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Improved knowledge of how habitat for water-dependent species is changing over space and time across entire river catchments is important in developing indicators for tracking changes and quantifying the effectiveness of environmentally-targeted water management actions. Such information is often difficult to obtain across large catchments, given that habitat for water-dependent species can change rapidly and typically depends on complex interactions of environmental variables. Models can help in filling these information gaps, by using incomplete data to generalise patterns at fine spatial and temporal resolution across large catchments. We developed dynamic habitat models for seven water-dependent species across the Murray-Darling Basin, the longest river system in Australia. We considered two plant species (river red gum and lignum), two waterbird species (royal spoonbill and straw-necked ibis), two fish species (Murray cod and golden perch) and a macroinvertebrate group (Decapoda). We utilised advances in basin-wide data on stream flow and inundation to derive a range of ecologically meaningful spatiotemporal habitat predictors, and used these to model occurrence and physiological condition for each species. This data-driven approach identified the environmental variables most important in predicting habitat quality for each species, and their associated response functions. The dynamic habitat models were used to generate basin-wide, fine resolution (≈90 m) predictions for each species across a time-series of several decades (1995–2020). The model predictions were summarised into indicators to identify changes in habitat quality over time and identify areas that consistently provided the highest quality habitat. These habitat models and predictions extend our understanding of the environmental drivers of habitat for each water-dependent species studied and enable a variety of assessments to quantify the ecological outcomes of past water management.

There are many advantages to transitioning from conducting marine wildlife surveys via human observers onboard light-aircraft, to capturing aerial imagery using drones. However, it is important to maintain the validity of long-term data series whilst transitioning from observer to imagery surveys. We need to understand how the detection rates of target species in images compare to those collected from observers in piloted aircraft, and the factors influencing detection rates from each platform. We conducted trial ScanEagle drone surveys of dugongs in Shark Bay, Western Australia, covering the full extent of the drone’s range (∼100 km), concurrently with observer surveys, with the drone flying above or just behind the piloted aircraft. We aimed to test the assumption that drone imagery could provide comparable detection rates of dugongs to human observers when influenced by same environmental conditions. Overall, the dugong sighting rate (i.e., count of individual dugongs) was 1.3 (95% CI [0.98–1.84]) times higher from the drone images than from the observers. The group sighting rate was similar for the two platforms, however the group sizes detected within the drone images were significantly larger than those recorded by the observers, which explained the overall difference in sighting rates. Cloud cover appeared to be the only covariate affecting the two platforms differently; the incidence of cloud cover resulted in smaller group sizes being detected by both platforms, but the observer group sizes dropped much more dramatically (by 71% (95% CI [31–88]) compared to no cloud) than the group sizes detected in the drone images (14% (95% CI [−28–57])). Water visibility and the Beaufort sea state also affected dugong counts and group sizes, but in the same way for both platforms. This is the first direct simultaneous comparison between sightings from observers in piloted aircraft and a drone and demonstrates the potential for drone surveys over a large spatial-scale.

Introduction Improving hospital oxygen systems can improve quality of care and reduce mortality for children, but we lack data on cost-effectiveness or sustainability. This study evaluated medium-term sustainability and cost-effectiveness of the Nigeria Oxygen Implementation programme.Methods Prospective follow-up of a stepped-wedge trial involving 12 secondary-level hospitals. Cross-sectional facility assessment, clinical audit (January–March 2021), summary admission data (January 2018–December 2020), programme cost data. Intervention: pulse oximetry introduction followed by solar-powered oxygen system installation with clinical and technical training and support. Primary outcomes: (i) proportion of children screened with pulse oximetry; (ii) proportion of hypoxaemic (SpO2

Protein from fish is essential for feeding the world’s population and is increasingly recognized as critical for food security. To ensure that fisheries resources can be sustainably maintained, fisheries management must be appropriately implemented. When logbook and landing records data are not complete or are incorrect, it is challenging to have an accurate understanding of catch volume. Focusing on Indonesian longline vessels operating in the Indian Ocean from 2012–2019 (n = 1124 vessels), our aims were to (1) assess compliance through identification of landing sites and potentially illicit behavior inferred by interruptions in VMS transmission, and (2) understand how the fishery operates along with quantifying the spatio-temporal distribution of fishing intensity by applying a Hidden Markov Model, which automatically classified each VMS position as fishing, steaming and anchoring. We found vessel compliance gaps in 90% of vessels in the dataset. Compliance was questionable due both to the widespread occurrence of long intermissions in relaying VMS positions (mean = 17.8 h, n = 973 vessels) and the use of unauthorized landing sites. We also observed substantial changes in fishing effort locations among years. The introduction of regulatory measures during the study period banning transshipment and foreign vessels may be responsible for the spatial shift in fishing activity we observed, from encompassing nearly the whole Indian Ocean to more recent intense efforts off western Sumatra and northern Australia.

