Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from Sub-Saharan Africa

Background

As voluntary medical male circumcision (VMMC) programs scale up, there is a pressing need for information about the important cost drivers, and potential efficiency gains. We examine those cost drivers here, and estimate the potential efficiency gains through an econometric model.

Methods and Findings

We examined the main cost drivers (i.e., personnel and consumables) associated with providing VMMC in sub-Saharan Africa along a number of dimensions, including facility type and service provider. Primary source facility level data from Kenya, Namibia, South Africa, Tanzania, Uganda, and Zambia were utilized throughout. We estimated the efficiency gains by econometrically estimating a cost function in order to calculate the impact of scale and other relevant factors. Personnel and consumables were estimated at 36% and 28%, respectively, of total costs across countries. Economies of scale (EOS) is estimated to be eight at the median volume of VMMCs performed, and EOS falls from 23 at the 25th percentile volume of VMMCs performed to 5.1 at the 75th percentile.

Conclusions

The analysis suggests that there is significant room for efficiency improvement as indicated by declining EOS as VMMC volume increases. The scale of the fall in EOS as VMMC volume increases suggests that we are still at the ascension phase of the scale-up of VMMC, where continuing to add new sites results in additional start-up costs as well. A key aspect of improving efficiency is task sharing VMMC procedures, due to the large percentage of overall costs associated with personnel costs. In addition, efficiency improvements in consumables are likely to occur over time as prices and distribution costs decrease.     

The influence of climate and sea-level change on the Holocene evolution of a Mediterranean coastal lagoon: Evidence from ostracod palaeoecology and geochemistry

Coastal lagoons provide an excellent basis for the study of processes controlling the evolution of a coastal zone. We examine the relative importance of these processes during the middle to late Holocene through a study of an 8.5 meter-long sediment record from the Albufera de Valencia (Spain). We combine sedimentological analyses with investigations into the palaeoecology, taphonomy and geochemistry (Mg/Ca, Sr/Ca, δ¹⁸O and δ¹³C) of ostracod valves in order to assess the effects of sea-level changes, storm events and effective moisture on the evolution of a Western Mediterranean coastal wetland. The late Pleistocene sediments represent a subaerial environment, which was followed by a hiatus in deposition. The first Holocene unit (～8700–7500 calendar yr. BP) is composed of typical lagoon-barrier and backshore sediments, deposited when seawater intruded into the lake and the climate was arid. The upper part of the sequence (between 7500 and 3400 yr.) is characterized by two sedimentary units, which correspond to Holocene progradation phases and humid climate associated with an increased freshwater influx to the lake accompanied by several high-energy events (palaeostorms). Overall, the record shows that an arid climate prevailed in the western Mediterranean area between 8400 and 7600 yr. The main marine transgression and accompanying progradational phases occurred between 7000 and 3400 yr., which is confirmed by other studies of coastal evolution along the Mediterranean coast. The multiproxy reconstructions demonstrate that controls on sedimentation and palaeoecology in this Mediterranean coastal lagoon were complex.     

Antioxidant activity of the simulated gastro-intestinal digestion hydrolysate of two edible Nigerian marine molluscs: Tympanatonus fuscatus var radula (L.) and Pachymelania aurita (M.)

The multifunctional nature of antioxidant peptides makes them more attractive candidates as dietary ingredients in health maintenance. Therefore, food protein-derived antioxidant peptides are continuously investigated. This study investigated the in vitro antioxidant properties of hydrolysate and ultrafiltered peptide fractions of Pachymelania aurita and Tympanatonus fuscatus var radula-two commonly consumed marine molluscs known as periwinkles in southern Nigeria. Simulated gastrointestinal digestion (SGID) of soluble proteins of T. fuscatus and P. aurita was carried out using pepsin, trypsin and chymotrypsin, and the SGID hydrolysates were fractionated using a 3 kDa membrane filter. The hydrolysates and their fractions were investigated for anti-lipid peroxidation, hydroxyl radical scavenging activity (HRSA), ferric reducing antioxidant property (FRAP) and metal chelation activity, and they demonstrated clear antioxidant properties in all the assay models used. Low molecular weight fractions of the hydrolysates demonstrated more potent antioxidant activity than higher molecular weight fractions. This is profound in the metal chelation assay, where low molecular weight peptide fractions, T ≤ 3 kDa and P ≤ 3 kDa (IC₅₀ values of 8.10 ± 0.011 and 5.56 ± 0.50 µg/ml respectively) had activity that is similar to that of EDTA (11.84 ± 0.89 µg/ml). Similar activity effects were observed in other assays where there was about 3-fold higher activity in low molecular weight fractions. These results demonstrate the presence of antioxidant peptide(s) in the protein hydrolysates of the periwinkles.     

