Maternal perceptions about caesarean section deliveries and their role in reducing perinatal and neonatal mortality in the Upper West Region of Ghana; a cross-sectional study.

BACKGROUND: Maternal perceptions about caesarean section contribute to delayed presentation of women for emergency obstetric care. This increases the risks of perinatal and neonatal mortality and slows down the reductions needed to achieve the sustainable development goal (SDG) target of reducing neonatal mortality and ending new-born deaths. The aim of the study is to determine maternal perceptions about caesarean section deliveries and their role in reducing neonatal mortality at a regional and a district hospital in the Upper West Region of Ghana. METHODS: This descriptive study was carried out at two hospitals in the Upper West Region, the most rural region in Ghana, between 15th January and 29th June, 2018. Maternal perceptions were examined among antenatal care attendants at the Upper West Regional Hospital (UWRH) and St Joseph's Hospital Jirapa (SJH), a district hospital, using questionnaires administered by trained nurses. RESULTS: Altogether, 416 completed questionnaires were obtained, comprising 206 from expectant women attending the UWRH and 210 from SJH. Although the majority of women in this study preferred spontaneous vaginal delivery (87.4%, n = 348) to caesarean section, most of the respondents (n = 281, 73%) indicated their willingness to have a caesarean section if necessary. The main reason for not wanting a CS was the long recovery time (51.8%, n = 148). Almost half of women interviewed, representing 45.1% (180) did not know or feel that CS can promote child survival and about a fifth, 21.6% (85) believed that CS can have adverse effects on child survival. Factors associated with poor perception of CS included, no formal education, age less than 19 years and no employment. CONCLUSION: Majority of women in this study had a positive attitude towards the uptake of CS if it becomes necessary. Lack of formal education, age less than 19 years and unemployment are associated with poor maternal perception of CS. Education to improve the perception of CS as a promoter of child survival is necessary and to discourage perceptions that it causes adverse perinatal or neonatal outcome particularly in at risk populations.

Designing and implementing interventions to change clinicians' practice in the management of uncomplicated malaria: lessons from Cameroon.

BACKGROUND: Effective case management of uncomplicated malaria is a fundamental pillar of malaria control. Little is known about the various steps in designing interventions to accompany the roll out of rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT). This study documents the process of designing and implementing interventions to change clinicians' practice in the management of uncomplicated malaria. METHODS: A literature review combined with formative quantitative and qualitative research were carried out to determine patterns of malaria diagnosis and treatment and to understand how malaria and its treatment are enacted by clinicians. These findings were used, alongside a comprehensive review of previous interventions, to identify possible strategies for changing the behaviour of clinicians when diagnosing and treating uncomplicated malaria. These strategies were discussed with ministry of health representatives and other stakeholders. Two intervention packages - a basic and an enhanced training were outlined, together with logic model to show how each was hypothesized to increase testing for malaria, improve adherence to test results and increase appropriate use of ACT. The basic training targeted clinicians' knowledge of malaria diagnosis, rapid diagnostic testing and malaria treatment. The enhanced training included additional modules on adapting to change, professionalism and communicating effectively. Modules were delivered using small-group work, card games, drama and role play. Interventions were piloted, adapted and trainers were trained before final implementation. RESULTS: Ninety-six clinicians from 37 health facilities in Bamenda and Yaounde sites attended either 1-day basic or 3-day enhanced training. The trained clinicians then trained 632 of their peers at their health facilities. Evaluation of the training revealed that 68% of participants receiving the basic and 92% of those receiving the enhanced training strongly agreed that it is not appropriate to prescribe anti-malarials to a patient if they have a negative RDT result. CONCLUSION: Formative research was an important first step, and it was valuable to engage stakeholders early in the process. A logic model and literature reviews were useful to identify key elements and mechanisms for behaviour change intervention. An iterative process with feedback loops allowed appropriate development and implementation of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01350752.

New phenotypes of the drought-tolerant cbp20 Arabidopsis thaliana mutant have changed epidermal morphology.

This paper provides a detailed phenotypic analysis of the abscisic acid (ABA) hypersensitive Cap Binding Protein 20 (cbp20) mutant. Some hitherto undescribed changes were found in the tissue structure and epidermal morphology of this mutant. These include more and smaller cells in the epidermis, a thicker cuticle and more frequent occurrence of trichomes on leaf surfaces. Some of these traits may contribute to the physiological processes responsible for the water-saving behaviour of the mutant. Abnormal spatial patterns between stomatal pore complexes were also found on various organs of the mutant. All these observations indicate profoundly disturbed development of epidermal tissue in the cbp20 mutant, which has not previously been reported for this class of mutants. A potential connection between the new phenotypes and disturbed miRNA metabolism and mRNA splicing of the mutant is discussed.

In vitro microspore selection in maize anther culture with oxidative-stress stimulators.

In order to produce doubled-haploid maize plants tolerant of oxidative stress, in vitro microspore selection was carried out in anther culture with reactive oxygen species (ROS) progenitors such as paraquat, menadione, tert-butylhydroperoxide (t-BHP), and methionine combined with riboflavin. All the ROS progenitors reduced the anther induction, the formation of microspore-derived structures, and their regeneration potential. Abnormal cell divisions and progeny cell degradation could be observed during the development of microspores treated with ROS progenitors. Menadione and t-BHP influenced the microspore developmental pathway, as menadione induced the formation of embryoids, while t-BHP increased the proportion of calli in the microspore-derived structures. As the result of in vitro selection, 15, 10, 10, and 3 fertile doubled-haploid plants were obtained in cultures treated with paraquat, t-BHP, methionine combined with riboflavin, and menadione, respectively.

Influence of Fe concentration in the medium on multicellular pollen grains and haploid plants induced by mannitol pretreatment in barley (Hordeum vulgare L.).

This study aims to clarify the short- and long-term effects of the iron concentration in the medium on androgenesis induced in barley by isolated microspore culture. The ultrastructural features and pectin composition of the intine wall were studied in the initial stages of androgenesis. The evolution of electron-dense iron deposits on the intine was analysed in multicellular pollen grains obtained by isolated microspore culture performed for 3, 6, and 9 days using various concentrations of FeNa(2) EDTA. Finally, the number of embryo-like structures and green plants obtained by microspore culture using different Fe concentrations was evaluated in order to estimate the optimum concentration for isolated microspore culture.

Cytological and ultrastructural changes induced in anther and isolated-microspore cultures in barley: Fe deposits in isolated-microspore cultures.

To gain further insight into the role played by sporophytic anther tissues in the early stages of the androgenic process, we have compared the cytology and ultrastructure of barley embryogenic pollen grains obtained by anther culture with those obtained by isolated-microspore culture. The microspores behaved similarly in both culture systems but ultrastructural studies detected a significant difference: the presence of electron-dense deposits on the intine of embryogenic pollen grains generated by isolated-microspore culture compared to their absence in grains generated by anther culture. To discover the nature of these deposits, we applied proteinase K and EDTA treatments to ultrathin sections. We also subjected the deposits to X-ray microanalysis and found that they contained iron. Anthers and isolated microspores were cultured in media containing different concentrations of iron so as to evaluate the presence of these deposits on the intine. Deposits were not found in anther cultures at any iron concentration used or in microspore cultures when concentrations were lower than 40 mg/L. The Fe deposits on the intine appear to derive from an excess of Fe in the isolated-microspore culture medium which, if allowed to pass through the cell wall, could well be toxic to the embryogenic development of the microspores.

Electro-fused isolated wheat (Triticum aestivum L.) gametes develop into multicellular structures.

The electrofusion-mediated fertilization of single egg cells of wheat with isolated individually selected wheat sperm cells was successfully carried out for the first time. On average the fusion frequency was 30% but under optimal conditions it was possible to reach as much as 55%. Two days after electric fusion 60% of the fusion products started to divide, 88.5% of them forming multicellular structures and in a few cases microcalluses. The culture of single unfertilized egg cells with or without the application of AC field and electric pulses induced no cell division. The egg cells and fusion products were cultured in a maize feeder-cell system.

