A mixed methods evaluation assessing the feasibility of implementing a PrEP data dashboard in the Southeastern United States.

BACKGROUND: Alabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a disproportionate burden of rural infections. To reverse growing infection rates, the state must increase its focus on prevention efforts, including novel strategies. One such approach is to utilize dashboards that visualize real-time data on the pre-exposure prophylaxis (PrEP) care continuum to assist in prioritizing evidence-based preventative care for those most vulnerable for HIV infection. METHODS: We conducted a mixed methods evaluation to ascertain stakeholders' perceptions on the acceptability, feasibility, appropriateness, and usability of a PrEP care continuum dashboard, as well as gain insight on ways to improve the activities necessary to sustain it. Clinicians, administrators, and data personnel from participating sites in Alabama completed surveys (n = 9) and participated in key informant interviews (n = 10) to better understand their experiences with the prototype data dashboard and to share feedback on how it can be modified to best fit their needs. RESULTS: Surveys and interviews revealed that all participants find the pilot data dashboard to be an acceptable, feasible, and appropriate intervention for clinic use. Overall, stakeholders find the pilot dashboard to be usable and helpful in administrative efforts, such as report and grant writing; however, additional refining is needed in order to reduce burden and optimize usefulness. Participants voiced concerns about their site's abilities to sustain the dashboard, including the lack of systematized PrEP protocols and limited funds and staff time dedicated to PrEP data collection, cleaning, and upload. CONCLUSION: Study participants from clinics providing HIV prevention services, including PrEP, in Alabama voiced interest in sustaining and refining a data dashboard that tracks clients across the PrEP care continuum. Despite viewing the platform itself as an acceptable, feasible, and appropriate intervention, participants agreed that efforts need to be focused on standardizing PrEP data collection protocols in order to ensure consistent, accurate data capture and that limited funds and staff time are barriers to the sustained implementation of the dashboard in practice.

Delivery of the HIV Service and Telemedicine Through Effective Patient-Reported Outcomes (+STEP) Intervention to Increase Screening and Treatment of Mental Health and Substance Use Disorders for People Living With HIV in Alabama: Protocol for an Effectiveness-Implementation Study.

BACKGROUND: The syndemic of mental health (MH) and substance use disorders (SUDs) is common among persons living with HIV and jeopardizes HIV treatment adherence, engagement in care, and viral load suppression. Electronic patient-reported outcomes (ePROs), completed through tablet or computer, and telemedicine are evidence- and technology-based interventions that have been used to successfully increase screening and treatment, respectively, a model that holds promise for persons living with HIV. To date, there is limited guidance on implementing ePROs and telemedicine into HIV clinical practice even though it is well known that these evidence-based tools improve diagnosis and access to care. OBJECTIVE: To address this, we aim to conduct a multicomponent intervention for persons living with HIV, including the delivery of HIV services and telemedicine through effective ePROs (+STEP), to increase screening and treatment of MH and SUD in Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Alabama. METHODS: Through this intervention, we will conduct a readiness, acceptability, and accessibility assessment and implement +STEP to improve the diagnosis and treatment of MH and SUD at RWHAP clinics in Alabama. To describe implementation strategies that address barriers to the uptake of +STEP in RWHAP clinics, we will conduct qualitative interviews in years 1 (early implementation), 2 (scale up), and 4 (maintenance) with patients and key staff to evaluate barriers, facilitators, and implementation strategies. Our Results will enable us to modify strategies to enhance +STEP penetration over time and inform the implementation blueprint, which we will develop for both RWHAP clinics in Alabama and future sites. We will assess the impact of implementing +STEP on diagnoses, referrals, and health care use related to MH, SUD, and HIV by comparing clinical outcomes from patients receiving these interventions (ePROs and telemedicine) with historical controls. RESULTS: The first study site began implementation in April 2022. A total of 2 additional sites have initiated ePROs. Final results are expected in 2026. The results of this study will provide a foundation for future research expanding access to ePROs for improved diagnosis linked to telemedicine access to accelerate patients along the continuum of care from MH and SUD diagnosis to treatment. CONCLUSIONS: Achieving the end of the HIV epidemic in the United States necessitates programs that accelerate movement across the MH and SUD care continuum from diagnosis to treatment for persons living with HIV. Scaling these services represents a path toward improved treatment outcomes with both individual health and population-level prevention benefits of sustained HIV viral suppression in the era of undetectable=untransmittable (U=U). This study will address this evidence gap through the evaluation of the implementation of +STEP to establish the necessary systems and processes to screen, identify, and better treat substance use and MH for people living with HIV. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40470.

