Features of human papillomavirus vaccination education strategies in low- and middle-income countries: a scoping review.

OBJECTIVE: We aimed to describe studies on human papillomavirus (HPV) vaccination education strategies from low- and middle-income countries in the published literature that could be applicable in Sub-Sahara Africa. STUDY DESIGN: This scoping review was guided by Arksey and O'Malley's methodological framework advanced by Levac et al. METHODS: We searched four electronic health sciences databases for relevant reports published between January 2006 and January 2021. Two reviewers screened for inclusion and extracted data for analysis and synthesis. Descriptive statistics and narrative descriptions were used to summarize the findings. RESULTS: The database search retrieved 1757 reports, of which 48 were from low- and middle-income countries and met the inclusion criteria. Of these, there were 39 interventional studies (81.3%). Less than one-fifth of the studies (n = 9) reported a theoretical basis for their strategies. Most strategies sought to improve knowledge and awareness about HPV (75%, n = 36), whereas outcomes for the remaining studies were related to increasing HPV vaccine acceptability. HPV education strategies (1) primarily targeted females, (2) were mostly provided by health professionals, and (3) used various modalities of learning, including in-person sessions, text-based materials, media, theater, and online delivery. CONCLUSIONS: HPV educational strategies are underresearched in most LMICs, suggesting the need for more primary observational, interventional, and experimental research, as well as program evaluations, focused on HPV educational strategies and theoretically informed. Once additional studies are added to the body of evidence, it will be valuable to review and synthesize diverse sources of evidence to determine what educational strategies are most useful and have the greatest impact on HPV vaccination in these settings, particularly Sub-Saharan Africa.

Childhood immunization appointment reminders and recalls: strengths, weaknesses and opportunities to increase vaccine coverage.

OBJECTIVES: Childhood immunization coverage has been shown to be greatly impacted by parental forgetfulness regarding immunizations and appointments. Evidence supports the use of reminders and recalls to overcome this barrier, which remind parents about upcoming immunization appointments and inform them once their child is overdue for an immunization. In this study, we sought to identify reminder/recall strategies used throughout a large Canadian province and determine the perceived strengths, weaknesses and areas of improvement of existing strategies. STUDY DESIGN AND METHODS: An environmental scan was performed in 2018 in two phases: (1) interviews with public health leaders from the five zones of Alberta and (2) an online survey of public health centres across the province. Data analysis occurred in 2018 and 2019. RESULTS: Commonly reported strengths of reminders and recalls included their ability to increase appointment attendance and remind parents about immunizations, respectively. A major identified weakness was their time-consuming/resource-intensive nature. Many participants believed reminder/recalls could be improved by modernizing delivery methods. Educational information or strategies to overcome language barriers were rarely incorporated into reminder/recall systems. CONCLUSIONS: There was support for incorporating text messaging and automation into reminder/recall systems while encouraging continued exploration of novel reminder/recall delivery methods. Tailoring reminder/recalls to the needs and preferences of target populations can maximize the effectiveness of these systems. This includes modernizing methods of delivery, addressing language barriers, providing educational information, and allotting some degree of flexibility to local level management of reminder/recalls.

Manipulating social information to promote frugivory by birds on a Hawaiian Island.

Animals across a range of taxa use social information when foraging. Fruit-eating vertebrates are no exception and use social information to find fruit, which may ultimately affect plant populations via seed dispersal. In many systems, mutualistic relationships between fruiting plants and frugivores are critical to maintain ecosystem functioning, especially in the tropics. On the island of O'ahu, Hawaii, USA, all native, fruit-eating birds are extinct and several plant species are experiencing reduced recruitment likely due to a lack of seed dispersal. Over the years, numerous bird species, many of which are frugivorous, have been introduced to the island. Yet, introduced birds may not recognize native fruits as a resource and social information may be needed for introduced frugivores to target and feed on native fruits. We investigated whether social information, in the form of broadcasted bird vocalizations, of introduced birds could increase visitations and more importantly frugivory on focal fruiting plants. We also tested whether the visitation rates of introduced bird species to focal plants were influenced by conspecific and/or heterospecific vocalizations. We conducted 80 playback experiments at native and introduced fruiting plants, and compared responses to silent control periods. Four times as many frugivores were detected and 10 times more frugivory events were recorded at plants with broadcasted vocalizations compared to control periods. The Japanese White-eye (Zosterops japonicus) exhibited the strongest response to both conspecific and heterospecific playbacks. White-eyes also consumed the most fruit from the widest array of plant species during trials. Introduced birds that use social information and readily identify novel resources may more effectively colonize new areas. We suggest that the White-eye's use of social information may help to support their robust population on O'ahu. Ecosystems throughout the world are affected by the loss of mutualistic relationships, many of which provide valuable ecological services. As humans continue to modify environments, novel conservation approaches may be required to maintain important ecological functions. The use of social information to facilitate frugivory may not only be important in Hawaii, but in other tropical systems where key frugivorous species are lost or abundances have been reduced.

Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study.

OBJECTIVES: To evaluate the relationship between individual bacterial and viral pathogens and disease severity. METHODS: Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). RESULTS: Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. CONCLUSIONS: In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.

Investigation of captive red wolf ejaculate characteristics in relation to age and inbreeding.

An evaluation of a large database of red wolf fresh ejaculate characteristics (n = 427 ejaculates from 64 wolves) was undertaken to increase knowledge of seminal characteristics in the red wolf and evaluate possible relationships between inbreeding, age, and seminal quality. Phase microscopy analysis of electroejaculates collected over 14 natural breeding seasons was compared with animal ages and inbreeding coefficients. Ejaculate volume increased and sperm concentration and total count decreased as wolves aged (P < 0.01, 0.001, and 0.05, respectively), and the proportion of sperm cell morphological abnormalities was greater in animals with higher coefficients of inbreeding (P < 0.001), particularly for older animals (P < 0.001). Moreover, the mean coefficient of inbreeding of animals that had failed to reproduce given at least one opportunity during their lifetimes was significantly greater than that of wolves with proven fertility, and wolves of proven fertility exhibited higher sperm concentrations and total counts than nonproven wolves. Thus, as the captive red wolf population becomes more inbred, the maximum age of reproduction is likely to decrease; an important finding to consider when projecting population dynamics and determining pairing recommendations.

The reproductive endocrinology and behavior of Vancouver Island marmot (Marmota vancouverensis).

The Vancouver Island marmot (Marmota vancouverensis; VIM) is one of North America's most endangered species with fewer than 150 individuals remaining in the wild. A captive breeding program was established across four facilities in Canada as an insurance population and source of animals for reintroduction to the wild. The purpose of this study was to gather information about the basic reproductive biology and behavior of this species, which is essential to improve captive breeding programs. Regular fecal samples were obtained from adult female (n = 14) and male (n = 10) marmots, 2 years of age and older, over 1-3 breeding seasons (2-3 months duration posthibernation) for steroid hormone analysis. Enzyme immunoassays were validated for quantifying fecal testosterone metabolite concentrations for males, and fecal estrogen and progesterone metabolite concentrations for females. Results indicated that fecal progesterone metabolite concentrations can be used to monitor ovulation and pregnancy. Behavioral monitoring through infrared video surveillance was conducted in four breeding pairs over a 2-year period (n = 7 behavioral profiles). Breeding behaviors correlated strongly with changes in reproductive endocrine profiles. A high frequency of play behavior or "wrestling" was observed in conjunction with breeding activity before an elevation in progesterone metabolite concentrations. Impending parturition was associated with increased aggression and exclusion of the male from the maternal nestbox as well as an increase in nesting activity. Observational data combined with hormonal analysis suggest that female VIMs are induced ovulators and that multiple breeding attempts may be required for ovulation and conception. Gestation appears to be approximately 34 days from peak breeding activity (32 days from estimated ovulation). Fecal testosterone concentrations suggest that testicular activity is seasonal with the reproductive activity occurring immediately posthibernation. Monitoring breeding behavior is a useful means of indicating estrus, conception and pregnancy, which can also be supported by the hormonal analysis of daily fecal samples of individual animals.

Retrospective investigation of captive red wolf reproductive success in relation to age and inbreeding.

The critically endangered red wolf (Canis rufus) has been subject to a strictly managed captive breeding program for three decades. A retrospective demographic analysis of the captive population was performed based on data from the red wolf studbook. Data analyses revealed a decrease in the effective population size relative to the total population size, and changes in age structure and inbreeding coefficients over time. To varying degrees, the probability of successful breeding and litter sizes declined in association with increasing dam age and sire inbreeding coefficients. Neonate survival also declined with increasing dam age. Recent changes in strategies regarding breed-pair recommendations have resulted in moderate increases in reproductive success.

Comparison of different osmolalities and egg-yolk composition in processing media for the cryopreservation of red wolf (Canis rufus) sperm.

