The feasibility, acceptability, appropriateness and impact of implementing person-centered communication for prevention of female genital mutilation in antenatal care settings in Guinea, Kenya and Somalia.

BACKGROUND: There is limited evidence on how to engage health workers as advocates in preventing female genital mutilation (FGM). This study assesses the feasibility, acceptability, appropriateness and impact of a person-centered communication (PCC) approach for FGM prevention among antenatal care (ANC) providers in Guinea, Kenya and Somalia. METHODS: Between August 2020 and September 2021, a cluster randomised trial was conducted in 180 ANC clinics in three countries testing an intervention on PCC for FGM prevention. A process evaluation was embedded, comprising in-depth interviews (IDIs) with 18 ANC providers and 18 ANC clients. A qualitative thematic analysis was conducted, guided by themes identified a priori and/or that emerged from the data. RESULTS: ANC providers and clients agreed that the ANC context was a feasible, acceptable and appropriate entry point for FGM prevention counselling. ANC clients were satisfied with how FGM-related information was communicated by providers and viewed them as trusted and effective communicators. Respondents suggested training reinforcement, targeting other cadres of health workers and applying this approach at different service delivery points in health facilities and in the community to increase sustainability and impact. CONCLUSION: These findings can inform the scale up this FGM prevention approach in high prevalence countries.

Cluster randomised trial of a health system strengthening approach applying person-centred communication for the prevention of female genital mutilation in Guinea, Kenya and Somalia.

INTRODUCTION: There is limited evidence on effective health systems interventions for preventing female genital mutilation (FGM). This study tested a two-level intervention package at primary care applying person-centred communication (PCC) for FGM prevention. METHODS: A cluster randomised trial was conducted in 2020-2021 in 180 antenatal care (ANC) clinics in Guinea, Kenya and Somalia. At baseline, all clinics received guidance and materials on FGM prevention and care; at month 3, ANC providers at intervention sites received PCC training. Data were collected from clinic managers, ANC providers and clients at baseline, month 3 and month 6 on primary outcomes, including delivery of PCC counselling, utilisation of level one materials, health facility preparedness for FGM prevention and care services and secondary outcomes related to clients' and providers' knowledge and attitudes. Data were analysed using multilevel and single-level logistic regression models. RESULTS: Providers in the intervention arm were more likely to deliver PCC for FGM prevention compared with those in the control arm, including inquiring about clients' FGM status (adjusted OR (AOR): 8.9, 95% CI: 6.9 to 11.5; p<0.001) and FGM-related beliefs (AOR: 9.7, 95% CI: 7.5 to 12.5; p<0.001) and discussing why (AOR: 9.2, 95% CI: 7.1 to 11.9; p<0.001) or how (AOR: 7.7, 95% CI: 6.0 to 9.9; p<0.001) FGM should be prevented. They were more confident in their FGM-related knowledge (AOR: 7.0, 95% CI: 1.5 to 32.3; p=0.012) and communication skills (AOR: 1.8; 95% CI: 1.0 to 3.2; p=0.035). Intervention clients were less supportive of FGM (AOR: 5.4, 95% CI: 2.4 to 12.4; p<0.001) and had lower intentions of having their daughters undergo FGM (AOR: 0.3, 95% CI: 0.1 to 0.7; p=0.004) or seeking medicalised FGM (AOR: 0.2, 95% CI: 0.1 to 0.5; p<0.001) compared with those in the control arm. CONCLUSION: This is the first study to provide evidence of an effective FGM prevention intervention that can be delivered in primary care settings in high-prevalence countries. TRIAL REGISTRATION AND DATE: PACTR201906696419769 (3 June 2019).

Measuring women's experiences during antenatal care (ANC): scoping review of measurement tools.

BACKGROUND: The new WHO model for antenatal care (ANC) focuses on improving practice, organisation and delivery of ANC within health systems, which includes both clinical care and women's experiences of care. The goal of this review is to identify tools and measures on women's experiences of ANC. METHODS: We conducted a scoping review to identify tools and measures on women's experiences of ANC. An iterative approach was used to review all tools in a series of four steps: (1) identify papers between 2007 and 2023; (2) identify the tools from these papers; (3) map relevant measures to conceptualizations of experiences of care, notably mistreatment of women and respectful maternity care and (4) identify gaps and opportunities to improve measures. RESULTS: Across the 36 tools identified, a total of 591 measures were identified. Of these, 292/591 (49.4%) measures were included and mapped to the typology of mistreatment of women used as a definition for women's experiences care during ANC in this review, while 299/591 (44.9%) irrelevant measures were excluded. Across the included measures, the highest concentration was across the domains of poor rapport between women and providers (49.8%) followed by failure to meet professional standards of care (23.3%). Approximately, 13.9% of measures were around overall respectful care, followed by health systems (6.3%), and any  physical or verbal abuse, stigma and/or discrimination (4.8%) . CONCLUSION: This analysis provides an overview of the existing tools, gaps and opportunities to measure women's experiences during ANC. Expanding beyond the childbirth period, these findings can be used to inform existing and future tools for research and monitoring measuring women's experiences of ANC.

