SARAH SMILEY

Have babysitters; will travel

At the beginning of the summer, before I headed to Boston for the weekend, I posted on the Dinner with the Smileys’ Facebook page, “Have babysitter; will travel.” Halfway across the world, my husband, Dustin, whose military training has afforded him far more etiquette than even my Southern background gave me, saw the post and sent me an email.

That sounds tacky, he wrote. You’re lucky to be able to take a babysitter with you. Most people could not.

I removed the post, picked up my teenage babysitter, Kara, and thought about Dustin’s advice as we drove south with my three boys.

For the record, I ended up doing two trips this summer with two different babysitters who are sisters, and I didn’t pay either of them for it. I gave them a roll-away bed in the hotel room and I bought them lunch and dinner.

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But this isn’t about money. And it’s not about me not being able to take care of the boys by myself, either. It’s about being lonely. While the boys fought in the backseat or played tic-tack-toe at the restaurant, I had someone to talk to. Ordinarily, on family vacations past, that person would have been Dustin. This summer, it was first Kara, and then her older sister Becca.

But the boys, who don’t have cousins or extended family in the area, benefited as well. It was as if we were traveling with their aunt or sister or cousin — someone willing to go to the hotel pool at 11 p.m. or stay up late watching movies when I was already ready for bed.

In other words: Dustin didn’t know what he was talking about!

I highly recommend this setup to military spouses dealing with a deployment. Although, it need not be a babysitter; any traveling companion will do. It’s a win-win situation. The babysitter or friend gets a free vacation (plus another bonus — keep reading), you are less lonely and the kids are happy. My trips this summer with Kara and Becca are ones I will never forget. I don’t think they will, either. (My apologies to their future spouses. More on this in a minute.)

Before I get too far, however, I should stop and tell you that when my husband and I travel, he is the adult. Dustin is much more worldly than I am. He knows about tipping and hailing cabs, and, most importantly, he knows that the water inside the in-room refrigerator isn’t free. Perhaps this is partly why he worried about my summer vacations with young babysitters. Kara, Becca and I were like puppies whose backyard gate had been left open. We ate at the breakfast “buffet” which ended up not being “all you can eat,” and we chose valet parking because — well, because when we pulled up to the hotel, a guy came along and told us he’d park the car for us.

Using a GPS, we circled Boston’s Back Bay more times than necessary (channeling Chevy Chase: “Hey, look kids, there’s Boston University! Fenway! Boston University again!”), but our dilemma did not lead, as it does with Dustin, to an argument about who’s better with directions and who lost the television remote two months ago. My sitters’ had a free vacation; of course they deferred to me. I mean …

It was yet another lesson in community: who says family vacations have to be “just family”? I didn’t necessarily need to take a babysitter with me; I wanted to take one. And throughout our trips, we all learned some valuable lessons about humanity, kindness and generosity. A hotel in Boston spontaneously upgraded our room and delighted in our responses: the boys dancing in the lobby, screaming “Oh, yeah! Oh, yeah!” and the babysitter awing over the special key for the elevator. A toll booth operator in New Hampshire patiently (never mind the traffic) gave us directions when we were headed the wrong way. At Aloft, in Lexington, Mass., an employee gave the boys Matchbox cars, then smiled at me and said, “I see how hard you’re working.”

The point is, had these been ordinary family vacations, I might have been in a Smiley bubble, hyper-focused on my husband and boys. We would have retreated to our room as if we were taking a holiday from the rest of the world. But my family of five was not together this summer, so the boys and I took a trip with and among the community. We were open to the possibility that people around us — even strangers — could make our vacation something better. And over and over again, they did.

After so much generosity and kindness, it’s only fair that I give something back. And, boy, did I! Free food and lodging weren’t the only things my young babysitters received this summer. They also got an education in traveling with three children. My gift to humanity: two fewer females at risk for unwed, teenage pregnancy.

Maine author and columnist Sarah Smiley’s writing is syndicated weekly to publications across the country. She and her husband, Dustin, live with their three sons in Bangor. She may be reached atwww.Facebook.com/Sarah.is.Smiley.


Q:

Is there a module that can count occurrences of a list of strings in Python?

I have defined a list that reads the contents of a number of files and stores all of them.
How do I create a dataframe, with each filename in a row, and the corresponding columns count the occurrence of each word and output it.
For the sake of example, assume this is all well-defined (but I can provide original code if needed):
#define list
words = [ file1_contents, file2_contents ]

file1_contents = "string with dogs, cats and my pet sea turtle that lives in my box with my other turtles."
file2_contents = "another string about my squirrel, box turtle (who lives in the sea), but not my cat or dog".

filter_words = ["cat", "dog", "box turtle", "sea horse"]

Output would be something like this:
output = {'file1'{'cat': 1, 'dog':1, 'box turtle': 1, 'sea horse': 0}, 'file2'{ ...}}

I have attached an image of my end goal. I am just beginning to use python, so I'm not too sure about what package/module I would use here? I know pandas lets you work with dataframes.
I had the idea of using Counter from collections
from collections import Counter
z = ['blue', 'red', 'blue', 'yellow', 'blue', 'red']
Counter(z)
Counter({'blue': 3, 'red': 2, 'yellow': 1})

BUT, here is where I am stuck. How do I organise a table in python which would look like the attached image?
Example output:

A:

Idea is loop be each file content, filter  values from list filter_words by re.findall, count by Counter and create dictionary for DataFrame:
file1_contents = "string with dogs, cats and my pet sea turtle that lives in my box with my other turtles."
file2_contents = "another string about my squirrel, box turtle (who lives in the sea), but not my cat or dog."

import re
from collections import Counter

words = {'file1': file1_contents, 'file2':file2_contents}

filter_words = ["cat", "dog", "box turtle", "sea horse"]

out = {}
for k, w in words.items():
    new = []
    for fw in filter_words:
        new.extend(re.findall(r"{}".format(fw),w) )
    out[k] = dict(Counter(new))
print (out)
{'file1': {'cat': 1, 'dog': 1}, 'file2': {'cat': 1, 'dog': 1, 'box turtle': 1}}

df = pd.DataFrame.from_dict(out, orient='index').fillna(0).astype(int)
print (df)
       cat  dog  box turtle
file1    1    1           0
file2    1    1           1


Why is the gap between rich and poor widening, both in the U.S. and globally? Linking income differentials to levels of education, Reich ( The Next American Frontier ) divides the universe of jobs into three categories: routine production, in-person services and symbolic-analytic. Symbolic analysts--those who identify, solve and broker problems--are doing well, while prospects for the other types of workers are declining, Reich maintains. He links their fortunes to a newly emerging, global economic order in which the description, ``U.S. corporation,'' is increasingly a fiction as companies operate transnationally in a decentralized web of goods and services. This immensely stimulating treatise holds that the prosperity of a nation and its people is ever more tenuously linked to corporate profitability. Reich urges Americans to develop skills that contribute to the world economy, to invest in infrastructure, education and training, and to be open to foreign investments in U.S. enterprises. BOMC and QPB alternate s . (Mar.)


/*
 * This file is part of OpenModelica.
 *
 * Copyright (c) 1998-CurrentYear, Open Source Modelica Consortium (OSMC),
 * c/o Linköpings universitet, Department of Computer and Information Science,
 * SE-58183 Linköping, Sweden.
 *
 * All rights reserved.
 *
 * THIS PROGRAM IS PROVIDED UNDER THE TERMS OF GPL VERSION 3 LICENSE OR
 * THIS OSMC PUBLIC LICENSE (OSMC-PL) VERSION 1.2.
 * ANY USE, REPRODUCTION OR DISTRIBUTION OF THIS PROGRAM CONSTITUTES RECIPIENT'S ACCEPTANCE
 * OF THE OSMC PUBLIC LICENSE OR THE GPL VERSION 3, ACCORDING TO RECIPIENTS CHOICE.
 *
 * The OpenModelica software and the Open Source Modelica
 * Consortium (OSMC) Public License (OSMC-PL) are obtained
 * from OSMC, either from the above address,
 * from the URLs: http://www.ida.liu.se/projects/OpenModelica or
 * http://www.openmodelica.org, and in the OpenModelica distribution.
 * GNU version 3 is obtained from: http://www.gnu.org/copyleft/gpl.html.
 *
 * This program is distributed WITHOUT ANY WARRANTY; without
 * even the implied warranty of  MERCHANTABILITY or FITNESS
 * FOR A PARTICULAR PURPOSE, EXCEPT AS EXPRESSLY SET FORTH
 * IN THE BY RECIPIENT SELECTED SUBSIDIARY LICENSE CONDITIONS OF OSMC-PL.
 *
 * See the full OSMC Public License conditions for more details.
 *
 */
/*
 *
 * @author Adeel Asghar <adeel.asghar@liu.se>
 *
 * RCS: $Id: SampleGDBMIOutput.txt 22008 2014-08-26 23:13:07Z hudson $
 *
 */

/*
  Following are the sample output strings that GDB Machine Interface returns.
*/

