Home delivery in Southern Lao PDR: challenges to achieving MDG 4 & 5 targets

This study investigated rural Lao PDR village women\u27s views and experiences of&nbsp;recent, or impeding, childbirth to better understand barriers to maternity service&nbsp;usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East&nbsp;Asian region with very low utilization rates for skilled birth assistance and health&nbsp;sector delivery services. The study site, Sekong, a southern Lao province, was&nbsp;lowest in the country on virtually all indicators of reproductive and maternal&nbsp;health, despite several recent maternal health service interventions. The study\u27s&nbsp;aim was to gain a fuller understanding of barriers to maternity services usage to&nbsp;contribute towards maternity services enhancement, and district and national&nbsp;policy-making for progressing towards 2015 MDG 4 &amp; 5 targets.&nbsp;A descriptive cross-sectional study was used. First, face-to-face questionnaires&nbsp;were used to collect demographic and reproductive health and health care&nbsp;experience data from 166 village woman (120 with a child born in the previous&nbsp;year, and 46 who were currently pregnant). In- epth individual interviews then&nbsp;followed with 23 purposively selected woman, to probe personal experiences and&nbsp;perspectives on why women preferred home birthing.The majority of women had given birth at home, assisted by untrained birth&nbsp;attendants (relatives or neighbours). While seventy percent had accessed some&nbsp;antenatal services, postpartum follow-up attendance was very low (17 percent).&nbsp;Limited finances, lack of access to transport and prior negative health service&nbsp;experiences were important factors influencing women\u27s decision making. Giving&nbsp;birth at home was seen by many, not just as unavoidable, but, as the preferred&nbsp;option.Recent top-down maternal health initiatives have had little impact in this region.&nbsp;Improving maternal and child-health strategies requires much greater community&nbsp;participation and use of participatory action methodologies, to increase women\u27s&nbsp;engagement in policy and planning and subsequent usage of health service&nbsp;developments.&nbsp;</div

Effects of model chemistry and data biases on stratospheric ozone assimilation

The innovations or observation minus forecast (O&amp;ndash;F) residuals produced by a data assimilation system provide a convenient metric of evaluating global analyses. In this study, O&amp;ndash;F statistics from the Global Ozone Assimilation Testing System (GOATS) are used to examine how ozone assimilation products and their associated O&amp;ndash;F statistics depend on input data biases and ozone photochemistry parameterizations (OPP). All the GOATS results shown are based on a 6-h forecast and analysis cycle using observations from SBUV/2 (Solar Backscatter UltraViolet instrument-2) during September&amp;ndash;October 2002. Results show that zonal mean ozone analyses are more independent of observation biases and drifts when using an OPP, while the mean ozone O&amp;ndash;Fs are more sensitive to observation drifts when using an OPP. In addition, SD O&amp;ndash;Fs (standard deviations) are reduced in the upper stratosphere when using an OPP due to a reduction of forecast model noise and to increased covariance between the forecast model and the observations. Experiments that changed the OPP reference state to match the observations by using an &quot;adaptive&quot; OPP scheme reduced the mean ozone O&amp;ndash;Fs at the expense of zonal mean ozone analyses being more susceptible to data biases and drifts. Additional experiments showed that the upper boundary of the ozone DAS can affect the quality of the ozone analysis and therefore should be placed well above (at least a scale height) the region of interest

Imaging gravity waves in lower stratospheric AMSU-A radiances, Part 2: Validation case study

Two-dimensional radiance maps from Channel 9 (~60&ndash;90 hPa) of the Advanced Microwave Sounding Unit (AMSU-A), acquired over southern Scandinavia on 14 January 2003, show plane-wave-like oscillations with a wavelength &lambda;_<i>h</i> of ~400&ndash;500 km and peak brightness temperature amplitudes of up to 0.9 K. The wave-like pattern is observed in AMSU-A radiances from 8 overpasses of this region by 4 different satellites, revealing a growth in the disturbance amplitude from 00:00 UTC to 12:00 UTC and a change in its horizontal structure between 12:00 UTC and 20:00 UTC. Forecast and hindcast runs for 14 January 2003 using high-resolution global and regional numerical weather prediction (NWP) models generate a lower stratospheric mountain wave over southern Scandinavia with peak 90 hPa temperature amplitudes of ~5&ndash;7 K at 12:00 UTC and a similar horizontal wavelength, packet width, phase structure and time evolution to the disturbance observed in AMSU-A radiances. The wave&apos;s vertical wavelength is ~12 km. These NWP fields are validated against radiosonde wind and temperature profiles and airborne lidar profiles of temperature and aerosol backscatter ratios acquired from the NASA DC-8 during the second SAGE III Ozone Loss and Validation Experiment (SOLVE II). Both the amplitude and phase of the stratospheric mountain wave in the various NWP fields agree well with localized perturbation features in these suborbital measurements. In particular, we show that this wave formed the type II polar stratospheric clouds measured by the DC-8 lidar. To compare directly with the AMSU-A data, we convert these validated NWP temperature fields into swath-scanned brightness temperatures using three-dimensional Channel 9 weighting functions and the actual AMSU-A scan patterns from each of the 8 overpasses of this region. These NWP-based brightness temperatures contain two-dimensional oscillations due to this resolved stratospheric mountain wave that have an amplitude, wavelength, horizontal structure and time evolution that closely match those observed in the AMSU-A data. These comparisons not only verify gravity wave detection and horizontal imaging capabilities for AMSU-A Channel 9, but provide an absolute validation of the anticipated radiance signals for a given three-dimensional gravity wave, based on the modeling of Eckermann and Wu (2006)

