Does Immediate Access to Birth Control Help Prevent Pregnancy? A Comparison of Onsite Provision Versus Off Campus Referral for Contraception at Two School-Based Clinics

PURPOSE: The purpose of this study was to assess the impact of different policies on access to hormonal contraception and pregnancy rates at two high school-based clinics. METHODS: Two clinics in high schools (Schools A and B), located in a large urban district in the southwest US, provide primary medical care to enrolled students with parental consent; the majority of whom have no health insurance coverage. The hormonal contraceptive dispensing policy of at School clinic A involves providing barrier, hormonal and emergency contraceptive services on site. School clinic B uses a referral policy that directs students to obtain contraception at an off-campus affiliated family planning clinic. Baseline data (age, race and history of prior pregnancy) on female students seeking hormonal contraception at the two clinics between 9/2008-12/2009 were extracted from an electronic administrative database (AHLERS Integrated System). Data on birth control use and pregnancy tests for each student was then tracked electronically through 3/31/2010. The outcomes measures were accessing hormonal contraception and positive pregnancy tests at any point during or after birth control use were started through 12/2009. The appointment keeping rate for contraceptive services and the overall pregnancy rates were compared between the two schools. In addition the pregnancy rates were compared between the two schools for students with and without a prior history of pregnancy. RESULTS: School clinic A: 79 students sought hormonal contraception; mean age 17.5 years; 68% were > 18 years; 77% were Hispanic; and 20% reported prior pregnancy. The mean duration of the observation period was 13 months (4-19 months). All 79 students received hormonal contraception (65% pill and 35% long acting progestin injection) onsite. During the observation period, the overall pregnancy rate was 6% (5/79); 4.7% (3/63) among students with no prior pregnancy. School clinic B: 40 students sought hormonal contraception; mean age 17.5 years; 52% > 18 years; 88 % were Hispanic; and 7.5% reported prior pregnancy. All 40 students were referred to the affiliated clinic. The mean duration of the observation period was 11.9 months (4-19 months). 50% (20) kept their appointment. Pills were dispensed to 85% (17/20) and 15% (3/20) received long acting progestin injection. The overall pregnancy rate was 20% (8/40); 21.6% (8/37) among students with no prior pregnancy. A significantly higher frequency of students seeking hormonal contraception kept their initial appointment for birth control at the school dispensing onsite contraception compared to the school with a referral policy for contraception (p<0.05). The pregnancy rate was significantly higher for the school with a referral policy for contraception compared to the school with onsite contraceptive services (p< 0.05). The pregnancy rate was also significantly higher for students without a prior history of pregnancy in the school with a referral policy for contraception (21.6%) versus the school with onsite contraceptive services (4.7%) (p< 0.05). CONCLUSION: This preliminary study showed that School clinic B with a referral policy had a lower appointment keeping rate for contraceptive services and a higher pregnancy rate than School clinic A with on-site contraceptive services. An on-site dispensing policy for hormonal contraceptives at high school-based health clinics may be a convenient and effective approach to prevent unintended first and repeat pregnancies among adolescents who seek hormonal contraception. This study has strong implications for reproductive health policy, especially as directed toward high-risk teenage populations.

Investigating Peatland Stratigraphy and Hydrogeology Using Integrated Electrical Geophysics

