Compared with the control, the Bacteroides population did not sig

Compared with the control, the Bacteroides population did not significantly change after 8- and 24-h incubations, whereas a significant increase in the Lactobacillus/Enterococcus spp. numbers was only observed after addition selleckchem of FOS. An increase in the C. coccoides/E. rectale numbers was observed in the presence of NS, BS and FOS, the almond skin digests showing a greater increase after the 24-h incubation. All the test fractions also stimulated the growth of bifidobacteria, with 0.50 and 0.64 log increases in their numbers at 8 h with almond skins and FOS, respectively. Species of the C. hystolyticum group (Clostridium clusters I and II) decreased after addition of all the fractions. No significant

differences were observed between NS and BS, their effect on bifidobacteria, Lactobacillus/Enterococcus spp. and C. coccoides/E. rectale numbers being optimal after the 8-h incubation. In order to obtain a general quantitative measure of

the prebiotic effect, a prebiotic index (PI) was calculated (Palframan et al., 2003). The PI represents a comparative relationship between the growth of ‘beneficial’ bacteria, such as bifidobacteria, Lactobacilli and E. rectale numbers, and KU-60019 in vivo the ‘less desirable’ ones, such as Clostridia and Bacteroides, in relation to the changes of the total number of bacteria (Fig. 2). For all substrates, the PI values obtained at 8-h incubation were higher than those at 24 h, FOS producing the highest values at all the time-points tested. No significant differences were observed between NS and BS, with a PI value slightly higher for BS (4.2) than NS (4.1) after an 8-h incubation, whereas a slightly lower PI value was recorded after 24 h for BS (3.2) compared with NS (3.3). The concentrations

of lactic, acetic, propionic and butyric acids produced during in vitro fermentations are shown in Table 3. FOS yielded the highest total SCFA production at all the time points tested. No significant enough differences in SCFAs were observed between NS and BS. The concentrations of propionic and butyric acids increased after 8 h and peaked after a 24-h fermentation with NS and BS, again correlating with C. coccoides/E. rectale population changes. Acetic acid production increased towards the end of incubation, whereas lactic acid concentrations increased after an 8-h incubation and remained stable. In the present study, we have demonstrated the prebiotic potential of almond skins using combined models of human digestion, which include gastric and duodenal digestion, followed by colonic fermentation. The evaluation of novel prebiotic compounds should take into account the resistance to hydrolysis by human alimentary enzymes and absorption in the small intestine, together with hydrolysis and fermentation in the large bowel. Almond skins contain a high amount of dietary fibre, which is made of plant cell wall polysaccharides able to provide the body with energy through fermentation and absorption of SCFAs.

Since 2000, about 10 transmissions from diagnosed women have been

Since 2000, about 10 transmissions from diagnosed women have been recorded each year in the UK, against a background of increasing prevalence. However, another 20–30 UK-born children are also diagnosed each year, at various ages, whose mothers were not known to have

been infected at the time of their birth [5]. http://www.selleckchem.com/products/abt-199.html An audit of the circumstances surrounding nearly 90 perinatal transmissions in England in 2002–2005 demonstrated that over two-thirds of these infants were born to women who had not been diagnosed before delivery [14]. About half of those undiagnosed women had declined antenatal testing. A smaller proportion had tested negative: these women presumably seroconverted in pregnancy, or while they were still breastfeeding. In 2009, the National Screening Committee considered the introduction of a routine repeat screening test in the third trimester to identify seroconversions in pregnancy, but concluded that a universal re-offer should not be introduced at that time. However, it was reiterated that women who declined the initial offer should be re-offered screening at about 28 weeks’ gestation, and that repeat tests could be offered to any woman who was thought to be at continuing risk of infection, and to any woman who requested a second or subsequent test [12]. It is the responsibility of Ceritinib price clinicians caring for women with HIV and their children to report them prospectively

to the NSHPC. Aggregated data tables from the UK and Ireland of ARV exposure and congenital malformations are regularly Endonuclease sent to the Antiretroviral Pregnancy Registry (APR). Individual prospective reports should also be made to the APR antenatally with postnatal follow-up. Antiretroviral Pregnancy Registry Research Park, 1011 Ashes Drive, Wilmington, NC 28405, USA In UK call Tel: 0800 5913 1359; Fax: 0800 5812 1658; For forms visit: www.apregistry.com This is the UK and Ireland’s surveillance system for obstetric and paediatric HIV, based at the Institute of Child Health, University College London. HIV-positive children and children born to HIV-positive women are reported through the British Paediatric

