Couples' decision making regarding the use of multipurpose prevention technology (MPT) for pregnancy and HIV prevention.

We conducted a secondary analysis of discrete choice experiment (DCE) data from 395 couples enrolled in the Microbicide Trials Network (MTN)-045/CUPID study in Uganda and Zimbabwe to understand couple decision making around choice of multipurpose prevention technologies (MPTs) to prevent both HIV and pregnancy. Members of couples completed the same DCE, first separately then jointly, choosing between two hypothetical MPTs in a series of nine questions. Most couples either had similar preferences at the outset or had equal decision-making around MPTs (62%). Couples with male influence (17%) were more likely to use contraceptive pills with a male partner's knowledge and couples with female influence (21%) were less likely to have shared decision making about family planning. Males influenced discussion around MPT duration, side effects, menstrual changes, and how the vagina feels during sex. Decision making was relatively shared, though decisions around certain attributes were more likely to be dominated by male partners.

Incorporating end-users' voices into the development of an implant for HIV prevention: a discrete choice experiment in South Africa and Zimbabwe.

BACKGROUND: Input from end-users during preclinical phases can support market fit for new HIV prevention technologies. With several long-acting pre-exposure prophylaxis (PrEP) implants in development, we aimed to understand young women's preferences for PrEP implants to inform optimal design. METHODS: We developed a discrete choice experiment and surveyed 800 young women in Harare, Zimbabwe and Tshwane, South Africa between September-November 2020. Women aged 18-30 years who were nulliparous, postpartum, or exchanged sex for money, goods or shelter in prior year were eligible; quotas were set for each subgroup. The DCE asked participants to choose between two hypothetical implants for HIV prevention in a series of nine questions. Implants were described by: size, number of rods and insertion sites, duration (6-months, 1-year, 2-years), flexibility, and biodegradability. Random-parameters logit models estimated preference weights. RESULTS: Median age was 24 years (interquartile range 21-27). By design, 36% had used contraceptive implants. Duration of protection was most important feature, with strong preference for a 2-year over 6-month implant. In Zimbabwe, the number of rods/insertion sites was second most important and half as important as duration. Nonetheless, to achieve an implant lasting 2-years, 74% were estimated to accept two rods, one in each arm. In South Africa, preference was for longer, flexible implants that required removal, although each of these attributes were one-third as important as duration. On average, biodegradability and size did not influence Zimbabwean women's choices. Contraceptive implant experience and parity did not influence relative importance of attributes. CONCLUSIONS: While duration of protection was a prominent attribute shaping women's choices for PrEP implants, other characteristics related to discreetness were relevant. Optimizing for longest dosing while also ensuring minimal detection of implant placement seemed most attractive to potential users.

Couples' Preferences for "2 in 1" Multipurpose Prevention Technologies to Prevent Both HIV and Pregnancy: Results of a Discrete Choice Experiment in Uganda and Zimbabwe.

End-user input early in biomedical product development may optimize design to support high uptake and adherence. We interviewed 400 couples (800 total participants) in Uganda and Zimbabwe to assess their preferences for multipurpose prevention technologies (MPTs) for HIV and pregnancy prevention. Using a discrete choice experiment, couples made a series of choices between hypothetical MPTs, including oral tablets and vaginal rings, inserts, and films and completed an interviewer-administered questionnaire assessing sociodemographic and behavioral measures. Most couples preferred presented MPTs over male condoms. Couples' MPT choices in both countries were influenced most by the combination of product form and dosing frequency, with monthly dosing preferred over daily. Analysis highlighted differences by country as to which side effects were most important: Ugandan couples placed greater importance on effects on the vaginal environment during sex, whereas Zimbabwean couples placed more importance on changes to menstruation and other side effects (headache, cramps). Couples' preferences signaled an openness to new product forms and more frequent dosing if preferred characteristics of other attributes were achieved.

Delayed Cord Clamping Uptake and Outcomes for Infants Born Very Preterm in California.

