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Abstract In many cancers, a stem-like cell subpopulation mediates tumor initiation, dissemination and drug resistance. Here, we report that cancer stem cell (CSC) abundance is transcriptionally regulated by C-terminally phosphorylated p27 (p27pT157pT198). Mechanistically, this arises through p27 co-recruitment with STAT3/CBP to gene regulators of CSC self-renewal including MYC, the Notch ligand JAG1, and ANGPTL4. p27pTpT/STAT3 also recruits a SIN3A/HDAC1 complex to co-repress the Pyk2 inhibitor, PTPN12. Pyk2, in turn, activates STAT3, creating a feed-forward loop increasing stem-like properties in vitro and tumor-initiating stem cells in vivo. The p27-activated gene profile is over-represented in STAT3 activated human breast cancers. Furthermore, mammary transgenic expression of phosphomimetic, cyclin-CDK-binding defective p27 (p27CK-DD) increases mammary duct branching morphogenesis, yielding hyperplasia and microinvasive cancers that can metastasize to liver, further supporting a role for p27pTpT in CSC expansion. Thus, p27pTpT interacts with STAT3, driving transcriptional programs governing stem cell expansion or maintenance in normal and cancer tissues.

Summary: Background: Crimean-Congo Haemorrhagic Fever (CCHF) is a viral haemorrhagic fever with a case fatality rate of 5–25% that has been prioritised for research and development by the World Health Organisation. There are no CCHF rapid diagnostic tests (RDTs) commercially available. We describe the development and evaluation of an antigen-targeting lateral flow immunoassay RDT for CCHF. Methods: Prospective clinical samples were collected and tested between July and October 2023 in Türkiye. Retrospective stored samples were obtained from the Central Public Health Laboratory, Baghdad, Iraq. The sensitivity and specificity of the CCHF RDT was compared to reverse transcription quantitative polymerase chain reaction assays. Findings: On prospective clinical samples in Türkiye, the sensitivity and specificity of the CCHF RDT was 90.4% [95% CI 81.5–95.3%] (n = 73) and 96.2% [95% CI 87.0–99.3%] (n = 52), respectively with a sensitivity of 92.9% [95% CI 84.3–96.9%] (n = 70) in samples with a cycle threshold (Ct) ≤30. On retrospective stored samples in Iraq, sensitivity and specificity of the RDT was 71.7% [95% CI 59.2–81.5%] (n = 60) and 92.5% [95% CI 80.1–97.8%] (n = 40), respectively with a sensitivity of 82.2% [95% CI 68.7–90.7%] (n = 45) in samples of Ct ≤30. Interpretation: The CCHF RDT was an effective rapid diagnostic test in this preliminary clinical evaluation, showing this RDT has the potential diagnostic capability for use at the point-of-care. Definitive evaluation is now required to ensure the RDT meets the regulatory requirements for commercialisation. Funding: The Liverpool School of Tropical Medicine, National Institute for Health Research Health Protection Research Unit in Emerging Zoonotic Infections, The Medical Research Council and The Pandemic Institute.

Musical hallucination is a rare perceptual phenomenon wherein individuals hear music in the absence of external auditory stimuli. This phenomenon occurs across diverse medical conditions and can be triggered by some drugs. The underlying mechanism of drug-induced hallucination is unknown. This study explores drug-induced musical hallucination through a literature review, aiming to investigate its pathophysiology and potential treatment modalities. A literature search was conducted until January 2024 using databases PubMed, WorldCat, Google Scholar, and DOAJ, with keywords “drugs induced musical hallucination” or “drugs” combined with “musical hallucination.” The search yielded 24 articles which met inclusion criteria, encompassing 27 cases. The average patient age was 58.3 years, with 67.9% females. Prevalent conditions among cases included hearing impairments, psychiatric disorders, cancers, and neurodegenerative conditions. Common trigger drugs comprised antidepressants, opioids, anti-Parkinson drugs, ketamine, and voriconazole. Musical hallucination descriptions varied widely, and 6 patients reported concurrent visual hallucinations. The onset of symptoms ranged from 75 min to 240 days. Treatment strategies included termination of trigger drugs, dosage reduction, alteration of administration routes or formula, switching to similar drugs, or addition of antidepressants, sedatives, or atypical antipsychotic medications. Musical hallucinations completely disappeared in 24/27 (88.9%) patients but continued in 3/27 (11.1%) patients. The current study concludes that drug-induced musical hallucination may arise from altering neurotransmitter/receptor balance and intricate interactions between trigger drugs and underlying conditions.

Introduction:. Orthopaedic applicants have increased the average number of publications on their residency application to compete with the growing competitiveness of the field. The purpose of this study was to assess whether research productivity before orthopaedic residency and caliber of one's institution is correlated with academic productivity during residency. Methods:. Scopus was used to extract publication metrics. Quantity and quality (how often the publications were cited) were analyzed at 2 different time periods: before and during residency. All subjects in the study had graduated an ACGME-accredited orthopaedic surgery residency in 2021. Military residents, international medical graduates, and residents not listed on their department's website were excluded. Residents were categorized as both high (≥2 publications) or low (

Abstract Tsunamis are a major hazard along many of the world's coastlines. To understand the impact of these events, a sufficiently long record of previous events is needed, which can be provided by their sedimentary deposits. A number of past events have left extensive sedimentary deposits that can be used to understand the hydrodynamics of the tsunami. The ca 8.15 ka Storegga submarine slide was a large, tsunamigenic mass movement off the coast of Norway. The resulting tsunami had estimated run‐up heights of around 10 to 20 m on the Norwegian coast, over 30 m in Shetland and 3 to 6 m on the Scottish mainland coast. New cores were taken from the Ythan Valley in North‐East Scotland, where Storegga tsunami deposits have previously been found. High‐resolution sedimentary analyses of the cores, combined with statistical (changepoint) analysis, shows signatures of multiple waves. Moreover, detailed CT scans of the erosional basal surface reveal sole marks called skim marks. Taken in conjunction with the grain size and sedimentary fabric characteristics of the tsunami deposits, this indicates that the flow exhibited a high‐concentration basal component, with an initial semi‐cohesive phase and that deposition was dominantly capacity driven. A multiple wave hypothesis is tested by creating a high‐resolution numerical model (metre‐scale) of the wave inundation, coupled to a previously published regional model. The inundation model confirms that multiple waves passed over the site in agreement with the sedimentological analysis. The sensitivity of the model to the reconstructed palaeocoastal geomorphology is quantitatively explored. It is concluded that local palaeogeomorphological reconstruction is key to understanding the hydrodynamics of a tsunami wave group in relation to its sedimentary deposit. Combining sedimentological data with high‐resolution inundation modelling is a powerful tool to help interpret the sedimentary record of tsunami events and hence to improve knowledge of their risks.

