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To reconcile observations of decomposition rates, carbon inventories, and net primary production (NPP), we estimated long-term averages for C exchange in boreal forests near Thompson, Manitoba. Soil drainage as defined by water table, moss cover, and permafrost dynamics, is the dominant control on direct fire emissions. In upland forests, an average of about 10-30% of annual NPP was likely consumed by fire over the past 6500 years since these landforms and ecosystems were established. This long-term, average fire emission is much larger than has been accounted for in global C cycle models and may forecast an increase in fire activity for this region. While over decadal to century times these boreal forests may be acting as slight net sinks for C from the atmosphere to land, periods of drought and severe fire activity may result in net sources of C from these systems.

Background: Most maternal and child deaths are preventable or treatable with proven, cost-effective interventions for infectious diseases and maternal and neonatal complications. In 2015 sub-Saharan Africa accounted for up to 66% of global maternal deaths and half of the under-five deaths. Access to essential medicines and commodities and trained healthcare workers to provide life-saving maternal, newborn and post-natal care are central to further reductions in maternal and child mortality., Methods: Available data for 24 priority medicines for women and children were extracted from WHO service availability and readiness assessments conducted between 2012 and 2015 for eight countries in sub-Saharan Africa. The mean availability of medicines in facilities stating they provide services for women or children and differences by facility type, ownership and location are reported., Results: The mean availability of 12 priority essential medicines for women ranged from 22% to 40% (median 33%; IQR 12%) and 12 priority medicines for children ranged from 28% to 57% (median 50%; IQR 14%). Few facilities (<1%) had all nominated medicines available. There was higher availability of priority medicines for women in hospitals than in primary care facilities: range 32%-80% (median 61%) versus 20%-39% (median 23%) and for children's medicines 31%-71% (median 58%) versus 27%-57% (median 48%). Availability was higher in public than private facilities: for women's medicines, range 21%-41% (median 34%) versus 4%-36% (median 27%) and for children's medicines 28%-58% (median 51%) versus 5%-58% (median 46%). Patterns were mixed for rural and urban location for the priority medicines for women, but similar for children's medicines., Conclusions: The survey results show unacceptably low availability of priority medicines for women and children in the eight countries. Governments should ensure the availability of medicines for mothers and children if they are to achieve the health sustainable development goals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Health facility data are a critical source of local and continuous health statistics. Countries have introduced web-based information systems that facilitate data management, analysis, use and visualisation of health facility data. Working with teams of Ministry of Health and country public health institutions analysts from 14 countries in Eastern and Southern Africa, we explored data quality using national-level and subnational-level (mostly district) data for the period 2013-2017. The focus was on endline analysis where reported health facility and other data are compiled, assessed and adjusted for data quality, primarily to inform planning and assessments of progress and performance. The analyses showed that although completeness of reporting was generally high, there were persistent data quality issues that were common across the 14 countries, especially at the subnational level. These included the presence of extreme outliers, lack of consistency of the reported data over time and between indicators (such as vaccination and antenatal care), and challenges related to projected target populations, which are used as denominators in the computation of coverage statistics. Continuous efforts to improve recording and reporting of events by health facilities, systematic examination and reporting of data quality issues, feedback and communication mechanisms between programme managers, care providers and data officers, and transparent corrections and adjustments will be critical to improve the quality of health statistics generated from health facility data., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. The views expressed in this article do not necessarily represent the views, decisions, or policies of the institutions to which the authors are affiliated.

The distributions of interisland gaps and captures zones for islands nucleated on a one-dimensional substrate during submonolayer deposition are considered using a novel retrospective view. This provides an alternative perspective on why scaling occurs in this continuously evolving system. Distributional fixed-point equations for the gaps are derived both with and without a mean-field approximation for nearest neighbor gap-size correlation. Solutions to the equations show that correct consideration of fragmentation bias justifies the mean-field approach, which can be extended to provide closed-from equations for the capture zones. Our results compare favorably to Monte Carlo data for both point and extended islands using a range of critical island size i=0,1,2,3. We also find satisfactory agreement with theoretical models based on more traditional fragmentation theory approaches.

The nucleation and growth of point islands during submonolayer deposition on a one-dimensional substrate is simulated for critical island size i=0,1,2,3. The small- and large-size asymptotics for the gap-size and capture-zone distributions (CZDs) are studied. Comparisons to theoretical predictions from fragmentation equation analyses are made, along with those from the recently proposed generalized Wigner surmise (GWS). We find that the simulation data can be fully understood in the framework provided by the fragmentation equations, while highlighting the theoretical areas that require further development. The GWS works well for the small-size CZD behavior, but completely fails to describe the large-size CZD asymptotics of the one-dimensional system., (© 2012 American Physical Society)

The Montreal Process was formed in 1994 to develop an internationally agreed upon set of criteria and indicators for the conservation and sustainable management of temperate and boreal forests. In response to this initiative, the Forest Inventory and Analysis (FIA) and Forest Health Monitoring (FHM) programs of the United States Department of Agriculture Forest Service have implemented soil measurements as part of a national monitoring program to address specific questions related to the conservation of soil and water resources. Integration of soil assessments into the national FIA program provides for systematic monitoring of soil properties across all forested regions of the U.S. using standardized collection, laboratory, and statistical procedures that are compatible with existing forest inventory data. The resulting information will provide quantitative benchmarks for regional, national, and international reporting on sustainable forest management and enhance our understanding of management effects on soil quality. This paper presents an overview of the FIA soil monitoring program, outlines the field and laboratory protocols as currently implemented, and provides examples of how these data may be used to assess indicators of sustainable management as defined by the Montreal Process.