OBJECTIVE: The aim of this study is to investigate whether the purported benefits of delayed cord clamping (DCC) translate into a reduction in mortality and intraventricular hemorrhage (IVH) among preterm neonates in practice. STUDY DESIGN: This was a prospective cohort study of very preterm infants constructed from data from the California Perinatal Quality Care Collaborative for infants admitted into 130 California neonatal intensive care units (NICUs) within the first 28 days of life from 2016 through 2020. Individual-level analyses were conducted using log-binomial regression models controlling for confounders and allowing for correlation within hospitals to examine the relationship of DCC to the outcomes of mortality and IVH. Hospital-level analyses were conducted using Poisson regression models with robust variance controlling for confounders. RESULTS: Among 13,094 very preterm infants included (5,856 with DCC and 7,220 without), DCC was associated with a 43% lower risk of mortality (adjusted risk ratio [aRR]: 0.57; 95% confidence interval [CI]: 0.47-0.66). Furthermore, every 10% increase in the hospital rate of DCC among preterm infants was associated with a 4% lower hospital mortality rate among preterm infants (aRR: 0.96; 95% CI: 0.96-0.99). DCC was associated with severe IVH at the individual level, but not at the hospital level. CONCLUSION: At the individual level and hospital level, the use of DCC was associated with lower mortality among preterm infants admitted to NICUs in California. These findings are consistent with clinical trial results, suggesting that the effects of DCC seen in clinical trials are translating to improved survival in practice. KEY POINTS: · DCC was associated with lower mortality among very preterm newborns in California.. · Hospitals using DCC more often had lower very preterm mortality.. · DCC was not associated with IVH at the hospital level..

A Bayesian Modelling Framework for Integration of Ecosystem Services into Freshwater Resources Management.

Models of ecological response to multiple stressors and of the consequences for ecosystem services (ES) delivery are scarce. This paper describes a methodology for constructing a BBN combining catchment and water quality model output, data, and expert knowledge that can support the integration of ES into water resources management. It proposes "small group" workshop methods for elucidating expert knowledge and analyses the areas of agreement and disagreement between experts. The model was developed for four selected ES and for assessing the consequences of management options relating to no-change, riparian management, and decreasing or increasing livestock numbers. Compared with no-change, riparian management and a decrease in livestock numbers improved the ES investigated to varying degrees. Sensitivity analysis of the expert information in the BBN showed the greatest disagreements between experts were mainly for low probability situations and thus had little impact on the results. Conversely, in our applications, the best agreement between experts tended to occur for the higher probability, more likely, situations. This has implications for the practical use of this type of model to support catchment management decisions. The complexity of the relationship between management measures, the water quality and ecological responses and resulting changes in ES must not be a barrier to making decisions in the present time. The interactions of multiple stressors further complicate the situation. However, management decisions typically relate to the overall character of solutions and not their detailed design, which can follow once the nature of the solution has been chosen, for example livestock management or riparian measures or both.

Refining benthic macroinvertebrate kick sampling protocol for wadeable rivers and streams in Ethiopia.

Streams and rivers cover a larger proportion of the Earth's surface but are highly affected by human pressures. Conversely, bioassessment methods are in their infancy in developing countries such as Ethiopia. In this study, we compared 2- and 3-min macroinvertebrate kick samples at multiple locations for both riffle habitat (RH) and multihabitat (MH) approaches. The performance of each method was evaluated statistically using benthic macroinvertebrate metrics and diversity indices. Results of the Kruskal-Wallis analysis in this study showed no significant differences among methods tested in minimally impacted streams in Ethiopia and generally performed equally irrespective of the methods employed except for total abundances and Ephemeroptera abundances. Furthermore, multivariate analysis of the relative abundances of macroinvertebrate communities using analysis of similarity (ANOSIM), RELATE, non-metric multidimensional scaling (MDS), and classification strength-sampling method comparability (CS-SMC) indicated a high similarity in the macroinvertebrate communities recorded among all methods employed in this study area. However, the index of multivariate dispersion (IMD) test showed variations in relative abundances of macroinvertebrate communities among the methods. In summary, if the focus is not on rare taxa and the required information is not dependent on additional evidence provided by the use of lower taxonomic levels of identification (genus and species), the results of the present study support the use of the shorter 2-min RH kick sampling method for the bioassessment of wadeable rivers and streams in Ethiopia.