Hydrology has been suggested as the mechanism controlling vegetation and related surficial pore-water chemistry in large peatlands. Peatland hydrology influences the carbon dynamics within these large carbon reservoirs and will influence their response to global warming. A geophysical survey was completed in Caribou Bog, a large peatland in Maine, to evaluate peatland stratigraphy and hydrology. Geophysical measurements were integrated with direct measurements of peat stratigraphy from probing, fluid chemistry, and vegetation patterns in the peatland. Consistent with previous field studies, ground-penetrating radar (GPR) was an excellent method for delineating peatland stratigraphy. Prominent reflectors from the peat-lake sediment and lake sediment-mineral soil contacts were precisely recorded up to 8 m deep. Two-dimensional resistivity and induced polarization imaging were used to investigate stratigraphy beneath the mineral soil, beyond the range of GPR. We observe that the peat is chargeable, and that IP imaging is an alternative method for defining peat thickness. The chargeability of peat is attributed to the high surface-charge density on partially decomposed organic matter. The electrical conductivity imaging resolved glaciomarine sediment thickness (a confining layer) and its variability across the basin. Comparison of the bulk conductivity images with peatland vegetation revealed a correlation between confining layer thickness and dominant vegetation type, suggesting that stratigraphy exerts a control on hydrogeology and vegetation distribution within this peatland. Terrain conductivity measured with a Geonics EM31 meter correlated with confining glaciomarine sediment thickness and was an effective method for estimating variability in glaciomarine sediment thickness over approximately 18 km(2). Our understanding of the hydrogeology, stratigraphy, and controls on vegetation growth in this peatland was much enhanced from the geophysical study.

Metacognitive monitoring and control in elementary school children: Their interrelations and their role for test performance

Contemporary models of self-regulated learning emphasize the role of distal motivational factors for student's achievement, on the one side, and the proximal role of metacognitive monitoring and control for learning and test outcomes, on the other side. In the present study, two larger samples of elementary school children (9- and 11-year-olds) were included and their mastery-oriented motivation, metacognitive monitoring and control skills were integrated into structural equation models testing and comparing the relative impact of these different constituents for self-regulated learning. For one, results indicate that the factorial structure of monitoring, control and mastery motivation was invariant across the two age groups. Of specific interest was the finding that there were age-dependent structural links between monitoring, control, and test performance (closer links in the older compared to the younger children), with high confidence yielding a direct and positive effect on test performance and a direct and negative effect on adequate control behavior in the achievement test. Mastery-oriented motivation was not found to be substantially associated with monitoring (confidence), control (detection and correction of errors), or test performance underlining the importance of proximal, metacognitive factors for test performance in elementary school children.

Provenance versus weathering control on the composition of tropical river mud (southern Africa)

This study presents an integrated mineralogical-geochemical data base on fine-grained sediments transported by all major rivers of southern Africa, including the Zambezi, Okavango, Limpopo, Olifants, Orange and Kunene. Clay mineralogy, bulk geochemistry, Sr and Nd isotopic signatures of river mud, considered as proxy of suspended load, are used to investigate the influence of source-rock lithology and weathering intensity on the composition of clay and silt produced in subequatorial to subtropical latitudes. Depletion in mobile alkali and alkaline-earth metals, minor in arid Namibia, is strong in the Okavango, Kwando and Upper Zambezi catchments, where recycling is also extensive. Element removal is most significant for Na, and to a lesser extent for Sr. Depletion in K, Ca and other elements, negligible in Namibia, is moderate elsewhere. The most widespread clay minerals are smectite, dominant in muds derived from Karoo or Etendeka flood basalts, or illite and chlorite, dominant in muds derived from metasedimentary rocks of the Damara Orogen or Zimbabwe Craton. Kaolinite represents 30-40% of clay minerals only in Okavango and Upper Zambezi sediments sourced in humid subequatorial Angola and Zambia. After subtracting the effects of recycling and of local accumulation of authigenic carbonates in soils, the regional distribution of clay minerals and chemical indices consistently reflect weathering intensity primarily controlled by climate. Bulk geochemistry identifies most clearly volcaniclastic sediments and mafic sources in general, but cannot discriminate the other sources of detritus in detail. Instead, Sr and Nd isotopic fingerprints are insensitive to weathering, and thus mirror faithfully the tectonic structure of the southern African continent. Isotopic tools thus represent a much firmer basis than bulk geochemistry or clay mineralogy in the provenance study of mudrocks.