Background The Society for Cardiovascular Angiography and Interventions proposed a staging system (A–E) to predict prognosis in cardiogenic shock. Herein, we report clinical outcomes of the RECOVER III study for the first time, according to Society for Cardiovascular Angiography and Interventions shock classification. Methods and Results The RECOVER III study is an observational, prospective, multicenter, single‐arm, postapproval study of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support. Patients enrolled in the RECOVER III study were assigned a baseline Society for Cardiovascular Angiography and Interventions shock stage. Staging was then repeated within 24 hours after initiation of Impella. Kaplan‐Meier survival curve analyses were conducted to assess survival across Society for Cardiovascular Angiography and Interventions shock stages at both time points. At baseline assessment, 16.5%, 11.4%, and 72.2% were classified as stage C, D, and E, respectively. At ≤24‐hour assessment, 26.4%, 33.2%, and 40.0% were classified as stage C, D, and E, respectively. Thirty‐day survival among patients with stage C, D, and E shock at baseline was 59.7%, 56.5%, and 42.9%, respectively (P=0.003). Survival among patients with stage C, D, and E shock at ≤24 hours was 65.7%, 52.1%, and 29.5%, respectively (P

Unintended pregnancy at a young age can lead to poor reproductive health, social and economic outcomes. The high rate of unintended teenage pregnancies in Tanzania is indicative of inadequate availability and uptake of modern contraception. Determining trends and determinants of unmet need for modern contraception among adolescent girls and young women (AGYW) in Tanzania will help address the burden of unintended pregnancies. An analytical cross-sectional study design was conducted using secondary data from three consecutive Tanzania Demographic and Health Surveys (TDHS) 2004/05, 2010 and 2015/6 among AGYW in need of modern contraception. Data analysis considered the complex survey design. Poisson regression model was used to determine factors associated with unmet need for modern contraception. We observed a steady decline in unmet need for modern contraception among sexually active AGYW in need of modern contraception from 31.8% in 2004/05 to 27.5% in 2015/16 survey. In the multivariable analysis, higher prevalence of unmet need for modern contraception was observed among adolescents, participants with at least one live birth, from poor wealth tertile, and those sexually active during the past four weeks compared to their counterparts. Despite declining levels, the unmet need for modern contraception among AGYW in Tanzania remains high. AGYW under 19 years, those from poor households, and those who are postpartum are most at risk. Greater efforts in empowering and educating AGYW at risk on their reproductive health rights and needs will further the uptake of modern contraceptive use, reduce the rates of unintended pregnancies, lower the adolescent fertility rate as a result lower unmet need for modern contraception.

The increasing prevalence of advanced maternal age (AMA) births necessitates the exploration of associated pregnancy outcomes within the healthcare-limited context of northern Tanzania to elucidate potential region-specific risks and implications. This study explored the influence of AMA on pregnancy outcomes in northern Tanzania, where healthcare resources and infrastructure are constrained in comparison to developed countries. This cross-sectional hospital-based study utilized maternally linked data from the Kilimanjaro Christian Medical Center (KCMC) Medical Registry and included 32,798 women who delivered single infants between 2004 and 2013. Multiple logistic regression models were used to determine adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for AMA-associated adverse pregnancy outcomes. A total of 16 % of mothers belonged to AMA with increased odds of undergoing a cesarean section (aOR: 1.32; 95%CI [1.24–1.41]; P

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Navicular fractures are uncommon foot fractures and there is scarce literature exploring the complications and radiologic outcomes of these fractures. The aim of this study is to examine fracture patterns and surgical data to see the effect they have on complications and radiographic outcomes after open reduction internal fixation of the navicular. Methods: A retrospective study was performed to identify patients who underwent operative treatment of a navicular fracture over a nine-year period (2013-2022). Patients were screened by review of CPT codes that included tarsal fractures and imaging review was used to identify those with navicular fractures. Minimum follow-up for inclusion was 6 months. Patient demographics were recorded and radiographs were reviewed and fractures were classified per the Sangeorzan and Schmid classification systems. Surgical data including approach(es), implants, and supplemental fixation was recorded. Postoperative radiographs were assessed for the presence of union, avascular necrosis, foot collapse, and arthritis. Complications defined as infection, unanticipated reoperation, and amputation were recorded. Results: 38 patients met inclusion criteria. 8 patients had a postoperative complication (21.1%). There was 1 superficial infection (2.6%) and 7 patients needed unanticipated reoperations: 2 (5.3%) for wound dehiscence, two (5.3%) for secondary arthritis, and 3 for symptomatic hardware removal (7.9%). Radiologic outcomes consisted of 7 cases of TNJ arthritis (18.4%), 6 cases of avascular necrosis (15.8%), and 7 cases of foot collapse (18.4%). There were significantly increased rates of TNJ arthritis in Schmid type III navicular fractures compared to type I and II (7 vs 0 vs 0, respectively; p=0.021), with 35% of Schmid type IIIs going on to develop TNJ arthritis. The need for reoperation of the navicular was increased if patients required a TNJ spanning construct [2 (50%) vs 2 (5.9%), p=0.007]. Conclusion: Navicular fractures that require ORIF have a high complication rate and a likelihood of developing suboptimal radiographic outcomes. We found that patients who dislocate their TNJ (Schmid Type-III), had an increased rate of TNJ arthritis which likely stems from the more severe nature of the injury, the keystone role of the navicular and the instability present across Chopart’s joint. For patients requiring a TNJ spanning construct there was an increased risk for unanticipated reoperation likely due to the size and nature of the spanning construct hardware. Patient education on these risk factors will guide treatment options and set proper expectations.

Abstract Background Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. Methods We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. Discussion Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

This study contributes to research on Quality in Education and examines what possibilities now exist for schools to reinvent and transform using technology-based systems as part of the equation. It is speculated that the pandemic has changed the future of work emphasizing hybrid solutions and networking. The purpose of this article is to present findings from phase two of the qualitative case study to examine what happened to a private school when it went “hybrid on a dime” to maintain attractive quality education.

We previously showed that green tea polyphenols (GTPs) exert antiadipogenic effects on preadipocyte proliferation. Here, we investigated the regulatory effects of GTPs on osteogenesis and adipogenesis during early differentiation of human adipose tissue-derived stem cells (hADSC). Adipogenesis of hADSCs was determined by oil-red-O staining and triglycerides synthesis measurement. Osteoporosis of hADSC was measured using alkaline phosphatase assays and intracellular calcium levels. Immunofluorescence staining and qRT-PCR were used to detect PPARγ-CEBPA regulated adipogenic pathway regulated by PPAR-CEBPA and the osteogenic pathway mediated by RUNX2-BMP2. We found that GTPs treatment significantly decreased lipid accumulation and cellular triglyceride synthesis in mature adipocytes and attenuated pioglitazone-induced adipogenesis in a dose-dependent manner. GTPs downregulated protein and mRNA expression of Pparγ and attenuated pioglitazone-stimulated-Cebpa expression. GTPs treatment significantly enhanced hADSCs differentiation into osteoblasts compared to control and pioglitazone-treated cells. GTPs upregulated RunX2 and Bmp2 proteins and mRNA expression compared to control and significantly attenuated decreased RunX2 and Bmp2 mRNA expression by pioglitazone. In conclusion, our data demonstrates GTPs possesses great ability to facilitate osteogenesis and simultaneously inhibits hADSC differentiation into adipogenic lineage by upregulating the RUNX2-BMP2 mediated osteogenic pathway and suppressing PPARγ-induced signaling of adipogenesis. These findings highlight GTPs’ potential to combat osteoporosis associated with obesity.

