Heavy metal-induced oxidative stress has been implicated in abnormal sperm functions and male infertility.Serum and seminal levels of heavy metals and biomarkers of oxidative stress were compared in fertile and infertile men.A total of 130 men aged 20–60 yr comprising 30 azoospermic, 50 oligozoospermic, and 50 normozoospermic men were studied. Semen analysis was done by world health organization guidelines, biomarkers of oxidative stress , total plasma peroxidase (TPP), oxidative stress index (OSI), vitamin C (vit C) and nitric oxide (NO)) and fructose by colorimetry and serum and seminal heavy metals (zinc (Zn), selenium (Se), cadmium (Cd) and lead (Pb)) by atomic absorption spectrophotometry.Azoospermic and oligozoospermic men had higher serum and seminal peroxides , higher serum heavy metals ) and lower sperm concentration, %motility, serum and seminal antioxidants ) compared to normozoospermic men. Higher seminal peroxides , heavy metals (Pb and Cd (p = 0.03)) and lower sperm concentration, %motility, and seminal antioxidants (TAC and NO (p = 0.00)) were also observed in azoospermic men compared to oligozoospermic men. Negative correlations were observed between seminal fructose and seminal vit C , GSH , NO , Zn  and Se  only in azoospermic men.Elevated heavy metal levels, increased lipid peroxidation and antioxidant depletion is associated with abnormal sperm functions in men studied. Male factor infertility is increasing in developing countries and has been shown to be responsible for 40–50% of all cases of infertility in Nigeria with regional variations in prevalence and causes. Genetic, anatomical, endocrinological, immunological, radiation, infection and unexplained factors has been implicated in the etiology of male infertility . Male infertility irrespective of etiopathologic mechanism most often presents in most cases by abnormal semen parameters (3). Toxic metals as lead and cadmium that act as endocrine disruptors have been shown to affect hormones responsible for sperm production. Induction of oxidative stress (OS) has been described as the major mechanism of heavy metal-mediated deterioration in spermatogenesis and sperm functions (4). OS, which describes a state of over abundance of reactive oxygen species (ROS) over antioxidants has been implicated in idiopathic male infertility (5). The abundance of membrane polyunsaturated fatty acid (PUFA) in spermatozoa and their capacity to generate ROS makes the spermatozoa highly susceptible to OS (3). Normal sperm functions as capacitation, motility, acrosome reaction, oocyte fusion and fertilization requires low level of ROS, however, excessive ROS is detrimental to normal sperm function by inducing peroxidation of PUFA and oxidative DNA strand breaks leading to impaired sperm viability, motility, capacitation and acrosome reaction (6). To counteract the deleterious effects of ROS, enzymatic antioxidants like catalase and superoxide dismutase (SOD) as well as non-enzymatic compounds like glutathione (GSH), vitamins C and E, zinc and selenium are present in the seminal plasma to neutralize ROS and preserve sperm function (7). Several studies have demonstrated higher levels of oxidants and heavy metals and depressed enzymatic and non-enzymatic antioxidants and essential antioxidant micronutrients in infertile men . Regional variations still exist on levels of OS indices in individuals with reproductive failure. This disparity may be attributed to the influence of infection, genetic, environmental and life style factors on oxidant/antioxidant balance. Although an association between oxidative damage and compromised sperm functions has been established, men are rarely screened for redox imbalance and treated for this condition during fertility investigations. More so, the relative or absolute contribution of OS to male factor infertility is still uncertain.We therefore assessed the serum and seminal levels of some heavy metals, antioxidants, and biomarkers of OS and their relationship with sperm functions in fertile and infertile men.This case-control study was carried out at the Microbiology unit of the University of Calabar Teaching Hospital, Calabar, Nigeria from February to July 2015. Test subjects were infertile adult males (infertility for a duration of at least one year) visiting the fertility clinic for investigation for infertility. Control subjects were apparently healthy individual who had optimal sperm function after a carefully performed seminal fluid analysis and had had at least one child within the last 2 yr. The standard guidelines of the National Health Service evaluation criteria were adopted for evaluation of infertility (9). Participants with previous history of testicular surgery, genital infections, testicular varicocele, chronic organ or systemic illness, heavy smokers and chronic alcoholics were excluded from the study. In this study, infertility was defined as the inability of a couple to conceive after a period of 12 months of unprotected sexual intercourse (10), while evidence of fertility was taken as the ability to have at least one child with the last child born within the last 2 yr (10).The study population comprised of 130 male subjects aged 20–60 yr who fulfilled the inclusion criteria were recruited for the study after semen analysis. Anthropometric data as height, weight, hip and waist circumference were obtained and used to calculate body mass index and waist-to-hip ratio respectively. Data on socio-demographic characteristics of the subjects including family history, medical history, medications and social habits were obtained using a semi-structured questionnaire. Based on semen analysis, subjects were categorized as: Azoospermic , Oligozoospermic , and Normozoospermic .Subjects were educated on the procedure for collection of semen samples. Semen samples were obtained through masturbation after 3–5 days of sexual abstinence and kept in sterile nontoxic containers, the time interval between collection and arrival to the laboratory was limited (within 30 min). The time of production, time received, and the time of analysis were recorded. Two sets of semen samples were collected from each subject of the study population within one month. The semen samples were allowed to liquefy in the incubator directly at 37A sample of 5 ml venous whole blood was collected from all subjects of the study into plain anticoagulant-free sample containers, allowed to clot and retract and then centrifuged at 500 g for 10 min at room temperature. Serum samples were collected and stored at –20Maroscopic evaluation of the semen samples was done by determining the volume, pH, and viscosity of the sample. A glass rod was introduced into the semen sample and observation of the nature of the thread that forms on withdrawal of the rod from the sample is an estimate of the viscosity. Threads from normal semen samples should not exceed 2cm in length (12).Wet preparation: The sample was well mixed and a drop was placed on a clean grease-free slide using a plastic Pasteur pipette and covered with a cover slip. The slide was then viewed microscopically using This was performed using a Neubauer counting chamber. A 1:20 dilution of the sample was made using the semen-diluting fluid. The Neubauer counting chamber was then charged with the diluted semen sample and allowed to stand for 5 min before counting microscopically.Atomic Absorption spectrometry (AAS) is based on the principle that a ground state atom is capable of absorbing light of the same characteristic wavelength as it would emit if excited to a higher energy level. In flame AAS, a cloud of ground state atoms is formed by aspirating a solution of the sample into a flame of a temperature sufficient to convert the element to its atomic state. The degree of absorption of characteristic radiation produced by a suitable source will be proportional to the population of ground state atoms in the flame, and hence to the concentration of the element in the analyte (13).TAC is determined based on the reaction of hydrogen peroxide (HTPP is determined based on the ferrous-butylated hydroxytoluene-xylenol orange complex (FOX-2) test system which is based on the oxidation of ferrous ions to ferric ions by various types of peroxides present in the serum sample; to produce a colored ferric-xylenol orange complex whose absorbance is measured spectrophotometrically at 560nm (15).The ratio of TPP to TAC was calculated as the OSI, an indicator of the degree of OS.The Griess test was used for detecting the total levels of nitrite or nitrous acid in samples. The NO-containing compounds in the serum combines with alpha-Naphthylamine to produce pink azo dye whose absorbance was measured at a wavelength of 540 nm. The measurement of nitric oxide metabolites which is estimated as total nitrite and nitrate levels, is considered as a direct marker of invivo NO production (16).Estimation of GSH was carried out following the modified standard Ellman's method. The GSH in the sample reacts with Ellman's reagent (5-5'-dithiobis-2-nitrobenzoic acid (DNTB)) to form the chromophore 5-thionitrobenzoic acid (TNB) and GS-TNB whose absorbance is measured at 412 nm (17).In the presence hydrochloric acid (HCl) under heat, fructose reacts with indole to produce a colored complex whose absorbance is measured at wavelength of 450–492 nm (18).Ascorbic acid is converted to