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  1. Article ; Online: Mobile solutions to Empower reproductive life planning for women living with HIV in Kenya (MWACh EMPOWER): Protocol for a cluster randomized controlled trial.

    Ngumbau, Nancy / Unger, Jennifer A / Wandika, Brenda / Atieno, Celestine / Beima-Sofie, Kristin / Dettinger, Julia / Nzove, Emmaculate / Harrington, Elizabeth K / Karume, Agnes K / Osborn, Lusi / Sharma, Monisha / Richardson, Barbra A / Seth, Aparna / Udren, Jenna / Zanial, Noor / Kinuthia, John / Drake, Alison L

    PloS one

    2024  Volume 19, Issue 4, Page(s) e0300642

    Abstract: Background: Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent ...

    Abstract Background: Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent them from achieving their reproductive goals. Patient-centered counseling interventions that support health care workers (HCWs) in providing high-quality RH counseling, tailored to the needs of WLWH, may improve reproductive health outcomes.
    Methods and design: We are conducting a non-blinded cluster randomized controlled trial (cRCT) of a digital health intervention for WLWH (clinicaltrials.gov #NCT05285670). We will enroll 3,300 WLWH seeking care in 10 HIV care and treatment centers in Nairobi and Western Kenya. WLWH at intervention sites receive the Mobile WACh Empower intervention, a tablet-based RH decision-support counseling tool administered at baseline and SMS support during two years of follow-up. WLWH at control sites receive the standard of care FP counseling. The decision-support tool is a logic-based tool for family planning (FP) counseling that uses branching logic to guide RH questions based on participants' reproductive life plans, tailoring counseling based on the responses. Follow-up SMSs are based in the Information-Motivation-Behavioral (IMB) Skills model of behavioral change and are tailored to participant characteristics and reproductive needs through separate SMS "tracks". Follow-up visits are scheduled quarterly for 2 years to assess plans for pregnancy, pregnancy prevention, and contraceptive use. The primary outcome, FP discontinuation, will be compared using an intent-to-treat analysis. We will also assess the unmet need for FP, dual method use, viral load suppression at conception and unintended pregnancy.
    Discussion: The Mobile WACh Empower intervention is innovative as it combines a patient-centered counseling tool to support initial reproductive life decisions with longitudinal SMS for continued RH support and may help provide RH care within the context of provision of HIV care.
    MeSH term(s) Pregnancy ; Humans ; Female ; Kenya ; Family Planning Services/methods ; Contraception ; Contraceptive Agents ; HIV Infections/prevention & control ; Randomized Controlled Trials as Topic
    Chemical Substances Contraceptive Agents
    Language English
    Publishing date 2024-04-01
    Publishing country United States
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0300642
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A self-guided curriculum on endocrinology standard of care for gender diverse youth, including ethical considerations.

    Sandberg, Elizabeth S / Baines, Hayley K / Aye, Tandy / Harris, Rebecca M / Hart-Unger, Sarah / Lopez, Ximena / Nikita, Maria Eleni / Nokoff, Natalie J / Persky, Rebecca / Roberts, Stephanie A

    Endocrine and metabolic science

    2023  Volume 11

    Abstract: Objective: While the field of pediatric endocrinology, and the American Board of Pediatrics, continues expanding training to include gender-affirming care, many pediatric endocrinology fellowship programs do not have formal curriculum for this patient ... ...

    Abstract Objective: While the field of pediatric endocrinology, and the American Board of Pediatrics, continues expanding training to include gender-affirming care, many pediatric endocrinology fellowship programs do not have formal curriculum for this patient population. Members of the Pediatric Endocrine Society (PES) that have a special interest in transgender health designed a curriculum based on Endocrine Society practice guidelines to expand the knowledge of gender affirming care for medical trainees' and faculty.
    Methods: PES members designed a 5-part self-guided educational module series with embedded knowledge questions. Uniquely, medical ethical reflections were included within each module. Participants completed baseline demographic and baseline and follow-up knowledge surveys.
    Results: Most participants were pediatric endocrinology fellows and 44 % percent (
    Conclusion: This is the first medical education curriculum in gender-affirming care created by pediatric endocrinologists grounded in the Endocrine Society practice guidelines. This study demonstrates medical knowledge gained in caring for gender diverse youth and is the first to incorporate ethical considerations for this patient population. While initially designed for pediatric endocrinology trainees and faculty, this curriculum may be of great utility for any provider interested in caring for gender diverse youth.
    Language English
    Publishing date 2023-05-06
    Publishing country England
    Document type Journal Article
    ISSN 2666-3961
    ISSN (online) 2666-3961
    DOI 10.1016/j.endmts.2023.100131
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Fluorescence Screens for Identifying Central Nervous System-Acting Drug-Biosensor Pairs for Subcellular and Supracellular Pharmacokinetics.

