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Feasible, scalable, and cost-effective approaches to ensure virological suppression among children living with HIV are urgently needed. The aim of the Opt4Kids study was to determine the effect of point of care viral load and targeted drug resistance mutation testing in improving virological suppression among children on antiretroviral therapy (ART) in Kenya.

'Thou art weighed in the balances, and art found wanting.' (1) The scales Lady Justice holds conjure notions of balance and fairness because the scales 'may be the mechanism by [...]

Background: Expedited partner therapy (EPT) has been shown to reduce the risk of persistent or recurrent gonorrhea and chlamydial infection in heterosexuals, and to increase the proportion of sex partners receiving treatment. The objective of this analysis was to evaluate the consistency of EPT's effect across sociodemographic and behavioral subgroups. Methods: Subset analyses from a randomized controlled trial compared EPT to standard partner referral (SPR) in sociodemographic and behaviorally defined subgroups. Outcomes included persistent or recurrent infection in study participants and participants' report that their partners received treatment. Results: Reinfection risk was lower among EPT recipients than non-recipients in 21 of 22 subgroups, with relative risks (RRs) varying from 0.4 to 0.94. Compared to persons receiving SPR, persons receiving EPT were more likely to report that their partners were very likely to have been treated in 33 of 34 subgroups (RRs range, 1.03-1.36). Although EPT reduced the risk of persistent or recurrent infection somewhat more in men (RR, 0.56; 95% CI, 0.3-1.08) than in women (RR, 0.81; 95% CI, 0.611.07) and more in persons with gonorrhea (RR, 0.32; 95% CI, 0.13-0.78) than those with chlamydial infection (RR, 0.82; 95% CI, 0.63-1.07), the RR of partners being treated associated with EPT was similar in men (RR, 1.21; 95% CI, 1.05-1.39) and women (RR, 1.18; 95% CI, 1.10-1.27), and also in persons with gonorrhea (RR, 1.33; 95% CI, 0.80-2.23) and chlamydial infection (RR, 1.33; 95% CI, 1.07-1.66). Conclusions: In this study, EPT is shown to be superior to SPR across a wide spectrum of sociodemographic and behaviorally defined subgroups. DOI: 10.1097/OLQ.0b013e3181e1a296

Background: Bacterial vaginosis (BV) is a common cause of vaginitis and, for unknown reasons, is common in lesbian and bisexual women. We defined risks for prevalent BV in lesbian and bisexual women with attention to detailed sexual risk history. Methods: Women 16 to 35 years reporting sex with [greater than or equal to] 1 woman in prior year underwent computer-assisted self-interview with extensive sexual and medical history. BV was defined by Amsel criteria, and associations with subject characteristics were estimated by Poisson regression and generalized estimating equation to adjust for potential coenrollment of current sexual partners. Results: Of 335 participants (median age, 25 years; 22% nonwhite race), 6% reported douching, 24% sex with men, and 91% any sex in the prior 3 months. 96 (29%) had BV, 40% of whom reported corresponding symptoms. BV was associated with reporting a partner with BV (39% vs. 12%; multivariate relative risk [MRR], 4.53 [2.59-7.93]), vaginal lubricant use (59% vs. 21%; MRR, 1.86 [0.94-3.68]), or sharing vaginal sex toys in prior 3 months (33% vs. 21%; MRR, 1.70 [0.96-3.01]). No association was seen for age, race, smoking, hormone use, douching, vaginal, anal or oral sex, or numbers of new partners. Lubricant use and shared vaginal toys were correlated (Spearman 0.29). Conclusions: BV is associated with practices that efficiently transmit vaginal fluid and with use of vaginal lubricant; since these are correlated, assessing independent effects will require further analysis. More research is required to understand relationships between role of transmission of BV-associated bacteria and vaginal lubricant on BV pathogenesis. DOI: 10.1097/OLQ.0b013e3181ca3cac

Oral pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective and is being implemented at scale at health clinics throughout sub-Saharan Africa. However, barriers to clinic-based PrEP delivery remain. We aimed to establish the efficiency of semiannual PrEP clinic visits supplemented with interim home-based HIV self-testing (HIVST) versus standard of care for HIV testing, drug refilling, and adherence among PrEP users.

