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IntroductionEarly childhood development (ECD) is a critical component for building the foundation of future physical and emotional health and subsequent academic success. The quality of the home environment to promote development is an important factor in ECD. Since large rural–urban disparities in the home environment exist in China, there is a critical need to develop and evaluate interventions to promote ECD in rural areas. Individual center-based or home-based interventions dominate the current ECD programmes in rural China. However, group-based interventions offer potential advantages in terms of both effectiveness and cost. Thus, we aim to: (1) evaluate the effectiveness of an integrated group-based intervention, the Care Group Intervention, in enhancing ECD among children age 6–18 months and (2) conduct a cost-effectiveness analysis.Methods and analysisThe Care Group Intervention uses a cluster (by township) randomised controlled trial conducted in Fenxi county, Shanxi province, China, from July 2019, for 1 year. The intervention focuses on five key components of nurturing care including good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for early learning. The intervention comprises small groups of 3–10 children within a certain age range and their primary caregivers that are led by well-trained local facilitators. Outcomes includes infants’ developmental quotient (Bayley Scales of Infant Development III, Ages & Stages Questionnaire: Social–Emotional, second edition); anaemia (HemoCue Hb 301+); nurturing environment (Infant/Toddler Home Observation for Measurement of the Environment), parent-child interaction (Teaching Scale) and caregiver depression (Center for Epidemiological Studies Depression). Cost data are collected throughout the entire study to carry out a cost-effectiveness analysis.Ethics and disseminationThis study was approved by the Ethical Committee of Capital Institute of Pediatrics, Beijing, China on 10 July 2018 (SHERLL2018014). Findings and results from this project will be disseminated via publications and presentations.Trial registration numberChinese Clinical Trials Registry: ChiCTR1900022894. Registered on 30 April 2019.

Design This a cluster-randomized parallel arm pragmatic trial to observe the association of home-based postpartum contraceptive provision, including the contraceptive implant, with implant utilization rates at 3 months post-enrollment. Methods In a region of rural Guatemala referred to as the Southwest Trifinio, twelve communities are served by a community-based antenatal and postnatal care program. The communities were combined into eight clusters based on 2017 birth rates and randomized to receive the home-based contraceptive delivery (condoms, pills, injection, implant) during the routine 40-day postpartum visit. All participants receive comprehensive contraceptive counseling beginning at the first antenatal visit, so control clusters received this as part of routine care; this education preceded the study intervention. Results Once the 12 communities were combined into 8 clusters by expected birth volume and nurse team, which we expected to translate to eventual postpartum visits, the allocation sequence was generated in SAS. Of 208 women enrolled in the study, 108 were in four intervention and 100 in four control clusters. We used descriptive statistics to produce counts and percentages of characteristics of the study population overall and by intervention arm followed by univariate modeling using a mixed effects regression adjusted for cluster. Three-month contraceptive initiation rates were 56.0% in the control clusters compared to 76.8% in the intervention clusters, p  < 0.001. Women in control clusters overwhelmingly opted for the injectable contraceptive (94.6%) while women in intervention clusters chose both the injection (61.5%) and the implant (33.7%), p  < 0.001. Implant use by 3 months, the primary outcome of the study, was significantly higher in the intervention arm (25.9%) compared to the control arm (3.6%), p  < 0.001, RR 1.3 CI [1.2, 1.4]. Conclusion Our study was designed to respond to previously identified barriers to contraceptive uptake, and it was successful. Not only did it increase overall use of contraception by 3 months, but it shifted that contraceptive use away from short-acting methods in favor of longer-acting methods, with high continuation and satisfaction rates and no adverse outcomes reported. Trial registration clinicaltrials.gov , NCT04005391 ; Retrospectively Registered 7/2/2019,