Surveillance Unit of the Royal College of Paediatrics and Child Health, or in the case of some units with large caseloads, direct to the NSHPC. Diagnosed pregnant women are reported prospectively through a parallel reporting scheme run under the auspices of the Royal College of Obstetricians and Gynaecologists. Longer-term data on infected children are subsequently collected through the Collaborative HIV Paediatric Study (CHIPS). For further information see the NSHPC website (http://www.nshpc.ucl.ac.uk), the CHIPS website (http://www.chipscohort.ac.uk) or email NSHPC (nshpc@ich.ucl.ac.uk). “
“The role of α-ketoglutarate (KG) in the detoxification of reactive oxygen species (ROS) has only recently begun to be appreciated.

Control of HIV infection in HCC is important Patients with a CD4

Control of HIV infection in HCC is important. Patients with a CD4 cell count >200 cells/μL have lower AFP levels, are more likely to receive active treatment,

and have a better median survival (11.7 months vs. 5.2 months) [43]. Correspondingly, an undetectable HIV RNA viral load (<400 copies/mL) is associated with check details a lower Child–Pugh score and a better median overall survival. The latter is only seen in untreated patients [44]. The degree of immunosuppression does not appear to correlate with BCLC stage [43,44]. Since use of HAART correlates with better overall survival, it is recommended for HIV-positive HCC patients [42]. In the HIV-negative population, solitary or a small number of HCC lesions are resectable. If complete resection is possible this should be performed without biopsy. These patients should have category A cirrhosis according to Child–Pugh classification [45]. This approach is associated with a 5-year survival of 60–70% in the HIV-negative population [46] and so HIV-positive patients should be considered for such treatments.

Other options for patients HIF-1 pathway with localized disease in whom resection is not possible include ethanol injection, radiofrequency ablation or trans-arterial chemo-embolization. It appears that transplantation may have superior results to resection alone in HIV-negative patients [47]. According to the Milan criteria, transplantation should be considered if there are three liver lesions less than 3 cm or one lesion less than 5 cm in diameter. Several series have reported on liver transplantation for HIV-associated HCC. Eligible patients tend

to be younger and, although there is a higher drop-out rate compared to HIV-negative patients, there is no significant difference in overall survival or relapse between the two groups [48]. Overall survival at 3 years of 74% and 3-year relapse free survival of 69% are reported [48]. Consequently HIV-positive patients should be considered for transplantation in the same way as HIV-negative patients. HIV status itself is not a prognostic factor for HCC patients undergoing liver transplantation [48]. Special attention is required for HIV-positive liver transplants due to the potential interaction Sulfite dehydrogenase between HAART and immunosuppressive therapy such as tacrolimus. This is particularly true for inhibitors of cytochrome P450 such as protease inhibitors. Sorafenib, an oral multi-TKI targeting the Raf cascade as well as vascular endothelial growth factor/platelet-derived growth factor receptors on tumour cells, significantly prolongs survival in HIV-negative patients with advanced, treatment-naïve HCC [49]. Early case studies/reports of sorafenib in HIV-positive HCC suggested synergy with HAART, with impressive response rates but more marked toxicity [50]. The largest series of HIV-positive HCC treated with sorafenib involves 27 patients and reported partial response in 11% and stable disease in 44% [51].

Control of HIV infection in HCC is important Patients with a CD4

Control of HIV infection in HCC is important. Patients with a CD4 cell count >200 cells/μL have lower AFP levels, are more likely to receive active treatment,

and have a better median survival (11.7 months vs. 5.2 months) [43]. Correspondingly, an undetectable HIV RNA viral load (<400 copies/mL) is associated with Selleckchem PLX4720 a lower Child–Pugh score and a better median overall survival. The latter is only seen in untreated patients [44]. The degree of immunosuppression does not appear to correlate with BCLC stage [43,44]. Since use of HAART correlates with better overall survival, it is recommended for HIV-positive HCC patients [42]. In the HIV-negative population, solitary or a small number of HCC lesions are resectable. If complete resection is possible this should be performed without biopsy. These patients should have category A cirrhosis according to Child–Pugh classification [45]. This approach is associated with a 5-year survival of 60–70% in the HIV-negative population [46] and so HIV-positive patients should be considered for such treatments.