Successful cryopreservation of sperm and the maintenance of a sperm-based genome resource bank have been identified as priorities for the recovery of the endangered red wolf (Canis rufus). The objectives were to improve sperm processing and to determine the relative timing of damage to red wolf sperm during freezing and thawing. Fresh ejaculates (n=37) from adult red wolves (n=15, aged 2-13 y) were collected via electroejaculation and subjected to cooling, freezing and thawing in four TRIS-egg-yolk extender treatments varying in osmolality ( approximately 305 mOsm versus approximately 350 mOsm) and egg-yolk composition (0.8 microm-filtered versus unfiltered). Ejaculates were evaluated for sperm percentage motility, forward progressive motion, and morphological characteristics immediately upon collection and following extension, cooling (prior to freezing) and thawing. Although no single treatment consistently produced superior results, sperm suspended in approximately 305 mOsm extenders exhibited slight losses in motility post-thawing (13 and 7%). Also, sperm suspended in approximately 350 mOsm extenders tended to have slower rates of decline in motility in vitro post-thawing than those stored in approximately 305 mOsm extenders (P=0.55). Finally, extenders incorporating unfiltered egg yolk exhibited a slightly larger ratio of absent to partial acrosomes than did sperm frozen in extenders prepared with clarified egg yolk. For approximately 350 mOsm extenders, most motility loss occurred during the cooling rather than freezing and thawing. In conclusion, these data contribute to knowledge regarding cryopreservation of red wolf sperm.

Maternal understanding of diarrhoea-related dehydration and its influence on ORS use in Indonesia.

Dehydration resulting from diarrhoea remains a significant cause of death for young children in developing countries such as Indonesia. Although Oral Rehydration Solution (ORS) is effective in preventing and treating dehydration, its use in home treatment is not widespread. This study sought to assess whether mothers' understanding of diarrhoea-related dehydration influenced their use of ORS in home treatment. One hundred mothers of children under the age of five years in rural Indonesia were surveyed using a structured questionnaire, administered in an interview format in their homes. Only 38 (38%) of the mothers surveyed could identify two or more correct signs of dehydration. Significant relationship was found between maternal knowledge of correct signs of dehydration and the use of ORS in home treatment (OR 3.36, 95% CI 1.24, 10.63). Resulting recommendations include improved health education programming for mothers of young children, as well as future programme evaluation and intervention studies.

Pathology of intrinsic cardiac neurons from ischemic human hearts.

Various populations of intrinsic cardiac neurons influence regional cardiac function tonically. It is not known whether such neurons are affected by disease states and, if so, in what manner. Therefore, the morphology of intrinsic cardiac ganglia obtained from patients with angiographic evidence of compromised regional coronary blood supply was studied. Posterior atrial ganglia and surrounding fat, removed at the time of cardiac surgery, were placed immediately in saline and within 15-120 min (average of about 40 min) in 0.5% paraformaldehyde/2.5% glutaraldehyde. In 32 studied ganglia, 35% of 473 intrinsic cardiac neurons displayed striking pathological changes at the light and ultrastructural level. The other cells displayed normal morphology. The cytoplasm of 74% of the abnormal cells had one or more of three types of inclusions: (1) darkly stained lamellated inclusions (Type I), (2) membrane-bound whorls and parallel arrays of lightly stained membranes, as well as fine granular material (Type II), or (3) concentric layers of lightly stained membranes with a darker, granular core (Type III). Neurons with inclusions were markedly enlarged (66 x 54 microm vs. 40 x 34 microm for normal neurons) and displayed fewer dendrites. Some neurons contained electron lucent vacuoles indicative of degeneration while others showed frank degeneration, being fragmented, shrunken, and misshapen. Phagocytic cells containing lamellated inclusions and cellular debris were found in ganglia with abnormal neurons. Some axon terminals also displayed degenerative changes. The identification of pathological changes in the human intrinsic cardiac nervous system has implications with respect to the functional integrity of this final common regulator of cardiac function in disease states.

Cholinesterases in cardiac ganglia and modulation of canine intrinsic cardiac neuronal activity.

