the [Co  iii ] λ5891 feature, and the [Co  iii ] and [Fe  ii ] feature at ∼6600 Å. We identify nine bimodal SNe in our sample, and we find that these SNe have average peak MV about 0.3 mag fainter than those that do not. This is consistent with theoretical predictions for explosions created by nearly head-on collisions of white dwarfs due to viewing angle effects and 56Ni yields. [ABSTRACT FROM AUTHOR]

Background: Papua New Guinea (PNG) has among the highest estimated burdens of cervical cancer globally but currently has no national cervical screening program. Visual inspection of the cervix with acetic acid (VIA) is a low‐cost screening strategy endorsed by the World Health Organization that has been adopted in many low‐resource settings but not previously evaluated in PNG. Aim: To evaluate the association between VIA examination findings and high‐risk HPV (hrHPV) infection; and the impact of concomitant genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis on the interpretation of VIA findings. Methods: A prospective clinical cohort study among women aged 30–59 years attending Well Woman Clinics in PNG. Main outcome measures were VIA examination findings and laboratory‐confirmed hrHPV, C. trachomatis, N. gonorrhoeae and T. vaginalis. Results: A total of 614 women were enrolled, of whom 87.5% (537/614) underwent VIA, and 12.5% (77/614) did not due to pre‐existing cervicitis or inability to visualise the transformation zone. Among the 537 women who underwent VIA, 21.6% were VIA positive, 63.7% VIA negative, and 14.7% had indeterminate findings. The prevalence of hrHPV infection (n = 614) was 14.7%; C. trachomatis, 7.5%; N. gonorrhoeae, 8.0%; and T. vaginalis, 15.0%. VIA positive women were more likely to have HPV16 (odds ratio: 5.0; 95%CI: 1.6–15.6; P = 0.006) but there was no association between HPV18/45, all hrHPV types (combined), C. trachomatis, N. gonorrhoeae or T. vaginalis. Conclusions: VIA positivity was associated with HPV16, but not with other hrHPV infections, nor with genital C. trachomatis, N. gonorrhoeae or T. vaginalis in this setting. [ABSTRACT FROM AUTHOR]

Background: Although global poverty rates have declined in the last decade, the fall in the Asia-Pacific region has been slow relative to the rest of the world. Poverty continues to be a major cause of poor maternal and newborn health, and a barrier to accessing timely antenatal care. Papua New Guinea has one of the highest poverty rates and some of the worst maternal and neonatal outcomes in the Asia-Pacific region. Few studies have investigated equity in antenatal care utilization in this setting. We explored equity in antenatal care utilization and the determinants of service utilization, which include a measure of multidimensional poverty in Papua New Guinea. Methods: To explore the association between poverty and antenatal care utilization this study uses data from a ten-cluster randomized controlled trial. The poverty headcount, average poverty gap, adjusted poverty headcount, and multidimensional poverty index of antenatal clinic attendees are derived using the Alkire-Foster method. The distribution of service utilization is explored using the multidimensional poverty index, followed by multivariate regression analyses to evaluate the determinants of service utilization. Results: The poverty headcount was 61.06%, the average poverty gap 47.71%, the adjusted poverty headcount 29.13% and the average multidimensional poverty index was 0.363. Further, antenatal care utilization was regressive with respect to poverty. The regression analyses indicated that older women; being a widow (small number of widows (n = 3) asserts interpreting result with caution); or formally employed increase the likelihood of accessing antenatal care more often in pregnancy. Travelling for over an hour to receive care was negatively associated with utilization. Conclusion: This study indicated high levels of multidimensional poverty in PNG and that ANC utilization was regressive; highlighting the need to encourage pregnant women, especially those who are economically more vulnerable to visit clinics regularly throughout pregnancy. [ABSTRACT FROM AUTHOR]

Abortion is significantly restricted by law in most Pacific Island countries, impacting the rights, health and autonomy of people who experience pregnancy. We undertook qualitative research between February and August 2022 on Rarotonga, Cook Islands, where abortion is illegal under most circumstances. We conducted interviews with women who had accessed or tried to access abortion services; people who had supported women to access abortion services; health workers; and advocates to understand their experiences regarding abortion. We conducted focus groups to explore broader social perceptions and experiences of sexual and reproductive health and rights, including abortion. Participants described their abortion decisions and methods, and their negotiation of the personal context of their sexual behaviours, pregnancies, and abortions relative to their socio-cultural context and values. As defined by the World Health Organization, safe abortion relates to the methods and equipment used and the skills of the abortion provider. We argue for an expansion of this definition to consider inclusion of reference to individuals' 'abortion safety nets' as the sum of their access to financial, political, health care and socio-cultural resources. These safety nets are shaped by discourses related to abortion and socio-cultural support and values, impacting physical, emotional, psychological, social and spiritual health. [ABSTRACT FROM AUTHOR]

