Disappearing cities on US coasts.

The sea level along the US coastlines is projected to rise by 0.25-0.3 m by 2050, increasing the probability of more destructive flooding and inundation in major cities1-3. However, these impacts may be exacerbated by coastal subsidence-the sinking of coastal land areas4-a factor that is often underrepresented in coastal-management policies and long-term urban planning2,5. In this study, we combine high-resolution vertical land motion (that is, raising or lowering of land) and elevation datasets with projections of sea-level rise to quantify the potential inundated areas in 32 major US coastal cities. Here we show that, even when considering the current coastal-defence structures, further land area of between 1,006 and 1,389 km2 is threatened by relative sea-level rise by 2050, posing a threat to a population of 55,000-273,000 people and 31,000-171,000 properties. Our analysis shows that not accounting for spatially variable land subsidence within the cities may lead to inaccurate projections of expected exposure. These potential consequences show the scale of the adaptation challenge, which is not appreciated in most US coastal cities.

Jatonik polyherbal mixture induced rat liver MMPT pore opening in normal Wistar rat: In vitro and in vivo studies.

Objective: To assess acute toxicity, the in vitro and in vivo effects of methanol and ethyl acetate extracts (JME and JEE) of Jatonik polyherbal mixture on some mitochondria-related parameters and their effect on the activity of some liver enzymes. Methods: Acute toxicity of JME and JEE was determined using Lorke's method. In vitro and in vivo opening of the mitochondrial membrane permeability transition pore (MMPT pore) was spectrophotometrically assayed. Production of malondialdehyde (MDA) as an index of lipid peroxidation and the activity of mitochondrial ATPase was evaluated in vitro and in vivo and the effect of JME and JEE on the activity of liver enzymes such as alkaline phosphatase (ALP), aspartate and alanine aminotransferase (AST and ALT) and gamma-glutamyl transferase (GGT) was also investigated. Results: JME had an LD50 of 3 808 mg/kg b.w whereas JEE had an LD50 greater than 5 000 mg/kg b.w. of rats. After the rats have been fed with both extracts, a photomicrograph of a piece of liver tissue showed no apparent symptoms of toxicity. From the in vitro and in vivo studies, both extracts prompted intact mitochondria to open their MMPT pores. When compared to the control, lipid peroxide product release and ATPase activity were significantly increased (P < 0.05) in vitro and in vivo. The activities of AST, ALT, and GGT were all reduced at 50 mg/kg when treated with JME, but the activity of AST was considerably enhanced when treated with JEE (P < 0.05). The results revealed that both JME and JEE of the Jatonik polyherbal mixture had low toxicity, profound MMPTpore induction, and enhanced ATPase activity, but an increased MDA production. Conclusion: Jatonik extracts may be a promising target for drug development in diseases where there is dysregulation of apoptosis, however, further studies are needed to better clarify the molecular mechanism involved in these phenomena.

Slowly but surely: Exposure of communities and infrastructure to subsidence on the US east coast.

Coastal communities are vulnerable to multihazards, which are exacerbated by land subsidence. On the US east coast, the high density of population and assets amplifies the region's exposure to coastal hazards. We utilized measurements of vertical land motion rates obtained from analysis of radar datasets to evaluate the subsidence-hazard exposure to population, assets, and infrastructure systems/facilities along the US east coast. Here, we show that 2,000 to 74,000 km2 land area, 1.2 to 14 million people, 476,000 to 6.3 million properties, and >50% of infrastructures in major cities such as New York, Baltimore, and Norfolk are exposed to subsidence rates between 1 and 2 mm per year. Additionally, our analysis indicates a notable trend: as subsidence rates increase, the extent of area exposed to these hazards correspondingly decreases. Our analysis has far-reaching implications for community and infrastructure resilience planning, emphasizing the need for a targeted approach in transitioning from reactive to proactive hazard mitigation strategies in the era of climate change.

