Data Collection Sites Research Articles

Association between childhood trauma and risk for obesity: a putative neurocognitive developmental pathway

BackgroundChildhood trauma increases the risk for adult obesity through multiple complex pathways, and the neural substrates are yet to be determined.MethodsParticipants from three population-based neuroimaging cohorts, including the IMAGEN cohort, the UK Biobank (UKB), and the Human Connectome Project (HCP), were recruited. Voxel-based morphometry analysis of both childhood trauma and body mass index (BMI) was performed in the longitudinal IMAGEN cohort; validation of the findings was performed in the UKB. White-matter connectivity analysis was conducted to study the structural connectivity between the identified brain region and subdivisions of the hypothalamus in the HCP.ResultsIn IMAGEN, a smaller frontopolar cortex (FPC) was associated with both childhood abuse (CA) (β = − .568, 95%CI − .942 to − .194; p = .003) and higher BMI (β = − .086, 95%CI − .128 to − .043; p < .001) in male participants, and these findings were validated in UKB. Across seven data collection sites, a stronger negative CA-FPC association was correlated with a higher positive CA-BMI association (β = − 1.033, 95%CI − 1.762 to − .305; p = .015). Using 7-T diffusion tensor imaging data (n = 156), we found that FPC was the third most connected cortical area with the hypothalamus, especially the lateral hypothalamus. A smaller FPC at age 14 contributed to higher BMI at age 19 in those male participants with a history of CA, and the CA-FPC interaction enabled a model at age 14 to account for some future weight gain during a 5-year follow-up (variance explained 5.8%).ConclusionsThe findings highlight that a malfunctioning, top-down cognitive or behavioral control system, independent of genetic predisposition, putatively contributes to excessive weight gain in a particularly vulnerable population, and may inform treatment approaches.

Reliability of the NIH toolbox cognitive battery in children and adolescents: a 3-year longitudinal examination.

Background.The Cognitive Battery of the National Institutes of Health Toolbox (NIH-TB) is a collection of assessments that have been adapted and normed for administration across the lifespan and is increasingly used in large-scale population-level research. However, despite increasing adoption in longitudinal investigations of neurocognitive development, and growing recommendations that the Toolbox be used in clinical applications, little is known about the long-term temporal stability of the NIH-TB, particularly in youth.Methods.The present study examined the long-term temporal reliability of the NIH-TB in a large cohort of youth (9–15 years-old) recruited across two data collection sites. Participants were invited to complete testing annually for 3 years.Results.Reliability was generally low-to-moderate, with intraclass correlation coefficients ranging between 0.31 and 0.76 for the full sample. There were multiple significant differences between sites, with one site generally exhibiting stronger temporal stability than the other.Conclusions.Reliability of the NIH-TB Cognitive Battery was lower than expected given early work examining shorter test-retest intervals. Moreover, there were very few instances of tests meeting stability requirements for use in research; none of the tests exhibited adequate reliability for use in clinical applications. Reliability is paramount to establishing the validity of the tool, thus the constructs assessed by the NIH-TB may vary over time in youth. We recommend further refinement of the NIH-TB Cognitive Battery and its norming procedures for children before further adoption as a neuropsychological assessment. We also urge researchers who have already employed the NIH-TB in their studies to interpret their results with caution.

Deaths from surgical conditions in Malawi\xa0- a randomised cross-sectional Nationwide household survey

BackgroundRelatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility.MethodsThe study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey.ResultsThe survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care.ConclusionIn Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.

Do Different Ascertainment Techniques Identify the Same Individuals as Sarcopenic in the Canadian Longitudinal Study on Aging?