dehydro-ascorbic acid by shaking with Norit-activated charcoal, and this is then coupled with 2,4-dinitrophenyl hydrazine in the presence of thiourea as a mild reducing agent. In the presence of sulphuric acid, dinitrophenyl hydrazone which is a red compound is assayed colorimetrically. The absorbance of colored compound is proportional to vit C concentration in the sample (19).This study was carried out in accordance with the Ethical Principles for Medical Research Involving Human Subjects as outlined in the Helsinki Declaration in 1975 and subsequent revisions. Informed consent was obtained from the subjects before recruitment into the study.Results were presented as mean The age, body mass index (BMI), semen parameters, fructose, seminal OS indices and heavy metals in normozoospermic, oligozoospermic and azoospermic males are presented in Table I. Significant variations were observed in semen volume, sperm concentration and seminal fructose, vit C, GSH, NO, TAC, TPP, OSI, Cd and Pb levels among normozoospermic, oligozoospermic and azoospermic men studied (p = 0.000). No significant variations were observed in the mean age, BMI, seminal GSH, Zn, Se, Pb and Cd among the three groups (p = 0.051). Table II shows the comparison of semen volume, sperm concentration and seminal fructose, vit C, GSH, NO, TAC, TPP, OSI, Cd and Pb levels among normozoospermic, oligozoospermic and azoospermic men using LSD post hoc analysis. Normozoospermic men had significantly higher semen volume and sperm concentration, seminal fructose, vit C, TAC, NO and lower seminal TPP and OSI compared to azoospermic men; and higher %motility, sperm count, seminal fructose, vit C, TAC and lower seminal TPP compared to oligozoospermic men (p = 0.026). Oligozoospermic men had higher sperm concentration, seminal TAC, NO, TPP, Cd and Pb and lower seminal OSI compared to azoospermic men (0.032). Table III shows serum OS indices and heavy metals in normozoospermic, oligozoospermic and azoospermic men studied. Significant variations were observed in the serum levels of GSH, NO, TAC, TPP, OSI, Zn, Se, Pb and Cd among normozoospermic, oligozoospermic and azoospermic men studied (0.018). Comparison of serum GSH, NO, TAC, TPP, OSI, Pb and Cd in normozoospermic, oligozoospermic, and azoospermic men using LSD post hoc are presented in Table IV. Normozoospermic men had significantly higher serum GSH, NO and TAC and lower TPP, OSI, Zn, Pb and Cd compared to oligozoospermic and azoospermic men studied (0.26). Table V shows the correlation of seminal fructose against seminal vit C, GHS, NO, Zn and Se in azoospermic men. Significant negative correlations were observed between seminal fructose and seminal vit C , GSH , NO , Zn  and Se  in azoospermic men.Abnormal sperm function and male infertility have been attributed to several factors including increased generation of ROS and OS which may be related to heavy metal accumulation. We examined the association between heavy metals, OS indices and defective sperm functions in fertile and infertile men.In this study, significantly lower serum and seminal TAC and higher TPP and OSI were observed in oligozoospermic and azoospermic men compared to their normozoospermic counterparts. The spermatozoa like any other cell under aerobic condition generate ROS whose activities are modulated by several enzymatic and non-enzymatic antioxidant systems (15). Overabundance of ROS results in sperm damage and impaired sperm functions, the extent of damage being dependent on the nature, amount, and duration of ROS insults . Increased TPP and OSI seen in oligozoospermic and azoospermic men compared to their normozoospermic counterparts may therefore be attributed to increased generation of ROS leading to increased membrane peroxidation and depressed antioxidants observed in these groups. Higher TPP and OSI and decreased TAC was also observed in azoospermic compared to oligozoospermic men. This may be an indication that azoospermic men generate the highest levels of ROS which may contribute to the absence of spermatozoa in their semen. Infertile men have been reported to have elevated levels of ROS, high enough to induce apoptosis compared to their fertile counterparts (21). Lower sperm concentration and percentage motility were observed in oligozoospermic and azoospermic men compared to normozoospermic men studied. This may result from increased lipid peroxidation induced by ROS (higher TPP) and the consequent antioxidant depression (lower TAC) observed in these individuals. Excess ROS and OS have been shown to exert toxic effects on sperm function leading to impaired sperm motility, concentration, and morphology . Impaired motility may result from inhibition of mitochondrial function, decreased axonemal protein phosphorylation, decreased sperm viability, increased mid-piece sperm defects, and sperm immobilization arising from lipid peroxidation; leading to reduced hyperactivation, oocyte penetration, and poor fertilization outcome. Pathological levels of ROS have been shown to cause oxidative DNA damage and apoptosis of spermatozoa resulting in cell death and reduced sperm concentration. Higher percentage of apoptotic spermatozoa have been demonstrated in oligoasthenozoospermic subjects than in normozoospermic men (4). Seminal fructose and vit C levels were significantly lower in oligozoospermic and azoospermic men compared to normozoospermic men studied. Seminal fructose, produced by seminal vesicles and the ampulla of the ductus deferens has been described as the major source of energy for spermatozoa and has been used as marker of seminal vesicle functions (23). Lower fructose levels coupled with lower ejaculate volume and sperm motility observed in oligozoospermic and azoospermic may be indicative of ejaculatory duct obstruction, seminal vesicle dysfunction, or hypoplasia. Contrary to our findings, higher seminal fructose levels often accompanied by lower sperm concentration and sperm motility have been reported (24). Negative associations were observed between seminal fructose and seminal antioxidant and antioxidant elements in azoospermic men studied. Similarly, an inverse relationship has been reported between seminal zinc and fructose concentrations. Effective seminal fluid activity has been related to the inverse relationship between seminal zinc and fructose levels (25). Association between vit C and normal functioning of the male reproductive system has been established. High concentration of vit C has been localized in the epididymal fluid and seminal plasma and has been associated with ejaculate volume, sperm count and sperm motility (26). Vit C has been described as a major antioxidant in the testis; it neutralizes ROS thereby protecting the spermatozoa from lipid peroxidation and oxidative DNA damage. Lower vit C levels seen in both oligozoospermic and azoospermic subjects may result from increase demand in ROS neutralization (26). Also lower sperm count and motility in this group may be a consequence of lower seminal vit C status. Improvement in sperm numbers, concentration, motility and amelioration of male reproductive traits with high fertility rates has been observed with vit C supplementation (27).The serum NO levels of normozoospermic men were significantly higher than those of oligozoospermic and azoospermic men and seminal NO higher in normozoospermic compared to azoospermic men studied. NO has been described as a mediator of several physiopathological events including regulation of vascular tone, neurotransmission, apoptosis, and inflammation (28). Nitric oxide has been localized in the spermatozoa, and has been reported to influence sperm function both positively and negatively. Low NO levels have been shown to increase sperm motility, capacitation, zona pellucida sperm-binding protein, and sperm viability (22). Higher levels of NO however have been associated with defective sperm motility, morphology, sperm count and viability through mechanisms that involves the inhibition of mitochondrial respiration that results in a depletion of adenosine triphosphate and the reduction of sperm motility (29). The effects of NO on sperm functions have been reported to be a function of the alternative redox state and relative NO level (30). Therefore, higher NO observed in normozoospermic men without defective sperm functions may be related to their normal redox status as shown by their higher TAC and lower TPP levels. Azoospermic and Oligozoospermic subjects on the other hand have relatively defective sperm function irrespective of their lower levels of NO which physiologically is supposed to increase sperm motility and viability. Defective sperm functions at lower NO levels in these subjects may therefore be related to their abnormal redox status as depicted by lower TAC levels and increased lipid peroxidation (30). Lower serum GSH levels were observed in azoospermic and oligozoospermic men compared to normozoospermic men. GSH, the most abundant non-enzymatic antioxidant has been detected in high concentrations in male reproductive tissues. The ability of GSH to react directly with ROS by donating hydrogen ion and also serve as a cofactor for antioxidant enzyme glutathione peroxidase (GPX) is responsible for its scavenging properties. GSH protects the sperm plasma membrane by neutralizing the cytotoxic aldehydes produced during lipid peroxidation (31). Normal