Safety,Effectiveness and Acceptability of the PrePex Device for Adult Male Circumcision in Kenya

Objective

To assess the safety, effectiveness and acceptability of the PrePex device for adult medical male circumcision (MMC) in routine service delivery in Kenya.

Methods

We enrolled 427 men ages 18–49 at one fixed and two outreach clinics. Procedures were performed by trained clinical officers and nurses. The first 50 enrollees were scheduled for six follow-up visits, and remaining men were followed at Days 7 and 42. We recorded adverse events (AEs) and time to complete healing, and interviewed men about acceptability and pain.

Results

Placement and removal procedures each averaged between 3 and 4 minutes. Self-reported pain was minimal during placement but was fleetingly intense during removal. The rate of moderate/severe AEs was 5.9% overall (95% confidence interval [CI] 3.8%–8.5%), all of which resolved without sequelae. AEs included 5 device displacements, 2 spontaneous foreskin detachments, and 9 cases of insufficient foreskin removal. Surgical completion of MMC was required for 9 men (2.1%). Among the closely monitored first 50 participants, the probability of complete healing by Day 42 was 0.44 (95% CI 0.30–0.58), and 0.90 by Day 56. A large majority of men was favorable about their MMC procedure and would recommend PrePex to friends and family.

Conclusions

The PrePex device was effective for MMC in Kenya, and well-accepted. The AE rate was higher than reported for surgical procedures there, or in previous PrePex studies. Healing time is longer than following surgical circumcision. Provider experience and clearer counseling on post-placement and post-removal care should lead to lower AE rates.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01711411","term_id":"NCT01711411"}}NCT01711411     

A Multi-Year Longitudinal Study of Water Quality Parameters in Four Salmon-Bearing and Recreational Streams on Mount Hood,Oregon

Four streams–Clear Fork, Lost Creek, Camp Creek and Still Creek–in northwestern Oregon’s Sandy River Basin were monitored for temperature, dissolved oxygen levels, and fecal bacterial concentrations in a multi-year analysis examining stream health for recreational users and anchor habitat for Pacific Salmon. Temperatures were recorded using micro –T temperature loggers at 15 locations, during 22 July - 5 September 2006, 2 July - 4 September 2007, 20 June - 7 September 2008, 23 June - 9 September 2009, and 2 July –9 September 2010. The Seven-Day Average Maximum water temperature (7-DAM) of 13°C was used as a reference value for the biological limit governing suitable salmonid spawning and egg incubation conditions. The maximum 7-DAM temperatures occurred on different dates and all streams neared or exceeded the 13°C standard at least once each summer. Dissolved oxygen levels were measured at weekly or longer intervals in 2006, 2007, 2008, and 2009. Dissolved oxygen levels fell below the 9.0 ppm standard for Clear Fork on almost half the sampling dates in 2006, 2007, and 2009. Concentrations of the bacterial genus Enterococcus were measured as an indicator of fecal contamination. Samples were collected at 15 sites along the four streams. Weekly samples were collected during a 9 week period from July - September 2007, an 11 week period from June - September 2008, and an 11 week period from June - September 2009. Enterococcus counts exceeded the federal recommended national criterion value of 61 colony forming units (CFU) per 100 mL every year in Camp Creek and occasionally elsewhere, with exceedances trending towards late summer.     

Heavy Metal Contamination in the Brownfield Soils of Cleveland

The results esults of a survey of heavy metal contamination at Cleveland area brownfields and public spaces are presented. Soils were analyzed using a 24?h, 1N HCl extraction procedure. The study was conducted to seek brownfield soils that manifest properties of “old” sequestered contamination and to develop a better understanding of the nature and extent of heavy metal burdens at brownfield sites in the Greater Cleveland area. The results indicated that Cleveland brownfields commonly yield soil burdens well above remediation triggers for residential soils and often yield values above industrial remediation triggers. It was also discovered that public areas in the vicinity of brownfields commonly have heavy metal contamination significantly above background levels and occasionally above residential remediation triggers. These results indicate that brownfields redevelopment initiatives should proceed with caution. The appropriate remediation goals or restrictions must be imposed to control urban exposure to heavy metal contamination.     

A modified DNA barcode approach to define trophic interactions between native and exotic pentatomids and their parasitoids

The establishment of invasive Halyomorpha halys (Stål) outside of its native range may impact native species assemblages, including other pentatomids and their scelionid parasitoids. This has generated interest in defining species diversity and host‐parasitoid associations in this system to better understand the impact of invasive alien species on trophic interactions in invaded regions. Information on scelionid–pentatomid associations in natural habitats is lacking, and species‐level identification of these associations can be tenuous using rearing and dissection techniques. Naturally occurring pentatomid eggs were collected in areas where H. halys has established in Canada and were analysed using a modified DNA barcoding approach to define species‐level trophic interactions. Identification was possible for >90% of egg masses. Eleven pentatomid and five scelionid species were identified, and trophic links were established. Approximately 70% of egg masses were parasitized; parasitism and parasitoid species composition were described for each species. Telenomus podisi Ashmead was the dominant parasitoid and was detected in all host species. Trissolcus euschisti Ashmead was detected in several host species, but was significantly more prevalent in Chinavia hilaris (Say) and Brochymena quadripustulata (Fabricius). Trissolcus brochymenae Ashmead and Tr. thyantae Ashmead were recorded sporadically. Parasitism of H. halys was 55%, and this species was significantly less likely to be parasitized than native pentatomids. The scelionid species composition of H. halys consisted of Te. podisi, Tr. euschisti and Tr. thyantae. Although these species cannot develop in fresh H. halys eggs, we demonstrate that parasitoids attempt to exploit this host under field conditions.     

