A nipple shield delivery system for oral drug delivery to breastfeeding infants : Microbicide delivery to inactivate HIV

A new drug delivery method for infants is presented which incorporates an active pharmaceutical ingredient (API)-loaded insert into a nipple shield delivery system (NSDS). The API is released directly into milk during breastfeeding. This study investigates the feasibility of using the NSDS to deliver the microbicide sodium dodecyl sulfate (SDS), with the goal of preventing mother-to-child transmission (MTCT) of HIV during breastfeeding in low-resource settings, when there is no safer alternative for the infant but to breastfeed. SDS has been previously shown to effectively inactivate HIV in human milk. An apparatus was developed to simulate milk flow through and drug release from a NSDS. Using this apparatus milk was pulsed through a prototype device containing a non-woven fiber insert impregnated with SDS and the microbicide was rapidly released. The total SDS release from inserts ranged from 70 to 100% of the average 0.07 g load within 50 ml (the volume of a typical breastfeed). Human milk spiked with H9/HIVIIIB cells was also passed through the same set-up. Greater than 99% reduction of cell-associated HIV infectivity was achieved in the first 10 ml of milk. This proof of concept study demonstrates efficient drug delivery to breastfeeding infants is achievable using the NSDS.

Voice, body and the transmission of the real in documentary theatre

This article analyses how listening is used to develop performances in Alecky Blythe’s verbatim theatre. Listening includes Blythe’s use of recorded oral interviews for devising performances, and also the actors’ creation of performance by precisely imitating an interviewee’s voice. The article focuses on listening, speaking and embodiment in London Road, Blythe’s recent musical play at London’s National Theatre, which adopted and modified theatre strategies used in her other plays, especially The Girlfriend Experience and Do We look Like Refugees. The article draws on interviews with performers and with Blythe herself, in its critical analysis of how voice legitimates claims to authenticity in performance. The work on Blythe is contextualised by brief comparative analyses. One is Clio Barnard’s film The Arbor, a ‘quasi-documentary’ on the playwright, Andrea Dunbar which makes use of an oral script to which the actors lip-sync. The other comparator is the Wooster Group’s Poor Theater, which attempts to recreate Grotowski's Akropolis via vocal impersonation. The article argues that voice in London Road both claims and defers authenticity and authority, inasmuch as voice signifies presence and embodied identity but the reworking of speech into song signals the absence of the real. The translation of voice into written surtitles works similarly in Do We Look Like Refugees. Blythe’s theatre, Barnard’s film and The Wooster Group’s performances are a useful framework for addressing questions of voice and identity, and authenticity and replication in documentary theatre. The article concludes by placing Blythe’s oral texts amid current debates around theatre’s textual practices.