Background: Hypoxaemia is a common complication of pneumonia and a major risk factor for death, but less is known about hypoxaemia in other common conditions. We evaluated the epidemiology of hypoxaemia and oxygen use in hospitalised neonates and children in Nigeria. Methods: We conducted a prospective cohort study among neonates and children (

There is growing interest from research and conservation groups in the potential for using small unoccupied aerial vehicles (UAVs;

Spatial risk assessments are an effective management tool used in multiple-use marine parks to balance the needs for conservation of natural properties and to provide for varying socio-economic demands for development. The multiple-use Great Barrier Reef Marine Park (GBRMP) has recently experienced substantial increases in current and proposed port expansions and subsequent shipping. Globally, large whale populations are recovering from commercial whaling and ship strike is a significant threat to some populations and a potential welfare issue for others. Within the GBRMP, there is spatial conflict between the main breeding ground of the east Australian humpback whale population and the main inner shipping route that services several large natural resource export ports. The east coast humpback whale population is one of the largest humpback whale populations globally, exponentially increasing (11% per annum) close to the maximum potential rate and estimated to reach pre-exploitation population numbers in the next 4–5 years. We quantify the relative risk of ship strike to calving and mating humpback whales, with areas of highest relative risk coinciding with areas offshore of two major natural resource export ports. We found females with a dependent calf had a higher risk of ship strike compared to groups without a calf when standardized for group size and their inshore movement and coastal dependence later in the breeding season increases their overlap with shipping, although their lower relative abundance decreases risk. The formalization of a two-way shipping route has provided little change to risk and projected risk estimates indicate a three- to five-fold increase in risk to humpback whales from ship strike over the next 10 years. Currently, the whale Protection Area in the GBRMP does not cover the main mating and calving areas, whereas provisions within the legislation for establishment of a Special Management Area during the peak breeding season in high-risk areas could occur. A common mitigation strategy of re-routing shipping lanes to reduce risk is not a viable option for the GBRMP due to physical spatial limitations imposed by the reef, whereas speed restrictions could be the most feasible based on current ship speeds.

Abstract Background Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity. Methods/design This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies. We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018. Discussion Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12617000341325 . Retrospectively registered on 6 March 2017.

BackgroundImproving oxygen systems may improve clinical outcomes for hospitalised children with acute lower respiratory infection (ALRI). This paper reports the effects of an improved oxygen system on mortality and clinical practices in 12 general, paediatric, and maternity hospitals in southwest Nigeria.Methods and findingsWe conducted an unblinded stepped-wedge cluster-randomised trial comparing three study periods: baseline (usual care), pulse oximetry introduction, and stepped introduction of a multifaceted oxygen system. We collected data from clinical records of all admitted neonates (ConclusionsWe observed no mortality benefit for children and a possible higher risk of neonatal death following the introduction of a multifaceted oxygen system compared to introducing pulse oximetry alone. Where some oxygen is available, pulse oximetry may improve oxygen usage and clinical outcomes for children with ALRI.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12617000341325.

Marine soundscapes consist of cumulative contributions by diverse sources of sound grouped into: physical (e.g., wind), biological (e.g., fish), and anthropogenic (e.g., shipping)—each with unique spatial, temporal, and frequency characteristics. In terms of anthropophony, shipping has been found to be the greatest (ubiquitous and continuous) contributor of low-frequency underwater noise in several northern hemisphere soundscapes. Our aim was to develop a model for ship noise in Australian waters, which could be used by industry and government to manage marine zones, their usage, stressors, and potential impacts. We also modelled wind noise under water to provide context to the contribution of ship noise. The models were validated with underwater recordings from 25 sites. As expected, there was good congruence when shipping or wind were the dominant sources. However, there was less agreement when other anthropogenic or biological sources were present (i.e., primarily marine seismic surveying and whales). Off Australia, pristine marine soundscapes (based on the dominance of natural, biological and physical sound) remain, in particular, near offshore reefs and islands. Strong wind noise dominates along the southern Australian coast. Underwater shipping noise dominates only in certain areas, along the eastern seaboard and on the northwest shelf, close to shipping lanes.