=thread-group-added,id="i1"
~"Reading symbols from c:\\openmodelica\\trunk\\testsuite\\openmodelica\\bootstrapping\\main.exe..."
6^done,bkpt={number="1",type="breakpoint",disp="keep",enabled="y",addr="0x00d0e905",func="omc_Interactive_evaluateGraphicalApi__dispatch",file="/c/OpenModelica/trunk/Compiler/Script/Interactive.mo",line="1424",times="0",original-location="Interactive.mo:1424"}
7^done,bkpt={number="2",type="breakpoint",disp="keep",enabled="y",addr="0x00d2a9b9",func="omc_Interactive_getComponentAnnotations",file="/c/OpenModelica/trunk/Compiler/Script/Interactive.mo",line="10815",times="0",original-location="Interactive.mo:10815"}
=thread-group-started,id="i1",pid="4784"
=thread-created,id="1",group-id="i1"
*stopped,reason="breakpoint-hit",disp="keep",bkptno="1",frame={addr="0x00d0e905",func="omc_Interactive_evaluateGraphicalApi__dispatch",args=[{name="_inStatements",value="0x5564d23"},{name="_inSymbolTable",value="0x15ce0a3"}],file="/c/OpenModelica/trunk/Compiler/Script/Interactive.mo",line="1424"},thread-id="1",stopped-threads="all"
14^done,stack=[frame={level="0",addr="0x00d0e905",func="omc_Interactive_evaluateGraphicalApi__dispatch",file="/c/OpenModelica/trunk/Compiler/Script/Interactive.mo",line="1424"},frame={level="1",addr="0x00d0086d",func="omc_Interactive_evaluateGraphicalApi",file="/c/OpenModelica/trunk/Compiler/Script/Interactive.mo",line="1191"},frame={level="2",addr="0x00d08abe",func="omc_Interactive_evaluate2",file="/c/OpenModelica/trunk/Compiler/Script/Interactive.mo",line="283"},frame={level="3",addr="0x00d1ce8b",func="omc_Interactive_evaluateToStdOut",file="/c/OpenModelica/trunk/Compiler/Script/Interactive.mo",line="183"},frame={level="4",addr="0x00dce4a7",func="omc_Main_translateFile",file="/c/OpenModelica/trunk/Compiler/Main/Main.mo",line="582"},frame={level="5",addr="0x00dc86fc",func="omc_Main_main2",file="/c/OpenModelica/trunk/Compiler/Main/Main.mo",line="1103"},frame={level="6",addr="0x00dc44a6",func="omc_Main_main",file="/c/OpenModelica/trunk/Compiler/Main/Main.mo",line="1019"},frame={level="7",addr="0x00401651",func="main",file="main.c",fullname="c:\\openmodelica\\trunk\\testsuite\\openmodelica\\bootstrapping\\main.c",line="37"}]


14 So.3d 732 (2008)
Daniel Ray WEATHERS, Appellant,
v.
METROPOLITAN LIFE INSURANCE COMPANY, Appellee.
No. 2007-CA-01180-COA.
Court of Appeals of Mississippi.
July 22, 2008.
Rehearing Denied October 28, 2008.
*733 John A. Owens, Dudley H. Carter, Columbus, Susie Taylor Carver, attorneys for appellant.
Sheryl Bey, Jackson, attorney for appellee.
Before KING, C.J., GRIFFIS and CARLTON, JJ.
KING, C.J., for the Court.
¶ 1. Daniel Ray Weathers (Weathers) filed suit against Metropolitan Life Insurance Company (MetLife) in the Circuit Court of Lowndes County, alleging fraud, breach of contract, and negligent supervision. The circuit court granted MetLife's motion for summary judgment. Aggrieved, Weathers appeals, raising the following issue:
Whether the trial court erred by granting MetLife's motion for summary judgment, finding no genuine issue of material fact, where Weathers presented evidence that:
(1) MetLife breached its contract with Weathers;
(2) MetLife defrauded Weathers and fraudulently concealed the alleged fraud;
(3) MetLife prevented Weathers from discovering his claim, thereby tolling the statute of limitations; and
(4) MetLife negligently trained and supervised its agent, Jim McKie.
¶ 2. Finding Weathers's claim time-barred, we affirm the circuit court's grant of summary judgment in favor of MetLife.

FACTS AND PROCEDURAL HISTORY
¶ 3. Weathers purchased a life insurance policy from McKie, then a MetLife insurance agent. McKie gave Weathers a presentation on how to obtain a $500,000 life insurance policy that would accrue cash value over time. McKie explained that Weathers could leave the dividends in the policy, take the cash out, or use the dividends to pay future premiums on the policy. The "Stop and Go" illustration demonstrated how Weathers would make premium payments for only ten years; after which, the policy would become self-sustaining. Weathers applied for the insurance policy, and MetLife delivered a policy to him on February 1, 1994, for $376,550.
¶ 4. After receiving the policy, Weathers gave it a cursory read and had a few concerns with its provisions. One, the policy was entitled "Life Paid Up at 98"; and two, the policy stated that Weathers had to make premium payments for fifty-six years. Weathers then contacted McKie and inquired as to what those terms meant and if his payments would still cease after ten years. McKie explained to Weathers that he could pay the policy until he turned ninety-eight years old, and the policy would simply build more value; or Weathers could stop paying the premiums out of pocket after ten years, as demonstrated by the illustration, and use the annual dividends to pay the premiums thereafter.
¶ 5. In 1999, Weathers received a notice of a class-action lawsuit against MetLife regarding the "vanishing premiums" life insurance policies. Again, Weathers called McKie for clarification. McKie advised Weathers that the policy might not perform as promised and that he should contact MetLife. Weathers alleged that he contacted MetLife on multiple occasions; however, MetLife failed to provide him a *734 clear explanation regarding the problems with his insurance policy. Upon the advice of his attorney, Weathers opted out of the class-action lawsuit on October 19, 1999, and filed a lawsuit against MetLife in 2001 in the Circuit Court of Lowndes County, asserting claims of fraud, breach of contract, and negligent supervision.
¶ 6. MetLife filed a motion for summary judgment on February 13, 2007, and oral argument on the motion was heard on May 25, 2007. The trial court found that there was no genuine issue of material fact and granted summary judgment in favor of MetLife on June 15, 2007. The trial court reasoned the following: (1) Weathers failed to prove fraudulent concealment, which would have tolled the three-year statute of limitations; and (2) Weathers was under an obligation to read the contract prior to signing it, and he will not be heard to complain of an oral misrepresentation that would have been corrected by reading the contract.
¶ 7. Aggrieved, Weathers timely filed this appeal.

STANDARD OF REVIEW
¶ 8. An appeal from the grant of a motion for summary judgment is reviewed de novo. Allen v. Mac Tools, Inc., 671 So.2d 636, 640 (Miss.1996) (citing Pace v. Fin. Sec. Life of Miss., 608 So.2d 1135, 1138 (Miss.1992)). "When reviewing an award of summary judgment, this Court views all evidence in the light most favorable to the non-movant, including `admissions in pleadings, answers to interrogatories, depositions, affidavits, etc.' and will presume that all evidence in the non-movant's favor is true." Id. (quoting Downs v. Choo, 656 So.2d 84, 85 (Miss.1995)). The trial court's grant of summary judgment will stand if there is no genuine issue as to any material fact. Id.

