Blooms of cyanobacteria in a temperate Australian lagoon system post and prior to European settlement

Blooms of noxious N2 fixing cyanobacteria such as Nodularia spumigena are a recurring problem in some estuaries; however, the historic occurrence of such blooms in unclear in many cases. Here we report the results of a palaeoecological study on a temperate Australian lagoon system (the Gippsland Lakes) where we used stable isotopes and pigment biomarkers in dated cores as proxies for eutrophication and blooms of cyanobacteria. Pigment proxies show a clear signal, with an increase in cyanobacterial pigments (echinenone, canthaxanthin and zeaxanthin) in the period coinciding with recent blooms. Another excursion in these proxies was observed prior to the opening of an artificial entrance to the lakes in 1889, which markedly increased the salinity of the Gippsland Lakes. A coincident increase in the sediment organic-carbon content in the period prior to the opening of the artificial entrance suggests that the bottom waters of the lakes were more stratified and hypoxic, which would have led to an increase in the recycling of phosphorus. After the opening of the artificial entrance, there was a  ∼  60-year period with low values for the cyanobacterial proxies as well as a low sediment organic-carbon content suggesting a period of low bloom activity associated with the increased salinity of the lakes. During the 1940s, the current period of re-eutrophication commenced, as indicated by a steadily increasing sediment organic-carbon content and cyanobacterial pigments. We suggest that increasing nitrogen inputs from the catchment led to the return of hypoxia and increased phosphorus release from the sediment, which drove the re-emergence of cyanobacterial blooms

The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study

Background Antenatal care (ANC) has been recognised as a way to improve health outcomes for pregnant women and their babies. However, only 29% of pregnant women receive the recommended four antenatal visits in Nepal but reasons for such low utilisation are poorly understood. As in many countries of South Asia, mothers-in-law play a crucial role in the decisions around accessing health care facilities and providers. This paper aims to explore the mother-in-law’s role in (a) her daughter-in-law’s ANC uptake; and (b) the decision-making process about using ANC services in Nepal. Methods In-depth interviews were conducted with 30 purposively selected antenatal or postnatal mothers (half users, half non-users of ANC), 10 husbands and 10 mothers-in-law in two different (urban and rural) communities. Results Our findings suggest that mothers-in-law sometime have a positive influence, for example when encouraging women to seek ANC, but more often it is negative. Like many rural women of their generation, all mothers-in-law in this study were illiterate and most had not used ANC themselves. The main factors leading mothers-in-law not to support/ encourage ANC check ups were expectations regarding pregnant women fulfilling their household duties, perceptions that ANC was not beneficial based largely on their own past experiences, the scarcity of resources under their control and power relations between mothers-in-law and daughters-in-law. Individual knowledge and social class of the mothers-in-law of users and non-users differed significantly, which is likely to have had an effect on their perceptions of the benefits of ANC. Conclusion Mothers-in-law have a strong influence on the uptake of ANC in Nepal. Understanding their role is important if we are to design and target effective community-based health promotion interventions. Health promotion and educational interventions to improve the use of ANC should target women, husbands and family members, particularly mothers-in-law where they control access to family resources

Accidents involving pedestrians with their backs to traffic or facing traffic: an evaluation of crash characteristics and injuries.

This paper examines pedestrian anatomical injuries and crash characteristics in back-to-traffic and facing-traffic crashes. Pedestrian crashes involving pedestrians walking along streets (i.e. with their backs to traffic or facing traffic) have been overlooked in literature. Although this is not the most frequent type of crash, the crash consequence to pedestrians is a safety concern. Combining Taiwan A1A2 police-reported accident data and data from the National Health Insurance Database from years 2003–2013, this paper examines anatomical injuries and crash characteristics in back-to-traffic and facing-traffic crashes. There were a total of 830 and 2267 pedestrian casualties in back-to-traffic and facing-traffic crashes respectively. The injuries sustained by pedestrians and crash characteristics of these two crash types were compared with those of other crossing types of crashes (nearside crash, nearside dart-out crash, offside crash, and offside dart-out crash). Odds of various injuries to body regions were estimated using logistic regressions. Key findings include that the percentage of fatalities in back-to-traffic crashes is the highest; logistic models reveal that pedestrians in back-to-traffic crashes sustained more head, neck, and spinal injuries than did pedestrians in other crash types, and unlit darkness and non-built-up roadways were associated with an increased risk of pedestrian head injuries. Several crash features (e.g. unlit darkness, overtaking manoeuvres, phone use by pedestrians and drivers, and intoxicated drivers) are more frequently evident in back-to-traffic crashes than in other types of crashes. The current research suggests that in terms of crash consequence, facing traffic is safer than back to traffic

Maternal health in resource-poor urban settings: how does women's autonomy influence the utilization of obstetric care services?

