Impact of increasing capacity for generating and using research on maternal and perinatal health practices in South East Asia (SEA-ORCHID Project)

Background

Maternal and neonatal mortality and morbidity remain unacceptably high in many low and middle income countries. SEA-ORCHID was a five year international collaborative project in South East Asia which aimed to determine whether health care and health outcomes for mothers and babies could be improved by developing capacity for research generation, synthesis and use.

Methods

Nine hospitals in Indonesia, Malaysia, the Philippines and Thailand participated in SEA-ORCHID. These hospitals were supported by researchers from three Australian centres. Health care practices and outcomes were assessed for 1000 women at each hospital both before and after the intervention. The capacity development intervention was tailored to the needs and context of each hospital and delivered over an 18 month period. Main outcomes included adherence to forms of care likely to be beneficial and avoidance of forms of care likely to be ineffective or harmful.

Results

We observed substantial variation in clinical practice change between sites. The capacity development intervention had a positive impact on some care practices across all countries, including increased family support during labour and decreased perineal shaving before birth, but in some areas there was no significant change in practice and a few beneficial practices were followed less often.

Conclusion

The results of SEA-ORCHID demonstrate that investing in developing capacity for research use, synthesis and generation can lead to improvements in maternal and neonatal health practice and highlight the difficulty of implementing evidence-based practice change.     

Ethanol production from sweet sorghum juice in repeated-batch fermentation by Saccharomyces cerevisiae immobilized on corncob

Ethanol fermentation from sweet sorghum juice containing 240 g/l of total sugar by Saccharomyces cerevisiae TISTR 5048 and S. cerevisiae NP 01 immobilized on low-cost support materials, corncob pieces, was investigated. In batch fermentation, S. cerevisiae TISTR 5048 immobilized on 6 × 6 × 6 mm³ corncobs gave higher ethanol production than those immobilized on 12 × 12 × 12 mm³ corncobs in terms of ethanol concentration (P), yield (Y _p/s ) and productivity (Q _p ) with the values of 102.39 ± 1.11 g/l, 0.48 ± 0.01 and 2.13 ± 0.02 g/l h, respectively. In repeated-batch fermentation, the yeasts immobilized on the 6 × 6 × 6 mm³ corncobs could be used at least eight successive cycles with the average P, Y _p/s and Q _p of 97.19 ± 5.02 g/l, 0.48 ± 0.02 and 2.02 ± 0.11 g/l h, respectively. Under the same immobilization and repeated-batch fermentation conditions, P (90.75 ± 3.05 g/l) and Q _p (1.89 ± 0.06 g/l h) obtained from S. cerevisiae NP 01 were significantly lower than those from S. cerevisiae TISTR 5048 (P < 0.05), while Y _p/s from both strains were not different. S. cerevisiae TISTR 5048 immobilized on the corncobs also gave significantly higher P, Y _p/s and Q _p than those immobilized on calcium alginate beads (P < 0.05).     

A Comparison of Statistical Methods for Identifying Out-of-Date Systematic Reviews

Background

Systematic reviews (SRs) can provide accurate and reliable evidence, typically about the effectiveness of health interventions. Evidence is dynamic, and if SRs are out-of-date this information may not be useful; it may even be harmful. This study aimed to compare five statistical methods to identify out-of-date SRs.

Methods

A retrospective cohort of SRs registered in the Cochrane Pregnancy and Childbirth Group (CPCG), published between 2008 and 2010, were considered for inclusion. For each eligible CPCG review, data were extracted and “3-years previous” meta-analyses were assessed for the need to update, given the data from the most recent 3 years. Each of the five statistical methods was used, with random effects analyses throughout the study.

Results

Eighty reviews were included in this study; most were in the area of induction of labour. The numbers of reviews identified as being out-of-date using the Ottawa, recursive cumulative meta-analysis (CMA), and Barrowman methods were 34, 7, and 7 respectively. No reviews were identified as being out-of-date using the simulation-based power method, or the CMA for sufficiency and stability method. The overall agreement among the three discriminating statistical methods was slight (Kappa = 0.14; 95% CI 0.05 to 0.23). The recursive cumulative meta-analysis, Ottawa, and Barrowman methods were practical according to the study criteria.

Conclusion

Our study shows that three practical statistical methods could be applied to examine the need to update SRs.     