    Beatty, Zoe G / Muthusamy, Anand K / Unger, Elizabeth K / Dougherty, Dennis A / Tian, Lin / Looger, Loren L / Shivange, Amol V / Bera, Kallol / Lester, Henry A / Nichols, Aaron L

    Bio-protocol

    2022  Volume 12, Issue 22

    Abstract: Subcellular pharmacokinetic measurements have informed the study of central nervous system (CNS)-acting drug mechanisms. Recent investigations have been enhanced by the use of genetically encoded fluorescent biosensors for drugs of interest at the plasma ...

    Abstract Subcellular pharmacokinetic measurements have informed the study of central nervous system (CNS)-acting drug mechanisms. Recent investigations have been enhanced by the use of genetically encoded fluorescent biosensors for drugs of interest at the plasma membrane and in organelles. We describe screening and validation protocols for identifying hit pairs comprising a drug and biosensor, with each screen including 13-18 candidate biosensors and 44-84 candidate drugs. After a favorable hit pair is identified and validated via these protocols, the biosensor is then optimized, as described in other papers, for sensitivity and selectivity to the drug. We also show sample hit pair data that may lead to future intensity-based drug-sensing fluorescent reporters (iDrugSnFRs). These protocols will assist scientists to use fluorescence responses as criteria in identifying favorable fluorescent biosensor variants for CNS-acting drugs that presently have no corresponding biosensor partner.
    Language English
    Publishing date 2022-11-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2833269-6
    ISSN 2331-8325 ; 2331-8325
    ISSN (online) 2331-8325
    ISSN 2331-8325
    DOI 10.21769/BioProtoc.4551
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: "Spoiled" girls: Understanding social influences on adolescent contraceptive decision-making in Kenya.

    Harrington, Elizabeth K / Casmir, Edinah / Kithao, Peninah / Kinuthia, John / John-Stewart, Grace / Drake, Alison L / Unger, Jennifer A / Ngure, Kenneth

    PloS one

    2021  Volume 16, Issue 8, Page(s) e0255954

    Abstract: Objectives: Despite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents' own reproductive priorities and the social ... ...

    Abstract Objectives: Despite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents' own reproductive priorities and the social influences on their decision-making align and compete. We examined the social context of contraceptive decision-making among Kenyan female adolescents.
    Methods: Using community-based sampling, we conducted 40 in-depth interviews and 6 focus group discussions among sexually-active or partnered adolescent girls and young women aged 15-19 in the Nyanza region of Kenya. We analyzed the data in Dedoose using an inductive, grounded theory approach, and developed a conceptual model from the data illustrating social influences on adolescent contraceptive decision-making.
    Results: Participants viewed adolescent pregnancy as unacceptable, and described severe social, financial, and health consequences of unintended pregnancy, including abortion under unsafe conditions. Yet, their contraceptive behaviors often did not reflect their desire to delay pregnancy. Contraceptive decision-making was influenced by multiple social factors, centering on the intersecting stigmas of adolescent female sexuality, pregnancy, and contraceptive use, as well as unequal power in sexual relationships. To prioritize pregnancy prevention, adolescents must navigate conflicting social norms and power dynamics, and put their perceived future fertility at risk.
    Conclusions: Contraceptive decision-making among Kenyan female adolescents is strongly influenced by opposing social norms within families, communities, and sexual relationships, which compel them to risk stigma whether they use a contraceptive method or become pregnant as adolescents. These findings put into perspective adolescents' seemingly incongruent pregnancy preferences and contraceptive behaviors. Interventions to address adolescent unintended pregnancy should focus on supporting adolescent decision-making agency, addressing fertility-related contraceptive concerns, and promoting innovative contraceptive access points rather than increasing contraceptive prevalence.
    MeSH term(s) Adolescent ; Contraception Behavior/psychology ; Decision Making ; Female ; Focus Groups ; Humans ; Interviews as Topic ; Kenya ; Pregnancy ; Pregnancy in Adolescence/prevention & control ; Psychology, Adolescent ; Sexual Behavior ; Social Norms ; Social Stigma ; Young Adult
    Language English
    Publishing date 2021-08-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0255954
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  5. Article ; Online: "Spoiled" girls