Sarcopenia is associated with poor health outcomes such as disability, institutionalization, and mortality. Efforts to manage sarcopenia clinically have been hindered by challenges in determining how to ascertain sarcopenia status correctly. The objective of this project was to assess the agreement between the different methods of ascertaining sarcopenia recommended by expert groups. Cross-sectional study of baseline data (2011-2015) from the Canadian Longitudinal Study on Aging. Population-based multicenter study of community-dwelling participants. Eligible participants (n = 12,646) aged 65 to 85 living within 25 to 50 km of 11 data collection sites in Canada. The analyses included 10,820 participants with the data required to diagnose sarcopenia. Sarcopenia was operationalized as appendicular lean mass (ALM), ALM and grip strength, ALM and gait speed, and grip strength and gait speed. Within each combination, ALM was adjusted for height squared, weight, body mass index, and the residual of regressing lean mass on height and fat mass. The lowest 20th sex-specific percentile values were used as the cutoffs for low ALM. Low grip strength cutoffs of 35.5 kg for men and 20 kg for women and a gait speed cutoff of .8 m/s were used. The mean age was 73.0 ± 5.6 years, and 51.9% of the sample was male. The agreement (Cohen's κ) between the different combinations of variables used to ascertain sarcopenia status was below .50. Agreement for the different lean mass adjustment techniques ranged from .04 to .76. The combination of variables used to ascertain sarcopenia and many of the ALM adjustment techniques have insufficient agreement to be considered equivalent. This has important clinical implications for the management of sarcopenia because treatments may differ based on how sarcopenia is identified. To improve the clinical utility of sarcopenia, a unified definition of sarcopenia is required.

Sensitivity of conventional gait model to lower limb marker misplacement

Walking speed influences a variety of typical outcome measures in gait analysis. Many researchers use a participant’s preferred walking speed (PWS) during gait analysis with a goal of trying to capture how a participant would typically walk. However, the best practices for estimating PWS and the impact of laboratory size and walk distance are still unclear.Is measured PWS consistent across different distances and between two laboratory sites?Participants walked overground at a “comfortable speed” for six different conditions with either dynamic (4, 6, 10, and 400 m) or static (4 and 10 m) starts and stops at two different data collection sites. Repeated measures ANOVA with Bonferroni corrections were used to test for differences between conditions and sites.Participants walked significantly faster in the 4, 6, and 10 m dynamic conditions than in the 400 m condition. On average, participants walked slower in the static trials than the dynamic trials of the same distance. There was a significant interaction of lab and condition and so results were examined within each lab. Across both labs, we found that the 4 and 10 m dynamic conditions were not different than the 6 m dynamic condition at both sites, while other tests did not provide consistent results at both sites.We recommend researchers use a 6 m distance with acceleration and deceleration zones to reliably test for PWS across different laboratories. Given some of the differences found between conditions that varied by site, we also emphasize the need to report the test environment and methods used to estimate PWS in all future studies so that the methods can be replicated between studies.

English

Poaching or illegal hunting of wildlife for bushmeat is common in Cote d’Ivoire and particularly in center-western regions where it is actually a major income source contrary to traditional livelihood need. In order to assess the threat and impact of illegal bushmeat off take on sustainable biodiversity and conservation of wildlife resources to fill the information gap we examined the quality and quantity of extracted wildlife fauna for bushmeat in these regions from September 2018 to April 2019. Forty- seven bushmeat data collection sites were considered. Data collection was designed to collect information on the species poached, quantity, sex of poached animals, age estimate as well as poaching methods. A total of 352 wildlife mammals corresponding to 8 orders and 18 species was collected from bushmeat traders and markets. The order of rodents comes largely in the lead with more than half of the specimens encountered that is, 67.05% and the grass cutter species, Thryonomys swinderianusis the most poached and the only one found in all the sites investigated. A significant sex-specific pressure (p<0.009) was noted. Despite 77.78% of the species collected are classified minor concern, it is undeniable that the conservation status of wildlife biodiversity will always be threatened by illegal hunting. It is therefore up to the state authorities to officially cover hunting with clear control measures for the sustainable management of wildlife biodiversity. Key words: Bushmeat, illegal hunting, poaching, biodiversity, wildlife, harvest, conservation.

Timing of the Diagnosis of Autism in African American Children.

