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The declaration of COVID-19 as a global pandemic by the World Health Organisation in March 2020 brought many changes to the early childhood sector internationally. The South African response is best understood in the context of an under-developed sector with pre-existing vulnerabilities. In this article, we present a contextual understanding of the lived experiences of early childhood development (ECD) teachers and managers during the lockdown and the opening phases of a risk-adjusted approach. Our use of a phenomenological lens together with systems theory provides a reality check through a focus on lived experiences. Data were produced through an online survey with 28 ECD teachers and managers. We conducted semi-structured interviews with a subset of 8 of these participants. Findings show that disruptions of COVID-19 led to entrenching inequities in service provision and early learning opportunities. These intersecting dimensions have implications for building effective ECD systems.

Background A test that helps predict the time to the final menstrual period (FMP) has been sought for many years. Objective To assess the ability of antimullerian hormone (AMH) measurements to predictions the time to FMP. Design Prospective longitudinal cohort study. Setting The Study of Women’s Health Across the Nation. Participants and Measurements AMH and FSH were measured in 1537 pre- or early perimenopausal women, mean age 47.5 ± 2.6 years at baseline, then serially until 12 months of amenorrhea occurred. AMH was measured using a 2-site ELISA with a detection limit of 1.85 pg/mL. Main Outcome Measure Areas under the receiver operating curves (AUC) for AMH-based and FSH-based predictions of time to FMP, stratified by age. Probabilities that women would undergo their FMP in the next 12, 24, or 36 months across a range of AMH values were assessed. Results AUCs for predicting that the FMP will occur within the next 24 months were significantly greater for AMH-based than FSH-based models. The probability that a woman with an AMH 100 pg/mL would not undergo her FMP within the next 12 months ranged from 97% in women Conclusions AMH measurement helps estimate when a woman will undergo her FMP, and, in general, does so better than FSH.

Context The relation between the menopause transition (MT) and changes in regional fat distribution is uncertain. Objective To determine whether the MT is associated with the development of central adiposity. Design Longitudinal analysis from the Study of Women’s Health Across the Nation, spanning 1996-2013 (median follow-up 11.8 years). Setting Community-based. Participants 380 women with regional body composition measures by dual energy X-ray absorptiometry. Mean baseline age was 45.7 years; racial/ethnic composition was 16% Black, 41% Japanese and 43% White. Outcomes Changes in android, gynoid and visceral fat and waist and hip circumferences. Results Android fat increased by 1.21% per year (py) and 5.54% py during premenopause and the MT, respectively (each P Conclusions The MT is associated with the development of central adiposity. Waist or hip circumferences are less sensitive to changes in fat distribution.

Background Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries’ bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. Methods PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized (“choice”) study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. Discussion The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103).

Serum estradiol (E2) concentrations in midreproductive women are easily measured using a variety of conventional immunoassays (IA). However, when women approach and traverse menopause, E2 eventually drops below levels where IA lacks sufficient sensitivity to accurately measure E2. Liquid chromatography and tandem mass spectrometry (LC/MS/MS) has become the standard method for assessing steroid hormones, especially when circulating concentrations are low. We evaluated the relationship between IA and LC/MS/MS E2 measurements in a cohort of women taken from the Study of Womens Health Across the Nation (SWAN) to assess the degree of agreement between the two methods and to determine the level of E2 at which IA becomes unreliable. Methods: 315 serum samples that had been previously measured for E2 using IA were re-analyzed using LC/MS/MS performed by one of the authors (RA). In this original set, E2 levels that were below the limit of assay detection (LLD, 6 pg/ml) were interpolated as a random number between 0 and the LLD. Agreement between all 315 samples was assessed using both Pearson and Spearman correlation. The analysis was repeated excluding the subset of specimens that were below the lower limit of detection (LLD) for the IA E2 assay (6 pg/ml; N=176), and a third set of correlations was obtained for specimens that measured Results: The overall dataset (N=315) demonstrated excellent agreement between IA and LC/MS/MS with a Pearson’s r and Spearmans r of 0.98 AND 0.60, respectively. When the subset of 176 samples above the LLD were assessed, Pearson’s r was 0.98 and Spearman’s r was 0.81. In contrast, when specimens measuring 6–15 pg/ml by IA were compared to LC/MS/MS, Pearson’s r was -0.03 and Spearman’s r was 0.09, indicating a complete loss of relationship between the two methods. Conclusions: The IA used by SWAN (England, Clin Chem 2002; 48: 1584) and LC/MS/MS demonstrate excellent correlation for E2 measurements above 15 pg/ml. However, circulating concentrations of E2 below 15 pg/ml were not accurately measured using IA.