Purpose: Pruritus is a common symptom in cutaneous malignancies, but its impact on patients with solid tumors is unclear. We explored the impact and management of pruritus in patients with solid tumors, using patient-reported outcomes (PRO) data from a real-world registry.Methods: From 2006 to 2011, patients seen in the Duke Cancer Institute reported their symptoms via the Patient Care Monitor v2.0, a validated PRO tool that includes a 0-10-point question about pruritus severity. From > 25,000 encounters, 203 patients reported severe pruritus (> 6/10) on at least one visit and 506 total visits were abstracted where patients reported either moderate or severe pruritus (> 3/10). From this cohort, we abstracted demographics, diagnosis, stage, cancer therapy, anti-pruritic therapy, and clinicians' responses.Results: Mean age was 59.8 (SD 13.3), 134 (66%) were female, 125 (62%) were Caucasian, and 65 (32%) were African American. Breast cancer was the most common tumor (36.5%), followed by lung cancer (23.2%). Mean pruritus severity score was 6.8 (SD 1.8) for patients on chemotherapy, 6.9 (SD 1.8) for patients on targeted therapy alone or in combination, and 7.1(SD 1.8) for patients off treatment. Overall, 67% of patients reported at least two episodes of moderate-severe pruritus (mean # of visits 4.2 (SD 2.7)). Despite frequent report of severe and persistent pruritus, this was mentioned in just 28% of clinician notes and an intervention was recommended/prescribed in only 7% of visits.Conclusions: Pruritus is an under-addressed symptom in patients with solid tumors. Additional research is needed to understand the burden of pruritus in affected populations. [ABSTRACT FROM AUTHOR]

We present photometric and spectroscopic observations of the unusual Type Ia supernova ASASSN-18tb, including a series of Southern African Large Telescope spectra obtained over the course of nearly six months and the first observations of a supernova by the Transiting Exoplanet Survey Satellite. We confirm a previous observation by Kollmeier et al. showing that ASASSN-18tb is the first relatively normal Type Ia supernova to exhibit clear broad (∼1000 km s−1) H α emission in its nebular-phase spectra. We find that this event is best explained as a sub-Chandrasekhar mass explosion producing |$M_{\mathrm{ Ni}} \approx 0.3\,\, \rm {M}_\odot$|⁠. Despite the strong H α signature at late times, we find that the early rise of the supernova shows no evidence for deviations from a single-component power-law and is best fit with a moderately shallow power law of index 1.69 ± 0.04. We find that the H α luminosity remains approximately constant after its initial detection at phase +37 d, and that the H α velocity evolution does not trace that of the Fe  iii  λ4660 emission. These suggest that the H α emission arises from a circumstellar medium (CSM) rather than swept-up material from a non-degenerate companion. However, ASASSN-18tb is strikingly different from other known CSM-interacting Type Ia supernovae in a number of significant ways. Those objects typically show an H α luminosity two orders of magnitude higher than what is seen in ASASSN-18tb, pushing them away from the empirical light-curve relations that define 'normal' Type Ia supernovae. Conversely, ASASSN-18tb exhibits a fairly typical light curve and luminosity for an underluminous or transitional SN Ia, with MR ≈ −18.1 mag. Moreover, ASASSN-18tb is the only SN Ia showing H α from CSM interaction to be discovered in an early-type galaxy. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is feasible in the high-burden, low-income setting of Papua New Guinea.Methods: Women attending their first antenatal clinic visit were invited to participate. CT/NG and TV were tested using the GeneXpert platform (Cepheid, USA), and BV tested using BVBlue (Gryphus Diagnostics, USA). Participants received same-day test results and antibiotic treatment as indicated. Routine antenatal care including HIV and syphilis screening were provided.Results: Point-of-care testing was provided to 125/222 (56 %) of women attending routine antenatal care during the three-month study period. Among the 125 women enrolled, the prevalence of CT was 20.0 %; NG, 11.2 %; TV, 37.6 %; and BV, 17.6 %. Over half (67/125, 53.6 %) of women had one or more of these infections. Most women were asymptomatic (71.6 %; 47/67). Women aged 24 years and under were more likely to have one or more STI compared with older women (odds ratio 2.38; 95 % CI: 1.09, 5.21). Most women with an STI received treatment on the same day (83.6 %; 56/67). HIV prevalence was 1.6 % and active syphilis 4.0 %.Conclusion: Point-of-care STI testing and treatment using a combination of novel, newly-available assays was feasible during routine antenatal care in this setting. This strategy has not previously been evaluated in any setting and offers the potential to transform STI management in pregnancy and to prevent their associated adverse health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility and acceptability of providing clean birth kits (CBKs) containing misoprostol for self-administration in a rural setting in Papua New Guinea.Methods: A prospective intervention study was conducted between April 8, 2013, and October 24, 2014. Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena. Participants received individual instruction and were then given a CBK containing 600μg misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their understanding of correct use of items in the CBK. Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up.Results: Among 200 participants, 106 (53.0%) had an unsupervised birth, and 99 (93.4%) of these women used the CBK. All would use the CBK again and would recommend it to others. Among these 99 women, misoprostol was self-administered by 98 (99.0%), all of whom would take the drug again and would recommend it to others.Conclusion: The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities. Large-scale interventions should be planned to further evaluate impact and acceptability. [ABSTRACT FROM AUTHOR]

