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Zusammenfassung Einleitung Einzel nukleotid polymorphismen (SNPs) im Cardiomyopathy-Associated Protein 5 (CMYA5)-Gen wurden in genomweiten Assoziationsstudien mit rheumatoider Arthritis (RA) in Verbindung gebracht. In dieser Studie wollten wir die Assoziation zwischen CMYA5-Genpolymorphismen und RA in unabhängigen kaukasischen Fall-Kontroll-Kohorten replizieren und eine Metaanalyse durchführen, um die Assoziation von CMYA5-Genpolymorphismen mit RA in kaukasischen Populationen zu untersuchen. Methoden Wir analysierten 2731 RA-Fälle und 1783 gesunde Kontrollen in vier unabhängigen kaukasischen Probensätzen. rs4704591 im CMYA5-Gen wurden unter Verwendung des TaqMan SNP-Genotypisierungsassays genotypisiert. Die Metaanalyse wurde über kaukasische Kohorten hinweg durchgeführt. Ergebnisse Unsere Analyse ergab keine Hinweise auf eine Assoziation von rs4704591 mit RA in den Replikationsprobensätzen (P=0,941, OR=0,997). Die Metaanalyse zeigte eine schwache Assoziation zwischen dem kleinen Allel der CMYA5-Variante rs4704591 (C) und RA in den kombinierten RA-Kohorten (P=0,023, OR=0,938) unter Verwendung des logistischen Regressionsmodells in der Matched-Case-Control-Studie. Schlussfolgerung Unsere Studie war nicht erfolgreich darin, die Assoziation der CMYA5-Variante rs4704591 mit RA zu replizieren. Daher können wir die Assoziation zwischen CMYA5-Genpolymorphismen und RA in der kaukasischen Bevölkerung nicht bestätigen.

This article offers the first publication of the mummified remains of two tattooed women in conjunction with three unpublished figurines with tattoo motifs from Deir el-Medina. Several recurrent motifs are shared between these women and the figurines, including the use of Bes-images, Nilotic elements, and points at the neck. These themes also appear in previously published tattooed figurines, so-called cosmetic spoons, and paintings. In some cases, the figurines and the women even share the same location of the tattoos on their body, suggesting that the combined location and tattoo motifs are integral to their function and/or meaning. Through linking tattooing on human remains with figurines, our work evaluates when we can interpret markings on figurines as tattooing while also exploring potential explanations for the tattoo motifs. To do so, we connect these new examples with texts and material culture that would have been accessible to the people of Deir el-Medina.

PurposeSixteen million adolescents give birth each year, constituting 11% of all births worldwide. Adverse adolescent pregnancy outcomes are well-documented. Available data on adolescent pregnancies have mainly relied on self-reported age and retrospective survey data, which might not capture adolescent births accurately. This paper reports on trends in adolescent pregnancy and associated adverse birth outcomes in Matlab, Bangladesh, using data from the Matlab Heath and Demographic System (HDSS) which precisely documents maternal age.Design/methodology/approachThe study was conducted in the rural subdistrict of Matlab in Bangladesh. HDSS data were used to examine trends in adolescent motherhood (10–19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) service areas (ISA) and government service areas (GSA) between 2007 and 2015. A total of 4,996 adolescent mothers were included in the analysis. Chi-square testing and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death.FindingsThe fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 years of the study period. The adjusted odd of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69. Significant determinants of perinatal death among adolescent mothers included maternal education, paternal education, mother’s age at first birth, asset score and distance from the nearest health facility.Originality/valueThis paper documents the real trend of adolescent pregnancy by capturing the accurate age at pregnancy for the first time in Bangladesh.

