Site categorisation for nitrogen measures

Final report to Natural England on project IPENS-049

Responding to the maternal health care challenge: The Ethiopian Health Extension Program

Background: Responding to challenges in achieving Millennium Development Goals (MDG), the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive, promotive and select curative health interventions through paid community level health extension workers.Objective: To explore Ethiopia’s progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program.Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP.Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32% skilled birth attendant use by 2010 but only about 12% use was found in the four most populated regions of the country in 2009.Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions, such as misoprostol for active management of third stage of labor, immediate postpartum visits, and improved coordination from community to referral level. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:105-109

Initial investigation using statistical process control for quality control of accelerator beam steering

<p>Abstract</p> <p>Background</p> <p>This study seeks to increase clinical operational efficiency and accelerator beam consistency by retrospectively investigating the application of statistical process control (SPC) to linear accelerator beam steering parameters to determine the utility of such a methodology in detecting changes prior to equipment failure (interlocks actuated).</p> <p>Methods</p> <p>Steering coil currents (SCC) for the transverse and radial planes are set such that a reproducibly useful photon or electron beam is available. SCC are sampled and stored in the control console computer each day during the morning warm-up. The transverse and radial - positioning and angle SCC for photon beam energies were evaluated using average and range (Xbar-R) process control charts (PCC). The weekly average and range values (subgroup n = 5) for each steering coil were used to develop the PCC. SCC from September 2009 (annual calibration) until two weeks following a beam steering failure in June 2010 were evaluated. PCC limits were calculated using the first twenty subgroups. Appropriate action limits were developed using conventional SPC guidelines.</p> <p>Results</p> <p>PCC high-alarm action limit was set at 6 standard deviations from the mean. A value exceeding this limit would require beam scanning and evaluation by the physicist and engineer. Two low alarms were used to indicate negative trends. Alarms received following establishment of limits (week 20) are indicative of a non-random cause for deviation (Xbar chart) and/or an uncontrolled process (R chart). Transverse angle SCC for 6 MV and 15 MV indicated a high-alarm 90 and 108 days prior to equipment failure respectively. A downward trend in this parameter continued, with high-alarm, until failure. Transverse position and radial angle SCC for 6 and 15 MV indicated low-alarms starting as early as 124 and 116 days prior to failure, respectively.</p> <p>Conclusion</p> <p>Radiotherapy clinical efficiency and accelerator beam consistency may be improved by instituting SPC methods to monitor the beam steering process and detect abnormal changes prior to equipment failure.</p> <p><b>PACS numbers: </b>87.55n, 87.55qr, 87.56bd</p

Programmatic correlates of maternal healthcare seeking behaviors in Ethiopia

Background: Considerable improvement in maternal healthcare use has been observed since the inception of the health extension program (HEP) in Ethiopia in 2003.Objective: This paper evaluates the influence of HEP outreach strategies on maternal healthcare use.Method: Cross-sectional survey of 2,916 women with children 0 to 11 months from Amhara, Oromiya, Southern Nations, Nationalities and People’s, and Tigray regions, obtained between December 2008 and January 2009, were analyzed using regression models to assess the impacts of HEP strategies on maternal health outcomes.Result: The analyses found that communities (i.e., kebeles) with relatively high prevalence of model families, higher rate of household visits by health extension workers, and higher rate of household visits by voluntary community health workers were associated with improved antenatal care use, tetanus toxoid vaccination coverage, and receiving postnatal care visits; but the strategies were not associated with deliveries attended by health professionals.Conclusion: Although the impacts of HEP strategies on maternal healthcare use were statistically significant, they were not optimum to reach the maternal mortality reduction targets of the government of Ethiopia. The HEP needs to review and strengthen its community based strategies in order to reach its goals. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:92-99

SiaA/D interconnects c-di-GMP and RsmA signaling to coordinate cellular aggregation of Pseudomonas aeruginosa in response to environmental conditions

© 2016 Colley, Dederer, Carnell, Kjelleberg, Rice and Klebensberger. Pseudomonas aeruginosa has emerged as an important opportunistic human pathogen that is often highly resistant to eradication strategies, mediated in part by the formation of multicellular aggregates. Cellular aggregates may occur attached to a surface (biofilm), at the air-liquid interface (pellicle), or as suspended aggregates. Compared to surface attached communities, knowledge about the regulatory processes involved in the formation of suspended cell aggregates is still limited. We have recently described the SiaA/D signal transduction module that regulates macroscopic cell aggregation during growth with, or in the presence of the surfactant SDS. Targets for SiaA/D mediated regulation include the Psl polysaccharide, the CdrAB two-partner secretion system and the CupA fimbriae. While the global regulators c-di-GMP and RsmA are known to inversely coordinate cell aggregation and regulate the expression of several adhesins, their potential impact on the expression of the cupA operon remains unknown. Here, we investigated the function of SiaA (a putative ser/thr phosphatase) and SiaD (a di-guanylate cyclase) in cupA1 expression using transcriptional reporter fusions and qRT-PCR. These studies revealed a novel interaction between the RsmA posttranscriptional regulatory system and SiaA/D mediated macroscopic aggregation. The RsmA/rsmY/Z system was found to affect macroscopic aggregate formation in the presence of surfactant by impacting the stability of the cupA1 mRNA transcript and we reveal that RsmA directly binds to the cupA1 leader sequence in vitro. We further identified that transcription of the RsmA antagonist rsmZ is controlled in a SiaA/D dependent manner during growth with SDS. Finally, we found that the siaD transcript is also under regulatory control of RsmA and that overproduction of RsmA or the deletion of siaD results in decreased cellular cyclic di-guanosine monophosphate (c-di-GMP) levels quantified by a transcriptional reporter, demonstrating that SiaA/D connects c-di-GMP and RsmA/rsmY/Z signaling to reciprocally regulate cell aggregation in response to environmental conditions