Underwater sound is modelled and mapped for purposes ranging from localised environmental impact assessments of individual offshore developments to large-scale marine spatial planning. As the area to be modelled increases, so does the computational effort. The effort is more easily handled if broken down into smaller regions that could be modelled separately and their results merged. The goal of our study was to split the Australian maritime Exclusive Economic Zone (EEZ) into a set of smaller acoustic zones, whereby each zone is characterised by a set of environmental parameters that vary more across than within zones. The environmental parameters chosen reflect the hydroacoustic (e.g., water column sound speed profile), geoacoustic (e.g., sound speeds and absorption coefficients for compressional and shear waves), and bathymetric (i.e., seafloor depth and slope) parameters that directly affect the way in which sound propagates. We present a multivariate Gaussian mixture model, modified to handle input vectors (sound speed profiles) of variable length, and fitted by an expectation-maximization algorithm, that clustered the environmental parameters into 20 maritime acoustic zones corresponding to 28 geographically separated locations. Mean zone parameters and shape files are available for download. The zones may be used to map, for example, underwater sound from commercial shipping within the entire Australian EEZ.

Understanding the circuit mechanisms behind motion detection is a long-standing question in visual neuroscience. In Drosophila melanogaster, recently discovered synapse-level connectomes in the optic lobe, particularly in ON-pathway (T4) receptive-field circuits, in concert with physiological studies, suggest a motion model that is increasingly intricate when compared with the ubiquitous Hassenstein-Reichardt model. By contrast, our knowledge of OFF-pathway (T5) has been incomplete. Here, we present a conclusive and comprehensive connectome that, for the first time, integrates detailed connectivity information for inputs to both the T4 and T5 pathways in a single EM dataset covering the entire optic lobe. With novel reconstruction methods using automated synapse prediction suited to such a large connectome, we successfully corroborate previous findings in the T4 pathway and comprehensively identify inputs and receptive fields for T5. Although the two pathways are probably evolutionarily linked and exhibit many similarities, we uncover interesting differences and interactions that may underlie their distinct functional properties.

Death or injury to whales from vessel strike is one of the primary threats to whale populations worldwide. However, quantifying the rate of occurrence of these collisions is difficult because many incidents are not detected (particularly from large vessels) and therefore go unreported. Furthermore, varying reporting biases occur related to species identification, spatial coverage of reports and type of vessels involved. The International Whaling Commission (IWC) has compiled a database of the worldwide occurrence of vessel strikes to cetaceans, within which Australia constitutes ~7% (35 reports) of the reported worldwide (~471 reports) vessel strike records involving large whales. Worldwide records consist largely of modern reports within the last two decades and historical evaluation of ship strike reports has mainly focused on the Northern Hemisphere. To address this we conducted a search of historical national and international print media archive databases to discover reports of vessel strikes globally, although with a focus on Australian waters. A significant number of previously unrecorded reports of vessel strikes were found for both Australia (76) and worldwide (140), resulting in a revised estimate of ~15% of global vessel strikes occurring in Australian waters. This detailed collation and analysis of vessel strike data in an Australian context has contributed to our knowledge of the worldwide occurrence of vessel strikes and challenges the notion that vessel strikes were historically rare in Australia relative to the rest of the world. The work highlights the need to examine historical records to provide context around current anthropogenic threats to marine fauna and demonstrates the importance of formalized reporting structures for effective collation of vessel strike reports. This paper examines the issues and biases in analysis of vessel strike data in general that would apply to any jurisdiction. Using the Australian data as an example we look at what information can be inferred from historical data and the dangers of inference without consideration of the reporting biases.

