A Mixed-Methods Study Exploring Colombian Adolescents' Access to Sexual and Reproductive Health Services: The Need for a Relational Autonomy Approach.

This study's objective was to understand Colombian adolescents' experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the ethical principle of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants' preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced "relational autonomy" approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS.

Period poverty and mental health in times of Covid-19 in France.

We investigate the relationship between period poverty and anxiety and depression in women aged from 18 to 50 years in the context of the first French Covid-19 lockdown. 890 participants completed an online survey. Anxiety was assessed with the General Anxiety Disorder scale, depression with the Major Depression Inventory. 9.6% of participants experienced difficulties accessing period protection during the first lockdown. Among the women experiencing period poverty, 49.4% showed depressive symptoms compared to 28.6% of the women who had not experienced menstrual poverty, 40% showed anxious symptoms (vs 24.1%). The relationships between period poverty, depression and are significant even in adjusted models controlled by sociodemographics variables (depression: AOR = 2.191 [1.372 - 3.499]; anxiety: AOR = 1.793, [1.110 - 2.897]). As clinicians, psychologists or social workers, it seems interesting to go beyond the first symptoms of depression and anxiety and question the patients' access to menstrual health products.

Transjugular patent ductus arteriosus occlusion in a cat with a peripheral vascular occlusion device.

A five-month-old, intact female domestic shorthair cat was presented to a specialty referral hospital for evaluation of a patent ductus arteriosus. Transvenous embolization of the defect was achieved with a commercially available peripheral vascular plug. The use of vascular plugs for the closure of patent ductus arteriosus has been validated in dogs, yet literature for its use in cats is lacking. The product and procedural details of the device are described.

Treatment of a mixed wood preservative leachate by a hybrid constructed wetland and a willow planted filter.

The performance and removal mechanisms of a hybrid constructed wetland (HCW) followed by a willow planted filter (WPF) were evaluated for the treatment of a leachate contaminated by wood pole preservatives (pentachlorophenol (PCP) and chromated copper arsenate) to reach the storm sewer discharge limits. The HCW aimed to dechlorinate the PCP and polychlorodibenzo-p-dioxins/polychlorodibenzofuran (PCDD/F) and to remove metals by adsorption and precipitation. The HCW was efficient in removing PCP (>98.6%), oil, arsenic (99.4%), chromium (>99.2%), copper (>99.6%%) and iron (29%) to under their discharge limits, but it was unable to reach those of Mn and PCDD/F, with residual concentrations of 0.11 mg Mn/L and 0.32 pg TEQ/L. Iron and manganese could be removed but were subsequently released by the HCW due to low redox conditions. No dechlorination of PCDD/F was observed since its chlorination profile remained the same in the different sections of the HCW. Adsorption was the most probable removal mechanism of PCDD/F. The WPF was able to remove some residual contamination, but it released Mn at a gradually decreasing rate. Total evapotranspiration of the leachate by a larger fertilized WPF and the construction of an underground retention basin are proposed to prevent any discharge of PCDD/F traces in the environment.

Audit feedback on reading performance of screening mammograms: An international comparison.

OBJECTIVE: Providing feedback to mammography radiologists and facilities may improve interpretive performance. We conducted a web-based survey to investigate how and why such feedback is undertaken and used in mammographic screening programmes. METHODS: The survey was sent to representatives in 30 International Cancer Screening Network member countries where mammographic screening is offered. RESULTS: Seventeen programmes in 14 countries responded to the survey. Audit feedback was aimed at readers in 14 programmes, and facilities in 12 programmes. Monitoring quality assurance was the most common purpose of audit feedback. Screening volume, recall rate, and rate of screen-detected cancers were typically reported performance measures. Audit reports were commonly provided annually, but more frequently when target guidelines were not reached. CONCLUSION: The purpose, target audience, performance measures included, form and frequency of the audit feedback varied amongst mammographic screening programmes. These variations may provide a basis for those developing and improving such programmes.

Assortative mixing as a source of bias in epidemiological studies of sexually transmitted infections: the case of smoking and human papillomavirus.

