PrEP for women in Europe: a systematic literature review.

BACKGROUND: Prevention of HIV transmission is fundamental to ending the HIV epidemic. Pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine (TDF-FTC) is an established HIV-prevention method; however, most PrEP services in Europe have been targeted at men who have sex with men (MSM). A survey in 2021 by Women Against Viruses in Europe (WAVE) showed considerable variation in PrEP access and guidance for women throughout Europe. WAVE therefore commissioned this systematic review to provide insight into PrEP provision and barriers to uptake for women in Europe. METHODS: PubMed, Embase, and Scopus were searched for studies (January 2013-May 2021) that reported on actual (e.g., efficacy and safety) or hypothetical (e.g., awareness, barriers, PrEP impact models) use of oral PrEP involving women (including cis, transgender, pregnant, migrant, and breastfeeding women). Search terms included HIV, pre-exposure prophylaxis (specifically TDF-FTC), and women. Studies performed outside of the World Health Organization European region were excluded. RESULTS: The search identified 4716 unique citations, and 45 peer-reviewed articles (44 studies) were included. The majority of these studies (34/44 [77%]) included recipients or potential recipients of PrEP, representing 4699 women (243 transgender women). However, few studies were women focused (4/34 [12%]) or took place outside of Western Europe (3/34 [9%]). Across the three clinical studies that reported women-specific outcomes (60 transgender women, 13 pregnant, and 19 cis women), no breakthrough infections were recorded during the use of PrEP. Lack of awareness of PrEP, low self-estimation of HIV acquisition risk, concerns about stigma, lack of protection against other sexually transmitted infections, and PrEP interaction with hormones (for transgender women) were identified as barriers to use. The remaining studies examined healthcare professionals' perceptions of PrEP (9/44 [20%]), asked for public opinion (2/44 [5%]), or modelled the potential of PrEP for HIV prevention (1/44 [2%]). CONCLUSIONS: This review revealed a notable lack of literature on PrEP for cis and transgender women in Europe. This is synonymous with a lack of PrEP provision for women in this region. Barriers to PrEP uptake are complex and rooted in institutional and societal stigma, which must be addressed at policy level. HIV prevention with PrEP is not 'one size fits all' and requires a nuanced gender-responsive approach. Further research into the use of PrEP in cis, pregnant, breastfeeding, and transgender women is essential if we are to stop HIV transmission by 2030.

Elastogranular columns and beams.

String and grains can be combined to create structures capable of bearing significant loads. In this work, we prepare columns and beams through a layer-by-layer deposition of granular matter and loops of fiber strings, and characterize their mechanical properties. The loops cause the grains to jam, and the inter-grain contact leads to a Hertzian-like constitutive response. Initially, one force chain that propagates vertically through the column bears most of the compressive load. As the magnitude of the load is increased, more force chains form in the column, which act in parallel to increase its stiffness, akin to a "super-Hertzian" regime. Applying a compressive prestress enables the structures to withstand shear, enabling the fabrication of cantilevered beams. This work provides a mechanical framework to use elastogranular jamming to create rapid, reusable infrastructure components, such as columns, beams, and arches from inexpensive, commonplace materials, such as rocks and string.

An Electronic Screening System for Oral Health Examination and Collection of Critical Data in a Nonclinical Setting: Validation Trial.

OBJECTIVE: To evaluate the reliability, ease, and efficiency of data entry for an oral health screening app that allows iPad® entry of data, including permanent versus deciduous teeth present, visual image comparison grading of demineralization/caries, fluorosis, periodontal inflammation, oral hygiene status, identification of sealants/restorations, dental trauma, orthodontic malocclusion, mandibular joint dysfunction, and early childhood caries. METHODS: 89 consented children were examined first by a public health dental hygienist in a dental office reception area and then by a dentist in a treatment operatory. The same research associate was used to prompt and record both examinations. RESULTS: The screenings prompted by the electronic oral health screening system were completed in 2 to 3 minutes each with favorable levels of comparison between examiners as assessed by weighted Kappa scores measuring 0.531 for all teeth examined, with the lower back teeth showing the greatest agreement (K = 0.601) and the upper back and upper front demonstrating less agreement (K = 0.446 and 0.468, respectively). Neither examiner identified any carious lesions among the lower front teeth. CONCLUSIONS: This study provides the first description of an oral health screening entry app with visual image comparisons and touchscreen data entry for efficient collection of oral health information.

Impact of volumetric muscle loss injury on persistent motoneuron axotomy.

INTRODUCTION: Volumetric muscle loss (VML) occurs following significant traumatic injury or surgical removal of skeletal muscle, resulting in nonrecoverable loss of tissue and long-term dysfunction. Perhaps less recognized is that VML injuries inherently disrupt the neuromuscular unit, resulting in fiber denervation and presumptive motor unit rearrangement, expansion, and/or loss. To characterize neural dysfunction we quantified motoneuron axotomy, in efforts to understand how this relates to the temporal coordination of neuromuscular and morphological alterations due to injury. METHODS: In an established rat tibialis anterior (TA) VML injury model, we examined the motoneuron, skeletal muscle, and maximal isometric torque at 3, 7, 14, and 21 days postinjury. RESULTS: Significant axotomy of 57-79% of all TA muscle motoneurons was observed through 21 days postinjury, which was coupled with a 45-90% TA maximal torque deficit. DISCUSSION: A ∼20% partial ablation of the TA muscle causes disproportionate damage across the motor unit acutely postinjury. Muscle Nerve 57: 799-807, 2018.

Forelimb training drives transient map reorganization in ipsilateral motor cortex.

Skilled motor training results in reorganization of contralateral motor cortex movement representations. The ipsilateral motor cortex is believed to play a role in skilled motor control, but little is known about how training influences reorganization of ipsilateral motor representations of the trained limb. To determine whether training results in reorganization of ipsilateral motor cortex maps, rats were trained to perform the isometric pull task, an automated motor task that requires skilled forelimb use. After either 3 or 6 months of training, intracortical microstimulation (ICMS) mapping was performed to document motor representations of the trained forelimb in the hemisphere ipsilateral to that limb. Motor training for 3 months resulted in a robust expansion of right forelimb representation in the right motor cortex, demonstrating that skilled motor training drives map plasticity ipsilateral to the trained limb. After 6 months of training, the right forelimb representation in the right motor cortex was significantly smaller than the representation observed in rats trained for 3 months and similar to untrained controls, consistent with a normalization of motor cortex maps. Forelimb map area was not correlated with performance on the trained task, suggesting that task performance is maintained despite normalization of cortical maps. This study provides new insights into how the ipsilateral cortex changes in response to skilled learning and may inform rehabilitative strategies to enhance cortical plasticity to support recovery after brain injury.