African American (AA) children affected by autism spectrum disorder (ASD) experience delays in diagnosis and obstacles to service access, as well as a disproportionate burden of intellectual disability (ID) as documented in surveillance data recently published by the US Centers for Disease Control and Prevention. Our objective in this study was to analyze data from the largest-available repository of diagnostic and phenotypic information on AA children with ASD, and to explore the wide variation in outcome within the cohort as a function of sociodemographic risk and specific obstacles to service access for the purpose of informing a national approach to resolution of these disparities. Parents of 584 AA children with autism consecutively enrolled in the Autism Genetic Resource Exchange across 4 US data collection sites completed event history calendar interviews of the diagnostic odysseys for their children with ASD. These data were examined in relation to developmental outcomes of the children with autism and their unaffected siblings. The average age of ASD diagnosis was 64.9 months (±49.6), on average 42.3 months (±45.1) after parents' first concerns about their children's development. The relationship between timing of diagnosis and ASD severity was complex, and ID comorbidity was not predicted in a straightforward manner by familial factors associated with cognitive variation in the general population. These findings document significant opportunity to expedite diagnosis, the need to further understand causes of ID comorbidity, and the necessity to identify effective approaches to the resolution of disparities in severity-of-outcome for AA children with autism.

Crime perceptions among international leisure tourists in Cape Town

PurposeThe main purpose of the study is to determine international leisure tourist perceptions with regard to crime, to assess the influence of demographic factors and to investigate the influence of prior, during and post-visit measures on international leisure tourists’ crime perceptions.Design/methodology/approachA personal intercept interview survey was used to collect the data at popular Cape Town (CT) tourist attractions via structured questionnaires. A generalized linear model was used to statistically assess respondents’ crime-related perceptions. Qualitative data was also generated via individual in-depth interviews, which were conducted among nine international leisure tourists.FindingsThe study found that international leisure tourists exhibited favorable sentiments regarding crime preparations; general safety information; post-visit crime related perceptions but were less positive about security safety information during their visit. International leisure tourists maintained that crime did not inhibit their activities and was not worse than anticipated during their visit. A majority of tourists indicated that they were not deterred by crime and would revisit CT.Research limitations/implicationsThe research was limited to a single city and to English-speaking international leisure tourists. The study was cross sectional in nature and the number of data collection sites was limited to four of the popular tourist attractions in CT.Practical implicationsThe study showed that a relatively high number of international leisure tourists had either witnessed or experienced crime in CT. Hence, a separate South African Police Service tourism protection unit could be established to help circumvent crime in CT.Originality/valueThe study used both quantitative and qualitative approaches to provide a comprehensive overview of international leisure tourist crime perceptions, which included prior, during and post-visit measures, of one of the top tourist destinations in the world. Additionally, this study is one of the few recent endeavors to assess the influence of a broad range of demographic and crime-related factors on international leisure tourists’ prior, during and post-visit crime perceptions in an African developing country.

A Critical Needs Assessment for Research in Companion Animals and Livestock Following the Pandemic of COVID-19 in Humans.

Problem: The emergence of novel coronavirus (SARS-CoV-2) in Wuhan, China, in November 2019 and a growing body of information compel inquiry regarding the transmissibility of infection between humans and certain animal species. Although there are a number of issues to be considered, the following points are most urgent: The potential for domesticated (companion) animals to serve as a reservoir of infection contributing to continued human-to-human disease, infectivity, and community spread. The ramifications to food security, economy, and trade issues should coronavirus establish itself within livestock and poultry. The disruption to national security if SARS-CoV-2 and its fairly well-established effects on smell (hyposmia/anosmia) to critical military service animals including explosive detector dog, narcotics detector dog, specialized search dog, combat tracker dog, mine detection dog, tactical explosive detector dog, improvised explosive device detector dog, patrol explosive detector dog, and patrol narcotics detector dog, as well as multipurpose canines used by special operations such as used by the U.S. customs and border protection agency (e.g., Beagle Brigade). This article presents in chronological order data that both individually (as received independently from multiple countries) and collectively urge studies that elucidate the following questions. 1.What animal species can be infected with SARS-CoV-2, the likely sources of infection, the period of infectivity, and transmissibility between these animals and to other animal species and humans? 2.What are the best diagnostic tests currently available for companion animals and livestock? 3.What expressions of illness in companion and other animal species can serve as disease markers? Although it is recognized that robust funding and methodology need to be identified to apply the best scientific investigation into these issues, there may be easily identifiable opportunities to capture information that can guide decision and study. First, it may be possible to quickly initiate a data collection strategy using in-place animal gatekeepers, such as zookeepers, veterinarians, kennel owners, feed lots, and military animal handlers. If provided a simple surveillance form, their detection of symptoms (lethargy, hyposmia, anosmia, and others) might be quickly reported to a central data collection site if one were created. Second, although current human COVID-19 disease is aligning around areas of population density and cluster events, it might be possible to overlay animal species density or veterinary reports that could signal some disease association in animals with COVID-19 patients. Unfortunately, although companion animals and zoo species have repeatedly served as sentinels for emerging infectious diseases, they do not currently fall under the jurisdiction of any federal agency and are not under surveillance.

