Experiences of women, men and healthcare workers accessing family planning services in Malawi: A grounded theory.

BACKGROUND: The importance of modern contraceptive methods in averting unwanted pregnancies has been acknowledged in Malawi. Currently, the country has registered the highest rates of unsafe abortions, unmet needs for contraception and a low contraceptive prevalence rate. Understanding why these rates exist is important. However, women's views and experiences regarding uptake of family planning methods in Malawi have not been explored. METHODS: A grounded theory methodology was used. Data were gathered through in-depth interviews with women (n = 18), men (n = 10), healthcare workers (n = 10) and non-participant observations of family planning clinic consultations (n = 10). Data were analysed using constant comparative technique. Methods of open, axial and selective coding enabled subsequent conceptualisations until theoretical saturation occurred. RESULTS: The core category 'disenabling environment prevents women's family planning needs from being met' provides an understanding of women's, men's and healthcare workers' experiences of contraceptive use and non-use. The disenabling environment contributed to shaping women's family planning experiences. This was supported by three main categories: navigating the processes, disempowerment of women and learning by chance. CONCLUSION: Findings from this study illuminate contextual issues into how women, men and healthcare workers experience family planning use and non-use in Malawi. A multifaceted strategy is required to support a woman's family planning needs. At community level, awareness and education of family planning methods is required to actively inform all people in society so that they support a woman's family planning needs. At national level, laws that would empower women with decision-making ought to be developed and enforced.

On the distance to the North Polar Spur and the local CO-H2 factor.

AIMS: Most models identify the X-ray bright North Polar Spur (NPS) with a hot interstellar (IS) bubble in the Sco-Cen star-forming region at ≃130 pc. An opposite view considers the NPS as a distant structure associated with Galactic nuclear outflows. Constraints on the NPS distance can be obtained by comparing the foreground IS gas column inferred from X-ray absorption to the distribution of gas and dust along the line of sight. Absorbing columns towards shadowing molecular clouds simultaneously constrain the CO-H2 conversion factor. METHODS: We derived the columns of X-ray absorbing matter N Habs from spectral fitting of dedicated XMM-Newton observations towards the NPS southern terminus (l II ≃ 29°, b II ≃ +5 to +11°). The distribution of the IS matter was obtained from absorption lines in stellar spectra, 3D dust maps and emission data, including high spatial resolution CO measurements recorded for this purpose. RESULTS: N Habs varies from ≃ 4.3 to ≃ 1.3 × 1021 cm-2 along the 19 fields. Relationships between X-ray brightness, absorbing column and hardness ratio demonstrate a brightness decrease with latitude governed by increasing absorption. The comparison with absorption data, local and large-scale dust maps rules out a NPS near side closer than 300 pc. The correlation between N Habs and the reddening increases with the sightline length from 300 pc to 4 kpc and is the tightest with Planck τ 353GHz -based reddening, suggesting a much larger distance. N(H)/E(B-V) τ ≃ 4.1 × 1021 cm-2 mag-1, close to Fermi-Planck determinations. N Habs absolute values are compatible with HI-CO clouds at -5 ≤ V LSR ≤ +25 to +45 km s-1 and a NPS potentially far beyond the Local Arm. A shadow cast by a b=+9° molecular cloud constrains X CO in that direction to ≤ 1.0 × 1020 cm-2 K-1 km-1 s. The average X CO over the fields is ≤ 0.75 × 1020 cm-2 K-1 km-1 s.

First detection of ethylphenidate in human fatalities after ethylphenidate intake.

Methylphenidate, a psychostimulant drug from the group of amphetamines is, among others, established in the treatment of attention deficit hyperactivity disorder and narcolepsy. It is also known to have a certain potential of abuse. In combination with alcohol, the metabolite ethylphenidate was detected in human plasma in small amounts. However, ethylphenidate is sold as "research chemical" via the Internet. It was put under German narcotics law in July 2013. In a recent case, where a deceased person was found in his apartment, the police seized a plastic bag with the inscription "ethylphenidate". An autopsy of the 32-year-old man yielded a mitral valve endocarditis, which must have persisted a while before death, in combination with a pneumonia. At the Forensic Toxicological Centre (FTC) in Munich femoral blood, liver, pericardium fluid, urine, stomach content and hair of the deceased were analyzed for ethylphenidate after sample preparation by an LC-Triple TOF 5600. Calibration curves were spiked with a methanolic 1mg/mL solution of ethylphenidate (substance provided by the State Office of Criminal Investigation in Munich) in whole blood in comparison to liver and femoral blood, in serum in comparison to pericardium fluid and in urine in comparison to urine and stomach content, respectively. Ethylphenidate was detected in all analyzed matrices. The spectrums of the human specimen were compared to those obtained from the calibration curves and identified as ethylphenidate. The measured concentrations were for femoral blood 110ng/mL, for liver 180ng/g, for pericardium fluid 131ng/mL, for urine 987ng/mL and for stomach content 20.7ng/mL, respectively. The stomach contained 200mL of a brownish-coloured liquid, resulting in a total amount of 4000ng ethylphenidate. The lowest calibrator for whole blood and serum was 1ng/mL and for urine 10ng/mL. As far as it is known to the authors, these are the first ethylphenidate levels measured in a case of ethylphenidate intake. Therefore these results can only be compared to methylphenidate concentrations with therapeutic levels ranging from 5 to 60ng/mL in serum. As the toxic levels for methylphenidate start from approximately 500ng/mL serum, we estimate that ethylphenidate in the concentrations mentioned above is not in a directly lethal range. But it has to be considered, that amphetamine-like drugs as methylphenidate are known for their cardiovascular side effects (like tachycardia and arrhythmia) and might therefore have contributed to death, which was attributed to endocarditis in combination with pneumonia.

Hepatic carnitine palmitoyltransferase I deficiency: acylcarnitine profiles in blood spots are highly specific.

BACKGROUND: In carnitine palmitoyltransferase I (CPT-I) deficiency (MIM 255120), free carnitine can be increased with no pathologic acylcarnitine species detectable. As inclusion of CPT-I deficiency in high-risk and newborn screening could prevent potentially life-threatening complications, we tested whether CPT-I deficiency might be diagnosed by electrospray ionization-tandem mass spectrometry (ESI-MS/MS). METHODS: A 3.2-mm spot of whole blood dried on filter paper was extracted with 150 microL of methanol. After derivatization of carnitine and acylcarnitines to their butyl esters, the samples were analyzed by ESI-MS/MS with 37.5 pmol of L-[(2)H(3)]carnitine and 7.5 pmol of L-[(2)H(3)]palmitoylcarnitine as internal standards. RESULTS: In all dried-blood specimens from each of three patients with CPT-I deficiency, we found an invariably increased ratio of free carnitine to the sum of palmitoylcarnitine and stearoylcarnitine [C0/(C16 + C18)]. The ratio in patients was between 175 and 2000, or 5- to 60-fold higher than the ratio for the 99.9th centile of the normal newborn population in Bavaria (n = 177 842). No overlap with the values of children that were known to be supplemented with carnitine was detected [C0/(C16 + C18), 34 +/- 30; mean +/- SD; n = 27]. CONCLUSIONS: ESI-MS/MS provides a highly specific acylcarnitine profile from dried-blood samples. The ratio of free carnitine to the sum of palmitoylcarnitine and stearoylcarnitine [C0/(C16 + C18)] is highly specific for CPT-I deficiency and may allow presymptomatic diagnosis.

The biochemical metabolite screen in the Munich ENU Mouse Mutagenesis Project: determination of amino acids and acylcarnitines by tandem mass spectrometry.

BACKGROUND: Gene mutations often result in altered protein expression and, in turn, lead to changes in metabolite levels in one or more distinct biochemical pathways. Traditional analytical methods for metabolite determination are usually time consuming, expensive, and, thus, not suitable for high throughput analysis. However, recent developments in electrospray-tandem-mass-spectrometry allow comprehensive metabolite scanning from very small amounts of blood with high speed, cost effectiveness, and accuracy. METHODS: A blood spot from a filter paper equivalent to 3 microl of blood was punched out and transferred to a 96-well microtiter plate. After addition of a set of 14 stable isotope-labeled internal standards, amino acids and acylcarnitines were extracted with methanol. The dried residue was derivatized with butanolic hydrochloric acid and subjected to MSMS analysis. RESULTS: Acyl-carnitines were all determined by a precursor ion scan of 85 Da. Neutral loss scanning of 102 Da was suitable for the quantitation of threonine, serine, proline, histidine, alanine, aspartic acid, glutamic acid, methionine, tyrosine, phenylalanine, isoleucine/leucine and valine. Glycine was detected by a loss of a 56-Da fragment, whereas a 119-Da loss was suitable for the measurement of citrulline, ornithine, arginine, and lysine. Specific problems encountered: owing to their identical molecular weight, isoleucine and leucine could not be quantitated separately, and, owing to their instability, glutamine and asparagine were found to be decarboxylated to their respective acids. Determination was linear over the concentration range tested (20 to 1000 micromol/L), and intraassay and interassay coefficients of variation were in the range of 10-15%. CONCLUSION: ESI-MSMS proved to be a highly sensitive, linear, and sufficiently precise method for the quantitative determination of amino acids and acylcarnitines in mouse blood, allowing large-scale screening applications when speed and cost effectiveness are mandatory.