Cholinergic neurotransmission plays a significant role in intrinsic cardiac ganglia with the action of acetylcholine being terminated by acetylcholinesterase (AChE, EC 3.1.1.7). Anatomical studies were performed to characterize neurons associated with AChE and a closely related enzyme, butyrylcholinesterase (BuChE, EC 3.1.1.8), in canine intrinsic cardiac ganglia. Histochemical staining for AChE and BuChE in canine right atrial neurons showed that there were four neuronal populations, namely, those that contained AChE only, BuChE only, both AChE and BuChE, and those that did not contain either enzymes. The neuronal activity of intrinsic cardiac neurons in response to substrates and inhibitors of cholinesterases were studied in anesthetized dogs. The activity of intrinsic cardiac neurons, as measured by changes in the number of action potentials, increased by local application of acetylcholine. However, local application of butyrylcholine led to a considerably greater increase in the activity of intrinsic cardiac neurons. In keeping with the neurochemical heterogeneity in intrinsic cardiac ganglia with respect to cholinesterases, the activity generated by most butyrylcholine-sensitive neurons was not influenced by acetylcholine and the activity generated by the most acetylcholine-sensitive neurons was not influenced by butyrylcholine. This suggests that these two agents preferentially influence different populations of intrinsic cardiac neurons. Enzyme kinetic studies demonstrated that canine AChE preferentially catalyzed the hydrolysis of acetylcholine while canine BuChE preferentially catalyzed the hydrolysis of butyrylcholine. Cholinesterase inhibitors Ro 2-1250 and Ro 2-0638 inhibited both canine cholinesterases, while huperzine A preferentially inhibited canine AChE and ethopropazine inhibited canine BuChE. The activity of neurons in the intrinsic cardiac ganglia significantly increased when Ro 2-1250 or Ro 2-0638 was administered locally. The activity of neurons was not affected when huperzine A or ethopropazine was administered, indicating that both cholinesterases must be inhibited to increase neuronal activity. In summary, these data show that in addition to AChE, intrinsic cardiac ganglia also contain distinct populations of neurons that are associated with BuChE, and the activity generated by these neurons is differentially influenced by their substrates. Because simultaneous inhibition of AChE and BuChE leads to increased neuronal activity, it is concluded that AChE- and BuChE-positive intrinsic cardiac neurons may act synergistically to influence the overall tonic activity of intrinsic cardiac ganglia.

Learning the configuration of a landmark array: I. Touch-screen studies with pigeons and humans.

Pigeons and humans searched on a touch-screen monitor for an unmarked goal located relative to an array of landmarks presented in varied screen locations. After training with the goal centered in various square arrays of 4 landmarks, humans, but not pigeons, transferred accurately to arrays with novel elements. Humans searched in the middle of expanded arrays, whereas pigeons preserved the distance and direction to a single landmark. When trained with the goal centered below 2 identical horizontally aligned landmarks, humans responded to horizontal expansions or contractions of the array by shifting their search vertically, preserving angles from landmarks to goal. Pigeons did not adjust their search vertically. Humans trained with a single landmark adjusted search distance when landmark size was changed. Both pigeons and humans use the configuration of a landmark array, but the underlying processes seem to differ.

Effects of cold storage and water stress on water relations and gas exchange of white spruce (Picea glauca) seedlings.

To determine the effects of lifting time and storage on water-stress resistance of nursery-grown white spruce (Picea glauca (Moench) Voss) seedlings, we compared gas exchange, water relations and mortality of 3-year-old seedlings lifted in October 1991 and stored at -2 degrees C for 3 months with seedlings lifted in January 1992. The seedlings were placed in nutrient solution and subjected to -1.1 or -2.7 MPa water stress induced by polyethylene glycol 3350 for 9 days. Water stress, but not lifting time, had a significant effect on seedling net assimilation, symplastic volume and turgor loss point. In a second experiment, seedlings lifted in October 1991 were stored at -2 degrees C for 7 months and compared with seedlings lifted in May 1992. The seedlings were planted in pots, and their gas exchange and water relation parameters measured in response to gradual water stress. The results suggest that prolonged cold storage retards photosynthetic recovery of seedlings after planting. Higher rates of net assimilation in seedlings lifted in May were not directly related to their water status. Nonstomatal limitations were the primary factor influencing photosynthetic rate. We conclude that the inferior ability of cold-stored seedlings to tolerate water stress was due to poor osmotic adjustment and a lag in recovery of photosynthesis.

Marmoset (Callithrix jacchus jacchus) spatial memory in a foraging task: win-stay versus win-shift strategies.

The spatial memory of common marmosets (Callithrix jacchus jacchus) was explored in 3 experiments with a simulated foraging task. In Experiment 1, individual monkeys foraged among 8 baited food sites. They appeared to use spatial memory to accurately avoid revisiting previously depleted sites. There was no difference in accuracy between the adult monkeys and a juvenile monkey tested on the same task. In Experiment 2, a win-stay paradigm was used. The adult monkey subject very accurately remembered locations that had previously contained food. The monkey tended to visit adjacent correct sites when retrieving food and thus minimized the total distance travelled. In Experiment 3, a win-shift paradigm was used with 2 adult monkeys. Although both monkeys performed at above-chance levels of accuracy on the win-shift task, they made many errors. These results suggest that marmosets may prefer tasks that require a win-stay strategy.