Other options for patients selleck screening library with localized disease in whom resection is not possible include ethanol injection, radiofrequency ablation or trans-arterial chemo-embolization. It appears that transplantation may have superior results to resection alone in HIV-negative patients [47]. According to the Milan criteria, transplantation should be considered if there are three liver lesions less than 3 cm or one lesion less than 5 cm in diameter. Several series have reported on liver transplantation for HIV-associated HCC. Eligible patients tend

to be younger and, although there is a higher drop-out rate compared to HIV-negative patients, there is no significant difference in overall survival or relapse between the two groups [48]. Overall survival at 3 years of 74% and 3-year relapse free survival of 69% are reported [48]. Consequently HIV-positive patients should be considered for transplantation in the same way as HIV-negative patients. HIV status itself is not a prognostic factor for HCC patients undergoing liver transplantation [48]. Special attention is required for HIV-positive liver transplants due to the potential interaction Dichloromethane dehalogenase between HAART and immunosuppressive therapy such as tacrolimus. This is particularly true for inhibitors of cytochrome P450 such as protease inhibitors. Sorafenib, an oral multi-TKI targeting the Raf cascade as well as vascular endothelial growth factor/platelet-derived growth factor receptors on tumour cells, significantly prolongs survival in HIV-negative patients with advanced, treatment-naïve HCC [49]. Early case studies/reports of sorafenib in HIV-positive HCC suggested synergy with HAART, with impressive response rates but more marked toxicity [50]. The largest series of HIV-positive HCC treated with sorafenib involves 27 patients and reported partial response in 11% and stable disease in 44% [51].

By contrast, in the SCZ of wild-type (WT) mice, only a few immatu

By contrast, in the SCZ of wild-type (WT) mice, only a few immature (but no mature) newly generated neurons were observed, suggesting that virtually all postnatally

generated immature neurons in the SCZ were eliminated by Bax-dependent PCD. Treatment of 2-month-old WT mice with a caspase inhibitor, or with the neurotrophic factor click here brain-derived neurotrophic factor, promoted the survival of adult-generated neurons, suggesting that it is the absence of sufficient neurotrophic signaling in WT SCZ that triggers the Bax-dependent, apoptotic PCD of newly generated SCZ neurons. Furthermore, following focal traumatic brain injury to the posterior brain, SCZ neurogenesis in WT mice was increased, and a subset of these newly generated neurons migrated toward the injury site. These data indicate that the adult SCZ maintains a neurogenic potential that could contribute to recovery in the brain in response to the injury-induced upregulation of neurotrophic signaling. “
“The subcortical projections to the marmoset frontal pole were mapped with the use of fluorescent tracer injections. The main thalamic Sorafenib projections, which originated in both the magnocellular and parvocellular subdivisions of the mediodorsal

nucleus, were topographically organized. Our results suggest the existence of a third, caudal subdivision of this nucleus, which is likely to be homologous to the macaque’s pars densocellularis. A substantial, but not topographically organized, projection to Brodmann’s area 10 originated in the medial part of the ventral anterior nucleus. Minor thalamic projections originated in the medial pulvinar nucleus and in the midline/intralaminar nuclei. Finally, the posterior thalamic group (including the limitans and suprageniculate nuclei) sent a small projection to rostral

area 10 that has not previously been documented in primates. The main extrathalamic projections stemmed from the claustrum, which contained as many as 50% of all subcortical labelled Oxymatrine neurons. Minor connections originated in the hypothalamus (mainly in the lateral anterior and lateral tuberal regions), dorsal periaqueductal grey matter, basal forebrain (nucleus basalis of Meynert and horizontal limb of the diagonal band of Broca), and amygdala (basal, accessory basal and lateral nuclei). The present results, combined with recent data on the cortical projections to area 10, reveal the frontal pole as a region that integrates information from multiple neural processing systems, including high-level sensory, limbic and working memory-related structures. Although the pattern of subcortical projections is similar to that previously described in the macaque, suggesting a homologous organization, the present data also suggest functional distinctions between medial and lateral sectors of area 10.