Optimization of the holographic wavefront sensor for open-loop adaptive optics under realistic turbulence. Part I: simulations.

The modal holographic wavefront sensor enables fast measurement of individual aberration modes without the need for time-consuming calculations. However, the measurement accuracy suffers greatly from intermodal crosstalk, caused when the wavefront contains more aberrations than the one to be measured. In this paper, we present sensor optimization to minimize this effect and show the improvement when using Karhunen-Lòeve instead of Zernike modes as the basis. Finally, we show in simulation that an open-loop adaptive optics system based on the optimized sensor can be used to correct the effect of realistic, dynamic atmospheric turbulence on a wavefront and increase its Strehl ratio significantly.

Straightness metric for measurement of turbulence-induced distortion in long-range imaging.

Algorithms used for mitigation of the effects of atmospheric turbulence on video sequences often rely on a process for creating a reference image to register all of the frames. Because such a pristine image is generally not available, no-reference image quality metrics can be used to identify frames in a sequence that have minimum distortion. Here, we propose a metric that quantifies image warping by measuring image straightness based on line detection. The average length of straight lines in a frame is used to select best frames in a sequence and to generate a reference frame for a subsequent dewarping algorithm. We perform tests with this metric on simulated data that exhibits varying degrees of distortion and blur and spans normalized turbulence strengths between 0.75 and 4.5. We show, through these simulations, that the metric can differentiate between weak and moderate turbulence effects. We also show in simulations that the optical flow that uses a reference frame generated by this metric produces consistently improved image quality. This improvement is even higher when we employ the metric to guide optical flow that is applied to three real video sequences taken over a 7 km path.

A hybrid, effectiveness-implementation research study protocol targeting antenatal care providers to provide female genital mutilation prevention and care services in Guinea, Kenya and Somalia.

BACKGROUND: In settings with high prevalence of female genital mutilation (FGM), the health sector could play a bigger role in its prevention and care of women and girls who have undergone this harmful practice. However, ministries of health lack clear policies, strategic plans or dedicated funding to implement anti-FGM interventions. Along with limited relevant knowledge and skills to prevent the practice of FGM and care for girls and women living with FGM, health providers have limited interpersonal communication skills and self-efficacy, while some may have supportive attitudes towards FGM and its medicalization. We propose to test the effectiveness of a health system strengthening intervention that includes training antenatal care (ANC) providers on person-centred communication (PCC) for FGM prevention. METHODS: This will be a two-level, hybrid, effectiveness-implementation research study using a cluster randomized trial design in Guinea, Kenya and Somalia conducted over a 6 months period. In each country, within pre-selected regions/counties, 60 ANC clinics will be randomized to intervention and control arms. At baseline, all clinics will receive the level one intervention involving provision of FGM-related clinical guidelines and handbook as well as anti-FGM policies and posters. At month 3, intervention clinics will receive the level two intervention comprising of a training for ANC providers on PCC to challenge their FGM-related attitudes and build their communication skills to effectively provide FGM prevention counselling. A process evaluation will be conducted to understand 'how' and 'why' the intervention package achieves intended results. Multi-level regression modelling will be used for quantitative data analysis while qualitative data will be assessed using thematic content analysis to determine the effectiveness, feasibility and acceptability of the different intervention levels. DISCUSSION: The proposed study will strengthen the knowledge base regarding how to effectively involve health providers in FGM prevention and care. TRIAL REGISTRATION: Trial registration and date: PACTR201906696419769 (June 3rd, 2019).

Prioritizing and synthesizing evidence to improve the health care of girls and women living with female genital mutilation: An overview of the process.

Female genital mutilation (FGM) constitutes a harmful traditional practice that can have a profound impact on the health and well-being of girls and women who undergo the procedure. In recent years, due to international migration, healthcare providers worldwide are increasingly confronted with the need to provide adequate health care to this population. Recognizing this situation the WHO recently developed the first evidence-based guidelines on the management of health complications from FGM. To inform the guideline recommendations, an expert-driven, two-step process was conducted. The first step consisted of developing and ranking a list of priority research questions for the evidence retrieval. The second step involved conducting a series of systematic reviews and qualitative data syntheses. In the present paper, we first provide the methodology used in the development and ranking of the research questions (step 1) and then detail the common methodology for each of the systematic reviews and qualitative evidence syntheses (step 2).