We carried out behavioural observations to investigate the function of long-term investment in vocal display by fallow bucks during the breeding season. The measures of long-term investment used were the date of initiation of vocal activity, the number of days vocal during the breeding season, and the proportion of time spent vocalizing. We analysed data from 3 years (1993-1995) to assess the relationship between the date of initiation of vocal activity, and the number of days vocal, and age, dominance rank and mating success. Observations from a sample of focal males in 1996 were used to determine the effect of the proportion of time vocal during the breeding season on dominance rank and mating success. The majority of socially immature males (/= 4 years old), dominance rank was more important than age in explaining variation in vocal activity. The onset of vocal activity by fallow bucks was not a direct consequence of the presence of mating opportunities since the first males became vocal more than 3 weeks before any matings occurred. Long-term investment in vocal activity did not alter the dominance relationships that had been established between males before they became vocal. When we considered all mature males from 3 years of observations, the majority of matings were achieved by those that had high rank, initiated vocal activity early during the breeding season and remained vocal on most days. For the 1-year sample of mature males, the factor most highly correlated with mating success was the proportion of time that males spent vocalizing during the rut. Thus we have shown a strong relationship between the time invested in vocal display by fallow bucks and their mating success. Copyright 1999 The Association for the Study of Animal Behaviour.

Approximately 500 children younger than 5 years old resident in 7 villages in a rural area of The Gambia were monitored closely for 1 year for episodes of acute lower respiratory tract infection (ALRI). Each episode was investigated with antigen detection techniques and antibody assays as well as culture for bacteria and viruses. A pathogen was identified in 76 (34.2%) of 222 cases with clinical signs of ALRI and in 34 (42%) of the 81 cases who, in addition, had radiologic evidence of ALRI. Evidence of infection with a bacterial pathogen, most commonly Streptococcus pneumoniae or Haemophilus influenzae, was obtained in 32 (14.4%) cases with clinical signs of ALRI (23.5% of those with radiologically proved pneumonia). Viral agents were cultured from 42 (19%) of 221 cases but also from 14 (14.6%) of 96 controls some of whom had minor symptoms of upper respiratory tract infection. In the absence of an outbreak of respiratory syncytial virus the viral agents recovered most often were influenza A and adenoviruses.

Endothelin, a potent vasoconstrictor, was found to be ineffective in the treatment of experimentally induced corneal neovascularization. Endothelin was administered topically, subconjunctivally, and intraluminally in serial concentrations ranging from 0.0005 to 5.0 micrograms/mL in New Zealand white rabbits without effect. Electron microscopy of the neovascular cornea revealed the vessels consisted only of endothelin and pericytes. Hence, the vessels were not responsive to endothelin because they lacked contractile smooth muscle.

Three patients with corneal ulcers had gram-positive cocci isolated on initial scrapings. There was no response to topical fortified aminoglycosides or cephalosporins. Cultures revealed methicillin-resistant Staphylococcus aureus that was sensitive only to topical vancomycin eye drops. Because the microbiologic spectrum is similar, vancomycin should be considered instead of a cephalosporin in the treatment of corneal ulcers to cover methicillin-resistant S. aureus and S. epidermidis.

Six eyes of six patients with myopia between -4.00 and -8.00 diopters underwent 193 nm Argon/fluoride excimer laser photorefractive keratectomy as part of a Phase II-A FDA Study. Six months after surgery, four of the six eyes had a spherical equivalent refraction within +/- 1.00 D; five eyes saw 22/30 or better without correction. All corneas demonstrated a faint reticulated subepithelial haze most visible by sclerotic scatter illumination. There were no episodes of delayed epithelial healing or recurrent erosions, and patients had no loss of contrast sensitivity, visual acuity under glare testing, or corneal sensation at the 3-month or 6-month visit. In this limited clinical trial, the excimer laser was capable of changing the refractive power of the cornea for correction of myopia. Long-term follow up of these patients will be necessary to determine the safety and efficacy of the procedure.

Two 4-year-old females with inferior fornix conjunctival lesions are described. Both cases proved to be cotton-material-induced granulomas. These cases are reported to emphasize that recognition of foreign body conjunctival granuloma remains as a challenge to ophthalmologists.