Preferences and Acceptability of Vaginal Delivery Forms for HIV Prevention Among Women, Male Partners and Key Informants in South Africa and Zimbabwe: Qualitative Findings.

The attributes of an HIV microbicide may affect its acceptability, uptake and use. Quatro, a clinical study with a qualitative component, was conducted to elicit input from end-users and key informants (KIs) on four different placebo vaginal microbicide delivery forms; fast dissolving insert, ring, film and gel. In-depth interviews and focus group discussions were conducted with young women, their male partners and KIs, to explore acceptability and preferences of the four placebo products, with the intention of improving product attributes, adherence, and consequently, long term effectiveness. None of the four microbicide delivery forms stood well above others as the most preferred. Product attributes; long-action, ease of use, invisibility, female initiated and non-interference during sex were favourable in both countries. Despite preference for the long-action, on-demand products were the most liked by women. Qualitative data from the Quatro study provided rich feedback on specific attributes important to the acceptability of four HIV prevention product platforms currently in development, enabling more informed and guided product development efforts moving forward.

Coarse sediment dynamics and low-head dams: Monitoring instantaneous bedload transport using a stationary RFID antenna.

Coarse sediment transport in fluvial systems serves an important role in determining in-stream physical habitat, spawning potential and benthic community structure. However, despite more than a decade of pressure in Europe to restore stream continuity under the Water Framework Directive (WFD), there have been relatively few empirical studies on how low-head, run-of-river structures (i.e., weirs) disrupt the processes and dynamics of bedload conveyance. In this study we present an investigation into how coarse sediment is transferred through a low-head dam via the real-time monitoring of bedload transport over a weir in southeast Ireland. Critical discharge values for particle entrainment over the structure were derived from the novel use of a stationary RFID antenna, coupled with continuous recording of water levels and sediment captured downstream using pit-style sediment traps. The stationary RFID antenna was installed along a weir crest using both 'pass-under' and 'pass-over' configurations as a means of detecting the moment bedload tracers moved over the dam crest. Results show that 10% of tracers deployed upstream were detected passing over the weir, while a further 15% that were not detected were recovered downstream. These results indicate bedload material as large as the upstream D70 (i.e., 90 mm) can move over the structure during infrequent high-flow events. However, thorough searches of the seeded area upstream of the dam also suggest that as many as 43% of the total number may have passed downstream, indicating that tracers moved over the weir after the antenna was damaged during a high-flow event, or were missed due to either particle velocity or signal collision. In addition, 30 of the tracers that remained upstream were shown to have either been buried due to the subsequent influx of sediment entering the reservoir, or were reworked though the surface material. Critical discharge values indicate size-selective transport patterns may dominate and a strong correlation between event peak discharge and total bedload captured downstream. These findings provide more evidence that low-head structures may eventually adopt a morphology that allows for the intermittent storage and later export of a channel's bedload downstream as hypothesized by other authors. Building upon these findings and those of other recent field studies, we present a set of possible schematic models that offer a basis for understanding the unique ways low-head dams can continue to disrupt sediment conveyance long after they have reached their functional storage capacity. The limitations of using a stationary RFID antenna and possible recommendations for future studies are discussed.

Effect of low-head dams on reach-scale suspended sediment dynamics in coarse-bedded streams.

River infrastructure is one of the primary threats to riverine ecosystems globally, altering hydromorphological processes and isolating habitats. Instream barriers and low-head dams can have significant effects on system connectivity, but despite this, very few empirical studies have assessed the impacts of these structures on suspended sediment transport. Through a paired turbidity study over a 20-month monitoring period we investigated the differences in suspended sediment flux above and below two low-head dams in the south-east of Ireland. Using sediment balance as a proxy for sediment storage, results showed that a net-export of sediment from the study reach occurred for 68% of the high-flow events analysed. As the primary controls on sediment dynamics at the downstream reach depend on sediment availability from upstream, we argue that these results indicate the presence of a substantial local source of sediment between monitoring stations that cannot be explained by natural intra-reach erosional processes. Here we hypothesise that as sediment supply from the catchment becomes exhausted, the structure's impounded zone (typically considered a depositional area) provides a major sediment source to the downstream reach. Our rationale is that if sediment trapped behind the weir is periodically available for transportation at the rates and frequencies observed in this study, then we can infer that both structures must be trapping sediment under lower flows.

