Prevalence and correlates of sex-selective abortions and missing girls in Nepal: evidence from the 2011 Population Census and 2016 Demographic and Health Survey.

OBJECTIVES: These were to: (1) produce national and subnational estimates of the sex ratio at birth (SRB) and number of missing girl births in Nepal and (2) understand the socioeconomic correlates of these phenomena. DESIGN: Observational secondary data analysis of (1) the 2011 population census of Nepal and (2) the Nepal Demographic and Health Survey (DHS) 2006, 2011 and 2016. SETTING: Nepal. PARTICIPANTS: (1) 2 567 963 children age 0-4 in the 2011 population census and (2) 27 329 births recorded in DHSs. PRIMARY AND SECONDARY OUTCOMES: We estimate the SRB, and number and proportion of missing girls in the year and 5 years before the census by district. We also calculate conditional sex ratios (the SRB dependant on parity and sex of previous children) by province, time, education and wealth. RESULTS: We find that 11 districts have significantly skewed sex ratios at birth in the 2011 population census, with the highest SRBs observed in Arghakhanchi (SRB=127) and Bhaktapur (SRB=123). 22 540 girl births were missing in the 5 years before the 2011 population census. Sex-selective abortion is geographically concentrated, especially in the Kathmandu Valley and Lumbini Province, with 53% of missing girls found in only 11 out of 75 districts.DHS data confirm this, with elevated conditional sex ratios observed in Bagmati and Lumbini Provinces; conditional sex ratios where previous births were all female also became more skewed over time. Skewed sex ratios are concentrated among wealthier more educated groups. CONCLUSIONS: It is clear that sex selection will persist and develop in Nepal unless a coordinated effort is made to address both the demand for and supply of this service. Policies should be holistic and encompass economic and legal gender equity, and strengthen monitoring mechanisms to prevent technology misuse, without jeopardising the right to safe, free and legal abortion.

The human foot and heel-sole-toe walking strategy: a mechanism enabling an inverted pendular gait with low isometric muscle force?

Mechanically, the most economical gait for slow bipedal locomotion requires walking as an 'inverted pendulum', with: I, an impulsive, energy-dissipating leg compression at the beginning of stance; II, a stiff-limbed vault; and III, an impulsive, powering push-off at the end of stance. The characteristic 'M'-shaped vertical ground reaction forces of walking in humans reflect this impulse-vault-impulse strategy. Humans achieve this gait by dissipating energy during the heel-to-sole transition in early stance, approximately stiff-limbed, flat-footed vaulting over midstance and ankle plantarflexion (powering the toes down) in late stance. Here, we show that the 'M'-shaped walking ground reaction force profile does not require the plantigrade human foot or heel-sole-toe stance; it is maintained in tip-toe and high-heel walking as well as in ostriches. However, the unusual, stiff, human foot structure--with ground-contacting heel behind ankle and toes in front--enables both mechanically economical inverted pendular walking and physiologically economical muscle loading, by producing extreme changes in mechanical advantage between muscles and ground reaction forces. With a human foot, and heel-sole-toe strategy during stance, the shin muscles that dissipate energy, or calf muscles that power the push-off, need not be loaded at all--largely avoiding the 'cost of muscle force'--during the passive vaulting phase.

The biomechanics of leaping in gibbons.

Gibbons are skilled brachiators but they are also highly capable leapers, crossing distances in excess of 10 m in the wild. Despite this impressive performance capability, no detailed biomechanical studies of leaping in gibbons have been undertaken to date. We measured ground reaction forces and derived kinematic parameters from high-speed videos during gibbon leaps in a captive zoo environment. We identified four distinct leap types defined by the number of feet used during take-off and the orientation of the trunk, orthograde single-footed, orthograde two-footed, orthograde squat, and pronograde single-footed leaps. The center of mass trajectories of three of the four leap types were broadly similar, with the pronograde single-footed leaps exhibiting less vertical displacement of the center of mass than the other three types. Mechanical energy at take-off was similar in all four leap types. The ratio of kinetic energy to mechanical energy was highest in pronograde single-footed leaps and similar in the other three leap types. The highest mechanical work and power were generated during orthograde squat leaps. Take-off angle decreased with take-off velocity and the hind limbs showed a proximal to distal extension sequence during take-off. In the forelimbs, the shoulder joints were always flexed at take-off, while the kinematics of the distal joints (elbow and wrist joints) were variable between leaps. It is possible that gibbons may utilize more metabolically expensive orthograde squat leaps when a safe landing is uncertain, while more rapid (less expensive) pronograde single-footed leaps might be used during bouts of rapid locomotion when a safe landing is more certain.