ANALYSIS
¶ 9. As a threshold issue, this Court must first determine whether Weathers's claim is time-barred. Weathers argues that the statute of limitations was tolled until 1999 when he received the class-action notice because, in 1994, MetLife fraudulently concealed the misrepresentations when McKie reassured Weathers that he did not have to pay premiums out of pocket after ten years. Conversely, MetLife argues that Weathers's claim is time-barred because the statute of limitations accrued when the sale of the policy was complete on February 1, 1994.
¶ 10. "This Court uses a de novo standard of review when passing on questions of law including statute of limitations issues." Stephens v. Equitable Life Assurance Soc'y of the U.S., 850 So.2d 78, 82(10) (Miss.2003) (quoting ABC Mfg. Corp. v. Doyle, 749 So.2d 43, 45(10) (Miss.1999)). Mississippi Code Annotated section 15-1-49 (Rev.2003) provides a three-year statute of limitations for claims of fraud. See also Warren v. Horace Mann Life Ins. Co., 949 So.2d 770, 772(8) (Miss.Ct.App.2006). The statute of limitations accrues upon the completion of the sale of the insurance policy. See Stephens, 850 So.2d at 81(9). However, the statute of limitations can be tolled for claims of fraudulent concealment. Id. at 83 (17-18). Mississippi Code Annotated section 15-1-67 (Rev.2003) provides:
If a person liable to any personal action shall fraudulently conceal the cause of action from the knowledge of the person entitled thereto, the cause of action shall be deemed to have first accrued at, and not before, the time at which such fraud shall be, or with reasonable diligence might have been, first known or discovered.
A plaintiff must show two things to prove fraudulent concealment: (1) an affirmative *735 act by the defendant that prevented discovery of the claim, and (2) the plaintiff exercised due diligence to discover the defendant's concealed fraud. See Warren, 949 So.2d at 772-73(10) (citing Stephens, 850 So.2d at 83-84(18)).
¶ 11. MetLife delivered Weathers's life insurance policy on February 1, 1994. Therefore, Weathers had three years from February 1, 1994, to file the lawsuit unless he can prove that MetLife fraudulently concealed the cause of action, thereby tolling the statute of limitations. In an attempt to prove fraudulent concealment, Weathers contends that MetLife committed an affirmative act that prevented his discovery of the claim when McKie reassured him that he did not have to pay premiums out of pocket after ten years. Further, Weathers argues that he was unaware that the illustrations and oral representations were false until he received the class-action notice in 1999. At this point, Weathers claims that he exercised due diligence to determine the truth and filed his lawsuit in 2001, within the three-year statute of limitations. We disagree and find that Weathers failed to exercise due diligence.
¶ 12. In his deposition, Weathers admits that he did not read the entire policy; but undeniably, Weathers read enough of the policy to be alarmed and voice concern over some of its provisions. "[A] person is under an obligation to read a contract before signing it, and will not as a general rule be heard to complain of an oral misrepresentation the error of which would have been disclosed by reading the contract." Anderson v. Equitable Life Assurance Soc'y of the U.S., 248 F.Supp.2d 584, 590 (S.D.Miss.2003) (quoting Godfrey, Bassett & Kuykendall Architects, Ltd. v. Huntington Lumber & Supply Co., Inc., 584 So.2d 1254, 1257 (Miss.1991)). Further, "knowledge of the contents of a contract are imputed to the parties thereto, even where they have not read the contract." Id. (citing Cherry v. Anthony, Gibbs, Sage, 501 So.2d 416, 419 (Miss. 1987)). Weathers had a duty to read the insurance policy, and he is therefore imputed with knowledge of its contents.
¶ 13. Weathers stated that he realized the following upon a cursory reading of the contract:
Well, it scared me on the front of the policy where it says, "Life paid up at 98." So, we had  I wanted to make sure that this was going to be paid in ten years. And he reassured me that this was going to be  after I paid this for ten years,....
Once "a person has knowledge of such facts as to excite the attention of a reasonably prudent man and to put him upon guard and thus to incite him to inquiry, he is chargeable with notice, equivalent in law to knowledge, of all those further relevant facts which such inquiry, if pursued with reasonable diligence, would have disclosed." First Nat'l Bank of Laurel v. Johnson, 177 Miss. 634, 643, 171 So. 11, 14 (1936). The quoted statement taken from Weathers's deposition undoubtedly shows that Weathers was put on notice that the policy's language was contrary to the illustrations and oral representations that he had received from McKie. As such, we find that Weathers failed to exercise due diligence to discover his cause of action.

CONCLUSION
¶ 14. We find that the trial court did not err in granting MetLife's motion for summary judgment because Weathers's claim was time-barred. The statute of limitations began to run on February 1, 1994, after Weathers read his insurance policy and expressed concern over its provisions. At that time, Weathers was on notice that the policy's language was contrary to the *736 information he received from McKie. Weathers unreasonably relied upon McKie's reassurance and failed to exercise due diligence to address his concerns. Therefore, the statute of limitations was not tolled, and Weathers's claim was time-barred when he filed suit against MetLife in 2001. Since this issue is dispositive, we do not address Weathers's remaining assignments of error.
¶ 15. THE JUDGMENT OF THE CIRCUIT COURT OF LOWNDES COUNTY IS AFFIRMED. ALL COSTS OF THIS APPEAL ARE ASSESSED TO THE APPELLANT.
LEE AND MYERS, P.JJ., IRVING, CHANDLER, GRIFFIS, BARNES, ISHEE, ROBERTS AND CARLTON, JJ., CONCUR.


Assessment of sexual function in Japanese men with prostate cancer undergoing permanent brachytherapy without androgen deprivation therapy: Analysis from the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation database.
To evaluate male sexual function in Japanese prostate cancer patients undergoing permanent brachytherapy without endocrine treatment, using quality of life measures of the Expanded Prostate Cancer Index Composite. A total of 482 patients were selected as analysis subjects from the nationwide database for the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation. The patients were asked to complete the Expanded Prostate Cancer Index Composite questionnaires before and at 3, 12, 24, and 36 months after the permanent brachytherapy. Changes in their responses were analyzed, and any association of the outcomes was investigated. Furthermore, changes over time in their answers to Q18 (usual quality of your erections) were analyzed. A total of 72 patients (14.9%) had received external beam radiation. A total of 68 patients (14.1%) had taken any 5-phosphodiesterase inhibitor medications. Regarding Q18, 232 patients (48.2%) selected either "There was no sexual activity" or "There was no desire for erection" before receiving permanent brachytherapy. Of all the 482 patients, sexual function was preserved in 138 patients (28.7%) 3 years after permanent brachytherapy. Overall satisfaction has significantly improved without regard for the deterioration of sexual function. Significant factors for maintaining sexual activity were patient age and sexual activity before permanent brachytherapy. In Japanese patients undergoing permanent brachytherapy alone for prostate cancer, the sexual function is not well preserved. However, decreased sexual function does not seem to represent a major factor determining patients' overall satisfaction. These findings might be peculiar to Japanese patients, in whom elderly subjects account for the majority.


Polita Glynn

Polita Glynn

Profile

Polita Glynn joined Pew in 2009 to direct of the Pew Fellows Program in Marine Conservation, which provides fellowships to outstanding natural and social scientists, researchers and others around the globe to support innovative projects aimed at developing and implementing solutions to critical challenges facing the world’s oceans.

She directed the Fellows Program from 2005 to 2008 when it was based at the University of Miami in Florida. Previously, she was a freelance project director, educator, media writer and producer specializing in marine conservation. She developed programs and campaigns for organizations such as Biscayne National Park, the Marineland Dolphin Conservation Center, International Year of the Reef and Sea Grant. As an educator, she worked with the Massachusetts State Department of Education, the Miami-Dade County Public Schools and the U.S. Agency for International Development on the design and development of media and multicultural education programs.

Glynn holds a bachelor’s degree in American studies from Bennington College and a master’s degree from the Harvard University Graduate School of Education. She studied film and television production at the University of Miami.

Recent Work

Polita Glynn joined the Pew Environment Group in 2009 as manager of the Pew Fellows Program in Marine Conservation, which provides fellowships to outstanding natural and social scientists, researchers and others around the globe to support innovative projects aimed at developing and implementing solutions to critical challenges facing the world's oceans. Read More

The Pew Environment Group announced today that five individuals, representing Argentina, China, France and the United States, received the distinguished 2009 Pew Fellowship in Marine Conservation for their proposals to improve conservation of the marine environment. The 2009 Pew Marine Fellowships will support projects to create marine protected areas in strategic locations, reduce illegal... Read More

About The Pew Charitable Trusts

The Pew Charitable Trusts is driven by the power of knowledge to solve today's most challenging problems. Pew applies a rigorous, analytical approach to improve public policy, inform the public and invigorate civic life.

Trust Magazine

Our quarterly news magazine. Every issue features articles on Pew’s work from across the organization.Read Current Issue


2012 FINA World Swimming Championships (25 m) – Men's 200 metre breaststroke

The men's 200 metre breaststroke event at the 11th FINA World Swimming Championships (25m) took place 14 December 2012 at the Sinan Erdem Dome.

Records
Prior to this competition, the existing world and championship records were as follows.

The following records were established during the competition:

Results

Heats

Final

The final was held at 19:36.

References

External links
2012 FINA World Swimming Championships (25 m): Men's 200 metre breaststroke entry list, from OmegaTiming.com.

Breaststroke 200 metre, men's
World Short Course Swimming Championships


The Definitive Guide to body beast

Menu

The Definitive Guide to body beast

You've got your devices ready, now it's time to select about 8 to 10 exercises, which arrives out to about just one exercise for each muscle group. Make use of the record beneath to choose at the least one exercise for every muscle mass team to start out.

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The ATR pathway: fine-tuning the fork.
The proper detection and repair of DNA damage is essential to the maintenance of genomic stability. The genome is particularly vulnerable during DNA replication, when endogenous and exogenous events can hinder replication fork progression. Stalled replication forks can fold into deleterious conformations and are also unstable structures that are prone to collapse or break. These events can lead to inappropriate processing of the DNA, ultimately resulting in genomic instability, chromosomal alterations and cancer. To cope with stalled replication forks, the cell relies on the replication checkpoint to block cell cycle progression, downregulate origin firing, stabilize the fork itself, and restart replication. The ATR (ATM and Rad3-related) kinase and its downstream effector kinase, Chk1, are central regulators of the replication checkpoint. Loss of these checkpoint proteins causes replication fork collapse and chromosomal rearrangements which may ultimately predispose affected individuals to cancer. This review summarizes our current understanding of how the ATR pathway recognizes and stabilizes stalled replication forks.