The Effect of Maternal Multiple Micronutrient Supplementation on Female Early Infant Mortality Is Fully Mediated by Increased Gestation Duration and Intrauterine Growth.

BACKGROUND: Maternal micronutrient supplementation in pregnancy (MMS) has been shown to improve birth weight among infants in low- and middle-income countries. Recent evidence suggests that the survival benefits of MMS are greater for female infants compared to male infants, but the mechanisms leading to differential effects remain unclear. OBJECTIVE: The objective of this study was to examine the potential mechanisms through which MMS acts on infant mortality among Tanzanian infants. METHODS: We used data collected from pregnant women and newborns in a randomized, double-blind, placebo-controlled trial of MMS conducted in Tanzania to examine mediators of the effect of MMS on 6-wk infant mortality (NCT00197548). Causal mediation analyses with the counterfactual approach were conducted to assess the contributions of MMS on survival via their effects on birth weight, gestational age, weight-for-gestational age, and the joint effect of gestational age and weight-for-gestational age. The weighting method allowed for interaction between gestational age and weight-for-gestational age. RESULTS: Among 7486 newborns, the effect of MMS on 6-wk survival was fully mediated (100%) through the joint effect of gestational age and weight-for-gestational age. MMS was also found to have a significant natural indirect effect through increased birth weight (P-value < 0.001) that explained 75% of the total effect on 6-wk mortality. When analyses were stratified by sex, changes in gestational age and weight-for-gestational age fully mediated the mortality effect among female infants (n = 3570), but these mediators only explained 34% of the effect among males (n = 3833). CONCLUSIONS: The potential sex-specific effects of MMS on mortality may be a result of differences in mechanisms related to birth outcomes. In the context of the Tanzanian trial, the observed effect of MMS on 6-wk mortality for female infants was entirely mediated by increased gestation duration and improved intrauterine growth, while these mechanisms did not appear to be major contributors among male infants.

REPLATINUM Phase III randomized study: RRx-001 + platinum doublet versus platinum doublet in third-line small cell lung cancer.

RRx-001 is a cysteine-directed anticancer alkylating agent with activity in a Phase II study in platinum refractory small cell lung cancer. Here, we describe the design of REPLATINUM, an open-label, Phase III trial. 120 patients with previously platinum-treated small cell lung cancer in third line will be randomized 1:1 to receive RRx-001 followed by four cycles of a platinum doublet, and then alternating cycles of RRx-001 and single agent platinum until progression versus four cycles of a platinum doublet. At radiologic progression on the platinum doublet, patients may cross over to the RRx-001 arm. Primary objective: to demonstrate superior progression-free survival in the RRx-001 population. Secondary objectives: to demonstrate superiority for overall survival and objective response rate. Clinical Trial registration: NCT03699956.

Non-native species and lake warming negatively affect Arctic char Salvelinus alpinus abundance; deep thermal refugia facilitate co-existence.