Objective: Higher levels of high-density lipoproteins cholesterol (HDL-C) may not always be cardio-protective in midlife women. Nuclear magnetic resonance (NMR) spectroscopy HDL subclasses have shown strong associations with CVD risk beyond HDL-C. Preliminary work suggests significant declines in large HDL particles (HDL-P) and overall HDL size, but increases in small HDL-P during the perimenopause stage. Our objective was to assess whether associations between NMR HDL subclasses and risk of coronary artery calcification (CAC) vary by menopausal stage. Design: We assessed 283 women (at baseline : age 51.4 ± 3.0 years; 56.6% Pre-/Early peri-, 8.8% late peri-, 34.6% post-menopausal) who had NMR HDL subclasses and CAC Agatston score measured once (N=48 [17%]) or twice (N=235 [83%]) around menopause. CAC presence was defined as CAC>0. Effect modifications of menopausal stage on associations between HDL subclasses and CAC presence overtime were tested using generalized estimating equation for binary outcome. Final models were adjusted for study site, race and time varying: age, body mass index, physical activity, alcohol consumption, insulin resistance, triglycerides and low-density lipoprotein cholesterol. Results: In final models, menopausal stage modified the associations of small HDL-P (p=.009), large HDL-P (p=.05) and overall HDL size (p=.007) with CAC presence ( Table ). Higher concentration of small HDL-P, lower concentration of large HDL-P, and smaller overall HDL size significantly associated with greater risk of CAC presence during the late-peri stage compared to pre-/early peri-menopausal stage ( Table) . Conclusions: Changes in HDL subclasses during the menopause transition may increase the likelihood of measurable CAC developing in women, particularly during the later peri-menopausal stage. Characterizing associations of HDL composition and function metrics with CVD risk over the menopause transition is critical to better understand the relationship of HDL to coronary disease in midlife women.

The Bologna Process affects the academic community, particularly faculty members who have to implement the process. This study is an initiative by a group of lecturers to evaluate the perception of...

Importance Acutely ill inpatients with COVID-19 typically receive antithrombotic therapy, although the risks and benefits of this intervention among outpatients with COVID-19 have not been established. Objective To assess whether anticoagulant or antiplatelet therapy can safely reduce major adverse cardiopulmonary outcomes among symptomatic but clinically stable outpatients with COVID-19. Design, Setting, and Participants The ACTIV-4B Outpatient Thrombosis Prevention Trial was designed as a minimal-contact, adaptive, randomized, double-blind, placebo-controlled trial to compare anticoagulant and antiplatelet therapy among 7000 symptomatic but clinically stable outpatients with COVID-19. The trial was conducted at 52 US sites between September 2020 and June 2021; final follow-up was August 5, 2021. Prior to initiating treatment, participants were required to have platelet count greater than 100 000/mm3and estimated glomerular filtration rate greater than 30 mL/min/1.73 m2. Interventions Random allocation in a 1:1:1:1 ratio to aspirin (81 mg orally once daily; n = 164), prophylactic-dose apixaban (2.5 mg orally twice daily; n = 165), therapeutic-dose apixaban (5 mg orally twice daily; n = 164), or placebo (n = 164) for 45 days. Main Outcomes and Measures The primary end point was a composite of all-cause mortality, symptomatic venous or arterial thromboembolism, myocardial infarction, stroke, or hospitalization for cardiovascular or pulmonary cause. The primary analyses for efficacy and bleeding events were limited to participants who took at least 1 dose of trial medication. Results On June 18, 2021, the trial data and safety monitoring board recommended early termination because of lower than anticipated event rates; at that time, 657 symptomatic outpatients with COVID-19 had been randomized (median age, 54 years [IQR, 46-59]; 59% women). The median times from diagnosis to randomization and from randomization to initiation of study treatment were 7 days and 3 days, respectively. Twenty-two randomized participants (3.3%) were hospitalized for COVID-19 prior to initiating treatment. Among the 558 patients who initiated treatment, the adjudicated primary composite end point occurred in 1 patient (0.7%) in the aspirin group, 1 patient (0.7%) in the 2.5-mg apixaban group, 2 patients (1.4%) in the 5-mg apixaban group, and 1 patient (0.7%) in the placebo group. The risk differences compared with placebo for the primary end point were 0.0% (95% CI not calculable) in the aspirin group, 0.7% (95% CI, –2.1% to 4.1%) in the 2.5-mg apixaban group, and 1.4% (95% CI, –1.5% to 5.0%) in the 5-mg apixaban group. Risk differences compared with placebo for bleeding events were 2.0% (95% CI, –2.7% to 6.8%), 4.5% (95% CI, –0.7% to 10.2%), and 6.9% (95% CI, 1.4% to 12.9%) among participants who initiated therapy in the aspirin, prophylactic apixaban, and therapeutic apixaban groups, respectively, although none were major. Findings inclusive of all randomized patients were similar. Conclusions and Relevance Among symptomatic clinically stable outpatients with COVID-19, treatment with aspirin or apixaban compared with placebo did not reduce the rate of a composite clinical outcome. However, the study was terminated after enrollment of 9% of participants because of an event rate lower than anticipated. Trial Registration ClinicalTrials.gov Identifier:NCT04498273

Study objective To summarize trial adaptation from in-clinic to virtual design in response to the SARS-2 coronavirus-2 (COVID-19). Design A clinical trial of a mobile health intervention to improve chronic disease self-management for rural individuals with atrial fibrillation (AF). The trial has a 4-month intervention – accessible regardless of health or digital literacy – to enhance AF medication adherence and patient experience with 8- and 12-month assessments of sustainability. Setting Rural, western Pennsylvania. Participants Rural individuals with AF receiving oral anticoagulation for stroke prevention. Interventions Enrolled participants underwent a telephone-based orientation, provided verbal consent, and were randomized using a digital platform. They received a smartphone with intervention or control applications and a curriculum on usage tailored for study arm. Participants received study assessments by mail with telephone-based administration and contact for the 12-month trial. Main outcome measures Successful adaptation to virtual engagement and recruitment. Results The study enrolled 18 participants during in-clinic recruitment (January–March 2020). From 5/1/2020 to 5/6/2021 the study team enrolled 130 individuals (median age 72.4 years, range 40.8–92.2; 49.2% women, 63.1% without college degree, and 45.4% with limited health literacy). Retention of participants enrolled using virtual methods during the 4-month intervention phase is 92%. Conclusions We report a virtual trial of a mobile health intervention for rural individuals with AF. Our successful implementation suggests promise for engaging geographically isolated rural individuals, potential to enhance digital health access, and advance rural health equity.

In the 2000s and 2010s, global arts cinema has seen a cluster of films which question gender and sexual ideologies through the non-conforming child-figure, and Latin American cinema has been no exception to this trend, with important examples emerging in countries such as Venezuela and, especially, in Argentina. This chapter examines the theme of ‘unruly child bodies’ in recent Latin American cinema, arguing that since the mid-2000s, such representations have made of the child-figure a significant means by which Latin American cinema communicates feminist and queer political thought. This recent development can be linked to the changing production and funding landscape, as well as to the changing political and legal contexts of Latin American countries. This chapter starts with a brief survey of films with related themes, before moving onto examine in depth two Argentine films from the late 2000s, Albertina Carri’s La rabia (2008) and Julia Solomonoff’s El ultimo verano de la boyita (2009) in which the child is linked to the animal as a way of imaging corporeal, sexual and gender non-conformity. The chapter shows how both films challenge post-Enlightenment imaginaries of childhood which emphasise the child as locus of innocence and purity, and image a revolt from established corporeal, gender and familial regimes through the animal connections of their child protagonists. This becoming is also elicited extra-diegetically, through the films’ appeals to embodied spectatorship, their production of a spectatorial ‘becoming-other’.