Pages

Monday, 28 March 2016

Earth-2: Rebirth. Where do I begin? I guess I could start by saying I feel like I've been dicked by DC for the umpteenth time. I guess I can begin by describing how quickly my enthusiasm for Rebirth was shot down the moment I saw the new Earth-2 was never mentioned during DC's announcements on Saturday. I guess I could describe the sharp pain I felt in my heart when Geoff Johns confirmed that the new Earth-2 is not a Rebirth property, but will simply be continuing Earth-2: Society while another Justice Society will eventually make a comeback. Exactly what that means, no one knows. But it doesn't leave me feeling optimistic given DC's past and current history with finding new ways to ruin this property. But really, I only have one question: why is a title like Batman Beyond--a narrative set on a possible/alternate DC future--considered a 'Rebirth property,' but not Earth-2, DC's Golden Age and Justice Society property? Hell, why is even the Earth-3 Crime Syndicate appearing in future Justice League narratives?

Summary: A mysterious man has recently landed on Themyscira, and it has all the women on the island all shaken up as his arrival coincides with the loss of their captain of the guard, Alcippe. Who is this mysterious man and where does he come from? Why is Antiope so eager to kill him and why is she conspiring against her own sister? What dark, deep secret is the mighty Queen Hippolyta hiding if she is aware of all the dangers her daughter, Princess Diana, has been sensing on the island all along?

The various conflicts begin to converge as Diana begins to question her priorities and her place in the society that has made her the woman she is, and the journey she soon has to embark. Is her place truly by her mother's side, or do the gods will her to fulfil a completely different destiny from the one that's been decided for her since birth? These are all questions Diana has to answer for herself as she faces her first real trial as both the champion of Themyscira and as a woman of honour. The perils that she faces soon take her out of the safety of Themyscira and into wilderness of the outside world, and onto the shores of Boston Massachusetts, 1944!

Wednesday, 9 March 2016

EARTH-2 SOCIETY #10
Written by DAN ABNETT
Art by JORGE JIMÉNEZ
Cover by JORGE JIMÉNEZ
While Batman and his allies fight to keep their city safe from organized crime, Green Lantern and his wonders struggle to prevent the world from toppling into all-out war. But Hawkgirl may have just uncovered a global threat greater than either of those dangers…one that has come with them all the way from Old Earth…the world-changing intentions of the mighty and secret Amazons!MARCH 09 | RATED T | $2.99 | PRINT | DIGITAL

Tuesday, 8 March 2016

THE LEGEND OF WONDER WOMAN #3
Written by RENAE DE LIZ
Art by RENAE DE LIZ and RAY DILLON
Cover by RENAE DE LIZ
On sale MARCH 9 • 40 pg, FC, 3 of 9, $3.99 US • RATED T • DIGITAL FIRST
Themyscira comes alive with the sounds of Amazons on the hunt. Will they find their prey before Diana has a chance to rescue the outsider who fell from the sky? Hippolyta stands against her foes, and announces a tournament that will change Themyscira forever as the fate of the mysterious stranger hangs in the balance.

Summary: It's Christmas Eve in Gotham City, and Power Girl starts to regain consciousness following the Ultra-Humanite's cerebral assault on the Infinitors. She finds most of the Infinitors missing except for the Huntress and the Star-Spangled Kid, whom she decides to wake up by taking them for a spin around Gotham. When they return to her flat, the three young JSAers try to figure out what happened to their missing new comrades, only for them to return on their own within seconds of opening dialogue.


/*
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#ifndef __AES_ALT_H__
#define __AES_ALT_H__

#include <os/mynewt.h>

#if MYNEWT_VAL(MBEDTLS_AES_ALT)

#ifdef __cplusplus
extern "C" {
#endif

#include <crypto/crypto.h>

typedef struct mbedtls_aes_context {
    struct crypto_dev *crypto;
    uint8_t key[AES_MAX_KEY_LEN];
    unsigned int keylen;
} mbedtls_aes_context;

void mbedtls_aes_init(mbedtls_aes_context *ctx);
void mbedtls_aes_free(mbedtls_aes_context *ctx);
int mbedtls_aes_setkey_enc(mbedtls_aes_context *ctx, const unsigned char *key,
        unsigned int keybits);
int mbedtls_aes_crypt_ecb(mbedtls_aes_context *ctx, int mode,
        const unsigned char input[16], unsigned char output[16]);

#ifdef __cplusplus
}
#endif

#endif /* MYNEWT_VAL(MBEDTLS_AES_ALT) */

#endif /* __AES_ALT_H__ */


Background {#Sec1}
==========

The number of new HIV infections among children has decreased globally due to effective preventive strategies such as the prevention of mother to child transmission (PMTCT) of HIV \[[@CR1]\]. Nevertheless, Nigeria still has the second largest HIV epidemic globally and contributes almost a third of paediatric HIV infections worldwide \[[@CR2]\]. By 2017, with 380,000 children living with HIV infection, Nigeria had the largest burden globally, with a quarter of this number being on ART \[[@CR3]\].

With increasing access to effective ART which has reduced HIV-related deaths by 42% since the year 2000, the proportion of children who survive into later childhood and live chronically with HIV has increased \[[@CR4]\]. Consequently, caregivers of children living with HIV are constantly being confronted with the dilemma of '*if*', '*when*', and '*how*' to tell these infected children of their HIV status \[[@CR5], [@CR6]\]. Disclosure of HIV to infected children poses serious implications for the child and their caregivers that relate to treatment adherence, adjusting to the illness at different stages of life such as entering adolescence and relationship with the wider community \[[@CR7]\].

Disclosure of HIV to infected children is a critical component of the process of living with HIV and is considered pivotal to the continuum of care \[[@CR6], [@CR8]\]. Disclosure is considered to have been done when a child has been fully informed of his or her HIV status and if the terms HIV, AIDS, or any local term specifically associated with HIV/AIDS had been used in a discussion with the child about their health \[[@CR6]\]. Rates of disclosure in children in sub-Saharan Africa vary widely, ranging from 0 to 69.2%, \[[@CR9]\] despite the World Health Organization (WHO) recommending in 2011 that children from 6 to 12 years living with HIV should be gradually informed about their status in an ongoing, age-appropriate manner \[[@CR6]\]. This may be related, but not limited to a complex social and cultural barrier regarding how child-caregiver relationships are conceptualised in the context of healthcare, with children expected to be compliant recipients of services, while the caregiver interacts with the health system on their behalf \[[@CR5]\].

There is evidence to suggest that it is beneficial to disclose HIV status to infected children before they reach adolescent as it fosters ART adherence, participation in ongoing care, and psychological resilience, while lessening the risk of horizontal transmission due to risky sexual behaviour \[[@CR9], [@CR10]\]. Most research on disclosure of HIV to infected children has mainly been quantitative focusing on the determinants of disclosure, patterns of disclosure, the differences between non-disclosers and disclosers, and the impact of disclosure on certain HIV outcomes in children and adolescents \[[@CR9]\]. It is, however, difficult to have an enhanced understanding of the '*why'*, and the '*how*' behind the evidence in terms of why disclosure is done or not done, and how disclosure is conceptualized by caregivers and their children living with HIV \[[@CR6], [@CR9]\]. Gaining an enhanced understanding of the contextual and granular issues behind the '*numbers*' would be pivotal in planning, implementing and evaluating strategies to scale up childhood disclosure and aiding improved childhood age-appropriate engagement in HIV/AIDS care.

Mixed method approach; a combination of quantitative and qualitative research paradigms produces an enhanced understanding and granular evidence in comparison to '*mono-methods*' research \[[@CR11], [@CR12]\]. There are limited African studies that have used mixed methodologies to explore the complex and context-specific issue of disclosing HIV to children living with HIV \[[@CR5], [@CR13], [@CR14]\]. Combining research methods draws on the commonalities of both paradigms and harnesses their differences in a complementary manner to generate robust research evidence, which may contribute to the understanding of a complex phenomenon like disclosure \[[@CR12]\]. This research, therefore, was designed with the foregoing in mind, drawing on the strengths of both paradigms to gain enhanced understanding of HIV disclosure to children living with HIV. Our aim was to determine the prevalence and predictors of disclosure and explore the barriers caregivers face in disclosing HIV status to infected children in Gombe, northeast Nigeria.

Methods {#Sec2}
=======

Study setting and population {#Sec3}
----------------------------

The study was conducted at the Federal Teaching Hospital, Gombe, a 450-bed capacity tertiary health facility located in Gombe State, northeast Nigeria. Gombe State is strategically located at the centre of the northeast sub-region of Nigeria between latitudes 90°30' and 12°30'N and longitudes 8°5' and 11°45' E and has a population of 2.4 million people, with children 18 years and below being approximately 50% of the population and has a projected population growth rate of 2.3% per year \[[@CR15]\]. The HIV sero-prevalence of 3.4% in Gombe State is identical to the National sero-prevalence rate \[[@CR16]\].

Established in the year 2000, the Federal Teaching Hospital Gombe serves as the major referral centre for hospitals within the state and from neighbouring states of the northeast region of Nigeria, which has a combined population of 23,558,674 \[[@CR15]\]. The facility has a specialised paediatric HIV/AIDS clinic operational since the inception of the hospital and serves about 200 children from birth till they turn 18 years. Services offered include PMTCT, HIV counselling and testing (HCT), monitoring/follow-up of patients including viral load; treatment of opportunistic and other infections and provision of ART. Clinics are held once a week and about 30 children usually accompanied by their primary caregivers are consulted during clinic days. The clinic is run by a consultant paediatrician (EI) specialised in HIV/AIDS care, supported by four paediatric trainees, five specialist nurses, laboratory and pharmacy staff on clinic days.

