Health worker text messaging for blended learning, peer support, and mentoring in pediatric and adolescent HIV/AIDS care: a case study in Zimbabwe.

BACKGROUND: In sub-Saharan Africa, shortages of trained healthcare workers and limited resources necessitate innovative and cost-effective approaches for training, supervising, and mentoring. This qualitative case study describes participants' and trainers' perspectives and experiences with a text messaging component of a blended training course in HIV counseling and testing in Zimbabwe, using minimal resources in terms of staff time and equipment requirements. This component included a whole-group discussion forum as well as two-person partner discussions designed to promote reflection and analysis, teamwork, and active learning. CASE PRESENTATION: The Ministry of Health and Child Care (MoHCC) of Zimbabwe collaborated with the International Training and Education Center for Health (I-TECH) on adaptation of a 5-day in-service training in HIV Testing Services for Children and Adolescents. The new 7-week blended format included in-person sessions, tablet-based self-study, and discussions using the text messaging application, WhatsApp. Between August 2016 and January 2017, 11 cohorts (293 participants in total) were trained with this new curriculum, incorporating text messaging to support peer-to-peer and work-based education. Data collected included training participants' feedback, key informant interviews with the training team, and thematic analysis of WhatsApp messages from full-cohort discussions and a sampling of one-to-one partner discussions. A total of 293 healthcare workers from 233 health facilities across all provinces in Zimbabwe completed the blended learning course. Participants strongly endorsed using WhatsApp groups as part of the training. In the whole-group discussions, the combined cohorts generated over 6300 text messages. Several categories of communication emerged in analysis of group discussions: (1) participants' case experiences and questions; (2) feedback and recommendations for work issues raised; (3) inquiries, comments, and responses about course assignments and specific course content; (4) encouragement; and (5) technical challenges encountered using the blended learning methodology. Case discussions were complex, including patient history, symptoms, medications, and psychosocial issues-child abuse, adherence, and disclosure. CONCLUSIONS: Using text messaging in a communication platform that is an ongoing part of healthcare workers' daily lives can be an effective adjunct to in-service training, minimizing isolation and providing interactivity, supporting students' ability to fully integrate content into new skill attainment.

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa.

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries (Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen) in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region.

First Report of Multiple Species of the Botryosphaeriaceae Causing Bot Canker Disease of Indian Laurel-Leaf Fig in California.