The estimated cervical cancer burden is over ten-fold greater in low- and middle-income countries (LMICs) than in high-income countries. This health gap is thought to be primarily due to limited access to effective screening and treatment programs for cervical pre-cancer and cancer in such settings. The World Health Organization advocates a policy of 'screen and treat' approach to cervical screening in LMICs and subsequently visual inspection of the cervix with acetic acid (VIA) or Lugo's iodine (VILI), followed by ablative cervical cryotherapy if indicated, and this policy has been implemented in many high-burden settings. The performance of VIA/VILI as a primary screening tool for the detection of cervical pre-cancer and cancer has, however, been inconsistent. Recently, many high-income countries have integrated HPV-DNA testing into their cervical cancer screening programs. The comparatively high cost and resource requirements of HPV-based screening have to date prevented many LMICs from doing the same. A significant development has been the entrance of innovative, easy-to-use and highly accurate HPV tests that can be provided at point of care; these could enable LMICs to implement 'test and treat' approaches for cervical cancer screening. [ABSTRACT FROM AUTHOR]

We present photometric and spectroscopic follow-up observations of the highly luminous Type Ibn supernova ASASSN-14ms, which was discovered on UT 2014-12-26.61 at mV ~ 16.5. With a peak absolute V-band magnitude brighter than -20.5, a peak bolometric luminosity of 1.7 × 1044 erg s-1, and a total radiated energy of 2.1 × 1050 erg, ASASSN-14ms is one of the most luminous Type Ibn supernovae yet discovered. In simple models, the most likely power source for this event is a combination of the radioactive decay of 56Ni and 56Co at late times and the interaction of supernova ejecta with the progenitor's circumstellar medium at early times, although we cannot rule out the possibility of a magnetar-powered light curve. The presence of a dense circumstellar medium is indicated by the intermediate-width He I features in the spectra. The faint (mg ~ 21.6) host galaxy SDSS J130408.52+521846.4 has an oxygen abundance below 12 + log (O/H) ≲ 8.3, a stellar mass of M* ~ 2.6 × 108M☉, and a star formation rate of SFR ~ 0.02 M☉ yr-1. [ABSTRACT FROM AUTHOR]

Introduction: Various forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level. Methods: We conducted a cross-sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face-to-face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory-based Herpes simplex type-2 (HSV-2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing. Results: Overall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV-2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV-2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV. Conclusions: In this large cross-sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV-2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection. Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level. [ABSTRACT FROM AUTHOR]

Modified vaccinia virus Ankara (MVA) is an attenuated vaccinia virus with restricted replication in human cells. The virus serves as an ideal vaccine vector suitable for safe use even in immune-compromised individuals. With its inherently large packaging capacity, expression cassettes encoding bulky genes can be inserted into deletion regions within the MVA genome. These deletion sites develop during the process of the attenuation of the virus by passage in Chicken Embryo Fibroblasts (pCEFs). Transgene stability in MVA is important to assure immunogenicity and efficacy. In the present study, we assessed the effect of substantial passage of recombinant MVA vectors on the stability of expression cassette encoding SIV Gag/Tat genes inserted at the Del-II site, as part of generating a vaccine to protect from HIV. Our data indicated that after 15 passages there was a significant loss or mutation of the inserted genes. [ABSTRACT FROM AUTHOR]

Actively engaging communities in effective partnerships for the design and implementation of HIV prevention research is vital to the successful conduct of ethically robust, locally-appropriate clinical trials in developing countries. This is especially true in vulnerable at-risk sub-populations, where definitions of “community”, “participation” and “representation” can be difficult to apply. This study was conducted to investigate the feasibility of a participatory model of community liaison among an occupational cohort of women at high-risk of HIV and sexually-transmitted infections in Mwanza City, northwest Tanzania in preparation for a Phase III vaginal microbicide trial. This approach was rooted in participatory action-orientated research and used tools adapted from participatory learning and action techniques. During the feasibility study, a mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern bars, restaurants, hotels and guesthouses was established in 10 city wards. Participatory mapping was carried out by project fieldworkers and wards divided into 78 geographical clusters of facilities in consultation with community members and study participants. Representatives at cluster and ward level were elected in a process facilitated by the site Community Liaison Officer and a site-level Community Advisory Committee established. A logical framework was used to guide the implementation, monitoring and evaluation of the community liaison system (CLS) within the broader feasibility study. The CLS was essential to the successful conduct of the feasibility study and has now been consolidated and expanded as part of the on-going MDP301 Phase III microbicide trial in Mwanza. The participatory model presented in this paper is likely to be generalisable to other vulnerable, stigmatised, at-risk study populations in resource-limited settings. [ABSTRACT FROM AUTHOR]