Abstract Zoster vaccines generate antibody responses against varicella-zoster virus (VZV). We compared antibody-dependent cell cytotoxicity (ADCC) elicited by zoster vaccine live (ZVL) and recombinant zoster vaccine (RZV). ADCC mediated by antibodies against VZV lysate (VZV-ADCC) and recombinant glycoprotein E (gE-ADCC) was measured using plasma from 20 RZV- and 20 ZVL-recipients, including half 50–60-years-old and half ≥70-years-old. Solid phase-bound anti-VZV antibodies stimulated TNFα in NK cells as measured by flow cytometry or ELISA. VZV-ADCC pre- and post-immunization was higher in younger vaccinees. ZVL did not appreciably increase VZV-ADCC, whereas RZV increased VZV-ADCC in older vaccinees. ELISA-measured gE-ADCC was similar across groups pre-immunization; significantly increased after ZVL; and RZV and was higher in younger RZV than ZVL recipients. IgG3 antibodies increased after RZV and ZVL, with greater anti-gE than anti-VZV responses. Moreover, gE-ADCC strongly correlated with anti-gE antibody avidity, but there were no appreciable correlations between VZV-ADCC and avidity. NK cells stimulated by anti-gE antibodies showed increased IFNγ and CD107a expression, which was not observed with anti-VZV antibodies. In conclusion, anti-gE antibodies generated more robust ADCC than anti-VZV antibodies. RZV induced higher ADCC antibodies than ZVL depending on the antigen and age of vaccinees. Older adults had lower ADCC antibodies before and after vaccination than younger adults.

Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the main trial was to report the effects of the intervention on infant birth weight. Here we evaluate the effects of a LPG stove and fuel intervention during pregnancy on spontaneous abortion, postpartum hemorrhage, hypertensive disorders of pregnancy, and maternal mortality compared to women who continued to use solid cooking fuels. Pregnant women (18–34 years of age; gestation confirmed by ultrasound at 9–19 weeks) were randomly assigned to an intervention (n = 1593) or control (n = 1607) arm. Intention-to-treat analyses compared outcomes between the two arms using log-binomial models. Among the 3195 pregnant women in the study, there were 10 spontaneous abortions (7 intervention, 3 control), 93 hypertensive disorders of pregnancy (47 intervention, 46 control), 11 post postpartum hemorrhage (5 intervention, 6 control) and 4 maternal deaths (3 intervention, 1 control). Compared to the control arm, the relative risk of spontaneous abortion among women randomized to the intervention was 2.32 (95% confidence interval (CI): 0.60, 8.96), hypertensive disorders of pregnancy 1.02 (95% CI: 0.68, 1.52), postpartum hemorrhage 0.83 (95% CI: 0.25, 2.71) and 2.98 (95% CI: 0.31, 28.66) for maternal mortality. In this study, we found that adverse maternal outcomes did not differ based on randomized stove type across four country research sites.

Introduction Breast cancer is increasing in sub-Saharan Africa (SSA), and most women are diagnosed at a late stage. This leads to increased suffering for the patients and challenging care situations for nurses. Limited resources in healthcare, lack of oncology training, and low health literacy in society result in even more demanding situations for nurses. Objective The objective was to explore nurses’ experiences of caring women for with breast cancer in Tanzania. Methods The study employed a descriptive qualitative design. Fifteen nurses, working in oncology units in three major hospitals in Tanzania were interviewed using a semistructured interview guide. The participants had a minimum of 6 months experience of caring for breast cancer patients. Purposive sampling was used. Data were analyzed by qualitative content analysis. Results Two main themes emerged: Challenges in caring for breast cancer patients and Nurses’ psychological distress . The late diagnosis was very challenging for the nurses. Low health literacy regarding breast cancer disease and treatment, patients’ financial difficulties, minimal oncology nursing education, and technology in healthcare systems were also major challenges. The nurses experienced psychological distress, lost hope, and faced ethical dilemmas while providing cancer care. Conclusion The findings of this study conclude that nurses face emotional distress and ethical dilemmas while caring for patients with breast cancer. Late diagnosis, lack of infrastructure and resources, and low health literacy among patients, family, and healthcare providers have a great impact on the stress that the nurses experience.

BackgroundDigital peer support enhances engagement in mental and physical health services despite barriers such as location, transportation, and other accessibility constraints. Digital peer support involves live or automated peer support services delivered through technology media such as peer-to-peer networks, smartphone apps, and asynchronous and synchronous technologies. Supervision standards for digital peer support can determine important administrative, educative, and supportive guidelines for supervisors to maintain the practice of competent digital peer support, develop knowledgeable and skilled digital peer support specialists, clarify the role and responsibility of digital peer support specialists, and support specialists in both an emotional and developmental capacity. ObjectiveAlthough digital peer support has expanded recently, there are no formal digital supervision standards. The aim of this study is to inform the development of supervision standards for digital peer support and introduce guidelines that supervisors can use to support, guide, and develop competencies in digital peer support specialists. MethodsPeer support specialists that currently offer digital peer support services were recruited via an international email listserv of 1500 peer support specialists. Four 1-hour focus groups, with a total of 59 participants, took place in October 2020. Researchers used Rapid and Rigorous Qualitative Data Analysis methods. Researchers presented data transcripts to focus group participants for feedback and to determine if the researcher’s interpretation of the data match their intended meanings. ResultsWe identified 51 codes and 11 themes related to the development of supervision standards for digital peer support. Themes included (1) education on technology competency (43/197, 21.8%), (2) education on privacy, security, and confidentiality in digital devices and platforms (33/197, 16.8%), (3) education on peer support competencies and how they relate to digital peer support (25/197, 12.7%), (4) administrative guidelines (21/197, 10.7%), (5) education on the digital delivery of peer support (18/197, 9.1%), (6) education on technology access (17/197, 8.6%), (7) supervisor support of work-life balance (17/197, 8.6%), (8) emotional support (9/197, 4.6%), (9) administrative documentation (6/197, 3%), (10) education on suicide and crisis intervention (5/197, 2.5%), and (11) feedback (3/197, 1.5%). ConclusionsCurrently, supervision standards from the Substance Abuse and Mental Health Services Administration (SAMHSA) for in-person peer support include administrative, educative, and supportive functions. However, digital peer support has necessitated supervision standard subthemes such as education on technology and privacy, support of work-life balance, and emotional support. Lack of digital supervision standards may lead to a breach in ethics and confidentiality, workforce stress, loss of productivity, loss of boundaries, and ineffectively serving users who participate in digital peer support services. Digital peer support specialists require specific knowledge and skills to communicate with service users and deliver peer support effectively, while supervisors require new knowledge and skills to effectively develop, support, and manage the digital peer support role.