Indian laurel-leaf fig (Ficus microcarpa L.) is a commonly used indoor and outdoor ornamental tree. F. microcarpa is most frequently encountered as lining city streets, especially in warmer southern California climates. A disease known as 'Sooty Canker,' caused by the fungus Nattrassia mangiferae (Syd. & P. Syd) B. Sutton & Dyko, is particularly devastating on F. microcarpa. Disease symptoms are characterized by branch dieback, crown thinning, and if the disease progresses to the trunk, eventual tree death (2). Recent taxonomic revisions have renamed Nattrassia mangiferae as Neofusicoccum mangiferae (Syd. & P. Syd.) Crous, Slippers & A. J. L. Phillips (1). An initial survey conducted during the spring of 2011 across four cities in Los Angeles County included, Culver City, Lakewood, Santa Monica, and Whittier. Five symptomatic branches per city were collected from trees showing branch cankers and dieback. Pieces of symptomatic tissue (2 mm2) were plated onto one-half-strength potato dextrose agar. Most isolates initially identified by morphological characteristics, such as growth pattern, speed of growth, and colony color, resembled those in the Botryosphaeriaceae (4). Two representative isolates from each site location were sequenced. Sequences obtained from amplification of the internal transcribed spacer region (ITS1-5.8rDNA-ITS2) and the ß-tubulin gene were compared in a BLAST search in GenBank. Results identified isolates as Botryosphaeria dothidea (identity of 99% to EF638767 and 100% to JN183856.1 for ITS and ß-tubulin, respectively); Neofusicoccum luteum (100% to EU650669 and 100% to HQ392752); N. mediterraneum (100% to HM443605 and 99% to GU251836); and N. parvum (100% to GU188010 and 100% to HQ392766) and have been deposited in GenBank with the following accession numbers: JN543668 to JN543671 (ITS) and JQ080549 to JQ080552 (ß-tubulin). Pathogenicity tests were conducted in the greenhouse on 6-month-old F. microcarpa with one isolate from each previously listed fungal species. Five plants per isolate were stem-wound inoculated with mycelial plugs and wrapped with Parafilm. Uncolonized agar plugs were used as a control. Inoculations were later repeated a second time in the same manner for a total of 10 plants per isolate. Plants were observed for 6 weeks and destructively sampled to measure vascular lesion lengths. Mean vascular lesion lengths were 26, 22, 54, and 46 mm for B. dothidea, N. luteum, N. mediterraneum, and N. parvum, respectively. The mean lesion lengths for all isolates were significantly different (P = 0.05) from the control. Each species was consistently recovered from inoculated plants, except the control, thus fulfilling Koch's postulates. To our knowledge, this is the first report on the pathogenicity of multiple Botryosphaeriaceae species causing branch canker and dieback on F. microcarpa in California. These results are significant since trees along sidewalks in southern California are often crowded and undergo extensive root and branch pruning and some Botryosphaeriaceae spp. are known to enter its host through wounds caused by pruning or mechanical injury (2,3). Further sampling is imperative to better assess the distribution of these canker-causing fungal pathogens on F. microcarpa. References: (1) P. W. Crous et al. Stud. Mycol. 55:235, 2006. (2) D. R. Hodel et al. West. Arborist 35:28, 2009. (3) V. McDonald et al. Plant Dis. 93:967, 2009. (4) B. Slippers et al. Fungal Biol. Rev. 21:90, 2007.

Comparison of gamma-ray dosimeters in a field study in the Chernobyl exclusion zone.

Five different models of dosimeters were compared in the Chernobyl Inner Exclusion Zone by measuring gamma radiation in 12 locations. We used an instrument made by Mirion Technologies, Inc., as the reference, since that instrument had an NIST-traceable calibration. Two models of dosimeters gave radiation values similar to the Mirion at all levels of radiation encountered. Two other models gave similar values to the Mirion instrument at low radiation levels but not at higher radiation levels encountered. These results offer a caution regarding the accuracy of inexpensive commercially available radiation instruments. Implications: Comparison of gamma ray dosimeters in the Chernobyl Exclusion Zone showed varying agreement with an NIST-calibrated instrument, as well as varying linearity of response to ambient radiation. These results suggest caution regarding accuracy of inexpensive dosimeters. However, dosimeters used that were manufactured in Ukraine exhibited good agreement with the reference instrument.

Survival of plant pathogens in static piles of ground green waste.

Ground green waste is used as mulch in ornamental landscapes and for tree crops such as avocados. Survival of Armillaria mellea, Phytophthora cinnamomi, Sclerotinia sclerotiorum, and Tylenchulus semipenetrans was assessed for 8 weeks within unturned piles of either recently ground or partially composted green waste. S. sclerotiorum survived at the pile surface and at 10, 30, and 100 cm within the pile for the entire 8 weeks in both fresh green waste (FGW) and aged green waste (AGW). A. mellea and T. semipenetrans did not survive more than 2 days in FGW, while P. cinnamomi persisted for over 21 days in FGW. AGW was less effective in reducing pathogen viability than FGW, most likely because temperatures in AGW peaked at 45 degrees C compared with 70 degrees C in FGW. Survival modeling curves based on pile temperatures indicate the time to inactivate 10 propagules of pathogens was 11, 30, 363, and 50 days for A. mellea, P. cinnamomi, S. sclerotiorum, and T. semipenetrans, respectively. Sclerotia-forming pathogens pose the greatest risk for escape; to ensure eradication of persistent fungi, green waste stockpiles should be turned intermittently to mix pile contents and move pathogen propagules to a location within the pile where they are more likely to be killed by heat, microbial attack, or chemical degradation.

Probabilities for survival of glassy-winged sharpshooter and olive fruit fly pests in urban yard waste piles.

