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BACKGROUND: This research prioritization aimed to identify major research gaps in maternal, newborn, child and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic. METHODS: We adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes and scoring criteria. We approached diverse global experts via email to submit their research ideas in MNCAH and MNCAH-related cross-cutting/health systems area. We curated the research ideas as research questions (RQs) and sent them to the consenting experts for scoring via the online link. For each RQ, the research priority score (RPS) was calculated as an average of individual criterion scores and ranked based on RPS in each area. RESULTS: We identified top-ranked 10 RQs in each maternal, newborn, and child and adolescent health and 5 in the cross-cutting/health systems area. In maternal health, indirect effects on care, measures to improve care, health risks and outcomes, and preventing and managing SARS-CoV-2 infection/COVID-19 disease were priority RQs. In newborn health, clinical characterization and managing SARS-CoV-2 infection/COVID-19 disease, mode of transmission and interventions to prevent transmission were the focus. For child and adolescent health, top-ranked RQs were indirect effects on care, clinical status and outcomes, interventions to protect against SARS-CoV-2 infection/COVID-19 disease, and educational institute-related RQs. The cross-cutting RQs were the effects of the pandemic on availability, access, care-seeking and utilization of MNCAH services and potential solutions. CONCLUSIONS: We call on partners, including governments, non-governmental organizations, research institutes, and donors, to address this urgent research agenda.

Renewed interest in developing vaccines against Neisseria gonorrhoeae has been sparked by the increasing threat of gonococcal antimicrobial resistance (AMR) and growing optimism that gonococcal vaccines are biologically feasible. Evidence suggests serogroup B Neisseria meningitidis vaccines might provide some cross-protection against N. gonorrhoeae, and new gonococcal vaccine candidates based on several approaches are currently in preclinical development. To further stimulate investment and accelerate development of gonococcal vaccines, greater understanding is needed regarding the overall value that gonococcal vaccines might have in addressing public health and societal goals in low-, middle-, and high-income country contexts and how future gonococcal vaccines might be accepted and used, if available. In January 2019, the World Health Organization (WHO) convened a multidisciplinary international group of experts to lay the groundwork for understanding the potential health, economic, and societal value of gonococcal vaccines and their likely acceptance and use, and for developing gonococcal vaccine preferred product characteristics (PPCs). WHO PPCs describe preferences for vaccine attributes that would help optimize vaccine value and use in meeting the global public health need. This paper describes the main discussion points and conclusions from the January 2019 meeting of experts. Participants emphasized the need for vaccines to control N. gonorrhoeae infections with the ultimate goals of preventing adverse sexual and reproductive health outcomes (e.g., infertility) and reducing the impact of gonococcal AMR. Meeting participants also discussed important PPC considerations (e.g., vaccine indications, target populations, and potential immunization strategies) and highlighted crucial research and data needs for guiding the value assessment and PPCs for gonococcal vaccines and advancing gonococcal vaccine development., Funding Agencies:Global Challenges Research Fund (GCRF) Networks in Vaccines Research and Development Medical Research Council UK (MRC)Biotechnology and Biological Sciences Research Council (BBSRC) BVNCP-03UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Allergy & Infectious Diseases (NIAID) U01AI139547

Guidelines on managing chronic suppurative lung disease (CSLD) and bronchiectasis (unrelated to cystic fi brosis [CF]) in Australian Indigenous children initiated in 20021 were extended to include Indigenous adults in 20082 and children and adults living in urban areas of Australia and New Zealand in 2010.3 Here, we present an updated guideline relevant for all sections of the community. The recommendations in this guideline are targeted principally to primary and secondary care, and are not intended for individualised specialist care. As with all guidelines, they are not a substitute for sound clinical judgement, particularly when investigating and treating such a phenotypically heterogeneous condition as bronchiectasis.Copyright © 2015, Australasian Medical Publishing Co. Ltd. All rights reserved.

Guidelines on managing chronic suppurative lung disease (CSLD) and bronchiectasis (unrelated to cystic fi brosis [CF]) in Australian Indigenous children initiated in 20021 were extended to include Indigenous adults in 20082 and children and adults living in urban areas of Australia and New Zealand in 2010.3 Here, we present an updated guideline relevant for all sections of the community. The recommendations in this guideline are targeted principally to primary and secondary care, and are not intended for individualised specialist care. As with all guidelines, they are not a substitute for sound clinical judgement, particularly when investigating and treating such a phenotypically heterogeneous condition as bronchiectasis.Copyright © 2015, Australasian Medical Publishing Co. Ltd. All rights reserved.