For studies examining risk factors of sexually transmitted infections (STIs), confounding can stem from characteristics of partners of study subjects, and persist after adjustment for the subjects' individual-level characteristics. Two conditions that can result in confounding by the subjects' partners are: (C1) partner choice is assortative by the risk factor examined and, (C2) sexual activity is associated with the risk factor. The objective of this paper is to illustrate the potential impact of the assortativity bias in studies examining STI risk factors, using smoking and human papillomavirus (HPV) as an example. We developed an HPV transmission-dynamic mathematical model in which we nested a cross-sectional study assessing the smoking-HPV association. In our base case, we assumed (1) no effect of smoking on HPV, and (2) conditions C1-C2 hold for smoking (based on empirical data). The assortativity bias caused an overestimation of the odds ratio (OR) in the simulated study after perfect adjustment for the subjects' individual-level characteristics (adjusted OR 1·51 instead of 1·00). The bias was amplified by a lower basic reproductive number (R 0), greater mixing assortativity and stronger association of smoking with sexual activity. Adjustment for characteristics of partners is needed to mitigate assortativity bias.

Characteristics affecting survival after locally advanced colorectal cancer in Quebec.

BACKGROUND: We estimated the relations of sociodemographic, organizational, disease, and treatment variables with the risk of death from colorectal cancer (crc) in a Quebec population-based sample of patients with locally advanced crc (lacrc) who underwent tumour resection with curative intent. METHODS: Information from medical records and administrative databases was obtained for a random sample of 633 patients surgically treated for stages ii-iii rectal and stage iii colon cancer and declared to the Quebec cancer registry in 1998 and 2003. We measured personal, disease, and clinical management characteristics, relative survival, and through multivariate modelling, relative excess rate (rer) of death. RESULTS: The relative 5- and 10-year survivals in this cohort were 67.7% [95% confidence interval (ci): 65.8% to 69.6%] and 61.2% (95% ci: 58.3% to 64.0%) respectively. Stage T4, stage N2, and emergency rather than elective surgery affected 18%, 24% and 10% of patients respectively. Those disease progression characteristics each independently increased the rer of death by factors of 2 to almost 5. Grade, vascular invasion, and tumour location were also significantly associated with the rer for death. Receiving guideline-adherent treatment was associated with a 60% reduction in the rer for death (0.41; 95% ci: 0.28 to 0.61), an effect that was consistent across age groups. Clear margins (proximal-distal, radial) and clinical trial enrolment were each associated with a nonsignificant 50% reduction in the rer. Of patients less than 70 years of age and 70 years of age and older, 81.3% and 42.0% respectively received guideline-adherent treatment. CONCLUSIONS: This study is the first Quebec population-based examination of patients with lacrc and their management, outcomes, and outcome determinants. The results can help in planning crc control strategies at a population level.

Using the Cancer Risk Management Model to evaluate colorectal cancer screening options for Canada.

BACKGROUND: Several screening methods for colorectal cancer (crc) are available, and some have been shown by randomized trials to be effective. In the present study, we used a well-developed population health simulation model to compare the risks and benefits of a variety of screening scenarios. Tests considered were the fecal occult blood test (fobt), the fecal immunochemical test (fit), flexible sigmoidoscopy, and colonoscopy. Outcomes considered included years of life gained, crc cases and deaths prevented, and direct health system costs. METHODS: A natural history model of crc was implemented and calibrated to specified targets within the framework of the Cancer Risk Management Model (crmm) from the Canadian Partnership Against Cancer. The crmm-crc permits users to enter their own parameter values or to use program-specified base values. For each of 23 screening scenarios, we used the crmm-crc to run 10 million replicate simulations. RESULTS: Using base parameter values and some user-specified values in the crmm-crc, and comparing our screening scenarios with no screening, all screening scenarios were found to reduce the incidence of and mortality from crc. The fobt was the least effective test; it was not associated with lower net cost. Colonoscopy screening was the most effective test; it had net costs comparable to those for several other strategies considered, but required more than 3 times the colonoscopy resources needed by other approaches. After colonoscopy, strategies based on the fit were predicted to be the most effective. In sensitivity analyses performed for the fobt and fit screening strategies, fobt parameter values associated with high-sensitivity formulations were associated with a substantial increase in test effectiveness. The fit was more cost-effective at the 50 ng/mL threshold than at the 100 ng/mL threshold. CONCLUSIONS: The crmm-crc provides a sophisticated and flexible environment in which to evaluate crc control options. All screening scenarios considered in this study effectively reduced crc mortality, although sensitivity analyses demonstrated some uncertainty in the magnitude of the improvements. Where possible, local data should be used to reduce uncertainty in the parameters.

No effect of scalp cooling on survival among women with breast cancer.

Scalp cooling can prevent chemotherapy-induced alopecia in some cancer patients. It is not used in all countries. No data are available regarding its impact, if any, on survival. The aim of this study was to compare overall survival according to whether or not scalp cooling was used during neoadjuvant or adjuvant chemotherapy for non-metastatic breast cancer. We conducted a retrospective cohort study of 1,370 women with non-metastatic invasive breast carcinoma who received chemotherapy in the neoadjuvant or adjuvant setting. A total of 553 women who used scalp cooling came from a tertiary breast cancer clinic in Quebec City (diagnosed between 1998 and 2002) and 817 were treated in other hospitals in the province of Quebec (between 1998 and 2003) where scalp cooling was not routinely available. Overall survival of women who used scalp cooling and those who did not was compared using Cox proportional hazards models. Median follow-up for the scalp-cooled and the non-scalp-cooled groups was 6.3 years and 8.0 years, respectively. Overall mortality was no different (adjusted hazard ratio 0.89, 95 % confidence interval: 0.68-1.17, p = 0.40) among scalp-cooled women, compared to those not getting scalp cooling. Among women getting neoadjuvant or adjuvant chemotherapy for non-metastatic breast cancer, scalp cooling used to prevent chemotherapy-induced alopecia had no negative effect on survival. To our knowledge, this is the first study to compare survival of women who used scalp cooling to that of women who did not.

Juvenile hormone titre and related gene expression during the change of reproductive modes in the pea aphid.

Most aphids show reproductive polyphenism, i.e. they alternate their reproductive modes from parthenogenesis to sexual reproduction in response to short photoperiods. Although juvenile hormone (JH) has been considered a likely candidate for regulating the transition from asexual to sexual reproduction after photoperiod sensing, there are few studies investigating the direct relationship between JH titres and the reproductive-mode change. In addition, the sequencing of the pea aphid genome has allowed identification of the genes involved in the JH pathway, which in turn allows us to examine their expression levels in relation to the reproductive-mode change. Using liquid chromatography-mass spectrometry in the pea aphid, JHIII titre was shown to be lower in aphids producing sexual morphs under short-day conditions than in aphids producing parthenogenetic morphs under long-day conditions. The expression levels of genes upstream and downstream of JH action were quantified by real-time quantitative reverse-transcription-PCR across the reproductive-mode change. The expression level of JH esterase, which is responsible for JH degradation, was significantly higher in aphids reared under short-day conditions. This suggests that the upregulation of the JH degradation pathway may be responsible for the lower JHIII titre in aphids exposed to short-days, leading to the production of sexual morphs.

Comprehensive survey of developmental genes in the pea aphid, Acyrthosiphon pisum: frequent lineage-specific duplications and losses of developmental genes.

Aphids exhibit unique attributes, such as polyphenisms and specialized cells to house endosymbionts, that make them an interesting system for studies at the interface of ecology, evolution and development. Here we present a comprehensive characterization of the developmental genes in the pea aphid, Acyrthosiphon pisum, and compare our results to other sequenced insects. We investigated genes involved in fundamental developmental processes such as establishment of the body plan and organogenesis, focusing on transcription factors and components of signalling pathways. We found that most developmental genes were well conserved in the pea aphid, although many lineage-specific gene duplications and gene losses have occurred in several gene families. In particular, genetic components of transforming growth factor beta (TGFbeta) Wnt, JAK/STAT (Janus kinase/signal transducer and activator of transcription) and EGF (Epidermal Growth Factor) pathways appear to have been significantly modified in the pea aphid.

Wing development genes of the pea aphid and differential gene expression between winged and unwinged morphs.

Little is known about when, how or even if the wing development gene network elucidated in Drosophila is deployed in direct-developing insects. Here we identify the wing development genes (as determined in Drosophila) of the pea aphid (Acyrthosiphon pisum), which produces winged or unwinged adults in response to environmental cues. We find that the principal wing development genes studied in Drosophila are present in the aphid genome and that apterous and decapentaplegic exhibit duplications. We followed expression levels of 11 of these developmental genes at embryogenesis and across the nymphal instars. Six showed significant stage-specific expression level effects and apterous1 exhibited significantly different expression levels between winged and unwinged morphs, suggesting this gene acts proximately to realize polyphenic development.

A functional DNA methylation system in the pea aphid, Acyrthosiphon pisum.