Surgical or medical interventions for female genital mutilation.

Deinfibulation can prevent or treat gynecological and obstetric complications in women living with type III female genital mutilation (FGM), and subsequently improve childbirth outcomes. Recently published WHO guidelines recommend use of deinfibulation in both circumstances. However, to really impact practice, evidence-based guidance needs to be matched with evidence-based implementation strategies. This qualitative evidence synthesis provides information on the factors that facilitate or act as barriers to use of deinfibulation, and the context and conditions that are necessary for implementing the procedure, including healthcare providers' knowledge and experience, the service delivery environment, as well as broader health system contexts. This information is of great value for policy makers and others considering this as an option for better clinical care of women living with FGM.

Health information interventions for female genital mutilation.

Providing information and education to women and girls living with female genital mutilation (FGM) could be an important influence on their healthcare-seeking behavior. Healthcare providers also need adequate knowledge and skills to provide good quality care to this population. Recent WHO guidelines on managing health complications from FGM contain best practice statements for health education and information interventions for women and providers. This qualitative evidence synthesis summarizes the values and preferences of girls and women living with FGM, and healthcare providers, together with other evidence on the context and conditions of these interventions. The synthesis highlights that healthcare providers lack skills and training to manage women, and women are concerned about the lack of discussion about FGM with providers. There is a need for more training for providers, and further research to understand how health information interventions may be perceived or experienced by women living with FGM in different contexts.

Psychological and counselling interventions for female genital mutilation.

Women and girls living with female genital mutilation (FGM) are more likely to experience psychological problems than women without FGM. As well as psychological support, this population may need additional care when seeking surgical interventions to correct complications of FGM. Recent WHO guidelines recommend cognitive behavioral therapy for women and girls experiencing anxiety disorders, depression, or post-traumatic stress disorder. The guidelines also suggest that preoperative counselling for deinfibulation, and psychological support alongside surgical interventions, can help women manage the physiological and psychological changes following surgery. This synthesis summarizes evidence on women's values and preferences, and the context and conditions that may be required to provide psychological and counselling interventions. Understanding women's views, their own ways of coping, as well social and cultural factors that influence women's mental well-being, may help identify the types of interventions this population needs at different times and stages of their lives.

Development of indole/indazole-aminopyrimidines as inhibitors of c-Jun N-terminal kinase (JNK): optimization for JNK potency and physicochemical properties.

A novel series of indole/indazole-aminopyrimidines was designed and synthesized with an aim to achieve optimal potency and selectivity for the c-Jun kinase family or JNKs. Structure guided design was used to optimize the series resulting in a significant potency improvement. The best compound (17) has IC50 of 3 nM for JNK1 and 20 nM for JNK2, with greater than 40-fold selectivity against other kinases with good physicochemical and pharmacokinetic properties.

Development of amino-pyrimidine inhibitors of c-Jun N-terminal kinase (JNK): kinase profiling guided optimization of a 1,2,3-benzotriazole lead.

A series of amino-pyrimidines was developed based upon an initial kinase cross-screening hit from a CDK2 program. Kinase profiling and structure-based drug design guided the optimization from the initial 1,2,3-benzotriazole hit to a potent and selective JNK inhibitor, compound 24f (JNK1 and 2 IC(50)=16 and 66 nM, respectively), with bioavailability in rats and suitable for further in vivo pharmacological evaluation.

Novel 3,3-disubstituted pyrrolidines as selective triple serotonin/norepinephrine/dopamine reuptake inhibitors.

A series of 3,3-disubstituted pyrrolidine monoamine triple reuptake inhibitors were discovered. Analogues with low nanomolar potency, good human in vitro microsomal stability and in vitro permeability, and low drug-drug interaction potential are described. One example showed in vivo anti-depressant-like effects in the mouse tail suspension assay with a minimum effective dose of 30 mg/kg i.p.

Synthetic dihydropacidamycin antibiotics: a modified spectrum of activity for the pacidamycin class.

Dihydropacidamycins having an antibacterial spectrum modified from that of the natural product pacidamycins and mureidomycins have been synthesized. Synthetic dihydropacidamycins with noteworthy antibacterial activity against wild-type and resistant Escherichia coli have been identified (MIC=4-8 microg/mL). Some dihydropacidamycins are shown to have activity against multi-resistant clinical strains of Mycobacterium tuberculosis. Compounds of this class are inhibitors of the cell wall biosynthetic enzyme, MraY.