A lung-on-chip array with an integrated bio-inspired respiration mechanism

We report about a lung-on-chip array that mimics the pulmonary parenchymal environment, including the thin, alveolar barrier and the three-dimensional cyclic strain induced by the breathing movements. A micro-diaphragm used to stretch the alveolar barrier is inspired by the in-vivo diaphragm, the main muscle responsible for inspiration. The design of this device aims not only at best reproducing the in-vivo conditions found in the lung parenchyma, but also at making its handling easy and robust. An innovative concept, based on the reversible bonding of the device, is presented that enables to accurately control the concentration of cells cultured on the membrane by easily accessing both sides of the membranes. The functionality of the alveolar barrier could be restored by co-culturing epithelial and endothelial cells that formed tight monolayers on each side of a thin, porous and stretchable membrane. We showed that cyclic stretch significantly affects the permeability properties of epithelial cell layers. Furthermore, we could also demonstrate that the strain influences the metabolic activity and the cytokine secretion of primary human pulmonary alveolar epithelial cells obtained from patients. These results demonstrate the potential of this device and confirm the importance of the mechanical strain induced by the breathing in pulmonary research.

IMRT with ¹⁸FDG-PET\CT based simultaneous integrated boost for treatment of nodal positive cervical cancer

BACKGROUND To evaluate toxicity and outcome of intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the positive lymph nodes in patients with loco-regional advanced cervical cancer (LRACC). METHODS The study population comprised ten patients with 18FDG-PET\CT positive lymph nodes (LNs), who underwent chemoradiation with IMRT and SIB. A dose of 50.4 Gy, in daily fractions of 1.8 Gy, was delivered to primary tumor and draining LNs. Primary tumor received an additional external beam boost to a total dose of 55.8 Gy. A SIB of 62 Gy, in daily fractions of 2 Gy, was delivered to the 18FDG-PET\CT positive LNs. Finally, a high dose rate brachytherapy (HDRB) boost (15 - 18 Gy) was administered to the primary tumor. The primary goal of this study was to evaluate acute and early late toxicity and loco-regional control. RESULTS The median number of irradiated LNs per patient was 3 (range: 1-6) with a median middle nodal SIB-volume of 26.10 cm3 (range, 11.9-82.50 cm3). Median follow-up was 20 months (range, 12 to 30 months). Acute and late grade 3 toxicity was observed in 1 patient. Three of the patients developed a recurrence, one in the form of a local tumor relapse, one had a paraaortic LN metastasis outside the treated volume and the last one developed a distant metastasis. CONCLUSION IMRT with SIB in the region of 18FDG-PET positive lymph nodes appears to be an effective therapy with acceptable toxicity and might be useful in the treatment of patients with locally advanced cervical cancer.

Long-term safety and feasibility of three-vessel multimodality intravascular imaging in patients with ST-elevation myocardial infarction: the IBIS-4 (integrated biomarker and imaging study) substudy.

We assessed the feasibility and the procedural and long-term safety of intracoronary (i.c) imaging for documentary purposes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary PCI in the setting of IBIS-4 study. IBIS4 (NCT00962416) is a prospective cohort study conducted at five European centers including 103 STEMI patients who underwent serial three-vessel coronary imaging during primary PCI and at 13 months. The feasibility parameter was successful imaging, defined as the number of pullbacks suitable for analysis. Safety parameters included the frequency of peri-procedural complications, and major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI) and any clinically-indicated revascularization at 2 years. Clinical outcomes were compared with the results from a cohort of 485 STEMI patients undergoing primary PCI without additional imaging. Imaging of the infarct-related artery at baseline (and follow-up) was successful in 92.2 % (96.6 %) of patients using OCT and in 93.2 % (95.5 %) using IVUS. Imaging of the non-infarct-related vessels was successful in 88.7 % (95.6 %) using OCT and in 90.5 % (93.3 %) using IVUS. Periprocedural complications occurred <2.0 % of OCT and none during IVUS. There were no differences throughout 2 years between the imaging and control group in terms of MACE (16.7 vs. 13.3 %, adjusted HR1.40, 95 % CI 0.77-2.52, p = 0.27). Multi-modality three-vessel i.c. imaging in STEMI patients undergoing primary PCI is consistent a high degree of success and can be performed safely without impact on cardiovascular events at long-term follow-up.