Objectives: To determine baseline characteristics of an occupational cohort of women in Mwanza City, Tanzania, and factors associated with reattendance at 3 months, in preparation for a microbicide trial.Study Design: One thousand five hundred seventy-three women aged 16-54 years working in food outlets and recreational facilities were enrolled, interviewed, and examined at community-based reproductive health clinics, provided specimens for HIV/STI and pregnancy testing, and attended 3 monthly clinical follow-up.Results: Baseline prevalence of HIV was 25.5%; pregnancy 9.7%; herpes simplex virus type-2 74.6%; active syphilis 10.2%, bacterial vaginosis 52.6%; gonorrhea 5.5%; chlamydia 5.9%; and trichomoniasis 12.3%. Reattendance at 3 months was 74.1% and was higher in older women, less mobile women, and in those who received an HIV-negative result at enrollment.Conclusions: Baseline characteristics of this occupational group suggest their suitability for microbicide trials. A screening round, locally appropriate informed consent procedures, and effective community tracing may help reduce losses to follow-up in such settings. [ABSTRACT FROM AUTHOR]

Falciparum malaria is an important cause of maternal, perinatal and neonatal morbidity in high transmission settings in Sub-Saharan Africa. Intermittent preventive treatment with sulphadoxine-pyrimethamine (SP-IPT) has proven efficacious in reducing the burden of pregnancy-associated malaria but increasing levels of parasite resistance mean that the benefits of national SP-IPT programmes may soon be seriously undermined in much of the region. Hence, there is an urgent need to develop alternative drug regimens for IPT in pregnancy. This paper reviews published safety and efficacy data on various antimalarials nd proposes several candidate combination regimens for assessment in phase II/III clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: Various forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level. Methods: We conducted a cross-sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face-to-face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory-based Herpes simplex type-2 (HSV-2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing. Results: Overall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV-2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV-2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV. Conclusions: In this large cross-sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV-2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection. Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level. [ABSTRACT FROM AUTHOR]

Deep tissue injuries (DTI) are severe forms of pressure ulcers that start internally and are difficult to diagnose. Magnetic resonance imaging (MRI) is the currently preferred imaging modality to measure anatomical features associated with DTI, but is not a clinically feasible risk assessment tool. B-mode ultrasound (US) is proposed as a practical, alternative technology suitable for bedside or outpatient clinic use. The goal of this research was to confirm US as an imaging modality for acquiring measurements of anatomical features associated with DTI. Tissue thickness measurements using US were reliable (ICC = .948) and highly correlated with MRI measurements (muscle r = .988, p ≤ .001; adipose r = .894, p ≤ .001; total r = .919; p ≤ .001). US measures of muscle tissue thickness were 5.4 mm (34.1%) higher than MRI, adipose tissue thickness measures were 1.6 mm (11.9%) lower, and total tissue thickness measures were 3.8 mm (12.8%) higher. Given the reliability and ability to identify high-risk anatomies, as well as the cost effectiveness and availability, US measurements show promise for use in future development of a patient-specific, bedside, biomechanical risk assessment tool to guide clinicians in appropriate interventions to prevent DTI. [ABSTRACT FROM AUTHOR]

We analyse a time series of optical spectra of SN 2014J from almost two weeks prior to maximum to nearly four months after maximum. We perform our analysis using the SYNOW code, which is well suited to track the distribution of the ions with velocity in the ejecta. We show that almost all of the spectral features during the entire epoch can be identified with permitted transitions of the common ions found in normal supernovae (SNe) Ia in agreement with previous studies. We show that 2014J is a relatively normal SN Ia. At early times the spectral features are dominated by Si II, S II, Mg II, and Ca II. These ions persist to maximum light with the appearance of Na I and Mg I. At later times iron-group elements also appear, as expected in the stratified abundance model of the formation of normal Type Ia SNe. We do not find significant spectroscopic evidence for oxygen, until 100 d after maximum light. The +100 d identification of oxygen is tentative, and would imply significant mixing of unburned or only slight processed elements down to a velocity of 6000 kms-1. Our results are in relatively good agreement with other analyses in the infrared. We briefly compare SN 2011fe to SN 2014J and conclude that the differences could be due to different central densities at ignition or differences in the C/O ratio of the progenitors. [ABSTRACT FROM AUTHOR]

