Tracking progress towards equitable child survival in a Nicaraguan community: neonatal mortality challenges to meet the MDG 4

<p>Abstract</p> <p>Background</p> <p>Nicaragua has made progress in the reduction of the under-five mortality since 1980s. Data for the national trends indicate that this poor Central American country is on track to reach the Millennium Development Goal-4 by 2015. Despite this progress, neonatal mortality has not showed same progress. The aim of this study is to analyse trends and social differentials in neonatal and under-five mortality in a Nicaraguan community from 1970 to 2005.</p> <p>Methods</p> <p>Two linked community-based reproductive surveys in 1993 and 2002 followed by a health and demographic surveillance system providing information on all births and child deaths in urban and rural areas of León municipality, Nicaragua. A total of 49 972 live births were registered.</p> <p>Results</p> <p>A rapid reduction in under-five mortality was observed during the late 1970s (from 103 deaths/1000 live births) and the 1980s, followed by a gradual decline to the level of 23 deaths/1000 live births in 2005. This community is on track for the Millennium Development Goal 4 for improved child survival. However, neonatal mortality increased lately in spite of a good coverage of skilled assistance at delivery. After some years in the 1990s with a very small gap in neonatal survival between children of mothers of different educational levels this divide is increasing.</p> <p>Conclusions</p> <p>After the reduction of high under-five mortality that coincided with improved equity in survival in this Nicaraguan community, the current challenge is the neonatal mortality where questions of an equitable perinatal care of good quality must be addressed.</p

Active management of the third stage of labour without controlled cord traction: a randomized non-inferiority controlled trial

BACKGROUND: The third stage of labour refers to the period between birth of the baby and complete expulsion of the placenta. Some degree of blood loss occurs after the birth of the baby due to separation of the placenta. This period is a risky period because uterus may not contract well after birth and heavy blood loss can endanger the life of the mother. Active management of the third stage of labour (AMTSL) reduces the occurrence of severe postpartum haemorrhage by approximately 60-70%. Active management consists of several interventions packaged together and the relative contribution of each of the components is unknown. Controlled cord traction is one of those components that require training in manual skill for it to be performed appropriately. If it is possible to dispense with controlled cord traction without losing efficacy it would have major implications for effective management of the third stage of labour at peripheral levels of health care. OBJECTIVE: The primary objective is to determine whether the simplified package of oxytocin 10 IU IM/IV is not less effective than the full AMTSL package. METHODS: A hospital-based, multicentre, individually randomized controlled trial is proposed. The hypothesis tested will be a non-inferiority hypothesis. The aim will be to determine whether the simplified package without CCT, with the advantage of not requiring training to acquire the manual skill to perform this task, is not less effective than the full AMTSL package with regard to reducing blood loss in the third stage of labour.The simplified package will include uterotonic (oxytocin 10 IU IM) injection after delivery of the baby and cord clamping and cutting at approximately 3 minutes after birth. The full package will include the uterotonic injection (oxytocin 10 IU IM), controlled cord traction following observation of uterine contraction and cord clamping and cutting at approximately 3 minutes after birth. The primary outcome measure is blood loss of 1000 ml or more at one hour and up to two hours for women who continue to bleed after one hour. The secondary outcomes are blood transfusion, the use of additional uterotonics and measure of severe morbidity and maternal death.We aim to recruit 25,000 women delivering vaginally in health facilities in eight countries within a 12 month recruitment period. MANAGEMENT: Overall trial management will be from HRP/RHR in Geneva. There will be eight centres located in Argentina, Egypt, India, Kenya, Philippines, South Africa, Thailand and Uganda. There will be an online data entry system managed from HRP/RHR. The trial protocol was developed following a technical consultation with international organizations and leading researchers in the field. EXPECTED OUTCOMES: The main objective of this trial is to investigate whether a simplified package of third stage management can be recommended without increasing the risk of PPH. By avoiding the need for a manual procedure that requires training, the third stage management can be implemented in a more widespread and cost-effective way around the world even at the most peripheral levels of the health care system. This trial forms part of the programme of work to reduce maternal deaths due to postpartum haemorrhage within the RHR department in collaboration with other research groups and organizations active in the field. TRIAL REGISTRATION: ACTRN12608000434392

Hundreds of genetic barcodes of the species-rich hydroid superfamily Plumularioidea (Cnidaria, Medusozoa) provide a guide toward more reliable taxonomy