Comparison of measurement protocols to estimate preferred walking speed between sites

BackgroundWalking speed influences a variety of typical outcome measures in gait analysis. Many researchers use a participant’s preferred walking speed (PWS) during gait analysis with a goal of trying to capture how a participant would typically walk. However, the best practices for estimating PWS and the impact of laboratory size and walk distance are still unclear. Research questionIs measured PWS consistent across different distances and between two laboratory sites? MethodsParticipants walked overground at a “comfortable speed” for six different conditions with either dynamic (4, 6, 10, and 400 m) or static (4 and 10 m) starts and stops at two different data collection sites. Repeated measures ANOVA with Bonferroni corrections were used to test for differences between conditions and sites. ResultsParticipants walked significantly faster in the 4, 6, and 10 m dynamic conditions than in the 400 m condition. On average, participants walked slower in the static trials than the dynamic trials of the same distance. There was a significant interaction of lab and condition and so results were examined within each lab. Across both labs, we found that the 4 and 10 m dynamic conditions were not different than the 6 m dynamic condition at both sites, while other tests did not provide consistent results at both sites. SignificanceWe recommend researchers use a 6 m distance with acceleration and deceleration zones to reliably test for PWS across different laboratories. Given some of the differences found between conditions that varied by site, we also emphasize the need to report the test environment and methods used to estimate PWS in all future studies so that the methods can be replicated between studies.

Perceptions of pregnant women regarding student accoucheurs’ involvement in maternal health care in the Free State Province

Worldwide midwifery has been regarded as a female domain until recently where female and male student nurses are trained to become midwives/accoucheurs. Most women are still reluctant to receive maternal healthcare from student accoucheurs. The purpose of the study was to explore and describe the perceptions of women regarding student accoucheurs’ involvement in maternal health care in the Free State Province. A descriptive, exploratory, qualitative research design was undertaken. The study was conducted in the Free State Province. Three regional hospitals, two district hospitals and five Primary Health Care clinics were purposefully selected to make a total of 10 maternal health care institutions that were used as data collection sites. Data was collected using one on one semi-structured interviews with 30 women in the post-partum period, 18 years of age and above, attending for post-natal health care services at the Free State maternal health care institutions. Data was organised and stored using ATLAS.ti program and analysed using Tesch’s open coding approach. The majority of the participants did not approve of student accoucheurs’ involvement in maternal health care. The perceptions of the participants were influenced by cultural beliefs, values, socio-economic factors and social interactions. The study findings cannot be generalized to the other provinces because the study was contextualized to the Free State Province. This study highlights the importance of understanding and consideration of cultural diversity in the provision of health care services.

Auditory EEG Biomarkers in Fragile X Syndrome: Clinical Relevance.

Sensory hypersensitivities are common and distressing features of Fragile X Syndrome (FXS). While there are many drug interventions that reduce behavioral deficits in Fmr1 mice and efforts to translate these preclinical breakthroughs into clinical trials for FXS, evidence-based clinical interventions are almost non-existent potentially due to lack of valid neural biomarkers. Local circuit function in sensory networks is dependent on the dynamic balance of activity in inhibitory/excitatory synapses. Studies are needed to examine the association of electrophysiological alterations in neural systems with sensory and other clinical features of FXS to establish their clinical relevance. Adolescents and adults with FXS (n = 38, Mean age = 25.5, std = 10.1; 13 females) and age matched typically developing controls (n = 40, Mean age = 27.7, std = 12.1; 17 females) completed auditory chirp and auditory habituation tasks while undergoing dense array electroencephalography (EEG). Amplitude, latency, and percent change (habituation) in N1 and P2 event-related potential (ERP) components were characterized for the habituation task; time-frequency calculations using Morlet wavelets characterized phase-locking and single trial power for the habituation and chirp tasks. FXS patients showed increased amplitude but some evidence for reduced habituation of the N1 ERP, and reduced phase-locking in the low and high gamma frequency range and increased low gamma power to the chirp stimulus. FXS showed increased theta power in both tasks. While the habituation finding was weaker than previously found, the remaining findings replicate our previous work in a new sample of patients with FXS. Females showed less deficit in the chirp task but not the habituation task. Abnormal increases in gamma power were related to more severe behavioral and psychiatric features as well as reductions in neurocognitive abilities. Replicating electrophysiological deficits in a new group of patients using different EEG equipment at a new data collection site with differing levels of environmental noise that were robust to data processing techniques utilizing multiple researchers, indicates a potential for scalability to multi-site clinical trials. Given the robust replicability, relevance to clinical measures, and preclinical evidence for sensitivity of these EEG measures to pharmacological intervention, the observed abnormalities may provide novel translational markers of target engagement and potentially outcome measures in large-scale studies evaluating new treatments targeting neural hyperexcitability in FXS.

