16,664 research outputs found
Could you have said no? A mixed-methods investigation of consent to HIV tests in four African countries
No full textIntroduction: Although most studies report high frequencies of consent to HIV tests, critics argue that clients are subject to pressure, that acceptors later indicate they could not have refused, and that provider-initiated HIV testing raises serious ethical issues. We examine the meaning of consent and why clients think they could not have refused. Methods: Clients in Burkina Faso, Kenya, Malawi and Uganda were asked about consenting to HIV tests, whether they thought they could have refused and why. Textual responses were analyzed using qualitative and statistical methods. Results: Among 926 respondents, 77percent reported they could not have said no, but in fact, 60percent actively consented to test, 24percent had no objection and only 7percent tested without consent. There were few significant associations between categories of consent and their covariates. Conclusions: Retrospectively asking clients if they could have refused to test for HIV overestimates coercion. Triangulating qualitative and quantitative data suggests a considerable degree of agency. © 2014 Obermeyer CM et al; licensee International AIDS Society.Angotti N, 2011, HEALTH POLICY PLANN, V26, P307, DOI 10.1093-heapol-czq066; Angotti N, 2009, SOC SCI MED, V68, P2263, DOI 10.1016-j.socscimed.2009.02.041; Appelbaum PS, 2009, HASTINGS CENT REP, V39, P30; Baggaley R, 2012, B WORLD HEALTH ORGAN, V90, P652, DOI 10.2471-BLT.11.100818; Bayer R, 2006, NEW ENGL J MED, V355, P647, DOI 10.1056-NEJMp068153; Groves AK, 2010, AIDS CARE, V22, P538, DOI 10.1080-09540120903311508; Gruskin S, 2008, DEV WORLD BIOETH, V8, P23, DOI 10.1111-j.1471-8847.2007.00222.x; Guenter Dale, 2008, J Obstet Gynaecol Can, V30, P17; Hensen B, 2012, TROP MED INT HEALTH, V17, P59, DOI 10.1111-j.1365-3156.2011.02893.x; Jurgens R, 2007, INCREASING ACCESS HI; Karim QA, 1998, AM J PUBLIC HEALTH, V88, P637; Kass Nancy E, 2005, IRB, V27, P1, DOI 10.2307-3563534; Larsson EC, 2012, HEALTH POLICY PLANN, V27, P69, DOI 10.1093-heapol-czr009; Mandava A, 2012, J MED ETHICS, V38, P356, DOI 10.1136-medethics-2011-100178; Marshall PA, 2006, J EMPIR RES HUM RES, V1, P25, DOI 10.1525-jer.2006.1.1.25; Njeru MK, 2011, BMC HEALTH SERV RES, V11, DOI 10.1186-1472-6963-11-87; Obermeyer CM, 2007, AM J PUBLIC HEALTH, V97, P1762, DOI 10.2105-AJPH.2006.096263; Obermeyer CM, 2012, PLOS MED, V9, DOI 10.1371-journal.pmed.1001329; Obermeyer CM, 2013, BMC INT HEALTH HUM R, V13, DOI 10.1186-1472-698X-13-6; QSR, 2011, N VIV 9 2; Rujumba J, 2013, BMC HEALTH SERV RES, V13, DOI 10.1186-1472-6963-13-189; StataCorp, 2009, STAT STAT SOFTW REL; Ujiji OA, 2011, BMC PUBLIC HEALTH, V11, DOI 10.1186-1471-2458-11-151; Weiser SD, 2006, PLOS MED, V3, P1013, DOI 10.1371-journal.pmed.003026110
Symptoms, menopause status, and country differences: A comparative analysis from DAMES
No full textOBJECTIVE: To investigate reported frequencies of menopausal symptoms among women in four countries, namely Lebanon, Morocco, Spain, and the United States, and to assess the relative role of menopause status, country of residence, and other factors in explaining differences in symptomatology. DESIGN: Surveys of representative samples of approximately 300 women aged 45 to 55 years in each site were conducted, using an instrument that includes demographic, health, and menopausal variables, in addition to perceptions and attitudes toward menopause. Statistical and textual analyses are used to examine differentials and the factors that influence them. RESULTS: The burden of symptoms and the frequencies of symptoms differ across sites, but hot flashes are reported everywhere by just under one half of the respondents. The most frequent symptoms are joint pain, fatigue, impatience-nervousness, sleep disturbances, memory loss, and one or more emotional symptoms. Menopause status is significantly associated with hot flashes and vasomotor symptoms and to a lesser extent with emotional and sexual symptoms. Smoking, schooling, employment, and age are also associated with the frequency of selected symptoms. Country of residence influences reported symptoms over and above other factors. CONCLUSIONS: Similarities among core symptoms and differences in the expression of symptoms were found across sites. Both biological (menopause status) and cultural (country of residence) variables influence symptomatology. ©2007The North American Menopause Society.Anderson Debra, 2004, Nurs Health Sci, V6, P173, DOI 10.1111-j.1442-2018.2004.00190.x; Avis Nancy E, 2005, Am J Med, V118 Suppl 12B, P37, DOI 10.1016-j.amjmed.2005.09.057; Avis NE, 2003, MED CARE, V41, P1262, DOI 10.1097-01.MLR.0000093479.39115.AF; AVIS NE, 1993, BAILLIERE CLIN ENDOC, V7, P17, DOI 10.1016-S0950-351X(05)80268-X; BELL