Abstract Background Caesarean delivery (CD) is the commonest obstetric surgery and surgical intervention to save lives of the mother and/or the new-borns. Despite been accepted as safe procedure, caesarean delivery has an increased risk of adverse maternal and fetal outcomes. The rising rate of caesarean delivery has been a major public health concern worldwide and the consequences that come along with it urgently need to be assessed, especially in resource limited settings. We aimed to examine the relationship between first birth caesarean delivery and adverse maternal and perinatal outcomes in the second pregnancy among women who delivered at a tertiary hospital in Northern Tanzania. Methods A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre. All women who had singleton second delivery between the years 2011 to 2015 were studied. A total of 5,984 women with singleton second delivery were analysed. Multivariable log-binomial regression was used to determine the association between first caesarean delivery and maternal-perinatal outcomes in the second pregnancy. Results Caesarean delivery in the first birth was associated with an increased risk of adverse maternal and perinatal outcomes in the second pregnancy. These included repeated CD (ARR 1.19; 95% CI: 1.05–1.34), pre/eclampsia (ARR 1.38; 95% CI: 1.06–1.78), gestational diabetes mellitus (ARR 2.80; 95% CI: 1.07–7.36), uterine rupture (ARR 1.56; CI: 1.05–2.32), peri-partum hysterectomy (ARR 2.28; CI: 1.04–5.02) and preterm birth (ARR 1.21; CI: 1.05–1.38). Conclusion Caesarean delivery in their first pregnancy had an increased risk of repeated caesarean delivery and other adverse maternal-perinatal outcomes in the following pregnancy. Findings from this study highlight the importance of devising regional specific measures to mitigate unnecessary primary caesarean delivery. Additionally, these findings may help both clinicians and women in deciding against or for trial of labor after previous caesarean delivery in an event of absent direct obstetric indication.

Abstract Background Prediction of low Apgar score for vaginal deliveries following labor induction intervention is critical for improving neonatal health outcomes. We set out to investigate important attributes and train popular machine learning (ML) algorithms to correctly classify neonates with a low Apgar scores from an imbalanced learning perspective. Methods We analyzed 7716 induced vaginal deliveries from the electronic birth registry of the Kilimanjaro Christian Medical Centre (KCMC). 733 (9.5%) of which constituted of low (

IntroductionMaternal HIV infection is associated with increased risk of having a preterm delivery, low birth weight baby, small for gestational age baby and stillbirth. Maternal use of combination antiretroviral treatment is also associated with preterm delivery and low birth weight, although the effects vary by the type of drugs and timing of initiation.ObjectiveTo examine time trends in adverse perinatal outcomes among HIV-positive compared with HIV-negative women.DesignRegistry-based cohort study.SettingNorthern Tanzania, 2000-2018.Study sampleMother-baby pairs of singleton deliveries (n = 41 156).MethodsPerinatal outcomes of HIV-positive women were compared with HIV-negative women during time periods representing shifts in prevention of mother-to-child transmission guidelines. Monotherapy was used as first-line therapy before 2007 while combination antiretroviral treatment was routinely used from 2007. Log binomial and quantile regression were used to analyze the data.Main outcome measuresPreterm delivery, low birth weight, perinatal death, stillbirth, low Apgar score, transfer to neonatal care unit and small for gestational age.ResultsOverall, maternal HIV infection was associated with a higher risk of low birth weight and small for gestational age. Moreover, this pattern became more pronounced over time for low birth weight, the last time period being an exception. For other outcomes we found none or only a small overall association with maternal HIV infection, although a trend towards higher risk over time in HIV-positive compared with HIV-negative women was observed for preterm delivery and perinatal death. Quantile regression showed an increase in birth weight in babies born to HIV-negative women over time and a corresponding decline in birth weight in babies born to HIV-positive women.ConclusionUnfavourable trends in some of the selected perinatal outcomes were seen for HIV-positive compared with HIV-negative women. Potential side-effects of combination antiretroviral treatment in pregnancy should be further explored.

BackgroundPost-term pregnancy is a health problem of clinical importance and; tends to recur in subsequent pregnancies. Maternal age, height, and male fetal sex are risk factors associated with Post-term pregnancy. The study aimed to determine the recurrence risk of post-term pregnancy and associated factors among women delivered at KCMC referral hospital.MethodologyThis retrospective cohort study used KCMC zonal referral hospital medical birth registry cohort data for 43472 women delivered between 2000 and 2018. Data were analyzed using STATA version 15 software. Log-binomial regression with robust variance estimator determined the factors associated recurrence of post-term pregnancy adjusted for other factors.ResultsA total of 43472 women were analyzed. The proportion of post-term pregnancy was 11.4%, and the recurrence was 14.8%. The recurrence risk of post-term pregnancy was increased when a woman had a history of previous post-term pregnancy (aRR: 1.75; 95%CI: 1.44, 2.11). Advanced maternal age, i.e., ≥35years (aRR: 0.80; 95%CI: 0.65, 0.99), having secondary and higher education (aRR: 0.8; 95%CI: 0.66, 0.97), and being employed (aRR: 0.68; 95%CI: 0.55, 0.84) decreased the recurrence risk of post-term pregnancy. Women with recurrence of post-term pregnancy had a higher risk of delivering newborns weighed ≥4000gm (aRR: 5.05; 95% CI: 2.80, 9.09).ConclusionPost-term pregnancy is associated with recurrence risk in subsequent pregnancies. A history of previous post-term pregnancy is associated risk factor and these women are at increased risk of delivering newborns weighed ≥4000gm. Clinical counselling of women at risk of post-term pregnancy and timely management is recommended to prevent adverse neonatal and maternal outcomes.