Study design {#Sec4}
------------

This was a sequential, explanatory, mixed-methods study (Fig. [1](#Fig1){ref-type="fig"}) that used a combined quantitative and qualitative research design in two distinct phases. The initial phase (phase 1) was a quantitative design, was cross-sectional descriptive in nature and was questionnaire based. In the next phase (phase 2) which was conducted to further explain and enhance our quantitative findings, we adopted a qualitative design that involved in-depth interviews of primary caregivers of HIV-positive children. Fig. 1A visual representation of the sequential, explanatory, mixed-methods design adopted in this study

Participants {#Sec5}
------------

All primary caregiver responsible for the care of children aged 6--17 years living with HIV and attending the specialist paediatric HIV clinic of the Federal Teaching Hospital Gombe, Nigeria, who consented to the study were eligible for inclusion in the study. We defined a *primary caregiver* as an adult aged ≥18 years attending our specialist clinic with their HIV-positive child, and responsible for the day-to-day care of the child (6--17 years), including but not limited to biological parents.

We chose caregivers of children of aged 6--17 years \[those with the cognitive skills and emotional maturity of a normally developing child of 6--17 years\] because the WHO recommends that children of this age group should have disclosure of their HIV status made to them in an age-appropriate manner \[[@CR6]\]. HIV positive children who did not have an identified primary caregiver were excluded from the study. One hundred and twenty-five (125) out of the 200 primary caregivers attending the specialist clinic with their HIV-positive children gave their consent and were recruited into the study. Participants were advised that they could withdraw from the study at any point.

Data collection {#Sec6}
---------------

All data for this study was collected between October 2017 and September 2018.

### Phase 1: quantitative component {#Sec7}

A pre-tested questionnaire (Additional file [1](#MOESM1){ref-type="media"}), developed specifically for the purposes of this study was administered to primary caregivers of HIV-positive children in the absence of the child. The questionnaire was developed based on our understanding of the study population and after reviewing the literature on predictors of disclosure of HIV status to infected children in the setting of sub-Saharan Africa. The questionnaire captured information on caregivers' sociodemographic characteristics, their relationship with the index child, disclosure status of the index child, opinion about the process of HIV disclosure and information about the care and management of the HIV-positive child. Disclosure was considered to have been done when a child had been fully informed of his or her status and if the terms HIV, AIDS, or any local term specifically associated with HIV/AIDS had been used in a discussion with the child about their health \[[@CR6]\]. The quantitative data was analysed after phase 1 and the findings informed the next sequential phase which was conducted to give an in-depth understanding and explanations for disclosure and non-disclosure among primary caregivers (Fig. [1](#Fig1){ref-type="fig"}).

### Phase 2: qualitative component {#Sec8}

In-depth one-on-one qualitative interviews were conducted with 17 primary caregivers who were selected purposively from the 125 primary caregivers who met the eligibility criteria. Caregivers who were interviewed were selected specifically based on whether or not they had disclosed to the child his/her HIV status. (Table [1](#Tab1){ref-type="table"}). We aimed to maximize diversity with respect to caregivers' HIV status, thus, we included HIV positive and HIV negative caregivers to provide multiple perspectives and lived experiences. Using this approach, we sought to gain an in-depth understanding through the lived experiences of caregivers, the reasons why most caregivers in our setting were reluctant to make disclosure to their children living with HIV. Table 1Characteristics of the 17 caregivers interviewed in the qualitative component of the studyCaregiver code noType of caregiverCaregiver HIV statusChild's age category\*Orphan?Disclosure done?01UncleNegativeMid adolescenceYes**Yes**02MotherPositiveMid adolescenceNo**Yes**03MotherPositiveEarly adolescenceNo**No**04Adopted motherNegativeEarly adolescenceYes**No**05MotherPositiveEarly adolescenceYes**Yes**06MotherPositiveEarly adolescenceNo**No**07MotherPositiveSchool ageNo**No**08AuntNegativeEarly adolescenceYes**Yes**09MotherPositiveSchool ageNo**No**10AuntNegativeEarly adolescenceYes**Yes**11MotherPositiveSchool ageNo**No**12FatherPositiveMid adolescenceNo**Yes**13FatherPositiveLate adolescenceNo**Yes**14MotherPositiveSchool ageNo**No**15FatherPositiveMid adolescenceNo**Yes**16FatherPositiveEarly adolescenceNo**No**17FatherPositiveEarly adolescenceNo**NoNote:** Caregivers' gender, parent vs non parent caregiver, HIV positive/ negative status, varying levels of education and religious backgrounds were other characteristics that were considered in purposively selecting caregivers for the in-depth interviews in addition to the main characteristics of whether or not caregivers have made disclosure to their children. \*School age (6--9 years), Early adolescence (10--13 years), Mid adolescence (14--16 years) and Late adolescence (17--18 years) \[[@CR17]\].

Interviews were held at times and locations determined by participants to be convenient for them. Interviews were semi-structured, used topic guides (Additional file [2](#MOESM2){ref-type="media"}) and were conducted by co-authors (AA, MPR and AI) who had previous experience of conducting qualitative interviews and facilitating focus group discussions. One interview each was conducted per primary caregiver and lasted about 60--90 min. Interviews were conducted in either *Hausa* (the predominant language spoken in northern Nigeria) or English language based on which language the participants preferred. Interviews conducted in *Hausa*, were professionally transcribed verbatim into Hausa language, before being translated to English. Narrative data were then cross-checked for trustworthiness by a co-author (co-author AA) who could read, write, and communicate fluently in *Hausa* by listening to the audio recording of interviews in *Hausa* repeatedly while reading through transcribed text in English.

Data analysis {#Sec9}
-------------

All quantitative data generated were processed and analysed using the IBM Corp SPSS statistics for windows version 24.0 (Armonk, NY: IBM Corp). Proportions, and percentages were reported for categorical variables, while mean and standard deviations were reported for continuous variables which were normally distributed.

To determine which caregiver or child's characteristic (the independent variables) that was predictive of disclosure of HIV status to infected children (the dependent variable), multiple logistic regression models were fitted for variables that were significantly associated with disclosure from the univariate analysis. The regression models were adjusted for confounders including age of the index child, duration the index child has been diagnosed HIV-positive and how long the index child has been on ART. The adjusted odds ratio (AOR), and 95% CI are reported, with significance level set at *p*-values of \< 0.05.

Qualitative narrative data generated from transcripts of in-depth interviews were imported into the QSR NVivo software version 10 (QSR International Pty Ltd. Version 10, 2012) and analysed thematically using the approach described by Braun and Clark \[[@CR18]\]. The thematic analysis was based on a combined inductive and deductive approach \[[@CR12]\]. The inductive approach determined meanings that emerged from within the data, while the deductive approach looked for categories and meaning within the data that were determined a priori based on evidence from literature*.* Researchers (OW and AA) separately read the transcripts several times to familiarize themselves with the key ideas, paying attention to recurring themes or patterns. Initial themes and their sub--themes were noted as codes. Transcripts were again re--read, re--checking for themes, how new themes supported the data and vice versa, identifying relationships within and between themes. This process was followed in an iterative manner until thematic saturation was reached. The emergent themes and sub-themes were then discussed and agreed on collectively by co-authors, and where there was a disagreement on a theme or sub-theme, a third person (a co-author) was consulted to help resolve the disagreement.

Results {#Sec10}
=======

Quantitative findings {#Sec11}
---------------------

### Primary caregivers characteristics and opinion on disclosure to HIV-infected children {#Sec12}

A total of 125 caregivers were recruited to this study. Of these, data was incomplete or missing for 5 participants leaving 120 participants that were included in the final analysis. There were 98 (81.7%) female caregivers, giving a female to male caregiver ratio of 4.5:1. The mean age of primary caregivers included in the study was 39.2 ± 9 years. Majority \[77.5% (93/120)\] of caregivers were the biological parents of the HIV positive child. Forty seven percent of caregivers were educated up to the tertiary level. Majority, 77.5% (93/120) of caregivers believed that disclosure had benefits and should be made to children living with HIV (Table [2](#Tab2){ref-type="table"}). Table 2Characteristics of 120 caregivers of children living HIV with included in quantitative component of the studyVariableCharacteristicsFrequency (n)Percentage (%)GenderMale9881.7Female2218.3Educational levelNone1815Primary1512.5Secondary3025Tertiary5747.5Relationship with ChildBiological parent9377.5*¶*Other family member2722.5Caregiver's HIV statusPositive9478.3Negative2621.7Opinion about telling a child his/her HIV statusAgree to disclose9377.5Disagree to disclose2722.5Opinion on benefits of telling a child his/her HIV statusNo benefits1714.2There are benefits10385.8Opinion about appropriate age of disclosureSchool age54.2Early adolescence3125.8Mid adolescence5344.2Late Adolescence3125.8Values presented as mean (SD), unless otherwise indicated, **n (%) =** Frequency (percentage)School age (6--9 years), Early adolescence (10--13 years), Middle adolescence (14--16 years), Late adolescence (17--18 years) as described by Cromber et al. \[[@CR17]\]¶Others: Sister, Brother, Neighbour, Step-mother, Guardian, and unknown person