This study combines caries and antemortem tooth loss rates with possible dental interventions and medical texts to evaluate whether dentistry was practiced in Pharaonic Egypt.The study includes 32 mandibles and 44 maxillae consisting of 485 teeth and 1052 tooth sockets. It includes 14 Egyptian texts on dental treatments.Human remains were observed macroscopically for carious lesions and antemortem tooth loss. Egyptian texts were translated from photographs.11 % of teeth were lost antemortem and 42 % of maxillae and mandibles had one or more teeth lost antemortem. One possible dental extraction is presented. Carious lesions were present in 10 % of teeth and 39 % of mandibles and maxillae. One example of a possible dental filling is presented. Two treatments from Papyrus Ebers discuss treatments to fill a tooth.AMTL and carious lesions were common in this sample, especially in older adults. The possible presence of a dental extraction and a dental filling in combination with textual references to dental fillings indicate dental interventions were sometimes used to manage dental health in Egypt.This study is the earliest evidence in Egypt for a dental filling in human remains. It also offers an interdisciplinary analysis of dental treatments that indicates, contrary to earlier publications, that dental interventions were practiced in Egypt during the New Kingdom.The poor dental health of many Egyptian populations makes it impossible to assess how frequently Egyptians used dental interventions.Future analysis of the dental filling could help determine its composition.

La campagne 2020 de la mission Ifao a Deir el-Medina s'est deroulee du 5 janvier au 1er mars sous la direction de Cedric Larcher. Nous remercions le Prof. Dr Khaled el-Enany, ministre du Tourisme et des Antiquites, le Dr Mostafa Waziri, secretaire general du Conseil supreme des antiquites, le Dr Nashwa Gaber, directrice des missions etrangeres et des commissions permanentes, le Dr Mohamed Yahya, directeur general des Antiquites de Haute Egypte, ...

The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC); both include the administration of oxytocin. Traditional parenteral oxytocin administration requires a consistent cold chain and for a skilled attendant to administer the injection. Inhaled oxytocin (IHO), which does not require a cold chain, has been shown to have similar efficacy to parenteral oxytocin, in preventing PPH. In Bangladesh there are non-functioning institutionalized guidelines from the Director General of Health Services on the storage of parenteral oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to consider replacing parenteral oxytocin with IHO, as the cold chain capacity in Bangladesh is strained, and institutional guidelines for injectable oxytocin are not used. In parallel, Bangladesh should also continue efforts to ensure universal access to quality AMSTL and CEmOC services.

La mission a debute plus tard que prevu, car les autorisations de la Securite ont ete delivrees fin janvier, deux semaines apres la date du 15 janvier fixee pour l’ouverture de la mission. Faute de temps, certaines equipes n’ont pas reussi a atteindre leurs objectifs. La mission a poursuivi les travaux engages en 2018 axes sur l’etude et la restauration des tombes de la necropole de l’ouest et du mobilier conserve dans les magasins du si...

The study conducted in a rural sub-district, Matlab, Bangladesh among adolescent motherhood (10-19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh included total of 4,996 adolescent mothers in the analysis. Chi-square tests and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death. The fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 year of study period. The adjusted odds of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69 (95% CI: 0.52 - 0.91, p-value

The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC). Both of these interventions mandate the administration of oxytocin. In Bangladesh there are nonfunctioning institutionalized guidelines from the Director General of Health Services on the storage of oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to evaluate the potency of current stores of oxytocin used in both in public and private facilities, develop and enforce protocols to ensure the potency of oxytocin, and promote universal access to quality AMSTL and CEmOC services.

Background Adolescent mothers (Girls aged 15-19) constitute 8% of annual global births, but account for 10% of annual maternal deaths. WHO recommended 4-8 Antenatal Care (ANC) visits, in addition to quality care and facility-based deliveries, are well-documented interventions to reduce maternal and child morbidity and mortality. Determinants of maternal and child health care in Bangladesh have received considerable attention, but less attention has been focused on adolescent mothers. This study explores the factors associated with 4 or more (4+) ANC visits and facility-based delivery among adolescent mothers in one rural area of Bangladesh, Methods This study uses Health and Demographic Surveillance System (HDSS) data. We conducted a comparative study on trends in 4+ ANC visits and facility-based deliveries among adolescent mothers (10-19 years) residing in an intervention area (icddr,b service area, ISA) against a comparison area (government service areas, GSA) of HDSS between 2007 and 2015. 4,996 adolescent mothers were included in the final analysis. Binary logistic regression was used to document the statistical difference on outcome indicators in the two study areas. Results Trends in 4+ANC visits and facility-based deliveries were higher in the ISA relative to the GSA. The adjusted odds of an adolescent mother accessing 4+ ANC visits in the GSA, relative to ISA was 0.57 (95% CI: 0.49 – 0.66, p-value

This article presents research on archaeological data creation and management practices at two excavations in Europe in order to gain a better understanding of how to align these practices with the data reuse needs of a broader research community. The Secret Life of Data project follows the life cycle of data from the field to the digital repository to better understand opportunities and challenges in data interpretation, publication, and preservation. Our “Slow Data” approach focuses not on maximizing the speed and quantity of data but, rather, on emphasizing curation, contextualization, communication, and broader understanding. Through a mixed-methods approach of interviews, field observations, and excavation data assessments, we recommended changes (both technical and organizational) to improve data creation and management practices. We report our findings and offer readers guidance on streamlining data collection for reuse during excavation.

Aminur Rahman,1,2 Sadika Akhter,1 Monjura Khatun Nisha,3 Syed Shariful Islam,4 Fatema Ashraf,5 Monjur Rahman,1 Nazneen Begum,6 Mahbub Elahi Chowdhury,1 Anne Austin,7 Iqbal Anwar1 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; 2College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand; 3Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 4Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, 5Department of Gyenaecology and Obstetric, Shaheed Suhrawardi Medical College and Hospital, 6Department of Gyenaecology and Obstetric, Dhaka Medical College and Hospital, Dhaka, Bangladesh; 7JSIResearch & Training Institute, Inc., Boston, MA, USA Purpose: Of the 99% maternal deaths that take place in developing countries, one-fourth is due to postpartum hemorrhage (PPH). PPH accounts for one-third of all blood transfusions in Bangladesh where the transfusion process is lengthy as most facilities do not have in-house blood bank facilities. In this context, the location where blood is obtained and the processes of obtaining blood products are not standardized, leading to preventable delays in collecting blood, when it is needed. This study evaluated the effectiveness of an online Blood Information Management Application (BIMA) system for reducing lag time in the blood transfusion process.Patients and methods: The study was conducted in a public medical college hospital in Dhaka, Bangladesh, and in two proximate, licensed blood banks between January 2014 and March 2015, using a before after design. A total of 310 women (143 before and 177 after), who needed emergency blood transfusion during their perinatal period, as determined by a medical professional, were included in the study. A median linear regression model was employed to assess the adjusted effect of BIMA on transfusion time.Results: After the introduction of BIMA, the median duration between the identified need for blood and blood transfusion reduced from 152 to 122minutes (P

Funding: This work is a contribution to FGG’s PhD study programme at the University of St Andrews, UK, and is funded by Secretaría de Educación Superior, Ciencia, Tecnología e Innovación de la República del Ecuador (SENESCYT). Foraminifera are expected to be particularly susceptible to future changes in ocean carbonate chemistry as a function of increased atmospheric CO2. Studies in an experimental recirculating seawater system were performed with a dominant benthic foraminiferal species collected from intertidal mudflats. We investigated the experimental impacts of ocean acidification on survival, growth/calcification, morphology and the biometric features of a calcareous species Elphidium williamsoni. Foraminifera were exposed for 6 weeks to four different pH treatments that replicated future scenarios of a high CO2 atmosphere resulting in lower seawater pH. Results revealed that declining seawater pH caused a decline in foraminiferal survival rate and growth/calcification (mainly through test weight reduction). Scanning electron microscopy image analysis of live specimens at the end of the experimental period show changes in foraminiferal morphology with clear signs of corrosion and cracking on the test surface, septal bridges, sutures and feeding structures of specimens exposed to the lowest pH conditions. These findings suggest that the morphological changes observed in shell feeding structures may serve to alter: (1) foraminiferal feeding efficiency and their long-term ecological competitiveness, (2) the energy transferred within the benthic food web with a subsequent shift in benthic community structures and (3) carbon cycling and total CaCO3 production, both highly significant processes in coastal waters. These experimental results open-up the possibility of modelling future impacts of ocean acidification on both calcification and dissolution in benthic foraminifera within mid-latitude intertidal environments, with potential implications for understanding the changing marine carbon cycle. Publisher PDF

An estimated 2.2 million women surveyed in low- and middle-income countries between 2005 and 2015 gave birth alone. This practice was concentrated in West and Central Africa and parts of East Africa. Women who delivered with no one present were very poor, uneducated, older, and of higher parity. Experience from northern Nigeria suggests the practice can be reduced markedly by mobilizing religious and civil society leaders to improve community awareness about the critical importance of having an attendant present., Evidence has shown that quality skilled care during labor and delivery is essential to improve maternal and newborn health outcomes. Unfortunately, analyses of Demographic and Health Survey (DHS) data show that there are a substantial number of women around the world that not only do not have access to skilled care but also deliver alone with no one present (NOP). Among the 80 countries with data, we found the practice of delivering with NOP was concentrated in West and Central Africa and parts of East Africa. Across these countries, the prevalence of giving birth with NOP was higher among women who were poor, older, of higher parity, living in rural areas, and uneducated than among their counterparts. As women increased use of antenatal care services, the proportion giving birth with NOP declined. Using census data for each country from the US Census Bureau’s International Database and data on prevalence of delivering with NOP from the DHS among countries with surveys from 2005 onwards (n = 59), we estimated the number of women who gave birth alone in each country, as well as each country’s contribution to the total burden. Our analysis indicates that between 2005 and 2015, an estimated 2.2 million women, who had given birth in the 3 years preceding each country survey, delivered with NOP. Nigeria, alone, accounted for 44% (nearly 1 million) of these deliveries. As countries work on reducing inequalities in access to health care, wealth, education, and family planning, concurrent efforts to change community norms that condone and facilitate the practice of women giving birth alone must also be implemented. Programmatic experience from Sokoto State in northern Nigeria suggests that the practice can be reduced markedly through grassroots community advocacy and education, even in poor and low-resource areas. It is time for leaders to act now to eradicate the practice of giving birth alone—one of many important steps needed to ensure no mother or newborn dies of a preventable death.

Archaeological excavations are comprised of interdisciplinary teams that create, manage, and share data as they unearth and analyse material culture. These team-based settings are ripe for collective curation during these data lifecycle stages. However, findings from four excavation sites show that the data interdisciplinary teams create are not well integrated. Knowing this, we recommended opportunities for collective curation to improve use and reuse of the data within and outside of the team.

During the 2014 Ifao mission at Deir el-Medina, we identified the torso of a female mummy that was heavily tattooed along the arms, shoulders, neck, and back. This article presents this tattooed mummy by first contextualizing the discovery within broader research on tattooing in ancient Egypt. We then describe the nature of this mummy and her tattoos through a detailed discussion of their placement and symbolism. Finally, we discuss the potential implications this woman has not only for the history of tattooing in Egypt, but also women’s roles in Egyptian magic, medicine, and religion during the New Kingdom. Lors de la campagne 2014 de la mission Ifao à Deir el-Medina, le torse d’une momie de femme largement tatouée sur les bras, les épaules, le cou, et le dos a été identifié. Cet article se propose de présenter cette momie tatouée en replaçant tout d’abord la découverte dans le contexte plus vaste de la pratique du tatouage en Égypte ancienne. La nature de cette momie est ensuite étudiée, et ses tatouages passés en revue, à travers l’examen de leur localisation et de leur portée symbolique. Enfin, les implications que cette femme peut avoir non seulement sur l’histoire de la pratique du tatouage en Égypte ancienne, mais aussi sur le rôle des femmes dans la pratique de la magie, de la médecine, et de la religion durant le Nouvel Empire, sont discutées.

Despite prominent previous research on disease in ancient Egypt through studies of human remains and Egyptian medical texts, we still know relatively little about how disease impacted daily life. This is especially true for short-term diseases, which leave no mark in the skeletal record and are often described only generally in medical texts. In this study, I use a scalar approach to analyze records recording absences from work at Deir el-Medina during the Nineteenth and Twentieth Dynasties, focusing on understanding how short-term diseases affected morbidity patterns at the site. At the broadest scale, I use a corpus of work texts to demonstrate a seasonal distribution of absences which can be accounted for by the seasonality of infectious disease in Upper Egypt. I then offer a circumstantial case for the contagion of one infectious disease in O. BM 5634 by identifying its transmission through the sequential absences of different workmen in the entire gang. Finally, I evaluate the impact of one disease on one workman through a close reading of the absences of Mr-%xm.t in O. Cairo CG 25785. This text elucidates how expectations for a workman’s productivity were likely harmful to his well-being. I then combine these three levels of analysis to explore the social and economic ramifications these diseases would have had on both individual workmen and workforce productivity at Deir el-Medina. Many scholars have examined the paleopathology of human remains in ancient Egypt and the history of Egyptian medicine.1 Their publications offer numerous detailed accounts of the kinds of diseases present in ancient Egypt and their remedies, but they offer relatively little information about the impact of shortterm diseases on daily life. Lesions from such diseases would not become manifest skeletally, and medical texts are often missing diagnostic criteria to reveal the

Background Postpartum haemorrhage (PPH) is a leading cause of maternal death in Sokoto State, Nigeria, where 95% of women give birth outside of a health facility. Although pilot schemes have demonstrated the value of community-based distribution of misoprostol for the prevention of PPH, none have provided practical insight on taking such programs to scale. Methods A community-based system for the distribution of misoprostol tablets (in 600ug) and chlorhexidine digluconate gel 7.1% to mother-newborn dyads was introduced by state government officials and community leaders throughout Sokoto State in April 2013, with the potential to reach an estimated 190,467 annual births. A simple outcome form that collected distribution and consumption data was used to assess the percentage of mothers that received misoprostol at labor through December 2014. Mothers’ conditions were tracked through 6 weeks postpartum. Verbal autopsies were conducted on associated maternal deaths. Results Misoprostol distribution was successfully introduced and reached mothers in labor in all 244 wards in Sokoto State. Community data collection systems were successfully operational in all 244 wards with reliable capacity to record maternal deaths. 70,982 women or 22% of expected births received misoprostol from April 2013 to December 2014. Between April and December 2013, 33 women (< 1%) reported that heavy bleeding persisted after misoprostol use and were promptly referred. There were a total of 11 deaths in the 2013 cohort which were confirmed as maternal deaths by verbal autopsies. Between January and December of 2014, a total 434 women (1.25%) that ingested misoprostol reported associated side effects. Conclusion It is feasible and safe to utilize government guidelines on results-based primary health care to successfully introduce community distribution of life saving misoprostol at scale to reduce PPH and improve maternal outcomes. Lessons from Sokoto State’s at-scale program implementation, to assure every mother’s right to uterotonics, can inform scale-up elsewhere in Nigeria.

Background Intermittent preventive treatment of malaria in pregnancy with 3+ doses of sulfadoxine-pyrimethamine (IPTp-SP) reduces maternal mortality and stillbirths in malaria endemic areas. Between December 2014 and December 2015, a project to scale up IPTp-SP to all pregnant women was implemented in three local government areas (LGA) of Sokoto State, Nigeria. The intervention included community education and mobilization, household distribution of SP, and community health information systems that reminded mothers of upcoming SP doses. Health facility IPTp-SP distribution continued in three intervention (population 661,606) and one counterfactual (population 167,971) LGAs. During the project lifespan, 31,493 pregnant women were eligible for at least one dose of IPTp-SP. Methods Community and facility data on IPTp-SP distribution were collected in all four LGAs. Data from a subset of 9427 pregnant women, who were followed through 42 days postpartum, were analysed to assess associations between SP dosages and newborn status. Nominal cost and expense data in 2015 Nigerian Naira were obtained from expenditure records on the distribution of SP. Results Eighty-two percent (n = 25,841) of eligible women received one or more doses of IPTp-SP. The SP1 coverage was 95% in the intervention LGAs; 26% in the counterfactual. Measurable SP3+ coverage was 45% in the intervention and 0% in the counterfactual LGAs. The mean number of SP doses in the intervention LGAs was 2.1; 0.4 in the counterfactual. Increased doses of IPTp-SP were associated with linear increases in newborn head circumference and lower odds of stillbirth. Any antenatal care utilization predicted larger newborn head circumference and lower odds of stillbirth. The cost of delivering three doses of SP, inclusive of the cost of medicines, was US$0.93–$1.20. Conclusions It is feasible, safe, and affordable to scale up the delivery of high impact IPTp-SP interventions in low resource malaria endemic settings, where few women access facility-based maternal health services. ClinicalTrials.gov Identifier NCT02758353. Registered 29 April 2016, retrospectively registered Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1578-x) contains supplementary material, which is available to authorized users.

