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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.

In Chromophobia, David Batchelor shows how Western culture is characterised by a fear of the corrupting, contaminating potential of colour, and how the art historical obsession with the containment of colour by line and form is expressive of socio-cultural anxieties about race, gender and sexuality, with colour coded as feminine and primitive, dangerous and alien. Of colour, Barthes writes that it is ‘[…] a kind of bliss […] a closing eyelid, a tiny fainting spell’. This chapter analyses Zama, a film in which colour is used decolonially, to challenge the subjective and corporeal boundaries of colonial white masculinity, and to create an enunciative position for a subaltern voice. Over the course of Zama, ochres and pinks give way to more intense and noticeable greens and reds, with Diego de Zama’s deteriorating mental state – dream, nightmare, fall, undoing – unfolding as a descent into colour, and accompanied by tactile moments of colouring, painting and daubing, instances in which the subordination of colour to the rule of line is overturned, along with the colonial imperative to demarcate and control, and in which narrative and representation give way to abstraction and absorption, the colonial to the Indigenous.

The menopause transition in women is a period of significant bone loss, with rapid declines in bone mineral density (BMD) commencing a year before the final menstrual period (FMP). Changes in menstrual bleeding patterns cannot reliably tell us if this rapid bone loss has begun or is imminent. We hypothesized that low circulating levels of anti-Mullerian hormone (AMH), which decline as women approach the FMP, would be associated with future and ongoing rapid bone loss. We used data from The Study of Women's Health Across the Nation, a multisite, multi-ethnic, prospective cohort study of the menopause transition to test this hypothesis. Adjusted for age, body mass index, race/ethnicity, and study site, every 50% decrement in AMH level in premenopause and early perimenopause was associated with 0.14% per year faster decline over the following 3 to 4 years in lumbar spine BMD and 0.11% per year faster decline in femoral neck BMD (p 0.001 for both). AMH in late perimenopause was not associated with the rate of future BMD decline. AMH was also associated with the magnitude of ongoing bone loss, measured as percent of peak BMD lost by the end of the next 2 to 3 years. Every 50% decrement in AMH level was associated with 0.22% additional loss in spine BMD in premenopause, 0.43% additional loss in early perimenopause, and 0.50% additional loss in late perimenopause (p 0.001 for all three). If a woman will lose more of her peak BMD than the site-specific least significant change (LSC) at either the lumbar spine or femoral neck by the next 2 to 3 years, then AMH below 100 pg/mL will detect it with sensitivity of 50% in premenopause, 80% in early perimenopause, and 98% in late perimenopause. These findings suggest that AMH measurement can help flag women at the brink of significant bone loss for early intervention. © 2022 American Society for Bone and Mineral Research (ASBMR).

BACKGROUND: Atrial fibrillation (AF) is a highly morbid condition which requires long-term adherence to oral anticoagulation and may be associated with adverse quality of life and health care utilization. We developed a relational agent–an interactive smartphone-based intervention accessible regardless of digital or health literacy–to assist individuals residing in rural, Western Pennsylvania, with AF with chronic disease self-management. METHODS: The “Mobile health intervention for rural atrial fibrillation” is a single center, parallel-arm randomized clinical trial for adults with AF funded by the National Institute of Health’s National Heart, Lung, and Blood Institute to enroll 264 participants. All participants receive a smartphone with data plan: The intervention is a 4 month relational agent coupled with the AliveCor Kardia for heart rate and rhythm monitoring provided by smartphone, and the control a pre-installed, smartphone-based application for health-related information (WebMD). The study uses remote recruitment and engagement to enroll individuals who would otherwise be unlikely to participate in clinical research due to rurality. The primary outcome of the trial is adherence to oral anticoagulation, determined by proportion of days covered, as measured at 12 months. The secondary outcomes are quality of life, both AF-specific and general, and health care utilization. The study entails a baseline visit, a 4 month intervention phase, and 8 and 12 month follow-up visits. CONCLUSIONS: This mobile health trial tests the effectiveness of a smartphone-based relational agent to improve clinical and patient-reported outcomes in rural-dwelling individuals.

Background: One can argue that literacy practices work to produce forms of literacy knowledge and literate children in early childhood contexts. However, one needs to interrogate how these literacy practices create technologies of power that construct and normalise the school ready literate child. Aim: The ethnographic study employed in this article explored everyday literacy practices in early childhood contexts that were considered ‘usual’, the kinds of literate children these practices engendered and its normalising effects on children and teachers. Settings: The study was conducted in two early childhood centres with two early childhood teachers and teaching children between the ages of 3 and 4. Methods: The study was qualitative in nature and used participant observation. A genealogical analysis of literacy practices showed how technologies of power were embodied in different literacy practices that worked to construct and normalise the school ready child in different ways. Results: The findings revealed that everyday literacy practices were used to produce a literate child through disciplinary processes of observation, normalisation and examination. These literacy practices operated in covert ways where school readiness was tied to educational success. However, during this process of normalisation, children began to [re]position themselves within the literacy space, showing individual agency and self-regulation. Conclusion: Although the findings of this study are not generalisable, it has implications for how literacy and literacy practices are conceptualised in early childhood settings. This article advocates a reconceptualisation of school readiness by questioning embedded practices within the competence model of school readiness and calls for the early childhood field to dissect incisively what and who are advantaged and disadvantaged through early literacy practices.

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.

This article analyses the performance Un violador en tu camino created by Chilean feminist theatre collective LasTesis, shared by millions and re‐staged across the globe. It explores the relationship between the original piece and theorist Rita Segato's insights on rape culture, and how it counters aspects of this culture. It examines how the transnational spread of ‘Un violador’ counters tendencies of MeToo, and examines four cases of the performance's re‐staging in Latin America and beyond, showing how they make manifest the pervasiveness of rape culture as well as how groups have adapted them to speak to local issues.

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.

Lucrecia Martel (b. 1966) is one of the best-known contemporary Latin American filmmakers. She is an innovative stylist who has gained worldwide recognition for her strange, oneiric, and sensorial feature films, which have won prizes at film festivals around the world. Martel has been seen as part of the wave of aesthetic experimentalism and the shift away from previous forms of filmmaking in Argentina that came to be known in the early 2000s as the “New Argentine Cinema,” and early criticism of her work is often preoccupied with locating it within that trend, which was seen as intrinsically linked with the context of economic crisis in Argentina. Feminist perspectives on Martel’s work were also among the first writings on her, later followed by a number of queer readings of her work. In addition, because of its formal innovations, critics of Martel’s work have also paid sustained attention to aesthetic and cinematographic questions, especially around sound and the extra-visual senses, including touch and the haptic. Martel’s first three features—La ciénaga (2001), La niña santa (2004), and La mujer sin cabeza (2008)—are often referred to as the “Salta Trilogy” and depict the life of the conservative middle classes in the provincial setting of Salta, Northwest Argentina, where Martel grew up. They have been read as critiquing gender, sexual, ethnic, and class power structures, while questions of phenomenology, the body, the senses, and the use of sound have also been to the fore. The more recent Zama (2017) is a departure from the earlier features in a number of respects: it is Martel’s first literary adaptation (of Antonio di Benedetto’s 1956 novel of the same name), the first of her features not to be set in Salta, and the first to have a male protagonist. Set in the colonial era, it is also Martel’s first historical film. However, it shares certain aesthetic and thematic tendencies with the earlier films. In particular, early readings of Zama indicate that it will be read as an exploration of the colonial underpinnings of the racist, classist society examined in the earlier features. In addition, Martel has made a number of short films. Of these, Rey Muerto (1995) and Nueva Argirópolis (2010) have attracted the most critical attention.

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