Monitoring and modeling of household air quality related to use of different Cookfuels in Paraguay.

In Paraguay, 49% of the population depends on biomass (wood and charcoal) for cooking. Residential biomass burning is a major source of fine particulate matter (PM2.5 ) and carbon monoxide (CO) in and around the household environment. In July 2016, cross-sectional household air pollution sampling was conducted in 80 households in rural Paraguay. Time-integrated samples (24 hours) of PM2.5 and continuous CO concentrations were measured in kitchens that used wood, charcoal, liquefied petroleum gas (LPG), or electricity to cook. Qualitative and quantitative household-level variables were captured using questionnaires. The average PM2.5 concentration (μg/m3 ) was higher in kitchens that burned wood (741.7 ± 546.4) and charcoal (107.0 ± 68.6) than in kitchens where LPG (52.3 ± 18.9) or electricity (52.0 ± 14.8) was used. Likewise, the average CO concentration (ppm) was higher in kitchens that used wood (19.4 ± 12.6) and charcoal (7.6 ± 6.5) than in those that used LPG (0.5 ± 0.6) or electricity (0.4 ± 0.6). Multivariable linear regression was conducted to generate predictive models for indoor PM2.5 and CO concentrations (predicted R2  = 0.837 and 0.822, respectively). This study provides baseline indoor air quality data for Paraguay and presents a multivariate statistical approach that could be used in future research and intervention programs

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)

In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. For example, a key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process versus those that measure fl ux through the autophagy pathway (i.e., the complete process including the amount and rate of cargo sequestered and degraded). In particular, a block in macroautophagy that results in autophagosome accumulation must be differentiated from stimuli that increase autophagic activity, defi ned as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (inmost higher eukaryotes and some protists such as Dictyostelium ) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the fi eld understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. It is worth emphasizing here that lysosomal digestion is a stage of autophagy and evaluating its competence is a crucial part of the evaluation of autophagic flux, or complete autophagy. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused on these processes. These guidelines are not meant to be a formulaic set of rules, because the appropriate assays depend in part on the question being asked and the system being used. In addition, we emphasize that no individual assay is guaranteed to be the most appropriate one in every situation, and we strongly recommend the use of multiple assays to monitor autophagy. Along these lines, because of the potential for pleiotropic effects due to blocking autophagy through genetic manipulation it is imperative to delete or knock down more than one autophagy-related gene. In addition, some individual Atg proteins, or groups of proteins, are involved in other cellular pathways so not all Atg proteins can be used as a specific marker for an autophagic process. In these guidelines, we consider these various methods of assessing autophagy and what information can, or cannot, be obtained from them. Finally, by discussing the merits and limits of particular autophagy assays, we hope to encourage technical innovation in the field

Stacked: In Their Favour? The Complexities of Fuel Stacking and Cooking Transitions in Cambodia, Myanmar, and Zambia

It remains unclear whether the decision to cook with both polluting and cleaner-burning fuels (‘fuel stacking’) serves as a transition phase towards the full adoption of clean-cooking practices, or whether stacking allows households to enhance fuel security and choose from a variety of cooking technologies and processes. This paper offers a unique contribution to the debate by positioning fuel stacking as the central research question in the exploration of existing household survey data. This research analyses the World Bank’s Multi-Tier Framework survey data concerning energy access and cooking practices in Cambodia, Myanmar, and Zambia. Its novel approach uses fuel expenditure data to group urban households according to the intensity of biomass consumption (wood, charcoal) relative to modern fuel consumption (electricity, gas). The research explores how different fuel-stacking contexts are associated with factors related to household finances, composition, experiences of electricity, and attitudes towards modern fuels. This study shows the diversity of characteristics and behaviours associated with fuel stacking in urban contexts, thus demonstrating the need for fuel stacking to feature prominently in future data collection activities. The paper ends with five key recommendations for further research into fuel stacking and its role in clean-cooking transitions

eCooking: challenges and opportunities from a consumer behaviour perspective.

New opportunities are opening for electric cooking (eCooking) as a cost-effective, practical and desirable solution to the twin global challenges of clean cooking and electrification. Globally, momentum is building behind the transformative potential of eCooking to achieve a range of environmental and social impacts. However, cooking is a complex, culturally embedded practice, that results in an array of behavioural change challenges that must be understood and overcome for these new opportunities to translate into impact at scale. The Modern Energy Cooking Services (MECS) programme was designed to explore this space and pilot innovative new eCooking services with the potential to rapidly scale. This paper reflects upon the programme’s key learnings to date on the behavioural change dimension of eCooking. It consolidates what we now know on the subject and highlights the gaps that remain, where further investigation is needed. The evidence shows that the uptake of eCooking can be hindered by (often false) perceptions around cost, taste and safety, the high cost and steep learning curve for new appliances, the lack of awareness/availability/after-sales service for energy-efficient appliances and the reluctance of male decision-makers to authorise appliance purchases. However, it also shows that the convenience and potential cost savings offered by energy-efficient appliances can offer an aspirational cooking experience and that uptake could be driven forward rapidly by urbanisation and changing lifestyles

Afecciones respiratorias por el uso de leña y carbón en comunidades de Paraguay

Introducción: El uso de combustibles sólidos está asociado con más de 4 millones de muertes prematuras anuales en el mundo, especialmente de mujeres y niños. El uso del carbón y la leña son todavía muy prevalentes en Paraguay donde el 21% de la población urbana y 71% de la población rural utilizan estos combustibles para cocinar.   Objetivo: describir el uso de energía en los hogares de dos comunidades en Paraguay, una semi urbana y una rural.   Metodología: Se trata de un estudio de tipo descriptivo y de corte transverso que se realizó por medio de una encuesta en 250 casas seleccionadas aleatoriamente.   Resultados: El análisis de los datos obtenidos muestra que más del 74% de los hogares usan carbón vegetal, ya sea como combustible principal o secundario, el gas licuado del petróleo (GLP) es más usado en la comunidad semiurbana (59% > 43%) y la leña es más usada en la comunidad rural (49.6% >22.8%). El uso de leña implica un mayor tiempo destinado a la recolección, acondicionamiento y cocinado de alimentos. El uso de leña y carbón se hace predominantemente al aire libre (84% de los hogares) en cocinas sin chimenea. Se encontró una mayor prevalencia de enfermedades respiratorias en los hogares que utilizan carbón o leña (45%> 29%). El uso de electricidad para cocinar no es muy prevalente (únicamente el 7% lo usa como combustible principal).   Conclusión: El uso de carbón y leña en los hogares del Paraguay es alto lo que tiene repercusiones en la salud y favorece las condiciones de inequidad social en el país. Se considera que una buena alternativa al uso de biomasa en Paraguay sería la electricidad, debido a que cuenta con grandes recursos hidroeléctricos y la red eléctrica cubre a casi la totalidad de la población (99%).   Conflicto de interés: Los autores declaran no poseer conflicto de interés. Recibido: 12/04/2018. Aceptado: 26/04/201