### Characteristics of index children living with HIV {#Sec13}

The mean age of index children living with HIV was 12.2 ± 3.2 years and there was no statistically significant difference between the ages of boys and girls with *p* = 0.363 (Table [3](#Tab3){ref-type="table"}). There were 60 (50%) Boys, making a Boys to Girls ratio of 1:1. The mean age at first diagnosis of HIV in these children was 4.9 ± 3.7 years, while the mean duration of treatment with ART was 7.0 ± 3.9 years, with no significant differences in boys and girls (Table [3](#Tab3){ref-type="table"}). Most, 98.3% (118/120) of children were on ART. Table 3Characteristics of index children living with HIV (*N* = 120) included in the quantitative component of the studyVariableBoys (***N*** = 60)Girls (***N*** = 60)***p*** valueTotal (***N*** = 120)***Age (years)***11.9 (2.9)12.5 (3.5)0.363\*12.2 (3.2)***Age at 1st diagnosis (years)***5.1 (3.8)4.6 (3.5)0.435\*4.9 (3.7)***Duration of ART treatment (years)***6.6 (3.4)7.6 (4.2)0.98\*7.0 (3.9)***Overall Age group: n (%)*** School age11 (18.8)11 (18.3)22 (18.3) Early adolescence25 (41.7)33 (55.0)58 (48.3) Mid adolescence15 (25.0)11 (18.3)26 (21.7) Late adolescence9 (15.0)5 (8.3)0.472\*\*14 (11.7)***School Attendance: n (%)***60 (100)58 (96.7)0.476\*\*118 (98.3)***On Antiretrovirals: n (%)***59 (98.3)58 (96.7)0.559\*\*117 (97.5)***Prevalence of disclosure: n (%)***18 (30.0)25 (41.7)0.253\*\*43 (35.8)***∫Disclosure rate by age-group: n (%)*** School age1 (9.1)2 (18.2)3 (13.6) Early adolescence3 (12.0)10 (30.3)13 (22.4) Mid adolescence6 (40.0)8 (72.7)14 (53.8) Late adolescence8 (88.9)5 (100)0.001\*\*13 (92.9)***Who made disclosure: N = 43 n (%)*** Mother alone7 (38.9)8 (32.0)15 (34.9) Father alone0 (0.0)5 (20.0)5 (11.6) Health worker4 (22.2)9 (36.0)13 (30.2) Grandmother2 (11.1)1 (4.0)3 (7.0)*¶*Others5 (27.8)2 (8.0)0.212\*\*7 (16.3)Values presented as mean (SD), unless otherwise indicated, **n (%) =** Frequency (percentage), \*Independent t-test p-values reported, **\*\***Chi-square p-values reported**∫**Disclosure rate by age-group calculated based on overall number of children within each age group category (disclosed and non-disclosed)¶Others: mother and father combined, Sister, Brother, Neighbour, Step-mother, Guardian, and unknown personSchool age (6--9 years), Early adolescence (10--13 years), Middle adolescence (14--16 years), Late adolescence (17--18 years) as described by Cromber et al. \[[@CR17]\]

### Prevalence of disclosure of HIV status to infected children {#Sec14}

The prevalence of HIV status disclosure to infected children was 35.8% (43/120). More mothers, 34.9% (15/43) compared to fathers, 11.6% (5/43) had made disclosures, however, the differences were not statistically significant (*p* = 0.212). Disclosure rate was higher in girls compared to boys, 41.7% vs 30%, *p* = 0.253 (Table [3](#Tab3){ref-type="table"}).

### Predictors of disclosure of HIV status to infected children {#Sec15}

HIV-positive children were ten times more likely to have been told their status if their caregivers believed that disclosure was beneficial and should be made to children living with HIV \[AOR = 9.9 (95% CI = 3.2--15.1)\]. Children's gender, caregiver's religion, and whether the caregiver was the child's biological parent or not did not predict disclosure (Fig. [2](#Fig2){ref-type="fig"}). Male caregivers compared to females were 3 times more likely, while HIV-negative caregivers compared to HIV-positive caregiver were 2 times more likely to have made disclosure to their children, however, the odds were not statistically significant (Fig. [2](#Fig2){ref-type="fig"}). Girls were 1.45 times more likely than boys to have been disclosed their HIV positive status even after adjusting for other variables \[AOR = 1.45 (95% CI = 0.6--3.5)\]. Fig. 2Comparative odds ratios for likelihood of telling a child his/her HIV status by caregiver and child's characteristics. Note: all variables were adjusted for child's age, duration (in years) the child has been on HAART, and duration (in years) since the child was first diagnosed with HIV

Qualitative findings {#Sec16}
--------------------

Three main themes; a) barriers to disclosure; b) the process of disclosure; and c) the perceived impact of disclosure on the child arose from the qualitative data related to why most caregivers have not made disclosure to their children living with HIV. The emergent sub-themes within the three themes (Table [4](#Tab4){ref-type="table"}) are presented below and supported with verbatim quotes. Table 4Major emergent themes and sub-themes from the qualitative dataThemesSub-Themes**Barriers**Stigma and discriminationBlame, guilt and responsibilityFear of the unknownThe 'right time'Multi-layer disclosure of secretsCultural sensitivity**Process**Ongoing and gradualOther peoples' or shared responsibilities**Impact**Mutually empoweringIntimacy and peer support

Barriers {#Sec17}
--------

### Stigma and discrimination {#Sec18}

There was consensus among parents, in a recurring manner across the interviews that discrimination and stigma were major deterrents to disclosure of HIV to their infected children. They opined that stigmatization in the community was still quite high and expressed deep-seated fears of what appeared to be the community's way of labelling and ostracizing HIV positive individuals. The discussion highlighted their fears of the negative impact of stigma and discrimination on their wards and they were reluctant to expose their children to such; fearing the impact it could have on them, hence they would rather resort to non-disclosure.""...honestly when he tells someone, almost the entire area \[community\] will come to know he is positive and knowing his status, they will start discriminating against him and when he goes somewhere, he may not be welcomed...at the time they start discriminating him he will feel hated and will prefer to die" (**Caregiver 1**: HIV negative caregiver of HIV orphan)"

""...when other children hear about it \[the child's HIV status\], they will start to disassociate themselves from him. These are my reasons why a child should not be disclosed his HIV status" (**Caregiver 6**: HIV positive caregiver of adolescence living with HIV)"

### Blame, guilt, and responsibility {#Sec19}

The caregivers shared the view that while already having to deal with the pain of watching their children grow-up HIV positive, disclosure was made more complex by thoughts of questions that would arise during the process. The caregivers in a repetitive manner harboured strong feelings of guilt and self--recrimination; anticipated being blamed and despised by their children for what they unwittingly brought upon them, and some considered the possibility of loss of the respect they have from their children, hence preferring non-disclosure. These views were more prominently expressed by HIV positive caregivers.

"\"This \[disclosure\] can lead him to query his parents from where and how they came about the disease...He may think his parents are irresponsible and it led to them contracting HIV, so you see the parent will not want to tell him because they fear they may lose the respect he has for them. So, this makes disclosure problematic for the parents. (**Caregiver 2**: HIV positive caregiver of adolescent living with HIV)"

""I don't know what my child will think of me if he hears I gave him HIV. He may say I have harmed him because it is like harming him by infecting him with the virus." (**Caregiver 7**: HIV positive caregiver of a school age child living with HIV)"

"The main reason parents will keep it a secret, like I told you, is the fear of what the children will think of them and how they look at them once they discover that their parents have the disease \[HIV\]...they will begin to ask themselves how their father became infected... is it through sex? (**Caregiver 17:** HIV positive caregiver of an adolescent living with HIV)*.*"

### Fear of the unknown {#Sec20}

Many caregivers feared that their children could not handle the news and their situation could be worsened following disclosure of their HIV positive status. Their uncertainty about the impact of this news on children who had grown up seemingly unaware of any problems could be felt across the discussions repeatedly. They expressed fears about this knowledge resulting in depression, anxiety, hopelessness and even suicidal thoughts in their wards.

""...he may resolve to take something \[poison\] to end his life because he will believe when told that he is HIV positive that his life is of no importance or that his parents have cheated him by bringing him into the world with this illness" (**Caregiver 5**: HIV positive caregiver of adolescent living with HIV)"

""I keep wondering what her state of mind will be when I finally confide in her" (**Caregiver 14**: HIV positive caregiver of a school age child living with HIV)"

### The 'right time' {#Sec21}

During discussions, it became apparent that 14--15 years and above was deemed to be the 'right time' to begin disclosure, thus, having younger children acted as a barrier to disclosure. Most caregivers perceived that at that age, the child would have attained the ability to process such information. Other caregivers' opinion was that since girls began to mature earlier than boys, the process should begin earlier in them.""The child doesn't have a right to know his or her status till age 15years. It is when they reach 15 years that the time is right for them to know their status and condition, they are in..." (**Caregiver 11:** HIV positive caregiver of a school age child living with HIV)"

""...in primary school between 7,8,9 to 10 years it may be difficult- for instance for female you can tell her from 10 years at least she has grown up...However, a male child can wait until when he is like 14, 15 years..." (**Caregiver 1**: HIV negative caregiver of an HIV orphan)"

### Multi-layer disclosure of secrets {#Sec22}

In a repeated manner, the caregivers emphasized the secrecy surrounding being HIV positive or having an HIV positive family member in their local context. Anxiety about knowledge of the child's and possibly parent status subsequently becoming known to the larger community through the child following disclosure was palpable. This concern appeared to be a primary contributor to most parents suggesting an optimal disclosure age purely based on when the child would be able to keep his/her "mouth shut".""...they will begin to say it outside and the neighbours may ask you in order to clarify the information, and it is from there that others will get to know the family's secret" (**Caregiver 7:** HIV positive caregiver of a school age child living with HIV)"

"'The children should be told that they can only tell a select few people who are also positive and who can keep this information secret, so that they will know that it is not everywhere you go talking about your status\". (**Caregiver 16**: HIV positive caregiver of a school age child living with HIV)"

### Cultural sensitivity {#Sec23}

There was a recurring theme during the discussions on the impact of cultural practices or beliefs on the disclosure process especially on issues relating to HIV and sexuality. Caregivers agreed there was a tendency to shy away from discussing topics relating to sex with their wards and admitted this presented a huge barrier to disclosure.""Assuming it is in our culture to always give answers to whatever \[including sexual topics\] a child asks by telling them the truth; I don't think there will be problems in disclosing HIV to our children" (**Caregiver 2**: HIV positive caregiver of adolescent living with HIV)"

Process of disclosure {#Sec24}
---------------------

### Ongoing and gradual {#Sec25}

The caregivers mostly agreed that disclosure needed to be done gradually, as a stepwise and ongoing process. They agreed that a process of gradually breaking the news over a long period would help the child cope better.""For a difficult issue like HIV, disclosure has to be gradual, systematic and continuous...it has to be slow, phase by phase" (**Caregiver 17:** HIV positive caregiver of an adolescent living with HIV)*.*"

### Other peoples' or shared responsibilities {#Sec26}

Most of the caregivers considered the process of disclosure as 'other peoples' or a 'shared' responsibility, believing that health care workers should play a key role in the process; either as facilitators or to provide support while caregivers make disclosure. Some, especially the HIV positive female caregivers emphasized parental responsibility to make disclosure or pointed fingers at fathers as responsible, blaming them for infecting the rest of the family.""The responsibility lies on both the parents and the doctors. The parents are the ones that know the problem of their children...On the other hand, the doctors can disclose to him because they are the ones that see him and prescribe medicine for him, they tell him the steps to take to protect his health..." (**Caregiver 11:** HIV positive caregiver of a school age child old living with HIV)"

""The father has the responsibility of disclosing the child's HIV status to him since he is the person that brought the disease home/ into the family" (**Caregiver 5**: HIV positive caregiver of an adolescent living with HIV)"

Impact of disclosure {#Sec27}
--------------------

### Mutually empowering {#Sec28}

Full disclosure was repeatedly described as associated with feelings of relief for the caregivers and liberating for the child throughout the discussions. Involvement of children in HIV management following disclosure was a major positive effect observed by caregivers who had made disclosure.""I saw clearly that if I left him to grow much older before telling him, he is likely to say I have been unfair to him by keeping him in darkness/ hiding things from him. We both have peace of mind since he came to understand the illness" (**Caregiver 8:** HIV negative caregiver of an adolescent HIV orphan)"

""When the doctor disclosed it to him, I saw some changes in his behaviour and noticed he was more serious about committing himself to taking his drugs more than before" (**Caregiver 13**: HIV positive caregiver of an adolescent living with HIV)"

### Intimacy and peer support {#Sec29}

Caregivers described how full disclosure positively impacted on their child or ward as it brought intimacy and an opportunity to get support from family members and peers in school who were dealing with similar situations or had someone who was also HIV positive. This intimacy or support was not possible prior, as the child's condition was kept secret.""He later told me that in school he has a friend whom he confided in about his HIV status and who also told him about his sister at home who had HIV. You see that person also knows about the disease from personal experience, so he won't go about telling people that my son is infected ...and he can now support my son" (**Caregiver 2**: HIV positive caregiver of an adolescent living with HIV)"

Discussion {#Sec30}
==========

The strength of our study was that it combined quantitative and qualitative methodologies in a sequential and complementing manner to gain in-depth information on the predictors, and experience of caregivers on the disclosure of HIV status to infected children attending an HIV-specialist clinic in the northeast of Nigeria. Thirty-six percent of the HIV positive children in this study have had their HIV status formally disclosed to them by their caregivers. This figure is much higher than an earlier report by Brown et al. (13.5%) in Ibadan, South-West Nigeria, and may be attributed to differences in study population, context, and increasing awareness about HIV disclosure \[[@CR19]\]. For example, most children studied in the earlier report were pre-adolescent (mean age 8.8 ± 2.2 years) compared to our study in which the majority were in early and mid-adolescence (mean age 12.2 ± 3.2 years), making disclosure more likely in our study with corresponding higher prevalence. More recent studies in Nigeria by Ubesie et al., \[[@CR20]\] and Odiachi et al. \[[@CR21]\] reported prevalence of disclosure to HIV positive children of 29.5 and 30.9% respectively; comparable to our findings which suggests an increase prevalence of disclosure to Nigerian children living with HIV within recent time. Although relatively higher than most reports from within Nigeria and the African continent, \[[@CR5], [@CR22]--[@CR28]\] our disclosure rate are lower compared with findings from the US, Canada and Europe \[[@CR29]--[@CR31]\].

Majority of caregivers appeared to support the idea of disclosing HIV to positive children as necessary however, up to 70% of them considered that it should be left till mid adolescence when the child would have become "mature". There was concordance between the quantitative and qualitative components of our study with both showing that caregivers preferred 14--15 years as the average age to tell children they were HIV infected. In a similar pattern, John-Stewart et al. \[[@CR32]\] reported that although 79% of Kenyan caregivers answered yes to the question "is it important for a parent/caregiver to inform a child of his/her status?" only 19% had disclosed, and the preferred age of disclosure was 12 years. The preferred age for commencement of disclosure by the caregivers we studied is both high and is discordant with Nigerian National guidelines, \[[@CR33]\] the recommendations by the African Network for the Care of Children Affected by HIV/AIDS (ANECCA), \[[@CR34]\] and WHO \[[@CR6]\] which encourage beginning the process of disclosure for school aged children. This discordance between the preferred age of disclosure in our study to national and international guidelines is disturbing. It could be due to the caregivers' perception of when the child is psychologically and emotionally mature and has gained relevant cognitive skills to deal with the disclosure. It further highlights the perception that disclosure should be a 'one-time' event in adolescence rather than a stepwise and gradual process \[[@CR35]\] and implies that children in our study setting are likely to learn of their HIV-status suddenly and at an older age. This could have critical implications for the continuation of HIV care.

In contrast to other reports, \[[@CR20], [@CR26]\] girls were 1.45 times more likely than boys to have been disclosed their HIV positive status. This quantitative finding was corroborated by the qualitative component of our study where caregivers shared their views that female children tend to attain 'maturity' earlier than their male counterparts and would therefore be better equipped to cope with the news, thus, explaining the higher likelihood of disclosure to female children in our study setting. Although biological and psychosocial models of development may support the assertion by the caregivers in our study that girls attain physical and psychological maturity earlier than boys, in the context of a complex condition like HIV, ensuring that caregivers are supported to make disclosure to their boys and girls alike is critical to effective treatment uptake.

Although not an independent predictor of disclosure, having secondary or tertiary education in our study was associated with a higher likelihood of disclosure to HIV positive children. Other reports have shown conflicting reports on the influence of caregivers' educational status on disclosure to HIV infected children with some suggesting that attainment of higher levels of education was negatively associated with disclosure to children \[[@CR36], [@CR37]\]. This quantitative finding was further explained by the observation in the qualitative component of the study that local traditions, more prevalent among non-educated caregivers discourage communication on sexuality and HIV infection between parents and their children. There is therefore a need to promote and encourage open discussions across families in the Nigerian context more broadly irrespective of their educational background, and specifically among families affected by HIV.

In our study, caregivers who believed that disclosure was beneficial and should be made to their children living with HIV were ten times more likely to disclose the HIV status to the child. Similar findings have been reported by other studies that have found higher disclosure rates among children of caregivers that understood the potential health benefit of disclosure \[[@CR23], [@CR31], [@CR38]\]. This, therefore, underscores the need for a systematic approach to providing training, guidance, and support for caregivers on disclosure to HIV positive children especially in resource constrained settings with the hope of encouraging them to believe in disclosure, thus, increasing disclosures to children across context.