In addition, a relationship was demonstrated between the absence

In addition, a relationship was demonstrated between the absence of capsule and the incapacity to assign a known serotype to S. suis isolates. We are grateful to K. Kim (Johns Hopkins University School of Medicine) for providing the HBMEC. We wish to thank Sonia Lacouture, Louis Grignon, and Richard Janvier for their technical assistance. This study was supported by the Fond Québécois de la Recherche sur la Nature

Pirfenidone clinical trial et les Technologies (FQRNT) and the Natural Sciences and Engineering Research Council of Canada (NSERC). All authors report no conflicts of interest related to their study. “
“In this study, we investigated the β-lactamase-encoding genes responsible for β-lactam resistance phenotypes detected among 56 Gram-negative isolates (Gamma- and Alpha-proteobacteria) recovered Lenvatinib cell line from wastewater, urban streams, and drinking water. The β-lactam resistance mechanisms detected in 36 isolates comprised the presence of class A (blaTEM-1, blaSHV-1, blaSHV-11, blaGES-5), class B (ImiS, L1), class C (blaCMY-2, blaCMY-34, blaCMY-65, blaCMY-89, blaCMY-90, blaACC-5, blaACT-13), and class D (blaOXA-309)β-lactamase-encoding genes, some variants described for the first time here. Notably, the results showed antimicrobial resistance genes related not only to commonly used antibiotics, but also to carbapenems, providing the first

description of a GES-5-producing Enterobacteriaceae. The importance of ubiquitous bacteria thriving in aquatic environments as reservoirs or carriers of clinically relevant resistance determinants was confirmed, and the need to monitor water habitats as potential sources for the emergence and/or spread of antibiotic resistance in the environment was highlighted. “
“Medizinische Fakultät, Klinik für Kinder-Onkologie-Hämatologie und Klinische Immunologie, Heinrich-Heine Universität

Düsseldorf, Düsseldorf, Germany Medizinische Fakultät, Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig-Maximilians-Universität München, fantofarone München, Germany The ubiquitous pathogen Listeria monocytogenes lives either saprophytically in the environment or within cells in a vertebrate host, thus adapting its lifestyle to its ecological niche. Growth experiments at 24 and 37 °C (environmental and host temperature) with ammonium or glutamine as nitrogen sources revealed that ammonium is the preferred nitrogen source of L. monocytogenes. Reduced growth on glutamine is more obvious at 24 °C. Global transcriptional microarray analyses showed that the most striking difference in temperature-dependent transcription was observed for central nitrogen metabolism genes, glnR (glutamine synthetase repressor GlnR), glnA (glutamine synthetase GlnA), amtB (ammonium transporter AmtB), glnK (PII regulatory protein GlnK), and gdh (glutamate dehydrogenase) when cells were grown on glutamine.

A simple and effective freezing medium consisting of 18% raffinos

A simple and effective freezing medium consisting of 18% raffinose and 3% skim milk without any permeating CPA has been successfully used to cryopreserve sperm from many inbred and outbred mouse strains [26] and [43]. One of the interesting findings of the current study is that, in contrast to its effectiveness for mouse sperm, skim milk was not effective in protecting rat sperm from freezing injury, even sperm from very closely related species (i.e. rats and mice) have their specific cryobiologic characteristics and emphasized the importance

of developing species-specific freezing Selleckchem SAHA HDAC protocols. Compared to mouse sperm [33] and [48], there have been little success in freezing rat sperm [22], [23], [34], [57] and [58]. Yamashiro et al. [57] reported higher (39.3%) post-thaw motility for epididymal rat sperm in mKRB containing 0.1 M raffinose, 0.75% Equex STM and 20% EY. It has been widely reported that non-permeating CPAs are more effective

than permeating CPAs for both rat and mouse sperm freezing [25], [26], [32], [33], [37] and [57]. The current study also showed that freezing extender containing 0.1 M raffinose provided good cryoprotection for rat Bafilomycin A1 chemical structure sperm. In addition, while the protective effect of non-permeating CPAs against cooling [51] was reported, few studies showed ineffectiveness of permeating CPA, glycerol, during rat sperm cryopreservation [34] and [57]. In our previous study, TL-HEPES, SM, Lactose, Tris and TES extenders served as good extenders but SM was not effective against chilling injury [51]. On the other hand, extender containing SM and 0.1 M raffinose in this study was effective against chilling injury, but it was ineffective during freezing. Cryopreservation in extender

containing 0.1 M raffinose or 0.1 M sucrose prepared in TES medium with 0.75% Equex-Paste and 20% egg yolk significantly Monoiodotyrosine improved the sperm motility compared to TL-HEPES and m-KRB for both SD and F344 strains. Yamashiro et al. [52] found that cryopreserving Wistar rat sperm in m-KRB provided better recovery of motility (39.3%) and acrosome (89.3%) integrity. Sperm cryopreserved in mKRB in this current study had lower motility (16.7% and 15.0% for F344 and SD rats). However, in a recent study, Yamashiro et al. [58] reported lower post-thaw sperm motility (21.5%) when m-KRB was used as an extender. These inconsistencies in post-thaw sperm characteristics in epididymal rat sperm may be attributed to (1) uncontrolled cooling rate (2) lack of optimal sperm extender components and (3) suboptimal handling throughout the cryopreservation procedure. For example although mouse sperm freezing protocol developed by Nakagata et al. [3], has been universally used to cryobank sperm from thousands of mouse strains, there are still undetermined aspects of the freezing protocol that can lead to significant differences in outcome.

, 1989) Wada׳s observations in cats are consistent with the earl

, 1989). Wada׳s observations in cats are consistent with the earlier macaque studies of Poggio et al. (1956), in which repeated stimulation of occipital cortex produced less frequent and shorter visual cortical afterdischarges, and with less subcortical progression than other parts of the brain. Bartlett et al. (1977) also noted that even with high current (5.0 mA) stimulus of Adriamycin ic50 macaque visual cortex, afterdischarges did not propagate beyond 6 mm from the site of stimulation. The influence of long-term blindness on the susceptibility of visual cortex to the development of seizures and/or kindling following long-term electrical stimulation is poorly understood. Examining

the susceptibility of visual cortex to kindling in immature and adult cats, Moneta and Singer (1986) noted that the developing visual cortex had a higher afterdischarge threshold and was more resistant to the kindling effect. In discussing potential mechanisms for the observed reduction in cortical excitability PS341 in kittens, the authors postulated that visual input may antagonize any kindling response (Moneta and Singer, 1986). Importantly, in the blind human subject, there would be no such visual input, potentially

increasing the risk of a kindling response. Clearly this is an area requiring further research. Seizure risk mitigation may be achieved with anticonvulsant medications such as phenytoin, which is known to suppress both neuronal afterdischarges in cats by raising the threshold current for their elicitation (Pollen, 1977 and Wada et al., 1990), in addition to suppressing kindled seizures (Wada et al., 1990). Alternatives include sodium valproate, which SPTLC1 has been shown to elevate afterdischarge threshold and prevent convulsions in a rat model of amygdala kindling (Salt et al., 1980).

There is little data on the prevention of kindled occipital seizures in humans, however occipital epilepsies generally respond equally well to a wide range of antiepileptics, although if a photosensitive component is present, then sodium valproate may be more effective (Taylor et al., 2003). Whether or not photosensitive epilepsy is a more appropriate model for kindled visual cortex seizures is a subject that requires further investigation. One possible seizure risk mitigation strategy proposed by Parker et al. (2011) was the interleaving of stimuli, maximizing the distance between any two individual, or groups of stimulated electrodes. This may have the added benefit of reducing another undesired side-effect of chronic stimulation, being the depression of neuronal excitability that is seen following 7 h of constant stimulation and may persist for several days (McCreery et al., 1997 and McCreery et al., 2002).

These enzymes catalyse

These enzymes catalyse Bcl-2 inhibitor the polymerisation of deoxyribonucleotides into the nascent DNA strand. While Pol α initiates DNA synthesis, Pol