Guidelines on managing chronic suppurative lung disease (CSLD) and bronchiectasis (unrelated to cystic fi brosis [CF]) in Australian Indigenous children initiated in 20021 were extended to include Indigenous adults in 20082 and children and adults living in urban areas of Australia and New Zealand in 2010.3 Here, we present an updated guideline relevant for all sections of the community. The recommendations in this guideline are targeted principally to primary and secondary care, and are not intended for individualised specialist care. As with all guidelines, they are not a substitute for sound clinical judgement, particularly when investigating and treating such a phenotypically heterogeneous condition as bronchiectasis.Copyright © 2015, Australasian Medical Publishing Co. Ltd. All rights reserved.

Aim: Indigenous Australians with asthma have higher morbidity and mortality compared with non‐Indigenous Australians. In children hospitalised with acute asthma, we aimed to (i) determine if acute severity, risk factors and management differed between Indigenous and non‐Indigenous children; and (ii) identify intervention points to reduce morbidity and mortality of asthma. Methods: Retrospective review of 200 children hospitalised to Royal Darwin Hospital with asthma. We compared admission characteristics, severity indices, treatment, discharge plans and readmissions in Indigenous and non‐Indigenous children. Results: Median age was 3.6 years (interquartile range 2.2, 6.8). A significantly higher proportion of Indigenous children (95.2%) were exposed to tobacco smoke compared with non‐Indigenous children (45.7%). The difference in proportions was −0.41 (95% confidence interval (CI) −0.60, −0.22). Other risk factors, asthma severity (moderate 83.9% vs. 83.3%; severe 16% vs. 16.1%), length of stay (1.9 vs. 1.3 days) and readmission rate (27.4% vs. 27.5%) were similar between Indigenous and non‐Indigenous children. Indigenous children were significantly more likely to be followed up in a community clinic (difference in proportions = 0.10, 95% CI 0.1, 0.17) and less likely by a paediatrician. Only 62.5% of all children had an asthma action plan on discharge. Conclusion: Unlike other common respiratory diseases requiring hospitalisation, biological factors are unlikely major contributors to the known gap in asthma outcomes between Indigenous and non‐Indigenous children. Intervention points include better identification, documentation and management of tobacco smoke exposure, delivery of salbutamol and discharge planning (including education and utilisation of asthma action plans).

Airway pathologies have been comprehensively researched in adult asthma, but in children, the extent of airway inflammation associated with episodic wheeze, often diagnosed as asthma, has not been fully characterized. It is not clear whether persistent airway inflammation is present in the absence of wheezing symptoms, and there is controversy regarding the role of age and atopy. This study assessed cellular and cytokine markers of airway inflammation in asymptomatic children with a history of episodic wheeze. Children with a history of episodic wheeze and cough (study group) and nonasthmatic patients requiring elective surgery (control group) were recruited. All subjects in the study group had a history of significant episodic wheezing (>2 episodes per year), and used only as-needed beta-agonist treatment. Bronchoalveolar lavage (BAL) was obtained using bronchoscopic lavage (study group) and nonbronchoscopic lavage (control group). Differential cell counts of BAL and flow cytometry were performed to identify T-lymphocyte phenotypes, and intracellular cytokine profiles were measured after phorbol-12-myristate 13-acetate (PMA) stimulation of BAL fluid T-cells. Twenty-one children with a history of 2-12 episodes of wheeze per year and 21 nonasthmatic subjects without respiratory symptoms were recruited. Study and control subjects were matched for age (median age, 5 years) and demographic characteristics. Study subjects had higher IgE levels, but their measurements were still within normal range. No significant differences in BAL differential cell counts were noted, and in both groups, the majority of T-cells were CD3+ CD8+, with a median CD4:CD8 ratio of 0.6. There was no significant difference in T-cell expression of the activation markers HLA-DR and CD25(IL-2 receptor), or in PMA-induced production of the intracellular cytokines IFN-gamma, IL-2, IL-4, IL-5, and IL-10. The results of this study suggest that significant T-cell-driven airway inflammation is absent in m

