Chemical leukoderma: An insight of pathophysiology and contributing factors.

Chemical leukoderma, or chemical-based vitiligo, is a dermal disease triggered by exposure to chemicals and characterized by the emergence of depigmentation or hypopigmentation of the skin. The etiology of this condition is associated with exposure to various chemical substances present in both occupational and non-occupational settings. The precise mechanism that underlies chemical leukoderma remains elusive and is believed to result from the demise of melanocytes, which are responsible for producing skin pigments. This condition has gained particular prominence in developing countries like India. An interesting connection between chemical leukoderma and vitiligo has been identified; studies suggest that exposure to many household chemicals, which are derivatives of phenols and catechol, may serve as a primary etiological factor for the condition. Similar to autoimmune diseases, its pathogenesis involves contributions from both genetic and environmental factors. Furthermore, over the last few decades, various studies have demonstrated that exposure to chemicals plays a crucial role in initiating and progressing chemical leukoderma, including cases stemming from occupational exposure.

Novel Targets and Drug Delivery System in the Treatment of Postoperative Pain: Recent Studies and Clinical Advancement.

Pain is generated by a small number of peripheral targets. These can be made more sensitive by inflammatory mediators. The number of opioids prescribed to the patients can be reduced dramatically with better pain management. Any therapy that safely and reliably provides extended analgesia and is flexible enough to facilitate a diverse array of release profiles would be useful for improving patient comfort, quality of care, and compliance after surgical procedures. Comparisons are made between new and traditional methods, and the current state of development has been discussed; taking into account the availability of molecular and cellular level data, preclinical and clinical data, and early post-market data. There are a number of benefits associated with the use of nanotechnology in the delivery of analgesics to specific areas of the body. Nanoparticles are able to transport drugs to inaccessible bodily areas because of their small molecular size. This review focuses on targets that act specifically or primarily on sensory neurons, as well as inflammatory mediators that have been shown to have an analgesic effect as a side effect of their anti- inflammatory properties. New, regulated post-operative pain management devices that use existing polymeric systems were presented in this article, along with the areas for potential development. Analgesic treatments, both pharmacological and non-pharmacological, have also been discussed.

The role of plant growth promoting rhizobacteria in strengthening plant resistance to fluoride toxicity: a review.

A wide variety of bacteria are present in soil but in rhizospheric area, the majority of microbes helps plant in defending diseases and facilitate nutrient uptake. These microorganisms are supported by plants and they are known as plant growth-promoting rhizobacteria (PGPR). The PGPRs have the potential to replace chemical fertilizers in a way that is more advantageous for the environment. Fluoride (F) is one of the highly escalating, naturally present contaminants that can be hazardous for PGPRs because of its antibacterial capacity. The interactions of F with different bacterial species in groundwater systems are still not well understood. However, the interaction of PGPR with plants in the rhizosphere region reduces the detrimental effects of pollutants and increases plants' ability to endure abiotic stress. Many studies reveal that PGPRs have developed F defense mechanisms, which include efflux pumps, Intracellular sequestration, enzyme modifications, enhanced DNA repair mechanism, detoxification enzymes, ion transporter/antiporters, F riboswitches, and genetic mutations. These resistance characteristics are frequently discovered by isolating PGPRs from high F-contaminated areas or by exposing cells to fluoride in laboratory conditions. Numerous studies have identified F-resistant microorganisms that possess additional F transporters and duplicates of the well-known targets of F. Plants are prone to F accumulation despite the soil's low F content, which may negatively affect their growth and development. PGPRs can be used as efficient F bioremediators for the soil environment. Environmental biotechnology focuses on creating genetically modified rhizobacteria that can degrade F contaminants over time. The present review focuses on a thorough systemic analysis of contemporary biotechnological techniques, such as gene editing and manipulation methods, for improving plant-microbe interactions for F remediation and suggests the importance of PGPRs in improving soil health and reducing the detrimental effects of F toxicity. The most recent developments in the realm of microbial assistance in the treatment of F-contaminated environments are also highlighted.

Responses of phenology, yield attributes, and yield of wheat varieties under different sowing times in Indo-Gangetic Plains.