Analysis of the genotypic effect on different developmental pathways in wheat gametophyte cultures.

Seven wheat cultivars and one wild subspecies Triticum aestivum ssp. spelta were compared for their in vitro fertility and androgenetic capacity by studying their anther culture response and in vitro seed production. Both haploid embryogenesis and in vitro seed set showed very wide genotype dependent variability in accordance with previous observations. At the same time, an analysis of the data showed a significant negative correlation between the in vitro androgenetic ability and the in vitro fertilization potential, which was especially obvious in the case of highly embryogenic genotypes. The reason for this inverse correlation might be the different genetic regulation of the two quantitative traits. Presumably, alleles which increase the stability of the gametogenetic developmental programme hinder the initiation of haploid embryogenesis, while alleles with the opposite effect promote the sporophytic type of growth.

Direct effect of colchicine on the microspore embryogenesis to produce dihaploid plants in wheat (Triticum aestivum L.).

In the present experiment, different chromosome reduplication techniques were applied to microspore-originated Triticum aestivum L. (cv 'Ciano') haploids. In addition to the conventional treatment (whole plant exposure to colchicine solution), spontaneously redoubled haploids were also examined. As an experimental treatment, different concentrations (0.01, 0.02, 0.04%) of colchicine were added directly to the induction media. Colchicine did not affect the anther response or the plant regeneration capacity. The success and stability of genome redoubling was estimated on the basis of the fertility of the regenerated (R0) plants and their progeny (R1). Chromosome doubling produced by colchicine before the first microspore mitosis was significantly more efficient than the conventionally used techniques.

Evidence for cytoplasmic control of in vitro microspore embryogenesis in the anther culture of wheat (Triticum aestivum L.).

Anthers were cultured from two sets of seven lines of hexaploid wheat (Triticum aestivum L.) with different cytoplasms, the euplasmic nucleus donors, 'Siete Cerros 66' and 'Penjamo 62', as well as their six alloplasmic lines derived from wild relative species of the genera Triticum and Aegilops. Significant cytoplasmic and nuclear effects but no cytoplasmic-nuclear interaction were found for embryogenic anther response, with the best performance of 'Penjamo 62' in Ae. kotschyi cytoplasm. Plant regeneration was not affected significantly by the cytoplasmic background of the lines cultured. The possible genetic implications of the observed cytoplasmic and nuclear influences on the in vitro haploid induction of wheat are discussed.

Substitution analysis of callus induction and plant regeneration from anther culture in wheat (Triticum aestivum L.).

The genetic determination of callus induction, total plant regeneration and green plant regeneration from anther culture were studied using a "Chinese Spring"/"Cheyenne" substitution series. All the three characteristics were found to be polygenically determined, but their inheritance was independent from one another. The 7A and 18 chromosomes had a considerable effect on callus induction. In the case of total plant regeneration the most influential chromosome "as the 3A while the 2D chromosome showed a definite influence on green plant regeneration. The interaction between the genetic background of the recipient plant and the substituted chromosome plays an important role in the manifestation of the studied features.

Ultrastructural studies on pollen embryogenesis in maize (Zea mays L.).

Maize anthers have been induced on modified N6 medium to produce embryoids. Different stages from the cultures were sampled and prepared for microscopical examination. The microspores at the onset of culture were in an early developmental stage, with the nucleus and numerous organelles centred in the middle, surrounded by many small vacuoles with a lipid content. The binuclear pollen grains contained small vesicles and much starch. The partially condensed vegetative nucleus indicated participation of the vegetative component in the formation of multicellular pollen grains (MPGs). Several MPGs have been observed which differed in morphology. We suggest, on the basis of these ultrastructural observations, that in maize mainly the vegetative cell contributes to the MPG which further develops directly into embryoids.