Identifying reproducible individual differences in childhood functional brain networks: An ABCD study

The 21-site Adolescent Brain Cognitive Development (ABCD) study provides an unparalleled opportunity to characterize functional brain development via resting-state functional connectivity (RSFC) and to quantify relationships between RSFC and behavior. This multi-site data set includes potentially confounding sources of variance, such as differences between data collection sites and/or scanner manufacturers, in addition to those inherent to RSFC (e.g., head motion). The ABCD project provides a framework for characterizing and reproducing RSFC and RSFC-behavior associations, while quantifying the extent to which sources of variability bias RSFC estimates. We quantified RSFC and functional network architecture in 2,188 9-10-year old children from the ABCD study, segregated into demographically-matched discovery (N = 1,166) and replication datasets (N = 1,022). We found RSFC and network architecture to be highly reproducible across children. We did not observe strong effects of site; however, scanner manufacturer effects were large, reproducible, and followed a “short-to-long” association with distance between regions. Accounting for potential confounding variables, we replicated that RSFC between several higher-order networks was related to general cognition. In sum, we provide a framework for how to characterize RSFC-behavior relationships in a rigorous and reproducible manner using the ABCD dataset and other large multi-site projects.

OVARIAN VOLUME BETWEEN FERTILE AND INFERTILE MARRIED WOMEN WITH TRANSVAGINAL SONOGRAPHY

Background: Infertility is a social problem and a big stigma. The objectives of the study were to determine the age wise distribution of ovarian volume and the difference in ovarian volume between married fertile and infertile women with transvaginal sonography. Materials &amp; Methods: This comparative, cross-sectional study was conducted in the Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from March 2013 to December 2013. Sample Size was 100 women selected by consecutive non probability sampling technique. Sample size was calculated using online calculator Raosoft. Inclusion criteria were women aged 18-50 years, married, fertile and infertile. Color Doppler sonoscape with multi frequency transvaginal probes were used in measurements on any day in the start of menstrual cycle by the same observer. The volume was calculated by applying formula for ellipsoid called Prolate ellipsoid formula. The total volume was represented by sum of volume of two ovaries. Data collection site was out patient department of Radiology DHQ Teaching Hospital, D.I.Khan. Demographic variable were age groups and presence of fertility. Research variable was ovarian volume. Mean and standard deviation were calculated for ovarian volume whereas frequency and percentages were calculated for age groups and presence of fertility. Descriptive statistics along with estimation of parameter was done at 95% confidence interval for proportion and mean. Student- t test was used for significance of difference in ovarian volume between fertile and infertile women with p value