δ and Pol ɛ replace Pol α after primer extension and perform the bulk of DNA replication. Most polymerases lack intrinsic error-checking activity, relying on Watson–Crick base pairing for their fidelity. However, the proofreading (exonuclease) domains of Pol δ and Pol ɛ ensure that these polymerases have a particularly low error rate, of the order of 10−7 substitution mutations per base. A variety of in vitro studies has shown that proofreading improves replication fidelity approximately 100-fold [ 3• and 4]. The Pol δ and Pol ɛ enzymes are heterotetramers in higher eukaryotes. Both Pol δ and Pol ɛ comprise a catalytic subunit, POLD1 and POLE respectively, and accessory subunits (POLD2/3/4 and POLE2/3/4) that interact with cofactors such as Proliferating Cell Nuclear Antigen (PCNA) [5]. Both genes are ubiquitously

expressed and show high levels of evolutionary conservation. The two polymerases differ from each other throughout most of their length, but are homologous (23% identity, 37% similarity) over their exonuclease http://www.selleckchem.com/products/cobimetinib-gdc-0973-rg7420.html domains (residues 268–471 of POLE and 304–517 of POLD1). Based on studies in yeast, it has been shown that Pol δ and Pol ɛ usually replicate the leading and lagging strand respectively [6 and 7•]. However, it is still not fully elucidated whether this is

always the case at replication forks. Pavlov proposed a model where Pol ɛ starts replicating the leading strand, but may later dissociate, and Pol δ then takes over to complete the replication [8]. A higher mutation rate in Pol δ exonuclease deficient yeast strains compared to Pol ɛ exonuclease-deficient strains endorses this hypothesis [8, 9 and 10]. There is substantial evidence that in addition to DNA synthesis, Pol ɛ and Pol δ play essential roles in repair of chromosomal DNA [8, 11 and 12]. Pol ɛ and Pol δ are thought to be involved in several repair pathway including nucleotide excision repair (NER), ismatch repair (MMR) and repair of double strand breaks (DSBR) [12 and 13]. Replication fidelity Avelestat (AZD9668) has been extensively studied in yeast and other microbes, though less is known about the impact of proofreading-defective DNA polymerase mutations in higher eukaryotes. The exonuclease domain catalyses the preferential hydrolysis of non-complementary nucleotides at the 3′-terminus, and in yeast, inactivating missense EDMs of Pol ɛ and Pol δ cause a base substitution mutator phenotype with variable severity [9, 10, 14, 15, 16 and 17]. It has been suggested that in yeast, Pol ɛ and Pol δ proofread opposite strands at defined replication origins and may proofread for each other [6, 18 and 19].

Fishing and harvesting of other marine resources is the primary l

Fishing and harvesting of other marine resources is the primary livelihood of many coastal people [44]. MPAs should benefit local fishers through the spillover of fish and other harvestable species [4]. Research shows that well managed MPAs can lead to fisheries benefits for local communities through increased catch and increased catch per unit effort [31], [45], [46], [47], [48], [49], [50] and [51]. Larger scale commercial fisheries, too, may benefit from the creation of no take zones; however, since spillover tends to occur at smaller spatial scales (on average up to 800 m from MPA boundaries) the

provision of benefits to larger commercial fisheries would most likely require creation of larger MPAs or extensive networks [31] and [45]. Osimertinib However, fisheries benefits may be unequally shared among groups within and between communities [52] and [53]. Though RG7420 MPAs may benefit local fisheries in the long term, in the short term compensation or alternative livelihood options need to be considered since displacement of rights to access the resource can lead to short-term hardships [50], [54] and [55]. Diversification into alternative livelihoods may also reduce overall pressure on fisheries and the resource base [56]. However, care must be taken in assessing the vulnerability of proposed alternative

livelihoods to future stressors such as climate change [57] and [58]. The development of alternative livelihood programs that benefit local people is an often-advertised benefit of MPA creation that is challenging to achieve in practice. The most often suggested alternative livelihood strategy is tourism, in the form of SCUBA diving, snorkeling, boating, wildlife viewing, historical and cultural tourism, eco-voluntourism, and even recreational fishing Janus kinase (JAK) [14], [59], [60], [61], [62] and [63]. Tourism has

significant potential as an MPA financing mechanism [15], [64], [65] and [66] and may lead to economic benefits at a broader scale; however, the level of local community benefit from and involvement in tourism can be minimal. Some MPAs, such as the Great Barrier Reef MPA in Australia [67], Mendes Island MPA in the Mediterranean [68], and Tsitskamma National Park in South Africa [69], have resulted in significant increases in tourism visitation and revenue [51] and [70]. A global study of 78 coral reef MPAs found that 75% of tourism jobs were retained locally [71]. However, a lack of testing for additionality – i.e., measuring the impact of an activity or intervention through comparison with a status quo metric or reference case – does not ensure that these benefits are causally related to the MPA and not just mirroring outside changes.