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BackgroundAmong countries in sub-Saharan Africa, Zambia has one of the highest incidences of HIV. Adolescent girls and young women (AGYW) are a particularly affected group because of their social and economic vulnerability. ObjectiveThe goal of this study is to test a multilevel package of interventions at the community and health system levels in Zambia in order to connect AGYW with a source of regular care, which will in turn allow for sustainable, successful implementation of regular HIV testing and adherence to antiretroviral treatment. MethodsWe will adapt prior tools to create the SHIELD (Support for HIV Integrated Education, Linkages to Care, and Destigmatization) intervention to educate and empower Zambian AGYW of 10-24 years of age and their families and to create community-based youth clubs to foster peer support. We will also develop integrated wellness care clinics to offer a youth-friendly environment that provides tailored clinical services. We will perform formative research, including focus groups and in-depth interviews, among AGYW, caregivers, and stakeholders to help inform the development and tailoring of the interventions. A cluster-randomized controlled trial will be implemented in Lusaka, with six clinic catchment areas randomized into three groups: zones with integrated wellness care clinics and SHIELD intervention, zones with only SHIELD intervention, and control zones with no intervention. We will assess HIV testing among the HIV-negative or unknown (HIV-/u) cohort, and retention in care along with viral load suppression will be evaluated in the HIV-positive (HIV+) cohort. We will use in-depth interviews and surveys to collect staff and stakeholder feedback after the trial. Cost-effectiveness of the interventions and return-on-investment impacts will be quantified using a microsimulation model. ResultsInterim results are expected in 2021, and the final results are expected in 2022. If this multilevel intervention is successful in establishing a comprehensive care continuum for HIV-affected AGYW, the Zambian Ministry of Health may advocate for expansion to additional settings to support national scale-up. ConclusionsThis integrated service delivery model can also be a platform to implement additional preventive services, so HIV-/u and HIV+ AGYW can receive comprehensive, integrated services. Trial RegistrationClinicalTrials.gov NCT03995953; https://clinicaltrials.gov/ct2/show/NCT03995953 International Registered Report Identifier (IRRID)PRR1-10.2196/15314

As obesity develops, metabolic changes increase the risk of non-communicable diseases such as type 2 diabetes (T2D). Weight loss is crucial for improving health in T2D and cardiometabolic conditions. However, weight loss rates vary between individuals, even with identical diets or energy restrictions, highlighting the need to identify markers or predictors of weight loss success to enhance intervention outcomes. Using nuclear magnetic resonance (NMR) spectroscopy-based metabolomics, we investigated the change in serum polar metabolites in 28 women with overweight or obesity and prediabetes who completed an 8-week low-energy diet (LED) as part of the PREVIEW (PREVention of diabetes through lifestyle intervention and population studies in Europe and around the World) clinical trial. We aimed to characterize the metabolic shift in substrate oxidation under fixed energy intake (~4 MJ/day) and its relation to weight loss success. Nine of the thirty-four serum metabolites identified significantly changed during the LED phase: 3-hydroxybutyrate, O-acetylcarnitine, 2-hydroxybutyrate, mannose, dimethyl sulfone and isobutyrate increased, whilst choline, creatine and tyrosine decreased. These results confirmed a shift towards lipid oxidation, but no metabolites predicted the response to the LED-induced weight loss. Further studies in larger populations are required to validate these metabolites as biomarkers of diet exposure. [ABSTRACT FROM AUTHOR]

Community science bioassessment has great potential to inform comprehensive stream management plans, but regional analytical tools are needed to evaluate macroinvertebrate data collected through community science programs. To this end, we modified a pre-existing professional index of biotic integrity (IBI) to create a community science IBI (CS-IBI), designed for stream macroinvertebrate data collected by community scientists with minimal training. We used data collected by both professional and community scientists to develop, calibrate, and validate the CS-IBI at 76 stream sites in the Puget Lowland and Willamette Valley ecoregions of the Pacific Northwest in the United States. Community science data were taxonomically coarser and more variable than data generated by professionals; however, IBI scores and assemblage data were statistically similar between community science and professional data. Stream impairment categories classified by family-level CS-IBI scores matched genus-level professional classifications 65% of the time and never diverged by >1 category. CS-IBI scores were negatively related to the percentage of agriculture and land development in the watershed, although this relationship was weaker than for professional IBI scores. Despite increased variability in data generated by community scientists, our findings suggest the CS-IBI performs similarly to a professional IBI across a gradient of human influence. Although we do not advocate using the CS-IBI in regulatory settings, we believe the development of community science IBIs enhances, expands, and strengthens public partnerships, thereby supporting environmental managers' efforts to monitor and restore degraded streams and rapidly respond to pollution events. Our hope is that the CS-IBI will improve the applicability of community science bioassessment data and serve as a model for how agencies can develop regionalized macroinvertebrate IBIs for use in comprehensive watershed management plans. [ABSTRACT FROM AUTHOR]

This paper presents the design, implementation and assessment of the Columbia River Basin Environmental Research Project (CERP) curriculum. CERP is an online inquiry-based, regional geographic curriculum designed to improve technology skills and content knowledge about water quality and watershed-level processes. Student attitudes and knowledge gains were assessed over a three-year period in a freshmen level general education inquiry class using pre- and post-surveys and work sample analysis. Results show students gained content knowledge, and Internet research and graphing skills. Our findings suggest that the CERP curriculum is effective in improving student understanding of complex environmental issues.