Furthermore, our study found that HIV negative caregivers were twice more likely to disclose HIV status to their infected children or wards compared to caregivers who were HIV positive. This quantitative finding may be explained by evidence from the qualitative component of our study which indicated that deep seated feeling of shame, guilt, self-blame, and self-recrimination among HIV-positive caregivers strongly influenced disclosure practices due to their perceived role in unknowingly transmitting HIV to their children during pregnancy, childbirth and after childbirth. HIV negative caregivers might be less likely to face these feelings when confronted with making disclosures, with a correspondingly higher likelihood of making disclosure to their HIV infected children or wards. Similar to our findings, Kiwanuka et al. reported that Ugandan HIV positive caregivers reported fears of being considered to have been promiscuous or irresponsible by their children following the disclosure of HIV status to their infected children \[[@CR39]\]. These findings suggest that the psychological burden of being responsible for the child's illness partly impedes the disclosure process by caregivers. Consequent upon this quantitative finding whose understanding was enhanced by the qualitative data, health care workers providing care to HIV positive children and their caregivers must therefore understand these undertones to enable them to provide supportive and empathetic care.

The qualitative data in our study showed that stigma and discrimination were major caregivers' concerns preventing disclosure to HIV positive children. Some parents felt their children might harm them or commit suicide when they became aware of their HIV status. The high level of stigma and discrimination against people living with HIV (PLHIV) in many communities across Nigeria which links HIV infection with promiscuity may perpetuate parental fears of being despised by their wards following disclosure \[[@CR40], [@CR41]\].. Fear of stigma also fuels the desire of parents to maintain the HIV status of family member's secret - a factor that militates against early disclosure to children for fear of inadvertent disclosure. Activities aimed at reducing stigma and discrimination within communities should be strengthened in order to reduce this trend.

Disclosure was mostly described as mutually beneficial for caregivers and children studied. In consonance with many other reports, \[[@CR19]--[@CR21], [@CR42], [@CR43]\] this study showed that major benefits accrued from telling children the truth about their HIV status which included relief for caregivers and children, improved commitment to involvement in medication and the opportunity to develop peer support. These benefits further highlight the importance of disclosure thus, strategies aimed at encouraging caregivers to make disclosures and supporting them through the disclosure process should be scaled up by health systems with similarities to our study context.

Our study has some limitations. Firstly, the fact that we relied on caregivers' reported information to determine if disclosure has been made could have increased the likelihood of reporting bias. This may have decreased or increased our reported prevalence of disclosure. However, the quantitative questionnaire was researcher administered and the fact that an operational definition \[[@CR6]\] was used to define disclosure could have minimized the possibility of this bias. Secondly, we interviewed majorly women, and HIV positive caregivers which could have influenced the perspectives and experience shared in the qualitative narrative data. However, our purposive sample represent our study setting and therefore, appropriately reflect the experience from our setting. One should be cautious when extrapolating our qualitative findings to other settings with different context.

Conclusion {#Sec31}
==========

This sequential, explanatory, mixed-methods study provides rich and granular research evidence that enhances the understanding of the barriers, predictors, experience and the dilemmas caregivers face in disclosing HIV status to infected children in a resource limited setting. HIV status disclosure to infected children was found to be low in our study setting. Disclosure was affected by caregivers' guilt and self-blame, HIV stigma, cultural sensitivity around HIV infection, the child's age/gender, caregivers' belief on the importance of disclosure, and caregiver's HIV status. Despite the pervasive barriers, disclosure was mostly described by caregivers as mutually beneficial for caregivers, children, and the continuum of HIV care. There is, therefore, a critical need to develop context-specific interventions to support caregivers who face multiple barriers in disclosing HIV status to infected children in our study setting. Such interventions could be delivered through the routine HIV treatment and care system by health workers who are trained and supported by locally-relevant guidelines based on local evidence. Through this process, caregivers would be empowered with practical skills needed to recognise windows of opportunities to initiate disclosure early and manage the process in a manner appropriate to their children's physical and emotional development.

Supplementary information
=========================

 {#Sec32}

**Additional file 1.** Pretested quantitative data collection questionnaire **Additional file 2.** Qualitative interview guide

AIDS

:   Acquired Immune-deficiency Syndrome

ANECCA

:   African Network for the Care of Children Affected with HIV/AIDS

AOR

:   Adjusted Odds Ratio

ART

:   Anti-Retroviral Therapy

CI

:   Confidence interval

HAART

:   Highly Active Anti-Retroviral Therapy

HCT

:   HIV Counselling and Testing

HIV

:   Human Immune-deficiency Virus

PLHIV

:   People Living with HIV

PMTCT

:   Prevention of Mother To Child Transmission of HIV

SD

:   Standard deviation

WHO

:   Word Health Organization

**Publisher's Note**

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Emmanuel Okpo and Elon Isaac are co-senior authors.

Supplementary information
=========================

**Supplementary information** accompanies this paper at 10.1186/s12889-020-08506-x.

The authors would like to acknowledge the staff of the specialist Paediatric HIV clinic at the Federal Teaching Hospital Gombe, caregivers, and their children living with HIV for their contributions to the success of this study. Specifically, we acknowledge Dr. Yesangra Rabo Adeniji, Dr. Ezra Daniel and Dr. Maryam Usman for their support throughout the quantitative data collection.

OW: conceived of the study and study design, designed the data collection tool, conducted quantitative data analysis, conducted qualitative data analysis, developed the first manuscript draft, and critically reviewed the final manuscript; AA: Conducted qualitative interviews, supervised transcription of the narratives, conducted qualitative data analysis, developed the first manuscript draft and critically reviewed the final manuscript; MPR: Collected quantitative data, conducted qualitative interviews, and commented on the final manuscript; AI: Collected quantitative data, conducted qualitative interviews, and commented on the final manuscript; OL: Collected quantitative data, and commented on the final manuscript; EO: Oversaw study design, and critically reviewed and commented on all drafts of the manuscript; EI: Oversaw study design, and critically reviewed and commented on all drafts of the manuscript. The author(s) read and approved the final manuscript.

No specific external funding for the conduct of this study.

The datasets analysed during the current study are available from the corresponding author on reasonable request.

The study protocol was reviewed and approved by the Federal Teaching hospital Gombe Institutional Review Board (NHREC/25/10/2013) before commencement of the study. Subsequent investigation was conducted according to the principles expressed in the Declaration of Helsinki. Written informed consent for participation in the study and for audio-recording of in-depth interviews (if participant was also selected for in-depth interviews) was sought from participants before data collection. We collected all data anonymously.

Not applicable.

The authors declare that they have no competing interests.


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# Copyright 2020 The Verible Authors.
#
# Licensed under the Apache License, Version 2.0 (the "License");
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# You may obtain a copy of the License at
#
#      http://www.apache.org/licenses/LICENSE-2.0
#
# Unless required by applicable law or agreed to in writing, software
# distributed under the License is distributed on an "AS IS" BASIS,
# WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
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# limitations under the License.

usage() {
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Here’s a proper Response after Receiving Fire

Hopefully, you will never have to experience or get into harms way as these men of the 101st Airborne did. But in every home/vehicle or active shooter defense scenario. If given a chance to foil an attack, you might want to do so in a similar fashion as these Airborne troopers.

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Video Transcription
Taliban Takes Shots At US Soldiers And Gets A Proper Reply

Chris Fields: So I’ve got a little bit of movement in the little tertiary valley to the left.

Joel Vowell: There’s movement up there?

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“They hit the vehicle.”

“Right. So good luck [indistinguishable]”
[Gunshot]

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DESCRIPTION Rabs regulate the important cellular process of vesicular transport. The importance of the prenyl modification of Rab proteins and how other proteins and membranes interact with this modification remains unclear. This proposal specifically aims to define the kinetic parameters of GDI- mediated Rab5 retrieval from membranes and to investigate the effects of synthetic Rab5 peptides on those parameters. The assay monitors the release of Rab5, by quantitative Western analysis, into the supernatant after pelleting the membrane source by centrifugation. The proposal outlines the determination of the cytosol, energy, and nucleotide requirements for the reaction as well as the activity's dependence on GDI, Rab5, and peptide concentrations. This proposal also specifically aims to determine how a photoreactive prenyl pyrophosphate analog affects the in vitro prenylation of Rab5. An in vitro system for the prenylation or Rab5 is available in the sponsoring lab. An in vitro system for the prenylation of Rab5 is available in the sponsoring lab. This proposal outlines how to test whether the analog competitively inhibits the reaction and whether it modifies the beta subunit of the Rab prenyl transferase enzyme. The proposal outlines how to test whether the analog competitively inhibits the reaction and whether it modifies the beta subunit of the Rab prenyl transferase enzyme. The proposal also describes how to create a photoreactive Rab5 probe for other proteins that interact with the Rab5 and for amino acid residues of GDI that lie in close proximity to the lipid modification. The results of these studies should provide important clues as to how prenyl modifications mediate protein-protein interactions.


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