Methylation of cytosine is one of the main epigenetic mechanisms involved in controlling gene expression. Here we show that the pea aphid (Acyrthosiphon pisum) genome possesses homologues to all the DNA methyltransferases found in vertebrates, and that 0.69% (+/-0.25%) of all cytosines are methylated. Identified methylation sites are predominantly restricted to the coding sequence of genes at CpG sites. We identify twelve methylated genes, including genes that interact with juvenile hormone, a key endocrine signal in insects. Bioinformatic prediction using CpG ratios for all predicted genes suggest that a large proportion of genes are methylated within the pea aphid.

Maximizing pollutant removal in constructed wetlands: should we pay more attention to macrophyte species selection?

While the positive role of macrophytes on removal efficiency in constructed wetlands has been well established, possible differences in performance between plants species of comparable life forms and sizes are much harder to demonstrate. We reviewed 35 experimental studies published in peer-reviewed journals and proceedings on the effect of macrophyte species selection on pollutant removal in SSFCW. The studies cover a wide range of macrophyte species, experimental approaches (from well-replicated microcosm experiments to comparison between full full-size constructed wetlands), climatic conditions (from tropical to cold-temperate) and types of effluent (domestic, industrial, etc.). Frequent methodological limitations in these studies compel caution in the interpretation of their results. Yet, the fact that the majority found some (occasionally large) differences in efficiency between plant species for one or more type of pollutant suggests that macrophyte species selection does matter. However, there is little generalization to be made that could help guide species selection for SSFCW, except for the exact conditions in which the experiments were done. For example, the same pair of species that was tested in different studies occasionally gave opposite results in terms of which one performs best. Also, most studies provided few insights on the mechanisms or plant properties that could explain the observed differences in plant species efficiency. Finally, we discuss other relevant research questions and approaches that could help better guide macrophyte species selection for CW.

Effect of loading rate on performance of constructed wetlands treating an anaerobic supernatant.

The effect of organic loading, season and plant species on the treatment of fish farm effluent was tested using three-year old mesocosm wetland systems. During one year, nine 1 m2 mesocosms (horizontal subsurface flow), located in a controlled greenhouse environment, were fed with a reconstituted fish farm effluent containing a high fraction of soluble components (1,600 microS/cm and in mg/L: 230 +/- 80 COD, 179 +/- 60 sCOD, 100 +/- 40 TSS, 37 +/- 7 TKN, 14 +/- 2 TP). Combinations of three hydraulic loading rates (30, 60 and 90 L.m(-2) d(-1)) and two plant species (Phragmites australis, Typha angustifolia) and an unplanted control were tested for treatment performance and hydraulic behaviour. Loadings higher than 15 g COD m(-2) d(-1) resulted in a net decrease of hydraulic performances (generation of short circuiting) coupled with low TKN removal. Maximal TKN removal rates (summer: 1.2, winter: 0.6 g.m(-2) d(-1)) were reached in planted units. In all mesocosms, phosphorus was removed during summer (maximal removal rate: 0.3 g TP m(-2) d(-1)) and was released in winter (release rate = approximately half of summer removal rate). This study confirmed that constructed wetlands are susceptible to clogging when treating anaerobic storage tank supernatant rich in highly biodegradable compounds. Contributions of plants to hydraulic efficiency were mainly observed in summer, associated with high evapotranspiration rates. Both plant species gave a similar removal efficiency for all pollutants.

Slag columns for upgrading phosphorus removal from constructed wetland effluents.

The current best option to upgrade constructed wetlands (CWs) for phosphorus (P) retention, in terms of efficiency, cost and simplicity, consists in using media having a strong P affinity. The media can be used either in the planted beds or in a filtration system downstream of the beds. The use of slag filters was shown to be efficient for removing P from wastewater as it represented a slow release source of calcium and hydroxide, favouring the formation of hydroxyapatite. Our study aimed at maximising the P retention capacity of slag filters located at the outlet of CWs since electric arc furnace slag has been shown to inhibit the growth of macrophytes when used in the filtration matrix. Bench-scale columns (Vtot = 6.2 L) filled with various combinations of filter media (slag, granite, limestone) of different sizes (2-5, 5-10, 10-20 mm) were fed on-site during four months with a CW effluent (in mg/L: 30 COD, 30 TSS, 10 Pt). Results showed that the best media combination enabling the maximum o-PO4 retention (more than 80% removal without clogging) consisted in a series of a ternary mix column (slag 5-10 mm, granite 2-5 mm, limestone 5-10 mm) followed by a slag column (slag 5-10 mm). Pilot scale columns (Vtot = 300 L), filled with the best media combination, were installed at the outlet of a 28 m2 CW. These columns showed more than 75% removal efficiency during one year and were designed to be easily replaced each year.

