Predictors of HIV-1 slow progression among vertically infected children in Botswana

HIV-1 infected children display a highly variable rate of progression to AIDS. Data about reasons underlying the variable progression to AIDS among vertically-infected children is sparse, and the few studies that have examined this important question have almost exclusively been done in the developed world. This is despite the fact that Sub-Saharan Africa is home to over 90% of all HIV infected children around the world.^ The main objective of this study was to examine predictors of HIV-1 slow progression among vertically infected children in Botswana, using a case control design. Cases (slow progressors) and controls (rapid progressors) were drawn from medical records of HIV-1 infected children being followed up for routine care and treatment at the BBCCCOE between February 2003 and February 2011. Univariate and Multivariate Logistic Regression Analyses were performed to identify independent predictors of slow disease progression and control for confounding respectively. ^ The study population comprised of 152 cases and 201 controls with ages ranging from 6 months to 16 years at baseline. Low baseline HIV-1 RNA viral load was the strongest independent predictor of slow progression (adjusted OR = 5.52, 95% CI = 2.75-11.07; P <0.001). Other independent predictors of slow disease progression identified were: lack of history of PMTCT with single dose Nevirapine plus Zidovudine (adjusted OR = 4.45, 95% CI = 1.45-13.69; P = 0.009) and maternal vital status (alive) (adjusted OR = 2.46, 95% CI = 1.51-4.01; P < 0.00 ).^ The results of this study may help clinicians and policy-makers in resource-limited settings to identify, at baseline, which children are at highest risk of rapid progression to AIDS and thus prioritize them for immediate intervention with HAART and other measures that would mitigate disease progression. At the same time HAART may be delayed among children who are at lower risk of disease progression. This would enable the highly affected, yet impoverished, Sub-Saharan African countries to use their scarce resources more efficiently which may in turn ensure that their National Antiretroviral Therapy Programs become more sustainable. Delaying HAART among the low-risk children would also lower the occurrence of adverse drug reactions associated with antiretroviral drugs exposure.^ Keywords. Slow Progressors, Rapid Progressors, HIV-1, Predictors, Children, Vertical Transmission, Sub-Saharan Africa^

Assessing and applying evidence-based interventions at the community level in India as a model policy to reduce neonatal mortality rates in Nigeria

Background. The United Nations' Millennium Development Goal (MDG) 4 aims for a two-thirds reduction in death rates for children under the age of five by 2015. The greatest risk of death is in the first week of life, yet most of these deaths can be prevented by such simple interventions as improved hygiene, exclusive breastfeeding, and thermal care. The percentage of deaths in Nigeria that occur in the first month of life make up 28% of all deaths under five years, a statistic that has remained unchanged despite various child health policies. This paper will address the challenges of reducing the neonatal mortality rate in Nigeria by examining the literature regarding efficacy of home-based, newborn care interventions and policies that have been implemented successfully in India. ^ Methods. I compared similarities and differences between India and Nigeria using qualitative descriptions and available quantitative data of various health indicators. The analysis included identifying policy-related factors and community approaches contributing to India's newborn survival rates. Databases and reference lists of articles were searched for randomized controlled trials of community health worker interventions shown to reduce neonatal mortality rates. ^ Results. While it appears that Nigeria spends more money than India on health per capita ($136 vs. $132, respectively) and as percent GDP (5.8% vs. 4.2%, respectively), it still lags behind India in its neonatal, infant, and under five mortality rates (40 vs. 32 deaths/1000 live births, 88 vs. 48 deaths/1000 live births, 143 vs. 63 deaths/1000 live births, respectively). Both countries have comparably low numbers of healthcare providers. Unlike their counterparts in Nigeria, Indian community health workers receive training on how to deliver postnatal care in the home setting and are monetarily compensated. Gender-related power differences still play a role in the societal structure of both countries. A search of randomized controlled trials of home-based newborn care strategies yielded three relevant articles. Community health workers trained to educate mothers and provide a preventive package of interventions involving clean cord care, thermal care, breastfeeding promotion, and danger sign recognition during multiple postnatal visits in rural India, Bangladesh, and Pakistan reduced neonatal mortality rates by 54%, 34%, and 15–20%, respectively. ^ Conclusion. Access to advanced technology is not necessary to reduce neonatal mortality rates in resource-limited countries. To address the urgency of neonatal mortality, countries with weak health systems need to start at the community level and invest in cost-effective, evidence-based newborn care interventions that utilize available human resources. While more randomized controlled studies are urgently needed, the current available evidence of models of postnatal care provision demonstrates that home-based care and health education provided by community health workers can reduce neonatal mortality rates in the immediate future.^

Seasonal cycles of monthly means of ground truth wind speed of METAR station GVAC and of area-averaged TMI wind speed at 37 GHz for the Cape Verde Island Sal

In the present paper ground truth and remotely sensed datasets were used for the investigation and quantification of the impact of Saharan dust on microwave propagation, the verification of theoretical results, and the validation of wind speeds determined by satellite microwave sensors. The influence of atmospheric dust was verified in two different study areas by investigations of single dust storms, wind statistics, wind speed scatter plots divided by the strength of Saharan dust storms, and wind speed differences in dependence of microwave frequencies and dust component of aerosol optical depth. An increase of the deviations of satellite wind speeds to ground truth wind speeds with higher microwave frequencies, with stronger dust storms, and with higher amount of coarse dust aerosols in coastal regions was obtained. Strong Saharan dust storms in coastal areas caused mean relative errors in the determination of wind speed by satellite microwave sensors of 16.3% at 10.7 GHz and of 20.3% at 37 GHz. The mean relative errors were smaller in the open sea area with 3.7% at 10.7 GHz and with 11.9% at 37 GHz.