Jatonik polyherbal mixture induced rat liver MMPT pore opening in normal Wistar rat: In vitro and in vivo studies / 中草药·英文版

OBJECTIVE@#To assess acute toxicity, the in vitro and in vivo effects of methanol and ethyl acetate extracts (JME and JEE) of Jatonik polyherbal mixture on some mitochondria-related parameters and their effect on the activity of some liver enzymes.@*METHODS@#Acute toxicity of JME and JEE was determined using Lorke's method. In vitro and in vivo opening of the mitochondrial membrane permeability transition pore (MMPT pore) was spectrophotometrically assayed. Production of malondialdehyde (MDA) as an index of lipid peroxidation and the activity of mitochondrial ATPase was evaluated in vitro and in vivo and the effect of JME and JEE on the activity of liver enzymes such as alkaline phosphatase (ALP), aspartate and alanine aminotransferase (AST and ALT) and gamma-glutamyl transferase (GGT) was also investigated.@*RESULTS@#JME had an LD50 of 3 808 mg/kg b.w whereas JEE had an LD50 greater than 5 000 mg/kg b.w. of rats. After the rats have been fed with both extracts, a photomicrograph of a piece of liver tissue showed no apparent symptoms of toxicity. From the in vitro and in vivo studies, both extracts prompted intact mitochondria to open their MMPT pores. When compared to the control, lipid peroxide product release and ATPase activity were significantly increased (P < 0.05) in vitro and in vivo. The activities of AST, ALT, and GGT were all reduced at 50 mg/kg when treated with JME, but the activity of AST was considerably enhanced when treated with JEE (P < 0.05). The results revealed that both JME and JEE of the Jatonik polyherbal mixture had low toxicity, profound MMPTpore induction, and enhanced ATPase activity, but an increased MDA production.@*CONCLUSION@#Jatonik extracts may be a promising target for drug development in diseases where there is dysregulation of apoptosis, however, further studies are needed to better clarify the molecular mechanism involved in these phenomena.

Hidden vulnerability of US Atlantic coast to sea-level rise due to vertical land motion.

The vulnerability of coastal environments to sea-level rise varies spatially, particularly due to local land subsidence. However, high-resolution observations and models of coastal subsidence are scarce, hindering an accurate vulnerability assessment. We use satellite data from 2007 to 2020 to create high-resolution map of subsidence rate at mm-level accuracy for different land covers along the ~3,500 km long US Atlantic coast. Here, we show that subsidence rate exceeding 3 mm per year affects most coastal areas, including wetlands, forests, agricultural areas, and developed regions. Coastal marshes represent the dominant land cover type along the US Atlantic coast and are particularly vulnerable to subsidence. We estimate that 58 to 100% of coastal marshes are losing elevation relative to sea level and show that previous studies substantially underestimate marsh vulnerability by not fully accounting for subsidence.

Unique Variants of Avian Coronaviruses from Indigenous Chickens in Kenya.

The avian gamma-coronavirus infectious bronchitis virus (AvCoV, IBV; Coronaviridae family) causes upper respiratory disease associated with severe economic losses in the poultry industry worldwide. Here, we report for the first time in Kenya and the Eastern African region two novel AvCoVs, designated IBV/ck/KE/1920/A374/2017 (A374/17) and AvCoV/ck/KE/1922/A376/2017 (A376/17), inadvertently discovered using random nontargeted next-generation sequencing (NGS) of cloacal swabs collected from indigenous chickens. Despite having genome organization (5'UTR-[Rep1a/1ab-S-3a-3b-E-M-4b-4c-5a-5b-N-6b]-3'UTR), canonical conservation of essential genes and size (~27.6 kb) typical of IBVs, the Kenyan isolates do not phylogenetically cluster with any genotypes of the 37 IBV lineages and 26 unique variants (UVs). Excluding the spike gene, genome sequences of A374/17 and A376/17 are only 93.1% similar to each other and 86.7-91.4% identical to genomes of other AvCoVs. All five non-spike genes of the two isolates phylogenetically cluster together and distinctly from other IBVs and turkey coronaviruses (TCoVs), including the indigenous African GI-26 viruses, suggesting a common origin of the genome backbone of the Kenyan isolates. However, isolate A376/17 contains a TCoV-like spike (S) protein coding sequence and is most similar to Asian TCoVs (84.5-85.1%) compared to other TCoVs (75.6-78.5%), whereas isolate A374/17 contains an S1 gene sequence most similar to the globally distributed lineage GI-16 (78.4-79.5%) and the Middle Eastern lineage GI-23 (79.8-80.2%) viruses. Unanswered questions include the actual origin of the Kenyan AvCoVs, the potential pathobiological significance of their genetic variations, whether they have indeed established themselves as independent variants and subsequently spread within Kenya and to the neighboring east/central African countries that have porous live poultry trade borders, and whether the live-attenuated Mass-type (lineage GI-1)-based vaccines currently used in Kenya and most of the African countries provide protection against these genetically divergent field variants.

Stakeholders, Institutional Challenges and the Valuation of Wetland Ecosystem Services in South Sudan: The Case of Machar Marshes and Sudd Wetlands.

A number of wetland ecosystem-services valuation studies around the world have been carried out, however, most of these studies have focused on wetlands in developed countries and few have been conducted in Africa, particularly in South Sudan. Thus, this study is conducted to value ecosystem services and identify the role and interests of stakeholders of the Machar Marshes and the Sudd wetlands for sustainable wetland management in the Nile basin. Market price and benefit transfer approaches have been applied to value the wetlands biodiversity and ecosystem services, by adjusting for income and price differences. In addition to environmental valuation methods, we conducted stakeholder analysis. Accordingly, Machar Marshes wetland provides an estimated per annum economic value of $200 million, of which the provisioning services contributed about $61 million, regulating services $132 million, and biodiversity services $7.35 million considering the 2015 price as a base year. Similarly, the Sudd wetland provides an estimated per annum economic value of 2.3 billion, of which regulating is about $1.2 billion, biodiversity $857 million, provisioning $209 million, and transportation service $293,400. The findings show that the ecosystem services from the wetlands have benefits beyond the local communities. Thus, to maintain and ensure sustainable wetlands ecosystem services, stakeholders should play a significant role to implement alternative wetland development options through managing the existing institutional challenges. Ecosystem-services assessment and wetland development options suffer from weak institutional capacity due to prolonged conflicts and instability and physical inaccessibility to critical natural resources in the wetlands.

The outcome of complementary and alternative medicine use among pregnant women in South-East Nigeria: a multi-centre prospective study.

There is a global increasing trend of complementary and alternative medicine (CAM) use among pregnant women. This study aimed at determining the maternal and perinatal outcome of CAM use among the pregnant women in South-East Nigeria. This was a prospective study in which self-administered semi-structured questionnaires were used to collate information from the consenting pregnant women who use CAM and those who did not use CAM from the gestational age of 36 weeks at four hospitals in South-East Nigeria. Both groups were matched for age, parity and address. Every participant was followed up until delivery. Data were analysed using SPSS version 23 (SPSS Inc., Chicago, IL). This study's ethical clearance number was NHREC/05/01/2008B-FWA00002458-1RB00002323 and it was obtained at UNTH and on February 15 2019. CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of babies when compared with non-CAM users (p value= <.05). In conclusion, CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them.Impact StatementWhat is already known on this subject? There is an increasing trend of CAM use among pregnant women in the world. Pregnancy is associated with certain conditions that predispose women to CAM use. The clinical indications for CAM use by the pregnant women are nausea and vomiting, labour pain, induction of labour, pedal oedema and waist pain.What the results of this study add? CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of the babies when compared with non-CAM users.What the implications are of these findings for clinical practice and/or further research? CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them.

RNA Toxicity and Perturbation of rRNA Processing in Spinocerebellar Ataxia Type 2.

BACKGROUND: Spinocerebellar ataxia type 2 (SCA2) is a neurodegenerative disease caused by expansion of a CAG repeat in Ataxin-2 (ATXN2) gene. The mutant ATXN2 protein with a polyglutamine tract is known to be toxic and contributes to the SCA2 pathogenesis. OBJECTIVE: Here, we tested the hypothesis that the mutant ATXN2 transcript with an expanded CAG repeat (expATXN2) is also toxic and contributes to SCA2 pathogenesis. METHODS: The toxic effect of expATXN2 transcripts on SK-N-MC neuroblastoma cells and primary mouse cortical neurons was evaluated by caspase 3/7 activity and nuclear condensation assay, respectively. RNA immunoprecipitation assay was performed to identify RNA binding proteins (RBPs) that bind to expATXN2 RNA. Quantitative PCR was used to examine if ribosomal RNA (rRNA) processing is disrupted in SCA2 and Huntington's disease (HD) human brain tissue. RESULTS: expATXN2 RNA induces neuronal cell death, and aberrantly interacts with RBPs involved in RNA metabolism. One of the RBPs, transducin ß-like protein 3 (TBL3), involved in rRNA processing, binds to both expATXN2 and expanded huntingtin (expHTT) RNA in vitro. rRNA processing is disrupted in both SCA2 and HD human brain tissue. CONCLUSION: These findings provide the first evidence of a contributory role of expATXN2 transcripts in SCA2 pathogenesis, and further support the role of expHTT transcripts in HD pathogenesis. The disruption of rRNA processing, mediated by aberrant interaction of RBPs with expATXN2 and expHTT transcripts, suggest a point of convergence in the pathogeneses of repeat expansion diseases with potential therapeutic implications. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Immortalized striatal precursor neurons from Huntington's disease patient-derived iPS cells as a platform for target identification and screening for experimental therapeutics.

We have previously established induced pluripotent stem cell (iPSC) models of Huntington's disease (HD), demonstrating CAG-repeat-expansion-dependent cell biological changes and toxicity. However, the current differentiation protocols are cumbersome and time consuming, making preparation of large quantities of cells for biochemical or screening assays difficult. Here, we report the generation of immortalized striatal precursor neurons (ISPNs) with normal (33) and expanded (180) CAG repeats from HD iPSCs, differentiated to a phenotype resembling medium spiny neurons (MSN), as a proof of principle for a more tractable patient-derived cell model. For immortalization, we used co-expression of the enzymatic component of telomerase hTERT and conditional expression of c-Myc. ISPNs can be propagated as stable adherent cell lines, and rapidly differentiated into highly homogeneous MSN-like cultures within 2 weeks, as demonstrated by immunocytochemical criteria. Differentiated ISPNs recapitulate major HD-related phenotypes of the parental iPSC model, including brain-derived neurotrophic factor (BDNF)-withdrawal-induced cell death that can be rescued by small molecules previously validated in the parental iPSC model. Proteome and RNA-seq analyses demonstrate separation of HD versus control samples by principal component analysis. We identified several networks, pathways, and upstream regulators, also found altered in HD iPSCs, other HD models, and HD patient samples. HD ISPN lines may be useful for studying HD-related cellular pathogenesis, and for use as a platform for HD target identification and screening experimental therapeutics. The described approach for generation of ISPNs from differentiated patient-derived iPSCs could be applied to a larger allelic series of HD cell lines, and to comparable modeling of other genetic disorders.

Surveillance and Genetic Characterization of Virulent Newcastle Disease Virus Subgenotype V.3 in Indigenous Chickens from Backyard Poultry Farms and Live Bird Markets in Kenya.

Kenyan poultry consists of ~80% free-range indigenous chickens kept in small flocks (~30 birds) on backyard poultry farms (BPFs) and they are traded via live bird markets (LBMs). Newcastle disease virus (NDV) was detected in samples collected from chickens, wild farm birds, and other domestic poultry species during a 2017-2018 survey conducted at 66 BPFs and 21 LBMs in nine Kenyan counties. NDV nucleic acids were detected by rRT-PCR L-test in 39.5% (641/1621) of 1621 analyzed samples, of which 9.67% (62/641) were NDV-positive by both the L-test and a fusion-test designed to identify the virulent virus, with a majority being at LBMs (64.5%; 40/62) compared to BPFs (25.5%; 22/62). Virus isolation and next-generation sequencing (NGS) on a subset of samples resulted in 32 complete NDV genome sequences with 95.8-100% nucleotide identities amongst themselves and 95.7-98.2% identity with other east African isolates from 2010-2016. These isolates were classified as a new sub-genotype, V.3, and shared 86.5-88.9% and 88.5-91.8% nucleotide identities with subgenotypes V.1 and V.2 viruses, respectively. The putative fusion protein cleavage site (113R-Q-K-R↓F 117) in all 32 isolates, and a 1.86 ICPI score of an isolate from a BPF chicken that had clinical signs consistent with Newcastle disease, confirmed the high virulence of the NDVs. Compared to genotypes V and VI viruses, the attachment (HN) protein of 18 of the 32 vNDVs had amino acid substitutions in the antigenic sites. A time-scaled phylogeographic analysis suggests a west-to-east dispersal of the NDVs via the live chicken trade, but the virus origins remain unconfirmed due to scarcity of continuous and systematic surveillance data. This study reveals the widespread prevalence of vNDVs in Kenyan backyard poultry, the central role of LBMs in the dispersal and possibly generation of new virus variants, and the need for robust molecular epidemiological surveillance in poultry and non-poultry avian species.

Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.

INTRODUCTION: Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities. MATERIAL AND METHODS: This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections. RESULTS: Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P < .05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species. CONCLUSIONS: Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.

A Comparison of the Characteristics of Maternal Near-Misses and Maternal Deaths in Enugu, Southeast Nigeria: A 3-Year Prospective Study.

BACKGROUND: Maternal near-misses, also known as severe acute maternal morbidity, have become globally recognized as an appropriate indicator of obstetric care. Women experiencing maternal near-misses are more in number than maternal deaths, and can provide more specific and detailed evidence, as the patient herself can be a leading source of useful information. OBJECTIVE: To determine the frequency of maternal near-misses and maternal deaths in the University of Nigeria Teaching Hospital in Ituku-Ozalla, Enugu, document the primary determinant factor that caused these, and compare cases of maternal near-miss and maternal deaths. METHODS: This was a 3-year prospective study of all women admitted for delivery or within 42 days of delivery or termination of pregnancy at the hospital. Data were collected prospectively in consecutive patients in a pro forma manner and entered into SPSS version 17 for Windows. RESULTS: There was a total of 2,236 deliveries, of which 88 had severe maternal outcomes. Of the latter, 60 were maternal near-misses, while 28 suffered maternal death. The maternal near-miss:mortality ratio was found to be 2.14. The maternal mortality ratio here was 1,252 per 100,000. All the 88 women that had severe maternal outcomes lived at least 5 km from the hospital. The leading organ-system dysfunction in this study was cardiovascular, manifesting as shock and cardiac arrest, and respiratory, manifesting as gasping and cyanosis. Leading complications were severe hemorrhage, anemia, and hypertensive disorders. The pattern of complications was similar in both near-misses and maternal deaths, but cases of hypertensive disorders and exploratory laparotomy as an intervention for those with organ dysfunction were noted to be higher in near-miss cases, and differences were statistically significant. CONCLUSION: It was concluded that despite numerous similarities in the characteristics of patients who had had maternal near-misses or died, our study points out that those who succumb to death are often <40 years of age, poorly educated, unemployed, usually present as unbooked emergencies from a distance >5 km and suffer maternal death within 24 hours of presentation.

Diagnostic value of Chorioquick for detecting chorioamnionitis in women with premature rupture of membranes.

OBJECTIVE: To determine the accuracy of a semi-quantitative interleukin-6 (IL-6) vaginal secretion rapid test (Chorioquick) for detecting chorioamnionitis in women with premature rupture of membranes (PROM). METHODS: A prospective cohort study in five tertiary hospitals in Nigeria involved women with confirmed PROM at term and preterm PROM with or without suspected chorioamnionitis from August 1, 2017, to October 31, 2018. Cervicovaginal fluid samples were tested for chorioamnionitis using the Chorioquick test. Samples were repeated at decision to deliver. The test was considered positive if at least the indicator 'IL-6 low' of the three Chorioquick biomarkers (low, medium, high) was positive, or negative if none of the biomarkers were positive. Chorioamnionitis was histologically confirmed post-delivery using three tissue samples. Primary outcome measures were sensitivity, specificity, and accuracy. RESULTS: Of 73 women, on histological confirmation, 39 were true positive and 29 were true negative (for chorioamnionitis) to the Chorioquick test at repeat assessment. Overall, the Chorioquick test had a sensitivity of 97.5% (95% confidence interval [CI] 85.3-99.9), specificity 87.9% (70.9-96.0), and accuracy 93.2% (79.5-99.1). Sub-group analysis of women <37 weeks of pregnancy showed a sensitivity of 100.0% (95% CI 83.4-100.0), specificity of 91.3% (70.5-98.5), and accuracy of 95.8% (82.5-99.5). Triple positive samples were 100.0% specific in all gestations. CONCLUSION: Chorioquick showed favorable utility for detecting chorioamnionitis in PROM and could be a reliable, non-invasive rapid tool in a real-world clinical setting.

Genetic characterization and pathogenesis of the first H9N2 low pathogenic avian influenza viruses isolated from chickens in Kenyan live bird markets.

Poultry production plays an important role in the economy and livelihoods of rural households in Kenya. As part of a surveillance program, avian influenza virus (AIV)-specific real-time RT-PCR (RRT-PCR) was used to screen 282 oropharyngeal swabs collected from chickens at six live bird markets (LBMs) and 33 backyard poultry farms in Kenya and 8 positive samples were detected. Virus was isolated in eggs from five samples, sequenced, and identified as H9N2 low pathogenic AIV (LPAIV) G1 lineage, with highest nucleotide sequence identity (98.6-99.9%) to a 2017 Ugandan H9N2 isolate. The H9N2 contained molecular markers for mammalian receptor specificity, implying their zoonotic potential. Virus pathogenesis and transmissibility was assessed by inoculating low and medium virus doses of a representative Kenyan H9N2 LPAIV isolate into experimental chickens and exposing them to naïve uninfected chickens at 2 -days post inoculation (dpi). Virus shedding was determined at 2/4/7 dpi and 2/5 days post placement (dpp), and seroconversion determined at 14 dpi/12 dpp. None of the directly-inoculated or contact birds exhibited any mortality or clinical disease signs. All directly-inoculated birds in the low dose group shed virus during the experiment, while only one contact bird shed virus at 2 dpp. Only two directly-inoculated birds that shed high virus titers seroconverted in that group. All birds in the medium dose group shed virus at 4/7 dpi and at 5 dpp, and they all seroconverted at 12/14 dpp. This is the first reported detection of H9N2 LPAIV from Kenya and it was shown to be infectious and transmissible in chickens by direct contact and represents a new disease threat to poultry and potentially to people.

A retrospective study of Newcastle disease in Kenya.

Newcastle disease (ND) is a major constraint to Kenya's poultry production, which is comprised of approximately 80% indigenous chickens (ICs; caged and free-range system) and 20% exotic chickens (intensive system). This study analyzed cases reported as suspected ND in Kenya between 2005 and 2015. Of the suspected 332 ND reported cases from the three production systems in 27 locations within six Kenyan Agro-Ecological Zones (AEZs), 140 diagnosed as infected with avian orthoavulavirus 1 (AOaV-1; formerly Newcastle disease virus) were present in every year in all AEZs. The numbers of AOaV-1-positive cases differed significantly (p < 0.05) between the production systems across the years depending on the season, climate, and location. In the free-range system, both ambient temperatures and season associated significantly (p = 0.001 and 0.02, respectively) with the number of cases, while in the intensive and caged systems, the positive cases correlated significantly with season and relative humidity, respectively (p = 0.05). Regardless of the production systems, the numbers of clinically sick birds positively correlated with the ambient temperatures (r = 0.6; p < 0.05). Failure to detect AOaV-1 in 58% of the ND cases reported, and mortalities exceeding the observed numbers of clinically sick birds suggest deficiencies in the current ND reporting and diagnostic system. Intensive farmers were the slowest in reporting the cases and diagnostic deficiencies were most evident by failure to test the exposure of ICs to natural infection with AOaV-1 and for the AOaV-1-negative cases lack of testing for other pathogens and/or AOaV-1 variants. This study indicates a need for improved surveillance and diagnostics in Kenyan domestic poultry.

Choice of birth place among antenatal clinic attendees in rural mission hospitals in Ebonyi State, South-East Nigeria.

BACKGROUND: Low utilization of health facilities for delivery by pregnant women poses a public health challenge in Nigeria. AIM: To determine the factors that influence the choice of birth place among antenatal clinic attendees. METHODOLOGY: This was a cross-sectional study of the eligible antenatal clinic attendees recruited at Mater Misericordiae Hospital, Afikpo and Saint Vincent Hospital, Ndubia in Ebonyi State from February 1, 2016 to June 30, 2016. Analysis was done using EPI Info 7.21 software (CDC Atlanta Georgia). RESULTS: A total of 397(99.3%) completely filled questionnaires were collated and analysed. Approximately 71% of the health facilities closest to the respondents had maternity services. It took at least 1 hour for 80.9% of the respondents to access health facilities with maternity services. Most (60.2%) of the respondents had at least one antenatal clinic attendance and majority of them did so at public hospitals. Approximately 43.8% of the respondents were delivered by the skilled birth attendants. The respondents' age and the couple's educational level, history of antenatal clinic attendance, distance of the health facility and availability of transport fare had a significant effect on delivery by skilled birth attendants. The common determinants of birth place were nearness of the health facilities, familiarity of healthcare providers, improved services, sudden labour onset and cost. Also 61.7% of the respondents chose to deliver in public health facilities due to favourable reasons but this could be hampered by the rudeness of some healthcare providers at such facilities. A significant proportion of private health facilities had unskilled manpower and shortage of drugs. CONCLUSION: A greater proportion of women will prefer to deliver in health facilities. However there are barriers to utilization of these facilities hence the need to address such barriers.

Premaquick© versus modified Bishop score for preinduction cervical assessment at term: A double-blind randomized trial.

AIM: To test whether Premaquick biomarkers were superior to modified Bishop score for preinduction cervical assessment at term. METHODS: A multicenter, double-blind randomized clinical trial in 151 nulliparous, cephalic presenting and singleton pregnancies was conducted. The cervix was considered 'ripe' when at least two out of three Premaquick biomarkers are positive or a Bishop score of ≥6. Main outcome measures were proportion of women who were administered or had additional prostaglandin E1 analogue (PGE1) as a preinduction agent and incidence of uterine rupture. The trial was registered in PACTR registry with approval number PACTR201604001592143. Analysis was performed by intention-to-treat principle. RESULTS: The need for initial PGE1 analogue (77.6% vs 98.7%, risk ratio [RR] =0.47, 95% confidence intervals [95% CI] =0.38-0.59, P < 0.001) and additional PGE1 analogue for cervical ripening after one insertion (44.7% vs 68.0%, RR = 0.63, 95% CI = 0.46-0.86, P = 0.004) was significantly lower in Premaquick group. There was no significant difference in incidence of uterine rupture (0% vs 1.4%, RR = 0.000, P = 0.324); however, the frequency of transition to labor was statistically higher in Premaquick group (44.7% vs 22.7%, RR = 1.59, 95% CI = 1.17-2.15, P = 0.004). Interval from start of induction to any type of delivery, need for oxytocin augmentation, vaginal delivery, number of women with cesarean section for failed induction and number of infants admitted to neonatal intensive care unit were similar between the two groups (P > 0.05). CONCLUSION: Preinduction cervical assessment with Premaquick was significantly associated with higher frequency of transition to labor and reduced need for PGE1 analogue when compared to modified Bishop score. Further similar trials in other settings are necessary to strengthen or refute this observation.

Utilisation of preconception care services and determinants of poor uptake among a cohort of women in Abakaliki Southeast Nigeria.

Preconception care (PCC) is a preventive strategy for maternal and perinatal morbidity and mortality. This study aimed to assess the level of awareness and utilisation of PCC services. A descriptive cross-sectional survey was conducted at a teaching hospital. Interviewer-administered questionnaires were used to extract information. A total of 450 participants responded; 44.2% (190/450) were aware, 31.7% (143/450) had good knowledge, while only 10.3% (46/450) received PCC. Health care providers were the main source of information (77.9%). There was statistically significant correlation between awareness and participants' level of education (p < .001) and residence (p < .001), as well as between utilisation and education (p < .001), and information from doctors (p < .001). There was a low level of awareness and poor utilisation of PCC, underpinning the need to scale up health education, establishment of functional PCC clinics and formulation of evidence-based guidelines to improve uptake and pregnancy outcome. Impact statement What is already known on the subject of the paper? PCC has been known in high-income countries as a prevention-based strategy, which aims at improving obstetric outcomes. However, the level of utilisation in low-income countries like Nigeria is either unknown or far too low. What do this study add? This work has provided local data on PCC; clearly indicating that the awareness and utilisation of PCC services in Abakaliki, Nigeria is very low when compared with other regions of the world, and this was influenced by the socio-demographic factors - particularly education and place of residence (for awareness), and level of education and information from health care providers (for utilisation), thus suggesting that enlightenment and improvement in social infrastructures could improve awareness, access and utilisation of PCC. What are the implications for clinical practice and/or further research? The implications of these findings in low resource settings like ours will include introducing interventions to scaling up health education, universal establishment of functional PCC units and formulation of evidence-based guidelines aimed at improving the uptake of PCC and pregnancy outcome. Further research will also be needed in future to assess the impact of such interventions and how to sustain potential benefits.