    Elizabeth K Harrington / Edinah Casmir / Peninah Kithao / John Kinuthia / Grace John-Stewart / Alison L Drake / Jennifer A Unger / Kenneth Ngure

    PLoS ONE, Vol 16, Iss 8, p e

    Understanding social influences on adolescent contraceptive decision-making in Kenya.

    2021  Volume 0255954

    Abstract: Objectives Despite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents' own reproductive priorities and the social influences ... ...

    Abstract Objectives Despite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents' own reproductive priorities and the social influences on their decision-making align and compete. We examined the social context of contraceptive decision-making among Kenyan female adolescents. Methods Using community-based sampling, we conducted 40 in-depth interviews and 6 focus group discussions among sexually-active or partnered adolescent girls and young women aged 15-19 in the Nyanza region of Kenya. We analyzed the data in Dedoose using an inductive, grounded theory approach, and developed a conceptual model from the data illustrating social influences on adolescent contraceptive decision-making. Results Participants viewed adolescent pregnancy as unacceptable, and described severe social, financial, and health consequences of unintended pregnancy, including abortion under unsafe conditions. Yet, their contraceptive behaviors often did not reflect their desire to delay pregnancy. Contraceptive decision-making was influenced by multiple social factors, centering on the intersecting stigmas of adolescent female sexuality, pregnancy, and contraceptive use, as well as unequal power in sexual relationships. To prioritize pregnancy prevention, adolescents must navigate conflicting social norms and power dynamics, and put their perceived future fertility at risk. Conclusions Contraceptive decision-making among Kenyan female adolescents is strongly influenced by opposing social norms within families, communities, and sexual relationships, which compel them to risk stigma whether they use a contraceptive method or become pregnant as adolescents. These findings put into perspective adolescents' seemingly incongruent pregnancy preferences and contraceptive behaviors. Interventions to address adolescent unintended pregnancy should focus on supporting adolescent decision-making agency, addressing fertility-related ...
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: An mHealth SMS intervention on Postpartum Contraceptive Use Among Women and Couples in Kenya: A Randomized Controlled Trial.

    Harrington, Elizabeth K / Drake, Alison L / Matemo, Daniel / Ronen, Keshet / Osoti, Alfred O / John-Stewart, Grace / Kinuthia, John / Unger, Jennifer A

    American journal of public health

    2019  Volume 109, Issue 6, Page(s) 934–941

    Abstract: Objectives. ...

    Abstract Objectives.
    MeSH term(s) Adult ; Contraception Behavior/statistics & numerical data ; Female ; Hospitals, Public ; Humans ; Kenya ; Male ; Patient Acceptance of Health Care ; Postpartum Period ; Self Report ; Telemedicine/methods ; Text Messaging ; Young Adult
    Language English
    Publishing date 2019-05-08
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 121100-6
    ISSN 1541-0048 ; 0090-0036 ; 0002-9572
    ISSN (online) 1541-0048
    ISSN 0090-0036 ; 0002-9572
    DOI 10.2105/AJPH.2019.305051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: An optimized method for the isolation of urinary extracellular vesicles for molecular phenotyping: detection of biomarkers for radiation exposure.