sperm function seen in normozoospermic men may therefore be an indication of the significant role played by higher GSH levels in protecting the spermatozoa against oxidative damage (7). Decreased serum GSH in oligozoospermic and azoospermic men studied may be attributed to their increased consumption to buffer the effects of increased ROS (decreased TAC) and lipid peroxidation (increased TPP) observed in this group. Disruption in the membrane integrity of spermatozoa leading to defective motility associated with OS has been linked to low seminal plasma and erythrocyte GSH levels (32). The serum levels of the antioxidant metals zinc and selenium were significantly higher in oligozoospermic and azoospermic men compared to their normozoospermic counterparts. However, no significant differences were observed in the seminal levels of these elements in normozoospermic compared to oligozoospermic and azoospermic. A similar observation has been reported by another study (33). Higher zinc and selenium levels in oligozoospermic and azoospermic compared to normozoospermic may be related to increased lipid peroxidation in these subjects. The body in response to increased lipid peroxidation may enhance the activities of the antioxidant enzymes glutathione peroxidase and Copper/Zn-SOD, which have selenium and zinc as components thereby leading to increased zinc and selenium levels observed. Contrary to our findings, higher serum and seminal levels of zinc and selenium have been demonstrated in normozoospermic subjects compared to oligozoospermic and azoospermic subjects . Seminal Zn and Se have been shown to be essential for normal testicular development and spermatogenesis (7); Zn has been described as the primary factor responsible for DNA transcription and protein synthesis during spermatogenesis (34). It is also a component of Copper/Zn-SOD antioxidant enzyme. Reduced levels have been associated with decline of its antioxidant capacity, increased lipid peroxidation and low sperm quality. Normal sperm function and protection against oxidative DNA damage requires Se (35). Increased incidence of sperm shape abnormalities, breakage at the middle piece and loss of motility has been associated with low levels of Se (7). The serum levels of the heavy metals lead and cadmium were higher in oligospermic and azoospermic men compared to normospermic subjects studied. Oligospermic men also had higher seminal Pb and Cd compared to azoospermic men. The negative impacts of Cd and Pb on the motility, morphology, quality and concentration of spermatozoa have been described. The chemical affinity of Cd for calcium ions in the cell membranes may alter the integrity of the acrosomal membrane of the spermatozoa leading to abnormal acrosomal reaction and impaired fertility. Cd has been implicated in modulating the initiation and duration of acrosome reaction and occurrence of separated flagellum (36). Possible damaging effect of Pb on the chromatin of spermatozoa and spermatogenesis has been reported. Defective sperm function associated with lead exposure has been linked to lead-associated increase in lipid peroxidation (37). Pb has been shown to reduce normal sperm metabolism through suppression of sperm creatine kinase activity thereby contributing to infertility in men (38). Subjects recruited into this study were not occupational exposed to lead and cadmium and other confounding factors as cigarette smoking were eliminated. Alterations in the homeostasis of seminal trace element composition have been shown to influence the fertility capacity of the spermatozoa (33).The findings of this study have shown that abnormal sperm functions may be related to elevated levels of heavy metals, increased lipid peroxidation and antioxidant depletion which may result in impaired fertility in men studied. Antioxidant supplementation may be beneficial in amelioration of impaired semen functions.The authors declare that there is no conflict of interests regarding the publication of this article.


Despite its low incidence, pediatric cancer makes up a significant portion of childhood illnesses. Yet information on pediatric cancer in Latin America is scarce. Since the early 2000s the World Health Organization (WHO) has been highlighting the role of cancer registries in cancer surveillance and control. This article describes the main aspects of pediatric cancer registration in Latin America, highlighting the successes of Argentina’s national pediatric cancer registry, Registro Oncopediátrico Hospitalario Argentino (ROHA), which allows for better health care and contributes to improved outcomes for children with cancer, to provide a rationale for the expansion and enhancement of pediatric cancer registration in other Latin American countries. Pediatric cancer refers to a group of cancers affecting children between 0–14 years of age . Current incidence rates are low, ranging from 50 to 200 cases per million per year, depending on the country , 4. ThesThe gap in survival between HICs and LMICs emerges from differences in available treatments; health resources; infrastructure; early detection; clinical support, and follow-up; and coexisting malnutrition and communicable diseases , 6. One aLatin American countries need to strengthen their cancer registration mechanisms to meet good-quality criteria for completeness, coverage, and timeliness of data . Cancer This article describes the main aspects of pediatric cancer in Latin America, highlighting the successes of ROHA, which allows for better health care and contributes to improved outcomes for children with cancer, to provide a rationale for the expansion of pediatric cancer registration in the region.Registries enable the surveillance of cancer through the ongoing, timely, and systematic collection of information on new cancer cases, treatments, and survival and deaths rates . The regBuilding and running a pediatric cancer registry with a population scope is challenging, especially in limited-resource settings . NeverthROHA was the first nationwide pediatric cancer registry in Latin America. It was created within the framework of the Kaleidos Foundation , an ArgeOne salient feature of ROHA is that it combines the characteristics of PB and HB registries in order to ensure national coverage. As the treatment of pediatric cancer is concentrated in highly specialized facilities in Argentina, it is possible to use hospitals as the basic unit of the registry. ROHA complements the information that hospitals provide with other relevant sources, such as private clinics, local population registries, death certificates, pathology laboratories, and radiotherapy centers. The doctors treating pediatric cancer patients are usually in charge of the registration, but specially trained administrative personnel can also fulfill this task. ROHA coordinates the network, provides support, and compiles the data. Its permanent staff includes a director, an epidemiologist, a systems analyst, and two coders trained to codify cases according to the ICCC. As of 2015, the network included 88 institutions .ROHA’s database contains information about type of tumor, incidence, place/s of treatment, survival, and mortality . The NatROHA provides crucial data for the identification and development of lines of action for public policies on pediatric cancer in Argentina. The availability of high-quality data is important for developing, implementing, and assessing pediatric cancer strategies. The recently published guideline “Pediatric Central Nervous System (CNS) Tumors”  and the Pediatric CNS tumor guidelines. ROHA’s data on CNS tumors highlighted the need for pediatric CNS tumor guidelines by identifying unjustified variations in survival outcomes across different provinces and an average national survival rate considerably lower than those observed in other HICs   has created a cancer registry training hub at the INC to stimulate collaboration and improve cancer registries in the region. Within this context, registries like ROHA could be developed and adapted to local conditions to expand the number of pediatric cancer registries in Latin America. Florencia Moreno, director of ROHA and member of the IARC’s “International Incidence of Childhood Cancer” editorial board , stated Pediatric cancer registries with population coverage are essential tools for monitoring and evaluating the performance of cancer treatments and health systems, tracking progress, and providing evidence for timely corrective actions. In Latin America, cancer registration in general, and pediatric cancer registration in particular, are still in the development stage and could benefit from lessons learned and benchmarks drawn from innovative registries like ROHA. The ongoing technical cooperation between Latin American countries allows for optimism regarding the future of pediatric cancer registration in the region. However, a long-term commitment from each Latin American country will be necessary for these initiatives to thrive.Florencia Moreno /Instituto Nacional del Cáncer (INC)) provided key inputs for this article through several interview sessions. Louisa Stüwe and Ana Cristina Castro (PAHO/WHO) and Nicole Corea (American University) reviewed the article and contributed valuable suggestions.Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/PAJPH, or the Pan American Health Organization (PAHO).