In Latin American cinema, the depiction of street children and slum children has a long history stretching back to Luis Bunuel’s Los olvidados. This chapter examines the representation of street children and severely marginalised children and the common tendency for these representations to end with the death of their child protagonists, in films from the 1990s and 2000s. Whilst in the ‘first’ world child death is rare as a filmic theme (except perhaps in horror), in Latin American cinema, it remains a common way of registering social protest. Indeed, the history of Latin American political filmmaking is littered with the bodies of dead, dying and suffering children. This chapter considers two examples of the proliferation of films about street children from the 1990s, Buenos Aires viceversa (Agresti, 1996), La vendedora de rosas (Gaviria, 1998) each of which ends with the death of its child protagonist, and pays particular attention to the ways in which the deaths of their child protagonists fit within tropes established not only in Bunuel’s classic, but also in the Spanish cine religioso tradition, and especially in film versions of Jose Sanchez Silva’s novel Marcelino, pan y vino. As well as considering these representations in terms of their power as social and political protest, the chapter draws on psychoanalyst Serge Leclaire’s contention that imagining child death responds to other adult desires, such as the necessary death of the infans, and proposes ways in which the representation of child death in these films also functions to bring about consolidation (of subjectivity or community) or reconciliation. The chapter argues that the deaths depicted in Buenos Aires viceversa are intensely visual and contrasts these with La mujer sin cabeza (Martel, 2008), arguing that whilst the narrative use of child death in this later film shares some motivations with the film’s 1990s counterparts, La mujer sin cabeza’s aesthetic strategies refuse the earlier films’ objectification and sentimentalisation of the child who dies, instead figuring him as a disruptive excess to, and thus as uncontainable by, systems of visual representation.

THIS ARTICLE presents an exploratory study that was financed and commissioned by Health Education, North Central and East London (NCEL), and the local education and training board (LETB); it was undertaken by the University of Hertfordshire between February and August 2014. The research was funded to explore the educational needs of the nursing workforce in relation to out-of-hospital care for children and young people in the UK. The data will be used to inform the development of service provision. Read More: http://journals.rcni.com/doi/10.7748/ncyp.27.5.28.e610 Open Access with Creative Commons Attribution 3.0 Unported (CC BY 3.0). Copyright © 2017 RCN Publishing Company Ltd.

This article examines Lucrecia Martel’s 2008 film La mujer sin cabeza, taking childhood and youth as its main category of analysis and discussing the relationship between the film’s uses and portrayals of these, and the categories of gender, race, and class. The article explores the film’s dialogue with discursive constructions of Argentine youth and proposes that the film figures female adolescence both as political redemption and means of escape from sexual and social stratification. The relationship between childhood and ghostliness is theorised in relation to Agamben and the figure of homo sacer. These figures are understood as ‘in-betweens’ or remnants of binary structures, and the film’s ethical project is to focus on thematically, and embody aesthetically, this interval. This project also extends to a detailed analysis and exposure of the mechanisms of exclusion and separations associated with the systems of domination depicted.

This article examines an understudied aspect of recent Argentine filmmaking: the focus on queer and intersex childhood and adolescence in XXY (2007) and El ultimo verano de la boyita/The last summer of La Boyita (2009), analysing them in the light of recent theory on queer childhoods, especially the notion that queer children carve out spaces of resistance to heteronormative models of development through ‘sideways movements’, involving the animal. In XXY’s utopian politics, the intersex body is figured as a locus of embodied becoming; in El ultimo verano, the child’s becoming-animal is the site of strategic, subversive reinscriptions of human–animal connections and their relationship to gender. Both films pair intersex characters with a queer double who models a desiring gaze on the intersexual and in El ultimo verano this is – in both aesthetic and political terms – a child’s gaze. Lastly, the article suggests that echoes of an older film, De eso no se habla/I don’t want to talk about it, can be identifi...