Triblock copolymer gels have garnered considerable scientific interest over the past few decades and are used in a variety of applications including consumer cushioning, pressure-sensitive adhesives, and ballistics gels. While many of their applications rely upon understanding mechanical properties, mechanical studies of block copolymer gels are relatively disjointed with each focusing on specific copolymers, which inherently have a fixed molecular weight and composition. The present study examines the quasistatic mechanical response of styrenic triblock copolymer gels composed of seven unique triblock copolymers at various concentrations. Resultant stress-extension data is fitted with the slip-tube network (STN) theory that describes gel mechanics based upon crosslinked network (G c) and chain entanglement (G e) modulus contributions. Collectively, modulus contributions imply that midblock bridging is independent of copolymer identity (i.e. , molecular weight and block fraction) and dependent on triblock copolymer concentration via F b ∝ φ ABA 0.91±0.39 over the concentration range examined (φ ABA = 0.05–0.39). Gels composed of a complementary diblock-triblock copolymer pair were subsequently analyzed to explore the influence of interlocking loop-loop and loop-bridge pairs within the effective midblock bridging population. These results point to the presence of a physically significant quantity of interlocked loops, but quantitative analysis was inconclusive. [Display omitted] • Quasistatic tensile testing was conducted on various triblock copolymer gels. • Midblock bridging fraction is independent of copolymer parameters – f B and M w. • Midblock bridging fraction is sensitive to copolymer concentration – F b ∝ φ 0.91 • Interlocking loop-loop and loop-bridge pairs play a significant role in gel network. [ABSTRACT FROM AUTHOR]

With the current global focus on strengthening HIV prevention through greater testing and treatment uptake, it is increasingly salient to identify and address barriers to testing. A review of the published, peer-reviewed literature and national reports from Australia, Canada, and the UK (2003–2013) on barriers to HIV testing was conducted to provide new information relevant to Australia and to complement earlier reviews from Canada and the UK. A systematic database search using keywords and a set of inclusion criteria yielded 36 studies (Australia = 13; Canada = 6; and the UK = 17). In addition 17 unpublished reports were included in the review. Our study uses a novel, comprehensive framework to describe barriers to HIV testing, and thus contributes to moving beyond the traditional patient–provider–system categorization. Within that framework, barriers are categorized as either intrapersonal (reported in 15 studies), interpersonal (21), or extrapersonal (16) and conceptualized within wider sociocultural and structural contexts. People's abilities and motivations to test (intrapersonal factors) are influenced by a host of interconnected factors spanning relationship (interpersonal) and broader socioeconomic, political and cultural (extrapersonal) factors. We suggest that the relative effects of interventions targeting barriers to HIV testing at the intrapersonal and interpersonal levels are limited by the extent to which the social determinants of health are addressed. The framework may also lend itself to thinking about the enabling factors for HIV testing, and future research may investigate the application of that framework for strategizing the most effective response. Future studies should also capture the lived experiences of barriers to HIV testing experienced by patients, especially in populations which are hard to reach based on social and geographic distance. Context-specific studies to evaluate the feasibility and effectiveness of various interventions proposed in the literature to address barriers to HIV testing are needed. [ABSTRACT FROM AUTHOR]

With the current global focus on strengthening HIV prevention through greater testing and treatment uptake, it is increasingly salient to identify and address barriers to testing. A review of the published, peer-reviewed literature and national reports from Australia, Canada, and the UK (2003–2013) on barriers to HIV testing was conducted to provide new information relevant to Australia and to complement earlier reviews from Canada and the UK. A systematic database search using keywords and a set of inclusion criteria yielded 36 studies (Australia = 13; Canada = 6; and the UK = 17). In addition 17 unpublished reports were included in the review. Our study uses a novel, comprehensive framework to describe barriers to HIV testing, and thus contributes to moving beyond the traditional patient–provider–system categorization. Within that framework, barriers are categorized as either intrapersonal (reported in 15 studies), interpersonal (21), or extrapersonal (16) and conceptualized within wider sociocultural and structural contexts. People's abilities and motivations to test (intrapersonal factors) are influenced by a host of interconnected factors spanning relationship (interpersonal) and broader socioeconomic, political and cultural (extrapersonal) factors. We suggest that the relative effects of interventions targeting barriers to HIV testing at the intrapersonal and interpersonal levels are limited by the extent to which the social determinants of health are addressed. The framework may also lend itself to thinking about the enabling factors for HIV testing, and future research may investigate the application of that framework for strategizing the most effective response. Future studies should also capture the lived experiences of barriers to HIV testing experienced by patients, especially in populations which are hard to reach based on social and geographic distance. Context-specific studies to evaluate the feasibility and effectiveness of various interventions proposed in the literature to address barriers to HIV testing are needed. [ABSTRACT FROM AUTHOR]

Background: In Papua New Guinea induced abortion is restricted under the Criminal Code Law. Unsafe abortions are known to be widely practiced and sepsis due to unsafe abortion is a leading cause of maternal mortality. Methods: We undertook a six month, prospective, mixed methods study at the Eastern Highlands Provincial Hospital. Semi structured and in depth interviews were undertaken with women presenting following induced abortion. This paper describes the reasons why women resorted to unsafe abortion, the techniques used, decision to seek post abortion care and women's reflections post abortion. Results: 28 women were admitted to hospital following an induced abortion. Reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors. Misoprostol was the most frequently used method to end the pregnancy. Physical and mechanical means, traditional herbs and spiritual beliefs were also reported. Women sought care post abortion due to excessive vaginal bleeding, and severe abdominal pain with some afraid they would die if they did not seek help. Conclusion: In the absence of contraceptive information and services to avoid, postpone or space pregnancies, women in this setting are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk. Women need access to safe, effective means of abortion. [ABSTRACT FROM AUTHOR]