A field experiment with wheat was conducted at Pusa (25.98°N, 85.67°E, 52 m amsl), Bihar (middle Gangetic plains of India), to assess the responses of phenology, yield attributes, and yield to growing season temperature and heat stress. For this purpose, wheat was planted on five dates (viz., 15 November, 25 November, 5 December, 15 December, and 25 December) for three consecutive years (viz., 2014-2015, 2015-2016, and 2016-2017) with three prominent cultivars of the region (viz., RAU-3711, HD-2824, and HD-2733). Five dates of sowing represent different wheat-growing micro-environments as imposed by varying sowing dates encompassing the entire sowing window. The study observed the significant effect of sowing dates on phenophase duration. In general, with progress in the date of sowing, tiller initiation was delayed, while the reverse trend was observed for later growth phases. Sowing environments significantly influenced the number of effective tillers m-2. Average numbers of effective tillers (ET) m-2 for the wheat sown during 15-25 November were almost 11.6% higher than those of the 25 December sown crop. Grain filling duration (GFD) showed a declining trend with the advancement of sowing dates due to increased thermal load on the crop during the reproductive period. 15 November planted crop exhibited the highest GFD (47 days), which was shortened significantly beyond 25 November, signifying agrometeorological non-suitability of wheat sowing beyond this window. Wheat sown on 25 November recorded the highest grain yield (3.21 Mg ha-1), 48.61% higher than the 25 December sown crop due to the congenial thermal regime. In this context, we have identified optimal and sub-optimal conditions to escape heat stress for higher wheat productivity. Moreover, the sum of deviation of temperature from optimum thresholds, computed for sensitive growth phases (50% flowering to physiological maturity), helped us to identify heat stress and its impact on wheat. Genotype-by-environment (GGE) biplot analysis revealed that RAU-3711 was found to be the most stable cultivar. A decrease in the yield of wheat by 4.9% to 12.0%, sown during November, and 33.8% to 42.4%, sown during December, is predicted in 2050-51 and 2080-81, respectively, under RCP 4.5.

Comparative study of ethanol production from sodium hydroxide pretreated rice straw residue using Saccharomyces cerevisiae and Zymomonas mobilis.

Rice straw is a suitable alternative to a cheaper carbohydrate source for the production of ethanol. For pretreatment efficiency, different sodium hydroxide concentrations (0.5-2.5% w/v) were tested. When compared to other concentrations, rice straw processed with 2% NaOH (w/v) yielded more sugar (8.17 ± 0.01 mg/ml). An alkali treatment induces effective delignification and swelling of biomass. The pretreatment of rice straw with 2% sodium hydroxide (w/v) is able to achieve 55.34% delignification with 53.30% cellulose enrichment. The current study shows the effectiveness of crude cellulolytic preparation from Aspergillus niger resulting in 80.51 ± 0.4% cellulose hydrolysis. Rice straw hydrolysate was fermented using ethanologenic Saccharomyces cerevisiae (yeast) and Zymomonas mobilis (bacteria). Overall, superior efficiency of sugar conversion to ethanol 70.34 ± 0.3% was obtained with the yeast compared to bacterial strain 39.18 ± 0.5%. The current study showed that pretreatment with sodium hydroxide is an effective method for producing ethanol from rice straw and yeast strain S. cerevisiae having greater fermentative potential for bioethanol production than bacterial strain Z. mobilis.

The rapid vegetation line shift in response to glacial dynamics and climate variability in Himalaya between 2000 and 2014.

Climate change is causing glaciers to retreat across much of the Himalaya, leading to a rapid shift of the vegetation cover to higher altitudes. However, the rate of vegetation shift with respect to glacier retreat, climate change, and topographic parameters is not empirically quantified. Using remote sensing measurements, we estimate (a) the rate of glacier-ice mass loss, (b) the upward vegetation line shift rate, (c) regional greening trends, and (d) a relationship between the factors influencing the greenness of the landscape and vegetation change in the Himalaya. We find that the glacier mass loss rate is 10.9 ± 1.2 Gt/yr and the mean vegetation line shifts upward in altitude by 7-28 ± 1.5 m/yr. Considering the land use/land cover change pattern, the grassland area is found to be expanding the most, particularly in the de-glaciated regions. The vegetation change is found to be controlled by soil moisture and slope of the area.

Comparison of forest stand height interpolation of GEDI and ICESat-2 LiDAR measurements over tropical and sub-tropical forests in India.