This chapter considers girlhood in the films of acclaimed Argentine director Lucrecia Martel, arguing for its central importance to their political and aesthetic project. It explores the local proliferation of girl-images which followed in the wake of Martel’s influential debut La Cienaga/The Swamp (2001), and indicates some of their global resonances. Whilst Martel has come to be seen as a crucial player in the experimental-ism and aesthetic break with previous Argentine filmmaking that, in the late 1990s and early 2000s came to be known by the label “New Argentine Cinema,” it is also vital to delineate the correspondences that exist between her work and that of other recent Argentine women filmmakers frequently excluded from this canon. As Jens Andermann suggests: “[I]t makes sense today to look beyond the uncertain boundaries of an ‘independent’ generational project, which has been in many ways a critical fiction […]. [W]hat this critical narrative missed was the wider, more contradictory and multi-layered landscape of film-making in Argentina.”1 I argue that Martel’s work has also played a crucial role in the development of a new feminist and queer cinema in Argentina, made by women filmmakers and focused in particular around young characters and girl-figures.

The purpose of this study was to test the effect of a motivational message on the intention of laypersons to learn cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. A pretest-posttest, double-blind, randomized design was used with 220 community-dwelling adults. Participants were randomly assigned to the treatment group reading the CPR and AED pamphlet emphasizing learning CPR and AED use to save someone they love and the 3-minute window for response time; or to the comparison group reading the identical pamphlet without the 2 motivational statements. Intention to learn CPR and AED use and to look for AEDs in public areas was measured before and after reading the respective pamphlet. No significant difference emerged between the groups for the number of participants planning to learn CPR and AED use. A significant number of participants in both groups increased intention to learn CPR and AED use. Significantly more treatment participants than comparison participants planned to routinely look for AEDs in public areas after reading the pamphlet, however. Teaching critical facts such as the low survival rate for out-of-hospital cardiac arrest might encourage laypersons to learn CPR and AED use. Routinely teaching family members of people at risk for a cardiac arrest about the short window of time in which CPR and AED use must begin and encouraging them to learn about CPR and AEDs to save someone they love may encourage family members to identify the location of AEDs in public places.

SUMMARY Background Data management and quality assurance play a vital but often neglected role in ensuring high quality research, particularly in collaborative and international studies. Objective A data management and quality assurance program was set up for a cross-national epidemiological study of Alzheimer’s disease, with centers in India and the United States. Methods The study involved (a) the development of instruments for the assessment of elderly illiterate Hindi-speaking individuals; and (b) the use of those instruments to carry out an epidemiological study in a population-based cohort of over 5000 persons. Responsibility for data management and quality assurance was shared between the two sites. A cooperative system was instituted for forms and edit development, data entry, checking, transmission, and further checking to ensure that quality data were available for timely analysis. A quality control software program (CHECKS) was written expressly for this project to ensure the highest possible level of data integrity. Conclusions This report addresses issues particularly relevant to data management and quality assurance at developing country sites, and to collaborations between sites in developed and developing countries. Copyright # 2002 John Wiley & Sons, Ltd.

Objective: This study was undertaken to compare the effects of 2 oral contraceptive regimens on menstrual cycle control and laboratory findings. Methods: In a multicenter randomized study 100 μg levonorgestrel with 20 μg ethinyl estradiol (Alesse or Loette) was given to 155 healthy women. A triphasic preparation of 500, 750, and 1000 μg norethindrone with 35 μg ethinyl estradiol (Ortho-Novum 7/7/7 or TriNovum) was given to 167 women for 1 to 4 cycles of treatment. Results: Overall, the percentages of normal menstrual cycles and the percentages of cycles with intermenstrual and withdrawal bleeding were similar between the 2 treatment groups. In the levonorgestrel with ethinyl estradiol group, there was a statistically significantly longer latent period and a statistically significantly shorter withdrawal bleeding episode. Adverse events were similar between treatment groups, and none were serious. Most mean changes from baseline laboratory values were comparable between groups, although the mean increase in cholesterol concentration was statistically significantly lower in the levonorgestrel with ethinyl estradiol group. Changes in triglyceride and glucose concentrations were not statistically significantly different between groups. Conclusions: Levonorgestrel (100 μg) with ethinyl estradiol (20 μg) provides menstrual cycle control equivalent to that obtained with triphasic norethindrone with ethinyl estradiol (75% higher estrogen dose) with similar safety and tolerability. (Am J Obstet Gynecol 1999;181:S45-52.)