Mutations in the haemagglutinin (HA), non-structural protein 1 (NS1) and polymerase basic protein 2 (PB2) of influenza viruses have been associated with virulence. This study investigated the association between mutations in these genes in influenza A(H1N1)pdm09 virus and the risk of severe or fatal disease. Searches were conducted on the MEDLINE, EMBASE and Web of Science electronic databases and the reference lists of published studies. The PRISMA and STROBE guidelines were followed in assessing the quality of studies and writing-up. Eighteen (18) studies, from all continents, were included in the systematic review (recruiting patients 0 - 77 years old). The mutation D222G was associated with a significant increase in severe disease (pooled RD: 11 %, 95 % CI: 3.0 % - 18.0 %, p = 0.004) and the risk of fatality (RD: 23 %, 95 % CI: 14.0 %-31.0 %, p = < 0.0001). No association was observed between the mutations HA-D222N, D222E, PB2-E627K and NS1-T123V and severe/fatal disease. The results suggest that no virus quasispecies bearing virulence-conferring mutations in the HA, PB2 and NS1 predominated. However issues of sampling bias, and bias due to uncontrolled confounders such as comorbidities, and viral and bacterial coinfection, should be born in mind. Influenza A viruses should continue to be monitored for the occurrence of virulence-conferring mutations in HA, PB2 and NS1. There are suggestions that respiratory virus coinfections also affect virus virulence. Studies investigating the role of genetic mutations on disease outcome should make efforts to also investigate the role of respiratory virus coinfections. [ABSTRACT FROM AUTHOR]

Background: In Papua New Guinea abortion is restricted under the Criminal Code Act. While safe abortions should available in certain situations, frequently they are not available to the majority of women. Sepsis from unsafe abortion is a leading cause of maternal mortality. Our findings form part of a wider, mixed methods study designed to identify complications requiring hospital treatment for post abortion care and to explore the circumstances surrounding unsafe abortion. Methods: Through a six month prospective study we identified all women presenting to the Eastern Highlands Provincial Hospital following spontaneous and induced abortions. We undertook semi-structured interviews with women and reviewed individual case notes, extracting demographic and clinical information. Findings: Case notes were reviewed for 56% (67/119) of women presenting for post abortion care. At least 24% (28/119) of these admissions were due to induced abortion. Women presenting following induced abortions were significantly more likely to be younger, single, in education at the time of the abortion and report that the baby was unplanned and unwanted, compared to those reporting spontaneous abortion. Obtained illegally, misoprostol was the method most frequently used to end the pregnancy. Physical and mechanical means and traditional herbs were also widely reported. Conclusion: In a country with a low contraceptive prevalence rate and high unmet need for family planning, all reproductive age women need access to contraceptive information and services to avoid, postpone or space pregnancies. In the absence of this, women are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk and putting an increased strain on an already struggling health system. Women in this setting need access to safe, effective means of abortion. [ABSTRACT FROM AUTHOR]

The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV. [ABSTRACT FROM AUTHOR]

Background Papua New Guinea (PNG) has a high burden of sexually transmitted infections (STIs) and the highest adult HIV prevalence in the Pacific region. Despite this burden of disease, heterosexual anal intercourse (HAI) has rarely been considered. Given the increasing number of, and interest in, behavioural surveys in PNG and the changing nature of PNG's HIV epidemic, it is timely to conduct a systematic review of HAI in PNG order to improve sexual health. Methods We performed a systematic review of HAI in PNG as reported in peer-reviewed and non-peer-reviewed publications for the period 1950-May 2012. The search strategy identified 475 publications. After screening by geographical location, topic and methodology, we identified 23 publications for full text review, following which 13 publications were included in the final review. Using data from the review, we performed a risk equation analysis to demonstrate the potential impact of HAI on HIV acquisition and incidence in PNG. Results There is a paucity of well-informed behavioural research on HAI in PNG. Inconsistency in key questions on HAI made it impossible to conduct a meta-analysis. The data available on HAI shows that it is practiced in all geographical areas and among all populations. Of those who reported HAI, rates varied from as low as 8% to as high as 77% depending on the recall period and partner type. Condom use during HAI was consistently low. Our risk equation analysis indicates that even if only 20% of females engage in HAI, and only 10% of sex acts involve HAI, the total number of new HIV infections among females would be 40% greater than if vaginal intercourse only occurred. Conclusions Our findings of indicate that HAI may be an important driver of the HIV epidemic in PNG. In order to improve the sexual health of Papua New Guineans, efforts are required to improve behavioural surveillance of HAI as well as develop national HIV/STI programing and policy to better address the risks associated with unprotected HAI. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Goka et al. (2013) Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality. Influenza and Other Respiratory Viruses 7(6), 1079-1087. Introduction Recent literature suggests that dual or multiple virus infections may affect disease severity. However, few studies have investigated the effect of co-infection with influenza A viruses. Objectives To identify the association between influenza A and respiratory viruses co-infections with disease outcome. Methodology Data for samples from North West England tested between January 2007 and June 2011 was analysed for patterns of co-infection between influenza A viruses and eight respiratory viruses. Risk of hospitalisation to ICU or general ward in single versus co-infections was assessed using logistic regression. Results Of the 25 596 samples analysed for respiratory viruses 40·7% (10 501) were positive for any virus. Co-infections were detected in 4·7% (137/2879) of all patients with influenza A(H1N1)pdm09, and 7·3% (57/779) of those with other influenza A virus infections. Co-infection between seasonal influenza A viruses and influenza B virus was associated with a significant increase in the risk of admission to ICU/death (OR: 22·0, 95% CI: 2·21-219·8, P = 0·008). Respiratory syncytial virus/influenza A (RSV/Flu A) co-infection also increased this risk but was not statistically significant. For influenza A(H1N1)pdm09, RSV and AdV co-infection increased risk of hospitalisation to general ward whereas Flu B increased risk of admission to ICU, but none of these were statistically significant. Conclusion Co-infection is a significant predictor of disease outcome; combined treatment, introduction of an integrated vaccine for all respiratory viruses and development of multi-target rapid diagnostic tests is recommended. Integration of respiratory viruses' co-infections into public health reports could also contribute to the accumulation of evidence. [ABSTRACT FROM AUTHOR]