Marine hydroids are important benthic components of shallow and deep waters worldwide, but their taxonomy is controversial because diagnostic morphological characters to categorize taxa are limited. Their genetic relationships are also little investigated. We tested taxonomic hypotheses within the highly speciose superfamily Plumularioidea by integrating a classical morphological approach with DNA barcoding of the 16S and COI mitochondrial markers for 659 and 196 specimens of Plumularioidea, respectively. Adding Genbank sequences, we inferred systematic relationships among 1,114 plumularioids, corresponding to 123 nominal species and 17 novel morphospecies in five families of Plumularioidea. We found considerable inconsistencies in the systematics of nominal families, genera and species. The families Kirchenpaueriidae and Plumulariidae were polyphyletic and the Halopterididae paraphyletic. Most genera of Plumularioidea are not monophyletic. Species diversity is considerably underestimated. Within our study, at least 10% of the morphologically-distinctive morphospecies are undescribed, and about 40% of the overall species richness is represented by cryptic species. Convergent evolution and morphological plasticity therefore blur systematic relationships. Additionally, cryptic taxa occur frequently in sympatry or parapatry, complicating correspondence with type material of described species. Sometimes conspecificity of different morphotypes was found. The taxonomy of hydroids requires continued comprehensive revision.This work relied on several hydrozoan samples collected from various sites, with the aid of many people. Supplementary Table S1 refers many of the people involved in the collection and/or preservation of the samples. C.J.M. acknowledges his great buddy-divers Jaime N.-Ruiz (CIMAR, Univ. Costa Rica), Axel Calderon, Nathaniel Chu, Eleni Petrou (STRI, Smiths. Inst.), Hanae Spathias, Karen Koltes (at the Belize station, Smith. Inst.), Freya Sommer (Hopkins Marine Station), Remilson Ferreira ('Costa Norte', Sao Tome), Frederico Cardigos (DOP, Univ. Azores) and others that assisted the dives. C.J.M. also acknowledges Rita Castillo (CIMAR, Univ. Costa Rica), Plinio Gondola, Ligia Calderon, Laura Geyer, Maria Castillo (STRI, Smiths. Inst.), Gregory Ruiz (SERC, Smiths. Inst.), Paul Greenhall, William Keel (MSC, Smith. Inst.), Manuel Enes, Valentina Matos (IMAR/DOP, Univ. Azores), Filipe Porteiro, Joao Goncalves (OKEANOS/IMAR, Univ. Azores), Marina Cunha, Ascensao Ravara (CESAM, Univ. Aveiro), Shirley Pomponi (Harbor Branch, Florida Atlantic Univ.), Estrela Matilde (Fundacao Principe Trust), Monica Albuquerque, Ines Tojeira (EMEPC), Diana Carvalho (Nat. Mus. Nat. Hist., Lisbon) and many others colleagues that facilitated the morphologic classifications and deposition of the samples. Peter Schuchert (Mus. d'Hist. Nat. Geneve) kindly provided some DNA extractes. Todd Kincaid and his team of GUE divers (Project Baseline - Azores) collected valuable samples from unusual depths. Joana Boavida (CIIMAR, Univ. Algarve) facilitated some samples of the 'DeepReefs' project. Jim Drewery (Marine Scotland Science Inst.) also provided few samples. Dale Calder (Royal Ontario Museum) provided some bibliography to C.J.M. and discussed/resolved some dubios taxonomic classifications. Colleagues at the L.A.B. (NMNH, Smith. Inst.) were very supportive. The APC fees for open access publication were supported by a program of the Regional Government of the Azores ("Apoio ao funcionamento e gestao dos centros de I&D regionais: 2018 - DRCT-medida 1

First description of feline inflammatory mammary carcinoma: clinicopathological and immunohistochemical characteristics of three cases

INTRODUCTION: Inflammatory breast cancer is a special type of locally advanced mammary cancer that is associated with particularly aggressive behaviour and poor prognosis. The dog was considered the only natural model in which to study the disease because, until now, it was the only species known to present with inflammatory mammary carcinoma (IMC) spontaneously. In the present study we describe clinicopathological and immunohistochemical findings of three cats with IMC, in order to evaluate its possible value as an animal model. METHODS: We prospectively studied three female cats with clinical symptoms of IMC, identified over a period of 3 years. Clinicopathological and immunohistochemical evaluations of Ki-67, and oestrogen, progesterone and androgen receptors were performed. RESULTS: All three animals presented with secondary IMC (postsurgical) characterized by a rapid onset of erythema, severe oedema, extreme local pain and firmness, absence of subjacent mammary nodules, and involvement of extremities. Rejection of the surgical suture was observed in two of the cats. Histologically, highly malignant papillary mammary carcinomas, dermal tumour embolization of superficial lymphatic vessels, and severe secondary inflammation were observed. The animals were put to sleep at 10, 15 and 45 days after diagnosis. Metastases were detected in regional lymph nodes and lungs in the two animals that were necropsied. All tumours had a high Ki-67 proliferation index and were positive for oestrogen, progesterone and androgen receptors. CONCLUSION: Our findings in feline IMC (very low prevalence, only secondary IMC, frequent association of inflammatory reaction with surgical suture rejection, steroid receptor positivity) indicate that feline IMC could be useful as an animal model of human inflammatory breast cancer, although the data should be considered with caution