Nd, Pb, and Be isotopes of ferromanaganese crusts of the Atlantic Ocean

The isotopic composition of Nd in present-day deep waters of the central and northeastern Atlantic Ocean is thought to fingerprint mixing of North Atlantic Deep Water with Antarctic Bottom Water. The central Atlantic Romanche and Vema Fracture Zones are considered the most important pathways for deep water exchange between the western and eastern Atlantic basins today. We present new Nd isotope records of the deepwater evolution in the fracture zones obtained from ferromanganese crusts, which are inconsistent with simple water mass mixing alone prior to 3 Ma and require additional inputs from other sources. The new Pb isotope time series from the fracture zones are inexplicable by simple mixing of North Atlantic Deep Water and Antarctic Bottom Water for the entire past 33 Myr. The distinct and relatively invariable Nd and Pb isotope records of deep waters in the fracture zones appear instead to have been controlled to a large extent by contributions from Saharan dust and the Orinoco/Amazon Rivers. Thus the previously observed similarity of Nd and Pb isotope time series from the western and eastern North Atlantic basins is better explainable by direct supply of Labrador Seawater to the eastern basin via a northern pathway rather than by advection of North Atlantic Deep Water via the Romanche and Vema Fracture Zones.

Saving Young Lives: Pathfinder International’s Youth-Friendly Postabortion Care Project

As many as 2.5 million adolescent women seek abortion each year, and nearly 70,000 women die from complications related to unsafe abortion, of which almost half are women under the age of 25. A further 5 million women suffer disability due to unsafe abortion yearly. In most developing countries, abortion is legally restricted or highly inaccessible, which leads young women to seek services from unskilled practitioners often leading to incomplete, septic abortions and massive bleeding, which can result in permanent injury, infertility, and death. Based on our deeply held belief that all people, including adolescents, have a right to sexual and reproductive health services and the importance of addressing adolescent needs within Postabortion Care (PAC) services, Pathfinder used private funds to initiate a Youth-Friendly Postabortion Care (YFPAC) program in eight sub-Saharan African countries. Implemented between June 2007 and May 2008, the YFPAC program offered an opportunity to apply the PAC Consortium’s Technical Guidance on Youth-Friendly PAC, generating promising approaches and lessons learned. The goal of the YFPAC initiative was to increase access to PAC services that are responsive to adolescent needs in sub-Saharan Africa. While outcomes varied according to the country, the overall outcomes included: Increased community support for services and activities that prevent unwanted pregnancy, decreased stigma around abortion, and awareness of the issue of unsafe abortion among adolescent women: 311 peer educators reached almost 17,487 youth and other community members; 171 stakeholders (e.g., religious and traditional leaders, health officials, and local government officials) were sensitized on YFPAC, resulting in a positive shift in communities’ attitudes toward youth in need of PAC services. 125 service providers were trained to deliver YFPAC services and three doctors in Ghana were provided with a technical update on YFPAC. YFPAC services are available in Angola, Ghana, Nigeria, Mozambique, Tanzania, Uganda, Ethiopia, and Kenya. Pathfinder introduced YFPAC services into 25 facilities (in 27 service delivery points), and provided more than 3,800 clients with YFPAC services throughout the eight countries. The number of adolescent PAC clients seen at the project facilities increased— 710 clients were seen in the first quarter, 1,144 were seen in the fourth. The number of adolescent PAC clients who adopt a contraceptive method to prevent future unintended pregnancies has increased. Statistics show an average postabortion contraceptive acceptance of 69%, with the highest acceptance being 83% and the lowest being 44%. Evidence-based approaches, tools, and lessons learned are being disseminated and used for scale-up or replication of YFPAC interventions.

Plutonium and americium concentrations in sea water and in sinking particles

Vertical fluxes of 239+240Pu and 241Am and temporal changes in their inventories in the northwestern Mediterranean Sea have been examined through high-resolution water column sampling coupled with direct measurements of the vertical flux of particle-bound transuranics using time-series sediment traps. Water column profiles of both radionuclides showed well-defined sub-surface maxima (2391240Pu between 100-400 m; 241Am at 100-200 m and 800 m), the depths of which are a result of the different biogeochemical scavenging behavior of the two radionuclides. Comparison of deep water column (0-2,000 m) transuranic inventories with those derived from earlier measurements demonstrate that the total 2391240Pu inventory had not substantially changed between 1976-1990 whereas 241Am had decreased by approximately 24%. Enhanced scavenging of 241Am and a resultant, more rapid removal from the water column relative to 239+240Pu was also supported by the observation of elevated Am/Pu activity ratios in sinking particles collected in sediment traps at depth. Direct measurements of the downward flux of particulate 239+240Pu and 241Am compared with transuranic removal rates derived from observed total water column inventory differences over time, show that particles sinking out of deep waters (1,000-2,000 m) could account for 26-72% of the computed total annual 239+240Pu loss and virtually all of the 241Am removal from the water column. Upper water column (0-200 m) residence times based on direct flux measurements ranged from 20-30 yr for 239+240Pu and 5-10 yr for 241Am. The observation that 241Am/239+240Pu activity ratios in unfiltered Mediterranean seawater are six times lower than those in the north Pacific suggests the existence of a specific mechanism for enhanced scavenging and removal of 241Am from the generally oligotrophic waters of the open Mediterranean. It is proposed that atmospheric inputs of aluminosilicate particles transported by Saharan dust events which frequently occur in the Mediterranean region could enhance the geochemical scavenging and resultant removal of 241Am to the sediments.