Forests absorb atmospheric carbon and hence play a vital role in carbon sequestration and climate regulation. Recent research emphasizes developing technology and methods to understand the carbon sequestration potential in various forest ecosystems. Forest stand height estimation is one of the crucial parameters in allometry that estimates forest biomass. An attempt is made in this study to map forest stand height in tropical and sub-tropical forests in India using recently launched spaceborne LiDAR platforms Ice Cloud and Elevation Satellite (ICESat-2) and Global Ecosystem Dynamics Investigation (GEDI). A geostatistical kriging approach is used to interpolate the forest stand height, and the generated stand height surface is validated using ground truth samples. The results showed that GEDI data performed better with an RMSE of 3.99 m and 2.62 m in tropical forests than the ICESat-2 data, which showed an RMSE of 5.71 m and 5.08 m, respectively. A similar pattern was observed in sub-tropical forests where GEDI modelled stand height outperformed ICESat-2 modelled stand height. This analysis demonstrates the potential of existing spaceborne LiDAR platforms in interpolating forest stand height at different forest types. Also, the research emphasizes the necessity of a high density of LiDAR footprints spread in both across- and along-track directions for accurate interpolation of forest stand height.

Classification of glacier with supervised approaches using PolSAR data.

Glacier comprises distinct features (snow, ice, and debris cover) and their identification and classification using satellite imagery is still a challenging task. Classification of different glacier features (zones) using remote sensing data is useful for numerous environmental and societal applications. The purpose of this study is to develop the fully polarimetric SAR (PolSAR) deep neural networks classification approach for the extraction of different features of the alpine glaciers. The developed approach was tested and classification results were compared with the support vector machines-based classification over the part of two glaciers: Siachen glacier and Bara Shigri glacier. The overall accuracy (OA) of GF-DNN classification is relatively high (91.17% for Siachen and 89% for Bara Shigri) with a good kappa coefficient (0.88 for Siachen and 0.85 for Bara Shigri) as compared to SVM for both the selected glaciers. An improvement of more than 10% is achieved in the OA of GF-DNN classification as compared to SVM for both the glaciers. The obtained classified results and accuracy demonstrates the potential of deep neural networks-based glacier features classification approach for glaciated terrain features.

Ice thickness distribution of Himalayan glaciers inferred from DInSAR-based glacier surface velocity.

Retrieval of glacier ice thickness is extremely important for monitoring water resources and predicting glacier dynamics and changes. The inter-annual glacier ice thickness observations (more than 5 years) exploit the glacier mass changes. Ice thickness is one of the important parameters to predict the future sea-level rise. Without adequate knowledge and precise information of glacier ice thickness distribution, future sea-level changes cannot be accurately assessed. In this study, we use an existing flow model to estimate the ice thickness of the High Mountain Asia (HMA) glaciers, using remote sensing techniques. The glacier ice velocity is one of the significant parameters in the Laminar flow model to retrieve the ice thickness. The glacier ice velocity is derived by utilizing the Differential SAR Interferometry (DInSAR) technique. The most optimum DInSAR data (ALOS-2/PALSAR-2) is used for estimating the ice velocity of the HMA glaciers. The ice thickness is mainly estimated for five different states in the HMA region, namely Himachal Pradesh, Uttarakhand, Sikkim, Bhutan, and Arunachal Pradesh. Most of the states are observed with a mean ice thickness of 100 m. Five benchmark glaciers (Samudra Tapu, Bara Shigri, Chhota Shigri, Sakchum, and Gangotri glaciers) are also selected for validating our results with the existing thickness information. The issues related to velocity-based ice thickness inversion are also emphasized in this study. The high-velocity rate due to the influx of melting water from adjacent glaciers causes an increment in the flow rate. This abnormal velocity derives erroneous ice thickness measurements. This is one of the major problems to be considered in the velocity-based thickness-derived procedures. Finally, the investigation suggests the inclusion of the velocity influencing parameters in the physical-based models for an accurate ice thickness inversion.

Integration of C-band SAR and high-resolution optical images for delineating palaeo-channels in Nagaur and Barmer districts, western Rajasthan, India.

Identifying hitherto unknown palaeo-channels, especially in the arid regions of the Thar Desert, is crucial since these channels may form excellent aquifers, and are also associated with valuable ore deposits of many precious minerals. This study employed integrated C-band Synthetic Aperture Radar (SAR) of Sentinel-1A and high-resolution multispectral Sentinel-2A data of pre- and post-monsoon seasons (June and November) to delineate playas and palaeo-channels. This approach is the first of its kind for this area. The palaeo-channels were delineated through a detailed visual inspection of colour composite (CC) images of Sentinel-2A data, SAR backscatter (VH) images and fused SAR and optical images. Then, we studied the topographic profiles generated from the Shuttle Radar Topography Mission - Digital Elevation Model (SRTM-DEM) across the identified palaeo-channels, Normalized Difference Vegetation Index (NDVI) and Normalized Difference Water Index (NDWI) to further confirm the existence of a palaeo-channel's course and playas. As a result, several playas and palaeo-channels in the area were successfully identified, some of which were previously unmapped and undetected. The results indicate that the post-monsoon datasets are more useful for the precise delineation of palaeo-channels due to the presence of relatively higher moisture along the palaeo-channels' courses.

Cross Talk Between Renal Transporters and Polycystin-1 as a Potential Molecular Target Involved in Autosomal Dominant Polycystic Kidney Disease.

INTRODUCTION: The mutational changes in Polycystin-1(PC-1) encoded by PKD1 gene is the main cause of Autosomal Dominant Polycystic kidney disease (ADPKD). The pathological changes in renal epithelial cells and multiple cyst formation occur due to activation of cascade of signalling pathways and membrane renal transporters (RTs). Our study have focused on the identification, of different RTs, their interactions with Polycystin-1 and other selected target proteins to find out their role in pathogenesis. METHODS: In this study, various RTs protein sequences were identified and retrieved from NCBI's GenBank and UniProt. RTs were categorized according to different nephronal segmenta as per their functional information retrieved from UniProt and Transpoter databases. Further, sequences were subjected for interaction network analysis in String database and Cytoscape 3.7.2. Different interactions including experimentally validated were identified and can be further validated through in vivo methods. RESULTS: The cross talk between different RT, Polycystin-1 and other sequences were analysed. The various pathways of the interaction with PC-1 were categorised. The total number of 119 nodes and 769 edges interactions were generated. The results were visualized and cross verified with other databases in cytoscape. CONCLUSION: The cross signalling of PKD1 with SCNN1A, SCNN1G, SLC12A1, AVPR2 shows their importance in the cyst formation and in pathogenesis of ADPKD.

Water quality restoration by harvesting mixed culture microalgae using Moringa oleifera.

Excessive growth of microalgae due to use of fertilizers, detergents, and discharge of domestic waste results in the eutrophication and degradation of the water quality of lakes and ponds. The present study aimed to improve the quality of pond water by harvesting mixed cultures of microalgae grown in a pond using Moringa oleifera (MO) extract as a coagulant. The study comprises evaluating the effects of coagulant dose, pH, mixing time, mixing rate, settling time, temperature, and algal biomass concentration on nutrient and microalgae cell removal. The pond water quality restoration was assessed by characterization of raw and MO-treated water. The MO was found to be very effective for mixed culture microalgae harvesting with flocculation efficiency of 92.97% at dose of 15 ml/L of MO extract, pH 8, mixing time 5 min, mixing rate 30 rpm, and 20-min settling time. The results have shown significant improvement in pond water quality with reduction in turbidity from 388.16 ± 48.23 to 8.39 ± 1.0 NTU, chlorophyll-a from 635.01 ± 86.20 to 15.03 ± 1.5 mg/m3 , total nitrogen (TN) from 20.37 ± 4.64 to 12.10 ± 1.19 mg/L, and total phosphorus (TP) from 2.05 ± 0.10 to 1.61 ± 0.24 mg/L. PRACTITIONER POINTS: Production of biomass and water quality improvement of the pond at the same time MO extract shows better removal efficiency at a lower dose with fast kinetics Cost-effective flocculant saves time and energy during flocculation Common bioflocculant to remove both microalgae and nutrients.

Author Correction: Spatial distribution of decadal ice-thickness change and glacier stored water loss in the Upper Ganga basin, India during 2000-2014.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Spatial distribution of decadal ice-thickness change and glacier stored water loss in the Upper Ganga basin, India during 2000-2014.

Himalayan glaciers have long been the focus of glaciologists across the world while trying to understand the contrasting patterns of elevation and mass changes. However, with limited number of ground observations, a comprehensive assessment of mass balance on a regional scale still remains elusive. Using the synoptic coverage of remote sensing data, we estimate a detailed spatial variation of glacier ice thickness change in the Central Himalaya of Uttarakhand using geodetic method, on a catchment scale. High resolution TerraSAR-X/TanDEM-X (12 m) and SRTM (30 m) digital elevation models (DEMs) have been utilized. The mean elevation change in the catchments is found to be -9.56 ± 0.2 m (mean annual elevation change rate is -0.68 ± 0.01 m a-1). To highlight the water potential of this region, the total ice mass loss has been estimated to be 16.0 ± 1.2 Gigatonne (Gt) from 2000-2014 from eight identified catchments namely Yamunotri, Bhagirathi, Mandakini, Alaknanda, Dhauliganga, Pindar, Goriganga and Kali/Sarda. The estimated mass balance has been validated using reported observations on five selective glaciers and the coefficient of determination is 0.93. This spatial variation of ice thickness estimated in the eight catchments is critical, as the melt-water from these glaciers contribute to the upper Ganga basin.

Microalgae harvesting techniques: A review.

Microalgae with wide range of commercial applications have attracted a lot of attention of the researchers in the last few decades. However, microalgae utilization is not economically sustainable due to high cost of harvesting. A wide range of solid - liquid separation techniques are available for microalgae harvesting. The techniques include coagulation and flocculation, flotation, centrifugation and filtration or a combination of various techniques. Despite the importance of harvesting to the economics and energy balance, there is no universal harvesting technique for microalgae. Therefore, this review focuses on assessing technical, economical and application potential of various harvesting techniques so as to allow selection of an appropriate technology for cost effectively harvesting of microalgae from their culture medium. Various harvesting and concentrating techniques of microalgae were reviewed to suggest order of suitability of the techniques for four main microalgae applications i.e biofuel, human and animal food, high valued products, and water quality restoration. For deciding the order of suitability, a comparative analysis of various harvesting techniques based on the six common criterions (i.e biomass quality, cost, biomass quantity, processing time, species specific and toxicity) has been done. Based on the order of various techniques vis-a-vis various criteria and preferred order of criteria for various applications, order of suitability of harvesting techniques for various applications has been decided. Among various harvesting techniques, coagulation and flocculation, centrifugation and filtration were found to be most suitable for considered applications. These techniques may be used alone or in combination for increasing the harvesting efficiency.

Identification of forest cutting in managed forest of Haldwani, India using ALOS-2/PALSAR-2 SAR data.

Large-scale forest clear-cut identification is one of the major application of remote sensing techniques. ALOS-2/PALSAR-2 is the latest SAR satellite providing multi-polarized L-band SAR data. With increasing deforestation, it is important to assess the potential of SAR data for identifying clear-cuts in forest regions. In this research work, multi-temporal ALOS-2/PALSAR-2 SAR data and supplementary Landsat-8 optical data sets are acquired over Indian tropical forest, and SAR parameters are analysed over a progressively clear-cut Teak plantation. Sensitivity of the SAR parameters to progressive clear-cuts is estimated and found that the cross-polarized backscatter σHV0 and entropy parameter H are most sensitive to both partial and complete clear-cut in forest compartments. An entropy thresholding based classification is carried out to identify clear-cut regions with a good accuracy. The study highlights the utility of SAR parameters to monitor forest clear-cuts for better forest management.

Parametric Optimization of Cultural Conditions for Carboxymethyl Cellulase Production Using Pretreated Rice Straw by Bacillus sp. 313SI under Stationary and Shaking Conditions.

Carboxymethyl cellulase (CMCase) provides a key opportunity for achieving tremendous benefits of utilizing rice straw as cellulosic biomass. Out of total 80 microbial isolates from different ecological niches one bacterial strain, identified as Bacillus sp. 313SI, was selected for CMCase production under stationary as well as shaking conditions of growth. During two-stage pretreatment, rice straw was first treated with 0.5 M KOH to remove lignin followed by treatment with 0.1 N H2SO4 for removal of hemicellulose. The maximum carboxymethyl cellulase activity of 3.08 U/mL was obtained using 1% (w/v) pretreated rice straw with 1% (v/v) inoculum, pH 8.0 at 35°C after 60 h of growth under stationary conditions, while the same was obtained as 4.15 U/mL using 0.75% (w/v) pretreated substrate with 0.4% (v/v) inoculum, pH 8.0 at 30°C, under shaking conditions of growth for 48 h. For maximum titre of CMCase carboxymethyl cellulose was optimized as the best carbon source under both cultural conditions while ammonium sulphate and ammonium nitrate were optimized as the best nitrogen sources under stationary and shaking conditions, respectively. The present study provides the useful data about the optimized conditions for CMCase production by Bacillus sp. 313SI from pretreated rice straw.

Isolation and screening of polyhydroxyalkanoates producing bacteria from pulp, paper, and cardboard industry wastes.

Background. Polyhydroxyalkanoates (PHAs) are storage materials that accumulate by various bacteria as energy and carbon reserve materials. They are biodegradable, environmentally friendly, and also biocompatible bioplastics. Unlike petrochemical-based plastics that take several decades to fully degrade, PHAs can be completely degraded within a year by variety of microorganisms into CO2 and water. In the present study, we aim to utilize pulp, paper, and cardboard industry sludge and waste water for the isolation and screening of polyhydroxyalkanoates (PHAs) accumulating bacteria and production of cost-effective PHB using cardboard industry waste water. Results. A total of 42 isolates showed black-blue coloration when stained with Sudan black B, a preliminary screening agent for lipophilic compounds, and a total of 15 isolates showed positive result with Nile blue A staining, a more specific dye for PHA granules. The isolates NAP11 and NAC1 showed maximum PHA production 79.27% and 77.63% with polymer concentration of 5.236 g/L and 4.042 g/L with cardboard industry waste water. Both of the selected isolates, NAP11 and NAC1, were classified up to genus level by studying their morphological and biochemical characteristics and were found to be Enterococcus sp., Brevundimonas sp. and, respectively. Conclusion. The isolates Enterococcus sp. NAP11 and Brevundimonas sp. NAC1 can be considered as good candidates for industrial production of PHB from cardboard industry waste water. We are reporting for the first time the use of cardboard industry waste water as a cultivation medium for the PHB production.

Poly ß-hydroxybutyrate production by Bacillus subtilis NG220 using sugar industry waste water.

The production of poly ß-hydroxybutyrate (PHB) by Bacillus subtilis NG220 was observed utilizing the sugar industry waste water supplemented with various carbon and nitrogen sources. At a growth rate of 0.14 g h(-1) L(-1), using sugar industry waste water was supplemented with maltose (1% w/v) and ammonium sulphate (1% w/v); the isolate produced 5.297 g/L of poly ß-hydroxybutyrate accumulating 51.8% (w/w) of biomass. The chemical nature of the polymer was confirmed with nuclear magnetic resonance, Fourier transform infrared, and GC-MS spectroscopy whereas thermal properties were monitored with differential scanning calorimetry. In biodegradability study, when PHB film of the polymer (made by traditional solvent casting technique) was subjected to degradation in various natural habitats like soil, compost, and industrial sludge, it was completely degraded after 30 days in the compost having 25% (w/w) moisture. So, the present study gives insight into dual benefits of conversion of a waste material into value added product, PHB, and waste management.

A public health perspective of women's experiences of antenatal care: an exploration of insights from a community consultation.

OBJECTIVES: to offer a critical discussion from a public health perspective of service user's experiences of antenatal care services. DESIGN: a qualitative, descriptive study using 18 group (n = 86) and six individual semi-structured interviews (n = 6) with thematic networks analysis conducted. SETTING: ninety-two participants recruited from organisations/groups who work with vulnerable populations and/or community groups were consulted in the North West of England. FINDINGS: analysis from a public health perspective suggested four key areas: antenatal care attendance, the frequency of antenatal appointments, the location of antenatal care and the provision of risk information. The benefits of universal access to antenatal care were mainly evident to participants. The need for targeting those with identified clinical risk was valued, but participants expressed frustration at a 'one-size fits all' approach for others, which failed to adequately consider their psychosocial and educational needs. In some women, this failure prompted non-compliant behaviour. Concerns were somewhat compensated for by community-based antenatal services. CONCLUSIONS AND RECOMMENDATIONS: inequities in antenatal care persist with service users from vulnerable population groups continuing to express that these services do not meet their needs. Neither a targeted approach based on clinical needs nor a population-based approach, which service users feel limits access, meet their expectations. Proportionate universalism offers a new paradigm in public health with level of service proportionate to need. Such an approach may facilitate health-care staff to meet the expectations of vulnerable families who may require more psychosocial and educational support.