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

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

Participant experiences with a multipurpose vaginal ring for HIV and pregnancy prevention during a phase 1 clinical trial: learning from users to improve acceptability.

Introduction: With high concurrent global rates of HIV incidence and unintended pregnancy, there is a need to provide options beyond condoms to enable users to simultaneously prevent HIV acquisition and pregnancy. Multiple vaginal rings are in development as "MPTs" (multipurpose prevention technologies) as they are shown to provide several co-occurring benefits such as discretion, convenience, reversibility and user control. Methods: In this Phase 1 trial of a 3-month MPT ring in the U.S., 25 participants (low-risk for HIV and pregnancy) were randomized to use the study ring for 90 days continuously or in 28-day cycles with 2-day removal periods in between. All participants completed in-depth interviews at the end of their study participation. Results: Overall, the ring was well tolerated. Participants resoundingly endorsed the concept of an extended-use, dual-purpose vaginal ring, but reported too many functional challenges and side effects to endorse this particular ring. Participants assigned to the continuous regimen reported more positive experiences with ring use than those in the cyclic group. A minority of participants who experienced minimal side effects and did not experience challenges with vaginal retention of the ring found it appealing. However, the majority of participants experienced challenges (ring slippage, expulsions, side effects, vaginal bleeding changes) with product use that outweighed the potential benefits and led them to report that - in the future - they would not be interested in using this specific version of the ring in its current form. A subset expressed interest in using the current MPT ring under certain conditions (e.g., if fewer expulsions, less bleeding, higher risk for HIV/pregnancy). Discussion: User feedback regarding participant experiences and challenges with the study ring was continuously shared with the product developer, underscoring the value of early-stage end-user feedback in product development.

Prospective acceptability of a multipurpose technology (MPT) implant in preclinical development to prevent HIV and unplanned pregnancy: Qualitative insights from women end users and health care providers in South Africa and Zimbabwe.

BACKGROUND: Given the high rates of both HIV and unintended pregnancies in sub-Saharan Africa, the SCHIELD program aims to develop a multipurpose technology implant for HIV and pregnancy prevention. An end-user evaluation was undertaken with young women and health care providers to assess preferences for modifiable implant attributes to improve future adoption and rollout. METHODS: Focus group discussions were conducted with potential women end users, and health care providers experienced in implant insertion or removal participated in in-depth interviews. All participants were recruited from Harare, Zimbabwe, or Soshanguve, South Africa. The purposively stratified sampled women were either implant experienced or implant naïve and were categorized into three groups: nulliparous, postpartum, or engaged in transactional sex. Topics covered included duration (six months to three years), biodegradability, removability, and independent rod retrievability (per indication). Data were analyzed using Dedoose software and summarized into emerging themes. RESULTS: Participants identified three key areas that could facilitate rollout, uptake, and adherence of an implant for HIV and pregnancy prevention. First, discreetness was the most salient topic and was associated with implant characteristics such as anatomical location, flexibility, and biodegradability. Second, the ability to independently retrieve the HIV or pregnancy prevention component was preferred, as life circumstances may change and was favored by all participants, except for young women in Soshanguve. Third, there is a need for proper counseling, sensitization, provider training, and health campaigns to facilitate rollout of a 2-in-1 implant. CONCLUSIONS: A 2-in-1 implant was seen as highly desirable by most young women and health care providers. Participants discussed potential concerns and barriers to uptake of a biodegradable implant with dual HIV prevention and contraceptive properties, identifying key implant attributes that product developers can modify while still in preclinical stages.

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

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

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

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

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

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

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

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

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

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

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

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

Making the Case for Joint Decision-Making in Future Multipurpose Prevention Technology (MPT) Choice: Qualitative Findings on MPT Attribute Preferences from the CUPID Study (MTN-045).

INTRODUCTION: Young women in sub-Saharan Africa account for two-thirds of all new HIV infections and face high rates of unintended pregnancy. Multipurpose prevention technologies (MPTs) are promising products under development that are designed to simultaneously prevent HIV and unintended pregnancy. Since MPTs will be used in the context of sexual relationships, ensuring acceptability and use requires understanding the role of male partners in MPT use decision-making. METHODS: This paper draws on qualitative data from 39 couples enrolled in the Microbicide Trials Network (MTN) 045 study, conducted in 2019-2020. Partners completed a discrete choice experiment (DCE), first separately and then jointly, to measure preferences for future MPT attributes and then completed a qualitative interview. We also draw on quantitative data from interviewer observation about who dominated the decision-making process during the joint DCE. Content analysis was used to examine (1) how couples made decisions on existing non-MPT HIV and pregnancy prevention products; (2) how couples made decisions on future ideal-MPT product during the DCE; and (3) how these decision-making processes varied by decision-making dominance (10 male, 10 female and 19 equal) and interview type (19 joint and 20 separate). RESULTS: Existing non-MPT product decisions focused on trust between partners and product attributes, while future ideal-MPT product decisions exclusively focused on product attributes. Across existing and future products, preferences for product attributes varied by gender. Male partners were most concerned with limiting side effects impacting sexual pleasure, female partners were most concerned with limiting side effects causing physical symptoms and both were concerned with the return to fertility. Across all dominance and interview types, couples reported making decisions together and female partners were often able to negotiate with male partners for their preferred product or set of product attributes. CONCLUSIONS: Research activities in this study provided an opportunity for couples to openly present their product attribute preferences to their partner, learn about their partner's attribute preferences, negotiate for their ideal set of attributes and ultimately choose attributes that benefited the couple without disempowering the female partner. Future research should focus on the utility of couple-based decision-making aids or similar tools for facilitating joint MPT decision-making.