Clinically relevant quality measures for risk factor control in primary care: a retrospective cohort study

BACKGROUND Assessment of the proportion of patients with well controlled cardiovascular risk factors underestimates the proportion of patients receiving high quality of care. Evaluating whether physicians respond appropriately to poor risk factor control gives a different picture of quality of care. We assessed physician response to control cardiovascular risk factors, as well as markers of potential overtreatment in Switzerland, a country with universal healthcare coverage but without systematic quality monitoring, annual report cards on quality of care or financial incentives to improve quality. METHODS We performed a retrospective cohort study of 1002 randomly selected patients aged 50-80 years from four university primary care settings in Switzerland. For hypertension, dyslipidemia and diabetes mellitus, we first measured proportions in control, then assessed therapy modifications among those in poor control. "Appropriate clinical action" was defined as a therapy modification or return to control without therapy modification within 12 months among patients with baseline poor control. Potential overtreatment of these conditions was defined as intensive treatment among low-risk patients with optimal target values. RESULTS 20% of patients with hypertension, 41% with dyslipidemia and 36% with diabetes mellitus were in control at baseline. When appropriate clinical action in response to poor control was integrated into measuring quality of care, 52 to 55% had appropriate quality of care. Over 12 months, therapy of 61% of patients with baseline poor control was modified for hypertension, 33% for dyslipidemia, and 85% for diabetes mellitus. Increases in number of drug classes (28-51%) and in drug doses (10-61%) were the most common therapy modifications. Patients with target organ damage and higher baseline values were more likely to have appropriate clinical action. We found low rates of potential overtreatment with 2% for hypertension, 3% for diabetes mellitus and 3-6% for dyslipidemia. CONCLUSIONS In primary care, evaluating whether physicians respond appropriately to poor risk factor control, in addition to assessing proportions in control, provide a broader view of the quality of care than relying solely on measures of proportions in control. Such measures could be more clinically relevant and acceptable to physicians than simply reporting levels of control.

Integrated pest management in multi-story public housing for the elderly in Houston, Texas

Integrated pest management is a viable alternative to traditional pest control methods. A paired sample design was utilized to measure the effect of IPM education on the number of cockroaches in a 200 unit, seven story public housing building for the elderly in Houston, TX. Glue traps were placed in 71 randomly selected apartments (5traps/unit) and left in place for two nights. Baseline cockroach counts were shared with the property manager, maintenance/janitorial staff, service coordinator, pest control professional and tenant representatives at the end of a one day “Integrated Pest Management in Multi-Family Housing” training course.^ There was a significant decrease in the average number of cockroaches after IPM education and implementation of IPM principles (P < 0.0003). Positive changes in behavior by members of the IPM team and changes in the housing authority operational plan were also found. Paired t-tests comparing the difference between mean cockroach counts at baseline and follow-up by location within the apartment all demonstrated a significant decrease in the number of cockroaches.^ Results supported the premise that IPM education and the implementation of IPM principles are effective measures to change pest control behaviors and control cockroaches. Cockroach infestations in multi-story housing are not solely determined by the actions of individual tenants. The actions of other residents, property managers and pest control professionals are also important factors in pest control.^ Findings support the implementation of IPM education and the adoption of IPM practices by public housing authorities. This study adds to existing evidence that clear communication of policies, a team approach and a commitment to ongoing inspection and monitoring of pests combined with corrective action to eliminate food, water and harborage and the judicial use of low risk pesticides have the potential to improve the living conditions of elderly residents living in public housing.^

Los bioinsecticidas de nim en el control de plagas de insectos en cultivos económicos : La Habana (Cuba)