Background and Objectives In Bangladesh, postpartum hemorrhage (PPH) is the leading cause of maternal mortality accounting for 31% of all blood transfusions in the country. Although safe blood transfusion is one of the 8 signal functions of Comprehensive Emergency Obstetric Care (CEmOC) strategy, most of the designated public sector CEmOC facilities do not have on-site blood storage system. Emergent blood is mainly available from external blood banks. As a result, emergent patients are to rely on an unregulated network of brokers for blood which may raise question about blood safety. This study explored lived experiences of patients’ attendants, managers, providers, and blood brokers before and after the implementation of an on-line Blood Information and Management Application (BIMA) in regards to barriers and facilitators of blood transfusion for emergent patients. Methods Data were collected at Dhaka Medical College Hospital (DMCH), a tertiary-level teaching hospital before (January 2014) and after (March 2015) the introduction of an online BIMA system. Data collection methods included 24 key informant interviews (KIIs) and 40 in-depth interviews (IDIs). KIIs were conducted with formal health service providers, health managers and unlicensed blood brokers. IDIs were conducted with the relatives and husbands of women who suffered PPH, and needed emergency blood. Results Patients’ attendants were unaware of patients’ blood type and availability of blood in emergency situation. Newly introduced online BIMA system could facilitate blood transfusion process for poor patients at lower cost and during any time of day and night. However, service providers and service recipients were heavily dependent on a network of unlicensed blood brokers for required blood for emergent PPH patients. Blood collected through unlicensed blood brokers is un-screened, unregulated and probably unsafe. Blood brokers feel that they are providing a needed service, acknowledged a financial incentive and unaware about safety of blood that they supply. Conclusions Ensuring safe and timely blood transfusion is necessary to end preventable maternal mortality. In a context where facilities have no on-site blood, and both providers and patient attendants are heavily dependent on an unregulated cadre of unlicensed blood brokers, access to timely safe blood transfusion is seriously threatened. BIMA is a promising intervention to reduce inefficiencies in obtaining blood, but steps must be taken to ensure buy-in from current purveyors of blood, and to increase the acceptance of the intervention.

* ADEM: : acute disseminated encephalomyelitis CSF: : cerebrospinal fluid CMV: : cytomegalovirus CT: : computed tomography EBV: : Epstein-Barr virus ED: : emergency department HSV: : herpes simplex virus IV: : intravenous PMNS: : postmalaria neurologic syndrome A 45-day-old girl presents to the emergency department (ED) with a 1-day history of slow breathing and decreased feeding. She was well the previous day, breastfeeding 5 to 6 times per day for 15 minutes during each feeding. She wets 6 to 8 diapers daily. She has been constipated since birth, passing 1 stool every 5 days, and, at the time of presentation, she had not had a bowel movement in 8 days. She was a term infant born via spontaneous vaginal delivery with Apgar scores of 9 at 1 and at 5 minutes. The delivery was complicated by her mother requiring a large episiotomy. Physical examination reveals a temperature of 98.4°F, heart rate of 154 beats/minute, respiratory rate of 20 breaths/minute, blood pressure of 71/52 mm Hg in the right upper extremity, and oxygen saturation of 69% on room air. Her length, weight, and head circumference are in the 50th percentile. She appears toxic, with sluggish movements and labored breathing. Femoral pulses are palpable with capillary refill of 2 seconds. Respiratory examination reveals slow, shallow, and irregular breathing, without wheezing or retractions. Her pupils are small, but reactive. The remainder of the physical examination, including cardiac assessment, is normal. Her complete blood cell count and serum electrolyte levels are within normal limits. Initial blood glucose level is 144 mg/dL, and a capillary blood gas shows a pH of 7.27, partial pressure of carbon dioxide of 54 mm Hg, and partial pressure of oxygen of 50 mm Hg. The results of a portable chest radiograph are normal. Additional history and laboratory findings reveal the diagnosis. A 7-year-old boy presents to the busy ED in India with a 1-day history of abnormal behavior, generalized seizures, and altered sensorium. Two weeks ago he was successfully treated for Plasmodium falciparum cerebral malaria and …