    Hinzman, Charles P / Jayatilake, Meth / Bansal, Sunil / Fish, Brian L / Li, Yaoxiang / Zhang, Yubo / Bansal, Shivani / Girgis, Michael / Iliuk, Anton / Xu, Xiao / Fernandez, Jose A / Griffin, John H / Ballew, Elizabeth A / Unger, Keith / Boerma, Marjan / Medhora, Meetha / Cheema, Amrita K

    Journal of translational medicine

    2022  Volume 20, Issue 1, Page(s) 199

    Abstract: Background: Urinary extracellular vesicles (EVs) are a source of biomarkers with broad potential applications across clinical research, including monitoring radiation exposure. A key limitation to their implementation is minimal standardization in EV ... ...

    Abstract Background: Urinary extracellular vesicles (EVs) are a source of biomarkers with broad potential applications across clinical research, including monitoring radiation exposure. A key limitation to their implementation is minimal standardization in EV isolation and analytical methods. Further, most urinary EV isolation protocols necessitate large volumes of sample. This study aimed to compare and optimize isolation and analytical methods for EVs from small volumes of urine.
    Methods: 3 EV isolation methods were compared: ultracentrifugation, magnetic bead-based, and size-exclusion chromatography from 0.5 mL or 1 mL of rat and human urine. EV yield and mass spectrometry signals (Q-ToF and Triple Quad) were evaluated from each method. Metabolomic profiling was performed on EVs isolated from the urine of rats exposed to ionizing radiation 1-, 14-, 30- or 90-days post-exposure, and human urine from patients receiving thoracic radiotherapy for the treatment of lung cancer pre- and post-treatment.
    Results: Size-exclusion chromatography is the preferred method for EV isolation from 0.5 mL of urine. Mass spectrometry-based metabolomic analyses of EV cargo identified biochemical changes induced by radiation, including altered nucleotide, folate, and lipid metabolism. We have provided standard operating procedures for implementation of these methods in other laboratories.
    Conclusions: We demonstrate that EVs can be isolated from small volumes of urine and analytically investigated for their biochemical contents to detect radiation induced metabolomic changes. These findings lay a groundwork for future development of methods to monitor response to radiotherapy and can be extended to an array of molecular phenotyping studies aimed at characterizing EV cargo.
    MeSH term(s) Animals ; Biomarkers/metabolism ; Extracellular Vesicles/metabolism ; Humans ; Mass Spectrometry ; Radiation Exposure ; Rats ; Ultracentrifugation
    Chemical Substances Biomarkers
    Language English
    Publishing date 2022-05-10
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2118570-0
    ISSN 1479-5876 ; 1479-5876
    ISSN (online) 1479-5876
    ISSN 1479-5876
    DOI 10.1186/s12967-022-03414-7
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  8. Article: Early Experience of the First Single-Room Gantry Mounted Active Scanning Proton Therapy System at an Integrated Cancer Center.

    Forsthoefel, Matthew K / Ballew, Elizabeth / Unger, Keith R / Ahn, Peter H / Rudra, Sonali / Pang, Dalong / Collins, Sean P / Dritschilo, Anatoly / Harter, William / Paudel, Nitika / Collins, Brian T / Lischalk, Jonathan W

    Frontiers in oncology

    2020  Volume 10, Page(s) 861

    Abstract: Introduction: ...

    Abstract Introduction:
    Language English
    Publishing date 2020-05-29
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2020.00861
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  9. Article ; Online: Engaging men in an mHealth approach to support postpartum family planning among couples in Kenya: a qualitative study.

    Harrington, Elizabeth K / McCoy, Erin E / Drake, Alison L / Matemo, Daniel / John-Stewart, Grace / Kinuthia, John / Unger, Jennifer A

    Reproductive health

    2019  Volume 16, Issue 1, Page(s) 17

    Abstract: Background: Involving male partners in family planning (FP) education and counseling may improve FP utilization and help meet couples' reproductive health needs in the postpartum period. We aimed to explore Kenyan men's and women's perspectives on an ... ...