Gene flow, genomic homogenization and the timeline to speciation in Amazonian manakins.

Phylogeographical studies of the most species-rich region of the planet-the Amazon basin-have repeatedly uncovered genetically distinctive, allopatric lineages within currently named species, but understanding whether such lineages are reproductively isolated species is challenging. Here we harness the power of genome-wide data sets together with detailed phylogeographical sampling to both characterize the number of unique lineages and infer levels of reproductive isolation for three parapatric manakin species that make up the genus Pipra. The mitochondrial and nuclear genomes both support six distinctive lineages. The youngest lineages are now highly admixed with each other across major portions of their geographical ranges with one lineage now extinct in a genomically unadmixed state. In contrast, the oldest sets of lineages-dated to 1.4 million years-exhibit narrow hybrid zones. By fitting demographic models to parapatric lineage pairs we found that levels of gene flow and genomic homogenization decline with increasing evolutionary age. Only lineages descending from the basal node at 1.4 million years ago in the genus experience negligible gene flow, possess genomes resistant to homogenization and are separated by narrow hybrid zones. We conclude that a million years or more were required for Pipra manakins to become reproductively isolated. We suggest the six lineages be reclassified as two or three reproductively isolated species. Our unique approach to quantifying reproductive isolation in parapatric lineages could be applied broadly to other phylogeographical studies and would help determine species classification of the plethora of newly identified lineages in the Amazon basin and other regions.

Leveraging Technology and Gamification to Engage Learners in a Microbiology Curriculum in Undergraduate Medical Education.

Background: Microbiology is a critical and expansive topic that many medical schools' curriculum must teach in a constrained time frame. We implemented a microbiology question bank smart phone app enhanced with game elements and clinical pearls during a microbiology course for first-year medical students. We hypothesized that these enhancements and clinical pearls would engage the students meaningfully and increase their knowledge base. Methods: Though use was optional, students' game play was recorded through the app, which was compared to test grades retrospectively. A player efficiency rating (PER) was calculated as a function of question response, accuracy, and engagement. Students were separated into tertiles of PER and median exam grades were compared using a non-parametric Kruskal-Wallis (KW) test. An anonymous satisfaction and usability feedback survey was also administered. Results: One hundred eighty-one of the 189 students (96%) answered at least one question, and 165 (87%) completed all 56 questions. The average PER was 84.75. We received feedback surveys from 61 (34%) students in the course, with positive responses regarding the perceived impact on learning microbiology. The KW test found a positive correlation for median exam scores of the player groups when divided into tertiles by PER (p = 0.0002). Conclusions: We leveraged gamification and clinical pearls to design a supplemental microbiology question bank. We found high engagement overall and higher class exam scores associated with greater use of the question bank.

Resource partitioning between Microlophus occipitalis and Stenocercus puyango (Sauria: Tropiduridae) in Cerros de Amotape National Park, Tumbes, Peru

Activity, microhabitat use, and diet are patterns commonly used to define the saurian community structure, because of differential exploitation allowing coexistence at the same time and place. We analyze resource partitioning between two sympatric saurian species, Stenocercus puyango and Microlophus occipitalis, in the transitional area of the Pacific Tropical Forest and the Dry Forest inside Cerros de Amotape National Park (PNCA) in Tumbes, northwestern of Peru. Microlophus occipitalis and S. puyango both showed a unimodal activity pattern with higher activity around 13:00 h, with a mean body temperature of 34.83 °C and 32.17 °C respectively, observing a significant relationship between body and environmental (air and substrate) temperatures. Rocks and tree trunks were the most frequent microhabitats used by M. occipitalis while S. puyango were registered more frequently over leaf litter. The diets of both tropidurids were composed by arthropods, ants, and insect larvae mainly. Similarities in activity times (temporal niche) and diet (trophic niche) should be related to phylogenetic relationship and environmental characteristics of PNCA (seasonality, vegetal composition) meanwhile differences in space use and microhabitat thermal quality will be related to thermal quality in the area.