In the 10 countries surveyed, the availability of oral contraceptives, injectables, and condoms varied greatly, and the availability of basic items indicating service readiness, such as guidelines, trained staff, equipment, and certain commodities, was low. In the 10 countries surveyed, the availability of oral contraceptives, injectables, and condoms varied greatly, and the availability of basic items indicating service readiness, such as guidelines, trained staff, equipment, and certain commodities, was low. Access to family planning services and appropriate contraceptive methods is crucial for ensuring good health outcomes for women and adolescent girls. The World Health Organization worked with the U.S. Agency for International Development to develop the Service Availability and Readiness Assessment (SARA) survey to measure health facility capacity to provide end users with appropriate, high-quality health care. In this study, we looked at the service availability and readiness of health facilities to provide contraception in 10 African countries: Benin, Burkina Faso, the Democratic Republic of the Congo, Djibouti, Mauritania, Niger, Sierra Leone, Tanzania, Togo, and Uganda.This study compared SARA survey data on family planning services from each of the 10 countries. We conducted a descriptive analysis of variations in facility readiness and the availability of services, contraceptive methods, trained staff, family planning guidelines, and basic health care equipment.Overall, many of the countries surveyed had a relatively high availability of at least 1 contraceptive method. Rural facilities tended to have more availability of contraception than urban facilities, and government facilities tended to have higher availability of family planning than other providers. The countries differed in their particular dominant contraceptive method, and stock-outs of contraceptive methods were observed. Countries had overall low levels of all 6 tracer items , indicating low health system readiness. There were discrepancies between reported and observed availability of blood pressure apparatuses and family planning guides and having at least 1 staff member trained to use these tools. In all countries, unmarried adolescents appeared to have less access to family planning than the general population.Stock-outs and logistics management problems were common among the countries surveyed. Critical gaps between reported and actual availability of products and services often makes it difficult for end users to access appropriate family planning methods. To address many of the issues, additional health worker training is needed and more effort to target and support adolescents should be undertaken. To achieve universal health coverage targets for family planning, gaps in the availability and readiness of health systems to provide contraceptive products and services must be reduced. Résumé en français à la fin de l'article.In working to achieve the Sustainable Development Goals,The SARA tool measures service readiness, i.e., physical access to and capacity of health facilities to provide health services.The SARA tool is a questionnaire that was designed to measure country-specific health-related goals, including family planning. Before the tool is implemented, a country must first compile a master facility list to direct the use of the surveys. The survey can then be used to either randomly sample health facilities within a country or assess all facilities within selected local districts.SARA is not intended to provide comprehensive data on all aspects of functioning of health services, rather, the tool focuses on key “tracer” items that are indicative of the essential health system underpinnings and crucial to programs that are scaling up or ready to do so. Family planning data from the SPA tool is more comprehensive—as it not only covers service availability and readiness but also examines client–provider interaction components of consultation, counseling and discussions, client knowledge levels, and feedback from family planning clients on service accessibility problems. In total, 10 sub-Saharan African countries have implemented the SARA tool since 2010, whereas only 3 countries have used the SPA tool during the same time frame.The SARA tool has been successfully used to generate a detailed assessment of the status of full health systems in such countries as UgandaThe data provided by the SARA tool can be used to generate detailed health system assessments and monitor and evaluate progress toward universal health coverage.In this study, we used data generated from SARA surveys conducted between 2010 and 2016 to assess and compare the availability and readiness of health facilities to provide patients with family planning services in 10 African countries, with the aim of generating further evidence for the planning and management of health systems.Countries tend to do SARA every 2 years.2—to obtain national estimates or (2) a census of all facilities in selected districts, which can be used for subnational estimates if desired.Countries implementing SARA used 1 of 2 different sampling methods: (1) a nationally representative simple/systematic random sample of health facilities—with stratification by type of health facility and managing authorityThe SARA indicators measure service availability, general service readiness, and service-specific readiness.SARA indicators measure service availability, general service readiness, and service-specific readiness, using an index of specific tracer items.SARA can be used to explore reported and actual percentages of facilities offering certain services in national health system. Here, the reported percentage refers to health facilities where SARA survey respondents reported that their respective health facility is providing oral contraceptives in service, which has implications for available stock. The actual percentage refers to health facilities where, on the day of the assessment, a SARA surveyor observed at least 1 valid stock of oral/injectable contraceptives in the service area or where supplies were routinely stored in the health facility. We defined the stock-out rate of a contraceptive method as the proportion of facilities providing family planning services where the SARA surveyor did not observe at least 1 valid stock of oral or injectable contraceptives in the service area or where supplies were routinely stored in the health facility on the day of the assessment.The SARA survey-based indicators measure contraceptive method choice and stock-out of oral contraceptives, injectable contraceptives, and male condoms. Other family planning provider readiness indicators—in terms of number of trained staff, availability and use of guidelines on delivering family planning services, and availability of a blood pressure apparatus for use of family planning staff—are used for cross comparison. The data are disaggregated by type (government or nongovernment) and location  of the family planning provider, and analysis is performed. Under the family planning section, there is a set of questions inquiring whether the facility provides or prescribes any of the following modern methods of family planning for unmarried adolescents: combined estrogen-progesterone oral contraceptive pills (COCs), male condoms, emergency contraceptive pills, and intrauterine devices (IUDs). We compared information on proportion of facilities providing these methods for unmarried adolescents across the countries.Niger (96%), closely followed by Sierra Leone (94%), had the highest proportion of health facilities offering family planning services , while tIn most countries, COCs, male condoms, and progestin-only injectables were offered at higher rates than other methods.Breakdowns of country-level urban and rural family planning availability showed that in 8 of the 10 countries—Benin, Burkina Faso, Mauritania, Niger, Sierra Leone, Tanzania, Togo, and Uganda—rural facilities had a higher availability of family planning services than urban facilities . LikewisIn 8 of the countries, rural facilities had a higher availability of family planning services than urban facilities.Supplement Table for more details). Burkina Faso, Niger, and Sierra Leone seemed to have consistently high levels of stock available, with a good mix of 3 options available at similarly high rates. In contrast, Togo had a large disparity between injectables with high amounts in stock compared with oral contraceptives and male condoms, and the DRC had a disparity between higher levels of male condoms being in stock compared with oral contraceptives or injectables. Among the 10 countries, government-run facilities tended to have a higher percentage of contraceptive methods in stock—condoms being the highest percentage stocked—compared with other facilities. Both types of facilities seemed to have similar percentages of oral contraceptives, injectables, and male condoms in stock. Whether a facility was urban or rural did not seem to affect availability of stock; however, facility-type data showed “government facilities” generally had more stock for each type of contraceptive compared with “other facilities,” with some exceptions. Stock-out rates also tended to be higher in countries with lower proportions of facilities providing family planning services.Among the 10 countries, stock levels varied depending on the type of method and the location or type of facility providing family planning methods . In 7 countries, the percentage of facilities providing family planning services was considerably higher than the percentage of facilities offering family planning services for unmarried adolescents, with Benin (31% difference), Niger (33% difference), and Togo (34% difference) having the biggest disparities . BurkinaWhile the percentage of facilities providing family planning services to unmarried adolescents varied greatly, adolescents remained underserved.The SARA tool provided insightful information on the availability of family planning products and services as well as the readiness of the facilities surveyed to provide services in the 10 countries surveyed. While the results indicated overall high levels of family planning availability of at least 1 method in 7 countries , they also showed that contraceptive options were limited in the countries assessed, which could limit usage of family planning if appropriate methods are not available.Despite results indicating overall high levels of family planning availability of 1 method in the countries assessed, contraceptive options were limited.Results also showed that government health facilities typically had more family planning availability, highlighting potential gaps where public facilities do not exist. The difference between rural and urban family planning availability noted here could be due to a concentration of private facilities in urban areas, which is to be explored separately. The delivery of family planning services may not be a priority area for the profit-oriented private sector, which could have indirectly contributed to the observed differences between rural and urban service availability.The typically higher stock levels in government facilities may be due to the government having better logistics management and/or supply chains than religious, private, or traditional health facilities. As a result, modern contraception may not be offered or considered as high of a priority in nongovernment facilities.Stock-outs are a common problem. The 10 countries had varying stock levels and inconsistent method availability of the 3 methods surveyed: oral contraceptives, injectables, and