Experiences of using the toll-free telephone line to access maternal and newborn health services in central Uganda: a qualitative study.

OBJECTIVES: Save the Mothers (STM) operates the toll-free telephone line (TFL) service in nine health facilities in Uganda. The TFL is influential in addressing the first and second delays in seeking care as it connects vulnerable mothers to health facilities at no cost. This study aimed at exploring the experiences of health workers and community members in using the TFL to access maternal and newborn health services in four health facilities in central Uganda. STUDY DESIGN: This phenomenological/qualitative study used focus group discussions (FGDs) to collect data in four health facilities. METHODS: A total of 10 FGDs were conducted; two with health workers, four with women, and another four with both men and women. Each session lasted 45-60 min and had a moderator, observer, and note taker. All discussions were audio-recorded after obtaining consent from the participants. Interviews were transcribed verbatim and translated to English from audio recordings. Data analysis was performed using the thematic analysis using QDA DATA Miner software. RESULTS: The TFL service was pivotal in improving health worker and community relations, relaying timely health advice, ensuring prompt response to obstetric emergencies and facilitated timely referrals. However, the service faced several obstacles: unanswered calls, language differences, poor connectivity/network, and misuse/abuse. CONCLUSION: This study demonstrates the potential of the TFL service in addressing the first and second delay as it allows for timely linkage of vulnerable mothers to health facilities. The TFL enhanced health worker and community relations and facilitated timely referrals and relaying of health advice. Addressing maternal mortality in low-income settings necessitates increased investment and scale up of such high-impact mHealth interventions.

A novel application of remote sensing for modelling impacts of tree shading on water quality.

Uncertainty in capturing the effects of riparian tree shade for assessment of algal growth rates and water temperature hinders the predictive capability of models applied for river basin management. Using photogrammetry-derived tree canopy data, we quantified hourly shade along the River Thames (UK) and used it to estimate the reduction in the amount of direct radiation reaching the water surface. In addition we tested the suitability of freely-available LIDAR data to map ground elevation. Following removal of buildings and objects other than trees from the LIDAR dataset, results revealed considerable differences between photogrammetry- and LIDAR-derived methods in variables including mean canopy height (10.5 m and 4.0 m respectively), percentage occupancy of riparian zones by trees (45% and 16% respectively) and mid-summer fractional penetration of direct radiation (65% and 76% respectively). The generated data on daily direct radiation for 2010 were used as input to a river network water quality model (QUESTOR). Impacts of tree shading were assessed in terms of upper quartile levels, revealing substantial differences in indicators such as biochemical oxygen demand (BOD) (1.58-2.19 mg L-1 respectively) and water temperature (20.1 and 21.2 °C respectively) between 'shaded' and 'non-shaded' radiation inputs. Whilst the differences in canopy height and extent derived by the two methods are appreciable they only make small differences to water quality in the Thames. However such differences may prove more critical in smaller rivers. We highlight the importance of accurate estimation of shading in water quality modelling and recommend use of high resolution remotely sensed spatial data to characterise riparian canopies. Our paper illustrates how it is now possible to make better reach scale estimates of shade and make aggregations of these for use at river basin scale. This will allow provision of more effective guidance for riparian management programmes than currently possible. This is important to support adaptation to future warming and maintenance of water quality standards.

Combined impacts of future land-use and climate stressors on water resources and quality in groundwater and surface waterbodies of the upper Thames river basin, UK.

It is widely acknowledged that waterbodies are becoming increasingly affected by a wide range of drivers of change arising from human activity. To illustrate how this can be quantified a linked modelling approach was applied in the Thames river basin in southern UK. Changes to river flows, water temperature, river and reservoir quality were predicted under three contrasting future "storylines"; one an extension of present day rates of economic development, the others representing more extreme and less sustainable visions. Modelling revealed that lower baseflow conditions will arise under all storylines. For the less extreme storyline river water quality is likely to deteriorate but reservoir quality will improve slightly. The two more extreme futures could not be supported by current management strategies to meet water demand. To satisfy these scenarios, transfer of river water from outside the Thames river basin would be necessary. Consequently, some improvement over present day water quality in the river may be seen, and for most indicators conditions would be better than in the less extreme storyline. However, because phosphorus concentrations will rise, the invoked changes in water demand management would not be of a form suitable to prevent a marked deterioration in reservoir water quality.