Efficacy of psychosocial intervention in patients with mild Alzheimer's disease:the multicentre, rater blinded, randomised Danish Alzheimer Intervention Study (DAISY)

Objective To assess the efficacy at 12 months of an early psychosocial counselling and support programme for outpatients with mild Alzheimer’s disease and their primary care givers. Design Multicentre, randomised, controlled, rater blinded trial. Setting Primary care and memory clinics in five Danish districts. Participants 330 outpatients with mild Alzheimer’s disease and their 330 primary care givers. Interventions Participating dyads (patient and primary care giver) were randomised to control support during follow-up or to control support plus DAISY intervention (multifaceted and semi-tailored counselling, education, and support). Main outcome measures Primary outcomes at 12 months for patients were change from baseline in mini mental state examination (MMSE) score, Cornell depression scale score, and proxy rated European quality of life visual analogue scale (EQ-VAS) score. For care givers, outcomes were change from baseline in geriatric depression scale (GDS 30 items) score and EQ-VAS score. Results Because of multiple testing, statistical significance was set at an adjusted P limit of <0.0005. At 12 months there were no significant differences between the two allocation groups in changes from baseline in the primary and secondary outcomes. However, although non-significant with the adjusted P limit, a small difference was observed for one of the primary patient outcomes (Cornell depression scale score) in patients in favour of the DAISY intervention group before and after adjusting for attrition (P=0.0146 and P=0.0103 respectively). Conclusions The multifaceted, semi-tailored intervention with counselling, education, and support for patients with mild Alzheimer’s disease and their care givers did not have any significant effect beyond that with well structured follow-up support at 12 months after adjustment for multiple comparisons. The small positive effect found in the unadjusted primary outcome addressing depressive symptoms in patients may call for further research focusing on patients with Alzheimer’s disease and comorbid depression. Trial registration ISRCTN74848736

Fasudil attenuates aggregation of α-synuclein in models of Parkinson’s disease

Parkinson's disease (PD) is the most common neurodegenerative movement disorder, yet disease-modifying treatments do not currently exist. Rho-associated protein kinase (ROCK) was recently described as a novel neuroprotective target in PD. Since alpha-synuclein (alpha-Syn) aggregation is a major hallmark in the pathogenesis of PD, we aimed to evaluate the anti-aggregative potential of pharmacological ROCK inhibition using the isoquinoline derivative Fasudil, a small molecule inhibitor already approved for clinical use in humans. Fasudil treatment significantly reduced alpha-Syn aggregation in vitro in a H4 cell culture model as well as in a cell-free assay. Nuclear magnetic resonance spectroscopy analysis revealed a direct binding of Fasudil to tyrosine residues Y133 and Y136 in the C-terminal region of alpha-Syn. Importantly, this binding was shown to be biologically relevant using site-directed mutagenesis of these residues in the cell culture model. Furthermore, we evaluated the impact of long-term Fasudil treatment on alpha-Syn pathology in vivo in a transgenic mouse model overexpressing human alpha-Syn bearing the A53T mutation (alpha-Syn(A53T) mice). Fasudil treatment improved motor and cognitive functions in alpha-Syn(A53T) mice as determined by Catwalk (TM) gait analysis and novel object recognition (NOR), without apparent side effects. Finally, immunohistochemical analysis revealed a significant reduction of alpha-Syn pathology in the midbrain of alpha-Syn(A53T) mice after Fasudil treatment. Our results demonstrate that Fasudil, next to its effects mediated by ROCK-inhibition, directly interacts with alpha-Syn and attenuates alpha-Syn pathology. This underscores the translational potential of Fasudil as a disease-modifying drug for the treatment of PD and other synucleinopathies

Primary demyelination induced by exposure to tellurium alters Schwann cell gene expression: a model for intracellular targeting of NGF receptor