Los horarios de actividad, el uso de microhábitat y dieta, son patrones comúnmente utilizados para dilucidar la estructura de una comunidad de saurios, ya que estos hacen un uso diferenciado de los recursos que explotan, lo que les permite coexistir de forma adecuada en el mismo tiempo y lugar. Analizamos la repartición de recursos entre dos especies simpátridas de saurios, Stenocercus puyango y Microlophus occipitalis, en la zona transicional entre el Bosque Tropical del Pacifico y el Bosque Seco en el Parque Nacional Cerros de Amotape (PNCA), departamento de Tumbes, analizando el solapamiento del nicho espacial, temporal y trófico entre ambas especies, incluyendo algunos aspectos de sus ecologías termales. Microlophus occipitalis y S. puyango presentaron un patrón de actividad unimodal con un pico de actividad hacia las 13:00 horas y una temperatura corporal promedio de 34.83 °C y 32.17 °C, respectivamente, registrándose una relación significativa entre la temperatura corporal y las temperaturas ambientales (aire y suelo). Los microhábitats más utilizados por M. occipitalis fueron los troncos caídos y rocas, mientras que S. puyango fue registrado principalmente sobre hojarasca. La dieta de ambos tropidúridos estuvo compuesta por artrópodos, principalmente hormigas y larvas de insectos. Las similitudes encontradas tanto en los horarios de actividad (nicho temporal) como en la dieta (nicho trófico), estarían asociadas a su parentesco filogenético y a características ambientales propias dentro del PNCA (estacionalidad, composición vegetal), mientras que las diferencias en el uso del espacio y temperaturas corporales entre ambas especies estarían relacionada a la calidad térmica de los microhábitats presentes en el área.

La salud pública y la mujer peruana / Public health and the Peruvian woman

RESUMEN Se detalla el inicio de la salud publica en la historia y el desarrollo que tuvo en el Perú en general y en particular su relación con eventos que impulsaron las mejoras en el ámbito de la salud materno-infantil, la anticoncepción y, posteriormente, en los derechos sexuales y reproductivos de las mujeres peruanas.

ABSTRACT This article details the beginning of public health in history and its development in Peru in general and in particular its relationship with events that drove improvements in the field of maternal and child health, contraception and, later, in the sexual and reproductive rights of Peruvian women.

Presence of Pathogenic Leptospira spp. in an Urban Slum of the Colombian Caribbean: A One Health Approach

Introducción: La leptospirosis es una zoonosis que tiene alto impacto en la salud de las personas y los animales, especialmente en áreas tropicales y subtropicales. Esta enfermedad es causada por el patógeno Leptospira spp. y es transmitida principalmente por los roedores. Objetivo: Describir la presencia de Leptospira patógena y los posibles factores de riesgo de leptospirosis en un sector marginal de Colombia, con un enfoque One-Health. Métodos: Se llevó acabo un estudio exploratorio en un sector marginal de Soledad, municipio situado en la costa norte de Colombia. Se tomaron muestras de sangre de 83 sujetos. Se analizaron variables sociodemográficas, clínicas y ecológicas relacionadas con la leptospirosis. La presencia de anticuerpos IgM anti-leptospira en el suero humano fue detectado mediante la prueba ELISA. También, se tomaron muestras de tejido renal de 53 roedores sinantrópicos para identificar Leptospira spp. patógenas mediante PCR convencional a través del uso de cebadores específicos. Resultados: Se detectaron anticuerpos IgM-anti-leptospira en el 30,12 por ciento de los sujetos de estudio. La Leptospira spp. patógena fue identificada en el 7,55 por ciento de los roedores analizados. En la muestra seleccionada se encontró asociación de casos seropositivos con ser comerciantes, ama de casa y estar en contacto con cerdos. Las condiciones higiénico-sanitarias subóptimas también fueron evidentes en el área de estudio. Conclusiones: La circulación de Leptospira spp. patógena y la exposición a factores de riesgo humanos y ecológicos es elevada en el sector marginal (área de pobreza) del Caribe colombiano. Se recomienda dirigir las intervenciones en la interfaz hombre-animal-ambiente de acuerdo con el paradigma One-Health; se debe considerar la extrema pobreza como un factor determinante para la ocurrencia de la leptospirosis(AU)