Vacuolar protein sorting genes regulate mat formation in Saccharomyces cerevisiae by Flo11p-dependent and -independent mechanisms

Saccharomyces cerevisiae generates complex biofilms called mats on low-density (0.3%) agar plates. The mats can be morphologically divided into two regions: (i) hub, the interior region characterized by the presence of wrinkles and channels, and (ii) rim, the smooth periphery. Formation of mats depends on the adhesin Flo11p, which is also required for invasive growth, a phenotype in which the S. cerevisiae yeasts grow as chains of cells that dig into standard-density (2%) agar plates. Although both invasive growth and mat formation depend on Flo11p, mutations that perturb the multivesicular body (MVB) protein sorting pathway inhibit mat formation in a FLO11-independent manner. These mutants, represented by vps27Δ, disrupt mat formation but do not affect invasive growth, FLO11 gene or protein expression, or Flo11p localization. In contrast, an overlapping subset of MVB mutants (represented by ESCRT [endosomal sorting complex required for transport] complex genes such as VPS25) interrupt the Rim101p signal transduction cascade, which is required for FLO11 expression, and thus block both invasive growth and mat formation. In addition, this report shows that mature Flo11p is covalently associated with the cell wall and shed into the extracellular matrix of the growing mat.     

Pond conservation: from science to practice

In Europe, ponds are an exceptionally numerous and widely distributed landscape feature forming a major part of the continental freshwater resource and contributing significantly to freshwater biodiversity conservation. This has been reflected by a growing scientific concern over the first few years of the twenty-first century and is evidenced by an increasing number of academic publications on pond related topics, particularly those relating to biodiversity. It is essential, however, that this expanding scientific knowledge is widely disseminated to those involved with pond management and is then rapidly translated into action. Inevitably, the task of transferring science to practice remains a significant challenge. As a first step towards meeting this challenge the European Pond Conservation Network (EPCN), at its biennial meeting in 2008 in Valencia (Spain), made this the main theme of the conference together with two special workshops further encouraging exchanges between scientists, practitioners and policy makers. The papers selected for this special issue of Hydrobiologia (from over 120 communications presented) are all from the conference. They represent a diverse collection of themes from across the continent and North Africa and present new and original insights into topics as wide ranging as: pond biodiversity; human disturbance; landscape ecology; ecological assessment and monitoring; practical management measures; ecological restoration; hydrology and climate change; invasive species and threatened species. In all cases, the papers demonstrate an overriding need for the development of a tight link between scientific knowledge and management. Furthermore, scientific advances have to be beneficial for on the ground management and, vitally, have to be disseminated, communicated and implemented into local, national and international policy. As such, national and international networks (such as the EPCN) have a central role to play and have to develop a robust information and communication strategy which will enable the dissemination of best practice materials and advice across the continent and beyond. The work contained in this volume represents a step in the right direction and will help to ensure that ponds remain a characteristic and highly visible feature of the European landscape in the twenty-first century. Guest editors: B. Oertli, R. Céréghino, A. Hull & R. Miracle Pond Conservation: From Science to Practice. 3rd Conference of the European Pond Conservation Network, Valencia, Spain, 14–16 May 2008     