En Cuba, la generalización del cultivo del Nim (Azadirachta indica A. Juss) y el uso de los bioinsecticidas producidos a partir de éste como apoyo al desarrollo de una agricultura sostenible y ecológica, trae consigo la necesidad de validar su efectividad biológica en una gama cada vez más amplia de plagas de interés agrícola. En el presente trabajo se demuestra que con el uso de los productos OleoNim 80 CE, NeoNim 60 CE, CubaNim T, CubaNim SM y FoliarNim HM es posible controlar con eficacia la acción nociva de plagas tales como Diaphania hyalinata (L.) en melón, Empoasca fabae (Harris) en poroto, Thrips palmi (Karny) en pepino en organopónico y bajo condiciones de cultivo protegido, y Bemisia tabaci (Genn.) en poroto y tomate. Las efectividades biológicas alcanzadas en estas experiencias, oscilaron entre 75 y 100 %, lo cual confirma la factibilidad del uso de estos bioinsecticidas insertados en el Manejo Integrado de Plagas para una agricultura sostenible.

Actividad biológica de Lonchocarpus guaricensis Pittier en el control de larvas de Tuta absoluta (Meyrick)

La actividad biológica de Lonchocarpus guaricensis Pittier fue evaluada utilizando dos dosis de Tecnona® en el control de larvas de Tuta absoluta (Meyrick), Valle de Azapa, Chile, mediante una pulverización sobre plantas de tomate cv. Naomi en macetas, ubicadas aleatoriamente en un invernáculo dentro de un vivero. Semanas previas a la pulverización, las macetas se infestaron artificialmente con adultos del fitófago para obtener larvas en los foliolos. Los tratamientos evaluados fueron los siguientes: T1 (0,21 g de IA de L. guaricensis·L-1), T2 (0,43 g de IA de L. guaricensis·L-1), T3 (control positivo a base de spinosad 0,048 g de IA·L-1) y T0 (control negativo a base de agua de pozo). De acuerdo con el porcentaje de mortalidad acumulada de larvas contabilizadas a las 24, 48, 120 horas y 9no día post aplicación, no hay diferencias estadísticas entre los tratamientos T0 y T1, a su vez, T2 alcanza una media de 53,05% de mortalidad, no diferenciándose de T3 que logra un 73,9%. Se concluye que la dosis experimental L. guaricensis de 0,43 g de IA∙ L-1 puede constituir una alternativa interesante de utilizar en el Manejo Integrado de Plagas del cultivo de tomate en el Valle de Azapa.

International Collection of JGOFS (Joint Global Ocean Flux Study), Volume 2: Integrated Data Sets (1989-2003)

The JGOFS International Collection Volume 2: Integrated Data Sets CD is a coherent, organised compilation of existing data sets produced by member countries which participated in JGOFS. In most cases, the data were gathered from the JGOFS International Collection, Volume 1: Discrete Datasets DVD. To produce Vol. 1 data were taken from the original sources and copied "as is" on the DVD. For Vol. 2 data and metadata have been harmonized using the conversion software PanTool and the import routine of PANGAEA checking for completeness of metadata and defining the relations between data and metadata. Prior to the import, data had performed a technical quality control, i.e. format and readability of the file, availability and combination of parameters and units, range of values.

Orbital control on carbonate-lignite cycles on sediment core KAP-107 in the Ptolemais Basin, northern Greece

Time control is essential for the reconstruction of geological processes. We use a combination of relative and absolute methods to establish the chronology and related paleoclimatic processes for Late Neogene lacustrine sediment from the Ptolemais Basin, northern Greece. We determined changes in magnetic polarity and correlated them to the global magnetic polarity time scale, which again is calibrated by radiometric methods, to provide a low-resolution age model for the Upper Miocene to Lower Pliocene (7 - 3 Ma). Sedimentary successions show rhythmic alterations of lignites, clays, and marls. Using photospetrometry we measured this variability at 1-cm resolution, and correlated the pattern to known changes in earth's orbital parameters, namely to eccentricity and precession. For 230-m long borehole KAP-107 from the Amynteon Sub-Basin we obtained a high-resolution age model that spans 2 myr from 5.1 to 3.1 Ma, with age control points at insolation maxima (20-kyr resolution). We recommend using photospectrometry as reliable tool to establish orbital-based chronologies and to reconstruct paleoclimate variability at high resolution.