male condoms. Some countries, particularly the DRC, had very high stock-out rates for certain commodities. In contrast, Burkina Faso, Niger, and Sierra Leone had the best stock mix of the countries surveyed. Poor levels of stock may be indicative of larger supply chain problems, such as poor logistics management information systems, incorrect ordering of stock, poor budget allocation and/or use, external supply chain issues, commercial market factors, or other transportation-related issues. Other factors, such as demand or intention, may have also influenced the different stock levels of these 3 methods in each of the surveyed countries. For example, a facility may stock male condoms for sexually transmitted infection prevention rather than family planning. Male condoms also do not offer women the same control or efficacy as other methods for family planning purposes. More worrisome are the countries such as the DRC, Mauritania, and Togo, which had lower levels of stock in general compared with the other countries surveyed. Stock-out rates were higher in countries with lower proportions of facilities—the DRC and Mauritania—providing family planning services, which may indicate that family planning is less of a priority for the government and/or public.The differences between reported and actual percentages of facilities offering family planning services indicate that each country had a disparity in their oral and injectable contraceptive supplies. This may be due to either weak logistics management information systems and inadequate information about inventory and procurement or incorrect ordering of inventory by staff members who may have not received proper training for procurement or documenting inventory, or both. Ministries of health should prioritize improving logistics management information systems to have more accurate inventories to improve family planning and other health services.Selected Practice Recommendations for Contraceptive Use,Readiness is an area where many of the countries surveyed could use improvement. Overall low levels of tracer items—guidelines for family planning, staff trained in family planning services, blood pressure apparatus, COCs, injectable contraceptives, and male condoms on the day of facility assessment—indicated that the readiness of many health facilities in these countries needs to be improved. The percentage of facilities with guidelines for family planning and at least 1 staff member trained in family planning was low in the countries surveyed. In each country, except for Sierra Leone and Uganda, family planning guidelines were more likely to be in a health facility than staff members trained in family planning. This is a cause of concern because even if guidelines are available in a facility, they may not be used if staff members are not trained to use them. Even greater disparities were seen between the high availability of blood pressure apparatuses and the share of family planning service delivery units equipped with blood pressure apparatuses. We only have information on mere availability of the apparatus, and not on whether the providers are effectively using them. However, as noted in WHO's latest Overall low levels of tracer items indicated that the readiness of many health facilities in these countries should be improved.According to SARA data, unmarried adolescents, in particular, are underserved. The data from Benin, Djibouti, the DRC, Niger, Togo, and Uganda showed especially low percentages of facilities with family planning services available for unmarried adolescents, which is a missed opportunity for country programs. By meeting the unmet need for modern contraception of women aged 15 to 19 years, countries could reduce unintended pregnancies by 6 million annually, thereby averting 2.1 million unplanned births, 3.2 million abortions, and 5,600 maternal deaths.By meeting adolescents' unmet need for modern contraception, countries could avert 2.1 million unplanned births, 3.2 million abortions, and 5,600 maternal deaths.At present, the core SARA tool focuses on measuring the availability of national guidelines, training of service providers, and availability of selected contraceptive methods, such as COCs, condoms, IUDs, and emergency contraception. The nature of information on adolescents in facility-level surveys is dependent on national policies and/or guidelines for providing family planning services for adolescents, which may vary from country to country. It is important to note that if a national policy does not support providing specific services to adolescents, then health facilities are not legally eligible to deliver them. In the absence of a national policy recommending provision of family planning method for adolescents, adolescent-specific service information is difficult to obtain. This is an inherent limitation in performing a cross-national comparison of adolescent access to various family planning methods using data from health facility surveys, including SARA.While SARA data can produce many useful findings, it is important to acknowledge its limitations. The data only provide information about facility availability and readiness; they do not measure actual use of contraceptives. Moreover, assessing the supply side of family planning does consider potential low demand for family planning in general or for certain methods specifically, and how facility availability or readiness to provide family planning services may be affected in a place where demand may not exist. The information obtained on the availability of family planning services for unmarried adolescents was collected by interviewing 1 or more staff members at the facility. The interviews were not in-depth or robust and may have resulted in the actual availability being less than the stated results, possibly due to courtesy bias. It is crucial to review and revise data collection methods, as suggested above, to obtain good quality and credible information for strengthening services.This analysis is limited, as it only looks at SARA data from 10 countries in sub-Saharan Africa and cannot necessarily be generalized to other countries or regions, and because long-acting reversible contraceptives (LARCs) and permanent methods were not included in the survey focus. The analysis was focused on short-acting reversible methods—oral contraceptives, injectables, and condoms—as the tracer for medicine and commodity availability for family planning services in SARA tool. Considering the increasing popularity of LARCs in sub-Saharan Africa, core SARA instruments may also consider adding them to the existing tracer items list.The SARA tool should be revised to include LARCs and permanent methods to more accurately reflect the method mix available in sub-Saharan African countries.By improving the availability of an appropriate contraceptive method mix through supply-chain and logistics solutions and increasing facility readiness through training and improved health systems, more women could gain access to contraception thereby reducing an already identified unmet need.Reducing gaps in availability and readiness of health systems to provide contraceptive products and services is needed to achieve universal health coverage targets for family planning. As discussed in this article, addressing time- and resource constraints-related limitations by expanding the scope of the core SARA tool can make it more programmatically useful for family planning planners and managers.


The dataset described in this data article represents four agricultural zones in West-Africa that are located in three countries: Benin, Mali and Sierra Leone. The dataset was created through a research collaboration between the Africa Rice Center (AfricaRice), Sierra Leone Agricultural Research Institute (SLARI) and the Institute for Rural Economy (IER). The dataset was compiled to investigate the potential for rice production in inland valleys of the three countries. The results of the investigation were published in Dossou-Yovo et al. (2017) and Djagba et al. (2018). The dataset describes the biophysical and socioeconomic conditions of 499 inland valleys in the four agricultural zones. In each inland valley data were collected through a focus group interview with a minimum of three farmers. In 499 interviews a total of 7496 farmers participated. The location of each inland valley was determined with handheld GPS devices. The geographic locations were used to extract additional parameters from digital maps on soils, elevation, population density, rainfall, flow accumulation, and distances to roads, market places, rice mills, chemical input stores, and settlements. The dataset contains 65 parameters in four themes . The GPS coordinates indicate the location of an inland valley, but they do not lead to the location of individual fields of farmers that were interviewed. The dataset is publicly shared as Supplementary data to this data article. Specifications tableValue of the data•A large multidisciplinary dataset comprising 499 inland valleys in three countries in West-Africa that cover location, biophysical characteristics, socioeconomic characteristics and inland valley exploitation.•The dataset can be deployed to analyze the potential for agricultural development, to characterize diverse inland valley landscapes, to perform environment impact assessments, to classify land use from satellite imagery, etc.•The dataset contributes to food security research and assessments in West-Africa and leads to further understanding of the diversity of agricultural systems and their potential to contribute to food production and income generation for the rural population.•The dataset was deployed to assess the diversity and importance of inland valley agricultural systems to a regional scale in Sierra Leone •To expand regional coverage the data can be linked to similar surveys conducted in inland valleys in Niger state (Nigeria), entire Burkina Faso and southern Mali 1The dataset contains biophysical and socioeconomic information on 499 inland valleys in four zones in Benin, Mali and Sierra Leone see . The inlsource) provides citation information and refers to this data article. The second sheet (variable explanation) outlines the variables. After that the sheet location provides the unique identifier of each surveyed inland valleys and the geographic coordinates expressed in longitude/latitude. The unique identifier can be linked to the variables stored in four sheets, one for each of the four zones, called Mali, Sierra Leone, Benin_Ouémé supérieur and Benin_Mono-Couffo , Upper Ouémé catchment (Benin), Sikasso and Kadiolo districts  and Bo and Kenema districts (Sierra Leone), respectively. These sites were visited by teams of trained surveyors equipped with a questionnaire and a GPS. Focus group interviews with at least three farmers operating in the inland valley were held and their responses were recorded. Focus groups existed of maximum 7496 farmers and on average 15 farmers participated in the focus group interviews. With the use of handheld GPS devices, the coordinates of the inland valleys were obtained.In a second phase, the locations of the inland valleys were imported into a Geographic Information System and their quality was checked. Spatial information available in the public domain were downloaded and imported in a GIS. These included maps of soil parameters, topology, rainfall, settlements, roads, population density, etc. Information for each inland valley was extracted using the location information of the sites and the values were added to the dataset of questionnaire responses and observations.