Drug repurposing can overcome both substantial costs and the lengthy process of new drug discovery and development in cancer treatment. Some Food and Drug Administration (FDA)-approved drugs have been found to have the potential to be repurposed as anti-cancer drugs. However, the progress is slow due to only a handful of strategies employed to identify drugs with repurposing potential. In this study, we evaluated GPCR-targeting drugs by high throughput screening (HTS) for their repurposing potential in triple-negative breast cancer (TNBC) and drug-resistant human epidermal growth factor receptor-2-positive (HER2+) breast cancer (BC), due to the dire need to discover novel targets and drugs in these subtypes. We assessed the efficacy and potency of drugs/compounds targeting different GPCRs for the growth rate inhibition in the following models: two TNBC cell lines (MDA-MB-231 and MDA-MB-468) and two HER2+ BC cell lines (BT474 and SKBR3), sensitive or resistant to lapatinib + trastuzumab, an effective combination of HER2-targeting therapies. We identified six drugs/compounds as potential hits, of which 4 were FDA-approved drugs. We focused on β-adrenergic receptor-targeting nebivolol as a candidate, primarily because of the potential role of these receptors in BC and its excellent long-term safety profile. The effects of nebivolol were validated in an independent assay in all the cell line models. The effects of nebivolol were independent of its activation of β3 receptors and nitric oxide production. Nebivolol reduced invasion and migration potentials which also suggests its inhibitory role in metastasis. Analysis of the Surveillance, Epidemiology and End Results (SEER)-Medicare dataset found numerically but not statistically significant reduced risk of all-cause mortality in the nebivolol group. In-depth future analyses, including detailed in vivo studies and real-world data analysis with more patients, are needed to further investigate the potential of nebivolol as a repurposed therapy for BC.

Objective: To describe a novel EEG rhythm, temporal intermittent rhythmic theta activity (TIRTA), and its potential association with epilepsy. Methods: We report TIRTA on scalp EEG in a series of 12 patients, all of whom were found to have epilepsy. The clinical and electroencephalographic characteristics of each patient were reviewed. In addition, features that may distinguish TIRTA from benign EEG patterns, including rhythmic temporal theta bursts of drowsiness (RTTBD), were identified. Results: TIRTA was unilateral in all cases. For all patients, TIRTA was seen in the awake and drowsy states. Eight patients also had TIRTA observed during N2 sleep. The average frequency of TIRTA was 5.5 Hz and the average duration of a train of TIRTA was 5.25 s. In seven cases the morphology was notched in appearance. Temporal intermittent rhythmic delta activity (TIRDA) was seen in seven patients on the same side as TIRTA. Eleven patients also had ipsilateral temporal sharp waves. Abnormal MRI (6/12) and or PET (5/5) findings were ipsilateral to TIRTA. Conclusions: In this preliminary report we suggest that TIRTA may be a novel marker of potential epileptogenicity, possibly representing a higher frequency variant of TIRDA.

Abstract Background Women’s empowerment is a multidimensional construct which varies by context. These variations make it challenging to have a concrete definition that can be measured quantitatively. Having a standard composite measure of empowerment at the individual and country level would help to assess how countries are progressing in efforts to achieve gender equality (SDG 5), enable standardization across and within settings and guide the formulation of policies and interventions. The aim of this study was to develop a women’s empowerment index for Tanzania and to assess its evolution across three demographic and health surveys from 2004 to 2016. Results Women’s empowerment in Tanzania was categorized into six distinct domains namely; attitudes towards violence, decision making, social independence, age at critical life events, access to healthcare, and property ownership. The internal reliability of this six-domain model was shown to be acceptable by a Cronbach’s α value of 0.658. The fit statistics of the root mean squared error of approximation (0.05), the comparative fit index (0.93), and the standardized root mean squared residual (0.04) indicated good internal validity. The structure of women’s empowerment was observed to have remained relatively constant across three Tanzanian demographic and health surveys. Conclusions The use of factor analysis in this research has shown that women’s empowerment in Tanzania is a six-domain construct that has remained relatively constant over the past ten years. This could be a stepping stone to reducing ambiguity in conceptualizing and operationalizing empowerment and expanding its applications in empirical research to study different women related outcomes in Tanzania.

BackgroundWhile the benefits of exclusive breastfeeding are widely acknowledged, it continues to be a rare practice. Determinants of exclusive breastfeeding in Tanzania have been studied; however, the existence and contribution of regional variability to the practice have not been explored.MethodsTanzania demographic and health survey data for 2015/2016 were used. Information on infants aged up to 6 months was abstracted. Exclusive breastfeeding was defined using a recall of feeding practices in the past 24 h. Enumeration areas and regions were treated as random effects. Models without random effects were compared with those that incorporated random effects using the Akaike information criterion. The determinants of exclusive breastfeeding were estimated using the generalized linear mixed model with enumeration areas nested within the region.ResultsThe generalized linear mixed model with an enumeration area nested within a region performed better than other models. The intra-cluster variability at region and enumeration area levels was 3.7 and 24.5%, respectively. The odds of practicing exclusive breastfeeding were lower for older and male infants, for mothers younger than 18, among mothers residing in urban areas, among those who were employed by a family member or someone else, those not assisted by a nurse/midwife, and those who were not counseled on exclusive breastfeeding within 2 days post-delivery. There was no statistical evidence of an association between exclusive breastfeeding practices and the frequency of listening to the radio and watching television. When mapping the proportion of exclusive breastfeeding, a variability of the practice is seen across regions.ConclusionThere is room to improve the proportion of those who practice exclusive breastfeeding in Tanzania. Beyond individual and setting factors, this analysis shows that a quarter of the variability in exclusive breastfeeding practices is at the community level. Further studies may explore the causes of variabilities in regional and enumeration area and how it operates. Interventions to protect, promote, and support exclusive breastfeeding in Tanzania may target the environment that shapes the attitude toward exclusive breastfeeding in smaller geographical areas.

As an essential part of solid-state lithium-ion batteries, solid electrolytes are receiving increasing interest. Among all solid electrolytes, garnet-type Li7La3Zr2O12 (LLZO) has proven to be one of the most promising electrolytes because of its high ionic conductivity at room temperature, low activation energy, good chemical and electrochemical stability, and wide potential window. Since the first report of LLZO, extensive research has been done in both experimental investigations and theoretical simulations aiming to improve its performance and make LLZO a feasible solid electrolyte. These include developing different methods for the synthesis of LLZO, using different crucibles and different sintering temperatures to stabilize the crystal structure, and adopting different methods of cation doping to achieve more stable LLZO with a higher ionic conductivity and lower activation energy. It also includes intensive efforts made to reveal the mechanism of Li ion movement and understand its determination of the ionic conductivity of the material through molecular dynamic simulations. Nonetheless, more insightful study is expected in order to obtain LLZO with a higher ionic conductivity at room temperature and further improve chemical and electrochemical stability, while optimal multiple doping is thought to be a feasible and promising route. This review summarizes recent progress in the investigations of crystal structure and preparation of LLZO, and the impacts of doping on the lithium ionic conductivity of LLZO.

Background: During the COVID-19 pandemic, restricted access to in-person facilities and traditional experiential learning activities meant that new, online solutions were needed to facilitate student learning/development across the disciplines of Allied Health and Engineering. Purpose: This article describes research conducted as part of an interdisciplinary Dietetic/Electronic Engineering project to evaluate student experiences of online problem-based learning (PBL) activities in addressing this necessity. Methodology/Approach: The authors implemented a specific, health technology-based assignment using an online PBL approach to evaluate and develop the effectiveness of this approach for students' experiential learning. Surveys and observations were used to evaluate the project effectiveness. Findings/Conclusions: Participating students reported on their experiences of working in interdisciplinary teams, focusing on aspects such as knowledge gained, collaboration, perspective, facilitation and experiential learning. Students identified enhanced learning and research skills as some key benefits. Drawbacks identified included difficulties associated with the online environment, such as synchronisation and remoteness. Implications: The use of interdisciplinary assignments highlights the many advantages/benefits which experiential pedagogies have in supporting students to integrate and apply their knowledge to a real-world problem space. The ability to connect student engagement and motivation to the development of critical thinking skills appears to enhance problem-solving in the student work.