Objective: This study aims to describe the presence of pathogenic Leptospira and potential risk factors for leptospirosis in a marginal sector of the Colombian Caribbean, with a One Health approach. Methods: an exploratory study was carried out in a marginal sector of Soledad, a municipality located in the north coast of Colombia. Blood samples were taken from 83 subjects, who were also questioned about sociodemographic, clinical and ecological variables related to leptospirosis. The presence of IgM Anti-Leptospira antibodies in human serum was performed by ELISA. A total 53 synanthropic rodents were also captured using Sherman traps. Renal tissue samples were taken from rodents to identify pathogen Leptospira spp. by conventional PCR using specific primers. Results: IgM-anti-Leptospira was present in 30.12 percent of study subjects and pathogenic Leptospira spp. was identified in 7.55 percent of captured rodents. In the selected sample we found an association of positive cases with being a merchant, housewife and being in contact with pigs. Suboptimal hygienic-sanitary conditions were also evident in the study area. Conclusions: Our results show the circulation of pathogenic Leptospira spp. and exposure to human and ecological risk factors in a marginal sector (slum) of the Colombian Caribbean. We suggest to direct interventions in the human-animal-environment interface according to the One Health paradigm, considering extreme poverty as a determining factor for Leptospirosis occurrence(AU)

Correction: Monitoring of the Venezuelan exodus through Facebook's advertising platform.

[This corrects the article DOI: 10.1371/journal.pone.0229175.].

Monitoring of the Venezuelan exodus through Facebook's advertising platform.

Venezuela is going through the worst economical, political and social crisis in its modern history. Basic products like food or medicine are scarce and hyperinflation is combined with economic depression. This situation is creating an unprecedented refugee and migrant crisis in the region. Governments and international agencies have not been able to consistently leverage reliable information using traditional methods. Therefore, to organize and deploy any kind of humanitarian response, it is crucial to evaluate new methodologies to measure the number and location of Venezuelan refugees and migrants across Latin America. In this paper, we propose to use Facebook's advertising platform as an additional data source for monitoring the ongoing crisis. We estimate and validate national and sub-national numbers of refugees and migrants and break-down their socio-economic profiles to further understand the complexity of the phenomenon. Although limitations exist, we believe that the presented methodology can be of value for real-time assessment of refugee and migrant crises world-wide.

Nitrogen excretion during marsupial development in the terrestrial isopod Armadillidium vulgare.

Marsupial embryos of Armadillidium vulgare (Isopoda: Oniscidea) were collected at different stages of development and assayed for products of nitrogen excretion. Stages were classified as early stage one, late stage one (clear embryo and somite differentiation), early stage two (chorion shed, prior to blastokinesis), late stage two (following blastokinesis), and mancae (vitelline membrane shed; second embryonic molt). Stage one and stage two embryos were primarily ammonotelic. Mancae showed a significant increase in stored uric acid and decrease in ammonia production, in most cases to undetectable levels. The increased metabolic rate of mancae, and the fact that they imbibe marsupial fluid prior to exiting the marsupium, may have favored a switch from ammonotely to uricotely to avoid ammonia toxicity. Protein metabolism, estimated from ammonia production, accounted for 7% of the measured catabolic rate in Stage 2 embryos. Newly emerged juveniles showed a >2-fold increase in metabolism relative to mancae, accompanying the transition from aquatic to aerial respiration. Following 48 h post-emergence, juveniles resumed ammonia excretion, volatilizing the base (NH3) as in later instars. Elevated ammonia excretion in early juveniles may derive from the catabolism of remaining yolk protein. A sharp increase in whole-animal glutamine in juveniles is consistent with its role as an intermediary nitrogen store during periodic ammonia excretion. Total ammonia concentration in the marsupial fluid fluctuated but did not increase significantly over time and ammonia was not volatilized across the oostegites, indicating that embryo ammonia is transported into the maternal hemolymph for excretion.