A perspective on aging in rotifers

Most research on aging in rotifers has been performed with populations, not with individuals. As a consequence, the dependent variable in these studies is usually either mean lifespan or rate of survivorship. After a brief consideration of the literature published since the last major review (King, 1969), the results of a series of experiments are presented. Males and females of three genetically distinct clones of Brachionus plicatilis were used for a factorial life table analysis at three different temperatures. The results of these experiments indicate several potential problems in using populations to study the aging process of individuals. These problems derive from the fact that lifespan is only one component of fitness, and its relative duration may not reflect the evolutionary success of the clone. That is, lifespan is free to vary in response to both stochastic and deterministic events without significantly reducing fitness. Under these conditions, neither mean lifespan nor pattern of survivorship will provide meaningful data on the determinants of individual senescence.We gratefully acknowledge the aid and advice of William R. Rice in conduct of the regression analysis. This work was supported by grants from the National Science Foundation and National Institutes of Health to CEK.     

The physical, chemical and biological characteristics of the holomictic sulphated Lake Arcas-2 (Cuenca, Spain)

The main limnological features of Lake Arcas-2 were followed through two consecutive stratification periods. Its morphometrical characteristics, such as the high relative depth (31%) and steep basin walls, enhance the sharp water stratification with the formation of an oxic-anoxic boundary at 8.8–9 m and a sulphide-rich hypolimnion during the thermal stagnation. The ionic sequence was SO ₄ ^2- >Alkal.>Cl^- and Ca²⁺>Mg²⁺>Na⁺>K⁺ and the mineralization was high, with water conductivity higher than 2500 S cm^-1. It is mesotrophic with epilimnetic chlorophyll a concentrations of 2–5 g l^-1 and metalimnetic of 8 g l^-1. The depth of the euphotic zone was established at around 8 m. Phosphorus concentration in the oxic waters was low but largely accumulated in the anoxic hypolimnion, together with other compounds such as ammonium, silicate, sulphide, etc. Nitrate was abundant in the oxic waters and is related to the use of fertilizers in the surrounding fields. A fine-layer sampler was used to study the oxic–anoxic interface where a dense plate of Chromatiaceae developed. The dominant species, Chromatium weissei, reached a maximum integrated biomass of 121 gWW m^-2 during August. Thiocapsa sp., representing less than 1% of total purple bacteria, had an integrated biomass of 0.8 gWW m^-2 and Amoebobacter sp. (1%) had 1 gWW m^-2. Other populations were sharply stratified i.e. Oscillatoria cf. ornata and Cryptomonas erosa. Those organisms, and mainly the cyanobacterium, accounted for the high chlorophyll a concentrations (>100 g l^-1) recorded in the anoxic waters of the hypolimnion. Green bacteria were scarcely developed due to the shadowing effect caused mainly by the purple bacterial bloom.     

Members of the Ikaros gene family are present in early representative vertebrates

Members of the Ikaros multigene family of zinc finger proteins are expressed in a tissue-specific manner and most are critical determinants in the development of both the B and T lymphocytes as well as NK and dendritic APC lineages. A PCR amplification strategy that is based on regions of shared sequence identity in Ikaros multigene family members found in mammals and several other vertebrates has led to the recovery of cDNAs that represent the orthologues of Ikaros, Aiolos, Helios, and Eos in Raja eglanteria (clearnose skate), a cartilaginous fish that is representative of an early divergence event in the phylogenetic diversification of the vertebrates. The tissue-specific patterns of expression for at least two of the four Ikaros family members in skate resemble the patterns observed in mammals, i.e., in hematopoietic tissues. Prominent expression of Ikaros in skate also is found in the lymphoid Leydig organ and epigonal tissues, which are unique to cartilaginous fish. An Ikaros-related gene has been identified in Petromyzon marinus (sea lamprey), a jawless vertebrate species, in which neither Ig nor TCRs have been identified. In addition to establishing a high degree of evolutionary conservation of the Ikaros multigene family from cartilaginous fish through mammals, these studies define a possible link between factors that regulate the differentiation of immune-type cells in the jawed vertebrates and related factors of unknown function in jawless vertebrates.