Abstract Since the arrival of the Coronavirus in the United States, Americans have been forced to quarantine themselves at home in dramatic fashion, unlike almost any other time in the nation’s history. Moreover, the American workforce has been equally impacted by virtue of state-imposed shutdowns that have affected innumerable businesses, including the Hollywood entertainment industry, which is the subject of this research. I examine how commercial entertainment conglomerates like AT&T, Comcast, Disney, ViacomCBS, and Fox have responded to mandatory closures for businesses that employ a human workforce upon whom they rely for their labor, and to human consumers they seek to distribute their film and television commodities to for profit. Using historical and discourse analyses in a political economic theoretical framework, I review contemporary reports about the economic conditions which have influenced the industry’s technological adaptation and innovation and argue that the Hollywood television and film industries will capitalize upon this current public health crisis as a motivator to adopt streaming platforms as the new preferred distribution mechanism of entertainment long after COVID 19 is a memory. This qualitative research examines the technological adaptations employed by these entertainment conglomerates to analyze (1) how the transition to streaming video on demand has occurred, and evaluates (2) what the adoption of these survival strategies mean for Hollywood’s long-term economic future and survival in a “digitally competitive” (Smith and Telang, 2017) marketplace.

We investigated the dynamics of seroconversion in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. During March 29–May 22, 2020, we collected serum samples and associated clinical data from 177 persons in London, UK, who had SARS-CoV-2 infection. We measured IgG against SARS-CoV-2 and compared antibody levels with patient outcomes, demographic information, and laboratory characteristics. We found that 2.0%–8.5% of persons did not seroconvert 3–6 weeks after infection. Persons who seroconverted were older, were more likely to have concurrent conditions, and had higher levels of inflammatory markers. Non-White persons had higher antibody concentrations than those who identified as White; these concentrations did not decline during follow-up. Serologic assay results correlated with disease outcome, race, and other risk factors for severe SARS-CoV-2 infection. Serologic assays can be used in surveillance to clarify the duration and protective nature of humoral responses to SARS-CoV-2 infection.

Abstract Background Globally, approximately half of all pregnancies occur before 24 months after child birth. In Sub Saharan Africa the unmet need for family planning is highest among postpartum women. There is a dearth of information regarding factors associated with postpartum use of long acting reversible contraception (LARC) in Tanzania particularly in the Lake zone. This study aimed to determine the prevalence and factors associated with postpartum use of LARC (

Introduction Health inequities are defined as unfair and avoidable differences in health between groups within a population. Most health research is conducted through observational studies, which are able to offer real-world insights about etiology, healthcare policy/programme effectiveness and the impacts of socioeconomic factors. However, most published reports of observational studies do not address how their findings relate to health equity. Our team seeks to develop equity-relevant reporting guidance as an extension of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. This scoping review will inform the development of candidate items for the STROBE-Equity extension. We will operationalise equity-seeking populations using the PROGRESS-Plus framework of sociodemographic factors. As part of a parallel stream of the STROBE-Equity project, the relevance of candidate guideline items to Indigenous research will be led by Indigenous coinvestigators on the team.Methods and analysis We will follow the Joanna Briggs Institute method for conducting scoping reviews. We will evaluate the extent to which the identified guidance supports or refutes our preliminary candidate items for reporting equity in observational studies. These candidate items were developed based on items from equity-reporting guidelines for randomised trials and systematic reviews, developed by members of this team. We will consult with our knowledge users, patients/public partners and Indigenous research steering committee to invite suggestions for relevant guidance documents and interpretation of findings. If the identified guidance suggests the need for additional candidate items, they will be developed through inductive thematic analysis.Ethics and dissemination We will follow a principled approach that promotes ethical codevelopment with our community partners, based on principles of cultural safety, authentic partnerships, addressing colonial structures in knowledge production and the shared ownership, interpretation, and dissemination of research. All products of this research will be published as open access.

Abstract Background The Household Air Pollution Intervention Network (HAPIN) trial aims to assess health benefits of a liquefied petroleum gas (LPG) cookfuel and stove intervention among women and children across four low- and middle-income countries (LMICs). We measured exposure contrasts for women, achievable under alternative conditions of biomass or LPG cookfuel use, at potential HAPIN field sites in India, to aid in site selection for the main trial. Methods We recruited participants from potential field sites within Villupuram and Nagapattinam districts in Tamil Nadu, India, that were identified during a feasibility assessment. We performed. (i) cross-sectional measurements on women (N = 79) using either biomass or LPG as their primary cookfuel and (ii) before-and-after measurements on pregnant women (N = 41), once at baseline while using biomass fuel and twice – at 1 and 2 months – after installation of an LPG stove and free fuel intervention. We involved participants to co-design clothing and instrument stands for personal and area sampling. We measured 24 or 48-h personal exposures and kitchen and ambient concentrations of fine particulate matter (PM2.5) using gravimetric samplers. Results In the cross-sectional analysis, median (interquartile range, IQR) kitchen PM2.5 concentrations in biomass and LPG using homes were 134 μg/m3 [IQR:71–258] and 27 μg/m3 [IQR:20–47], while corresponding personal exposures were 75 μg/m3 [IQR:55–104] and 36 μg/m3 [IQR:26–46], respectively. In before-and-after analysis, median 48-h personal exposures for pregnant women were 72 μg/m3 [IQR:49–127] at baseline and 25 μg/m3 [IQR:18–35] after the LPG intervention, with a sustained reduction of 93% in mean kitchen PM2.5 concentrations and 78% in mean personal PM2.5 exposures over the 2 month intervention period. Median ambient concentrations were 23 μg/m3 [IQR:19–27). Participant feedback was critical in designing clothing and instrument stands that ensured high compliance. Conclusions An LPG stove and fuel intervention in the candidate HAPIN trial field sites in India was deemed suitable for achieving health-relevant exposure reductions. Ambient concentrations indicated limited contributions from other sources. Study results provide critical inputs for the HAPIN trial site selection in India, while also contributing new information on HAP exposures in relation to LPG interventions and among pregnant women in LMICs. Trial registration ClinicalTrials.Gov. NCT02944682 ; Prospectively registered on October 17, 2016.

Over the past years there have been many revelations that have made it clear autonomous technology will become increasingly prevalent in our communities. Despite optimism about the technology there is a high degree of uncertainty about how they will be deployed in urban environs, particularly with regard to street design. Based on the concepts of autonomy, livability and human scale design, this paper provides a dialogue of possible opportunities for street design in an autonomous future. This paper develops a framework for best practice, identifying policies including roadway design/thinning, curbside policy, and parking removal.