Efficient monitoring of organisms is at the foundation of protected area and biodiversity management. Such monitoring programs are based on a systematically selected set of survey locations that, while able to track trends at those locations through time, lack inference for the overall region being "monitored". Advances in spatially-balanced sampling approaches offer alternatives but remain largely untested in marine ecosystems. This study evaluated the merit of using a two-stage, spatially-balanced survey framework, in conjunction with generalized additive models, to estimate epifauna cover at a reef-wide scale for mesophotic reefs within a large, cross-shelf marine park. Imagery acquired by an autonomous underwater vehicle was classified using a hierarchical scheme developed under the Collaborative and Automated Tools for Analysis of Marine Imagery (CATAMI). At a realistic image subsampling intensity, the two-stage, spatially-balanced framework provided accurate and precise estimates of reef-wide cover for a select number of epifaunal classes at the coarsest CATAMI levels, in particular bryozoan and porifera classes. However, at finer hierarchical levels, accuracy and/or precision of cover estimates declined, primarily because of the natural rarity of even the most common of these classes/morphospecies. Ranked predictor importance suggested that bathymetry, backscatter and derivative terrain variables calculated at their smallest analysis window scales (i.e. 81 m2) were generally the most important variables in the modeling of reef-wide cover. This study makes an important step in identifying the constraints and limitations that can be identified through a robust statistical approach to design and analysis. The two-stage, spatially-balanced framework has great potential for effective quantification of epifaunal cover in cross-shelf mesophotic reefs. However, greater image subsampling intensity than traditionally applied is required to ensure adequate observations for finer-level CATAMI classes and associated morphospecies.

Automatic Identification Systems (AIS) are a standard feature of ocean-going vessels, designed to allow vessels to notify each other of their position and route, to reduce collisions. Increasingly, the system is being used to monitor vessels remotely, particularly with the advent of satellite receivers. One fundamental problem with AIS transmission is the issue of gaps in transmissions. Gaps occur for three basic reasons: 1) saturation of the system in locations with high vessel density; 2) poor quality transmissions due to equipment on the vessel or receiver; and 3) intentional disabling of AIS transmitters. Resolving which of these mechanisms is responsible for generating gaps in transmissions from a given vessel is a critical task in using AIS to remotely monitor vessels. Moreover, separating saturation and equipment issues from intentional disabling is a key issue, as intentional disabling is a useful risk factor in predicting illicit behaviors such as illegal fishing. We describe a spatial statistical model developed to identify gaps in AIS transmission, which allows calculation of the probability that a given gap is due to intentional disabling. The model we developed successfully identifies high risk gaps in the test case example in the Arafura Sea. Simulations support that the model is sensitive to frequent gaps as short as one hour. Results in this case study area indicate expected high risk vessels were ranked highly for risk of intentional disabling of AIS transmitters. We discuss our findings in the context of improving enforcement opportunities to reduce illicit activities at sea.

Illegal, Unreported and Unregulated (IUU) fishing activities pose one of the most significant threats to sustainable fisheries worldwide. Identifying illegal behaviour, specifically fishing and at-sea transhipment, continues to be a fundamental hurdle in combating IUU fishing. Here, we explore the use of spatial statistical methods to identify vessels behaving anomalously, in particular with regard to loitering, using the Indonesian Exclusive Economic Zone (EEZ) and surrounding waters as a case-study. Using Automatic Identification System (AIS) for vessel tracking, we applied Generalized Additive Models to capture both the temporal and spatial nature of loitering behaviour. We identified three statistically anomalous loitering behaviours (based on time, speed and distance) and applied the models to 2700 vessels in the region. We were able to rank vessels for individual and joint probability of atypical behaviour, providing a hierarchical list of vessels engaging in anomalous behaviour. While identification of irregular behaviour does not mean vessels are definitely engaging in illegal activities, this statistical modelling approach can be used to prioritise the allocation of enforcement resources and assist authorities under the United Nations Food and Agricultural Organization Port State Measures Agreement for management and enforcement of IUU fishing associated activities.

We report striking evidence of semi-strong inefficiency in the UK fixed-odds football betting market using a reputable newspaper tipster which offers probabilities of match outcomes rather than simple result indicators. Betting on the Fink Tank probabilities of home wins across 10 bookmakers, when there are positive expected returns, would have generated positive returns in each of the seasons from 2006–07 to 2011–12 for a variety of different betting strategies. These returns could have been enhanced by employing the best odds from a greater number of bookmakers. However, the fact that pure arbitrage bets have existed for years and appear to last for several hours or days suggest they are in practice not exploitable to a magnitude that poses any threat to bookmakers.