    Abstract Background: Involving male partners in family planning (FP) education and counseling may improve FP utilization and help meet couples' reproductive health needs in the postpartum period. We aimed to explore Kenyan men's and women's perspectives on an interactive short message service (SMS) approach to support postpartum FP decision-making, and inform intervention content for a randomized controlled trial (RCT).
    Methods: We conducted four focus group discussions (FGD) among men (n = 35) and two among pregnant/postpartum women (n = 15) in western Kenya. Female participants were recruited at antenatal clinics; male participants were referred by antenatal attendees. FGDs included participant critique of pilot theory-based SMS messages. FGD transcripts were coded by two investigators and analyzed using an iterative, modified grounded theory approach. These data informed the intervention and RCT design, in which women had the option to refer male partners for trial enrollment.
    Results: Men strongly desired inclusion in FP programs, and frequently discussed negative relationship consequences of women's covert contraceptive use. Female and male participants voiced a variety of concerns about contraceptive side effects and potential harms, which were central to narratives of community influence on personal contraceptive choices. Most participants felt that receiving FP-focused SMS and including men would be beneficial. They perceived that SMS dialogue with a nurse about FP could reduce misperceptions and may stimulate communication within couples, thereby improving contraceptive access and continuation. Shared decision-making around FP within couple relationships, in consultation with clinicians, was highly valued.
    Conclusions: Health concerns about FP and limited couple communication are perceived contributors to postpartum unmet contraceptive need. With women's consent, the inclusion of male partners in FP services, and specifically in an mHealth SMS intervention, is acceptable and desired. Receiving SMS may trigger communication about postpartum FP within couples. SMS content should address contraceptive knowledge gaps, anticipated side effects and FP misperceptions, and allow for real-time method choice assistance.
    MeSH term(s) Adult ; Contraception Behavior/psychology ; Counseling ; Decision Making ; Family Planning Services/education ; Family Planning Services/methods ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Kenya ; Male ; Maternal Health Services ; Men/psychology ; Mobile Applications ; Postpartum Period ; Qualitative Research ; Randomized Controlled Trials as Topic ; Sex Education ; Telemedicine ; Text Messaging ; Women/psychology
    Language English
    Publishing date 2019-02-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2149029-6
    ISSN 1742-4755 ; 1742-4755
    ISSN (online) 1742-4755
    ISSN 1742-4755
    DOI 10.1186/s12978-019-0669-x
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  10. Article ; Online: Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study.

    Kemps, Naomi / Holband, Natanael / Boeddha, Navin P / Faal, Abdoulie / Juliana, Amadu E / Kavishe, Godfrey A / Keitel, Kristina / van 't Kruys, Kevin H / Ledger, Elizabeth V / Moll, Henriëtte A / Prentice, Andrew M / Secka, Fatou / Tan, Rainer / Usuf, Effua / Unger, Stefan A / Zachariasse, Joany M

    PLOS global public health

    2024  Volume 4, Issue 3, Page(s) e0002716

    Abstract: Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score ( ... ...

    Abstract Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMICs. This observational study is based on previously collected clinical data from consecutive children attending four diverse settings in LMICs. Inclusion criteria and study periods (2010-2021) varied. We simulated the ED-PEWS, consisting of patient age, consciousness, work of breathing, respiratory rate, oxygen saturation, heart rate, and capillary refill time, based on the first available parameters. Discrimination was assessed by the area under the curve (AUC), sensitivity and specificity (previously defined cut-offs < 6 and ≥ 15). The outcome measure was for each setting a composite marker of high urgency. 41,917 visits from Gambia rural, 501 visits from Gambia urban, 2,608 visits from Suriname, and 1,682 visits from Tanzania were included. The proportion of high urgency was variable (range 4.6% to 24.9%). Performance ranged from AUC 0.80 (95%CI 0.70-0.89) in Gambia urban to 0.62 (95%CI 0.55-0.67) in Tanzania. The low-urgency cut-off showed a high sensitivity in all settings ranging from 0.83 (95%CI 0.81-0.84) to 1.00 (95%CI 0.97-1.00). The high-urgency cut-off showed a specificity ranging from 0.71 (95%CI 0.66-0.75) to 0.97 (95%CI 0.97-0.97). The ED-PEWS has a moderate to good performance for the recognition of high urgency children in these LMIC settings. The performance appears to have potential in improving the identification of high urgency children in LMICs.
    Language English
    Publishing date 2024-03-21
    Publishing country United States
    Document type Journal Article
    ISSN 2767-3375
    ISSN (online) 2767-3375
    DOI 10.1371/journal.pgph.0002716
    Database MEDical Literature Analysis and Retrieval System OnLINE

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