According to the World Health Organization (WHO), 46% of adult females in Egypt are obese. This research was aimed at documenting obesity trends and identifying the populations most at risk for obesity. Using data from the 1995 and 2005 Egyptian Demographic and Health Surveys a linear model was employed to seek associations between household wealth, urban/rural residence, governorate of residence, employment status, parity and age and increases in body mass index (BMI) among married Egyptian women between the ages of 15–49. Between 1995 and 2005, the mean BMI of women of reproductive age in Egypt increased from 26.31 to 28.52. Although there was an overall trend towards greater obesity between 1995 and 2005, older women residing in rural, poor households became obese at a faster rate than younger women residing in richer, urban households. Studies have shown that household wealth is a key determinant of food consumption patterns. Rising obesity rates among the poor in developed countries are linked to the relatively cheap price of high-calorie, nutrient-poor foods. One factor that may be contributing to the rapid increases in obesity among the rural poor in Egypt is the subsidisation of high-energy, low-nutritive value foods that form a larger part of the diet of poor, rural populations.

We cultured the benthic, calcitic foraminifera, Elphidium williamsoni , over a range of pH NIST (7.89, 8.15 and 8.30) for 60 days. Secondary ion mass spectrometry was used to determine both the Mg/Ca and Sr/Ca of chambers deposited in the culture system. Both Mg/Ca and Sr/Ca vary significantly within individual test chambers and between specimens cultured under the same conditions. We do not typically observe significant correlations between Mg/Ca and Sr/Ca, either within single tests or between tests cultured at the same pH and we conclude that Rayleigh fractionation, indicated by a positive correlation between Sr and Mg in calcite, is not the predominant control on the chemistry of the tests. Although test morphology, particularly fossette and ponticuli appearance, varies substantially between individuals cultured at the same pH, we perceive no simple relationship between test morphology and geochemistry. Mean test Mg/Ca or Sr/Ca does not vary significantly between treatments. No significant correlation is observed between the amount of calcite deposited in each test and mean test Sr/Ca and Mg/Ca, in the foraminifera cultured at ambient pH (8.15), suggesting that calcification rate is not a significant influence on Sr and Mg test chemistry in this foraminifera species.

Anaemia remains the most prevalent nutritional disorder among women and children in the Middle East and North Africa region. We examined anaemia trends using data from the Egyptian Demographic and Health Surveys. Between 2000 and 2005 the prevalence of anaemia (defined as haemoglobin concentrations

We cultured the benthic foraminifera, Elphidium williamsoni , in a physicochemically stable, large volume (400 l) recirculating seawater system over a range of pH (7.6, 8.1 and 8.3) for 8 weeks. During this period the foraminifera typically deposited 1–3 new chambers which were analysed by electron probe microanalysis. Intertest Mg/Ca variations are large (± 22%, 1 standard deviation, at ambient pH) and in good agreement with variance reports from other benthic foraminifera species. These variations do not reflect changes in ambient water chemistry but must reflect biological variability between individual foraminifera, e.g. dependent on genotype or phenotype. Variations in test chemistry may reflect variability in the composition of the calcifying fluid used for test construction, variability in the amount of Mg incorporated into the test calcite or variations in the relative proportions of high and low Mg calcites incorporated in each test. Within each of the pH treatments we observed no relationship between amount of calcite deposited in the culture system and test Mg/Ca. Foraminifera test Mg/Ca is a commonly used palaeothermometer. Our study shows that variations in the relative proportions of individual foraminifera of different geochemistry, that make up a sample for chemical analysis, may affect bulk determinations of test chemistry and subsequent estimates of past climate. Foraminifera cultured at low pH produced significantly thinner chamber walls but we observed no relationship between culture pH (or seawater ∆[CO 3 2− ]) and test Mg/Ca. Pore water gradients are unlikely to develop in the culture substrate and E. williamsoni is an epibenthic species so it is doubtful that this observation reflects changes in the ambient chemistry of pore waters. This suggests that a correlation between ambient water ∆[CO 3 2− ] and test Mg/Ca is not ubiquitous in all calcitic foraminifera species. E. williamsoni is an intertidal species and is adapted to living in highly variable physicochemical conditions. Further work is required to ascertain the significance of these results to other benthic foraminifera species.