This study was designed to discover blood biomarkers of cancer susceptibility using invasive multiple (n = 21), single primary breast cancer (n = 21), and control subjects (n = 20). Heparinized whole blood was incubated at 37 °C for 2 hours after 0–10 Gy of radiation, then cell cycle arrest marker CDKN1A and apoptosis marker BBC3 mRNA were quantified. This epidemiological study was practically feasible because radiation-induced mRNA was preserved for at least 1 day whenever blood was stored at 4 °C (r2 = 0.901). Moreover, blood could be stored frozen after radiation treatment (r2 = 0.797). Radiation- induced CDKN1A and BBC3 mRNA were dose dependent, and the degree of induction of CDKN1A was correlated with that of BBC3 (r2 = 0.679). Interestingly, multiple primary cases showed higher induction of CDKN1A mRNA than single primary and control groups, whereas BBC3 did not show such differences. The results suggested that cancer susceptibility represented by the multiple primary breast cancer cases was related to over-reaction of CDKN1A mRNA, not BBC3. The study also suggests that ex vivo gene expression analysis could potentially be used as a new tool in epidemiological studies for cancer and radiation sensitivity research.

OBJECTIVE: To compare oxygen supply options for health facilities in the Gambia and develop a decision-making algorithm for choosing oxygen delivery systems in Africa and the rest of the developing world. METHODS: Oxygen cylinders and concentrators were compared in terms of functionality and cost. Interviews with key informants using locally developed and adapted WHO instruments, operational assessments, cost-modelling and cost measurements were undertaken to determine whether oxygen cylinders or concentrators were the better choice. An algorithm and a software tool to guide the choice of oxygen delivery system were constructed. FINDINGS: In the Gambia, oxygen concentrators have significant advantages compared to cylinders where power is reliable; in other settings, cylinders are preferable as long as transporting them is feasible. Cylinder costs are greatly influenced by leakage, which is common, whereas concentrator costs are affected by the cost of power far more than by capital costs. Only two of 12 facilities in the Gambia were found suitable for concentrators; at the remaining 10 facilities, cylinders were the better option. CONCLUSION: Neither concentrators nor cylinders are well suited to every situation, but a simple options assessment can determine which is better in each setting. Nationally this would result in improved supply and lower costs by comparison with conventional cylinders alone, although ensuring a reliable supply would remain a challenge. The decision algorithm and software tool designed for the Gambia could be applied in other developing countries.

We consider the fitting of normal or t-component mixture models to multivariate data, using maximum likelikhood via the EM algorithm. This approach requires the initial specification of an initial estimate of the vector of unknown parameters, or equivalently of an initial classification of the data with respect to the components of the mixture model under fit. We describe an algorithm called EMMIX that automatically undertakes this fitting: including the provision of suitable initial values if not supplied by the user. The EMMIX algorithm has several options, including the option to carry out a resampling-based test for the number of components in the mixture model.

Collecting enough data to obtain reasonable abundance estimates of whales is often difficult, particularly when studying rare species. Passive acoustics can be used to detect whale sounds and are increasingly used to estimate whale abundance. Much of the existing effort centres on the use of acoustics to estimate abundance directly, e.g. analysing detections in a distance sampling framework. Here, we focus on acoustics as a tool incorporated within mark-recapture surveys. In this context, acoustic tools are used to detect and track whales, which are then photographed or biopsied to provide data for mark-recapture analyses. The purpose of incorporating acoustics is to increase the encounter rate beyond using visual searching only. While this general approach is not new, its utility is rarely quantified. This paper predicts the "acoustically-assisted" encounter rate using a discrete-time individual-based simulation of whales and survey vessel. We validate the simulation framework using existing data from studies of sperm whales. We then use the framework to predict potential encounter rates in a study of Antarctic blue whales. We also investigate the effects of a number of the key parameters on encounter rate. Mean encounter rates from the simulation of sperm whales matched well with empirical data. Variance of encounter rate, however, was underestimated. The simulation of Antarctic blue whales found that passive acoustics should provide a 1.7-3.0 fold increase in encounter rate over visual-only methods. Encounter rate was most sensitive to acoustic detection range, followed by vocalisation rate. During survey planning and design, some indication of the relationship between expected sample size and effort is paramount; this simulation framework can be used to predict encounter rates and establish this relationship. For a case in point, the simulation framework indicates unequivocally that real-time acoustic tracking should be considered for quantifying the abundance of Antarctic blue whales via mark-recapture methods.