Background: Despite various international efforts initiated to improve maternal health, morethan half a million women worldwide die each year as a result of complications arising frompregnancy and childbirth. This research was guided by the following questions: 1) How doeswomen's autonomy influence the choice of place of delivery in resource-poor urban settings? 2)Does its effect vary by household wealth? and 3) To what extent does women's autonomy mediatethe relationship between women's education and use of health facility for delivery?Methods: The data used is from a maternal health study carried out in the slums of Nairobi, Kenya.A total of 1,927 women (out of 2,482) who had a pregnancy outcome in 2004–2005 were selectedand interviewed. Seventeen variable items on autonomy were used to construct women's decisionmaking,freedom of movement, and overall autonomy. Further, all health facilities serving the studypopulation were assessed with regard to the number, training and competency of obstetric staff;services offered; physical infrastructure; and availability, adequacy and functional status of suppliesand other essential equipment for safe delivery, among others. A total of 25 facilities weresurveyed.Results: While household wealth, education and demographic and health covariates had strongrelationships with place of delivery, the effects of women's overall autonomy, decision-making andfreedom of movement were rather weak. Among middle to least poor households, all threemeasures of women's autonomy were associated with place of delivery, and in the expecteddirection; whereas among the poorest women, they were strong and counter-intuitive. Finally, thestudy showed that autonomy may not be a major mediator of the link between education and useof health services for delivery.Conclusion: The paper argues in favor of broad actions to increase women's autonomy both asan end and as a means to facilitate improved reproductive health outcomes. It also supports thecall for more appropriate data that could further support this line of action. It highlights the needfor efforts to improve households' livelihoods and increase girls' schooling to alter perceptions ofthe value of skilled maternal health care

Female autonomy and child nutritional status: The extended-family residential unit in Amman, Jordan

This study explores the hypothesis that the mother's position within household power relations--her autonomy with respect to other household members--influences her ability to provide for the health of her children. We argue that in the context of the Arab Middle East, a woman's structural position within the household is a good indicator of her relative autonomy: if she if the daughter-in-law in a vertically extended residential unit, she has less autonomy than if she is head or co-head of household. Our analysis is based on data collected from 1341 households in 1985 as a part of the Follow-up Health and Population Assessment of four urban settlements in Amman, Jordan. They include measures of the child's weight and age, plus a variety of socioeconomic factors. We analyze the effect of the mother's autonomy on child nutritional status within a multiple regression framework that controls for rival hypotheses. In particular, we investigate whether it is the availability of other potential child-care substitutes, particularly the grandmother, that influences child nutrition rather than household structure. We also look at household income, mother's education, the area of residence, and the child's sex. Our results show a strong negative influence associated with having a mother whose autonomy in the household is low. This effect does not disappear when mother's age and education, and household size and composition are taken into consideration. Nor is it a proxy for the higher household incomes characteristics of extended-family residential units with their multiple earners.female autonomy preschool nutrition extended family Jordan

Women's work and infant care in the Philippines

Using data from a survey of 3000 Filipino infants and mothers, we analyze the implications of having more than one preschooler on several work outcomes, as well as the effect of availability of substitute care givers. The work outcomes of interest are those thought to be least compatible with infant care: work outside the home, wage work remunerated on a time basis, and long working hours. Our findings suggest that having multiple preschoolers only makes a difference for mothers whose household income is below the median: it increases their likelihood of working outside the home. Grandmothers and paid helpers consistently increase the likelihood of the various work outcomes and increase hours worked. Our findings suggest that urban residence, an indicator of work opportunity structure, increase the likelihood of wage-time work and is associated with longer working hours.child care women's work job compatibility Philippines

Very late onset LASIK flap Acremonium fungal keratitis confirmed by metagenomic deep sequencing.

Purpose: To describe a unique case of LASIK flap fungal keratitis confirmed by next generation sequencing. Observations: A 56-year-old female presented with refractory keratitis involving her LASIK flap 21 years after surgery. Confocal was positive for filamentous structures. The patient underwent immediate flap amputation followed by topical antifungal treatment. Corneal culture was positive for Acremonium sp. Metagenomic deep sequencing confirmed Acremonium as the primary source of infection and also identified Fusarium as a likely contributor of a mixed fungal infection. Sequencing also identified hay as the likely source of the infection. Treatment resulted in eradication of the infection. The patients final best corrected visual acuity was 20/30 with rigid contact lens overrefraction. Conclusions: Metagenomic deep sequencing is a novel diagnostic tool that is increasingly being utilized for diagnosis of refractory keratitis. This case demonstrates the diagnostic potential of deep sequencing for identifying post-LASIK keratitis and reinforces the utility of LASIK flap amputation in the setting of tectonic flap instability due to keratolysis. Importance: This case highlights several important clinical points for treating LASIK flap keratitis and highlights the emerging role metagenomic sequencing has in the diagnosis of infectious keratitis. This is first known case using next generation sequencing to diagnose a post-LASIK infectious keratitis