The emergency response to Zika virus disease required coordinated efforts and heightened collaboration among federal, state, local, and territorial public health jurisdictions. CDC activated its Emergency Operations Center on January 21, 2016, with seven task forces to support the national response. The State Coordination Task Force, which functions as a liaison between jurisdictions and federal operations during a response, coordinated the development of CDC Guidelines for Development of State and Local Risk-based Zika Action Plans, which included a Zika Preparedness Checklist  in the United States in 2016  and phase 1 . Phase 2 was defined by confirmed local transmission, and phase 3 by confirmed local multiperson transmission. Respondents completed up to 112 questions depending on the presence of capable vectors and the extent of local transmission. Questions were aggregated within the following seven activity domains: 1) operations and planning, 2) communications and community education, 3) vector control, 4) surveillance, 5) laboratory testing, 6) outreach to pregnant women, and 7) blood safety. For each reporting period, the number and percentage of jurisdictions reporting activity on ≥85% of the guidance elements (selected as the minimum indicator of Zika preparedness) was determined.Jurisdictions with multiple confirmed cases of local mosquitoborne transmission of Zika virus increased from three in June 2016 to seven in July 2017 . By OctoDuring phases 0 and 1, the percentage of 53 jurisdictions reporting activity on ≥85% of the guidance elements ranged from 77% (operations and planning) to 98% (communications and community education and outreach to pregnant women) . During Jurisdictions reporting development of Zika virus readiness, response, and recovery plans increased from 14 (26%) in June 2016 to 34 (64%) in July 2017 . There wAmong the seven jurisdictions experiencing local transmission in July 2017 , five monitored effectiveness of vector control treatments through trapping and re-treating if mosquito numbers began to increase again (vector control), and five had laboratory testing staff members and surge reagents in place (laboratory testing). Similarly, six of the seven jurisdictions developed community outreach plans to prevent sexual transmission (communications and community education), expanded vector control efforts within areas of local transmission (vector control), expanded surveillance and monitoring of pregnant women (surveillance), developed procedures to follow up with Zika positive blood donors (blood safety), and identified geographic areas for aggressive response efforts (operations and planning).Since May 2015, CDC has responded to reports of adverse pregnancy and birth outcomes associated with Zika virus infection during pregnancy. Collaboration with jurisdictions about case reports, surveillance, and registry data facilitated surveillance and increased knowledge about the impact of Zika virus infection on pregnant women and their fetuses and infants. According to CDC U.S. Zika Pregnancy Registry data since 2016, among women in the United States who had laboratory evidence of possible Zika virus infection during pregnancy, 6%–11% of fetuses or infants had evidence of Zika-associated birth defects (The quarterly Zika preparedness assessments facilitated active monitoring of progress toward Zika preparedness and response activities in 53 jurisdictions and provided situational awareness among internal and external partners, including the Zika response leadership, professional health care associations, nonprofit organizations, academic and research institutions, and the private sector. The checklist documented that health departments prepared for and implemented strategies to reduce the transmission of Zika virus. From June 2016 to July 2017, the percentage of jurisdictions reporting full completion of actions across all domains in the Zika Preparedness Guidance increased overall. The largest reported increases were in the following domains: operations and planning, communications and community education, outreach to pregnant women, and blood safety. The Zika supplemental funding, along with the funding provided through the Public Health Emergency Preparedness cooperative agreement, supports public health preparedness infrastructure to respond to large-scale emerging public health threats (The findings in this report are subject to at least two limitations. First, the data were collected through quarterly assessments. Second, the data represent self-reported progress on broad Zika Preparedness Guidance elements rather than objectively reviewed specific performance measures. A more detailed assessment ascertained by independent evaluators could potentially facilitate better planning and response actions in future outbreaks.The quarterly assessment findings provide objective evidence of progress toward meeting Zika planning and preparedness goals among the 53 jurisdictions receiving supplemental funding. As a result, the preparedness plans and strategies to reduce transmission and adverse effects of Zika in these jurisdictions improved compared with those in June 2016. CDC collaboration with state, local, and territorial health departments strengthened the response to this emerging threat and demonstrated the ability of public health departments to prepare and respond to an emerging public health event.Zika virus infection can cause adverse pregnancy-related birth defects and brain abnormalities. Local transmission of Zika virus was documented in the United States and its territories after the spread of Zika virus in the World Health Organization’s Region of the Americas.Among 53 jurisdictions, Zika planning and response activities increased from June 2016 to July 2017, with the largest increases in percentage of jurisdictions reporting fully completed actions for the operations and planning, communications and community education, outreach to pregnant women, and blood safety domains.Zika planning, preparedness, and response activities from June 2016 to July 2017 demonstrated the importance of collaboration between CDC and U.S. state, local, and territorial public health departments in preparation for and response to an emerging event.


AbstractBOLD (Barcode of Life Datasystems) COI dataset comprising over 77,000 Canadian records. To date, 8302 species of Coleoptera have been recorded in Canada, a 23% increase from the first assessment in 1979. A total of 639 non-native beetle species have become established in Canada, with most species in the Staphylinidae (153 spp.), Curculionidae (107 spp.), Chrysomelidae (56 spp.) and Carabidae (55 spp.). Based on estimates from the taxonomic community and our BOLD dataset, we estimate that slightly more than 1000 beetle species remain to be reported from Canada, either as new records or undescribed species. Renewed enthusiasm toward and financial support for surveys, especially in the central and western provinces of Canada will be critical for detecting, documenting and describing these species. The Barcode of Life database is still far from comprehensive for Canadian Coleoptera but substantial progress has been made and the number of Barcode Index Numbers (BINs) (as candidate species) has reached nearly 70% of the number of species reported from Canada. Comparison of BINs to observed species in a group of Canadian Staphylinidae suggests that BINs may provide a good estimate of species diversity within the beetles. Histeridae is a diverse family in Canada that is notably underrepresented in BOLD. Families such as Mordellidae, Scraptiidae, Latridiidae, Ptiliidae and Scirtidae are poorly known taxonomically in Canada and are represented in our BOLD dataset by many more BINs than recorded species.The beetle fauna of Canada was assessed, including estimates of yet unreported diversity using information from taxonomists and COI sequence clusters in a  Georissidae, Helophoridae and Hydrochidae separate from Hydrophilidae . In cases of multiple estimates, a range was reported to show the minimum and maximum values. We stress that these values were not intended to be precise but were included to provide the reader with an estimate of how well each group is known taxonomically in Canada. A dataset comprised of 77,626 Canadian Coleoptera records associated with a BIN  was also used to estimate beetle diversity in Canada. Number of BINs was used as a proxy for species diversity in Canada with the caveat that there will be instances where closely related species may share a BIN or a single species may be represented by multiple BINs. Beetle families with fewer reported species than BINs were estimated to contain in Canada at least as many undescribed or unreported species as BINs. Families with many more described species than BINs are considered to be underrepresented in BOLD and would benefit from focused sequencing and collecting effort in the future.Coleopterists within the taxonomic community were asked for estimates of undescribed and unreported Canadian beetles in their group of specialisation (contributors listed in Acknowledgments). Estimates accounted for both unrecognised distribution records and undescribed species, including those indicated by Archostemata, Adephaga, and Polyphaga , Carabidae (983 spp.), Curculionidae (826 spp.) and Chrysomelidae (595 spp.)  and the total number of species in Canada might eventually exceed 2000 , Curculionidae (107 spp.), Chrysomelidae (56 spp.), and Carabidae (55 spp.).In total, 639 non-native beetle species are established in Canada Table , althougBOLD by Canadian specimens, i.e., the number of BINs is <20% of the number of recorded species in Canada, making it difficult to use barcode data to assess overall taxonomic knowledge ; Georissidae and Sphaeritidae (Hydrophiloidea); Glaphyridae and