How many births in sub-Saharan Africa and South Asia will not be attended by a skilled birth attendant between 2011 and 2015?

<p>Abstract</p> <p>Background</p> <p>The fifth Millennium Development Goal target for 90% of births in low and middle income countries to have a skilled birth attendant (SBA) by 2015 will not be met. In response to this, policy has focused on increasing SBA access. However, reducing maternal mortality also requires policies to prevent deaths among women giving birth unattended. We aimed to generate estimates of the absolute number of non-SBA births between 2011 and 2015 in South Asia and sub-Saharan Africa, given optimistic assumptions of future trends in SBA attendance. These estimates could be used by decision makers to inform the extent to which reductions in maternal mortality will depend on policies aimed specifically at those women giving birth unattended.</p> <p>Methods</p> <p>For each country within South Asia and sub-Saharan Africa we estimated recent trends in SBA attendance and used these as the basis for three increasingly optimistic projections for future changes in SBA attendance. For each country we obtained estimates for the current SBA attendance in rural and urban settings and forecasts for the number of births and changes in rural/urban population over 2011-2015. Based on these, we calculated estimates for the number of non-SBA births for 2011-2015 under a variety of scenarios.</p> <p>Results</p> <p>Conservative estimates are that there will be between 130 and 180 million non-SBA births in South Asia and sub-Saharan Africa from 2011 to 2015 (90% of these in rural areas). Currently, there are more non-SBA births per year in South Asia than sub-Saharan Africa, but our projections suggest that the regions will have approximately the same number of non-SBA births by 2015. We also present results for each of the six countries currently accounting for more than 50% of global maternal deaths.</p> <p>Conclusions</p> <p>Over the next five years, many millions of women within South Asia and sub-Saharan Africa will give birth without an SBA. Efforts to improve access to skilled attendance should be accompanied by interventions to improve the safety of non-attended deliveries.</p

The Child and Adolescent Psychiatry: Study of Training in Europe (CAP-STATE)

There is great cultural diversity across Europe. This is reflected in the organisation of child and adolescent mental health (CAMH) services and the training of the respective professionals in different countries in Europe. Patients and their parents will want a high quality, knowledgeable, and skillful service from child and adolescent psychiatrists (CAPs) wherever they see them in Europe. A European comparison of training programs allows all stakeholders in different European countries to assess the diversity and to initiate discussions as to the introduction of improvements within national training programs. Major issues to be addressed in comparing child and adolescent psychiatric training programs across Europe include: (1) formal organisation and content of training programs and the relationship to adult psychiatry and paediatrics; (2) flexibility of training, given different trainee interests and that many trainees will have young families; (3) quality of governance of training systems; (4) access to research; and (5) networking. The Child and Adolescent Psychiatry-Study of Training in Europe (CAP-State) is a survey of training for child and adolescent psychiatrists (CAPs) across European countries. It aims to revisit and extend the survey carried out in 2006 by Karabekiroglu and colleagues. The current article is embedded in a special issue of European Child + Adolescent Psychiatry attempting to for the first time address training in CAP at the European and global levels. Structured information was sought from each of 38 European and neighboring countries (subsequently loosely referred to as Europe) and obtained from 31. The information was provided by a senior trainee or recently qualified specialist and their information was checked and supplemented by information from a senior child and adolescent psychiatry trainer. Results showed that there is a very wide range of provision of training in child and adolescent psychiatry in different countries in Europe. There remains very substantial diversity in training across Europe and in the degree to which it is subject to national oversight and governance. Some possible reasons for this variation are discussed and some recommendations made.info:eu-repo/semantics/publishedVersio

Molecular mechanisms and cellular functions of cGAS-STING signalling

The cGAS–STING signalling axis, comprising the synthase for the second messenger cyclic GMP–AMP (cGAS) and the cyclic GMP–AMP receptor stimulator of interferon genes (STING), detects pathogenic DNA to trigger an innate immune reaction involving a strong type I interferon response against microbial infections. Notably however, besides sensing microbial DNA, the DNA sensor cGAS can also be activated by endogenous DNA, including extranuclear chromatin resulting from genotoxic stress and DNA released from mitochondria, placing cGAS–STING as an important axis in autoimmunity, sterile inflammatory responses and cellular senescence. Initial models assumed that co-localization of cGAS and DNA in the cytosol defines the specificity of the pathway for non-self, but recent work revealed that cGAS is also present in the nucleus and at the plasma membrane, and such subcellular compartmentalization was linked to signalling specificity of cGAS. Further confounding the simple view of cGAS–STING signalling as a response mechanism to infectious agents, both cGAS and STING were shown to have additional functions, independent of interferon response. These involve non-catalytic roles of cGAS in regulating DNA repair and signalling via STING to NF-κB and MAPK as well as STING-mediated induction of autophagy and lysosome- dependent cell death. We have also learnt that cGAS dimers can multimerize and undergo liquid–liquid phase separation to form biomolecular condensates that could importantly regulate cGAS activation. Here, we review the molecular mechanisms and cellular functions underlying cGAS–STING activation and signalling, particularly highlighting the newly emerging diversity of this signalling pathway and discussing how the specificity towards normal, damage-induced and infection-associated DNA could be achieved

The January 2022 eruption of Hunga Tonga-Hunga Ha’apai volcano reached the mesosphere

Explosive volcanic eruptions can loft ash, gases, and water into the stratosphere, which affects both human activities and the climate. Using geostationary satellite images of the 15 January 2022 eruption of the Hunga Tonga-Hunga Ha’apai volcano, we find that the volcanic plume produced by this volcano reached an altitude of 57 kilometers at its highest extent. This places the plume in the lower mesosphere and provides observational evidence of a volcanic eruption injecting material through the stratosphere and directly into the mesosphere. We then discuss potential implications of this injection and suggest that the altitude reached by plumes from previous eruptions, such as the eruption of Mount Pinatubo in 1991, may have been underestimated because of a lack of observational data

Uncertainty-bounded estimates of ash cloud properties using the ORAC algorithm: application to the 2019 Raikoke eruption

Uncertainty-bounded satellite retrievals of volcanic ash cloud properties such as ash cloud-top height, effective radius, optical depth and mass loading are needed for the robust quantitative assessment required to warn aviation of potential hazards. Moreover, there is an imperative to improve quantitative ash cloud estimation due to the planned move towards quantitative ash concentration forecasts by the Volcanic Ash Advisory Centers. Here we apply the Optimal Retrieval of Aerosol and Cloud (ORAC) algorithm to Advanced Himawari Imager (AHI) measurements of the ash clouds produced by the June 2019 Raikoke (Russia) eruption. The ORAC algorithm uses an optimal estimation technique to consolidate a priori information, satellite measurements and associated uncertainties into uncertainty-bounded estimates of the desired state variables. Using ORAC, we demonstrate several improvements in thermal infrared volcanic ash retrievals applied to broadband imagers. These include an improved treatment of measurement noise, accounting for multi-layer cloud scenarios, distinguishing between heights in the troposphere and stratosphere, and the retrieval of a wider range of effective radii sizes than existing techniques by exploiting information from the 10.4 µm channel. Our results indicate that 0.73 ± 0.40 Tg of very fine ash (radius ≤ 15 µm) was injected into the atmosphere during the main eruptive period from 21 June 18:00 UTC to 22 June 10:00 UTC. The total mass of very fine ash decreased from 0.73 to 0.10 Tg over ∼ 48 h, with an e-folding time of 20 h. We estimate a distal fine ash mass fraction of 0.73 % ± 0.62 % based on the total mass of very fine ash retrieved and the ORAC-derived height–time series. Several distinct ash layers were revealed by the ORAC height retrievals. Generally, ash in the troposphere was composed of larger particles than ash present in the stratosphere. We also find that median ash cloud concentrations fall below peak ash concentration safety limits (< 4 mg m−3) 11–16 h after the eruption begins, if typical ash cloud geometric thicknesses are assumed. The ORAC height retrievals for the near-source plume showed good agreement with GOES-17 side-view height data (R=0.84; bias = −0.75 km); however, a larger negative bias was found when comparing ORAC height retrievals for distal ash clouds against Cloud-Aerosol Lidar with Orthogonal Polarisation (CALIOP) measurements (R=0.67; bias = −2.67 km). The dataset generated here provides uncertainties at the pixel level for all retrieved variables and could potentially be used for dispersion model validation or be implemented in data assimilation schemes. Future work should focus on improving ash detection, improving height estimation in the stratosphere and exploring the added benefit of visible channels for retrieving effective radius and optical depth in opaque regions of nascent ash plumes