Glassy-winged sharpshooter (Homolodisca coagulate) and olive fruit fly (Bactrocera oleae) were introduced into unturned, chipped yard waste piles to evaluate their survival with time and depth within the piles. In all three trials, no pests lasted more than 14 d, and in no trial did pests survive more than 4d at the 30 and 100 cm depths. No survivors were found after 14 d in any of the treatments at any depth. Neither of the pests survived 100 cm after 2d. A mathematical model for describing pest survival probabilities is described. The model modifies time according to the Arrhenius equation in order to include heat effects on pest survival and can be used to determine exposure times necessary to eliminate these pests with a determined statistical probability. Model projections suggest that for conditions similar to this study, there is 99% confidence that all glassy-winged sharpshooter eggs would be eliminated from 1000 infected leaves in 6.1d at 15 cm depth and in 4.8d at 30 cm or below. Olive fruit fly larvae at these depths would require 4.8 and 4.1d, respectively, for 1000 infected olive fruits. Projected elimination times at the surface were longer, 6.5d for sharpshooter eggs and 14.3d for fruit fly larvae.

Evaluation of an AIDS training program for traditional healers in the Central African Republic.

Training designed to improve AIDS knowledge, attitude, and practice was delivered to 96 traditional healers in the Central African Republic. The training (17 to 36 hours) was conducted by traditional healers with the assistance of staff from the Ministry of Health. Training included the following topics: prevention of HIV transmission during traditional practice; diagnosis, treatment, and prevention of sexually transmitted diseases; condom promotion; AIDS education at the community level; psychosocial support for people with AIDS; and promotion of a positive image for traditional healers. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. These assessments were conducted using structured interviews. Improvement in knowledge and/or attitudes was observed in all areas assessed except for prevention of HIV transmission during traditional practice. We concluded that AIDS training can be successfully delivered to traditional healers.

Effects of Cellulytic Enzymes on Phytophthora cinnamomi.

ABSTRACT Two enzyme systems, cellulase (beta-1,4-glucanase) and laminarinase (beta-1,3-glucanase), were added to soil extracts to simulate (in vitro) lytic components found in mulches suppressive to Phytophthora cinnamomi. Concentration ranges of each enzyme were incubated with Phytophthora cinnamomi mycelium, zoospores, zoospores cysts, and zoospore-infected excised roots to evaluate the roles of each enzyme in potential control of avocado root rot disease. Cellulase significantly retarded the development of zoosporangia and chlamydospores when mycelia were incubated in soil extract containing the enzyme at concentrations greater than 10 units/ml. Zoospore production was also reduced by cellulase but not by laminarinase. Laminarinase had little effect on zoosporangia or chlamydospore formation. At high concentrations, laminarinase was consistently more effective at preventing encystment than cellulase. Chlamydospores preformed in root tips were immune to the lytic effects of all treatments except cellulase at 100 units/ml. Zoospores placed in enzyme solutions and plated on a selective medium survived high cellulase concentrations and formed colonies, but there were fewer surviving zoospores when laminarinase was present at greater than 10 units/ml. Low concentrations of cellulase stimulated infection of excised roots, however, low concentrations of laminarinase prevented infection. Cellulase and laminarinase have different effects on the structures of the Phytophthora cinnamomi life history, however, each enzyme may have a role in reduction of inoculum.

Association of Cellulytic Enzyme Activities in Eucalyptus Mulches with Biological Control of Phytophthora cinnamomi.

