Total CO2 output from Vulcano island (Aeolian Islands, Italy)

Total CO2 output from fumaroles, soil gas, bubbling gas discharges and water dissolved gases discharged from the island, was estimated for Vulcano island, Italy. The CO2 emission from fumaroles from the La Fossa summit crater was estimated from the SO2 crater output, while CO2 discharged through diffuse soil emission was quantified on the basis of 730 measurements of CO2 fluxes from the soil of the island, performed by using the accumulation chamber method. The results indicate an overall output of ≅500 t day 1 of CO2 from the island. The main contribution to the total CO2 output comes from the summit area of the La Fossa cone (453 t day 1), with 362 t day 1 from crater fumaroles and 91 t day 1 from crater soil degassing. The release of CO2 from peripheral areas is ≅20 t day 1 by soil degassing (Palizzi and Istmo areas mainly), an amount comparable to both the contribution of water dissolved CO2 (6 t day 1), as well as to seawater bubbling CO2 (4 t day 1 measured in the Istmo area). Presented data (September 2007) refer to a period of moderate solphataric activity, when the fumaroles temperature were 450°C and gas/water molar ratio of fumaroles was up to 0.16. The calculated total CO2 emission allows the estimation of the mass release and related thermal energy from the volcanic-hydrothermal system

The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME).

Rapid diagnostic tests for malaria (mRDTs) have been scaled-up widely across Africa. The PRIME study evaluated an intervention aiming to improve fever case management using mRDTs at public health centers in Uganda. A cluster-randomized trial was conducted from 2010-13 in Tororo, a high malaria transmission setting. Twenty public health centers were randomized in a 1:1 ratio to intervention or control. The intervention included training in health center management, fever case management with mRDTs, and patient-centered services; plus provision of mRDTs and artemether-lumefantrine (AL) when stocks ran low. Three rounds of Interviews were conducted with caregivers of children under five years of age as they exited health centers (N = 1400); reference mRDTs were done in children with fever (N = 1336). Health worker perspectives on mRDTs were elicited through semi-structured questionnaires (N = 49) and in-depth interviews (N = 10). The primary outcome was inappropriate treatment of malaria, defined as the proportion of febrile children who were not treated according to guidelines based on the reference mRDT. There was no difference in inappropriate treatment of malaria between the intervention and control arms (24.0% versus 29.7%, adjusted risk ratio 0.81 95\% CI: 0.56, 1.17 p = 0.24). Most children (76.0\%) tested positive by reference mRDT, but many were not prescribed AL (22.5\% intervention versus 25.9\% control, p = 0.53). Inappropriate treatment of children testing negative by reference mRDT with AL was also common (31.3\% invention vs 42.4\% control, p = 0.29). Health workers appreciated mRDTs but felt that integrating testing into practice was challenging given constraints on time and infrastructure. The PRIME intervention did not have the desired impact on inappropriate treatment of malaria for children under five. In this high transmission setting, use of mRDTs did not lead to the reductions in antimalarial prescribing seen elsewhere. Broader investment in health systems, including infrastructure and staffing, will be required to improve fever case management

Preliminary estimate of CO2 budget discharged from Vulcano island

Total CO2 output from fumaroles, soil gases, bubbling and water dissolved gases were estimated at Vulcano Island, Italy. The fumaroles output has been estimated from SO2 plume flux, while soil flux emission has been carried out through 730 CO2 fluxes measured on the island surface, performed by means of accumulation chamber method. Vulcano Island, located in the Aeolian Archipelago, is an active volcano that has been in state of solphataric activity, since the last eruption (1888-1890). At present, the main exhalative activity is in the northern part of the island, it is revealed by a wide fumaroles field, on the active edifice of “La Fossa” crater, (100°C <T<450°C); by low temperature fumaroles (T<100°C) and sea-bubbling gases in the Baia Levante area; moreover, strong soil degassing occurs in the Vulcano Porto area and around the volcanic edifice, where the active tectonic discontinuities drive CO2 to the surface. Finally, numerous carbon-rich thermal wells (up to 80°C) in the Vulcano Porto Area, testify the presence of a geothermal system with equilibrium temperature around 200°C. The preliminary results indicate an overall output of 470 T/day of CO2 from the island. The main contribution to the total output is from the summit area of the active cone (450 T/day), where 360 T/day and 90 T/day are from crater fumaroles and crater soil degassing, respectively. Peripheral areas release 8 T/day by soil degassing (Palizzi and Istmo areas mainly), a measure comparable to the contribution of water dissolved CO2 (estimated as 6 T/day) and higher than sea-bubbling CO2 (1 T/day measured in the Istmo area). The presented data (September 2007) refer to a period of moderate solphataric activity, when the highest temperature and gas/water ratio of fumaroles were 457°C and 0.17 respectively. These preliminary data allow the estimation of the background mass release and related thermal energy from the volcanic system. They represent the first complete data set, collected during moderate volcanic activity which can be compared to the new one acquired during subsequent (the next o future) evolution of the activity

The use of mediation analysis in evaluation of complex health interventions

This article presents an application of the causal inference approach to mediation analysis using the example of a complex intervention that aimed to improve the quality of care at health centres in Uganda. Mediation analysis is a statistical method that aims to isolate the causal mechanisms that make an intervention work in a given context. We combined data from a cluster randomized control trial and a mixed-methods process evaluation. We developed two causal models following our hypotheses of how the intervention was intended to work through mechanisms at health centres to improve health outcomes in the community. In adjusted analyses, there was evidence of an effect of the intervention on some health centre mechanisms; however, these did not lead to improvements in community health outcomes. We discuss the practical and epistemological challenges encountered when using mediation analysis to evaluate a complex intervention. These findings will inform future evaluations. Trial registration: The trial reported in this article is registered at: clinicaltrials.gov, NCT01024426. Registered 2 December 2009, https://clinicaltrials.gov/ct2/show/record/NCT01024426?term=NCT01024426&amp;draw=2&amp;rank=

Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone.

Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers' experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers' prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed

The Impact of an Intervention to Improve Malaria Care in Public Health Centers on Health Indicators of Children in Tororo, Uganda (PRIME): A Cluster-Randomized Trial.

Optimizing quality of care for malaria and other febrile illnesses is a complex challenge of major public health importance. To evaluate the impact of an intervention aiming to improve malaria case management on the health of community children, a cluster-randomized trial was conducted from 2010-2013 in Tororo, Uganda, where malaria transmission is high. Twenty public health centers were included; 10 were randomized in a 1:1 ratio to intervention or control. Households within 2 km of health centers provided the sampling frame for the evaluation. The PRIME intervention included training in fever case management using malaria rapid diagnostic tests (mRDTs), patient-centered services, and health center management; plus provision of mRDTs and artemether-lumefantrine. Cross-sectional community surveys were conducted at baseline and endline (N = 8,766), and a cohort of children was followed for approximately 18 months (N = 992). The primary outcome was prevalence of anemia (hemoglobin < 11.0 g/dL) in children under 5 years of age in the final community survey. The intervention was delivered successfully; however, no differences in prevalence of anemia or parasitemia were observed between the study arms in the final community survey or the cohort. In the final survey, prevalence of anemia in children under 5 years of age was 62.5% in the intervention versus 63.1% in control (adjusted risk ratio = 1.01; 95% confidence interval = 0.91-1.13; P = 0.82). The PRIME intervention, focusing on training and commodities, did not produce the expected health benefits in community children in Tororo. This challenges common assumptions that improving quality of care and access to malaria diagnostics will yield health gains

Continuous in situ measurements of volcanic gases with a diode-laser-based spectrometer: CO2 and H2O concentration and soil degassing at Vulcano (Aeolian islands: Italy)

We report on a continuous-measurement campaign carried out in Vulcano (Aeolian islands, Sicily), devoted to the simultaneous monitoring of CO2 and H2O concentrations. The measurements were performed with an absorption spectrometer based on a semiconductor laser source emitting around a 2-μm wavelength. The emitted radiation was selectively absorbed by two molecular ro-vibrational transitions specific of the investigated species. Data for CO2 and H2O concentrations, and CO2 soil diffusive flux using an accumulation chamber configuration, were collected at several interesting sampling points on the island (Porto Levante beach- PLB, Fossa Grande Crater – FOG- and Valley of Palizzi, PAL). CO2/H2O values, measured on the ground, are very similar (around 0.019 (± 0.006)) and comparable to the previous discrete detected values of 0.213 (Fumarole F5-La Fossa crater rim) and 0.012 (Fumarole VFS – Baia Levante beach) obtaid during the 1977–1993 heating phase of the crater fumaroles

Strengthening patient-centred communication in rural Ugandan health centres: A theory-driven evaluation within a cluster randomized trial.

This article describes a theory-driven evaluation of one component of an intervention to improve the quality of health care at Ugandan public health centres. Patient-centred services have been advocated widely, but such approaches have received little attention in Africa. A cluster randomized trial is evaluating population-level outcomes of an intervention with multiple components, including 'patient-centred services.' A process evaluation was designed within this trial to articulate and evaluate the implementation and programme theories of the intervention. This article evaluates one hypothesized mechanism of change within the programme theory: the impact of the Patient Centred Services component on health-worker communication. The theory-driven approach extended to evaluation of the outcome measures. The study found that the proximal outcome of patient-centred communication was rated 10 percent higher (p < 0.008) by care seekers consulting with the health workers who were at the intervention health centres compared with those at control health centres. This finding will strengthen interpretation of more distal trial outcomes

Hepatic P450 Enzyme Activity, Tissue Morphology and Histology of Mink (Mustela vison) Exposed to Polychlorinated Dibenzofurans

Dose- and time-dependent effects of environmentally relevant concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalents (TEQ) of 2,3,7,8-tetrachlorodibenzofuran (TCDF), 2,3,4,7,8-pentachlorodibenzofuran (PeCDF), or a mixture of these two congeners on hepatic P450 enzyme activity and tissue morphology, including jaw histology, of adult ranch mink were determined under controlled conditions. Adult female ranch mink were fed either TCDF (0.98, 3.8, or 20 ng TEQTCDF/kg bw/day) or PeCDF (0.62, 2.2, or 9.5 ng TEQPeCDF/kg bw/day), or a mixture of TCDF and PeCDF (4.1 ng TEQTCDF/kg bw/day and 2.8 ng TEQPeCDF/kg bw/day, respectively) for 180 days. Doses used in this study were approximately eight times greater than those reported in a parallel field study. Activities of the cytochrome P450 1A enzymes, ethoxyresorufin O-deethylase (EROD) and methoxyresorufin O-deethylase (MROD) were significantly greater in livers of mink exposed to TCDF, PeCDF, and a mixture of the two congeners; however, there were no significant histological or morphological effects observed. It was determined that EROD and MROD activity can be used as sensitive biomarkers of exposure to PeCDF and TCDF in adult female mink; however, under the conditions of this study, the response of EROD/MROD induction occurred at doses that were less than those required to cause histological or morphological changes