Background Postpartum contraception is important to prevent unintended and closely spaced pregnancies following childbirth. Methods This study is a cluster-randomized trial of communities in rural Guatemala where women receive ante- and postnatal care through a community-based nursing program. When nurses visit women for their postpartum visit in the intervention clusters, instead of providing only routine care that includes postpartum contraceptive education and counseling, the nurses will also bring a range of barrier, short-acting, and long-acting contraceptives that will be offered and administered in the home setting, after routine clinical care is provided. Discussion A barrier to postpartum contraception is access to medications and devices. Our study removes some access barriers (distance, time, cost) by providing contraception in the home. We also trained community nurses to place implants, which are a type of long-acting reversible contraceptive method that was previously only available in the closest town which is about an hour away by vehicular travel. Therefore, our study examines how home-based delivery of routinely available contraceptives and the less routinely available implant may be associated with increased uptake of postpartum contraception within 3 months of childbirth. The potential implications of this study include that nurses may be able to be trained to safely provide contraceptives, including placing implants, in the home setting, and provision of home-based contraception may be an effective way of delivering an evidence-based intervention for preventing unintended and closely spaced pregnancies in the postpartum period. Trial registration Clinicaltrials.gov, NCT04005391 . Retrospectively registered on 1 July 2019.

IntroductionThis study aims to measure how transmission of SARS-CoV-2 occurs in communities and to identify conditions that lend to increased transmission focusing on congregate situations. We will measure SARS-CoV-2 in exhaled breath of asymptomatic and symptomatic persons using face mask sampling—a non-invasive method for SARS-CoV-2 detection in exhaled air. We aim to detect transmission clusters and identify risk factors for SARS-CoV-2 transmission in presymptomatic, asymptomatic and symptomatic individuals.Methods and analysisIn this observational prospective study with daily follow-up, index cases and their respective contacts are identified at each participating institution. Contact definitions are based on Centers for Disease Control and Prevention and local health department guidelines. Participants will wear masks with polyvinyl alcohol test strips adhered to the inside for 2 hours daily. The strips are applied to all masks used over at least 7 days. In addition, self-administered nasal swabs and (optional) finger prick blood samples are performed by participants. Samples are tested by standard PCR protocols and by novel antigen tests.Ethics and disseminationThis study was approved by the Colorado Multiple Institutional Review Board and the WHO Ethics Review Committee. From the data generated, we will analyse transmission clusters and risk factors for transmission of SARS-CoV-2 in congregate settings. The kinetics of asymptomatic transmission and the evaluation of non-invasive tools for detection of transmissibility are of crucial importance for the development of more targeted control interventions—and ultimately to assist with keeping congregate settings open that are essential for our social fabric.Trial registration numberClinicalTrials.gov (#NCT05145803).

The impact of demographic, psychosocial, and medical regimen-related variables on adherence of 123 human immunodeficiency virus (HIV)-infected patients to antiretroviral therapy was assessed by means of refill methodology. Satisfaction with social support (P = .029), problem-focused coping (P = .027), and active-behavioral coping (P = .011) correlated significantly with adherence, whereas loss of motivation (P = .006), hopelessness (P = .16), and avoidant coping (p = .015) correlated with nonadherence. At the 6-month follow-up, the mean CD4 cell count differed significantly among adherent versus nonadherent patients (a mean increase of 78/mm3 vs. a mean decrease of 5/mm3; P = .018). Adherence did not correlate with the number of antiretroviral medications consumed per day (mean, 3.0 vs. 2.5). Non-Caucasian patients were more likely to be nonadherent than Caucasian patients (relative risk, 2.5; 95% confidence interval, 1.2–5.3; P = .013); this difference was not explained by age, education, employment, income, history of intravenous drug use, or medical regimen. Non-Caucasian patients, however, were less satisfied with their social support (P = .04) and informational support (P = .016) and were more likely to utilize emotion-focused coping (P = .01). Thus, satisfaction with social support and coping style significantly impacted adherence and likely accounted for the observed racial difference in adherence among HIV-infected patients.

ObjectiveSleep quality is vital for healthy development in children. Sleep disorders are prevalent and negatively affect sleep quality. Early identification and appropriate intervention can improve children’s health and quality of life. The current reference standard, polysomnography (PSG) has limitations regarding availability, cost, and access and may not replicate normal sleep patterns in the home. Simple, accurate sleep tests, available for repeated testing should be beneficial in management of sleep disorders.MethodSecondary analysis of PSG data from the prospective multicenter Childhood Adenotonsillectomy Trial (CHAT) to evaluate FDA-cleared cloud-based software (Software-as-a-Medical-Device), which is based on analysis of photoplethysmogram data (PPG; plethysmogram-signal (PLETH) and oxygen saturation data (SpO2)), to automatically generate a novel apnea-hypopnea index (sAHI). sAHI is compared to manually scored AHI from PSG.ResultsSignificant correlation is observed comparing the software-generated sAHI and manually derived AHI from the in-laboratory PSG-studies (Pearson correlation = 0.954, p < 0.0001) and receiver operating characteristics (ROC) demonstrate strong agreement in all OSA categories (mild, moderate, severe) 91.4%[CI95%89.5, 93.4]; 96.7%[CI95%95.4, 97.9]; 98.6%[CI95%97.8, 99.4], sensitivities 95.4%[CI95%93.2, 97.0]; 86.5%[CI95%80.3, 91.3]; 88.4%[CI95%78.4, 94.9] and specificities 84.4%[CI95%79.7, 88.4]; 99.2%[CI95%98.2, 99.7]; 99.6%[CI95%98.8, 99.9], respectively.ConclusionsAHI is comparable to manual scoring of AHI from in-laboratory PSG studies and effective to rule-in and rule-out obstructive sleep apnea (OSA) in all disease categories, providing safe and convenient approach for diagnosis and management of OSA in children. The data is recorded with a single-sensor, making the method suitable for multi-night testing in the child’s home at considerably lower cost. This technology provides a simple tool to adhere to guidelines for diagnosis and management of OSA in children.Clinical trial registration name and numberChildhood Adenotonsillectomy Study for Children with OSA (CHAT) https://clinicaltrials.gov/ct2/show/NCT00560859

The University of Virginia (Charlottesville) hosted an international conference on Infinite-dimensional Aspects of Representation Theory and Applications. This volume contains papers resulting from the mini-courses and talks given at the meeting. Beyond the techniques and ideas related to representation theory, the book demonstrates connections to number theory, algebraic geometry, and mathematical physics. The specific topics covered include Hecke algebras, quantum groups, infinite-dimensional Lie algebras, quivers, modular representations, and Gromov-Witten invariants. The book is suitable for graduate students and researchers interested in representation theory.

[...]inappropriate antibiotic treatment of the condition encourages the emergence of multidrug-resistant strains of bacterial pathogens. [...]in acute otitis media, the symptoms are nonspecific and often result from viral upper respiratory infections. [...]the definition of acute otitis media is sometimes modified to include otoscopic findings of membrane inflammation, regardless of other symptoms. The nature of the relation between viral and bacterial infection is controversial. Since viruses have been identified as the sole infective agent in only 6 percent of the middle-ear aspirates obtained from children with acute otitis media,9 viruses may promote bacterial superinfection by impairing eustachian-tube function and other host defenses, such as the respiratory epithelial-cell barrier. [...]the difference between combination therapy with an antibiotic plus a corticosteroid and either placebo or an antibiotic alone was significant. [...]considering all the evidence and pending the availability of data from additional clinical trials, it is my view that all three options -- combination therapy with an antibiotic plus a corticosteroid, antibiotics alone, and observation without drug therapy -- should be considered.

An important theorem in the theory of infinite dimensional Lie algebras states that any affine Kac-Moody algebra can be realized (that is to say constructed explicitly) using loop algebras. In this paper, we consider the corresponding problem for a class of Lie algebras called extended affine Lie algebras (EALAs) that generalize affine algebras. EALAs occur in families that are constructed from centreless Lie tori, so the realization problem for EALAs reduces to the realization problem for centreless Lie tori. We show that all but one family of centreless Lie tori can be realized using multiloop algebras (in place of loop algebras). We also obtain necessary and sufficient conditions for two centreless Lie tori realized in this way to be isotopic, a relation that corresponds to isomorphism of the corresponding families of EALAs.

This paper describes four alternatives for expanding childhood insurance coverage, discusses key health policy issues, and assesses the political possibilities for enacting universal coverage. Alternatives are (1) a single federal child health program for all children; (2) a hybrid federal child health program (replacing Medicaid and the State Children's Health Insurance Program [SCHIP]), combined with employer coverage; (3) a new federal wraparound program for the uninsured (that keeps the existing Medicaid program); and (4) expansion of SCHIP. Key policy issues include the type of universal coverage, use of competing commercial health plans, financing, employer and individual mandates, and the definition of benefits. [PUBLICATION ABSTRACT]