Smoking among female daily smokers in Surabaya, Indonesia

ObjectivesNationally representative studies suggest 1–2% of Indonesian women (2.3 million) smoke various tobacco products daily; however, in recent years, there has been concern that the tobacco industry has successfully increased female smoking. Our objective was to describe current cigarette smoking behaviors, past quit attempts, and intention to quit of female daily smokers in Surabaya, Indonesia. Study designSurvey. MethodsFemale daily smokers (n = 112) in Surabaya, Indonesia, the country's second largest city, were recruited to participate in a survey during 2018. Convenience sampling was utilized in two malls. Potential participants were intercepted in or near designated smoking areas and invited to the nearby data collection site. Survey items from Global Adult Tobacco Survey and the International Tobacco Control Policy Evaluation Project were utilized. ResultsParticipants self-reported smoking 13.8 cigarettes per day (7.3 white machine-rolled cigarettes per day, 4.2 kreteks per day, and 2.4 roll-your-own cigarettes per day). Over 75% smoked their first cigarette within 30 min of waking. Over 53% had a heaviness of smoking index score suggesting moderate or high addiction. Approximately half (51%) did not attempt to quit smoking in the previous 12 months, and 55% planned to quit beyond 6 months or not at all. ConclusionsOur sample smoked five to six more cigarettes per day than female daily smokers in previous national surveys. Relative to previous studies, our data suggest an unexpected preference for white machine-rolled cigarettes and that there could be, at a minimum, pockets of increased smoking and addiction among female daily smokers in Indonesia.

Neurodevelopmental effects of ante-partum and post-partum antiretroviral exposure in HIV-exposed and uninfected children versus HIV-unexposed and uninfected children in Uganda and Malawi: a prospective cohort study

Antiretroviral medication during pregnancy and breastfeeding substantially decreases the risk of HIV transmission from mothers to infants, but its effects on the child's neurodevelopment are unknown. This study compared neurodevelopmental outcomes of ante-partum and post-partum antiretroviral exposure in HIV-exposed and uninfected children with HIV-unexposed and uninfected children at ages 12, 24, 48, and 60 months. For this study, a prospective cohort of HIV-exposed and uninfected children was identified from two research sites in the PROMISE-BF trial (at Blantyre, Malawi, and Kampala, Uganda), in which pregnant HIV-infected mothers were randomly assigned to triple antiretroviral prophylaxis (lopinavir-ritonavir plus either lamivudine and zidovudine or emtricitabine and tenofovir), versus zidovudine alone. Post partum, the mother-infant pairs were randomly assigned to maternal triple antiretroviral treatment or infant nevirapine during breastfeeding. HIV-unexposed and uninfected children matched for age, sex, and socioeconomic background were enrolled at vaccination and well-child clinics at the study sites. We included only children without a history of documented brain infection or injury or substantial malnutrition, and whose mothers were randomly assigned and maintained within their assigned ante-partum and post-partum phases throughout their treatment arm periods. Primary outcomes were the Mullen Scales of Early Learning (MSEL) cognitive composite score at age 12 months, 24 months, and 48 months; and the mental processing index for the Kaufman Assessment Battery for Children, second edition (KABC-II) global score at 48 months and 60 months. Repeated measures were analysed using a linear mixed-effects model controlling for data collection site. Between Aug 23, 2013, and Dec 17, 2014, we co-enrolled 861 children. For MSEL assessments, 738 were eligible for inclusion at age 12 months, 790 at age 24 months, and 692 at age 48 months. For KABC-II assessments, 685 were eligible for inclusion at age 48 months and 445 at age 60 months. There were no differences in MSEL cognitive composite scores according to exposure at age 12 and 24 months (p=0·19 and 0·24, respectively, for comparison of all groups). At 48 months, MSEL cognitive composite scores were worse for children of mothers who did not remain on triple antiretroviral treatment throughout both the ante-partum and post-partum treatment phases (adjusted means 80·64 [95% CI 77·74-83·54] and 81·34 [78·19-84·48], respectively), compared with those who did remain on triple treatment (adjusted mean 85·93, 95% CI 83·05-88·80; p=0·0486 for the comparison of all groups). The KABC-II composite scores (mental processing index) did not differ at 48 or 60 months according to exposure (p=0·81 and 0·89, respectively, for comparison of all groups). Scores for MSEL and KABC-II for children of mothers on triple antiretrovirals in both the ante-partum and post-partum treatment phases were similar to those for children in the HIV-unexposed and uninfected reference group at all timepoints. Maternal triple antiretroviral exposure during both the ante-partum and post-partum phases did not result in greater developmental risks for the mothers' HIV-exposed and uninfected children through age 60 months, compared with children who were HIV-unexposed and uninfected. This might be because ante-partum triple antiretroviral protection of the health of mothers with HIV during pregnancy might be neuroprotective for the child, and when continued post partum, could enhance the quality of caregiving for the child through better clinical care for the mother. National Institutes of Health and Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Visual impairment and the use of formal and informal home care in Canada: the Canadian Longitudinal Study on Aging

