Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania

BACKGROUND: The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania. METHODS: Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10). RESULTS: While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment. CONCLUSIONS: Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged

Vision, challenges and opportunities for a Plant Cell Atlas

With growing populations and pressing environmental problems, future economies will be increasingly plant-based. Now is the time to reimagine plant science as a critical component of fundamental science, agriculture, environmental stewardship, energy, technology and healthcare. This effort requires a conceptual and technological framework to identify and map all cell types, and to comprehensively annotate the localization and organization of molecules at cellular and tissue levels. This framework, called the Plant Cell Atlas (PCA), will be critical for understanding and engineering plant development, physiology and environmental responses. A workshop was convened to discuss the purpose and utility of such an initiative, resulting in a roadmap that acknowledges the current knowledge gaps and technical challenges, and underscores how the PCA initiative can help to overcome them.</jats:p

The Effect of Suture Wick Technique on Early Intraocular Pressure Control After Nonvalved (Baerveldt 350) Glaucoma Drainage Device Surgery

Purpose: The purpose of this study was to compare early postoperative outcomes of patients who underwent Baerveldt 350-mm(2) aqueous drainage device (Abbott Medical Optics Inc., Santa Ana, CA) implantation with and without 7-0 polyglactin (vicryl) suture placement through tube fenestration to serve as a stenting wick. Methods: Patients were identified by a retrospective review of the electronic medical records of one attending surgeon's Baerveldt implantation (LWH) conducted by searching the Current Procedural Terminology code "placement of aqueous shunt." All patients had tube ligature with 7-0 vicryl suture and 6-0 prolene placed as a ripcord with 4 fenestrations. Thirty-seven patients had no vicryl wick while 38 patients had a stenting wick. Data were collected from the preoperative visit, postoperative day 1, postoperative week 3, postoperative week 5, and postoperative month 2. Results: Although intraocular pressure (IOP) and number of medications were reduced at every follow-up visit, there was no significant difference in IOP, percent reduction of IOP, number of medications, and visual acuity between patients with and without vicryl wick at each time point. Both groups also had comparable morbidity with no significant difference in ripcord removal, incidence of complications, or need for additional surgery. Conclusions: Baerveldt implantation with vicryl wick placement can safely lower IOP and medication burden but does not seem to offer additional utility to fenestration without vicryl wick

Cigarette smoke promotes drug resistance and expansion of cancer stem cell-like side population.

It is well known that many patients continue to smoke cigarettes after being diagnosed with cancer. Although smoking cessation has typically been presumed to possess little therapeutic value for cancer, a growing body of evidence suggests that continued smoking is associated with reduced efficacy of treatment and a higher incidence of recurrence. We therefore investigated the effect of cigarette smoke condensate (CSC) on drug resistance in the lung cancer and head and neck cancer cell lines A549 and UMSCC-10B, respectively. Our results showed that CSC significantly increased the cellular efflux of doxorubicin and mitoxantrone. This was accompanied by membrane localization and increased expression of the multi-drug transporter ABCG2. The induced efflux of doxorubicin was reversed upon addition of the specific ABCG2 inhibitor Fumitremorgin C, confirming the role of ABCG2. Treatment with CSC increased the concentration of phosphorylated Akt, while addition of the PI3K inhibitor LY294002 blocked doxorubicin extrusion, suggesting that Akt activation is required for CSC-induced drug efflux. In addition, CSC was found to promote resistance to doxorubicin as determined by MTS assays. This CSC-induced doxurbicin-resistance was mitigated by mecamylamine, a nicotinic acetylcholine receptor inhibitor, suggesting that nicotine is at least partially responsible for the effect of CSC. Lastly, CSC increased the size of the side population (SP), which has been linked to a cancer stem cell-like phenotype. In summary, CSC promotes chemoresistance via Akt-mediated regulation of ABCG2 activity, and may also increase the proportion of cancer stem-like cells, contributing to tumor resilience. These findings underscore the importance of smoking cessation following a diagnosis of cancer, and elucidate the mechanisms of continued smoking that may be detrimental to treatment

CSC treatment increases the side population in 10B cells.

<p>FACS-based Hoechst extrusion assay shows the size of side population (SP) in 10B cells incubated with two doses of CSC. The size of the SP increases with increasing dosage of CSC. Cells were incubated in 5 ug/ml of Hoechst for 90 min and then in DMEM w/CSC or normal DMEM for 24 hours.</p

CSC treatment increases doxorubicin efflux in cell lines 10B and A549.

<p>(<b>A</b>) 15 and 30 µg/mL cigarette smoke condensate (CSC) increases doxorubicin efflux in both cell lines 10B and A549 in a dose-dependent pattern. The specific ABCG2 inhibitor fumitremorgin C (FTC) is able to reverse the CSC-mediated increase in doxorubicin efflux. Percentage change was derived from flow cytometric analysis of median intracellular doxorubicin levels and calculated using the formula described in the <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0047919#s2" target="_blank">methods</a> section. (<b>B</b>) CSC increases doxorubicin efflux dose-dependently. Relative efflux gauged by comparing the differences in the median doxorubicin fluorescence channels of extrusion and no extrusion samples. Numerical label reflect the median channel of doxorubicin fluorescence as measured in one sample of flow cytometric analysis of intracellular doxorubicin levels in 10B. Although absolute fluorescence levels in the treated samples are higher due to fluorescence of CSC, the decrease from no extrusion to extrusion is greater for these samples compared to control.</p

CSC treatment induces the expression and membrane localization of ABCG2.

<p>(<b>A</b>) Immunofluorescence microscopy identifies the cellular localization of ABCG2 with and without CSC. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0047919#s3" target="_blank">Results</a> indicate that CSC exposure induces translocation of ABCG2 to the plasma membrane in 10B and A549. (<b>B</b>) Western blot analysis shows dose dependent increase in ABCG2 expression in response to CSC treatment.</p