Exposure of developing rats to tellurium results in a highly synchronous segmental demyelination of peripheral nerves with sparing of axons; this demyelination is followed closely by a period of rapid remyelination. Demyelination occurs subsequent to a tellurium-induced block in the synthesis of cholesterol, the major myelin lipid. We utilized the techniques of Northern blotting, in situ hybridization, and immunocytochemistry to examine temporal alterations in Schwann cell gene expression related to demyelination and remyelination. Tellurium- induced demyelination is associated with downregulation of myelin protein expression and a corresponding upregulation of NGF receptor (NGF-R) and glial fibrillary acidic protein (GFAP) expression. Steady- state mRNA levels (expressed on a “per nerve” basis) for P0, the major myelin protein, were decreased by about 50% after 5 d of tellurium exposure, while levels of mRNA for NGF-R and GFAP were markedly increased (about 15-fold). In situ hybridization of teased fibers suggested that the increase in steady-state mRNA levels for NGF-R was primarily associated with demyelinated internodes and not with adjacent unaffected internodes. Although P0 message was almost totally absent from demyelinating internodes, it was also reduced in normal-appearing internodes as well. This suggests that limiting the supply of a required membrane component (cholesterol) may lead to partial downregulation of myelin gene expression in all myelinating Schwann cells. In partially demyelinated internodes, NGF-R and GFAP immunofluorescence appeared largely confined to the demyelinated regions. This suggests specific targeting of these proteins to local areas of the Schwann cell where there is myelin loss. These results demonstrate that demyelination is associated with reversion of the affected Schwann cells to a precursor cell phenotype. Because axons remain intact, our results suggest that these changes in Schwann cell gene expression do not require input from a degenerating axon, but instead may depend on whether concerted synthesis of myelin is occurring

First tomographic observations of gravity waves by the infrared limb imager GLORIA

Atmospheric gravity waves are a major cause of uncertainty in atmosphere general circulation models. This uncertainty affects regional climate projections and seasonal weather predictions. Improving the representation of gravity waves in general circulation models is therefore of primary interest. In this regard, measurements providing an accurate 3-D characterization of gravity waves are needed. Using the Gimballed Limb Observer for Radiance Imaging of the Atmosphere (GLORIA), the first airborne implementation of a novel infrared limb imaging technique, a gravity wave event over Iceland was observed. An air volume disturbed by this gravity wave was investigated from different angles by encircling the volume with a closed flight pattern. Using a tomographic retrieval approach, the measurements of this air mass at different angles allowed for a 3-D reconstruction of the temperature and trace gas structure. The temperature measurements were used to derive gravity wave amplitudes, 3-D wave vectors, and direction-resolved momentum fluxes. These parameters facilitated the backtracing of the waves to their sources on the southern coast of Iceland. Two wave packets are distinguished, one stemming from the main mountain ridge in the south of Iceland and the other from the smaller mountains in the north. The total area-integrated fluxes of these two wave packets are determined. Forward ray tracing reveals that the waves propagate laterally more than 2000 km away from their source region. A comparison of a 3-D ray-tracing version to solely column-based propagation showed that lateral propagation can help the waves to avoid critical layers and propagate to higher altitudes. Thus, the implementation of oblique gravity wave propagation into general circulation models may improve their predictive skills

The Deep Propagating Gravity Wave Experiment (DEEPWAVE): An airborne and ground-based exploration of gravity wave propagation and effects from their sources throughout the lower and middle atmosphere

The Deep Propagating Gravity Wave Experiment (DEEPWAVE) was designed to quantify gravity wave (GW) dynamics and effects from orographic and other sources to regions of dissipation at high altitudes. The core DEEPWAVE field phase took place from May through July 2014 using a comprehensive suite of airborne and ground-based instruments providing measurements from Earth’s surface to ∼100 km. Austral winter was chosen to observe deep GW propagation to high altitudes. DEEPWAVE was based on South Island, New Zealand, to provide access to the New Zealand and Tasmanian “hotspots” of GW activity and additional GW sources over the Southern Ocean and Tasman Sea. To observe GWs up to ∼100 km, DEEPWAVE utilized three new instruments built specifically for the National Science Foundation (NSF)/National Center for Atmospheric Research (NCAR) Gulfstream V (GV): a Rayleigh lidar, a sodium resonance lidar, and an advanced mesosphere temperature mapper. These measurements were supplemented by in situ probes, dropsondes, and a microwave temperature profiler on the GV and by in situ probes and a Doppler lidar aboard the German DLR Falcon. Extensive ground-based instrumentation and radiosondes were deployed on South Island, Tasmania, and Southern Ocean islands. Deep orographic GWs were a primary target but multiple flights also observed deep GWs arising from deep convection, jet streams, and frontal systems. Highlights include the following: 1) strong orographic GW forcing accompanying strong cross-mountain flows, 2) strong high-altitude responses even when orographic forcing was weak, 3) large-scale GWs at high altitudes arising from jet stream sources, and 4) significant flight-level energy fluxes and often very large momentum fluxes at high altitudes