ObjectiveTo determine the use of home care services in those with and without visual impairment in Canada. DesignPopulation-based cross-sectional study. ParticipantsParticipants came from the baseline examination of the Canadian Longitudinal Study on Aging Comprehensive Cohort. Inclusion criteria included age between 45 and 85 years, community dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. People were excluded if they were in an institution, were living on a First Nations reserve, were full-time members of the Canadian Armed Forces, did not speak French or English, or had cognitive impairment. MethodsPresenting visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart at 2 meters. Visual impairment was defined as binocular acuity worse than 20/60. The use of formal, informal, and both types of home care was determined by questionnaire. ResultsFor 29 666 participants, the use of any home care was greater in those with visual impairment than in those without (28% vs 12%, respectively, p < 0.01). After adjusting for demographics and health, people with visual impairment were more likely to use informal home care (odds ratio [OR] = 1.89, 95% CI 1.35–2.63) and formal home care/both types of home care (OR = 2.70, 95% CI 1.79–4.07) than those without visual impairment. Marital status was a modifier. ConclusionVisual impairment is associated with use of home care services. These findings warrant further exploration and, if confirmed, have major health service implications, given the rising prevalence of visual impairment due to age-related eye diseases.

Codemixing in an Entertainment TV Show: How Which Is Functions in Indonesians’ Repertoire

The present article portrays the use of “which is” as a currently popular mixed-code among Indonesians, especially teenagers and public figures, since the 2010s or popularly named as the language of South-Jakartans (Bahasa Anak Jaksel) by taking an Indonesian TV show as the data collection sites. The data were the comments of one of the judges of Indonesian Idol 2018, named ME. For investigation purpose, videos containing the “which is”phrase uttered by ME were sorted, transcribed, and analyzed. The analysis focused on how “which is”functions in the utterances. It was found that remarkable functions of “which is”include as substituting conjunctions and discourse markers. The substituting conjunctions include cause-effect and coordinating conjunctions, as for the discourse markers likely function to minimize face-threatening act.

Evaluation of a routine point-of-care intervention for early infant diagnosis of HIV: an observational study in eight African countries

In 2017, there were 180 000 estimated new HIV infections in children aged 0-14 years. Without early diagnosis and treatment, half of infants with HIV die by age 2 years, with peak mortality around age 8-10 weeks. Conventional early infant diagnosis (EID) systems have not consistently returned results in a timely manner. However, point-of-care (POC) EID devices, which are new to market, could improve outcomes. In December, 2016, POC EID testing was introduced in eight sub-Saharan African countries as part of routine service delivery. We aimed to compare key service delivery and clinical outcomes and costs of POC versus conventional EID. In our observational study, we compared service delivery and clinical outcomes in eight countries (Cameroon, Côte d'Ivoire, Kenya, Lesotho, Mozambique, Rwanda, Swaziland, and Zimbabwe), before and after a POC intervention was introduced for EID of HIV. For the baseline, pre-intervention sample, we sampled 30 consecutive tests for HIV-exposed infants who had a documented date of blood collection for EID within Ministry of Health registers in a subset of Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)-supported sites that would be enrolled in POC. For the post-intervention sample, all infants who were tested with POC EID for HIV at an EGPAF site were included in the sample. For both conventional and POC EID testing, we did not specify an age range, but used national EID guidelines for EID eligibility. A range of sites for conventional data collection were selected to represent both primary testing sites (where POC EID instruments would be placed) and spoke sites, rural and urban environment, and high throughput and low throughput sites. In all countries, except Mozambique, we developed a POC EID test request form in conjunction with the Ministry of Health. In Mozambique, EGPAF-trained staff extracted data from health facility registers and other sources using a data collection form. Certain specific indicators were required for all countries, but countries could collect additional variables, as the POC EID test request form was used for patient management for the duration of the project. These forms were filled in by health-care providers at the facility. Once the form was completed it was collected by EGPAF staff and entered into a project-specific database. The cost per test result returned was approximated by use of the Global Fund's total cost of ownership estimates. Retrospective collection of data on clinical and service delivery outcomes of conventional testing began on Nov 14, 2016, and was completed on Nov 26, 2017, for tests done between March 3, 2014, and March 30, 2017, at 96 health-care facilities using conventional testing. POC tests were done at 339 health-care facilities between Dec 1, 2016, and Dec 31, 2017. We evaluated data from 2875 infants exposed to HIV who were tested with conventional testing methods (2899 tests) and 18 220 infants tested with POC testing (19 071 tests). Several EID outcomes were significantly improved with POC testing relative to conventional testing. The return of results to caregivers within 30 days (in 18 737 [98·3%] of 19 058 infants receiving POC testing vs 542 [18·7%] of 2898 infants receiving conventional testing; p<0·0001), the median time from sample collection to return of results to caregivers (0 vs 55 days; p<0·0001), the number of infants with HIV initiating antiretroviral therapy (ART) within 60 days of sample collection (639 [92·3%] of 692 infants vs 42 [43·3%] of 97 infants; p<0·0001), the median time from sample collection to ART initiation among infants with HIV (0 vs 49 days; p<0·0001), and the median age at ART initiation among infants with HIV who were tested at 6-8 weeks (1·6 vs 3·3 months; p<0·0001) were all improved with POC testing compared with conventional testing. The cost per test result returned within 30 days was less for POC (US$27·24, range 21·39-33·10) than conventional testing ($131·02, 96·26-165·76). POC EID improves the speed of return of HIV test results and enables earlier ART initiation; this approach could potentially reduce morbidity and mortality in infants with HIV. National programmes, funders, and implementing partners should consider POC EID as a preferred testing strategy for implementation. Unitaid.