ABSTRACT A series of samples were taken from mulched and unmulched trees starting at the surface of mulch or soil to a 15 cm soil depth, forming a vertical transect. Saprophytic fungi isolated from the soil samples on rose bengal medium and surveyed visually were most abundant in mulches and at the interface of mulch and soil (P < 0.05). Microbial activity as assayed by the hydrolysis of fluorescein diacetate was significantly greater in mulch layers than in soils. Cellulase and laminarinase enzyme activities were greatest in upper mulch layers and rapidly decreased in soil layers (P < 0.05). Enzyme activities against Phytophthora cinnamomi cell walls were significantly greater in mulch than in soil layers. When Phytophthora cinnamomi was incubated in situ at the various transect depths, it was most frequently lysed at the interface between soil and mulch (P < 0.001). Roots that grew in mulch layers were significantly less infected with Phytophthora cinnamomi than roots formed in soil layers. In mulched soil, roots were commonly formed at the mulch-soil interface where Phytophthora populations were reduced, whereas roots in unmulched soil were numerous at the 7.5 cm depth where Phytophthora cinnamomi was prevalent. Enzyme activities were significantly and positively correlated with each other, microbial activity, and saprophytic fungal populations, but significantly and negatively correlated with Phytophthora recovery.

Polymer surface properties and their effect on the adhesion of Proteus mirabilis.

A problem encountered in patients undergoing long-term catheterization of the urinary tract is that of encrustation and blockage of the catheter by crystalline bacterial biofilms. This is principally caused by the action of the urease-producing pathogen Proteus mirabilis. A major aim of this work is to develop materials resistant to encrustation. Here, the effects of polymer surface properties on the adhesion of P. mirabilis are examined. Spin-coated polymer films were characterized through contact angle measurements to give the Lifschitz-van der Waals, electron acceptor and electron donor terms of the surface free energy, gamma(s)LW, gamma(s)+ and gamma(s)- respectively. A parallel-plate flow cell was used to assess adhesion to these polymer films of P. mirabilis suspended in an aqueous phosphate buffer, pH 7.4, ionic strength 0.26 mol/kg. P. mirabilis was found to adhere significantly less (p < 0.02) to films of agarose, poly(2-hydroxyethylmethacrylate) and cross-linked poly(vinyl alcohol) than to more hydrophobic materials. These polymer films were found to be strongly electron donating, i.e. possessing large gamma(s)-. Films examined using scanning electron microscopy mostly showed no evidence of roughness down to a scale of 1-10 microm. The better performance is thought to be due to a repulsive interaction with the bacterial surface caused by acid/base-type interactions.

AIDS: what you and your friends need to know--a lesson plan for adolescents.

The AIDS knowledge and attitudes of students attending an urban high school in Seattle were pretested. Subsequently, a 50-minute AIDS lesson plan was designed using the findings. Instruction occurred one month following the pretest, with a posttest administered one week after instruction. Significant increases in knowledge about AIDS, and parallel changes in tolerant and compassionate beliefs about people with AIDS were observed. Learning outcomes were retained at retesting eight weeks after instruction. Prior to receiving the AIDS lesion, 34% of students listed schools as their source of learning about AIDS. Schools became the major source of learning (82%) after one hour of instruction.

A clinical study of competency to consent to treatment in pediatrics.

A 19-item competency questionnaire for pediatric patients (CQ-Peds) was used to evaluate competency to consent to treatment in pediatric outpatients and inpatients at two university hospitals. Sixty-nine consecutive English-speaking pediatric outpatients were studied at Hospital A, and 23 consecutive English-speaking pediatric inpatients were studied at Hospital B. Demographic data were statistically analyzed using the chi-square test, and there were no significant differences between the competent and incompetent groups (using CQ-Peds scores and cutoffs). CQ-Peds scores correlated highly with age (r = .947, p < .003; Outpatient Hospital A). Using the Child Behavior Checklist (CBCL) and the Pediatric Symptom Checklist (PSC) as a screen for psychopathology, the presence of psychiatric disturbance, per se, did not correlate with low CQ-Peds scores, nor was there a statistical difference between children from Spanish-speaking households and those from English-speaking households (Inpatient Hospital B). Overall, the children scored well on the CQ-Peds and demonstrated a good appreciation for their illnesses and treatment. The CQ-Peds score correlated highly with the that on the Wechsler Intelligence Scale for Children Revised Edition (WISC-R) vocabulary, comprehension, and similarities subtests and also with the Wide-Range Achievement Test-III (WRAT-III) reading assessment score (Inpatient Hospital B).