SE, 1987, SOC SCI MED, V24, P535, DOI 10.1016-0277-9536(87)90343-1; Blumel JE, 2006, MENOPAUSE, V13, P706, DOI 10.1097-01.gme.0000227338.73738.2d; BOULET MJ, 1994, MATURITAS, V19, P157, DOI 10.1016-0378-5122(94)90068-X; Cohen LS, 2006, ARCH GEN PSYCHIAT, V63, P385, DOI 10.1001-archpsyc.63.4.385; Crawford SL, 2000, MENOPAUSE, V7, P96, DOI 10.1097-00042192-200007020-00005; Dennerstein L, 2004, MENOPAUSE, V11, P778, DOI 10.1097-01.GME.0000138544.50670.CC; FLINT M, 1990, ANN NY ACAD SCI, V592, P134; Ford K, 2005, MENOPAUSE, V12, P308, DOI 10.1097-01.GME.0000163869.89878.D9; FREEMAN EW, 2006, ARCH GEN PSYCHIAT, V63, P378; Guthrie JR, 2005, MENOPAUSE, V12, P460, DOI 10.1097-01.GME.0000155200.80687.BE; Hardy R, 2005, BJOG-INT J OBSTET GY, V112, P346, DOI 10.1111-j.147-0528.2004.00348.x; Jasienska G, 2005, WOMEN HEALTH ISS, V15, P145, DOI 10.1016-j.whi.2005.02.002; KAUFERT P, 1986, SOC SCI MED, V22, P1285, DOI 10.1016-0277-9536(86)90196-6; KAUFERT P, 1981, SOC SCI MED-MED PSYC, V15, P173, DOI 10.1016-0271-5384(81)90011-9; Lee C, 2004, AUST NZ J PUBL HEAL, V28, P144, DOI 10.1111-j.1467-842X.2004.tb00928.x; Lindenbaum S., 1993, KNOWLEDGE POWER PRAC; Lock M, 1998, PSYCHOSOM MED, V60, P410; Loh FH, 2005, MATURITAS, V52, P169, DOI 10.1016-j.maturitas.2004.11.004; LUOTO R, 1994, AM J EPIDEMIOL, V139, P64; Matthews KA, 2001, INT J OBESITY, V25, P863, DOI 10.1038-sj.ijo.0801618; MCKINLAY SM, 1992, MATURITAS, V14, P103, DOI 10.1016-0378-5122(92)90003-M; Melby MK, 2005, MENOPAUSE, V12, P250, DOI 10.1097-01.GME.0000146108.27840.D9?; Melby MK, 2005, HUM REPROD UPDATE, V11, P495, DOI 10.1093-humupd-dmi018; Obermeyer CM, 2004, MENOPAUSE, V11, P456, DOI 10.1097-01.GME.0000109318.11228.DA; Obermeyer CM, 1999, MATURITAS, V33, P249; Obermeyer CM, 2005, MATURITAS, V52, P190, DOI 10.1016-j.maturitas.2005.01.011; Obermeyer CM, 2002, MATURITAS, V41, P87, DOI 10.1016-S0378-5122(01)00289-4; PARAZZINI F, 1992, MATURITAS, V15, P141, DOI 10.1016-0378-5122(92)90248-3; *QSR INT PTY LTD, 2002, N6 NONN UNSTR DAT IN; Randolph JF, 2005, J CLIN ENDOCR METAB, V90, P6106, DOI 10.1210-jc.2005-1374; Reynolds RF, 2005, AM J HUM BIOL, V17, P331, DOI 10.1002-ajhb.20121; Reynolds RF, 2001, ANN HUM BIOL, V28, P21; Shinberg DS, 1998, SOC SCI MED, V46, P1381, DOI 10.1016-S0277-9536(97)10085-5; Sievert Lynnette Leidy, 2005, J Cross Cult Gerontol, V20, P127, DOI 10.1007-s10823-005-9087-3; Sievert LL, 2007, MENOPAUSE, V14, P798, DOI 10.1097-gme.0b013e31804f8175; Sievert LL, 2006, MENOPAUSE BIOCULTURA; SPSS for Windows, 2005, SPSS WIND39414
Herbage Nutritive Value in Extensively Grazed Grassland as Affected by Botanical Composition, Sward Heterogeneity and Grazing Intensity
No full textABSTRACT Extensive grazing management is an effective strategy to conserve biodiversity. Grazing intensity directly affects sward heterogeneity, resulting in the formation of short and tall vegetation patches, which influence the botanical composition and nutritive value of herbage. Understanding the seasonal dynamics of herbage nutritive value under different grazing intensities is essential to optimise animal performance. Herbage nutritive value data were collected over three years (2019–2021) in the long‐term ‘FORBIOBEN’ experiment in Central Germany to analyse the effects of patches, grazing intensity and season. The trial was a one‐factorial experiment on grazing intensity in a randomised block design with three replicates, each represented by a one‐hectare paddock. Grazing intensities—moderate, lenient and very lenient—were managed based on target compressed sward heights of 6, 12 and 18 cm, respectively. Results show that herbage nutritive value was significantly affected by the patches, sometimes in interaction with season. Short patches contained in general 32.6% higher crude protein and 14.6% lower fibre concentrations than tall patches and also remained seasonally more stable, while in tall patches the phenological development of the plants was ongoing. The higher the grazing intensity the greater was the area covered by short patches per paddock. Thus, when accounting for patch proportions, a higher grazing intensity resulted in significantly improved herbage nutritive value compared to more lenient grazing. To accurately assess herbage nutritive value in areas of extensive grazing management, it is therefore recommended to account for patch‐specific variability and to know the patch proportions which result from the grazing intensity.Interreg https://doi.org/10.13039/100013276European Commission https://doi.org/10.13039/501100000780Deutsche Forschungsgemeinschaft https://doi.org/10.13039/50110000165
The politics and economics of regulatory impact assessment
No full textThis is the author accepted manuscript. The final version is available from the publisher via the link in this record