Computer-Mediated Communication to Facilitate Synchronous Online Focus Group Discussions: Feasibility Study for Qualitative HIV Research Among Transgender Women Across the United States.

BackgroundNovel, technology-based methods are rapidly increasing in popularity across multiple facets of quantitative research. Qualitative research, however, has been slower to integrate technology into research methodology. One method, computer-mediated communication (CMC), has been utilized to a limited extent for focus group discussions.ObjectiveThis study aimed to assess feasibility of an online video conferencing system to further adapt CMC to facilitate synchronous focus group discussions among transgender women living in six cities in eastern and southern United States.MethodsBetween August 2017 and January 2018, focus group discussions with adult transgender women were conducted in English and Spanish by research teams based in Boston, MA, and Baltimore, MD. Participants were sampled from six cities: Baltimore, MD; Boston, MA; New York, NY; Washington, DC; Atlanta, GA; and Miami, FL. This was formative research to inform a technology-enhanced cohort study to assess HIV acquisition among transgender women. This analysis focused on the methodologic use of CMC focus groups conducted synchronously using online software that enabled video or phone discussion. Findings were based on qualitative observations of attendance and study team debriefing on topics of individual, social, technical, and logistical challenges encountered.ResultsA total of 41 transgender women from all six cities participated in seven online focus group discussions—five English and two Spanish. There was equal racial distribution of black/African American (14/41, 34%) and white (14/41, 34%) attendees, with 29% (12/41) identifying as Hispanic/Latina ethnicity. Overall, 29 of 70 (41%) eligible and scheduled transgender women failed to attend the focus group discussions. The most common reason for nonattendance was forgetting or having a scheduling conflict (16/29, 55%). A total of 14% (4/29) reported technical challenges associated with accessing the CMC focus group discussion. CMC focus group discussions were found to facilitate geographic diversity; allow participants to control anonymity and privacy (eg, use of pseudonyms and option to use video); ease scheduling by eliminating challenges related to travel to a data collection site; and offer flexibility to join via a variety of devices. Challenges encountered were related to overlapping conversations; variable audio quality in cases where Internet or cellular connection was poor; and distribution of incentives (eg, cash versus gift cards). As with all focus group discussions, establishment of ground rules and employing both a skilled facilitator and a notetaker who could troubleshoot technology issues were critical to the success of CMC focus group discussions.ConclusionsSynchronous CMC focus group discussions provide a secure opportunity to convene participants across geographic space with minimal time burden and without losing the standardized approach that is expected of focus group discussions. This method may provide an optimal alternative to engaging hard-to-reach participants in focus group discussions. Participants with limited technological literacy or inconsistent access to a phone and/or cellular data or service, as well as circumstances necessitating immediate cash incentives may, however, require additional support and accommodation when participating in CMC focus group discussions.