Airway pathologies have been comprehensively researched in adult asthma, but in children, the extent of airway inflammation associated with episodic wheeze, often diagnosed as asthma, has not been fully characterized. It is not clear whether persistent airway inflammation is present in the absence of wheezing symptoms, and there is controversy regarding the role of age and atopy. This study assessed cellular and cytokine markers of airway inflammation in asymptomatic children with a history of episodic wheeze. Children with a history of episodic wheeze and cough (study group) and nonasthmatic patients requiring elective surgery (control group) were recruited. All subjects in the study group had a history of significant episodic wheezing (>2 episodes per year), and used only as-needed beta-agonist treatment. Bronchoalveolar lavage (BAL) was obtained using bronchoscopic lavage (study group) and nonbronchoscopic lavage (control group). Differential cell counts of BAL and flow cytometry were performed to identify T-lymphocyte phenotypes, and intracellular cytokine profiles were measured after phorbol-12-myristate 13-acetate (PMA) stimulation of BAL fluid T-cells. Twenty-one children with a history of 2-12 episodes of wheeze per year and 21 nonasthmatic subjects without respiratory symptoms were recruited. Study and control subjects were matched for age (median age, 5 years) and demographic characteristics. Study subjects had higher IgE levels, but their measurements were still within normal range. No significant differences in BAL differential cell counts were noted, and in both groups, the majority of T-cells were CD3+ CD8+, with a median CD4:CD8 ratio of 0.6. There was no significant difference in T-cell expression of the activation markers HLA-DR and CD25(IL-2 receptor), or in PMA-induced production of the intracellular cytokines IFN-gamma, IL-2, IL-4, IL-5, and IL-10. The results of this study suggest that significant T-cell-driven airway inflammation is absent in m

Objective: To describe the characteristics of children admitted to Royal Darwin Hospital with bronchiolitis, and to compare the severity of illness and incidence of subsequent readmission in Indigenous and non‐Indigenous children. Design, Setting and Participants: Retrospective study of 101 children (aged ≤2 years) hospitalised with bronchiolitis to Royal Darwin Hospital between April 2005 and December 2006. Main Outcome Measures: Admission characteristics and indices of severity, treatment required (antibiotics etc.), reasons and incidence of readmissions (within 6 months). Results: Indigenous children had significantly more severe illness then non‐Indigenous children (n= 80 and 21, respectively), longer hospital stay (median = 6 and 3 days; P= 0.001) and oxygen requirement (median = 3 and 0; P= 0.004), pneumonia (n= 14 and 0; P= 0.04) and antibiotics treatment (48 and 4; P= 0.001). The readmission rate for bronchiolitis was high (23%) with no significant difference between Indigenous and non‐Indigenous children. Conclusion: Indigenous Australian children hospitalised with bronchiolitis have significantly more severe illness than non‐Indigenous children. Points of intervention that can address this and the identified high readmission rate (within 6 months) are required.

The five large solar particle events during October–November 2003 presented an opportunity to test shock acceleration models with in-situ observations. We use solar particle spectra of H to Fe ions, measured by instruments on ACE, SAMPEX, and GOES-11, to investigate the Q/M-dependence of spectral breaks in the 28 October 2003 event. We find that the break energies scale as (Q/M)^b with b ≈ 1.56 to 1.75, somewhat less than predicted. We also conclude that SEP spectra >100 MeV/nucleon are best fit by a double power-law shape. ©2005 American Institute of Physics

Energy spectra provide a powerful tool in understanding solar energetic particle (SEP) events, in that spectra contain information on all aspects of SEP production, including source plasma, interplanetary transport effects, and characteristics of the accelerator. We compare energy spectra of two very large gradual events (1998 April 20 and 2000 July 14), produced by shocks driven by fast coronal mass ejections (CMEs). We show that differences in their Fe spectra can be understood in terms of a small, variable admixture of remant flare suprathermals in the SEP source population., Published in Proceedings of the 27th International Cosmic Ray Conference, 2001. Sponsored in part by NASA DPR-19-493. Prepared in collaboration with NASA/Goddard Space Flight Center, Greenbelt, MD. Prepared in cooperation with the California Institute of Technology, Pasadena, the Laboratory for Astrophysics & Space Research, University of Chicago, Chicago, IL, Bell Laboratories, Lucent Technologies, Murray Hill, NJ, and the Department of Astronomy, University of Maryland, College Park.