Monitoring the recovery of Juncus roemerianus marsh burns with the normalized difference vegetation index and Landsat Thematic Mapper data

Nine atmospherically corrected Landsat Thematic Mapper images were usedto generate mean normalized difference vegetation indices (NDVI) at 11burn sites throughout a coastal Juncus roemerianus marsh in St. MarksNational Wildlife Refuge, Florida. Time-since-burn, the time lapse from thedate of burn to the date of image collection, was related to variation inmean NDVI over time. Regression analysis showed that NDVI increasedfor about 300 to 400 days immediately after the burn, overshooting thetypical mean NDVI of a nonburned marsh. For about another 500 to 600days NDVI decreased until reaching a nearly constant NDVI of about0.40. During the phase of increasing NDVI the ability to predicttime-since-burn was within about ±60 days. Within the decreasingphase this dropped to about ±88 days.Examination of each burn site revealed some nonburn related influences onNDVI (e.g., seasonality). Normalization of burn NDVI by site-specificnonburn control NDVI eliminated most influences. However, differentialresponses at the site-specific level remained related to either storm impactsor secondary burning. At these sites, collateral data helped clarify theabnormal changes in NDVI. Accounting for these abnormalities,site-specific burn recovery trends could be broadly standardized into fourgeneral phases: Phase 1 – preburn, Phase 2 – initial recovery (increasingNDVI), Phase 3 – late recovery (decreasing NDVI), and Phase 4 – finalcoalescence (unchanging NDVI). Phase 2 tended to last about 300 to 500days, Phase 3 an additional 500 to 600 days, and finally reaching Phase 4,900 to 1,000 days after burn.     

Identification of newly settled Caribbean coral recruits by ITS-targeted single-step nested multiplex PCR

Coral Reefs - As coral cover has declined throughout the Caribbean, interest in determining the potential for reef recovery via natural recruitment processes has increased. Studies investigating...     

Moral Distress,Workplace Health,and Intrinsic Harm

Moral distress is now being recognized as a frequent experience for many health care providers, and there's good evidence that it has a negative impact on the health care work environment. However, contemporary discussions of moral distress have several problems. First, they tend to rely on inadequate characterizations of moral distress. As a result, subsequent investigations regarding the frequency and consequences of moral distress often proceed without a clear understanding of the phenomenon being discussed, and thereby risk substantially misrepresenting the nature, frequency, and possible consequences of moral distress. These discussions also minimize the intrinsically harmful aspects of moral distress. This is a serious omission. Moral distress doesn't just have a negative impact on the health care work environment; it also directly harms the one who experiences it. In this paper, I claim that these problems can be addressed by first clarifying our understanding of moral distress, and then identifying what makes moral distress intrinsically harmful. I begin by identifying three common mistakes that characterizations of moral distress tend to make, and explaining why these mistakes are problematic. Next, I offer an account of moral distress that avoids these mistakes. Then, I defend the claim that moral distress is intrinsically harmful to the subject who experiences it. I conclude by explaining how acknowledging this aspect of moral distress should reshape our discussions about how best to deal with this phenomenon.     

The wise use of wetlands: identifying development options for Ghana's coastal Ramsar sites

The Government of Ghana has recently declared five coastal wetlands to be Ramsar sites. This requires the wise use of wetlands of international importance for bird habitat, but does not preclude human habitation or ecologically friendly development. The sites are Muni-Pomadze, Densu Delta, Sakumo, Songor and Keta. An attempt was made to identify and assess a range of development options for initiation within the sites that would be compatible with the environmental concerns of Ramsar, while also being technically and economically viable and socially acceptable to the communities in the sites. The appraisal included developing a detailed understanding of the physical, biological, human and institutional resources of the areas, the land uses and prevailing livelihood systems of local people, and the pressures placed on the natural resources of the wetlands. Many of the developments nominated by stakeholders were rejected, but twenty topics passed the initial tests. These were considered in more detail using information collected for the study by national specialists. Most of the options were considered suitable for local level implementation by community groups or local entrepreneurs. Government assistance will be needed to ensure an enabling institutional framework for small-scale business development is provided.     

Routes of Acquisition of the Gut Microbiota of the Honey Bee Apis mellifera

Studies of newly emerged Apis mellifera worker bees have demonstrated that their guts are colonized by a consistent core microbiota within several days of eclosure. We conducted experiments aimed at illuminating the transmission routes and spatiotemporal colonization dynamics of this microbiota. Experimental groups of newly emerged workers were maintained in cup cages and exposed to different potential transmission sources. Colonization patterns were evaluated using quantitative real-time PCR (qPCR) to assess community sizes and using deep sequencing of 16S rRNA gene amplicons to assess community composition. In addition, we monitored the establishment of the ileum and rectum communities within workers sampled over time from natural hive conditions. The study verified that workers initially lack gut bacteria and gain large characteristic communities in the ileum and rectum within 4 to 6 days within hives. Typical communities, resembling those of workers within hives, were established in the presence of nurse workers or nurse worker fecal material, and atypical communities of noncore or highly skewed compositions were established when workers were exposed only to oral trophallaxis or hive components (comb, honey, bee bread). The core species of Gram-negative bacteria, Snodgrassella alvi, Gilliamella apicola, and Frischella perrara, were dependent on the presence of nurses or hindgut material, whereas some Gram-positive species were more often transferred through exposure to hive components. These results indicate aspects of the colony life cycle and behavior that are key to the propagation of the characteristic honey bee gut microbiota.