This study finds that non-native species and warming temperatures have significant negative effects on Arctic char Salvelinus alpinus abundance in Irish lakes. Eutrophication was not important at the range of total phosphorus tested (0.005-0.023 mg l-1 ). Model results predict that S. alpinus occur across the temperature range sampled (8.2-19.7°C) when non-natives are absent, but S. alpinus catch is predicted to be close to zero irrespective of temperature when non-native catch is high. This result indicates that to persist, S. alpinus may require a habitat where non-natives are at low abundance or absent. Salvelinus alpinus segregated from other species along the thermal axis, inhabiting significantly colder water and actively avoided non-native species, which appeared to limit their distribution. The thermal niche realized by S. alpinus in non-native dominated lakes was thus compressed relative to native dominated lakes and S. alpinus population density was significantly lower. These findings were consistent even when the only non-native present was Perca fluviatilis. Temperature appeared to limit the distribution of non-native species, such that the presence of deep thermal refugia is currently facilitating S. alpinus co-existence with non-natives in associated lakes. Diet analysis identified P. fluviatilis as potential predators and competitors. This study provides strong evidence that non-native species are a key driver of low S. alpinus abundance in Irish lakes. Temperature increases associated with climate change are identified as a secondary concern, as they could erode S. alpinus' thermal niche and lead to their extirpation. The lower thermal buffering capacity of shallow lakes identifies these as higher risk systems. Salvelinus alpinus conservation in Ireland should focus on preventing future illegal non-native species introductions because unlike other stressors (e.g., eutrophication etc.), species introductions are rarely reversible.

Pollution Assessment of Toxic and Potentially Toxic Elements in Agricultural Soils of the City Addis Ababa, Ethiopia.

Due to the significantly fast urban expansion and increased industrial activities, the soils in the farms in Addis Ababa are contaminated by some toxic and potentially toxic elements (As, V, Cr, Fe, Co, Ni, Cu, B, Ba, Sr, Zn, Mn, Pb and Cd) in varying degrees. The mean concentrations of Cr, Ni, As and B in most of the soil farms were found to be higher than the maximum recommended limits. The mean concentrations of Cd, Cu, Pb, Co, Ni and Mn were found to be higher than the background soil concentrations given for uncontaminated soils. Multivariate analyses coupled with correlation analysis were used to identify possible sources. The geo-accumulation index values for Cr, Mn and Pb indicated that the farm soils were unpolluted to moderately polluted as a result of anthropogenic activities. A comprehensive environmental management strategy should be formulated by the government to measure further pollution of the farmland soil.

Developing an undue influence screening tool for Adult Protective Services.

The study purpose was to develop and pilot an undue influence screening tool for California's Adult Protective Services (APS) personnel based on the definition of undue influence enacted into California law January 1, 2014. Methods included four focus groups with APS providers (n = 33), piloting the preliminary tool by APS personnel (n = 15), and interviews with four elder abuse experts and two APS administrators. Social service literature-including existing undue influence models-was reviewed, as were existing screening and assessment tools. Using the information from these various sources, the California Undue Influence Screening Tool (CUIST) was developed. It can be applied to APS cases and potentially adapted for use by other professionals and for use in other states. Implementation of the tool into APS practice, policy, procedures, and training of personnel will depend on the initiative of APS management. Future work will need to address the reliability and validity of CUIST.

Compact solar autoclave based on steam generation using broadband light-harvesting nanoparticles.

The lack of readily available sterilization processes for medicine and dentistry practices in the developing world is a major risk factor for the propagation of disease. Modern medical facilities in the developed world often use autoclave systems to sterilize medical instruments and equipment and process waste that could contain harmful contagions. Here, we show the use of broadband light-absorbing nanoparticles as solar photothermal heaters, which generate high-temperature steam for a standalone, efficient solar autoclave useful for sanitation of instruments or materials in resource-limited, remote locations. Sterilization was verified using a standard Geobacillus stearothermophilus-based biological indicator.

Implementation of a 24-hour pharmacy service with prospective medication review in the emergency department.