Nanopore metatranscriptomics reveals cryptic catfish species as potential Shigella flexneri vectors in Kenya.

Bacteria in the Shigella genus remain a major cause of dysentery in sub-Saharan Africa, and annually cause an estimated 600,000 deaths worldwide. Being spread by contaminated food and water, this study highlights how wild caught food, in the form of freshwater catfish, can act as vectors for Shigella flexneri in Southern Kenya. A metatranscriptomic approach was used to identify the presence of Shigella flexneri in the catfish which had been caught for consumption from the Galana river. The use of nanopore sequencing was shown to be a simple and effective method to highlight the presence of Shigella flexneri and could represent a potential new tool in the detection and prevention of this deadly pathogen. Rather than the presence/absence results of more traditional testing methods, the use of metatranscriptomics highlighted how primarily one SOS response gene was being transcribed, suggesting the bacteria may be dormant in the catfish. Additionally, COI sequencing of the vector catfish revealed they likely represent a cryptic species. Morphological assignment suggested the fish were widehead catfish Clarotes laticeps, which range across Africa, but the COI sequences from the Kenyan fish are distinctly different from C. laticeps sequenced in West Africa.

Using weighted expert judgement and nonlinear data analysis to improve Bayesian belief network models for riverine ecosystem services.

Rivers are a key part of the hydrological cycle and a vital conduit of water resources, but are under increasing threat from anthropogenic pressures. Linking pressures with ecosystem services is challenging because the processes interconnecting the physico-chemical, biological and socio-economic elements are usually captured using heterogenous methods. Our objectives were, firstly, to advance an existing proof-of-principle Bayesian belief network (BBN) model for integration of ecosystem services considerations into river management. We causally linked catchment stressors with ecosystem services using weighted evidence from an expert workshop (capturing confidence among expert groups), legislation and published literature. The BBN was calibrated with analyses of national monitoring data (including non-linear relationships and ecologically meaningful breakpoints) and expert judgement. We used a novel expected index of desirability to quantify the model outputs. Secondly, we applied the BBN to three case study catchments in Ireland to demonstrate the implications of changes in stressor levels for ecosystem services in different settings. Four out of the seven significant relationships in data analyses were non-linear, highlighting that non-linearity is common in ecosystems, but rarely considered in environmental modelling. Deficiency of riparian shading was identified as a prevalent and strong influence, which should be addressed to improve a broad range of societal benefits, particularly in the catchments where riparian shading is scarce. Sediment load had a lower influence on river biology in flashy rivers where it has less potential to settle out. Sediment interacted synergistically with organic matter and phosphate where these stressors were active; tackling these stressor pairs simultaneously can yield additional societal benefits compared to the sum of their individual influences, which highlights the value of integrated management. Our BBN model can be parametrised for other Irish catchments whereas elements of our approach, including the expected index of desirability, can be adapted globally.

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

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

Acceptability of the Dapivirine Vaginal Ring in Postmenopausal US Women.

For women in the United States who remain sexually active beyond child-bearing years, susceptibility to HIV infection remains, yet condom use is low. We assessed acceptability of the dapivirine vaginal ring (ring) among 96 postmenopausal US women enrolled in a placebo-controlled multisite phase II trial of the ring, using questionnaires and in-depth interviews. Three quarters of women reported "perfect" adherence (ring never out) over the 3-month trial period. At study exit, the ring was found to be very easy to use by 72%, very comfortable to wear by 65%, and 4% reported it ever interfered with their daily activities. The most common worries among participants at preinitiation had decreased significantly at study exit (e.g., worries about inserting the ring declined from 46% to 6%, discomfort during daily activities from 53% to 3%, ring not staying in place from 48% to 14%, all p < 0.0001). Despite some couples feeling the ring during sex, the ring was perceived as more suitable than condoms for prevention because it was not burdensome to use, did not interfere with erection, and provided (for some) additional vaginal lubrication. The ring is a promising, highly acceptable HIV prevention method that is suitable to the lives of postmenopausal women and their male partners and can provide them with an additional prevention choice. Clinical Trials Registration: NCT02010593.

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

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

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

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

What Is Your Diagnosis?

In collaboration with the American College of Veterinary Radiology.

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

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

Giving voice to the end-user: input on multipurpose prevention technologies from the perspectives of young women in Kenya and South Africa.

ABSTRACTUnintended pregnancy and unmet need for modern contraception contribute substantially to reproductive health disparities globally. In sub-Saharan Africa they occur in contexts of disproportionately high rates of HIV infection. Multipurpose prevention technologies (MPTs) can address HIV and pregnancy prevention needs in a single "2-in-1" product; however, few studies have solicited end-user views to inform design of new MPTs. We conducted the Tablets, Ring, Injections as Options (TRIO) study with young women aged 18-30 in Kenya and South Africa (N = 277) to examine preferences and acceptability of future MPTs. In a randomised clinical cross-over study in which women used three placebo delivery forms, we complemented quantitative acceptability assessments with in-depth interviews and focus group discussions (N = 88 participants). We examined anticipated enablers and barriers to adoption and use of future MPTs and synthesised novel product design recommendations. Participants expressed high interest in MPTs. Anticipated side effects constituted a primary concern; however, many expected barriers were not dosage form-specific, but addressed contextual factors instead, such as fears regarding use of new biomedical technologies, misunderstandings and stigma regarding use, and navigating partner disclosure and engagement. Women preferred MPTs that offered discreetness and long-duration protection to minimise user-burden, did not interfere with their relationships, and conferred protection for unanticipated situations. End-user research to identify and pre-emptively address potential barriers while underscoring benefits to a new MPT product is vital. Attention to cultural contexts in implementation of new MPTs is important to communicating perceived benefits, achieving acceptability and maximising public health benefits.

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

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