Problem Solving Incorporated into Blending Learning in Nursing Masters Degree

Online and face-to-face learning are integrated in a teaching format called blended learning. In recent years, educators have begun to use blended learning for a number of education related purposes. Typically, blended learning is used to involve the nurse students in a more active and constructive learning process. In a pilot project, five modules of a Masters nursing course were redesigned and implemented in blending learning format. While redesigning the modules, the first challenge was to assure the balance between online and face-to-face classroom activities. The second was to incorporate problem solving phases into blended learning in an efficient way. Moodle is the learning management system used for the online teaching and learning activities. The preliminary results concern the description of the redesign process of the five modules and their implementation. Some critical issues emerged and they must be corrected to improve the teachers\u2019 involvement and the redesign

Behavioural susceptibility theory: the role of appetite in genetic susceptibility to obesity in early life

Excess weight gained during the early years and, in particular, rapid weight gain in the first 2 years of life, are a major risk factors for adult obesity. The growing consensus is that childhood obesity develops from a complex interaction between genetic susceptibility and exposure to an 'obesogenic' environment. Behavioural susceptibility theory (BST) was developed to explain the nature of this gene-environment interaction, and why the 'obesogenic' environment does not affect all children equally. It hypothesizes that inherited variation in appetite, which is present from birth, determines why some infants and children overeat, and others do not, in response to environmental opportunity. That is, those who inherit genetic variants promoting an avid appetite are vulnerable to overeating and developing obesity, while those who are genetically predisposed to have a smaller appetite and lower interest in food are protected from obesity-or even at risk of being underweight. We review the breadth of research to-date that has contributed to the evidence base for BST, focusing on early life, and discuss implications and future directions for research and theory. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part I)'

Method and system for aligning fibers during electrospinning

A method and system are provided for aligning fibers in an electrospinning process. A jet of a fiberizable material is directed towards an uncharged collector from a dispensing location that is spaced apart from the collector. While the fiberizable material is directed towards the collector, an elliptical electric field is generated via the electrically charged dispenser and an oppositely-charged control location. The field spans between the dispensing location and the control location that is within line-of-sight of the dispensing location, and impinges upon at least a portion of the collector. Various combinations of numbers and geometries of dispensers, collectors, and electrodes can be used

Aligned and Electrospun Piezoelectric Polymer Fiber Assembly and Scaffold

A scaffold assembly and related methods of manufacturing and/or using the scaffold for stem cell culture and tissue engineering applications are disclosed which at least partially mimic a native biological environment by providing biochemical, topographical, mechanical and electrical cues by using an electroactive material. The assembly includes at least one layer of substantially aligned, electrospun polymer fiber having an operative connection for individual voltage application. A method of cell tissue engineering and/or stem cell differentiation uses the assembly seeded with a sample of cells suspended in cell culture media, incubates and applies voltage to one or more layers, and thus produces cells and/or a tissue construct. In another aspect, the invention provides a method of manufacturing the assembly including the steps of providing a first pre-electroded substrate surface; electrospinning a first substantially aligned polymer fiber layer onto the first surface; providing a second pre-electroded substrate surface; electrospinning a second substantially aligned polymer fiber layer onto the second surface; and, retaining together the layered surfaces with a clamp and/or an adhesive compound

Aligned and Electrospun Piezoelectric Polymer Fiber Assembly and Scaffold

A method of manufacturing and/or using a scaffold assembly for stem cell culture and tissue engineering applications is disclosed. The scaffold at least partially mimics a native biological environment by providing biochemical, topographical, mechanical and electrical cues by using an electroactive material. The assembly includes at least one layer of substantially aligned, electrospun polymer fiber having an operative connection for individual voltage application. A method of cell tissue engineering and/or stem cell differentiation that uses the assembly seeded with a sample of cells suspended in cell culture media, incubates and applies voltage to one or more layers, and thus produces cells and/or a tissue construct. In another aspect, the invention provides a method of manufacturing the assembly including the steps of providing a first pre-electroded substrate surface; electrospinning a first substantially aligned polymer fiber layer onto the first surface; providing a second pre-electroded substrate surface; electrospinning a second substantially aligned polymer fiber layer onto the second surface; and, retaining together the layered surfaces with a clamp and/or an adhesive compound