Background: Bacterial vaginosis frequently persists after treatment. The role of newly defined bacterial vaginosis-associated bacteria (BVAB), which have a specificity for this condition of 97% or greater, has not been assessed. Objective: To define risks for bacterial vaginosis persistence, including pretreatment detection of specific vaginal bacteria, among women reporting sex with women. Design: Observational cohort study. Setting: University-based research clinic. Patients: 335 women age 16 to 29 years reporting sex with at least 1 woman in the past year. Participants were recruited through advertisements and provider referral. Intervention: Bacterial vaginosis was treated with intravaginal metronidazole gel (0.75%), 37.5 mg nightly for 5 nights. Measurements: Species-specific 16S recombinant DNA polymerase chain reaction assays targeting 17 bacterial species were applied to vaginal fluid obtained at baseline. Test of cure by clinical criteria and Gram stain analysis and repeated polymerase chain reaction assays of vaginal fluid were performed 1 month after treatment, and interim behaviors were assessed by using computer-assisted self-interview. Results: Of 335 women, 24% of whom also reported sex with men within 3 months before enrollment, 131 (39%) had bacterial vaginosis. In the 120 (92%) women who returned for follow-up, the incidence of persistent bacterial vaginosis was 26% and was statistically significantly higher in women with baseline detection of 3 Clostridiales bacteria, designated as BVAB1 (risk ratio, 2.0 [95% CI, 1.1 to 4.0]), BVAB2 (risk ratio, 8.7 [CI, 2.5 to [infinity]]), or BVAB3 (risk ratio, 3.1 [CI, 1.7 to 5.8]); Peptoniphilus lacrimalis (risk ratio, 3.5 [CI, 1.6 to 15.5]); and Megasphaera phylotype 2 (risk ratio, 3.4 [CI, 1.4 to 5.5]). Persistence was lower with treatment adherence (risk ratio, 0.4 [0.2 to 0.9]). Detection of these bacteria at the test-of-cure visit was associated with persistence, whereas post-treatment sexual activity was not. Limitations: Findings may not be generalizable to women who have sex only with men, or to women whose bacterial vaginosis is treated with oral antibiotics. The study may be too small and may involve a population that is too highly selected to draw definitive conclusions about associations of persistent infection with posttreatment sexual behaviors. Conclusion: Persistent bacterial vaginosis is associated with several bacteria in the Clostridiales order, Megasphaera phylotype 2, and P. lacrimalis, suggesting that vaginal microbiology at diagnosis may determine risk for antibiotic failure.

Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV acquisition. However, adherence among young women (aged 18–24 years) has been challenging. SMS reminders have been shown to improve adherence to antiretroviral therapy in some contexts, including in combination with real-time adherence monitoring. We aimed to determine the effect of SMS reminders on PrEP adherence among young women in Kenya over a 2-year period.

Objective: The objective of this study was to determine why different criteria for response to treatment of bacterial vaginosis (BV) led to markedly different conclusions about treatment efficacy in a randomized trial comparing metronidazole gel versus metronidazole/nystatin ovules. Study: We compared the impact of two treatment regimens on individual components of Amsel and Nugent criteria at follow-up visits 14, 42, and 104 days after initiating treatment. Results: Compared with gel, ovules more effectively eliminated amines, clue cells, and Gardnerella, Prevotella, or Mobiluncus morphotypes from vaginal fluid, thus achieving cure based on 'usual' criteria (absence of BV by Amsel or Nugent criteria), but did not more effectively restore Lactobacillus morphotypes or lower vaginal pH, thus not meeting Federal Drug Administration (FDA) criteria for cure. Conclusion: Because early vaginal recolonization by lactobacilli was poor after both gel and ovules, FDA draft criteria for cure missed marked differences in treatment efficacies against Gardnerella, clue cells, and amines. Cure defined more 'usually' may give more useful information.

The metronidazole 0.75 percent gel is compared with ovules containing metronidazole 500 mg and nystatin 100,000 U, for intravaginal treatment of bacterial vaginosis (BV). Metronidazole/nystatin ovules were significantly more effective than metronidazole gel and unprotected sex predicted recurrence after initial improvement.

Older Medicare patients with diabetes may not receive consistenly optimal care. According to medical records, many of the 5,980 patients who were at least 75 years old had elevated blood glucose levels, poor control of hypertension, and failed to take their medication properly. Diabetes control was generally better in men and those at least 85 years old. Quality improvement efforts are needed for the care of elderly diabetics.

As oral pre-exposure prophylaxis (PrEP) becomes the standard of prevention globally, its potential effect on HIV incidence in clinical trials of new prevention interventions is unknown, particularly for trials among women. In a trial measuring HIV incidence in African women, oral PrEP was incorporated into the standard of prevention in the trial's last year. We assessed the effect of on-site access to PrEP on HIV incidence in this natural experiment.

Isoniazid preventive therapy prevents active tuberculosis in people with HIV, but previous studies have found no evidence of benefit in people with HIV who had a negative tuberculin skin test, and a non-significant effect on mortality. We aimed to estimate the effect of isoniazid preventive therapy given with antiretroviral therapy (ART) for the prevention of tuberculosis and death among people with HIV across population subgroups.

Monitoring HIV treatment with laboratory testing introduces delays for providing appropriate care in resource-limited settings. The aim of our study was to determine whether point-of-care HIV viral load testing with task shifting changed treatment and care outcomes for adults on antiretroviral therapy (ART) when compared with standard laboratory viral load testing.

Women recently released from incarceration have increased rates of co-occurring substance use, physical health, and mental health disorders. During re-entry, they face challenges navigating needed health services and social services stemming from these problems. Women’s Initiative Supporting Health Transitions Clinic (WISH-TC) is a primary care program that facilitates treatment access for re-entering women. Strategies include support and navigation assistance from peer community health workers. Thirteen participants, of whom 11 had a substance use disorder, completed semi-structured interviews about their experiences in WISH-TC as part of a process evaluation. We conducted a qualitative framework analysis informed by self-determination theory. WISH-TC supported autonomy as staff helped motivate women to work toward personal health goals. Women were empowered to have their health needs met, and consequently, prioritized attending clinic. Regarding competence, WISH-TC built upon women’s existing knowledge to increase their health literacy and better understand their individual health needs. Relatedness support, both prior to re-entry and ongoing with clinic staff, was key in women’s satisfaction with their care. The clinic made procedural changes in response to the interviews, including providing orientation for the patients and training the clinic in trauma-informed practices. Our findings highlight the potential of a program for re-entering women, including those with substance use disorders to strengthen their abilities to navigate complex healthcare and societal systems. WISH-TC helped women feel supported, motivated, and competent to address their substance use, physical, and mental health conditions.

This study examined the relationship between physical literacy (i.e., motor competence, physical activity, and health-related fitness) and academic performance (i.e., executive function, class attendance, and standardized test scores) among adolescents. Second, we investigated whether these relationships differ between boys and girls using a structural invariable test. Using a prospective research design, we recruited 330 adolescents (154 boys and 176 girls; Mage= 12.52 years, SD= 0.86) in Texas and conducted correlational analyses, finding that physical literacy variables were significantly related to executive function (while the rs range was from −.16 to −.30, the high scores on the instrument we used, the Behavior Rating Inventory of Executive Function, indicate higher risks for executive dysfunction; p< .01) and positively associated with school attendance (rs range from .19 to .34; p< .05). Structural equation models supported the significant direct and indirect effects of motor competence on executive function and school attendance for boys and girls through physical fitness (all three components) and school-based moderate-to-vigorous physical activity, respectively. The structural invarince test indicated noninvariant models (based on path coefficients) between girls and boys (p< .01). Embracing psychomotor associations with physical literacy may be a promising way to elicit behavioral change in physical fitness and create a behavioral channel to academic success for adolescents.

Observational and laboratory studies suggest that some hormonal contraceptive methods, particularly intramuscular depot medroxyprogesterone acetate (DMPA-IM), might increase women's susceptibility to HIV acquisition. We aimed to compare DMPA-IM, a copper intrauterine device (IUD), and a levonorgestrel (LNG) implant among African women seeking effective contraception and living in areas of high HIV incidence.

ObjectivesInformation to guide counselling and management for pregnancy in women with Marfan syndrome (MFS) is limited. We therefore conducted a UK multicentre study.MethodsRetrospective observational study of women with MFS delivering between January 1998 and March 2018 in 12 UK centres reporting data on maternal and neonatal outcomes.ResultsIn total, there were 258 pregnancies in 151 women with MFS (19 women had prior aortic root replacements), including 226 pregnancies ≥24 weeks (two sets of twins), 20 miscarriages and 12 pregnancy terminations. Excluding miscarriages and terminations, there were 221 live births in 139 women. Only 50% of women received preconception counselling. There were no deaths, but five women experienced aortic dissection (1.9%; one type A and four type B—one had a type B dissection at 12 weeks and subsequent termination of pregnancy). Five women required cardiac surgery postpartum. No predictors for aortic dissection could be identified. The babies of the 131 (65.8%) women taking beta-blockers were on average 316 g lighter (p<0.001). Caesarean section rates were high (50%), particularly in women with dilated aortic roots. In 55 women, echocardiographic aortic imaging was available prepregnancy and postpregnancy; there was a small but significant average increase in AoR size of 0.84 mm (Median follow-up 2.3 months)ConclusionThere were no maternal deaths, and the aortic dissection rate was 1.9% (mainly type B). There with no identifiable factors associated with aortic dissection in our cohort. Preconception counselling rates were low and need improvement. Aortic size measurements increased marginally following pregnancy.

The categorical model of classification in the fifth edition of the Diagnostic and Statistical Manual of Mental Disordersis sorely problematic. A proposed solution is emerging in the form of a quantitative nosology, an empirically based dimensional organization of psychopathology. More specifically, a team of investigators has proposed the Hierarchical Taxonomy of Psychopathology (HiTOP). The purpose of this article is to discuss the potential role, importance, and implications of personality within the HiTOP dimensional model of psychopathology. Suggested herein is that personality provides a foundational base for the HiTOP dimensional model of psychopathology. Implications concern the potential value of the early assessment of and screening for personality as well as the development of protocols for the treatment of personality trait domains, which may in turn contribute to substantial improvements in quality of life as well as mental and physical health.

•We used photography-based grid point intercept (GPI) analysis and Daubenmire to assess ecosystem services in high-shrub rangelands.•Cover estimates were higher for some functional groups when using Daubenmire, likely because Daubenmire frames were situated below the shrub canopy and thus included subcanopy cover, whereas GPI photographs taken above the canopy could not eliminate shrubs that obscured subcanopy attributes.•Choice of methods affected assessment of two ecosystem services: sage-grouse habitat quality and site biodiversity; each was higher when using Daubenmire.•Understanding cover-estimate differences that stem from using GPI photo plots versus Daubenmire will allow practitioners to decide if GPI methods address project objectives.

Sedentary behavior (SB), physical activity (PA), and attributes of physical fitness have been shown to be related to depressive symptoms in adolescents. The purpose of the present study was to investigate whether SB and fitness-producing activity predicted depression in active adolescents over and above gender and fitness attributes.

In the aftermath of hurricanes in Texas in recent years, the Texas Board of Nursing (BON) has developed a history of working with multiple stakeholders to provide disaster relief nursing services. The BON, along with other stakeholders, has established several methodologies to expedite licensure verification. User feedback from the BON’s processes is reviewed, as are lessons learned during Hurricane Harvey.

This article presents an integrative literature review to identify and assess how regulatory bodies, professional associations, and trade union organizations differ and interact. A small number of studies, from across a diverse range of disciplines, have researched this topic. Nine studies were analyzed, resulting in the identification of 16 themes and their associated characteristics. Although these three organizational types may share some overarching ambitions, the perspectives taken in achieving these ambitions are often different, as is the ultimate or primary beneficiary of the actions. Further research is needed to validate these findings and to explore which of the various themes have the greatest impact on achieving organizational goals and avoiding tensions, conflict, and bias.

There have been increased calls to examine the performance of nursing regulatory bodies. Despite this, few studies have been conducted. This article aims to identify potential measures that differentiate the performance or characteristics of umbrella and independent nursing boards.

Male circumcision decreases HIV acquisition by 60%, and antiretroviral therapy (ART) almost eliminates HIV transmission from HIV-positive people who are virally suppressed; however, coverage of these interventions has lagged behind targets. We aimed to assess whether community-based HIV testing with counsellor support and point-of-care CD4 cell count testing would increase uptake of ART and male circumcision.

We describe the first case of venous air embolism during percutaneous tracheostomy performed during continuous renal replacement therapy with citrate anticoagulation. Venous air embolism is a known risk during percutaneous dilatational tracheostomy; concurrent use of extracorporeal circuits may present a compounded risk due to the negative pressure developed by the blood pump. Use of regional citrate anticoagulation, permitting invasive procedures to be performed without discontinuing renal replacement therapy, may lead to an increase in the incidence of venous air embolism during tracheostomy.

PURPOSE: The ability of medical students to recognize heart sounds is alarmingly low (~21%). We previously demonstrated students who listened to intensive repetition of abnormal heart sounds in a classroom [...]

Criminal history is becoming a significant challenge in determining appropriate sanctions for licensed nurses and applicants. Through the development of objective disciplinary guidelines for criminal conduct, the Texas Board of Nursing has been able to ensure consistency and fair consideration of criminal history information in licensing and disciplinary decisions. This article describes the development of the guidelines, the underlying policy considerations, and the efforts to maintain and improve them.

Daily oral antiretroviral preexposure prophylaxis (PrEP) is a promising strategy for prevention of HIV-1 acquisition. Three clinical trials demonstrated PrEP efficacy; however, two PrEP trials among women did not find protection against HIV-1. One hypothesis proposed for these divergent results is that PrEP efficacy may be reduced in populations with higher HIV-1 incidence.