Introduction The South Australian Couples Sildenafil (SACS) study sought to look more closely at the role of sexual functioning in couples by exploring the impact of treatment for erectile dysfunction (ED) with sildenafil. Aim The SACS study investigated the individual and dyadic impact of the drug sildenafil (Viagra) on couples over a 6-month period. Main Outcome Measures A range of outcome measures were utilized including the Dyadic Adjustment Scale (DAS), the International Index of Erectile Function (IIEF), and the Erectile Dysfunction Inventory of Treatment Satisfaction. Methods Couples were recruited through the use of local media and general practitioners. Couples were randomly allocated to placebo or active drug with the option of using up to one study tablet per day for 6 months. Couples were reviewed at 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months. Results There were 108 couples who were eligible for the study with the eventual analysis including 49 couples in the active treatment group and 47 in the placebo group with similar demographic and background profiles found in both groups. A large number of psychosocial, quality-of-life, and sexual measures were recorded at the end of the trial for both male subjects and their female partners. Predictably, the erectile response in the active treatment group showed a significant improvement as measured by the IIEF although no change was found between the active and placebo groups in relationship functioning as measured by the DAS scores. Conclusions The SACS study found no difference between treatment arms with regard to relationship functioning after the use of sildenafil for ED. Potential contributing factors to a “no change” result are discussed. The SACS study adds to the available literature on psychological and interpersonal factors in the treatment of ED which have not been sufficiently investigated until recently. Hundertmark J, Esterman A, Ben-Tovim D, Austin M-A, and Dougherty M. The South Australian Couples Sildenafil Study: Double-blind, parallel-group randomized controlled study to examine the psychological and relationship consequences of sildenafil use in couples.

Background Increasing women’s access to and use of facilities for childbirth is a critical national strategy to improve maternal health outcomes in Ethiopia; however coverage alone is not enough as the quality of emergency obstetric services affects maternal mortality and morbidity. Addis Ababa has a much higher proportion of facility-based births (82%) than the national average (11%), but timely provision of quality emergency obstetric care remains a significant challenge for reducing maternal mortality and improving maternal health. The purpose of this study was to assess barriers to the provision of emergency obstetric care in Addis Ababa from the perspective of healthcare providers by analyzing three factors: implementation of national referral guidelines, staff training, and staff supervision. Methods A mixed methods approach was used to assess barriers to quality emergency obstetric care. Qualitative analyses included twenty-nine, semi-structured, key informant interviews with providers from an urban referral network consisting of a hospital and seven health centers. Quantitative survey data were collected from 111 providers, 80% (111/138) of those providing maternal health services in the same referral network. Results Respondents identified a lack of transportation and communication infrastructure, overcrowding at the referral hospital, insufficient pre-service and in-service training, and absence of supportive supervision as key barriers to provision of quality emergency obstetric care. Conclusions Dedicated transportation and communication infrastructure, improvements in pre-service and in-service training, and supportive supervision are needed to maximize the effective use of existing human resources and infrastructure, thus increasing access to and the provision of timely, high quality emergency obstetric care in Addis Ababa, Ethiopia. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0493-4) contains supplementary material, which is available to authorized users.

Field-collected living specimens of the benthic foraminifera Haynesina germanica were maintained in the laboratory and fed a naturally occurring motile benthic diatom assemblage dominated by Pleurosigma angulatum. The extracellular removal of diatom contents was inferred for P. angulatum in controlled experiments. A characteristic pattern of fracturing of the diatom frustule was observed that was directly attributed to foraminiferal feeding/sequestration mechanisms. These feeding/sequestration mechanisms have a potentially important bearing on our understanding of foraminiferal aperture morphology, foraminiferal evolution and the preservation of diatoms in marine sediments. Recognition of this characteristic breakage pattern of diatom frustules may provide insight into the natural importance of foraminifera in grazing diatom biofilms.

This series of papers focuses on a quality of care framework for maternal health, and systematically reviews the evidence of interventions aimed at improving care at the community-, district- and factility-levels. While the systematic reviews highlight the effectiveness of specific quality improvement efforts on maternal and newborn health, it also illlustrates the dearth of evidence on community-, district- and facility-level interventions, particulary for issues specific to quality of maternal health care and maternal newborn health outcomes. Further evidence is now needed to evaluate the best possible combination of the strategies. Governments, stakeholders and donors need to work together to form these policies and develop models of health care to suit the needs of their own population.