Gorillas' (Gorilla gorilla gorilla) spatial memory in a foraging task.

The spatial memory of 2 gorillas (Gorilla gorilla gorilla) was explored in a simulated foraging task. Trials consisted of 2 parts separated by a delay. In the 1st part, half of the total number of food sites were baited with a highly preferred food, and the subject was allowed to search, find, and consume these items (search phase). During the delay the same locations were again baited. After the delay the animal was reintroduced to the test enclosure and allowed to search through the sites again (re-search phase). In Experiment 1, an adult gorilla was very accurate in remembering locations that had previously contained food at delay intervals of 24 hr or more. In Experiment 2, a juvenile gorilla was also accurate in remembering locations that had previously contained food at delays up to 10 min. The adult gorilla appeared to use a counting strategy during the search phase to minimize the number of sites visited.

A comparison of family physicians' and obstetricians' intrapartum management of low-risk pregnancies.

BACKGROUND: We hypothesized that family physicians' style of intrapartum management was less interventional than the management style of obstetricians, and that this would not adversely affect maternal or neonatal outcomes. METHODS: A retrospective, matched-pair study design was used to compare low-risk women cared for by community family physicians with those cared for by obstetricians at a small teaching hospital. The subjects were matched on the basis of age and parity. We compared the rates of intervention between family physicians and obstetricians. RESULTS: We studied 351 matched pairs of women. The demographic characteristics of patients were similar as were the rates for most labor and delivery procedures. Family physicians had lower rates for induction, external and internal fetal monitoring, narcotic analgesia use, and postpartum oxytocin use. Women cared for by family physicians spent less time in the hospital, both during labor and postpartum. CONCLUSION: This study supports the hypothesis that at our center family physicians intervene less than obstetricians in intrapartum management. Comparisons with similar studies conducted at other academic centers illustrate differences in styles of practice between institutions, not just between specialties.

Ecophysiology of shade needles of Picea glauca saplings in relation to removal of competing hardwoods and degree of prior shading.

We studied shade needles of Picea glauca (Moench) Voss saplings that were growing in 15, 45 or 90% shade from competing vegetation at northern boreal forest sites in Alberta and Saskatchewan. At each site, in late May or early June 1990, all hardwoods were removed within a 2-m radius of each of eight saplings in each shade treatment (released saplings), and eight saplings in each shade treatment were left as controls. Light-saturated net assimilation (NA), stomatal and mesophyll conductance and water use efficiency of one-year-old needles were measured four times during the 1990 growing season and in the spring of 1991. There was a trend of increased photosynthetic capacity within one week following release. By August 1990 and in the following spring, NA was higher in released trees than in controls. The increase in NA appeared to be related to increased stomatal conductance to water vapor and to increased foliar nitrogen and resulting increases in mesophyll conductance to CO(2). There was no measurable effect of degree of shading prior to release on NA following release. Foliage of the released saplings appeared capable of rapid acclimation to the open conditions.

Diurnal variation and interrelations of ecophysiological parameters in three peatland woody species under different weather and soil moisture conditions.

The diurnal patterns of twig xylem water potential, net photosynthesis rate, water use efficiency of photosynthesis, and stomatal and mesophyll conductance to CO2 in tamarack, black spruce and swamp birch growing in a natural peatland in central Alberta, Canada, were examined. The relationships of photosynthesis to other ccophysiological parameters were investigated. Data were collected on three days with different weather and soil moisture conditions in the 1988 growing season. Day 1 was clear and warm and the ground water table was 7 cm above the average peat surface. Day 2 was clear and hot. Day 3 was cloudy but warm. On day 2 and day 3, the water tables were in the normal range for that season. Major findings were: 1) Soil flooding depressed photosynthesis in tamarack and black spruce. 2) Swamp birch was better adapted to flooding than tamarack or black spruce. 3) The trees experienced water stress in the afternoons of the two days with lower water table. 4) Changes in photosynthesis of the three species were primarily affected by changes in mesophyll conductance (gm) and the response of photosynthesis to changes in gm was similar for all three species.

Caffeine intoxication: a near fatality.

A 37-year-old woman ingested approximately 27 g caffeine in a suicide attempt. After initial presentation with supraventricular tachycardia, hypotension, and coma, she suffered repeated episodes of ventricular fibrillation. Resin hemoperfusion was performed, with prompt stabilization of the patient's cardiovascular status. Methylxanthine toxicity is briefly reviewed.