Hybrid speciation leads to novel male secondary sexual ornamentation of an Amazonian bird.

Hybrid speciation is rare in vertebrates, and reproductive isolation arising from hybridization is infrequently demonstrated. Here, we present evidence supporting a hybrid-speciation event involving the genetic admixture of the snow-capped (Lepidothrix nattereri) and opal-crowned (Lepidothrix iris) manakins of the Amazon basin, leading to the formation of the hybrid species, the golden-crowned manakin (Lepidothrix vilasboasi). We used a genome-wide SNP dataset together with analysis of admixture, population structure, and coalescent modeling to demonstrate that the golden-crowned manakin is genetically an admixture of these species and does not represent a hybrid zone but instead formed through ancient genetic admixture. We used spectrophotometry to quantify the coloration of the species-specific male crown patches. Crown patches are highly reflective white (snow-capped manakin) or iridescent whitish-blue to pink (opal-crowned manakin) in parental species but are a much less reflective yellow in the hybrid species. The brilliant coloration of the parental species results from nanostructural organization of the keratin matrix feather barbs of the crown. However, using electron microscopy, we demonstrate that the structural organization of this matrix is different in the two parental species and that the hybrid species is intermediate. The intermediate nature of the crown barbs, resulting from past admixture appears to have rendered a duller structural coloration. To compensate for reduced brightness, selection apparently resulted in extensive thickening of the carotenoid-laden barb cortex, producing the yellow crown coloration. The evolution of this unique crown-color signal likely culminated in premating isolation of the hybrid species from both parental species.

A Web-Based Data Collection Platform for Multisite Randomized Behavioral Intervention Trials: Development, Key Software Features, and Results of a User Survey.

BACKGROUND: Meticulous tracking of study data must begin early in the study recruitment phase and must account for regulatory compliance, minimize missing data, and provide high information integrity and/or reduction of errors. In behavioral intervention trials, participants typically complete several study procedures at different time points. Among HIV-infected patients, behavioral interventions can favorably affect health outcomes. In order to empower newly diagnosed HIV positive individuals to learn skills to enhance retention in HIV care, we developed the behavioral health intervention Integrating ENGagement and Adherence Goals upon Entry (iENGAGE) funded by the National Institute of Allergy and Infectious Diseases (NIAID), where we deployed an in-clinic behavioral health intervention in 4 urban HIV outpatient clinics in the United States. To scale our intervention strategy homogenously across sites, we developed software that would function as a behavioral sciences research platform. OBJECTIVE: This manuscript aimed to: (1) describe the design and implementation of a Web-based software application to facilitate deployment of a multisite behavioral science intervention; and (2) report on results of a survey to capture end-user perspectives of the impact of this platform on the conduct of a behavioral intervention trial. METHODS: In order to support the implementation of the NIAID-funded trial iENGAGE, we developed software to deploy a 4-site behavioral intervention for new clinic patients with HIV/AIDS. We integrated the study coordinator into the informatics team to participate in the software development process. Here, we report the key software features and the results of the 25-item survey to evaluate user perspectives on research and intervention activities specific to the iENGAGE trial (N=13). RESULTS: The key features addressed are study enrollment, participant randomization, real-time data collection, facilitation of longitudinal workflow, reporting, and reusability. We found 100% user agreement (13/13) that participation in the database design and/or testing phase made it easier to understand user roles and responsibilities and recommended participation of research teams in developing databases for future studies. Users acknowledged ease of use, color flags, longitudinal work flow, and data storage in one location as the most useful features of the software platform and issues related to saving participant forms, security restrictions, and worklist layout as least useful features. CONCLUSIONS: The successful development of the iENGAGE behavioral science research platform validated an approach of early and continuous involvement of the study team in design development. In addition, we recommend post-hoc collection of data from users as this led to important insights on how to enhance future software and inform standard clinical practices. TRIAL REGISTRATION: Clinicaltrials.gov NCT01900236; (https://clinicaltrials.gov/ct2/show/NCT01900236 (Archived by WebCite at http://www.webcitation.org/6qAa8ld7v).