Passalidae (Scarabaeoidea); Rhipiceridae (Dascilloidea); Dryopidae and Limnichidae (Byrrhoidea); Nosodendridae (Derodontoidea); Endecatomidae (Bostrichoidea); Biphyllidae (Cleroidea); Prostomidae (Tenebrionoidea); Bothrideridae, Euxestidae, Mycetaeidae, and Teredidae (Coccinelloidea). Efforts are underway to generate DNA barcodes for these families based on Canadian specimens. The family Histeridae, which has more than 130 species in Canada, is particularly underrepresented, with only 22 BINs  currently available in BOLD. Most members of this family are small, and live in microhabitats that are not sampled frequently such as mammal and bird nests, or under bark (Bousquet and Laplante 2006). This lack of representation could also be partly due to sequencing bias against Histeridae resulting from primer mismatch, or differences in DNA preservation at the collecting and archiving stages. For example, only 3% (8/256) of a diverse sample of Histeridae specimens from the Canadian National Collection of Insects, Arachnids and Nematodes  yielded barcode-compliant (and therefore BIN-compatible) sequences, versus 22% of submitted CNCStaphylinidae (522/2356).Nineteen beetle families are currently not or only poorly represented in ge Table . These fge Table . SixteenBINs in BOLD for Canadian specimens, sixteen beetle families are more diverse in Canada than would appear from the recorded number of species (Table BINs most greatly exceeds the number of species reported in Canada are: Mordellidae (+32 BINs) and Scraptiidae (+28 BINs) (Tenebrionoidea), Latridiidae (+23 BINs) (Coccinelloidea), Ptiliidae (+21 BINs) (Staphylinoidea), and Scirtidae (+21 BINs) (Scirtoidea). These families, generally with poorly known and small-sized species, require focused taxonomic studies because they may contain many undescribed species or described species yet unreported from Canada. This work should reconcile the unidentified BIN clusters with available names and describe any species new to science to adequately document the Canadian fauna. Researchers at the CNC and the Canadian Museum of Nature have made numerous contributions to the knowledge of Canadian Coleoptera. However, because most federal employees in Canada focus their research on agriculturally-significant taxa  that was discovered in North America based on congruent evidence from ecological data, mating studies, morphology and DNA barcode data  and the subject of modern taxonomic revision in North America, including critical examination of male genitalia for species concepts . A similar result was found for the well-studied Quediina of Central Europe where similar diversity  was represented by about 51% coverage (36 species with 39 BINs) in BOLD and only 7.7% of BINs (involving two species) were incongruent with prevailing species concepts .The utility of ic scale , as the Future prioritiesStaphylinoidea, Cucujoidea, Chrysomeloidea and Curculionoidea will continue to add many species to the Canadian fauna, new biosystematics work on several poorly studied families  is greatly needed. Although recent collecting in eastern Canada has yielded many discoveries, these biomes and, especially, those of central and western Canadian provinces remain inadequately sampled. A renewed effort toward exploring the Canadian beetle fauna will be critical for the documentation of the more than 1000 unrecorded or undescribed species that are estimated to be undetected or undescribed in Canada. Since DNA barcoding is a useful tool for assessing species diversity and appears to be highly compatible and synergistic with traditional morphological taxonomy, knowledge of beetle diversity in Canada will further benefit from continued development of the DNA barcode library through focused collecting, authoritative vouchering and continued integrative taxonomic research. However, improved and continued documentation of the Canadian fauna can only be achieved with new funding for surveys, including a variety of sampling methods, and by hiring or otherwise supporting scientists that include taxonomic work on the Canadian fauna as part of their research profile.The number of known species from Canada will continue to increase as new species are described, new populations of described species are discovered and species arrive as a result of climate change or global trade. While further taxonomic work on


Field research target regions within two basaltic geologic provinces are described as Earth analogs to Mars. Regions within the eastern Snake River Plain of Idaho and the Big Island of Hawai‘i, the United States, provinces that represent analogs of present-day and early Mars, respectively, were evaluated on the basis of geologic settings, rock lithology and geochemistry, rock alteration, and climate. Each of these factors provides rationale for the selection of specific targets for field research in five analog target regions: (1) Big Craters and (2) Highway lava flows at Craters of the Moon National Monument and Preserve, Idaho, and (3) Mauna Ulu low shield, (4) Kīlauea Iki lava lake, and (5) Kīlauea caldera in the Kīlauea Volcano summit region and the East Rift Zone of Hawai‘i. Our evaluation of compositional and textural attributes, as well as the effects of syn- and posteruptive rock alteration, shows that basaltic terrains in Idaho and Hawai‘i provide a way to characterize the geology and major geologic substrates that host biological activity of relevance to Mars exploration. This work provides the foundation to better understand the scientific questions related to the habitability of basaltic terrains, the rationale behind selecting analog field targets, and their applicability as analogs to Mars. ASA's BASALT  research program comprises an international team of scientists, engineers, mission operators, and astronauts investigating martian habitability and the technologies necessary for human/robotic exploration of Mars. The driving goal of the BASALT program is to integrate three Mars-focused disciplines  to inform future human spaceflight activities  may be derived through either magmatic evolution or processes related to the subsequent alteration of pristine rock. Primary magmatic processes, related to volcanism style and geologic setting, lead to differentiated products that may comprise a wide spectrum of compositions in any volcanic province. Subsequent changes to rock mineralogy and texture via alteration can dramatically affect the availability of CHNOPS elements and other chemical species used by biology , while secondary minerals are formed through the subsolidus alteration of primary minerals by the interactions of aqueous fluids, gases, or heat.Basalt is a fine-grained, mostly crystalline igneous rock composed of varying amounts of plagioclase feldspar and pyroxene often forming with other components, including olivine, oxides, glass, and minor accessory minerals such as apatite and sulfides. These primary constituents are all nominally anhydrous. Following the emplacement of a fresh lava flow, a variety of secondary processes can act to form secondary minerals and textural modifications that will reflect the alteration process. The extent of alteration depends on the temperature, length of exposure time, and the compositions of the primary rock substrate and fluids/gases involved. Alteration conditions can be relatively hot and dry (syn-eruptive), hot and wet , cool and wet (long-term meteoric water interaction), or even cool and dry (high desert conditions). Wet conditions can entail additional complexities related to relatively high or low pH and the concentration of dissolved solids.in situ analyses  material consisting of basalt that has not been altered by volatiles. Rock is typically black/dark gray with dense to vesicular textures. Outcrops with minimal alteration may be considered essentially “unaltered” with respect to secondary mineralization, especially in locations where significant textural variability is related to syn-eruptive processes . It is eAlteration is caused by the high-temperature, near-instantaneous, oxidizing effect of volcanic gases derived during an eruption . Fresh l2O, CO2, SO2, HCl, HS, and F) released following emplacement or development of the volcanic feature . Magmatic gases tend to have relatively low pH due to the addition of carbonic and sulfur-containing components to aqueous fluids  that result in chemical breakdown of primary minerals such as plagioclase to produce clay minerals  within a province, such as the East Rift Zone (ERZ) and Kīlauea Volcano in Hawaii or Craters of the Moon National Monument and Preserve (COTM) and the Great Rift in Idaho. Regions are set within zones and refer to specific features, generally <10 km2, that derive from a given event. Examples include Mauna Ulu shield volcano on the ERZ and the Highway Flow at COTM. Here we provide the geologic details of target regions. While smaller subdivisions are not considered in detail, many of the features used as rationale for target region selection occur at the scale of station  or location (1 m2 outcrop). Specifically, we focus on regions within the volcanic terrains of COTM  of Idaho. Designations adopted by the BASALT program for smaller size areas  that lie of COTM , upper,  of COTM , lower.Volcanic provinces in Idaho and Hawaii represent significant diversity in geologic setting and lava flow surface types. Lava flow surfaces vary across a wide spectrum of morphologies , exhibitThe textures of basalt and derivative volcanic rocks are mainly microcrystalline or glassy, some with small (less than a few mm) crystals (phenocrysts) of primary minerals such as plagioclase, olivine, and pyroxene. Many groundmass textures, that is, the material between crystals, are glassy in appearance to the naked eye and even under microscopic analysis, but they actually may have a