Ninety infants less than 1 year of age with pneumonia and 43 control infants were investigated for viral and chlamydial infection with the use of culture and serology and for bacterial infection with the use of blood cultures, lung aspirates, antibody assays and antigen detection procedures. One or more potential pathogens were identified in 62 (69%) cases with pneumonia and in 12 (28%) controls. Infection by respiratory viruses was identified in 42 (49%) cases and in 8 (19%) controls. Respiratory syncytial virus was the commonest pathogen identified and was found in 32 cases (37%). Bacterial infections were also common, being found in 27 (30%) cases and 3 (7%) controls, and predominantly involved Streptococcus pneumoniae (20%) or Haemophilus influenzae (11%). Bacterial infections were associated with raised white blood cell counts and were identified more often by antigen detection procedures (68%) than by culture of blood or lung aspirates (34%) or by serology (33%). Mixed viral-bacterial infections were identified in 13 cases (15%). Infection with Chlamydia trachomatis was diagnosed in 2 infants with acute lower respiratory tract infection and in 1 control infant.

Seventy-four children ages 1 to 9 years hospitalized because of severe pneumonia were investigated using blood cultures, lung aspirates, nasopharyngeal aspirates, serology and antigen detection procedures. A bacterial infection was identified in 57 (77%), a viral infection was seen in 25 (34%) and 18 (24%) had mixed viral-bacterial infections. The bacterial pathogens most frequently identified were Streptococcus pneumoniae and Haemophilus influenzae found in 61 and 15% of patients, respectively. The viral pathogen most frequently recovered was respiratory syncytial virus (12%). Evidence of Chlamydia pneumoniae strain TWAR and Mycoplasma pneumoniae infection was found in 12 and 4% of cases, respectively. Overall a potential pathogen was identified in 60 (81%) children, with evidence of polymicrobial infection in 30 cases (40.5%). The study provides information on the relative role of different infectious agents in the etiology of severe pneumonia in children in a developing country.

134 Gambian children under 5 years of age with severe pneumonia (as defined by the World Health Organisation classification of acute respiratory infections) were given either oral co-trimoxazole for 5 days, or a single intramuscular dose of fortified procaine penicillin and 5 days of oral ampicillin. At 2 weeks, there was no significant difference in outcome between the two groups. Co-trimoxazole is much less expensive than ampicillin or procaine penicillin, requires only twice-daily administration, and can be given by health-care staff with little training. The results support the use of co-trimoxazole as the antibiotic of first choice in outpatient management of young children with pneumonia in developing countries.

To investigate the hypothesis that rotavirus infection in young children can trigger chronic diarrhoeal disease, a group of cases from a documented epidemic of rotavirus and a group of matched controls were followed for a 1-year period after infection. No evidence of excess chronic diarrhoea or vomiting in the group known to have been infected with rotavirus was found.

222 acute lower respiratory tract infections (LRI), as defined by the World Health Organisation, were identified during one year's surveillance of a cohort of 500 Gambian children aged 0 to 4 years. Symptoms and signs at presentation were related to radiological evidence of lobar consolidation, indicating severe LRI. In infants, a fever of greater than 38.5 degrees C, refusal to breast-feed, or the presence of vomiting were the best predictors of severe LRI. In children aged 1 to 4 years, a fever of greater than 38.5 degrees C or a respiratory rate greater than 60/min were the most accurate clinical signs for severe LRI. Chest indrawing did not discriminate severe LRI. These community-based findings differ from results of hospital-based studies.

Objective: To prepare and assess the sensitivity and specificity of a latex agglutination test specific for the serotype of antigen in diagnosing pneumococcal pneumonia in Gambian children., Design: Comparison of agglutination test specific for serotype with culture of blood and lung aspirates, countercurrent immunoelectrophoresis, and commercial latex agglutination tests in diagnosing pneumococcal pneumonia. Cross reaction studies and investigation of 102 control children to determine specificity of agglutination test specific for serotype., Setting: General medical ward of Medical Research Council laboratories, The Gambia., Patients: 101 Gambian children aged between 2 months and 10 years admitted with severe pneumonia., Interventions: Serum samples were boiled and treated with edetic acid, and urine samples were boiled and concentrated 25 times before testing., End Point: A latex agglutination test specific for the serotype of pneumococcal antigen that is sensitive and highly specific for detecting pneumococcus in the urine of patients with pneumococcal pneumonia., Measurements and Main Results: Concentrated urine samples from 16 of the 21 children (76%) with pneumococcal pneumonia established by results of culture of blood or lung aspirates gave a positive result with the agglutination test specific for serotype, whereas only four of the 102 urine samples obtained from control children without pneumonia gave positive results. The serotypes of antigens detected in the urine of children with pneumococcal pneumonia and the serotypes of pneumococci isolated from cultures of blood or lung aspirates were the same in all cases., Conclusions: When performed on urine samples the agglutination test specific for serotype has a high specificity and is more sensitive than culture of blood or lung aspirates, commercial agglutination tests, or countercurrent immunoelectrophoresis in identifying pneumococcal pneumonia. It is easy to use and should be especially useful in communities with limited laboratory facilities.