Response of the Christchurch groundwater system to exploitation: Carbon-14 and tritium study revisited.

The Christchurch groundwater system is an exceptional water resource with very high drinking water quality supplying all the water requirements of the city. The groundwater system has changed over the years because of rising groundwater abstraction due to increasing population and development. The present (2017) data revealed slightly older 14C ages and increasingly steep west-east age gradients compared to the earlier work from 1976 to 2006, showing continued upflow of deep water into the exploited aquifers which is much older on the east (coastal) side than on the west (inland) side. In addition, the 3H ages for wells on the west side of the system are often much younger than their 14C ages showing that there is input of young shallow water to the wells in addition to the deep water input. Application of a binary model identifies the ages and amounts of the two components, showing that the young component is becoming younger although smaller as a proportion of the flow, and the old component from depth is becoming larger. Newly completed wells near the Waimakariri River have allowed identification of the young component, which is almost entirely composed of very young Waimakariri River seepage at all depths and therefore has very little chemical loading. Instead any chemical input (e.g. chloride, nitrate) to the Christchurch aquifers is being brought in by the old deep component which on the western side of the Christchurch system is derived from rainfall recharge on the developing Ashley-Waimakariri Plains area (plus river seepage). Chemical traces of this deep input from the northwest are at present very subtle, although more appreciable signals are seen in some wells further to the north of Christchurch. In the future, slowly increasing chemical input to the Christchurch aquifers on the west side of the system is to be expected as abstraction increases.

Evaluating anthropogenic and environmental tritium effects using precipitation and Hokkaido snowpack at selected coastal locations in Asia.

Tritium dating requires a good understanding of the tritium and water inputs into hydrologic systems, including their main trends due to latitudinal, seasonal and altitudinal effects. Although tritium reached ambient levels at the end of the 20th century, tritium released from nuclear facilities and bomb tests since then has the potential to confound use of tritium for age dating. We therefore collected precipitation and snowpack samples for tritium analysis to confirm that tritium levels in Japanese precipitation had not exceeded ambient levels following the North Korean nuclear tests in January 6th 2016 and September 3rd 2017. As the result, the highest tritium concentration was 5.52(±0.27)TU at samples collected from January 8 to 11th at one Honshu and four Hokkaido locations and samples collected at six Honshu locations had 8.01(±1.5)TU from September 6 to 19th 2017. Confirming ambient tritium concentrations after both events we investigated the latitude tritium effect at selected coastal stations in Asia, indicating a break of latitude trend around Tokyo area, and established the latitude scaling factors to the north and south of the Tokyo area data. The seasonal trend was investigated during the winter-spring 2016 in precipitation samples confirming the higher spring tritium compared with winter continental tritium values. The altitude effect on tritium and stable (18O and 2H) isotopes was observed in Hokkaido snowpack, which had tritium concentrations ranging between 4.08 and 5.93 TU during March-April, and demonstrated two trends for western and central Hokkaido mountain ranges. Using established latitude and altitude scaling factors with the long-term continuous time-series of monthly Tokyo area tritium we estimated the annual weighted tritium at 110 meteorological stations in Japan with monthly precipitation demonstrating the applicability of this approach for future tritium-tracer studies across Asia.

Evaluation of long-term surgical site occurrences in ventral hernia repair: implications of preoperative site independent MRSA infection.

PURPOSE: Previous work demonstrated that prior MRSA infection [MRSA(+)] is associated with 30-day surgical site infection (SSI) following ventral hernia repair (VHR). We aimed to determine the impact of MRSA(+) on long-term wound outcomes after VHR. PARTICIPANTS: A retrospective cohort study was performed at a tertiary center between July 11, 2005, and May 18, 2012, of patients undergoing elective VHR with class I wounds. Patients with documented preoperative MRSA infection at any site (urinary, bloodstream, SSI, etc.) were considered MRSA(+). Primary outcome was 2-year surgical site occurrence (SSO), defined as SSI, cellulitis, necrosis, nonhealing wound, seroma, hematoma, dehiscence, or fistula. SSOs were subdivided into those that required procedural intervention (SSOPI) and those that did not. RESULTS: Among 632 patients, 46 % were female with average age 53 ± 13 years. There were 368 SSOs in 193 patients (31 %); an SSOPI occurred in 9.8 % (n = 62). The most common SSOs were cellulitis (91/632), seroma (91/632), and serous drainage (58/632). The rate of 2-year SSO was higher with MRSA(+) compared to those without (46 vs. 29 %, p = 0.023), attributed to increased soft tissue necrosis, purulent drainage, serous drainage, cellulitis, and fistula. In multivariable analysis, MRSA(+) was not associated with 2-year SSO (HR 1.5, 95 % CI 0.91-2.55, p = 0.113); factors associated with SSO included obesity, immunosuppression, mesh repair, and operative times. CONCLUSIONS: This study is the first to evaluate long-term SSOs and SSOPIs after VHR, highlighting the importance of long-term follow-up. Though not independently associated with SSOs, MRSA(+) may be a marker of hernia complexity.

Mott physics near the insulator-to-metal transition in NdNiO3.

An optical study of NdNiO(3) ultrathin films with insulating and metallic ground states reveals new aspects of the insulator-to-metal transition that point to Mott physics as the driving force. In contrast with the behavior of charge-ordered systems, we find that the emergence of the Drude resonance across the transition is linked to a spectral weight transfer over an energy range of the order of the Coulomb repulsion U, as the energy gap is filled with states instead of closing continuously.

Cx43 suppresses mammary tumor metastasis to the lung in a Cx43 mutant mouse model of human disease.

Gap junctions, the channels formed by the connexin (Cx) family of proteins, are responsible for direct intercellular communication. Although connexins are considered as tumor suppressors, their overall role in cancer onset, progression and metastasis is somewhat controversial. This study uses a novel Cx43 mutant mouse model (G60S mice) and cross-breeding strategies to determine the role of Cx43 in all stages of breast tumorigenesis. G60S mice were cross-bred with ErbB2 overexpressing mice, and spontaneous and 7,12-dimethylbenz[α]anthracene (DMBA)-induced tumor development was evaluated. Mice were killed when tumors reached ∼1 cm(3) or when mice showed signs of critical illness. In both spontaneous and DMBA studies, onset of palpable tumors was delayed in G60S mice compared with mice in control groups. Moreover, while tumors from control mice reached the size threshold, most DMBA-exposed Cx43 mutant mice were killed prematurely because of labored breathing, independent of the presence of a palpable tumor. Reduced Cx43 levels in Cx43 mutant mice were accompanied by extensive mammary gland hyperplasia. Lung histology revealed that all Cx43 mutant mice exhibited mammaglobin-positive mammary gland metastases to the lung, and the number of metastases was increased by threefold in Cx43 mutant mice on treatment with DMBA. Thus, while reduced levels of Cx43 delayed the onset of palpable tumors, normal Cx43 levels inhibited mammary gland tumor metastasis to the lungs. Understanding the mechanisms of how Cx43, which is expressed primarily in myoepithelial cells, inhibits mammary gland tumor metastasis is critical as Cx43 is assessed as a candidate for therapeutic intervention.

Systematics of radon at the Wairakei geothermal region, New Zealand.

222Rn and 220Rn in geothermal steam at Wairakei, NZ, range from 11 to 19, 500 Bq kg-1, and 25 to 16, 700 Bq kg-1, respectively, but do not cause toxic concentrations in air. The wide ranges are mainly due to differences in different physical conditions underground (e.g. thin silica diffusion barriers), not geochemical differences. Groundwater Rn from outside the area probably plays only a minor role. 210Po was found present in non-toxic levels in the steam. Historical records showed little change in Rn concentration over several decades, therefore potentially hazardous concentrations might be predicted from early exploration. 220Rn concentrations at Wairakei should decrease as the field becomes steam-dominated. Rock surfaces were variably leached or enriched with U, Th, Ra and 210Pb, providing a possible model for deposition in cooler regions near the field. Estimates of 222Rn permeability ranged from 2 to 77% of the maximum possible, with a median of 13%.

Physicians play important role in families' long-term care decisions. Choice of home care vs. nursing home.

Physicians are often involved in decisions about long-term care for the elderly and adults with disabilities. In Arkansas, some home and community-based services (HCBS) have been established for these Medicaid-eligible populations, as a nursing home alternative, but some are under-utilized. Unnecessary use of nursing home care burdens the state Medicaid budget. A recent study on service utilization suggests that physicians' lack of knowledge about HCBS may be a factor in their under-utilization. A number of programs that enable individuals to remain in their homes in Arkansas, including ElderChoices, Alternatives, the Developmental Disabilities Waiver and the Assisted Living Waiver are described.

Issues in measuring maternal morbidity: lessons from the Philippines Safe Motherhood Survey Project.

This report explores the limitations of survey research for obtaining population-based data to define the magnitude of maternal morbidity in settings that lack a well-developed infrastructure to support women's health requirements. The experience gained in the Philippines Safe Motherhood Survey Project is described. The drawbacks and benefits of the preliminary validation and qualitative phase of research conducted to develop the questionnaire are presented. The survey results indicate that interview-based diagnosis, although it implies the commitment of considerable resources, may be the only way to obtain an idea of the prevalence of some kinds of maternal morbidity in a given population, information necessary to the improvement of obstetric care and women's overall health status.

PIP: The major goal of the 1993 Philippines Safe Motherhood Survey (SMS) was to determine the prevalence of key obstetric complications and to describe related patterns of health service use. Validation and qualitative research helped in development of the final SMS questionnaire. The SMS was one of few studies that have tried to provide population-based data on specific issues of maternal health. There are no standard and accepted data collection techniques for maternal health as there are for the study of fertility and child health. Validation studies help quantify the sensitivity and specificity of interview questions about selected symptoms of obstetric complications, while qualitative research provides insight into women's own perceptions about their experiences as well as some of the sociocultural issues influencing their reports. The findings from these preliminary studies and the SMS suggest that interview-based diagnosis of obstetric complications is the only method of obtaining any indication of how prevalent maternal morbidity is among women within a population. Interviews do require considerable resources, however. For example, in the Philippines, 4-5 months of intensive activity took place before implementation of the standard pretest, interviewer training, and survey fieldwork. This intensive activity involved an epidemiologist and a social scientist with qualitative research skills, both of whom might not normally participate in a Demographic and Health Survey-type survey. Yet this information is needed to improve obstetric care and women's overall health status.

Validation study of women's reporting and recall of major obstetric complications treated at the Philippine General Hospital.

In settings where most births occur at home, collection of data on complications experienced around the time of delivery is often dependent on self-reported data, collected through individual interviews. This paper describes a study designed to validate interview data on obstetric complications by comparing women's responses with data extracted from their medical records. The major complications of hemorrhage, dystocia, sepsis, and eclampsia were the main focus of the study. The sample was drawn from women hospitalized for delivery in a Manila hospital within the past 4 years. The main goal of the study was to assist in development of a survey instrument to be used in a national sample survey of women in the Philippines. The best sensitivity and specificity, respectively, for combinations of questions on these four conditions were: for hemorrhage, 0.70 and 0.78; for dystocia, 0.69 and 0.97; for sepsis, 0.89 and 0.83; and for eclampsia, 0.44 and 0.96. There were no significant differences in the duration of the recall periods according to diagnosis.

Program- and method-related determinants of first DMPA use duration in rural Bangladesh.

This article examines the determinants of first-time use durations of the injectable contraceptive Depo Medroxy Progesterone Acetate (DMPA) for rural Bangladeshi women. The method's side effects were defined by 200 first-time users in Matlab district during lengthy, open-ended interviews. Women with many children used the method longer than did women of low parity. Those who experienced side effects had shorter use durations than those who did not, and those who cited heavy bleeding as their main problem discontinued use soonest. Women whose husbands approved of family planning had significantly longer use durations than those whose husbands disapproved. Respondents who adopted DMPA because of perceived positive aspects of the drug used it longer than those who chose it for other reasons. Results of the study underscore the importance of viewing side effects in a specific social and cultural context. Expanded side-effects counseling for women and their husbands is needed.

PIP: During March-May 1990, in-depth interviews were conducted with 200 women who first accepted the injectable contraceptive depo-medroxyprogesterone acetate (DMPA) between July and August 1988 from the Maternal and Child Health and Family Planning program of the International Centre for Diarrhoeal Disease Research, Bangladesh in the rural Matlab district. The researchers analyzed the data to examine the determinants of first-time use durations of DMPA. 90% of the women chose DMPA because of negative experiences or fears of such experiences with other methods. Women who reported bleeding and nonbleeding side effects were more likely to have shorter use durations than those who reported no side effects (rate ratio [RR] = 1.83 and 3.07, respectively). Women who had heavy bleeding had the shortest use duration (median, 9 vs. 20 months for no problems). Amenorrhea was rarely considered to be the most significant problem linked to DMPA use. Women who chose DMPA because of its perceived positive aspects were more likely to have longer use duration than those who did not choose it for its positive aspects (RR = 0.38). Women who chose DMPA based on the community health worker's advise were more likely to have shorter use durations than those who did not choose it based on their advice (RR = 2.48). Women whose husbands approved of family planning were more likely to have longer use duration than those whose husbands did not approve (RR = 0.72). Multiparous women used DMPA longer than did those with less than 3 children (RR = 0.56 for 3-5 children and 0.36 for =or 6 children). These findings emphasize the importance of considering side effects in a social and cultural context to determine why they are important to women and which side effects are perceived as problematic and which are not. They also show the need to improve pre-use counseling and side effect management and to seek the support of husbands towards family planning.

Acute respiratory infections (ARI) in rural Bangladesh: perceptions and practices.

Acute Respiratory Infections (ARI) are a major cause of death in children under five in rural Bangladesh. A popular strategy for lowering ARI mortality in such settings includes detecting and managing pneumonia in children at the community level. The success of programs using this approach requires a well-trained community-based cadre of health workers and the appropriate utilization of services provided. Determinants of health care seeking behavior are clearly of interest in this regard. A qualitative study was conducted in Matlab, Bangladesh to describe community perceptions of signs and symptoms of ARI, case management behavior, and constraints to service utilization. Mothers recognized pneumonia and thought it to be caused by "exposure to cold." They were able to identify labored breathing, chest retractions, lethargy, and inability to feed as signs of severe disease needing treatment outside the home. Nevertheless, similar illnesses were sometimes believed to be due to attack by evil influences. In these cases, spiritual healers were sought and allopathic treatment was avoided or delayed. The mothers' observance of purdah and "proper" behavior were reported to play a role in prevention of child death from disease. Implications of this belief and its impact on service utilization are discussed. Suggestions for program managers are made in addition to recommendations for further research.

PIP: 20 case history interviews with mothers of children younger than 5 and 12 focus groups with young and older mothers, mothers-in-law (grandmothers), traditional birth attendants, spiritual healers, and untrained or semitrained allopaths (village doctors) were conducted in the Matlab in Bangladesh. The qualitative research aimed to examine obstacles to service utilization and community beliefs and practices regarding acute respiratory infections (ARIs) in a rural community where an ARI control project operates. Severe signs and symptoms were more likely to upset mothers than grandmothers. Signs that mothers recognized as severe enough to seek treatment outside the home were labored breathing, chest retractions, lethargy, and inability to feed. Mothers believed that exposure to cold was responsible for pneumonia. Yet, they often thought that an attack by evil influences caused similar illnesses. They refrained from or delayed taking their children with an evil-induced illness for allopathic treatment. Instead, they would seek the services of spiritual healers. Previous experience with a successfully treated case of pneumonia (caused by exposure to cold) was the factor most strongly associated with the decision to seek allopathic treatment. The most common external constraint to bringing children to the Matlab hospital was no one at home to do household work, particularly care for other children. Internal constraints included reluctance to violate purdah and fear of traveling alone. Mothers thought that adhering to purdah kept disease attacks from their children. Mother-blaming attitudes were prevalent, which had a negative effect on mothers' ability to obtain appropriate treatment for ill children.

Impact on mortality of a community-based programme to control acute lower respiratory tract infections.

Acute lower respiratory tract infections (ALRIs) are a major cause of death among young children in developing countries. A targeted programme designed to treat children with ALRI was implemented in 1988 in a primary health care project in rural Bangladesh. In the 2 years preceding the introduction of the programme (1986-87), non-ALRI-specific health services were provided, including promotion of oral rehydration therapy, family planning, immunization of children and mothers, distribution of vitamin A, referral of severely sick children to field clinics, and nutritional rehabilitation of malnourished children. The targeted ALRI programme, which was in place in 1988-89, was based on systematic ALRI case detection and management by community health workers, who were linked to a referral system for medical support. These two levels of intervention have been evaluated by comparing the ALRI-specific mortality in the programme area and a neighbouring control area during the two periods. During the first phase (1986-87), the ALRI mortality among under-5-year-olds was 28% lower in the intervention than in the comparison area (P less than 0.01). During the second phase (1988-89), the ALRI mortality was 32% lower in the intervention area than during the preceding phase, while there was no significant difference for the comparison area. These findings suggest that in the study region the combination of specific and nonspecific interventions can reduce ALRI mortality by as much as 50% and the overall mortality among under-5-year-olds by as much as 30%.

Ventilatory and gas exchange dynamics in response to head-down tilt with and without venous occlusion.

The purpose of these experiments was to examine ventilatory and gas exchange responses to acute head-down tilt. Subjects (N = 5) participated in two series of head-down tilt experiments. Both experimental protocols involved movement from a near-vertical position (120 degrees) to a -30 degrees head-down position. One set of experiments employed venous occlusion (VO) in the legs during the first 30 s of tilt, while the second set was performed without occlusion (control experiment). Oxygen uptake (VO2), carbon dioxide output (VCO2) and expired ventilation (VE) increased significantly (p less than 0.05) above vertical values in both experimental conditions during the first 75 s following tilt. Further, VO2, VCO2, and VE were greater (p less than 0.05) during the VO experiment compared to control immediately following removal of venous occlusion. Although end-tidal CO2 tension (PETCO2) tended to increase following tilt, mean PETCO2 averaged over 15-s periods remained unaltered (p greater than 0.05) during tilt in both experimental protocols compared to the vertical position. These data demonstrate that acute head-down tilt results in an increase in VE and the general maintenance of isocapnia.