Aerial surveys of marine mammals are routinely conducted to assess and monitor species' habitat use and population status. In Australia, dugongs (Dugong dugon) are regularly surveyed and long-term datasets have formed the basis for defining habitat of high conservation value and risk assessments of human impacts. Unmanned aerial vehicles (UAVs) may facilitate more accurate, human-risk free, and cheaper aerial surveys. We undertook the first Australian UAV survey trial in Shark Bay, western Australia. We conducted seven flights of the ScanEagle UAV, mounted with a digital SLR camera payload. During each flight, ten transects covering a 1.3 km(2) area frequently used by dugongs, were flown at 500, 750 and 1000 ft. Image (photograph) capture was controlled via the Ground Control Station and the capture rate was scheduled to achieve a prescribed 10% overlap between images along transect lines. Images were manually reviewed post hoc for animals and scored according to sun glitter, Beaufort Sea state and turbidity. We captured 6243 images, 627 containing dugongs. We also identified whales, dolphins, turtles and a range of other fauna. Of all possible dugong sightings, 95% (CI = 90%, 98%) were subjectively classed as 'certain' (unmistakably dugongs). Neither our dugong sighting rate, nor our ability to identify dugongs with certainty, were affected by UAV altitude. Turbidity was the only environmental variable significantly affecting the dugong sighting rate. Our results suggest that UAV systems may not be limited by sea state conditions in the same manner as sightings from manned surveys. The overlap between images proved valuable for detecting animals that were masked by sun glitter in the corners of images, and identifying animals initially captured at awkward body angles. This initial trial of a basic camera system has successfully demonstrated that the ScanEagle UAV has great potential as a tool for marine mammal aerial surveys.

This study was designed to discover blood biomarkers of cancer susceptibility using invasive multiple (n = 21), single primary breast cancer (n = 21), and control subjects (n = 20). Heparinized whole blood was incubated at 37 °C for 2 hours after 0–10 Gy of radiation, then cell cycle arrest marker CDKN1A and apoptosis marker BBC3 mRNA were quantified. This epidemiological study was practically feasible because radiation-induced mRNA was preserved for at least 1 day whenever blood was stored at 4 °C (r 2 = 0.901). Moreover, blood could be stored frozen after radiation treatment (r 2 = 0.797). Radiation- induced CDKN1A and BBC3 mRNA were dose dependent, and the degree of induction of CDKN1A was correlated with that of BBC3 (r 2 = 0.679). Interestingly, multiple primary cases showed higher induction of CDKN1A mRNA than single primary and control groups, whereas BBC3 did not show such differences. The results suggested that cancer susceptibility represented by the multiple primary breast cancer cases was related to over-reaction of CDKN1A mRNA, not BBC3. The study also suggests that ex vivo gene expression analysis could potentially be used as a new tool in epidemiological studies for cancer and radiation sensitivity research.

OBJECTIVE: In 2000, a referral hospital in the Gambia accepted a donation of oxygen concentrators to help maintain oxygen supplies. The concentrators broke down and were put into storage. A case study was done to find the reasons for the problem and to draw lessons to help improve both oxygen supplies and the success of future equipment donations. METHODS: A technical assessment of the concentrators was carried out by a biomedical engineer with relevant expertise. Semi-structured interviews were undertaken with key informants, and content analysis and inductive approaches were applied to construct the history of the episode and the reasons for the failure. FINDINGS: Interviews confirmed the importance of technical problems with the equipment. They also revealed that the donation process was flawed, and that the hospital did not have the expertise to assess or maintain the equipment. Technical assessment showed that all units had the wrong voltage and frequency, leading to overheating and breakdown. Subsequently a hospital donations committee was established to oversee the donations process. On-site biomedical engineering expertise was arranged with a nongovernmental organization (NGO) partner. CONCLUSION: Appropriate donations of medical equipment, including oxygen concentrators, can be of benefit to hospitals in resource-poor settings, but recipients and donors need to actively manage donations to ensure that the donations are beneficial. Success requires planning, technical expertise and local participation. Partners with relevant skills and resources may also be needed. In 2002, WHO produced guidelines for medical equipment donations, which address problems that might be encountered. These guidelines should be publicized and used.