BackgroundAs digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. ObjectiveThe goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. MethodsPeer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. ResultsAnalysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. ConclusionsThe introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Images of supermassive black holes produced using very long baseline interferometry provide a pathway to directly observing effects of a highly curved spacetime, such as a bright “photon ring” that arises from strongly lensed emission. In addition, the emission near supermassive black holes is highly variable, with bright high-energy flares regularly observed. We demonstrate that intrinsic variability can introduce prominent associated changes in the relative brightness of the photon ring. We analyze both semianalytic toy models and GRMHD simulations with magnetic flux eruption events, showing that they each exhibit a characteristic “loop” in the space of relative photon ring brightness versus total flux density. For black holes viewed at high inclination, the relative photon ring brightness can change by an order of magnitude, even with variations in total flux density that are comparatively mild. We show that gravitational lensing, Doppler boosting, and magnetic field structure all significantly affect this feature, and we discuss the prospects for observing it in observations of M87∗ and Sgr A∗ with the next-generation Event Horizon Telescope.

Background We aimed to understand the characteristics and outcomes of patients readmitted with a recurrent myocardial infarction (RMI) within 90 days of discharge after an acute myocardial infarction (early RMI). Methods and Results We analyzed the timing of reinfarction, etiology, and outcome for all patients admitted with an early RMI within 90 days of discharge after an acute myocardial infarction between January 1, 2010 and January 1, 2017. We identified 6626 admissions for acute myocardial infarction (index myocardial infarction) which led to 168 cases of RMI within 90 days of discharge. The mean patient age was 65.1±13.1 years, and 37% were women. The 90‐day probability of readmission with an early RMI was 2.5%. Black race, medical management, higher troponin T, and shorter length of stay were independent predictors of early RMI. Medically managed group had a higher risk for early RMI compared with percutaneous coronary intervention (P=0.04) or coronary artery bypass grafting (P=0.2). Predominant mechanisms for reinfarction were stent thrombosis (17%), disease progression (12%), and unchanged coronary artery disease (11%). At 5 years, the all‐cause mortality rate for patients with an early RMI was 49% (95% CI, 40%–57%) compared with 22% (95% CI, 21%–23%) for patients without an early RMI (P

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor’s residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation.

We measured 24-hour average personal exposure to fine particulate matter (PM2.5) among rural Honduran women using a lightweight, gravimetric monitor – the Ultrasonic Personal Aerosol Sampler (UPAS). Performance of the UPAS was compared with a commonly used gravimetric pump, cyclone, and filter sampling system. We observed strong agreement and correlation (Spearman ρ = 0.91; PM2.5 concentration range: 19–120 μg/m3) between 43 paired measures, supporting the use of the UPAS as a personal exposure monitor for household air pollution studies. Keywords: Household air pollution, Honduras, Personal exposure, Ultrasonic Personal Aerosol Sampler (UPAS), Gravimetric analysis

On 30 June 2020, young scholars presented & discussed their work in a virtual forum, as a special session organized by The 15th International Conference on Waste Management and Technology (June 28–30), 2020 Beijing China. The forum convened researchers and attendees approaching innovative aspects of waste management from a variety of perspectives and disciplines. While their presentations spanned topics as broad as the stakeholder coordination and as specific technological approach for rapid carbonization of agricultural waste, several conceptual threads could be traced across them.

The increase in health research in sub-Saharan Africa (SSA) has led to a high demand for biostatisticians to develop study designs, contribute and apply statistical methods in data analyses. Initiatives exist to address the dearth in statistical capacity and lack of local biostatisticians in SSA health projects. The Sub-Saharan African Consortium for Advanced Biostatistics (SSACAB) led by African institutions was initiated to improve biostatistical capacity according to the needs identified by African institutions, through collaborative masters and doctoral training in biostatistics. SACCAB has created a critical mass of biostatisticians and a network of institutions over the last five years and has strengthened biostatistics resources and capacity for health research studies in SSA. SSACAB comprises 11 universities and four research institutions which are supported by four European universities. In 2015, only four universities had established Masters programmes in biostatistics and SSACAB supported the remaining seven to develop Masters programmes. In 2019 the University of the Witwatersrand became the first African institution to gain Royal Statistical Society accreditation for a Biostatistics Masters programme. A total of 150 fellows have been awarded scholarships to date of which 123 are Masters fellowships (41 female) of whom 58 have already graduated. Graduates have been employed in African academic (19) and research (15) institutions and 10 have enrolled for PhD studies. A total of 27 (10 female) PhD fellowships have been awarded; 4 of them are due to graduate by 2020. To date, SSACAB Masters and PhD students have published 17 and 31 peer-reviewed articles, respectively. SSACAB has also facilitated well-attended conferences, face-to-face and online short courses. Pooling of limited biostatistics resources in SSA combined with co-funding from external partners has shown to be an effective strategy for the development and teaching of advanced biostatistics methods, supervision and mentoring of PhD candidates.

Lack of attendance to cervical cancer screening (CCS) services is the most attributable factor to the development of cervical cancer. Transgender men, individuals whose gender identity does match with their natal female sex, use CCS less often than the general female population. The underlying reasons for deficient CCS among transgender men relate mostly to their stigmatized identity, such as discrimination and unwelcoming healthcare environments. However, additional research is needed to expand our understanding of this complex issue. This exploratory qualitative research study aimed to identify the determinants of CCS from the perspective of transgender men. Twenty transgender men ages 21–65 were conveniently sampled to participate in a semi-structured interview in 2018. The data were analyzed using a deductive-inductive content analysis approach and the results were sorted into a socioecological framework (SEM). The participants were mostly non-Hispanic and white. The mean age was 33, and 55% of the sample had attended CCS in the last three years. Eight overarching factors were identified in the data. Each factor included descriptive sub-factors. At the institutional and interpersonal SEM levels, factors related to healthcare providers and healthcare organizations. At the individual level, factors related to past negative experiences, gender identity development, and socioeconomic status. To the investigators’ knowledge, this is the first study to report the relationship between gender identity development and CCS behaviors. Gender identity development refers to the transition or coming-out process and gender dysphoria. This suggests that attendance to CCS services change as a transgender person’s identity evolves. Keywords: Cervical neoplasm, Cancer screening, Transgender persons, Gender identity, Qualitative research

Inter-pregnancy interval is an important determinant of both maternal and child health. Suboptimal inter-pregnancy interval has been associated with adverse maternal outcomes -including postpartum hemorrhage and hypertensive disorders, direct causes of maternal mortality. Both overall maternal mortality and the contribution of postpartum hemorrhage on maternal mortality have increased in Tanzania. If we are to achieve sustainable development goal (SDG) number 3.1 to reduce the global maternal mortality ration to less than 70 per 100,000 live births by 2030, it is highly important that such contributors are dealt with. This study aimed to determine the distribution and trends of inter-pregnancy interval and to deduce its association with adverse maternal outcomes among women who delivered at Kilimanjaro Christian Medical Centre (2000-2015).A retrospective cohort study was designed using Kilimanjaro Christian Medical Centre medical birth registry data for women who delivered from 2000 to 2015. Women with at least two births recorded in the registry were included. A total of 7,995 births from 6,612 mothers were analyzed. Anemia during pregnancy, post-partum hemorrhage and pre-eclampsia were adverse maternal outcomes of interest. Data analysis was performed using multivariable logistic regression models allowing for robust standard errors. Crude and adjusted odds ratio with their respective 95% confidence intervals were estimated. More than half (51.7%) of non-first births were born within sub-optimal IPI. The median IPI was 34 months (IQR: 33.5 months). The median IPI increased from 11 months in 2002 to 35 months in 2006 and plateaued until 2014, but it rose to 41.6 months in 2015. Median IPI was shorter in young women

IntroductionModern contraceptive use during the first year postpartum potentially prevents unplanned pregnancies and help to improve maternal and child health. Therefore, identifying factors associated with contraceptive utilization among women of reproductive age during extended postpartum period is essential.ObjectiveThis study aimed to assess factors associated with modern contraceptives use among postpartum women in Bukombe District, Geita region.MethodA community-based cross-sectional study was conducted among women who were in their first year after child birth in Bukombe district. A total of 511 women were included using multistage sampling techniques. Data were collected using a structured questionnaire. Data analysis was performed using Stata 15 (College Station, Texas, USA).ResultsThe prevalence of postpartum modern contraceptive was 11.9%. The most frequently used method was implant (6.5%). Most women started to use the contraceptive during the first three months after delivery. Living in urban (AOR = 1.85, 95% CI: 1.20-3.79), having business (AOR = 2.35, 95% CI: 1.31-2.28), last born aged 3-4 months (AOR = 3.31, 95% CI: 1.11-9.85) and menses resumption (AOR = 9.24, 95% CI: 3.60-23.72) were predictors for postpartum contraceptive use. However, fear of side effects, poor knowledge about contraceptives, husband restrictions, distance to health facility and contraceptive availability were reported as barriers for postpartum modern contraceptive use.ConclusionPrevalence of postpartum modern contraceptive use in the study area is still low. Numerous factors were reported as barriers for postpartum contraceptive use. A strategy such as health education on befits of post-partum modern contraceptive use and counseling women about side effects may help to improve its uptake.

Far-red absorbing chlorophylls are constitutively present as chlorophyll (Chl) d in the cyanobacterium Acaryochloris marina, or dynamically expressed by synthesis of Chl f, red-shifted phycobiliproteins and minor amounts of Chl d via far-red light photoacclimation in a range of cyanobacteria, which enables them to use near-infrared-radiation (NIR) for oxygenic photosynthesis. While the biochemistry and molecular physiology of Chl f-containing cyanobacteria has been unraveled in culture studies, their ecological significance remains unexplored and no data on their in situ activity exist. With a novel combination of hyperspectral imaging, confocal laser scanning microscopy, and nanoparticle-based O2 imaging, we demonstrate substantial NIR-driven oxygenic photosynthesis by endolithic, Chl f-containing cyanobacteria within natural beachrock biofilms that are widespread on (sub)tropical coastlines. This indicates an important role of NIR-driven oxygenic photosynthesis in primary production of endolithic and other shaded habitats.

In recent decades, there has been a movement toward rectifying injustices and developing collab­orations between Indigenous communities and mainstream researchers to address environmental challenges that are of concern to Indigenous Peo­ples. This movement, primarily driven by Indige­nous community leaders and scholars, emphasizes community-driven research that addresses Indige­nous People’s interests, foregrounds Indigenous Knowledge systems, and both respects and asserts Indigenous sovereignty. This article describes a nascent model in the movement—the Indigenous Foods Knowledges Network (IFKN)—designed to connect Indigenous communities and scholars across the Arctic and the U.S. Southwest. IFKN’s goal is to foster a network of Indigenous leaders, citizens, and scholars who are focused on research and community capacity related to food sover­eignty and resilience. IFKN members collectively work to promote and carry out research that (1) utilizes Indigenous research processes, (2) embraces and respects Indigenous Knowledge sys­tems, and (3) supports Indigenous communities (IFKN, 2018). The authors discuss relational accountability and centering of story, which form the foundation for the methodological approaches and work of IFKN.

Abstract Background Preeclampsia is among the leading causes of maternal mortality and morbidity worldwide, occurs in 2-8% of all pregnancies, and is estimated to account for at least 9 % of maternal deaths in Africa. Studies from developed countries show that high pre pregnancy body mass index (BMI) increases the risk of preeclampsia. We examined the association between pre pregnancy BMI and the risk of preeclampsia in Tanzania, a low income country. Methods Data from the Kilimanjaro Christian Medical Center (KCMC) Medical Birth Registry recorded between July 2000 and May 2013 were used. We restricted the study population to singleton deliveries among women with no or one previous pregnancy. Pre pregnancy BMI (kg/m2) was categorized according to the WHO categories of underweight (less than 18.5), normal (18.5 – 24.9), overweight (25.0 – 29.9) and obese (30 or more). Potential confounders were adjusted for in multivariable analyses. Results Among the 17,738 singleton births, 6.6% of the mothers were underweight, 62.1% were of normal BMI, 24.0% were overweight, and 7.3% were obese. Five hundred and eighty-two pregnancies (3.3%) were affected by preeclampsia. Compared to those with normal BMI, overweight and obese women had a higher risk of preeclampsia (aOR (95% CI) 1.4 (1.2 – 1.8) and 1.8 (1.3 – 2.4)), respectively, while underweight women had a lower risk (0.7 (0.4-1.1)). Conclusions Pre pregnancy maternal overweight and obesity were associated with an increased risk of preeclampsia in Tanzania. Risks were similar to those reported in high income countries.

Abstract A systematic analysis of 240 causes of death in 2013 revealed that parasitic diseases were responsible for more than one million deaths. The vast majority of these fatalities resulted from protozoan infections presenting with neurological sequelae. In the absence of a vaccine, development of effective therapies is essential to improving global public health. In 2015, an intriguing strategy to prevent cerebral malaria was proposed by Gordon et al. 2015 mBio, 6:e00625. Their study suggested that inhibition of the mammalian target of rapamycin prevented experimental cerebral malaria by blocking the damage to the blood brain barrier and stopping the accumulation of parasitized red blood cells and T cells in the brain. Here, we hypothesize that the same therapeutic strategy could be adopted for other protozoan infections with a brain tropism, to prevent cerebral parasitosis by limiting pathogen replication and preventing immune mediated destruction of brain tissue.