Functional performance study of an adapted design of the woman’s condom: a crossover,noninferiority, randomized clinical trial

Objectives: We aimed to assess the functional performance and safety of a modified Woman’s Condom (WC2) against the existing FC2 female condom.

Study design: This randomized clinical trial enrolled 287 women in one South African site. The primary outcome of the study was the rate of female condom failure. Participants were asked to use five of each female condom type and to collect information on use in a condom log at home and were interviewed after use of each FC type.

Results: Noninferiority was demonstrated for the WC2 with respect to the reference condom FC2 for all condom functions. The WC2 was found to be superior to the FC2 reference condom for clinical failure (p?=?.000), total female condom failure (p?=?.001), misdirection (p?=?.000) and slippage (p?=?.004).

Conclusion: The WC2 female condom performs as well as the FC2 female condom and offers good stability during use.

Implications: Results from this study will inform further refinement of this female condom design, resulting in a new and potentially less expensive Woman’s Condom.     

The new political economy of the UK NHS

This paper applies Jessop's analysis of the new political economy of welfare to the case of the NHS, exploring the insights into the changes in health policy in the UK that such a perspective offers. Alongside Jessop's analysis, the paper also considers the competing tension of path dependency in health policy, and the possibility of alternative futures to those envisaged in Jessop's model.     

Clinical Judgment in Nurse-Midwifery

The purpose of this paper is to provide a review of the literature in medicine and nursing that may be helpful for understanding and teaching clinical judgment and decision-making in nurse-midwifey. An overview of the major theoretical perspectives is presented, and research related to the discovery of processes and progression of expertise in clinical judgment are discussed from each framework. Studies on teaching methods in the area of clinical judgment are analyzed, and the implications for nurse-midwifery teaching and evaluation are discussed.     

HIV Prevention Among Young Women in South Africa: Understanding Multiple Layers of Risk

Despite concerted prevention efforts, young South African women remain at the epicenter of the HIV epidemic. Although these women have grown up in a community powerfully affected by HIV, systematic investigation into how this “second generation” of HIV-affected youth navigates HIV risk is lacking. This study qualitatively explored a complex interplay of factors influencing HIV risk among young pregnant women in KwaZulu-Natal, South Africa. We conducted in-depth interviews with 35 pregnant women (22 HIV-uninfected and 13 HIV-infected) aged 18–21, 18 healthcare providers, and focus groups with 19 community stakeholders. Among the young women, HIV knowledge was high, and many reported taking some action to prevent pregnancy or HIV; however, these efforts were not routinely implemented. Themes related to HIV acquisition risk from all participants were organized using a socioecological framework and revolved around individual and developmental experiences (personal experience with HIV, perceived invincibility), family barriers (lack of adult supervision, pressure to leave school), relational barriers (lack of disclosure and partner communication, “burn out” around attempts to discuss condom use with partners, overdependence on partners), community-level barriers (township environment, lack of structured activities), and social barriers (poverty, HIV-related stigma). Some novel concepts emerged from the data, including an understanding of how overdependence on the romantic relationship may develop. Current HIV prevention efforts, including traditional HIV counseling and testing, condom distribution, and biomedical agents for HIV prevention, are unlikely to be effective without a broader, ecological up-to-date understanding of the evolving, intertwined, and complex constellation of factors that drive HIV risk behavior in this high-risk population.     

Use of freshly isolated capillary endothelial cells for the immediate establishment of a monolayer on a vascular graft at surgery

Endothelial seeding of vascular graft surfaces may lead to a less thrombogenic surface. We examined the feasibility of using microvessel endothelial cells derived from human fat for seeding purposes. Human fat was treated with collagenase for 24 minutes, washed, and purified in a Percoll gradient separation. This yielded 1.25 +/- 0.45 X 10(6) cells/gm of fat. After a 1-hour incubation on plasma-coated Dacron, 2.8 +/- 1.5 X 10(4) cells remained firmly adherent to the surface. When exposed to flow for 2 hours at a shear stress of 0 to 80 dyne/cm2, between 50% and 100% of the initially adherent cells remained adherent. Statistical analysis of this data failed to demonstrate a strong relationship between the number of adherent cells and the shear rate. Scanning electron microscopy demonstrated endothelial cells in various stages of attachment to the plasma-coated Dacron. Although most cells were still round and only focally attached to the surface, some cells were maximally flattened, forming cell-to-cell contact. Because of the high cell yield and the firm adherence characteristics, we conclude that microvessel endothelial cells may offer the possibility for confluent endothelial cell seeding of a graft at the time of surgical implantation without the need for cell culture.     

Non-linear in vitro wear of posterior composites with time

Several clinical studies have found the wear rate of posterior composites to be nonlinear, with greater wear occurring initially. This relationship and its causes were sought in an in vitro test that used the Taber Abraser. Three commercial composites--Marathon, Occlusin, and P-30--were tested. Sixteen cured samples of each were initially finished with 600-grit paper and then abraded by medium-grit wheels for 30,000 cycles. Periodically, the weight losses were recorded and then converted to volume losses. Analysis included comparison of volume losses per 5000-cycle interval and comparison of first derivatives (wear rate) and second derivatives of the best-fit second-order regression line. Significant differences (p less than 0.05), as analyzed by ANOVA, were consistently realized between the volume losses for the first interval and those for subsequent intervals. Rank, with regard to wear resistance, depended on whether volume loss or initial wear rate was compared. The Taber Abraser did show non-linear trends similar to those observed clinically. Initial surface preparation, which apparently contributes to the greater early wear rates recorded in this in vitro study, may also be a factor clinically.     

Risk and vulnerability: do socioeconomic factors influence the risk of acquiring HIV in Asia?

HIV epidemics in Asia have been mainly concentrated among certain population groups such as injecting drug users, sex workers and their clients and men who have sex with men (MSM). HIV risk has also been associated with labour migrants and their partners. Many of the people at risk through these behaviours are very poor, and this raises the question that poverty and social deprivation may be underlying factors that drive the adoption of risk behaviours and can be regarded as 'determinants' of vulnerability to HIV infection in Asia. The study presents some observations of the socioeconomic pattern of HIV spread in Asia, using country-level and household-level data. The discussion then draws tentative conclusions about what is known concerning the mechanisms influencing the risk of HIV acquisition in Asia and what they might imply for programme design and policy. In summary, the data presented here do not support the hypothesis that HIV epidemics in Asia are primarily driven by poverty and social deprivation, though sex inequality and education for women and girls are strongly associated factors. There is clearly a multidimensional relationship between the risk of HIV infection and a host of underlying social and cultural factors that confound any attempt at a single explanation for the HIV epidemic in Asia or elsewhere. There is an undeniable need for further research through multicountry studies and better analysis of existing household data, as well as through further investigation of the quantitative relationship between the barriers to HIV services and the risk of infection. The key message for policy is to seek a broad balance between a focus on prevention and treatment for the higher-risk behaviours without losing sight of the importance of programmes that address vulnerability and behavioural change among the sexually active adult population. The implication of these findings for the allocation of resources for downstream factors such as risk behaviours as well as upstream development factors is briefly discussed.