Background: The motivation of health workers (HWs) to deliver services in developing countries has been described as a critical factor in the success of health systems in implementing programmes. How the sociocultural context of Papua New Guinea (PNG) affects the values, motivation and actions of HWs involved in sexual and reproductive health services is important for policy development and programme planning. With interest in male circumcision (MC) as an HIV prevention option in PNG, this study explored the perceptions and motivations of HWs involved in sexual and reproductive health services in PNG, examining their implications for the possible future roll out of a national MC programme.Methods: A multi-method qualitative study was conducted with HWs across a range of health care professions working in sexual health facilities. A total of 29 in-depth interviews and one focus group discussion were completed. Qualitative thematic analysis of the transcripts and field notes was undertaken using a social constructivist approach and complemented by documentary organizational, programme and policy analysis.Results and Discussions: Introduction of new health programmes, such as a MC programme for HIV prevention, are likely to impact upon one or more of the many motivational determinants. Social-cultural and individual factors influencing HW motivation to be involved in sexual and reproductive health services in PNG included community expectation and concern, sense of accomplishment and religious conviction. Strong links to community responsibility outweighed organizational ties. Faced with an often dysfunctional work environment, HWs perceived themselves as responsible to compensate for the failed health system. The impact of community influence and expectation needs to be considered when introducing a MC programme, particularly to communities in PNG where penile foreskin cutting is a common and accepted practice.Conclusions: The potential contribution to the success of a MC programme that HWs may have means that taking into account the differing needs of communities as well as the motivational influences on HWs that exist within the sociocultural environment is important. These findings will assist not only in programme planning for MC, but also in the expansion of other existing sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

As the population ages and co-morbidities become more prevalent, the complexity of patients presenting for coronary artery bypass surgery is increasing. Cardiopulmonary bypass and aortic cross-clamping in these patients carry increased risk and, indeed, in some patients, with ascending aortic disease, the risks are prohibitive. Total-arterial anaortic coronary artery surgery is a technique that provides complete surgical coronary artery revascularization without cardiopulmonary bypass and without manipulating the ascending aorta. The technique essentially eliminates the risk of cerebral embolization of aortic atheroma and aortic injury. Anaortic techniques are an essential skillset for coronary artery surgery centers treating higher-risk patients. [ABSTRACT FROM AUTHOR]

The Oceania region is home to some of the world's most restrictive abortion laws, and there is evidence of Pacific Island women's reproductive oppression across several aspects of their reproductive lives, including in relation to contraceptive decision‐making, birthing, and fertility. In this paper we analyse documents from court cases in the Pacific Islands regarding the illegal procurement of abortion. We undertook inductive thematic analysis of documents from eighteen illegal abortion court cases from Pacific Island countries. Using the lens of reproductive justice, we discuss the methods of abortion, the reported context of these abortions, and the ways in which these women and abortion were constructed in judges' summing up, judgements, or sentencing. Our analysis of these cases reveals layers of sexual and reproductive oppression experienced by these women that are related to colonialism, women's socioeconomic disadvantage, gendered violence, limited reproductive control, and the punitive consequences related to not performing gender appropriately. [ABSTRACT FROM AUTHOR]