Biodegradation of an aldehyde biocide in rotating biological contactors

Biodegradation of an aldehyde biocide, glutaraldehyde (GA), in a single-stage laboratory-scale rotating biological contactor (RBC) was studied under biocide or organic loadings (OL) of 12–66 g COD m⁻² day⁻¹ and hydraulic retention times (HRT) of 0.6–3.0 h. Biofilms on the RBC were acclimated in 180 ppm GA at a hydraulic loading (HL) of 0.18 m³ m⁻² day⁻¹ and the HRT of 0.60 h. The results showed that under a constant initial chemical oxygen demand (COD) concentration and sufficient mineral salts available, the degree of GA removal in the RBC system was increased with either decreasing OL or increasing HRT. After a period of acclimation, treatment efficiency in terms of GA removal by the RBC receiving GA as a sole carbon source was 89%. The biofilms played an important role in biodegradation of biocide in the RBCs, whereas bio-oxidation of their planktonic counterparts was totally inhibited in the presence of 50 ppm GA. The biochemical oxygen demand (BOD) test could be used as an appropriate analytical procedure for investigating the efficiency of wastewater treatment units when seed was acclimated and had adequate amount.     

Prediction of Percentage Body Fat in Rural Thai Population Using Simple Anthropometric Measurements

Objective: To develop and validate sex‐specific equations for predicting percentage body fat (%BF) in rural Thai population, based on BMI and anthropometric measurements. Research Methods and Procedures: %BF (DXA; GE Lunar Corp., Madison, WI) was measured in 181 men and 255 women who were healthy and between 20 and 84 years old. Anthropometric measures such as weight (kilograms), height (centimeters), BMI (kilograms per meter squared), waist circumference (centimeters), hip circumference (centimeters), thickness at triceps skinfold (millimeters), biceps skinfold (millimeters), subscapular skinfold (millimeters), and suprailiac skinfold (millimeters) were also measured. The sample was randomly divided into a development group (98 men and 125 women) and a validation group (83 men and 130 women). Regression equations of %BF derived from the development group were then evaluated for accuracy in the validation group. Results: The equation for estimating %BF in men was: %BF(men) = 0.42 × subscapular skinfold + 0.62 × BMI ? 0.28 × biceps skinfold + 0.17 × waist circumference ? 18.47, and in women: %BF(women) = 0.42 × hip circumference + 0.17 × suprailiac skinfold + 0.46 × BMI ? 23.75. The coefficient of determination (R²) for both equations was 0.68. Without anthropometric variables, the predictive equation using BMI, age, and sex was: %BF = 1.65 × BMI + 0.06 × age ? 15.3 × sex ? 10.67 (where sex = 1 for men and sex = 0 for women), with R² = 0.83. When these equations were applied to the validation sample, the difference between measured and predicted %BF ranged between ±9%, and the positive predictive values were above 0.9. Discussion: These results suggest that simple, noninvasive, and inexpensive anthropometric variables may provide an accurate estimate of %BF and could potentially aid the diagnosis of obesity in rural Thais.     

Time to Update and Quantitative Changes in the Results of Cochrane Pregnancy and Childbirth Reviews

Background

The recommended interval between updates for systematic reviews included in The Cochrane Library is 2 years. However, it is unclear whether this interval is always appropriate. Whereas excessive updating wastes time and resources, insufficient updating allows out-of-date or incomplete evidence to guide clinical decision-making. We set out to determine, for Cochrane pregnancy and childbirth reviews, the frequency of updates, factors associated with updating, and whether updating frequency was appropriate.

Methodology/Principal Findings

Cochrane pregnancy and childbirth reviews published in Issue 3, 2007 of the Cochrane Database of Systematic Reviews were retrieved, and data were collected from their original and updated versions. Quantitative changes were determined for one of the primary outcomes (mortality, or the outcome of greatest clinical significance). Potential factors associated with time to update were assessed using the Cox proportional hazard model. Among the 101 reviews in our final sample, the median time before the first update was 3.3 years (95% CI 2.7–3.8). Only 32.7% had been updated within the recommended interval of 2 years. In 75.3% (76/101), a median of 3 new trials with a median of 576 additional participants were included in the updated versions. There were quantitative changes in 71% of the reviews that included new trials (54/76): the median change in effect size was 18.2%, and the median change in 95% CI width was 30.8%. Statistical significance changed in 18.5% (10/54) of these reviews, but conclusions were revised in only 3.7% (2/54). A shorter time to update was associated with the same original review team at updating.

Conclusions/Significance

Most reviews were updated less frequently than recommended by Cochrane policy, but few updates had revised conclusions. Prescribed time to update should be reconsidered to support improved decision-making while making efficient use of limited resources.     