submicroscopic crystalline texture that is discernible only via electron microscopy. One example is the Big Craters (BC) lava flow  that hase.g., Greeley and Spudis, et al., Selection of BASALT field targets on Earth was based on the premise that the biomass and diversity of life that can proliferate on volcanic rock substrates are influenced by conditions of surface morphology, age, weathering, and rock chemistry, including chemical alteration. Research targets (RTs) in Idaho , and Hawet al., While the ERZ remains volcanically active in a relatively warm, moist tropical climate, the Great Rift is currently inactive in a cooler, drier climate . Kīlaueai.e., not associated with active plate margins). This primary difference is the foremost rationale for selecting these zones, namely that oceanic and continental lithospheres have significantly different compositions and structures. Volcanic derivatives, therefore, will exhibit differences in compositional trends reflected in geochemistry, mineralogy, and texture. Regardless, both systems have been attributed in some degree to volcanic hotspots, generated by mantle thermal plumes from deep sources. They both exhibit deposits related to volcanic fissure eruptions along magmatic rift zones and have many similar surface constructs such as spatter ramparts and cones, pāhoehoe and ‘a'ā lava flows, and self-leveed stagnated lava ponds.The Great Rift–COTM system on the ESRP and the Kīlauea–ERZ system on the Big Island of Hawaii represent, respectively, continental and oceanic intraplate volcanism  hotspot   .et al., et al., Geochemical differences may further be associated with the processes and products of rock alteration and, by inference, they will further modify the availability of nutrients and energy sources for biological activity. Subdued surface weathering likely characterizes present-day Mars such that the rate of rock alteration is currently slow relative to surface processes on Earth. Although analog field targets on Earth are generally younger and therefore will have experienced weathering processes over a shorter time span compared with their martian counterparts, rock alteration on early Mars was possibly more acidic, which would enhance mineral decomposition and the deposition of secondary jarosite  is shown in RS data sets are evaluated here to illustrate the issues that go into mission planning and, especially, daily field excursions. Selection of targeted regions is based on preliminary RS data aimed at specific scientific interest and expected results , and in outcrop, as extensive dark-gray to black patches  in the upper 1–2 km of the ESRP. The surface morphology of the ESRP, a 400 × 100 km topographic and structural depression, is dominated by basaltic low shields and lava fields that erupted from ∼1–2 m.y. ago to the present; most are younger than ∼400 k.y. The most recent (Holocene) eruptions of both basaltic and evolved lavas on the ESRP  in e.g., Hughes et al., et al., et al., et al., Extensive geologic mapping and petrologic analyses  and mugearite  . Surface2) alkalic composition of outcrops analyzed by Curiosity Rover at Gale Crater   is a thiet al., As a research target, regardless of challenging accessibility issues, the Highway flow provides opportunity to evaluate variability in rock textures as well as possible zones of alteration associated with such variances. Notably, the Highway flow has abrupt variations in texture between dense, stony material and vesicular (“frothy”), glassy material. Field investigations and detailed measurements of this bimodal transition . Regular updates from the US Geological Survey (https://volcanoes.usgs.gov/volcanoes/Kīlauea) indicate that the lower ERZ, which is currently quiet, entered a vigorous eruptive stage in May 2018 that continued for several months along fissures in the area of Leilani Estates. The recent eruption produced a prodigious amount of lava that consumed numerous homes and reached the ocean in several places (https://volcanoes.usgs.gov/volcanoes/kilauea/multimedia_maps.html). Moreover, the summit region deformed considerably due to magma drain-out since our personal observations in 2016 when the Halema‘uma‘u lava lake was full. The resulting rim collapses have apparently compromised one of our research targets . Significant activity has also occurred along flanking magmatic rift zones, along the Southwest Rift Zone in 1920, 1971, and 1974, and along the ERZ, which has been nearly continuously active since 1955  different styles of lava eruption and emplacement and (2) different types of alteration related to fumarolic or syn-eruptive gases. These targets include the following: (RT 3) the flanks and proximal lavas of Mauna Ulu, (RT 4) lava lake of Kīlauea Iki, and (RT 5) altered basalts near the SE margin of Kīlauea caldera .et al., et al., et al. , shelly to dense vesicular pāhoehoe, a morphology that is characteristic of most fresh lavas on Kīlauea . Meager et al., et al., The Kīlauea Iki lava lake was the result of lavas filling the Kīlauea Iki pit crater during the spectacular 1959–1960 summit eruption of Kīlauea Volcano  are some of the dominant features in Kīlauea caldera.A growing body of evidence indicates that such features also define the evolution of summit calderas of most basaltic shield volcanoes on Earth and other planetary bodies  suggests that the widespread phyllosilicates might be associated with subsurface low-grade metamorphism rather than surface meteoric water. While these environments likely ranged from hot springs , evidenced by extensive phyllosilicate deposition and the formation of valley networks .Differences in oxidation state and subsequent core formation were likely responsible for notable differences in the composition of bulk silicate Mars versus bulk silicate Earth Taylor, . The mosin situ lander- and rover-based investigations has shown that the upper crust and much of the surface of Mars are dominated by basaltic materials  in Gale Crater  suggests that silicic volcanism has occurred on Mars . Examples of relatively small plains-style shields, lava flows, and fissures on the eastern flank of the Tharsis region  represent an analogous system for comparison of the volcanic processes occurring on Earth and Mars.Despite the chemical and physical differences between Mars and Earth, the study of martian meteorites and extensive orbital and et al., Volcanism on the ESRP provides numerous geomorphologic features considered to be analogues to volcanism recognized on Mars where plains-style volcanism occurred largely in the Tharsis region and locally in the Elysium Mons region  collected from the summit regions of Haleakala and Mauna Kea have shown that these materials are a compelling, although incomplete, spectral analogue to the globally distributed martian dust  and is typified by the presence of amorphous silica, sulfate minerals, Fe-oxides, and native sulfur  include additional lava flow types and compositions to fill in textural and chemical gaps; (2) venture into active high-temperature systems appropriate to extremophile biota; (3) investigate more remote areas that might require greater logistical support, but may yield significantly different results by comparison; and (4) attempt to gain access to subsurface features (deeper than a few cm) in lava flows. The latter two efforts could include venturing into lava caves, which might provide additional information regarding mineral deposits as well as natural protection from surface exposure.et al., Basaltic terrains on Earth host a diverse microbiota. Even just 2 months after an eruption, lava is capable of hosting a diverse microbial assemblage that includes the capacity to oxidize sulfur and iron as sources of energy (Kelly


Pupillary light reflex (PLR) measurement is one of the frequent physical examinations used by emergency physicians for assessment of brain stem function and monitoring of intracranial pressure , 2. PLR Direct PLR measurement is not always possible in patients with ocular trauma suffering from hematoma, hyphema, and etc. One helpful tool for measuring PLR in this situation is ultrasonography , 4. UsinUsing consecutive sampling, the authors of this letter examined all head trauma patients suffering from unilateral ocular trauma, who visited the emergency departments of Shahid Sadooghi and Shahid Rahnemoun hospitals, Yazd, Iran, from 2017 to 2018 (ethics code: IR.SSU.MEDICINE.REC.1396.265). Patients with bilateral ocular trauma, penetrating trauma, history of any chronic disease , or previous eye surgeries were excluded.Using EZONO 3000 ultrasound system and a linear probe with a 10 MHz frequency in coronal sections, PLR was measured in both intact and injured eyes. The probe is fanned until the iris and pupil are visualized and a bright light is flashed (distance 1 cm).The pupil sizes for both intact and injured eyes were measured and registered through physical examination and ultrasonography before and after flashing light to the eye, separately (PLR in injured eye was measured using indirect light and light was flashed into the intact eye). Then, the initial pupil size and PLR were compared between physical and ultrasonography examinations (The study was performed on both conscious and unconscious patients). Finally, 74 cases with the mean age of 20.30 There was a significant difference between physical examination and ultrasonography findings regarding the pupil size of injured eyes , while this was not observed in healthy eyes .It seems that, the use of ultrasound could be helpful in decreasing the number of unclear PLR through accurate detection and measurement of pupil size in injured eyes. Emergency physicians can consider ultrasonography as an accessible tool, complementary to physical examination for more accurate decision making in treatment of trauma patients.