Background: Interventions to prevent mother to child transmission of human immunodeficiency virus (HIV) during childbirth and breastfeeding can reduce HIV infections in infants to less than 5% in low and middle income countries. The World Health Organization (WHO) recommends all mothers, regardless of their HIV status, practice exclusive breastfeeding for the first six months of an infant's life. In line with these recommendations and to protect, promote and support breastfeeding, in 2009 the PNG National Department of Health revised their National HIV infant feeding guidelines, reinforcing the WHO recommendation of exclusive breastfeeding for the first six months followed by the introduction of other food and fluids, while continuing breastfeeding. The overall aim of this paper is to explore health care workers' knowledge regarding infant feeding options in PNG, specifically as they relate to HIV exposed infants. Methods: As part of a study investigating women's and men's experiences of prevention of mother to child transmission (PMTCT) services in two sites in PNG, 28 key informant interviews were undertaken. This paper addresses one theme that emerged from thematic data analysis: Health care workers' knowledge regarding infant feeding options, specifically how this knowledge reflects the Papua New Guinea National HIV Care and Treatment Guidelines on HIV and infant feeding (2009). Results: Most informants mentioned exclusive breastfeeding, the majority of whom reflected the most up-to-date National Guidelines of exclusive breastfeeding for six months. The importance of breastfeeding continuing beyond this time, along with the introduction of food and fluids was less well understood. The most senior people involved in PMTCT were the informants who most accurately reflected the national guidelines of continuing breastfeeding after six months. Conclusion: Providing advice on optimal infant feeding in resource poor settings is problematic, especially in relation to HIV transmission. Findings from our study reflect those found elsewhere in identifying that key health care workers are not aware of up-to-date information relating to infant feeding, especially within the context of HIV. Greater emphasis needs to be placed on ensuring the most recent feeding guidelines are disseminated and implemented in clinical practice in PNG. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of the present study was to explore the phonological working memory of adults who stutter through the use of a non-word repetition and a phoneme elision task. Participants were 14 adults who stutter (M =28 years) and 14 age/gender matched adults who do not stutter (M =28 years). For the non-word repetition task, the participants had to repeat a set of 12 non-words across four syllable lengths (2-, 3-, 4-, and 7-syllables) (N =48 total non-words). For the phoneme elision task, the participants repeated the same set of non-words at each syllable length, but with a designated target phoneme eliminated. Adults who stutter were significantly less accurate than adults who do not stutter in their initial attempts to produce the longest non-words (i.e., 7-syllable). Adults who stutter also required a significantly higher mean number of attempts to accurately produce 7-syllable non-words than adults who do not stutter. For the phoneme elision task, both groups demonstrated a significant reduction in accuracy as the non-words increased in length; however, there was no significant interaction between group and syllable length. Thus, although there appear to be advancements in the phonological working memory for adults who stutter relative to children who stutter, preliminary data from the present study suggest that the advancements may not be comparable to those demonstrated by adults who do not stutter. Educational objectives: At the end of this activity the reader will be able to (a) summarize the nonword repetition data that have been published thus far with children and adults who stutter; (b) describe the subvocal rehearsal system, an aspect of the phonological working memory that is critical to nonword repetition accuracy; (c) employ an alternative means to explore the phonological working memory in adults who stutter, the phoneme elision task; and (d) discuss both phonological and motoric implications of deficits in the phonological working memory. [Copyright &y& Elsevier]

Background: The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Socio-cultural factors likely to impact on future product uptake and effectiveness, such as women's ability to negotiate safer sexual choices, and intravaginal hygiene and menstrual practices (IVP), remain unclear in this setting. Methods: A mixed-method qualitative study was conducted among women and men attending a sexual health clinic in Port Moresby. During in-depth interviews, participants used copies of a hand-drawn template to indicate how they wash/clean the vulva and/or vagina. Interviewers pre-filled commercially available vaginal applicators with 2-3mL KY Jelly® to create a surrogate vaginal microbicide product, which was demonstrated to study participants. Results: A total of 28 IDIs were conducted (women=16; men=12). A diverse range of IVP were reported. The majority of women described washing the vulva only with soap and water as part of their daily routine; in preparation for sex; and following sexual intercourse. Several women described cleaning inside the vagina using fingers and soap at these same times. Others reported cleaning inside the vagina using a hose connected to a tap; using vaginal inserts, such as crushed garlic; customary menstrual 'steaming' practices; and the use of material fragments, cloth and newspaper to absorb menstrual blood. Unprotected sex during menstruation was common. The majority of both women and men said that they would use a vaginal microbicide gel for HIV/STI protection, should a safe and effective product become available. Microbicide use was considered most appropriate in 'high-risk' situations, such as sex with non-regular, transactional or commercial partners. Most women felt confident that they would be able to negotiate vaginal microbicide use with male sexual partners but if necessary would be prepared to use product covertly. Conclusions: Notional acceptability of a vaginal microbicide gel for HIV/STI prevention was high among both women and men. IVP were diverse in nature, socio-cultural dimensions and motivators. These factors are likely to impact on the future acceptability and uptake of vaginal microbicides and other biomedical HIV prevention technologies in this setting. [ABSTRACT FROM AUTHOR]