We analyze ionospheric convection patterns over the polar regions during the passage of an interplanetary magnetic cloud on January 14, 1988, when the interplanetary magnetic field (IMF) rotated slowly in direction and had a large amplitude. Using the assimilative mapping of ionospheric electrodynamics (AMIE) procedure, we combine simultaneous observations of ionospheric drifts and magnetic perturbations from many different instruments into consistent patterns of high-latitude electrodynamics, focusing on the period of northward IMF. By combining satellite data with ground-based observations, we have generated one of the most comprehensive data sets yet assembled and used it to produce convection maps for both hemispheres. We present evidence that a lobe convection cell was embedded within normal merging convection during a period when the IMF By and Bz components were large and positive. As the IMF became predominantly northward, a strong reversed convection pattern (afternoon-to-morning potential drop of around 100 kV) appeared in the southern (summer) polar cap, while convection in the northern (winter) hemisphere became weak and disordered with a dawn-to-dusk potential drop of the order of 30 kV. These patterns persisted for about 3 hours, until the IMF rotated significantly toward the west. We interpret this behavior in terms of a recently proposed merging model for northward IMF under solstice conditions, for which lobe field lines from the hemisphere tilted toward the Sun (summer hemisphere) drape over the dayside magnetosphere, producing reverse convection in the summer hemisphere and impeding direct contact between the solar wind and field lines connected to the winter polar cap. The positive IMF Bx component present at this time could have contributed to the observed hemispheric asymmetry. Reverse convection in the summer hemisphere broke down rapidly after the ratio |By/Bz| exceeded unity, while convection in the winter hemisphere strengthened. A dominant

We analyze ionospheric convection patterns over the polar regions during the passage of an interplanetary magnetic cloud on January 14, 1988, when the interplanetary magnetic field (IMF) rotated slowly in direction and had a large amplitude. Using the assimilative mapping of ionospheric electrodynamics (AMIE) procedure, we combine simultaneous observations of ionospheric drifts and magnetic perturbations from many different instruments into consistent patterns of high-latitude electrodynamics, focusing on the period of northward IMF. By combining satellite data with ground-based observations, we have generated one of the most comprehensive data sets yet assembled and used it to produce convection maps for both hemispheres. We present evidence that a lobe convection cell was embedded within normal merging convection during a period when the IMF By and Bz components were large and positive. As the IMF became predominantly northward, a strong reversed convection pattern (afternoon-to-morning potential drop of around 100 kV) appeared in the southern (summer) polar cap, while convection in the northern (winter) hemisphere became weak and disordered with a dawn-to-dusk potential drop of the order of 30 kV. These patterns persisted for about 3 hours, until the IMF rotated significantly toward the west. We interpret this behavior in terms of a recently proposed merging model for northward IMF under solstice conditions, for which lobe field lines from the hemisphere tilted toward the Sun (summer hemisphere) drape over the dayside magnetosphere, producing reverse convection in the summer hemisphere and impeding direct contact between the solar wind and field lines connected to the winter polar cap. The positive IMF Bx component present at this time could have contributed to the observed hemispheric asymmetry. Reverse convection in the summer hemisphere broke down rapidly after the ratio |By/Bz| exceeded unity, while convection in the winter hemisphere strengthened. A dominant

Ground-based magnetometer data, recorded at AT&T Bell Laboratories' stations located at low to mid-latitudes (L=2-4) and AFGL station (L=2-3), have been analyzed to search for associations between dayside Pc3-5 pulsations (15-240 second periods) and solar wind parameters measured by instrumentation on board the IMPJ spacecraft. The statistical analysis techniques used in the work (power spectral analysis, correlation analysis, multiple linear regression methods) have led to the discovery and quantification of relationships between hydromagnetic waves in the magnetosphere as manifested by magnetic pulsations and interplanetary parameters. Multiple linear regression (MLR) analyses showed that the most important interplanetary parameter controlling ground hourly magnetic energy (in the period range 60-240 seconds) was the solar wind speed. MLR analyses further showed that hourly magnetic energy in the 15-60 second period range was also controlled by the solar wind speed but more so by the interplanetary magnetic field direction.

The near-equatorial fluxes of outer zone electrons (E>0.5 MeV and E>1.9 MeV) measured by an instrument on the satellite Explorer 15 following the geomagnetic storm of December 17-18, 1962, are used to determine the electron radial diffusion coefficients and electron-lifetimes as functions of L for selected values of the conserved first invariant mu. For each value of mu the diffusion coefficient is assumed to be time-independent and respresentable in the form D = (D sub n)(L sup n). The diffusion coefficients and lifetimes are then obtained simultaneously by requiring that the L-dependent reciprocal electron-lifetime, as determined from the Fokker-Planck equation, deviate minimally from a constant in time. Applied to the data, these few assumptions yield a value of D that is smaller by approximately a factor of ten than the value obtained recently by Newkirk and Walt in a separate analysis of 1.6-MeV electron data obtained during the same time period on another satellite. The electron-lifetimes are found to be strong functions of L, with 4-6 day lifetimes observed at the higher L-values (4.6-4.8). (Author)