Phase Distribution Efficiency of cm-Scale Ultrasonically Powered Receivers
No full textIn the domain of ultrasonically powered biomedical implants, there is an increasing interest in cm-scale ultrasonic receivers (RX). However, when a single-element transducer is used as the RX transducer, an uneven phase distribution across the RX area can significantly reduce the harvestable power. In this paper, we investigate the impact of lateral and angular misalignment on the acoustic field phase distribution across the RX surface. We show that, for a single-element RX transducer, lateral misalignment has minimal effect on the harvestable power, whereas even small angular misalignments can cause a considerable reduction, especially for larger RX sizes. We present a potential solution that consists of subdividing a large RX transducer (e.g. 20 × 20mm2) into smaller elements, which significantly improves power transfer efficiency by taking advantage of the smaller phase variation across the surface of each element. The trade-offs between achieving a minimum acceptable power transfer efficiency and managing the increased complexity in packaging and matching circuitry are also discussed.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Electronic Components, Technology and MaterialsBio-Electronic
Highly efficient laser-driven Compton gamma-ray source
No full textThe recent advancement of high-intensity lasers has made all-optical Compton scattering become a promising way to produce ultrashort brilliant gamma-rays in an ultra-compact system. However, so far achieved Compton gamma-ray sources are limited by low conversion efficiency and spectral intensity. Here we present a highly efficient gamma photon emitter obtained by irradiating a high-intensity laser pulse on a miniature plasma device consisting of a plasma lens and a plasma mirror. This concept exploits strong spatiotemporal laser-shaping process and high-charge electron acceleration process in the plasma lens, as well as an efficient nonlinear Compton scattering process enabled by the plasma mirror. Our full three-dimensional particle-in-cell simulations demonstrate that in this novel scheme, brilliant gamma-rays with very high conversion efficiency (higher than 10(-2)) and spectral intensity (similar to 10(9) photons/0.1%BW) can be achieved by employing currently available petawatt-class lasers with intensity of 10(21) W cm(-2). Such efficient and intense gamma-ray sources would find applications in wide-ranging areas. ©2019 The Author(s)
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Cross-cultural comparisons: midlife, aging, and menopause
No full text663-66
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Frequencies and clustering of somatic symptoms at mid-life: Comparing quantitative and qualitative responses
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The social and gender context of HIV disclosure in sub-Saharan Africa: A review of policies and practices
No full textThis paper reviews the legal and policy context of HIV disclosure in sub-Saharan Africa, as well as what is known about rates, consequences and social context of disclosure, with special attention to gender issues and the role of health services. Persistent rates of nondisclosure by those diagnosed with HIV raise difficult ethical, public health and human rights questions about how to protect the medical confidentiality, health and well-being of people living with HIV on the one hand, and how to protect partners and children from HIV transmission on the other. Both globally and within the sub-Saharan African region, a spate of recent laws, policies and programmes have tried to encourage or – in some cases – mandate HIV disclosure. These policies have generated ethical and policy debates. While there is consensus that the criminalization of transmission and nondisclosure undermines rights while serving little public health benefit, there is less clarity about the ethics of third party notification, especially in resource-constrained settings. Despite initiatives to encourage voluntary HIV disclosure and to increase partner testing in sub-Saharan Africa, health workers continue to grapple with difficult challenges in the face of nondisclosure, and often express a need for more guidance and support in this area. A large body of research indicates that gender issues are key to HIV disclosure in the region, and must be considered within policies and programmes. Taken as a whole, this evidence suggests a need for more attention to the challenges and dilemmas faced by both clients and providers in relation to HIV disclosure in this region and for continued efforts to consider the perspectives and rights of all those affected.Keywords: HIV testing, disclosure, policies, health providers, gende
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