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BackgroundSouth Africa is home to the world's largest antiretroviral therapy program but sustaining engagement along the HIV care continuum has proven challenging in the country and throughout the wider region. Population mobility is common in South Africa, but there are important research gaps in describing this mobility and its impact on engagement in HIV care. Postpartum women and their infants in South Africa are known to be at high risk of dropping out of HIV care after delivery and are frequently mobile.MethodsIn 2017, we developed a beta version of a smartphone application (app) - CareConekta - that detects a user's smartphone location to allow for prospective characterization of mobility. Now we will adapt and test CareConekta to conduct essential formative work on mobility and evaluate an intervention - the CareConekta app plus text notifications and phone calls and/or WhatsApp messages - to facilitate engagement in HIV care during times of mobility. During the 3-year project period, our first objective is to evaluate the feasibility, acceptability, and initial efficacy of using CareConekta as an intervention to improve engagement in HIV care. Our second objective is to characterize mobility among South African women during the peripartum period and its impact on engagement in HIV care. We will enroll 200 eligible pregnant women living with HIV and receiving care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa.DiscussionThis work will provide critical information about mobility during the peripartum period and the impact on engagement in HIV care. Simultaneously, we will pilot test an intervention to improve engagement with rigorously assessed outcomes. If successful, CareConekta offers tremendous potential as a research and service tool that can be adapted and evaluated in multiple geographic regions, study contexts, and patient populations.Trial registrationClinicalTrials.gov: NCT03836625. Registered on 8 February 2019.

This narrative review aims to provide a clinical perspective on the potential role of co-crystal of tramadol–celecoxib (CTC) in the management of acute moderate-to-severe pain by synthesizing the available preclinical and clinical data, with emphasis on phase 3 trials. A non-systematic literature review was performed using a targeted PubMed search for articles published between January 1, 2000, and May 2, 2023; all publication types were permitted, and selected articles were limited to those published in English. Search results were manually reviewed to identify references based on their preclinical and clinical relevance to CTC and management of acute moderate-to-severe pain. The crystalline structure of CTC alters the physicochemical properties of tramadol and celecoxib, modifying their pharmacokinetics. If taken in a free combination, tramadol reduces absorption of celecoxib. Conversely, administration of CTC slows tramadol absorption and lowers its maximum plasma concentration, while increasing celecoxib plasma concentration through its enhanced release. In clinical studies across models of acute moderate-to-severe pain, CTC demonstrated an early onset of analgesia, with improved efficacy and lower rescue medication use, compared with either agent alone. CTC's safety profile was in line with that expected for the individual components; no additive effects were observed. CTC exhibited tramadol-sparing effects, with efficacy seen at lower daily/cumulative opioid doses vs. tramadol alone. Results from phase 3 trials suggest that the modified physicochemical properties of tramadol and celecoxib in CTC translate into an improved clinical benefit–risk profile, including fewer opioid-related adverse effects due to lower overall opioid dosing. [ABSTRACT FROM AUTHOR]

The Samalayuca Dunes (SMD) (Médanos de Samalayuca), Chihuahua, México, are one of México's largest and least studied dune fields, now managed as a Protected Area for their ecological characteristics. We present a morphometric characterization of the dune field based on remote sensing and field studies, to advance under standing of its physical environment. SMD's generally-fine sands originate from shoreline deposits of Paleolake Palomas, transported eastward (downwind) along an aeolian corridor, accumulating primarily as echo dunes upwind of the sierras of Samalayuca and Presidio. A complex wind regime, with northerly and southerly winds complementing regionally-prevailing southwesterlies, modified by topographic effects, shapes the SMD's morphology. The sand sea covers ~139.7 km2, with ~113.8 km2 in the main eastern body and ~25.9 km2 in a northwester n subfield. We describe six major dune for ms: north to south straight-crested dunes, east to west straight-crested dunes, star dunes, vegetated parabolic dunes, relict transverse dunes, and "megastar" (draa) dunes. Mean interdune centroid spacing is 76.5 m. The active dunes, previously described as an "aklé" pattern, are predominantly straight-crested dune sets oriented near-perpendicular to each other with general north-south and east-west crest orientations, 4-5 m high, spaced ~67 m apart for north-south trending crests and ~53 m for east-west trending crests, representing a nearly perpendicular interference pattern in some locations. The active dunes are superimposed in a compound and complex arrangement on relict remnants of much larger north-northwest trending transverse dune ridges fanning out from south to north-northwest, spaced approximately ~1 km apart and ~50 m high. The easternmost dune ridge contains an active set of at least 15 active megastar and reversing dunes up to 120 m tall, increasing in size and complexity from south to north. As a protected area with historical and ecological value, additional geologic investigations should be performed at the SMD, to help conserve this remarkable geologic feature. [ABSTRACT FROM AUTHOR]

Historical and recent social changes and the roles of women and men in New Zealand are examined. Epidemiological trends and suicide rates are compared cross-nationally. Social and economic changes, Maori cultural perspectives, and the problem of negotiating ethnic identity formation are used to explain high suicide rates. (EMK)

Examines sex differences in suicide-related behaviors in older adolescents and young adults. Males reported more risk-taking, more injury-producing, and more negative health-related behaviors than did females. Females reported more depression symptoms than did males. Hopelessness scores differed among male and female young adults. (MMU)

A randomized trial was conducted to assess the safety of valdecoxib and its intravenous prodrug parecoxib after it involved risk following the coronary-artery bypass grafting (CABG). The use of parecoxib and valdecoxib after CABG was found to be associated with an increased incidence of cardiovascular events aroused serious concern about the use of these drugs in such circumstances.