BACKGROUND: It is reported that more than 128 million patients are seen in emergency departments (EDs) annually. Patient overcrowding had been associated with an increased occurrence of medication errors. PURPOSE: Due to increased patient volume and the need for improved patient safety, a 24-hour pharmacy service was established for our institution's ED. The purpose of the study is to quantify and demonstrate the impact of a 24-hour pharmacy service in an urban ED. METHODS: This was a retrospective descriptive study conducted at a regional level 1 trauma center. The study period occurred between December 2012 and July 2013. The following variables were quantified and analyzed: number of medication orders reviewed, number of intravenous medications compounded, and number of clinical interventions that were recommended by the ED pharmacy team (EDPT) and accepted by ED clinicians. RESULTS: A total of 3,779 medication orders were reviewed by the EDPT. Of these orders, 3,482 (92%) were prospectively reviewed. A total of 3,068 (81.2%) and 711 (18.8%) orders were reviewed for the adult and pediatric ED, respectively. During the study period, the EDPT procured 549 intravenous admixtures and conducted 642 clinical interventions. Most of the interventions involved providing drug information for physicians and nurses (45.9%), adjusting drug dosages (21.1%), and recommending antimicrobial therapy (15.1%). CONCLUSION: The implementation of a 24-hour pharmacy service at our institution was an innovative practice that increased the role of pharmacists in the ED. The EDPT conducted prospective medication review, procured intravenous admixtures from a sterile environment, and provided therapeutic recommendations for the ED interdisciplinary team.

Phase 1 pilot study of RRx-001 + nivolumab in patients with advanced metastatic cancer (PRIMETIME).

Background: Bromonitrozidine (RRx-001) is a minimally toxic, NLRP3 inhibitor that has been observed, in experimental systems, to also downregulate CD47, repolarize tumor associated macrophages (TAMs) and normalize aberrant tumor perfusion. This phase 1 pilot study was undertaken to determine the safety and feasibility of RRx-001 and nivolumab in patients with advanced cancer and no standard options. Methods: This single arm, single site, open-label pilot study (NCT02518958) called PRIMETIME was designed to evaluate the safety profile of RRx-001 and nivolumab in patients with advanced malignancies and no other standard therapeutic options. A 3 + 3 trial design was used to establish safety of the combination at each dose level and guide the decision to escalate dose. RRx-001 is infused once weekly while nivolumab is given at 3mg/kg once every 2 weeks. The RRx-001 starting dose was 2 mg IV weekly with 4 dose level escalations up to 16 mg IV weekly. From January 2015 to November 2015, twelve patients received treatment for only 4 cycles (total 12 weeks) with the combination due to unavailability of nivolumab, which was not supplied to the Sponsor. Treatment-emergent (all cause, TEAEs) and treatment-related (TRAEs) adverse events that occurred within 16 weeks of the first dose of RRx-001 and nivolumab were characterized according to CTCAE v4.03. Results: Twelve patients received ≥1 dose of RRx-001 and nivolumab. One discontinuation occurred due to pneumonitis and one to voluntary withdrawal after a post-procedural infection. There were no DLTs. The main adverse event related to RRx-001 was infusion reaction (33.3%). The main adverse event related to the combination was pseudoprogression manifested by larger tumors in patients that were symptomatically improved (25%). The most common immune-related treatment-emergent AEs were pneumonitis (8.3%), and hypothyroidism (8.3%). The objective response rate at 12 weeks was 25% and the disease control rate (DCR) consisting of ≥SD was 67% by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. 25% of the patients progressed on the combination. Conclusions: The combination of RRx-001 and nivolumab was safe and well-tolerated with preliminary evidence of anti-cancer activity. Further clinical trials with RRx-001 and nivolumab are warranted. Clinical trial registration: ClinicalTrials.gov identifier, NCT02518958.

Impact of COVID-19 on health care and quality of life in women with breast cancer.

BACKGROUND: The aims of this study were to explore the impact of COVID-19 on health-care services and quality of life (QoL) in women diagnosed with breast cancer (BC) in Ireland and whether the impact varied by social determinants of health (SDH). METHODS: Women diagnosed with BC completed a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during COVID-19 restrictions. The association between COVID-19 impact and disruption to BC services and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within the regression models. RESULTS: A total of 30.5% (n = 109) of women reported high COVID-19 impact, and these women experienced more disruption in BC services (odds ratio = 4.95, 95% confidence interval = 2.28 to 10.7, P < .001) and lower QoL (ß = -12.01, SE = 3.37, P < .001) compared with women who reported low COVID-19 impact. Health insurance status moderated the effect of COVID-19 on disruption to BC services and QoL. Women who reported high COVID-19 impact experienced more disruption to BC services and lower QoL compared with women with low COVID-19 impact; however, the magnitude of these unfavorable effects differed by insurance status (Pinteraction < .05). CONCLUSIONS: There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact was not the same for all women. It is important that women with BC are reintegrated into proper care and QoL is addressed through multidisciplinary support services.