Armed Rollers: Does Nestling’s Vomit Function as a Defence against Predators?

Chemical defences against predators are widespread in the animal kingdom although have been seldom reported in birds. Here, we investigate the possibility that the orange liquid that nestlings of an insectivorous bird, the Eurasian roller (Coracias garrulus), expel when scared at their nests acts as a chemical defence against predators. We studied the diet of nestling rollers and vomit origin, its chemical composition and deterrent effect on a mammal generalist predator. We also hypothesized that nestling rollers, as their main prey (i.e. grasshoppers) do from plants, could sequester chemicals from their prey for their use. Grasshoppers, that also regurgitate when facing to a threat, store the harmful substances used by plants to defend themselves against herbivores. We found that nestling rollers only vomit after being grasped and moved. The production of vomit depended on food consumption and the vomit contained two deterrent chemicals (hydroxycinnamic and hydroxybenzoic acids) stored by grasshoppers and used by plants to diminish herbivory, suggesting that they originate from the rollers’ prey. Finally, we showed for the first time that the oral secretion of a vertebrate had a deterrent effect on a model predator because vomit of nestling rollers made meat distasteful to dogs. These results support the idea that the vomit of nestling rollers is a chemical defence against predators.Financial support was provided by the Junta de Andalucía (project P06-RNM-02177) and the Spanish Ministry of Science and Education/FEDER (projects CGL2008-00718 and CGL2011-27561)

Neuroscience and education: prime time to build the bridge

As neuroscience gains social traction and entices media attention, the notion that education has much to benefit from brain research becomes increasingly popular. However, it has been argued that the fundamental bridge toward education is cognitive psychology, not neuroscience. We discuss four specific cases in which neuroscience synergizes with other disciplines to serve education, ranging from very general physiological aspects of human learning such as nutrition, exercise and sleep, to brain architectures that shape the way we acquire language and reading, and neuroscience tools that increasingly allow the early detection of cognitive deficits, especially in preverbal infants. Neuroscience methods, tools and theoretical frameworks have broadened our understanding of the mind in a way that is highly relevant to educational practice. Although the bridge’s cement is still fresh, we argue why it is prime time to march over it

Spatial Frequency-Based Analysis of Mean Red Blood Cell Speed in Single Microvessels: Investigation of Microvascular Perfusion in Rat Cerebral Cortex

BACKGROUND: Our previous study has shown that prenatal exposure to X-ray irradiation causes cerebral hypo-perfusion during the postnatal development of central nervous system (CNS). However, the source of the hypo-perfusion and its impact on the CNS development remains unclear. The present study developed an automatic analysis method to determine the mean red blood cell (RBC) speed through single microvessels imaged with two-photon microscopy in the cerebral cortex of rats prenatally exposed to X-ray irradiation (1.5 Gy). METHODOLOGY/PRINCIPAL FINDINGS: We obtained a mean RBC speed (0.9±0.6 mm/sec) that ranged from 0.2 to 4.4 mm/sec from 121 vessels in the radiation-exposed rats, which was about 40% lower than that of normal rats that were not exposed. These results were then compared with the conventional method for monitoring microvascular perfusion using the arteriovenous transit time (AVTT) determined by tracking fluorescent markers. A significant increase in the AVTT was observed in the exposed rats (1.9±0.6 sec) as compared to the age-matched non-exposed rats (1.2±0.3 sec). The results indicate that parenchyma capillary blood velocity in the exposed rats was approximately 37% lower than in non-exposed rats. CONCLUSIONS/SIGNIFICANCE: The algorithm presented is simple and robust relative to monitoring individual RBC speeds, which is superior in terms of noise tolerance and computation time. The demonstrative results show that the method developed in this study for determining the mean RBC speed in the spatial frequency domain was consistent with the conventional transit time method

Bowel management for the treatment of pediatric fecal incontinence

Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a bowel management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process