Evaluación rápida de la situación de los servicios de salud sexual y reproductiva en el marco de la epidemia del zika en el Perú / Rapid assessment of the situation of the sexual and reproductive health services in the framework of Zika virus epidemic in Peru

En América Latina, los primeros meses del 2016 estuvieron marcados por crecientes reportes de microcefalia, que poco después se demostró estaba causado por el virus zika. Inicialmente su transmisión fue caracterizada como metaxénica (a través del mosquito del dengue, Aedes aegypti), para luego encontrarse evidencias de transmisión sexual. Por ello, el Ministerio de Salud (MINSA) del Perú solicitó evaluar la capacidad de respuesta de sus servicios de salud reproductiva en las áreas de mayor riesgo de contagio, el área nororiental del Perú y Lima, a fin de identificar necesidades y nudos críticos y elaborar un plan de mejora de la oferta de servicios. En el caso de Lima, también se incluyeron dos establecimientos de EsSalud. Mediante entrevistas individuales, grupales, listas de chequeo y guías de observación, se analizaron variables claves del sistema de salud. El presupuesto en las regiones fue siempre menor al solicitado, mientras que el de planificación familiar recibía otros usos. Los horarios de atención fueron limitados, en tanto que se requiere actualizar las competencias del personal para usar el dispositivo intrauterino (DIU) y métodos de larga duración. El 83% de establecimientos tenía desabastecimiento del inyectable mensual, mientras que 17% presentó substock. Asimismo, resultó clara la necesidad de capacitar al personal para la prevención del zika durante las relaciones sexuales, así como antes y durante el embarazo. No se reconoció los vínculos con la violencia sexual. Los servicios orientados a usuarias/os adolescentes brindaban atención con horarios restringidos, además de otras limitaciones a su acceso. Solo el 22% de usuarias había recibido información de parte de los proveedores.

In Latin America, the first months of 2016 were marked by the increasing reports of microcephaly, which was shortly afterwards shown to have been caused by the Zika virus. Initially, its transmission was typified as metaxenic (caused by the Dengue mosquito Aedes aegypti); later, evidences of sexual transmission were detected. Thus, the Ministry of Health of Peru required to evaluate the response capacity of the reproductive health services to needs and critical knots and to draft a plan to improve the offer. In the case of Lima, EsSalud facilities were also included. Through individual and group interviews, and check lists and observation lists, key variables of the health system were analyzed. The budget of the regions was always lower than that requested; the family planning budget was expended in other uses. Office hours were limited. The staff skills on both intrauterine device (IUD) and long-acting reversible contraception (LARC) use needed to be updated. 83% of the facilities had shortage of monthly injectable contraception, and 17% were sub-stocked. Likewise, the staff needed to be trained on Zika prevention during sexual activity, and before and during pregnancy. The links with sexual violence were not recognized. The services for adolescent users had restricted office hours, and other access limitations. Only 22% of the users had received information from the suppliers.

Metodología para el diseño de un Sistema de Gestión de Calidad en la Universidad de Ciencias Médicas de Holguín / Methodology for the Design of a Quality Management System in the Medical Sciences University in Holguin

En la actualidad las universidades adecuan sus procesos y los perfeccionan para lograr un servicio de calidad entre las partes interesadas. En el presente trabajo se presenta una metodología para el diagnóstico de la calidad en la Universidad de Ciencias Médicas de Holguín. En la búsqueda de un instrumento que garantizara la eficiencia y eficacia dentro de la organización se decide realizar un diseño de un Sistema de Gestión de la Calidad (SGC), que se define como el conjunto de normas interrelacionadas por los cuales se administra de forma ordenada su calidad, en la búsqueda de la mejora, planteándose cómo registrar la información, auto controlarla y auditar internamente los procesos de formación, investigación y extensión y obtener indicadores para medir la eficiencia de sistema de gestión de calidad según los criterios de medidas seleccionados, bajo la Norma ISO 9001:2008(AU)

Nowadays the universities adapt and improve their processes to get a service of quality between the involved parts. In this paper a methodology for the diagnosis of quality in the Medical Sciences University of Holguin is presented. Looking for an instrument that guarantees the eficiency and eficacy in the organization it is decided to make a design of a Quality Gestion System (QGS), that is defined as a joint of interrelated norms by means of which the quality is administered, seeking for improvement, stating how to register and control information, getting indicators to measure the eficiency in the Quality Gestion System according to the measure criteria selected under the ISO 9001:2008 norms(AU)

Diabetes Connect: Developing a Mobile Health Intervention to Link Diabetes Community Health Workers With Primary Care.

Community health worker (CHW) interventions can help improve diabetes self-management and health outcomes. There is limited evidence on how to effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the health care team and enhance care. We tested a model for the integration of a CHW-delivered mHealth intervention to improve diabetes self-management. Seventy-two African American patients with diabetes were followed using the mHealth tool. This project partnered an academic institution, a safety-net clinic, and African American churches. The integration of mHealth technology into CHW programs was successfully achieved and readily accepted.

Hybridization in headwater regions, and the role of rivers as drivers of speciation in Amazonian birds.

Many understory birds and other groups form genetically differentiated subspecies or closely related species on opposite sides of major rivers of Amazonia, but are proposed to come into geographic contact in headwater regions where narrower river widths may present less of a dispersal barrier. Whether such forms hybridize in headwater regions is generally unknown, but has important implications to our understanding of the role of rivers as drivers of speciation. We used a dataset of several thousand single nucleotide polymorphisms to show that seven taxon pairs that differentiate across a major Amazonian river come into geographic contact and hybridize in headwater regions. All taxon pairs possessed hybrids with low numbers of loci in which alleles were inherited from both parental species, suggesting they are backcrossed with parentals, and indicating gene flow between parental populations. Ongoing gene flow challenges rivers as the sole cause of in situ speciation, but is compatible with the view that the wide river courses in the heart of Amazonia may have driven interfluvial divergence during episodes of wet forest retraction away from headwater regions. Taxa as old as 4 Ma in our Amazonian dataset continue to hybridize at contact zones, suggesting reproductive isolation evolves at a slow pace.

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in three cities of Colombia.

OBJECTIVE: To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene (HH) approach in Colombia, and analyze predictors of poor HH compliance. METHODS: An observational, prospective, interventional, before-and-after study was conducted from May 2003 through September 2010 in 10 intensive care units (ICUs) of six hospitals in three cities. The study was divided into two periods: a baseline and a follow-up period. Observations for HH compliance were done in each ICU during randomly selected 30-min periods. The multidimensional HH approach included: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. RESULTS: A total of 13 187 opportunities for HH were observed. Overall HH compliance increased from 50% to 77% (relative risk 1.55, 95% confidence interval 1.43-1.68; p=0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor HH compliance: males vs. females (67% vs. 77%; p=0.0001), physicians vs. nurses (59% vs. 78%; p<0.0001), and adult vs. pediatric ICUs (76% vs. 42%; p<0.001), among others. CONCLUSIONS: Adherence to HH was increased by 55% with the INICC approach. Programs targeted at improving HH in variables found to be predictors of poor compliance should be implemented.