An examination of the influence of drained peatlands on regional stream water chemistry.

Currently, 50% of Irish rivers do not meet water quality standards, with many declining due to numerous pressures, including peatland degradation. This study examines stream water quality in the Irish midlands, a region where raised bogs have been all historically disturbed to various extent and the majority drained for industrial or domestic peat extraction. For the first time, we provide in-depth analysis of stream water chemistry within a heavily modified bog landscape. Small streams from degraded bogs exhibited greater levels of pollutants, in particular: total dissolved nitrogen (0.48 mg/l) and sulphate (18.49 mg/l) as well as higher electrical conductivity (mean: 334 µS/cm) compared to similar bog streams in near-natural bogs. Except for site-specific nitrogen pollution in certain streams surrounding degraded peatlands, the chemical composition of the receiving streams did not significantly differ between near-natural and degraded sites, reflecting the spatio-temporal scales of disturbance in this complex peat-scape. Dissolved organic carbon concentrations in all the receiving streams were high (27.2 mg/l) compared to other Irish streams, even within other peatland catchments. The region is experiencing overall a widespread loss of fluvial nitrogen and carbon calling for (a) the development of management instruments at site-level (water treatment) and landscape-level (rewetting) to assist with meeting water quality standards in the region, and (b) the routine monitoring of water chemistry as part of current and future peatland management activities. Supplementary Information: The online version contains supplementary material available at 10.1007/s10750-023-05188-5.

Menstrual hygiene management practices and determinants among schoolgirls in Addis Ababa, Ethiopia: The urgency of tackling bottlenecks - Water and sanitation services.

Background: Menstrual hygiene management (MHM) service provision and improving schoolgirls' hygienic practices in schools are among the major challenges for low and middle income countries, including Ethiopia, in meeting the 2030 Sustainable Development Goals. This study was conducted to assess schoolgirls' MHM practices and what influences those practices in Addis Ababa, the capital city of Ethiopia. Methods: A cross-sectional study was conducted on 401 adolescent schoolgirls and 98 school directors that were selected using a multistage sampling method. Pretested semi-structured interviewer-administered questionnaires and observational checklists were used to collect data. Results: During menstruation, about 90% of schoolgirls used commercially made disposable sanitary pads. However, only 45.9% of girls had access to emergency pads from their schools. Of the 98 directors, 79 (80.6%) responded that they had MHM provisions for schoolgirls. However, 42 (42.9%) schools had no water and soap in the pad changing rooms/toilets, and 70% lacked a covered dustbin for disposal/storage of soiled sanitary pads. Besides, more than 55% of the schools practiced open burning and dumping to dispose of used menstrual materials. More than half of the schools had no sanitary pad changing rooms, three-quarters of them lack MHM education, and only 2.5% had a bathing area. The location of schools (AOR = 5.44, 95% CI: (2.34-12.66)), health club availability (AOR = 3.14, 95% CI: (1.53, 6.42)), being informed about MHM before menarche (AOR = 2.04, 95% CI: (1.04, 4.00)), and availability of emergency sanitary pad at schools (AOR = 2.59, 95% CI: (1.36, 4.91)) were significantly associated with the status of schoolgirls menstrual hygiene practices. Conclusions: About one-quarter of the schoolgirls had poor menstrual hygiene practices. Being a student in inner-city schools, attending a school that had a health club, being informed about MHM before menarche, and having access to emergency pads from schools were the determinant factors for good menstrual hygiene practices. However, most schools lack water, soap, and a covered dustbin in the pad changing rooms/toilets. Moreover, only a few schools provided MHM education and emergency pads. Improving water and sanitation services along with tailored MHM education are urgently needed to circumvent unsafe MHM practices among adolescent schoolgirls.