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries [Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen] in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region

Les laboratoires ont besoin de directeurs à même d'utiliser les ressources internes de façon efficace, de maximiser leurs capacités à dépister les maladies, et d'oeuvrer pour le bien de ces établissements dans un environment de soins de santé en perpétuel changement. Pour répondre à ces besoins, l'Université de Washington [Etats-Unis], en partenariat avec le Bureau régional de l'OMS pour la Méditerranée orientale, a mis au point le Programme de certification en direction et gestion de laboratoire qui a été suivi par 17 participants et 11 mentors issus de laboratoires de santé clinique et publique dans 10 pays [Arabie saoudite, Egypte, Iraq, Jordanie, Liban, Maroc, Oman, Pakistan, Qatar et Yémen] au cours de l'année 2014. Conçu pour former les responsables de laboratoire aux compétences de direction et de gestion, le programme a permis aux participants de renforcer la qualité du dépistage et des opérations de leurs laboratoires. Le programme a été une réussite dans l'ensemble puisqu'il a été suivi jusqu'à son terme par 80% des participants et que ceux-ci ont ensuite pu mettre en place des changements réels dans leurs laboratoires. Ce succès est encourageant et pourrait servir de modèle afin de renforcer davantage encore les capacités des laboratoires dans la Région

Observations on the adherence of Proteus mirabilis onto polymer surfaces.

AIMS: Infection of the catheterized urinary tract with Proteus mirabilis causes blockage of the catheter by crystalline bacterial biofilms. The aim of this work is to identify a surface-coating for catheters that is not vulnerable to colonization by Pr. mirabilis. METHODS AND RESULTS: A parallel-plate flow-cell and phase contrast microscopy were used to follow bacterial adhesion onto polymer films. Experiments with a urease-negative mutant of Pr. mirabilis suspended in buffer or urine, identified agarose as a polymer on which biofilm did not form. In tests with wild-type urease-producing cells in urine, no adhesion of cells onto agarose was observed for 3 h but then as the pH rose above 8.2, the surface rapidly became colonized by crystalline biofilm. CONCLUSIONS: In urine at pH below 8.0, Pr. mirabilis does not adhere to agarose-coated surfaces. When the pH rises above 8.2, however, aggregates of crystals and bacteria form in the urine and are deposited on such surfaces. SIGNIFICANCE AND IMPACT OF THE STUDY: Strategies to prevent the formation of crystalline biofilms on urinary catheters will need to consider both the properties of the surface-coatings and the requirement to prevent the alkaline conditions that induce crystal formation in urine.

Cryotherapy for animals.

The advisability of using cold depends on the character and stage of the pathologic change, the therapist's knowledge of the patient's condition, and an understanding of how cold affects tissues. Cold is simple to use, requires no expensive special equipment, relieves pain, and helps to control acute and chronic stages of inflammation. Combined with other therapeutic procedures, it is a valuable addition to the treatment regimen.

Sexual and drug-use risk factors for HIV and STDs: a comparison of women with and without bisexual experiences.

OBJECTIVES: This study was done to compare risk factors for HIV/STDs in women who reported having had sex with both men and women and women who reported having had sex with men only. METHODS: Female participants in a multisite, randomized HIV/STD prevention study in the Seattle area reported both having had sex with a man in the 3 months before and having at least 1 risk factor for HIV/STDs during the year before the study. Of these women, 38% who reported ever having had sex with a woman were compared with those who reported having had sex with men only. RESULTS: Women who had had sex with both men and women were more likely than women who had had sex with men only to report drug use in the 3 months before the study, a greater lifetime number of male partners, a sex partner who had had sex with a prostitute, an earlier age at sexual debut, and forced sexual contact (P < .01 for all comparisons). Women who had had sex with both men and women had a mean of 3.2 of these 5 risk factors, vs 2.1 among women who had had sex with men only (P < .001). CONCLUSION: Women who had had sex with both men and women were more likely than women who had had sex with men only to engage in multiple risk behaviors. Health workers should be aware of bisexual experience among women, since this may be a marker for multiple risk behaviors for HIV/STDs.