Characterisation of a major phytoplankton bloom in the River Thames (UK) using flow cytometry and high performance liquid chromatography.

Recent river studies have observed rapid phytoplankton dynamics, driven by diurnal cycling and short-term responses to storm events, highlighting the need to adopt new high-frequency characterisation methods to understand these complex ecological systems. This study utilised two such analytical methods; pigment analysis by high performance liquid chromatography (HPLC) and cell counting by flow cytometry (FCM), alongside traditional chlorophyll spectrophotometry and light microscopy screening, to characterise the major phytoplankton bloom of 2015 in the River Thames, UK. All analytical techniques observed a rapid increase in chlorophyll a concentration and cell abundances from March to early June, caused primarily by a diatom bloom. Light microscopy identified a shift from pennate to centric diatoms during this period. The initial diatom bloom coincided with increased HPLC peridinin concentrations, indicating the presence of dinoflagellates which were likely to be consuming the diatom population. The diatom bloom declined rapidly in early June, coinciding with a storm event. There were low chlorophyll a concentrations (by both HPLC and spectrophotometric methods) throughout July and August, implying low biomass and phytoplankton activity. However, FCM revealed high abundances of pico-chlorophytes and cyanobacteria through July and August, showing that phytoplankton communities remain active and abundant throughout the summer period. In combination, these techniques are able to simultaneously characterise a wider range of phytoplankton groups, with greater certainty, and provide improved understanding of phytoplankton functioning (e.g. production of UV inhibiting pigments by cyanobacteria in response to high light levels) and ecological status (through examination of pigment degradation products). Combined HPLC and FCM analyses offer rapid and cost-effective characterisation of phytoplankton communities at appropriate timescales. This will allow a more-targeted use of light microscopy to capture phytoplankton peaks or to investigate periods of rapid community succession. This will lead to greater system understanding of phytoplankton succession in response to biogeochemical drivers.

Identifying multiple stressor controls on phytoplankton dynamics in the River Thames (UK) using high-frequency water quality data.

River phytoplankton blooms can pose a serious risk to water quality and the structure and function of aquatic ecosystems. Developing a greater understanding of the physical and chemical controls on the timing, magnitude and duration of blooms is essential for the effective management of phytoplankton development. Five years of weekly water quality monitoring data along the River Thames, southern England were combined with hourly chlorophyll concentration (a proxy for phytoplankton biomass), flow, temperature and daily sunlight data from the mid-Thames. Weekly chlorophyll data was of insufficient temporal resolution to identify the causes of short term variations in phytoplankton biomass. However, hourly chlorophyll data enabled identification of thresholds in water temperature (between 9 and 19°C) and flow (<30m(3)s(-1)) that explained the development of phytoplankton populations. Analysis showed that periods of high phytoplankton biomass and growth rate only occurred when these flow and temperature conditions were within these thresholds, and coincided with periods of long sunshine duration, indicating multiple stressor controls. Nutrient concentrations appeared to have no impact on the timing or magnitude of phytoplankton bloom development, but severe depletion of dissolved phosphorus and silicon during periods of high phytoplankton biomass may have contributed to some bloom collapses through nutrient limitation. This study indicates that for nutrient enriched rivers such as the Thames, manipulating residence time (through removing impoundments) and light/temperature (by increasing riparian tree shading) may offer more realistic solutions than reducing phosphorus concentrations for controlling excessive phytoplankton biomass.

An empirical investigation of climate and land-use effects on water quantity and quality in two urbanising catchments in the southern United Kingdom.

Using historical data of climate, land-use, hydrology and water quality from four catchments located in the south of England, this study identifies the impact of climate and land-use change on selected water quantity and water quality indicators. The study utilises a paired catchment approach, with two catchments that have experienced a high degree of urbanisation over the past five decades and two nearby, hydrologically similar, but undeveloped catchments. Multivariate regression models were used to assess the influence of rainfall and urbanisation on runoff (annual and seasonal), dissolved oxygen levels and temperature. Results indicate: (i) no trend in annual or seasonal rainfall totals, (ii) upward trend in runoff totals in the two urban catchments but not in the rural catchments, (iii) upward trend in dissolved oxygen and temperature in the urban catchments, but not in the rural catchments, and (iv) changes in temperature and dissolved oxygen in the urban catchments are not driven by climatic variables.

The effect of weirs on nutrient concentrations.

The removal of a weir in 1999 from the River Nidd in Yorkshire, UK, was assessed in terms of its impact on in-stream nitrate removal along a 15.8 km long stretch of river. Models of channel hydraulics and denitrification quantified the impact on an annual basis, using, as inputs, river flow, water temperature, water quality data and cross-section geometry collected both before and after the weir was removed. To remove the confounding influences of year-specific conditions, two counterfactual simulations were set up whereby the pre-removal configuration was driven by data from the post-removal period (and vice versa). Results revealed the removal of the weir to have reduced the annual fraction of the upstream nitrate load being retained along the stretch by 2.6% (i.e. 812 kg) and 1.8% (382 kg) for the years 1997 and 2000 respectively. Differences resulting from the presence or absence of the weir were most marked during low flow summer conditions.

Which offers more scope to suppress river phytoplankton blooms: reducing nutrient pollution or riparian shading?

River flow and quality data, including chlorophyll-a as a surrogate for river phytoplankton biomass, were collated for the River Ouse catchment in NE England, which according to established criteria is a largely unpolluted network. Against these data, a daily river quality model (QUESTOR) was setup and successfully tested. Following a review, a river quality classification scheme based on phytoplankton biomass was proposed. Based on climate change predictions the model indicated that a shift from present day oligotrophic/mesotrophic conditions to a mesotrophic/eutrophic system could occur by 2080. Management options were evaluated to mitigate against this predicted decline in quality. Reducing nutrient pollution was found to be less effective at suppressing phytoplankton growth than the less costly option of establishing riparian shading. In the Swale tributary, ongoing efforts to reduce phosphorus loads in sewage treatment works will only reduce peak (95th percentile) phytoplankton by 11%, whereas a reduction of 44% is possible if riparian tree cover is also implemented. Likewise, in the Ure, whilst reducing nitrate loads by curtailing agriculture in the headwaters may bring about a 10% reduction, riparian shading would instead reduce levels by 47%. Such modelling studies are somewhat limited by insufficient field data but offer a potentially very valuable tool to assess the most cost-effective methods of tackling effects of eutrophication.

A meta-analysis of the efficacy of intraperitoneal cisplatin for the front-line treatment of ovarian cancer.

Ovarian cancer is the fourth leading cause of cancer death among women in the United States. First-line chemotherapy offered to patients with ovarian cancer generally consists of an intravenous (IV) platinum plus taxane regimen and has remained virtually unchanged for the past 10 years. A number of recently completed phase III randomized trials in the United States have reported improved progression-free survival (PFS) and/or overall survival (OS) with the intraperitoneal (IP) administration of cisplatin. The purpose of this study was to pool the published data to perform a meta-analysis of randomized trials of IP cisplatin in the initial chemotherapy treatment of ovarian cancer patients. This study was initiated to obtain a more valid estimate of the therapeutic impact of IP treatment for these patients. A search strategy was initiated that searched published findings of randomized trials of IP cisplatin therapy from multiple sources from January 1990 through January 2006. Six randomized trials of 1716 ovarian cancer patients were identified and included in this analysis. The pooled hazard ratio (HR) for PFS of IP cisplatin as compared to IV treatment regimens is 0.792 (95% CI: 0.688-0.912, P= 0.001), and the pooled HR for OS is 0.799 (95% CI: 0.702-0.910, P= 0.0007). These findings strongly support the incorporation of an IP cisplatin regimen to improve survival in the front-line treatment of stage III, optimally debulked ovarian cancer.

The relationship between potentially erosive storm energy and daily rainfall quantity in England and Wales.

Erosive storm energy is the primary driver of soil detachment, and hence a major determinant of transfer of sediment and particulate phosphorus (P) to surface waters. Modelling of sediment and P loss at catchment scale, for example for the development of catchment and national mitigation policies, requires a spatially interpolated estimate of variation in erosion risk. To this end we present a method of estimating total rainfall erosivity, as kinetic energy (KE), for any location in England and Wales, from daily rainfall data or monthly climate data. Analysis of detailed, high-resolution records from eleven contrasting sites showed strong predictive correlations between daily rainfall quantity and associated daily total kinetic energy estimated from hourly rainfall intensities. The coefficients showed systematic seasonal variation, with greatest KE per unit of rainfall in late summer and autumn months. In contrast, no systematic spatial variation was found as a function of location or continentality index. The relationships were integrated with probability distributions of rainfall quantity per rain day derived from spatial climate data (monthly rainfall totals and numbers of rain days). The resulting map captures and quantifies the effects of rainfall quantity and intensity patterns on risk of sediment detachment, and as such provides a critical input layer to catchment-scale models of sediment and P transfer.

Cvt19 is a receptor for the cytoplasm-to-vacuole targeting pathway.

Cvt19 is specifically required for the transport of resident vacuolar hydrolases that utilize the cytoplasm-to-vacuole targeting (Cvt) pathway. Autophagy (Apg) and pexophagy, processes that use the majority of the same protein components as the Cvt pathway, do not require Cvt19. Cvt19GFP is localized to punctate structures on or near the vacuole surface. Cvt19 is a peripheral membrane protein that binds to the precursor form of the Cvt cargo protein aminopeptidase I (prAPI) and travels to the vacuole with prAPI. These results suggest that Cvt19 is a receptor protein for prAPI that allows for the selective transport of this protein by both the Cvt and Apg pathways.

Vacuolar localization of oligomeric alpha-mannosidase requires the cytoplasm to vacuole targeting and autophagy pathway components in Saccharomyces cerevisiae.

One challenge facing eukaryotic cells is the post-translational import of proteins into organelles. This problem is exacerbated when the proteins assemble into large complexes. Aminopeptidase I (API) is a resident hydrolase of the vacuole/lysosome in the yeast Saccharomyces cerevisiae. The precursor form of API assembles into a dodecamer in the cytosol and maintains this oligomeric form during the import process. Vacuolar delivery of the precursor form of API requires a vesicular mechanism termed the cytoplasm to vacuole targeting (Cvt) pathway. Many components of the Cvt pathway are also used in the degradative autophagy pathway. alpha-Mannosidase (Ams1) is another resident hydrolase that enters the vacuole independent of the secretory pathway; however, its mechanism of vacuolar delivery has not been established. We show vacuolar localization of Ams1 is blocked in mutants that are defective in the Cvt and autophagy pathways. We have found that Ams1 forms an oligomer in the cytoplasm. The oligomeric form of Ams1 is also detected in subvacuolar vesicles in strains that are blocked in vesicle breakdown, indicating that it retains its oligomeric form during the import process. These results identify Ams1 as a second biosynthetic cargo protein of the Cvt and autophagy pathways.

Peroxisome degradation in Saccharomyces cerevisiae is dependent on machinery of macroautophagy and the Cvt pathway.

Organelle biogenesis and turnover are necessary to maintain biochemical processes that are appropriate to the needs of the eukaryotic cell. Specific degradation of organelles in response to changing environmental cues is one aspect of achieving proper metabolic function. For example, the yeast Saccharomyces cerevisiae adjusts the level of peroxisomes in response to differing nutritional sources. When cells are grown on oleic acid as the sole carbon source, peroxisome biogenesis is induced. Conversely, a subsequent shift to glucose-rich or nitrogen-limiting conditions results in peroxisome degradation. The degradation process, pexophagy, requires the activity of vacuolar hydrolases. In addition, peroxisome degradation is specific. Analyses of cellular marker proteins indicate that peroxisome degradation under these conditions occurs more rapidly and to a greater extent than mitochondrial, Golgi, or cytosolic protein delivery to the vacuole by the non-selective autophagy pathway. To elucidate the molecular mechanism of selective peroxisome degradation, we examined pexophagy in mutants that are defective in autophagy (apg) and the selective targeting of aminopeptidase I to the vacuole by the cytoplasm to vacuole targeting (Cvt) pathway. Inhibition of peroxisome degradation in cvt and apg mutants indicates that these pathways overlap and that peroxisomes are delivered to the vacuole by a mechanism that utilizes protein components of the Cvt/autophagy pathways.

Comparison of acetaminophen, ibuprofen, and nabumetone therapy in rats with pulpal pathosis.

The purpose of this study was to determine if daily treatment with acetaminophen, ibuprofen, or nabumetone would alter prostaglandin E2 (PGE2)/leukotriene B4 (LTB4) synthesis in exposed, infected dental pulp and periradicular tissue in rats. Dental pulp of the bilateral first and second mandibular molars were exposed for 15 or 24 days. Rats were divided into four groups. A daily pharmacological oral dose of one of the medications or the suspending solution alone was administered to the designated group. Eicosanoids were extracted from pulpal and periradicular tissues and assayed. PGE2 was significantly elevated in pulp-exposed, nontreated rats and was significantly reduced in the ibuprofen- and nabumetone-treated groups. LTB4 was significantly increased in all pulp-exposed groups at 15 days when compared with control nonexposed groups. Results showed that only ibuprofen reduced LTB4 in the exposed dental pulp at 24 days, although it did not do so at 15 days. Repetitive treatment with acetaminophen did not suppress PGE2/LTB4 in pulp-exposed molars.

V1-situated stalk subunits of the yeast vacuolar proton-translocating ATPase.

The proton-translocating ATPase of the yeast vacuole is an enzyme complex consisting of a large peripheral membrane sector (V1) and an integral membrane sector (V0), each composed of multiple subunits. The V1 sector contains subunits that hydrolyze ATP, whereas the V0 sector contains subunits that translocate protons across the membrane. Additional subunits in both sectors couple these activities. Here we have continued our examination of intermediate subunits primarily associated with the V1 but also implicated in interactions with the V0. Interactions between Vma7p (F) and Vma8p (D) and between Vma4p (E) and Vma10p (G) are described. Although Vma7p and Vma10p have been observed to interact with the V0 sector, our results indicate that these subunits behave primarily as canonical V1 sector subunits. We categorize these four subunits as "stalk" subunits to distinguish them from the known catalytic (A and B) and proton-translocating (c, c', and Vma16p) subunits and to highlight their intermediate nature. Furthermore, we show that the in vivo stability of Vma4p is dependent upon interaction with Vma10p. This may be important in the regulation of assembly, since these two subunits add to the V1 during later stages of V1 assembly. This is the first demonstration of interdependence between ATPase subunits for structural stability.

Hyperthermia during repair of pectus excavatum.

We have observed an elevation of body temperature during surgical repair of pectus excavatum. To document this phenomenon and attempt to prevent it, we undertook a combination retrospective-prospective study. The retrospective arm included an analysis of the anesthetic records of patients undergoing repair of pectus excavatum during the past 5 years and included 22 boys and 3 girls. Body temperature increased in all 25 patients, from a starting temperature of 36.1 degrees C +/- 0.5 degree C to 38.0 degrees C +/- 0.6 degree C. The maximum temperature exceeded 38 degrees C in 12 patients and 39 degrees C in 3 patients. An additional retrospective review of the anesthetic records of 15 children undergoing another type of thoracic procedure (thoracotomy) for noninfectious problems revealed only a modest, statistically nonsignificant rise in temperature from a starting point of 35.9 degrees C +/- 0.7 degree C to a maximum of 36.3 degrees C +/- 1.2 degrees C. The maximum temperature was greater than 38 degrees C in one of these 15 patients. The prospective arm of the study included a standardized anesthetic technique in 10 patients. Neither a heated humidifier nor a warming blanket were used, and the ambient temperature of the room was maintained at 70 degrees F. Core body temperature increased from a starting temperature of 36.1 degrees C +/- 0.6 degree C to 36.8 degrees C +/- 0.8 degree C. A significant elevation of body temperature occurs in children during repair of pectus excavatum that may be avoided by eliminating the use of exogenous methods to prevent hypothermia (e.g., heated humidifier, warming blanket).