Assessment of dairy cow locomotion in a commercial farm setting: the effects of walking speed on ground reaction forces and temporal and linear stride characteristics.

Objectives of this study were to determine the effects of walking speed on ground reaction force (GRF) parameters and to explore inter- and intra-individual variability with unsupervised data collection in a commercial farm setting. We used eight high producing loose-housed Holstein Friesian cows consistently scored sound, with no veterinary treatment during the collection period. Cows walked freely (0.52-1.37 m/s) over a five force platform array, twice daily, following milking. GRF data were split into speed categories and temporal and kinetic gait parameters extracted. A general linear model was carried out to determine effects of speed. Variation in parameters between cows is inconsistent, while between speed categories (containing data from multiple cows) the parameters which vary are consistent. Stance and stride time were reduced with increasing speed but no change in peak vertical GRF or duty factor was found. This ability to track parameters within an individual over time aids detection of subtle changes associated with lameness.

Variability of Manson and Leaver locomotion scores assigned to dairy cows by different observers.

The gait scoring system developed by Manson and Leaver was used by five experienced observers to assess the gait of 83 milking Holstein-Friesian cows in a live recording session, and video recordings were made. The agreement between the scores of the observers at the live session, and between each observer's scores at the live session and a video session, were compared at three levels of stringency. The scores of the observers were highly variable at all but the least stringent threshold - whether a cow had a score of less than 3 or 3 or more, that is, whether it was not lame or lame.

Exploring the mechanical basis for acceleration: pelvic limb locomotor function during accelerations in racing greyhounds (Canis familiaris).

Animals in their natural environments are confronted with a regular need to perform rapid accelerations (for example when escaping from predators or chasing prey). Such acceleration requires net positive mechanical work to be performed on the centre of mass by skeletal muscle. Here we determined how pelvic limb joints contribute to the mechanical work and power that are required for acceleration in galloping quadrupeds. In addition, we considered what, if any, biomechanical strategies exist to enable effective acceleration to be achieved. Simultaneous kinematic and kinetic data were collected for racing greyhounds undergoing a range of low to high accelerations. From these data, joint moments and joint powers were calculated for individual hindlimb joints. In addition, the mean effective mechanical advantage (EMA) of the limb and the ;gear ratio' of each joint throughout stance were calculated. Greatest increases in joint work and power with acceleration appeared at the hip and hock joints, particularly in the lead limb. Largest increases in absolute positive joint work occurred at the hip, consistent with the hypothesis that quadrupeds power locomotion by torque about the hip. In addition, hindlimb EMA decreased substantially with increased acceleration - a potential strategy to increase stance time and thus ground impulses for a given peak force. This mechanism may also increase the mechanical advantage for applying the horizontal forces necessary for acceleration.

Determinants of post-partum maternal mortality at Queen Elizabeth Central Hospital, Blantyre, Malawi: a case-control study 2001-2002.

The aim of this research is to identify the clinical, demographic and service-based determinants of postpartum maternal mortality within Queen Elizabeth Central Hospital, Blantyre, Malawi, during 2001 and 2002. The study uses a case-control design using all postpartum maternal deaths in 2001 and 2002 as cases, with analysis conducted using conditional logistic regression. The results indicate that the mothers' reason for admission into hospital and the outcome of the birth were significantly related to maternal death when analysing all potential explanatory variables in one model. A group of high-risk mothers can be identified using these factors. If these criteria were applied as a predictive tool in the clinical setting the resulting sensitivity and specificity would be over 85%. Identification within the hospital setting of a group of very high-risk mothers in whom serious complications are aggressively managed in a coordinated way across the medical specialties may reduce maternal mortality.

Determinants of post-partum maternal mortality at Queen Elizabeth Central Hospital, Blantyre, Malawi: a case-control study 2001-2002

The aim of this research is to identify the clinical, demographic and service-based determinants of postpartum maternal mortality within Queen Elizabeth Central Hospital, Blantyre, Malawi, during 2001 and 2002. The study uses a case-control design using all postpartum maternal deaths in 2001 and 2002 as cases, with analysis conducted using conditional logistic regression. The results indicate that the mothers' reason for admission into hospital and the outcome of the birth were significantly related to maternal death when analysing all potential explanatory variables in one model. A group of high-risk mothers can be identified using these factors. If these criteria were applied as a predictive tool in the clinical setting the resulting sensitivity and specificity would be over 85%. Identification within the hospital setting of a group of very high-risk mothers in whom serious complications are aggressively managed in a coordinated way across the medical specialties may reduce maternal mortality (Afr J Reprod Health 2008; 12[3]:35-48)