Ethanol production from sweet sorghum juice using very high gravity technology: Effects of carbon and nitrogen supplementations

Ethanol production from sweet sorghum juice by Saccharomyces cerevisiae NP01 was investigated under very high gravity (VHG) fermentation and various carbon adjuncts and nitrogen sources. When sucrose was used as an adjunct, the sweet sorghum juice containing total sugar of 280 g l⁻¹, 3 g yeast extract l⁻¹ and 5 g peptone l⁻¹ gave the maximum ethanol production efficiency with concentration, productivity and yield of 120.68 ± 0.54 g l⁻¹, 2.01 ± 0.01 g l⁻¹ h⁻¹ and 0.51 ± 0.00 g g⁻¹, respectively. When sugarcane molasses was used as an adjunct, the juice under the same conditions gave the maximum ethanol concentration, productivity and yield with the values of 109.34 ± 0.78 g l⁻¹, 1.52 ± 0.01 g l⁻¹ h⁻¹ and 0.45 ± 0.01 g g⁻¹, respectively. In addition, ammonium sulphate was not suitable for use as a nitrogen supplement in the sweet sorghum juice for ethanol production since it caused the reduction in ethanol concentration and yield for approximately 14% when compared to those of the unsupplemented juices.     

The effect of an aldehyde biocide on the performance and characteristics of laboratory-scale rotating biological contactors

The effect of an aldehyde biocide, glutaraldehyde, on the treatment efficiency of laboratory-scale rotating biological contactors (RBCs) as well as their component biofilms was studied. Biofilms were established on the RBCs and then exposed to 0-120 ppm glutaraldehyde at a flow rate of 2.5 l x h(-1). The results showed that glutaraldehyde up to 80 ppm did not cause any adverse effect on chemical oxygen demand (COD) removal of the RBC units, microbial activity (ATP content) of biofilms on the RBC disc and viability of the biofilms. Glutaraldehyde at 80 ppm could be almost totally removed by the units regardless of the presence of simple carbon sources. There was at least a fourfold difference in susceptibility of planktonic and sessile bacteria to glutaraldehyde. Cells acclimatized to glutaraldehyde did not increase their capability to degrade normal carbon sources or glutaraldehyde under the conditions used in this study.     

A study of the effect of isothiazolones on the performance and characteristics of a laboratory-scale rotating biological contactor

AIMS: To study the effect of the isothiazolone biocide (Kathon WT) on the performance of laboratory-scale rotating biological contactors (RBCs) and their component biofilms. METHODS AND RESULTS: Biofilms were established on the RBCs and then exposed to 0.7-15 p.p.m. isothiazolones. Young, 1-week-old, biofilms were found to attain treatment efficiency equal to that of mature, 2-month-old, biofilms. Isothiazolone concentrations at 3 p.p.m. and above caused a progressive decline in treatment efficiency and 15 p.p.m. isothiazolones inhibited all microbial activity and resulted in the death of the biofilms. Bio-oxidation and the biodegradation of isothiazolones within the biofilms ontinued unhindered at concentrations which caused the total inhibition of planktonic bacteria. CONCLUSION: There was at least a 10-fold difference in susceptibility of planktonic and biofilm bacteria to isothiazolones. The chemical oxygen demand (COD) test was shown to be a reliable tool for investigating the efficiency of wastewater treatment units when the influent contains isothiazolones, while the biochemical oxygen demand (BOD) was unreliable due to the inhibition of bio-oxidation by the biocide. SIGNIFICANCE AND IMPACT OF THE STUDY: The results show that RBCs can be used to treat effluents containing isothiazolones at concentrations up to 1.5 p.p.m.     

Detection of superoxide dismutase (Cu–Zn) isoenzymes in leaves and pseudobulbs of Bulbophyllum morphologlorum Kraenzl orchid by comparative proteomic analysis

Typically, biological systems are protected from the toxic effect of free radicals by antioxidant defense. Extracts from orchids have been reported to show high levels of exogenous antioxidant activity including Bulbophyllum orchids but so far, there have been no reports on antioxidant enzymes. Therefore, differences in protein expression from leaves and pseudobulbs of Bulbophyllum morphologlorum Kraenzl and Dendrobium Sonia Earsakul were studied using two-dimensional gel electrophoresis and mass spectrometry (LC/MS/MS). Interestingly, the largest group of these stress response proteins were associated with antioxidant defense and temperature stress, including superoxide dismutase (Cu–Zn) and heat shock protein 70. The high expression of this antioxidant enzyme from Bulbophyllum morphologlorum Kraenzl was confirmed by activity staining on native-PAGE, and the two Cu/Zn-SODs isoenzymes were identified as Cu/Zn-SOD 1 and Cu/Zn-SOD 2 by LC/MS/MS. The results suggested that Bulbophyllum orchid can be a potential plant source for medicines and natural antioxidant supplements.