Childhood periodic syndromes are thought to be early life expressions of the genetic tendency for migraine. The objective of this study was to determine whether maternal migraine is associated with an increased risk of infant colic, because this may indicate that colic is a childhood periodic syndrome.

Objectives. We assessed chlamydia trends, individual-level risk factors, and population-level area-based socioeconomic measures (ABSMs) associated with chlamydia infection in women attending U.S. Public Health Service (PHS) Region X Infertility Prevention Project (IPP) family planning (FP) clinics from 1997–2006. We then explored these measures within racial/ethnic subpopulations.Methods. Using data from 667,223 chlamydia tests obtained from women aged 15–24 years screened in 201 FP clinics, we employed a generalized mixed model with logistic link, incorporating clinic and ZIP code as random effects to adjust for risk of chlamydia associated with individual- and population-level (areal) measures for the overall population and for each racial/ethnic subpopulation.Results. Significant racial/ethnic differences in chlamydia persisted after adjusting for individual and aggregate factors. Relatively steep chlamydia gradients were found across racial/ethnic ABSM levels. Compared with white women, infection risk was significantly higher for black (adjusted odds ratio [AOR] = 1.93), American Indian/Alaska Native (AOR=1.62), Asian/Pacific Islander (AOR=1.42), and Hispanic (AOR=1.28) women. The impact of population-level ABSMs on chlamydia varied across racial/ethnic groups and was generally modest. Among white women, there was a significant 4% relative annual increase in predicted chlamydia during the 10-year period 1997–2006. Chlamydia positivity over time did not change for racial/ethnic minority groups after adjusting for individual- and population-level factors.Conclusions. Racial/ethnic differences in chlamydia persisted over time and were not mitigated by adjustment for aggregate socioeconomic position or areal racial/ethnic measures. Changes in project strategies will be needed to address racial/ethnic disparities for chlamydial infection among young female FP clinic clients.

In 1999, the National Council of State Boards of Nursing (NCSBN) undertook a major initiative to develop minimal licensure requirements and, upon recommendation by an appointed committee and approval of the NCSBN Board of Directors, the 1999 Uniform Licensure Requirements (ULRs) were adopted by the Delegate Assembly. Enactment of these requirements by individual boards of nursing (BONs), however, varied to wide degrees and as a result many variances emerged and uniformity was not achieved. During the 10 years that followed, both intrinsic and extrinsic environmental factors affected the nursing profession and impacted health care delivery, causing major stakeholders to request uniformity among state nursing laws and regulations, especially in regard to licensure. In August 2011, NCSBN’s Delegate Assembly adopted the 2011 ULRs to serve as new national standards for registered nurse and licensed practical/vocational nurse licensure across all states and territories. States are urged to adopt the new 2011 ULRs included in this article. Once adopted, they will establish uniformity across all U.S. jurisdictions and ease the portability of nurses in the United States.

This commentary begins with a brief overview of recent developments in healthcare policy and practice in the UK. Particular attention is paid to the demise of the concept (and practice) of compliance along with and rise of the concept (and practice) of concordance. Analysis suggests that despite considerable changes in the organisation and delivery of healthcare there remains a clear gap between rhetoric and reality. Drawing on insights from qualitative health research issues of identity, embodiment and self-care are explored and synthesised in a single descriptive framework. Neither compliance nor concordance alone adequately captures the reality of patient experiences in everyday life. The framework of understanding proposed here contextualises compliance and concordance and their corollaries within distinct horizons of expectation. For a truly user-driven healthcare it is not a question of either/or but both and more and asking, in reality, what can a body do?

The blue colouration seen in the leaves of Selaginella willdenowiiis shown to be iridescent. Transmission electron microscopy studies confirm the presence of a layered lamellar structure of the upper cuticle of iridescent leaves. Modelling of these multi-layer structures suggests that they are responsible for the blue iridescence, confirming the link between the observed lamellae and the recorded optical properties. Comparison of blue and green leaves from the same plant indicates that the loss of the blue iridescence corresponds to a loss of the multi-layer structure. The results reported here do not support the idea that iridescence in plants acts to enhance light capture of photosynthetically important wavelengths. The reflectance of light in the range 600–700 nm is very similar for both iridescent and non-iridescent leaves. However, owing to the occurrence of blue colouration in a wide variety of shade dwelling plants it is probable that this iridescence has some adaptive benefit. Possible adaptive advantages of the blue iridescence in these plants are discussed.

High plasma HIV-1 RNA concentrations are associated with increased risk of HIV-1 transmission. Initiation of antiretroviral therapy (ART) reduces plasma HIV-1 concentrations. We aimed to assess the effect of ART use by patients infected with HIV-1 on risk of transmission to their uninfected partners.

Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression.