Explainer: what dust from the Sahara does to you and the planet

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Rising popularity of injectable contraceptives in sub-Saharan Africa

Injectable contraceptives are fast becoming the method of choice among married women in sub-Saharan Africa. In several countries in the region, the proportion of women using injectable methods has surpassed the proportion of women using the pill. This is true even in some countries where the pill had been the most popular modern method in the 1980s and 1990s. This paper analyzes data from six sub-Saharan African countries that have participated four or more times in the Demographic and Health Surveys program to investigate recent increases in prevalence of injectable contraceptives and identify factors that drive the increase. It discusses the programmatic implications of this trend for the region, especially in terms of contraceptive security and sustainability

Assessment of the contamination potentials of some foodborne bacteria in biofilms for food products

AbstractObjectiveTo assess biofilms formed by different bacterial strains on glass slides, and changes in biofilm mass and biofilm-associated cell populations after brief contacts between biofilms and either media agar or food products.MethodsTwo Listeria monocytogenes and Escherichia coli (E. coli) strains and a single Staphylococcus aureus (S. aureus) strain were inoculated separately in tryptic soy broth containing glass coupons incubated for 24, 48 or 72 h at 37 °C. The biofilms formed by individual bacterial strains and biofilm-associated cell populations were determined. Biofilms were subsequently allowed to have brief contacts (1-3 times), through gentle touching, with either agar, meat or soft white cheese (2 cm3). Changes in biofilm mass on glass slides and cell populations embedded in biofilms were quantified.ResultsA nonpathogenic E. coli formed more biofilms than an E. coli O157:H7 strain. Biofilms formed by S. aureus and Listeria monocytogenes were essentially similar. The biofilm mass increased as incubation time increased within 48 h of incubation and was not positively correlated with cellulose production. Biofilm mass at 48 and 72 h of incubation was not significantly different. More frequent contacts with agar or foods did not remove more biofilms or biofilm-associated cells from glass slides. More S. aureus biofilms were removed followed by Listeria and E. coli biofilms. Mean contamination of agar or food models was 0.00 to 7.65 log CFU/cm2. Greater contaminations in cell populations were observed with S. aureus and Listeria biofilms.ConclusionsThe results provide a clearer assessment of contaminating potential of foods that comes in contact with them

Infant mortality and childhood nutrition in Ondo State, Nigeria : their correlates and socio-cultural explanations

This thesis examines the factors associated with mortality among children under the age of 12 months (infant mortality) and nutritional status among children aged 6-36 months (childhood nutrition) in Ondo State, Nigeria. The primary purpose of the study was to identify the variables that were most important in explaining the level and pattern of infant mortality and childhood nutrition in the state. A secondary objective was to compare the pattern of association between the key variables for both infant mortality and childhood nutrition. Both quantitative and qualitative analysis has been used in the thesis. Bivariate and multivariate statistical methods were applied to the 1986-87 Ondo State Demographic and Health Survey (ODHS) to assess the effects of certain socio-economic variables and some of the Mosley and Chen's (1984) proximate determinants on infant mortality and childhood nutrition. Qualitative information from two phases of a micro-level study of an Ondo State town was also used to provide the context of infant mortality and childhood nutrition in a particular community. The findings on infant mortality showed that levels were lower in Ondo State than in Nigeria as a whole and that the level of infant mortality in the state was comparable to that observed in the southwest region in which it is located. In this study, the key variables associated with infant mortality were duration of breastfeeding, maternal age at childbirth and birth order. Among the three groups of proximate determinants for which data were available, only maternal factors had a significant effect on infant mortality. At the bivariate level, the pattern of association between infant mortality and mothers' education was not in the expected direction. However, when the effect of breastfeeding duration was controlled, the usually-observed inverse relationship between infant mortality and mothers' education emerged. This study appears to support the observation that demographic variables are more important than socio-economic factors in explaining infant mortality. Available qualitative data, on the other hand, suggested that economic disadvantage was at the root of many of the observed demographic effects, especially in relation to teenage childbearing. The economic disadvantage that resulted in high infant mortality among the children of mothers with secondary education also tended to result in stunting of their children. The findings on childhood nutrition showed about one-third of children in Ondo State had moderate to severe stunting, even though very few had moderate or severe wasting. The major predictors of stunting were source of drinking water, succeeding birth interval, maternal age at childbirth and diarrhoea. The major predictors of wasting were succeeding birth interval, toilet availability, and diarrhoea. This suggests that good child spacing coupled with environmental hygiene and the consequent reduction in exposure to disease pathogens enhances children's nutritional status. Economic resources can also ensure an adequate supply of food to the household. The study concludes that efforts to reduce infant mortality in Ondo State should include encouraging mothers to breastfeed their children, and improved economic well-being of mothers. Similarly, better environmental sanitation and general economic well-being will enhance the nutritional status of Ondo State children, and in turn bolster their survival prospects

Archaean chromitites show constant Fe 3+ /ΣFe in Earth's asthenospheric mantle since 3.8 Ga

Theoretical and planetary studies show that the Earth’s upper mantle is more oxidised than it should be. The mechanism by which this took place and the timing of the oxidation is contested. Here we present new Mössbauer spectroscopy measurements of the ionic ratio Fe3+/(Fe3++Fe2+) in the mineral chromite hosted in mantle-derived melts to show that there is no change in mantle Fe3+/(Fe3++Fe2+) ratio before and after the oxidation of the Earth’s atmosphere at ca. 2.4 Ga and over Earth history from 3.8 Ga to 95 Ma. Our finding supports the view that the oxidation of the asthenospheric mantle was very early and that the oxygenation of the Earth’s atmosphere was not directly coupled to mantle processes.Uo

Mineralogical and geochemical characterisation of warm water, shallow marine glaucony from the Tertiary of the London Basin

Glaucony is present in the Palaeocene sediments of the London Basin, from the Thanet Sand Formation to the gravel beds at the base of the Lower Mottled Beds of the Reading Formation. The Upnor Formation glaucony is a rare example of formation in warm, shallow brackish water and this, combined with the ready availability of fresh material from boreholes, make this study important in developing our understanding of this mineral. Glaucony comprises up to 50% of the Upnor Formation, a grey to green sandstone, of variable thickness and composition, that was deposited in a warm, shallow marine to estuarine environment, ~55.6-56.2 Ma. Using morphological criteria, X-ray diffraction data and K+ abundance, the Upnor glaucony may be defined as evolved. The underlying shallow marine Thanet Sand contains <5% of nascent to slightly evolved glaucony. The REE data for the Upnor Formation suggest more than one source for the sediment from which the Upnor glaucony formed, while the Thanet REE data are consistent with a high detrital clay component. In the Upnor Formation, the high proportion of glaucony that occurs as granule fragments rather than whole granules, and the high energy estuarine to shallow marine environment of deposition, are indicative of reworking. The Upnor glaucony is inferred to be intraformationally reworked, rather than derived from the Thanet Sand Formation. The glaucony may have formed in sediments deposited away from the main estuarine channel, and been subsequently reworked into higher energy sediments. Warm seas with freshwater mixing are more typically characteristic of verdine formation than of glaucony. The shallow, brackish environment of deposition suggests that there is not a clear distinction between the environmental requirements of verdine (or odinite) and glaucony (or glauconite), as is often proposed. The highly fractured, delicate nature of some granules indicates that they have experienced some maturation in situ, after reworking. The oxygen and hydrogen isotopic compositions of Upnor Formation shark teeth and glaucony point to formation in low salinity water at ~23±3°C, also consistent with formation in the Upnor Formation, rather than in a fully marine sediment and subsequent reworking. A higher than normal temperature of formation may have increased the rate of evolution of glaucony. Our multidisciplinary study considers many of the factors relating to depositional environment that must be considered when glaucony rich facies are encountered in comparable palaeoenvironmental settings elsewhere in the geological record

Low temperature, authigenic illite and carbonates in a mixed dolomite-clastic lagoonal and pedogenic setting, Spanish Central System, Spain

The aim of this study was to further our understanding of the pedogenic and lacustrine modification of clay minerals. Some of these modifications are of special interest because they constitute reverse weathering reactions, rare in surface environments, and because there is not yet an accurate assessment of their global relevance in mineralogical and geochemical cycles. For this study, two sections from the Central System in Spain were selected. Both are sections through the Uppper Cenomanian-Turonian mixed clastic and carbonate succession, containing both calcite and dolomite, in the Sierra de Guadarrama. Mid-Turonian sea level fall resulted in the formation of a coastal plain environment in which extensive pedogenesis occurred around saline lagoons. The mineralogical changes that have occurred as a result of sedimentation in saline lagoons and as a consequence of pedogenesis are described. Textural relationships indicate that the dolomite cement pre-dates the calcite. Silicate minerals are represented by quartz, kaolinite, illite-smectite, illite, minor plagioclase and alkali feldspar, and trace chlorite and palygorskite. There is a positive correlation between the intensity of pedogenesis and the proportion of illite in the clay assemblage in one of the sections, indicating pedogenic illitisation. In this section, the intensity of the illitisation process increases up, reaching a maximum where pedogenesis is most intense in the middle part, and then decreases as marine influence increases towards the top of the Alcorlo Formation and the overlying marine Tranquera Formation. The clay assemblages are consistent with a slow transformation process from 42 kaolinite to illite by way of illite-smectite, taking place under surface conditions. The illitisation process has resulted in a less Fe-rich, more Mg-, and Al-rich illite than the majority of previously documented cases in the near surface. Formation of Al-rich illite is not therefore restricted to the deep subsurface. The mechanism for low temperature illitisation involves enhanced layer charge resulting from Mg2+ substitution for Al3+ (or Fe3+) and Fe3+ to Fe2+ reduction. Mg2+ enrichment may have occurred principally in saline lagoons or lakes, while Fe3+ to Fe2+ reduction occurred as a result of wetting and drying in a pedogenic environment. So far as it has been possible to establish, this dual mechanism has not previously been documented. This study indicates clearly that the dolomite and calcite are authigenic cements that precipitated in a clastic sediment, probably soon after deposition. Dolomitisation and Mg enrichment of the clay may have occurred at the same time. Seawater is the most probable source of Mg

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (&lt; 5 years, 5–10 years, 10–20 years, and &gt; 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (&lt; 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs &gt; 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (&lt; 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs &gt; 20 years: 0.62), and only surgeons with &gt; 20 years of experience did not have substantial reliability on assessment 2 (&lt; 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs &gt; 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment