Synanthropic Mites of Kolkata, India: An Ecological Appraisal

Ecological observations were made on house dust mites of Kolkata as they form a major part of synanthropic mite community. Dust samples were collected with regard to the abundance of mite in relation to certain socio-ecological parameters like, habitat preference, location of house, construction pattern of house, types of mattresses used and the frequency of cleaning of mattresses. Among two different habitats examined, bed dust contained significantly higher mite population (p < 0.01) than the corresponding bedroom floor dust. The density of total mites and glycyphagids are significantly higher in rural houses in comparison to those of urban houses. In contrast, rural houses contained least number of pyroglyphids/g of dust. The density of total mites as well as pyroglyphid mites/g of dust are higher in mud house in comparison to concrete house. The density of total mites, pyroglyphids and glycyphagids are higher in cotton mattress in comparison to that of foam mattress. The frequency of cleaning has a significant effect on reducing mite densities i.e., the more the frequency of cleaning the lesser are the mite densities.     

Barriers to Sustained Use of Contraception in Nepal: Quality of Care,Socioeconomic Status,and Method-Related Factors

Owing to previously limited data availability, low contraceptive prevalence, and predominance of permanent method use in Nepal, there have been few studies of contraceptive-use dynamics. The aim of this article is to examine contraceptive use dynamics in Nepal in light of the country's ongoing fertility transition and change in contraceptive method-mix. Drawing on the 2003 Contraceptive Acceptance and Use Patterns Survey of Nepal and the quality-of-care framework, a proportional hazards model is used to explore contraceptive discontinuation of injections and pills. Results show that source of method from non-government services, high level of information given, one-to-one counseling, satisfaction with services, and shorter travel time to source are associated with lower odds of discontinuation. Despite the experience of side effects, women in Nepal are highly motivated to regulate their fertility. Results suggest detailed information given to users can have significant influence on continuation of methods rather than merely providing information on alternative methods and group counseling.     

Socioeconomic Inequalities in Childhood Undernutrition in India: Analyzing Trends between 1992 and 2005

Background

India experienced a rapid economic boom between 1991 and 2007. However, this economic growth has not translated into improved nutritional status among young Indian children. Additionally, no study has assessed the trends in social disparities in childhood undernutrition in the Indian context. We examined the trends in social disparities in underweight and stunting among Indian children aged less than three years using nationally representative data.

Methods

We analyzed data from the three cross-sectional rounds of National Family Health Survey of India from 1992, 1998 and 2005. The social factors of interest were: household wealth, maternal education, caste, and urban residence. Using multilevel modeling to account for the nested structure and clustering of data, we fit multivariable logistic regression models to quantify the association between the social factors and the binary outcome variables. The final models additionally included age, gender, birth order of child, religion, and age of mother. We analyzed the trend by testing for interaction of the social factor and survey year in a dataset pooled from all three surveys.

Results

While the overall prevalence rates of undernutrition among Indian children less than three decreased over the 1992–2005 period, social disparities in undernutrition over these 14 years either widened or stayed the same. The absolute rates of undernutrition decreased for everyone regardless of their social status. The disparities by household wealth were greater than the disparities by maternal education. There were no disparities in undernutrition by caste, gender or rural residence.

Conclusions

There was a steady decrease in the rates of stunting in the 1992–2005 period, while the decline in underweight was greater between 1992 and 1998 than between 1998 and 2005. Social disparities in childhood undernutrition in India either widened or stayed the same during a time of major economic growth. While the advantages of economic growth might be reaching everyone, children from better-off households, with better educated mothers appear to have benefited to a greater extent than less privileged children. The high rates of undernutrition (even among the socially advantaged groups) and the persistent social disparities need to be addressed in an urgent and comprehensive manner.     

Impact of Pay for Performance on Prescribing of Long-Acting Reversible Contraception in Primary Care: An Interrupted Time Series Study

Background

The aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-for-performance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care.

Methods

Negative binomial interrupted time series analysis using practice level prescribing data from April 2007 to March 2012. The main outcome measure was the prescribing rate of long-acting reversible contraceptives (LARC), including hormonal and non hormonal intrauterine devices and systems (IUDs and IUSs), injectable contraceptives and hormonal implants.

Results

Prescribing rates of Long-Acting Reversible Contraception (LARC) were stable before the introduction of contraceptive targets to the QOF and increased afterwards by 4% annually (rate ratios  = 1.04, 95% CI = 1.03, 1.06). The increase in LARC prescribing was mainly driven by increases in injectables (increased by 6% annually), which was the most commonly prescribed LARC method. Of other types of LARC, the QOF indicator was associated with a step increase of 20% in implant prescribing (RR =  1.20, 95% CI =  1.09, 1.32). This change is equivalent to an additional 110 thousand women being prescribed with LARC had QOF points not been introduced.

Conclusions

Pay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods.     

Dominance,grooming, and clasped-sleeping relationships among bonnet monkeys in India

Social relationships, including dominance, grooming, and clasped-sleeping, were studied in a troop of bonnet monkeys (Macaca radiata) at Dharwar, India, the study period lasting two months and a half. Three measurements, the peanut test, the drinking test, and the spatial distribution test, were used to analyze dominance relationships. The peanut test showed a straight linear ranking order among adult males and females; however, among females drinking and spatial distribution orders are slightly different from that of feeding (peanut test). Grooming was observed more frequently between adult female and adult female and was seldom observed between adult male and juvenile female or between juvenile male and juvenile female. Apparently all monkeys tend to groom with females. On the other hand, monkeys of the same sex tend to sleep with each other. It is clear that monkeys select their partners when they groom and sleep.     

Shifts in Dominance and Species Assemblages over Two Decades in Alternative Successions in Central Amazonia

Following perturbation, different assemblages that originate under the same abiotic conditions initiate successional pathways that may continue to diverge or converge toward an eventual climax. Forest regeneration in the Central Amazon begins with alternative successional pathways associated with prior land use. In a 12‐yr study of secondary forests, initially ranging between 2 and 19 yrs after abandonment, we compared species compositions through time along two pathways, abandoned clear‐cuts dominated by Cecropia and abandoned pastures dominated by Vismia; prior results at these sites have not directly evaluated species composition. At all ages, the Chao–Jaccard similarity index of species composition was highest comparing pasture transects to each other, lowest comparing pastures transects to clear‐cut transects, and intermediate comparing clear‐cut transects to each other. Through time, clear‐cut transects became less similar to each other, as did pasture transects. Changes in similarity reflected declining dominance along both pathways, but Cecropia dominance of clear‐cut transects declined more rapidly than Vismia dominance of pasture transects. A rich association of species replaced Cecropia in clear‐cut transects, resulting in decreased similarity among them. In pasture transects one genus, Bellucia, replaced the lost Vismia, so similarity of Vismia transects was maintained despite some turnover in dominance. Overall, even with turnover of individuals and decline of the dominant pioneers, the alternative pathways exhibited strikingly different species assemblies after two decades of succession, suggesting that the effect of land use persists well beyond initial floristic composition.     

Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures

Background

Whether non-communicable diseases (NCDs) are diseases of poverty or affluence in low-and-middle income countries has been vigorously debated. Most analyses of NCDs have used self-reported data, which is biased by differential access to healthcare services between groups of different socioeconomic status (SES). We sought to compare self-reported diagnoses versus standardised measures of NCD prevalence across SES groups in India.

Methods

We calculated age-adjusted prevalence rates of common NCDs from the Study on Global Ageing and Adult Health, a nationally representative cross-sectional survey. We compared self-reported diagnoses to standardized measures of disease for five NCDs. We calculated wealth-related and education-related disparities in NCD prevalence by calculating concentration index (C), which ranges from −1 to +1 (concentration of disease among lower and higher SES groups, respectively).

Findings

NCD prevalence was higher (range 5.2 to 19.1%) for standardised measures than self-reported diagnoses (range 3.1 to 9.4%). Several NCDs were particularly concentrated among higher SES groups according to self-reported diagnoses (C_srd) but were concentrated either among lower SES groups or showed no strong socioeconomic gradient using standardized measures (C_sm): age-standardised wealth-related C: angina C_srd 0.02 vs. C_sm −0.17; asthma and lung diseases C_srd −0.05 vs. C_sm −0.04 (age-standardised education-related C_srd 0.04 vs. C_sm −0.05); vision problems C_srd 0.07 vs. C_sm −0.05; depression C_srd 0.07 vs. C_sm −0.13. Indicating similar trends of standardized measures detecting more cases among low SES, concentration of hypertension declined among higher SES (C_srd 0.19 vs. C_sm 0.03).

Conclusions

The socio-economic patterning of NCD prevalence differs markedly when assessed by standardized criteria versus self-reported diagnoses. NCDs in India are not necessarily diseases of affluence but also of poverty, indicating likely under-diagnosis and under-reporting of diseases among the poor. Standardized measures should be used, wherever feasible, to estimate the true prevalence of NCDs.     

Hormonal Contraception and the Risk of HIV Acquisition: An Individual Participant Data Meta-analysis

BackgroundObservational studies of a putative association between hormonal contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC.ConclusionsThis IPD meta-analysis found no evidence that COC or NET-EN use increases women’s risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at high HIV risk. A randomized controlled trial would provide more definitive evidence about the effects of hormonal contraception, particularly DMPA, on HIV risk.     

Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis

Background

Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India.

Methods and Findings

Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold (∼23%–35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately prevent four of five maternal deaths; this approach coupled stepwise improvements in family planning and safe abortion with consecutively implemented strategies that incrementally increased skilled attendants, improved antenatal/postpartum care, shifted births away from home, and improved recognition of referral need, transport, and availability/quality of EmOC. The strategies in this approach ranged from being cost-saving to having incremental cost-effectiveness ratios less than US$500 per year of life saved (YLS), well below India''s per capita gross domestic product (GDP), a common benchmark for cost-effectiveness.

Conclusions

Early intensive efforts to improve family planning and control of fertility choices and to provide safe abortion, accompanied by a paced systematic and stepwise effort to scale up capacity for integrated maternal health services over several years, is as cost-effective as childhood immunization or treatment of malaria, tuberculosis, or HIV. In just 5 y, more than 150,000 maternal deaths would be averted through increasing contraception rates to meet women''s needs for spacing and limiting births; nearly US$1.5 billion would be saved by coupling safe abortion to aggressive family planning efforts; and with stepwise investments to improve access to pregnancy-related health services and to high-quality facility-based intrapartum care, more than 75% of maternal deaths could be prevented. If accomplished over the next decade, the lives of more than one million women would be saved. Please see later in the article for the Editors'' Summary     

Socioeconomic differentials in nutritional status of children in the states of West Bengal and Assam, India

Malnutrition among children is prevalent in almost all the states in India. This study assesses the extent and causes of malnutrition in two eastern Indian states with similar climates, namely West Bengal and Assam, using data from the National Family Health Survey 1998-99 (NFHS-2). The three indices of malnutrition taken for analysis are weight-for-height (WHZ), height-for-age (HAZ) and weight-for-age (WAZ). These are assumed to depend on birth order, preceding birth interval, parent's educational status, working status of the mother, mother's age at delivery of the children, source of drinking water, toilet facilities and standard of living of the household. Logistic regression was carried out separately for each of the three indices on the explanatory variables for both the states. It was found that not all variables are equally important in determining whether a baby is underweight, or suffering from acute or chronic malnutrition. Also, the importance of variables is not the same in the two states. It was observed that the coefficients associated with the variables in determining weight-for-height are not significant compared with those for weight-for-age and height-for-age.     

Measuring Dominance and Constructing Hierarchies: An Example Using Mule Deer

Important issues that are still unresolved in the study of animal social groups are how dominance is measured and how individuals are ranked. Based on observations of mule deer (Odocoileus hemionus hemionus), we constructed hierarchies for the same 26 bucks using five potential correlates of dominance and three measures based on the outcome of agonistic interactions. Data for each of six behavior measures were converted to ranks by six different numerical techniques. Different measures of behavior resulted in different hierarchies. This was especially so when the hierarchy based on sparring rates was compared to hierarchies based on other criteria. Although our results showed that dominance is not a unitary concept, several measures of dominance were highly correlated with one another. Thus, one measure, in some instances, may be a good but imperfect predictor of dominance defined by other criteria. For data sets based on index scores or rates of performing behavior, the mean difference and standard-error difference ranking methods had distinct advantages. Both produced equally weighted ranks that minimized the effects of sampling errors.     

Dominance competition through affiliation and support in Japanese macaques: An experimental study

It has been proposed that monkeys direct grooming to high-ranking individuals in an attempt to obtain agonistic support in return. But whether these two categories of interactions are causally related has proven difficult to establish. Part of the problem stems from the fact that in stable groups social relationships reflect an equilibrium state and that behaviors need only be performed at low rates and long intervals to maintain the current social structure. In theory, however, if affiliative and supportive interactions are indeed causally related, it should be possible to accentuate their temporal relation, hence their causal dynamics. For example, destabilizing dominance relations can be expected to induce competition for status and force individuals to deploy behavioral tactics for settling new rank relations. We experimentally induced rank reversals in a captive group of Japanese macaques (Macaca fuscata) composed of three matrilines (A-B-C rank order). A reversed C-A-B order composed of three individuals per matriline was maintained for 2 weeks. The results show the close temporal relation among (i) asserting one’s rank, (ii) competing for access to dominants through affiliation and interferences in affiliation, (iii) receiving support from dominants against lower-ranking individuals, and (iv) supporting dominants against subordinates. These findings are compatible with one version of the affiliation-for-support hypothesis, namely that monkeys affiliate with dominants as a way to assert their position in the hierarchy. In a functional perspective, mutual selfishness provides a better explanation than reciprocal altruism because the possibility that both groomers and supporters derive immediate net benefits cannot be excluded.     

Individual Choices in Dynamic Networks: An Experiment on Social Preferences

Game-theoretic models of network formation typically assume that people create relations so as to maximize their own outcome in the network. Recent experiments on network formation suggest that the assumption of self-interest might be unwarranted and that social preferences, such as altruism and inequality aversion, play a role in the formation of social networks. We developed an experiment to systematically investigate whether people show preferences for outcomes of others during network formation. We find that such preferences play a role when network decisions degenerate to simple two-person decision tasks. In more complex environments, however, we find little evidence for social preferences as a significant decision criterion. Furthermore, we find some evidence for farsighted behavior in network formation.     

An Appraisal of Proliferation and Apoptotic Markers in Papillary Thyroid Carcinoma: An Automated Analysis

Introduction

Proliferation and apoptosis are opposing processes by which the cell numbers are kept in a delicate balance, essential for tissue homeostasis, whereas uncontrolled growth of cells is a hallmark of cancer. Papillary thyroid cancer (PTC) is the commonest type of thyroid cancer, with some PTC following an indolent course, whereas the other ones are more aggressive.

Aim

To evaluate respective contribution of proliferation and apoptosis in the tumorigenesis of PTC by automated analysis.

Materials and Methods

We investigated the immunolabeling of phosphorylated histone H3 (pHH3), cyclin D1, active caspase-3, and bcl-2 in thirteen cases each of metastatic PTC, follicular variant of PTC (FVPTC), papillary microcarcinoma (PMC) and well differentiated tumor of uncertain malignant potential (WDT-UMP). FVPTC cases comprised seven encapsulated and six unencapsulated cases.

Results

Proliferation, as assessed by pHH3 and cyclin D1 immunolabeling, was increased in all PTC variants, including the putative precursor lesion WDT-UMP, compared to normal thyroid tissue. pHH3 was immunolabeled in more cells of metastatic PTC than of PMC and of encapsulated FVPTC. Surprisingly, metastatic PTC and unencapsulated FVPTC also demonstrated more cleaved caspase-3 immunolabeled cells than the other types. In contrast, increased expression of bcl-2 protein was seen in normal thyroid areas, encapsulated FVPTC and PMC as compared to metastatic PTC. Metastatic PTC shows higher proliferation than other types of PTC but unexpectedly also higher apoptotic levels. Similar results were also seen with unencapsulated FVPTC, thus suggesting that unencapsulated FVPTC has a potential for adverse outcome. Bcl-2 was immunolabeled in a low percentage of cells in WDT-UMP.

Conclusions

The expression of the proliferative protein pHH3 together with the apoptotic marker cleaved caspase-3 may indicate an aggressive behaviour of PTC and loss of apoptosis inhibition by bcl-2 protein can further amplify the role of these proteins in tumor progression. Both cyclin D1 and bcl-2 could prove to be interesting markers of PTC precursor lesions. Automated/digital image quantification approach helps in refining the diagnostic accuracy.     

Fitness in the universe: Choices and necessities

We live in a universe of chance, but not of accident. Repeatedly in the course of its development choices have been made for which one can ask the reasons. One such choice is fundamental: if the proton had not so much greater mass than the electron, all matter would be fluid; and if the proton did not have exactly the same numerical charge as the electron — or some simple multiple of that charge — virtually all matter would be charged. If a universe were started with charged hydrogen, it could expand, but probably nothing more. Hydrogen, carbon, nitrogen and oxygen play as fundamental — and irreplaceable — roles in the metabolism of stars as of living organisms. Both metabolisms are coupled, through radiation from the stars providing the energy on which life must come ultimately to run on the planets. In the course of their evolution on the Earth, living organisms have found their way repeatedly and exclusively to certain types of organic molecule to perform specific functions; so, for example, the chlorophylls for photosynthesis, and carotenoids for plant phototropism and for vision. It is argued that some measure of necessity has governed these choices; and that an extended principle of natural selection has operated at all levels of material organization to produce such elements of order and compatibility in the universe.