Influence of macrophyte species on microbial density and activity in constructed wetlands.

It is often assumed that planted wastewater treatment systems outperform unplanted ones, mainly because plants stimulate belowground microbial population. Yet, fundamental interactions between plants and associated microorganisms remain only partly understood. The aim of our project was to evaluate microbial density and activity associated to the rhizosphere of three plant species. Experimental set-up, in six replicates, consisted of four 1.8-L microcosms respectively planted in monoculture of Typha angustifolia, Phragmites australis, Phalaris arundinacea and unplanted control. Plants were grown for two months with 25 L m(-2) d(-1) of secondary effluent (in g m(-2) d(-1): 1.3 TSS, 7.5 COD, 1.0 TKN). Sampling of substrate, roots and interstitial water was made according to depth (0-10, 10-20 cm). Biofilm was extracted with 500 mL of a buffer solution. Microbial density was directly estimated by flow cytometry and indirectly by protein measurements. Biological activity was determined using respirometry assays, dehydrogenase and enzymatic activity measurements. Our results show that microbial density and activity are higher in the presence of plants, with significantly higher values associated with Phalaris arundinacea. Greater density of aerobic or facultative bacteria was present in planted microcosm, particularly on root surface, suggesting root oxygen release. Microbes were present on substrate and roots as an attached biofilm and abundance was correlated to root surface throughout depth. Plant species root morphology and development seem to be a key factor influencing microbial-plant interaction.

Wing dimorphism in aphids.

Many species of insects display dispersing and nondispersing morphs. Among these, aphids are one of the best examples of taxa that have evolved specialized morphs for dispersal versus reproduction. The dispersing morphs typically possess a full set of wings as well as a sensory and reproductive physiology that is adapted to flight and reproducing in a new location. In contrast, the nondispersing morphs are wingless and show adaptations to maximize fecundity. In this review, we provide an overview of the major features of the aphid wing dimorphism. We first provide a description of the dimorphism and an overview of its phylogenetic distribution. We then review what is known about the mechanisms underlying the dimorphism and end by discussing its evolutionary aspects.

The benefit of participating to clinical research.

We assessed the impact of participating to clinical research among 1727 women with localized breast cancer. Using as referent individuals not treated according to guidelines for systemic therapy, the adjusted hazard ratio of death was 0.70 (95% confidence interval (CI): 0.54,0.90, p-value: 0.006) in those treated according to current guidelines and 0.45 (95% CI: 0.27,0.73, p-value: 0.001) in participants to research. Participation to clinical trials results in a substantial gain in survival.

Novel polar lipids of halophilic eubacterium Planococcus H8 and archaeon Haloferax volcanii.

As part of a study to identify novel lipids with immune adjuvant activity, a structural comparison was made between the polar lipids from two halophiles, an archaeon Haloferax volcanii and a eubacterium Planococcus H8. H. volcanii polar lipid extracts consisted of 44% archaetidylglycerol methylphosphate, 35% archaetidylglycerol, 4.7% of archaeal cardiolipin, 2.5% archaetidic acid, and 14% sulfated glycolipids 1 and 2. Nuclear magnetic resonance (NMR) and Fast atom bombardment mass spectrometry (FAB MS) data determined the glycolipids to be 6-HSO(3)-D-Man(p)-alpha1-2-D-Glc(p)-alpha1,1-[sn-2,3-di-O-phytanylglycerol] and a novel glycocardiolipin 6'-HSO(3)-D-Man(p)-alpha1-2-D-Glc(p)-alpha1,1-[sn-2,3-di-O-phytanylglycerol]-6-[phospho-sn-2,3-di-O-phytanylglycerol]. The polar lipids of Planococcus H8 consisted of 49% saturated phosphatidylglycerol and cardiolipin (9:1, w/w), and surprisingly 51% of the photosynthetic membrane lipid sulfoquinovosyldiacylglycerol (SQDG). This study documents archaeal cardiolipin and a novel glycocardiolipin in H. volcanii (lacking purple membrane), and is the first report of SQDG in a non-photosynthetic, halophilic bacterium.