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Background Assessment of the safety and efficacy of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in different populations is essential, as is investigation of the efficacy of the vaccines against emerging SARS-CoV-2 variants of concern, including the B.1.351 (501Y.V2) variant first identified in South Africa. Methods We conducted a multicenter, double-blind, randomized, controlled trial to assess the safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) in people not infected with the human immunodeficiency virus (HIV) in South Africa. Participants 18 to less than 65 years of age were assigned in a 1:1 ratio to receive two doses of vaccine containing 5×1010 viral particles or placebo (0.9% sodium chloride solution) 21 to 35 days apart. Serum samples obtained from 25 participants after the second dose were tested by pseudovirus and live-virus neutralization assays against the original D614G virus and the B.1.351 variant. The primary end points were safety and efficacy of the vaccine against laboratory-confirmed symptomatic coronavirus 2019 illness (Covid-19) more than 14 days after the second dose. Results Between June 24 and November 9, 2020, we enrolled 2026 HIV-negative adults (median age, 30 years); 1010 and 1011 participants received at least one dose of placebo or vaccine, respectively. Both the pseudovirus and the live-virus neutralization assays showed greater resistance to the B.1.351 variant in serum samples obtained from vaccine recipients than in samples from placebo recipients. In the primary end-point analysis, mild-to-moderate Covid-19 developed in 23 of 717 placebo recipients (3.2%) and in 19 of 750 vaccine recipients (2.5%), for an efficacy of 21.9% (95% confidence interval [CI], −49.9 to 59.8). Among the 42 participants with Covid-19, 39 cases (95.1% of 41 with sequencing data) were caused by the B.1.351 variant; vaccine efficacy against this variant, analyzed as a secondary end point, was 10.4% (95% CI, −76.8 to 54.8). The incidence of serious adverse events was balanced between the vaccine and placebo groups. Conclusions A two-dose regimen of the ChAdOx1 nCoV-19 vaccine did not show protection against mild-to-moderate Covid-19 due to the B.1.351 variant. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT04444674; Pan African Clinical Trials Registry number, PACTR202006922165132.

This study aimed to describe: 1) soil-transmitted helminthiasis (STH) and schistosomiasis prevalence and intensity in preschool-age children (PSAC) and school-age children (SAC), 2) schistosomiasis seroprevalence in SAC, 3) undernutrition prevalence in SAC, 4) sanitary toilet coverage in households, and 5) association between STH, Schistosoma japonicum exposure, nutritional status, and sanitation. PSAC and SAC in two Haiyan-stricken provinces were examined using Kato–Katz technique and ELISA Antibody test. Anthropometric and hemoglobin measurements were also obtained. The reported sanitary toilet coverage was validated in a survey. The prevalence of any STH in PSAC and SAC was 50.2% and 41.3%, respectively. Moderate-heavy intensity (MHI) STH prevalence in PSAC and SAC was 20.8% and 5.9%, respectively. The prevalence of any STH, MHI STH, ascariasis, MHI ascariasis, and MHI trichuriasis was significantly higher in PSAC. Stunting, underweight, wasting, overweight/obesity, and anemia prevalence was 38.4%, 24.5%, 4.8%, 2.7%, and 34.7% in PSAC, while the prevalence was 34.3%, 21.6%, 8.7%, 3.0%, and 19.2% in SAC, respectively. Anemia and wasting prevalence were significantly higher in PSAC and SAC, respectively. There were five schistosomiasis cases found (0.8% prevalence), while schistosomiasis seroprevalence was 60.1%. Validated and reported sanitary toilet coverage was significantly different in eight out of 13 barangays. Stunting and anemia were associated with STH. STH and anemia prevalence were significantly higher in non-ZOD barangays. High STH burden in PSAC and SAC persists. A more coordinated response addressing STH, undernutrition, and WASH in disaster-stricken areas will require strengthening local health systems and promoting intersectoral collaboration.

Introduction Ebola virus (EBOV), species Zaire ebolavirus, may persist in the semen of male survivors of Ebola virus disease (EVD). We conducted a study of male survivors of the 2014–2016 EVD outbreak in Liberia and evaluated their immune responses to EBOV. We report here findings from the serologic testing of blood for EBOV-specific antibodies, molecular testing for EBOV in blood and semen, and serologic testing of peripheral blood mononuclear cells (PBMCs) in a subset of study participants. Methods We tested for EBOV RNA in blood by quantitative reverse transcription polymerase chain reaction (qRT-PCR), and for anti-EBOV-specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies by enzyme-linked immunosorbent assay (ELISA) for 126 study participants. We performed PBMC analysis on a subgroup of 26 IgG-negative participants. Results All 126 participants tested negative for EBOV RNA in blood by qRT-PCR. The blood of 26 participants tested negative for EBOV-specific IgG antibodies by ELISA. PBMCs were collected from 23/26 EBOV IgG-negative participants. Of these, 1/23 participants had PBMCs that produced anti-EBOV-specific IgG antibodies upon stimulation with EBOV-specific glycoprotein (GP) and nucleoprotein (NP) antigens. Conclusions The blood of EVD survivors, collected when they did not have symptoms meeting the case definition for acute or relapsed EVD, is unlikely to pose a risk for EBOV transmission. We identified 1 IgM/IgG negative participant who had PBMCs that produced anti-EBOV-specific antibodies upon stimulation. Immunogenicity following acute EBOV infection may exist along a spectrum, and absence of antibody response should not be exclusionary in determining an individual’s status as a survivor of EVD.

Transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is ongoing in many communities throughout the United States. Although case-based and syndromic surveillance are critical for monitoring the pandemic, these systems rely on persons obtaining testing or reporting a COVID-19-like illness. Using serologic tests to detect the presence of SARS-CoV-2 antibodies is an adjunctive strategy that estimates the prevalence of past infection in a population. During April 28-May 3, 2020, coinciding with the end of a statewide shelter-in-place order, CDC and the Georgia Department of Public Health conducted a serologic survey in DeKalb and Fulton counties in metropolitan Atlanta to estimate SARS-CoV-2 seroprevalence in the population. A two-stage cluster sampling design was used to randomly select 30 census blocks in each county, with a target of seven participating households per census block. Weighted estimates were calculated to account for the probability of selection and adjusted for age group, sex, and race/ethnicity. A total of 394 households and 696 persons participated and had a serology result; 19 (2.7%) of 696 persons had SARS-CoV-2 antibodies detected. The estimated weighted seroprevalence across these two metropolitan Atlanta counties was 2.5% (95% confidence interval [CI] = 1.4-4.5). Non-Hispanic black participants more commonly had SARS-CoV-2 antibodies than did participants of other racial/ethnic groups (p

There are conflicting reports on the effects of HIV on COVID-19. Here, we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (Beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV-negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.

Human milk (HM) insulin plays many roles for the infant, especially for the newborn. We hypothesized HM insulin in women with type 2 diabetes (T2DM) would be higher than BMI-matched women with either gestational diabetes (GDM) or normal glucose tolerance (NGT). In T2DM, we also assessed macronutrient composition and relationships between maternal glycemic control and HM insulin.HM was characterized at 2-weeks postpartum among three BMI-matched groups: T2DM (Fasting HM insulin was two times higher in T2DM compared to GDM and NGT (These data are the first to show HM insulin concentrations are doubled in T2DM compared to BMI-matched GDM and NGT. In HM of T2DM, insulin increases postprandially, may be concentrated relative to plasma, and is influenced by maternal glycemic control, with potential clinical implications that merit further study.

Background Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks occurred at universities during Fall 2020, but little is known about risk factors for campus-associated infections or immunity provided by anti–SARS-CoV-2 antibodies in young adults. Methods We conducted surveys and serology tests among students living in dormitories in September and November to examine infection risk factors and antibody presence. Using campus weekly reverse-transcription polymerase chain reaction (RT-PCR) test results, the relationship between survey responses, SARS-CoV-2 antibodies, and infections was assessed. Results Of 6136 students, 1197 completed the survey and 572 also completed serologic testing in September compared with 517 and 414 in November, respectively. Participation in fraternity or sorority events (adjusted risk ratio [aRR], 1.9 [95% confidence interval {CI}, 1.4–2.5]) and frequent alcohol consumption (aRR, 1.6 [95% CI, 1.2–2.2]) were associated with SARS-CoV-2 infection. Mask wearing during social events (aRR, 0.6 [95% CI, .6–1.0]) was associated with decreased risk. None of the 20 students with antibodies in September tested positive for SARS-CoV-2 during the semester, while 27.8% of students who tested RT-PCR positive tested negative for antibodies in November. Conclusions Frequent drinking and attending social events were associated with SARS-CoV-2 infection. Antibody presence in September appeared to be protective from reinfection, but this finding was not statistically significant.

Background and Purpose: Clot fragmentation and distal embolization during endovascular thrombectomy for acute ischemic stroke may produce emboli downstream of the target occlusion or in previously uninvolved territories. Susceptibility-weighted magnetic resonance imaging can identify both emboli to distal territories (EDT) and new territories (ENT) as new susceptibility vessel signs (SVS). Diffusion-weighted imaging (DWI) can identify infarcts in new territories (INT). Methods: We studied consecutive acute ischemic stroke patients undergoing magnetic resonance imaging before and after thrombectomy. Frequency, predictors, and outcomes of EDT and ENT detected on gradient-recalled echo imaging (EDT-SVS and ENT-SVS) and INT detected on DWI (INT-DWI) were analyzed. Results: Among 50 thrombectomy-treated acute ischemic stroke patients meeting study criteria, mean age was 70 (±16) years, 44% were women, and presenting National Institutes of Health Stroke Scale score 15 (interquartile range, 8–19). Overall, 21 of 50 (42%) patients showed periprocedural embolic events, including 10 of 50 (20%) with new EDT-SVS, 10 of 50 (20%) with INT-DWI, and 1 of 50 (2%) with both. No patient showed ENT-SVS. On multivariate analysis, model-selected predictors of EDT-SVS were lower initial diastolic blood pressure (odds ratio, 1.09 [95% CI, 1.02–1.16]), alteplase pretreatment (odds ratio, 5.54 [95% CI, 0.94–32.49]), and atrial fibrillation (odds ratio, 7.38 [95% CI, 1.02–53.32]). Classification tree analysis identified pretreatment target occlusion SVS as an additional predictor. On univariate analysis, INT-DWI was less common with internal carotid artery (5%), intermediate with middle cerebral artery (25%), and highest with vertebrobasilar (57%) target occlusions ( P =0.02). EDT-SVS was not associated with imaging/functional outcomes, but INT-DWI was associated with reduced radiological hemorrhagic transformation (0% versus 54%; P Conclusions: Among acute ischemic stroke patients treated with thrombectomy, imaging evidence of distal emboli, including EDT-SVS beyond the target occlusion and INT-DWI in novel territories, occur in about 2 in every 5 cases. Predictors of EDT-SVS are pretreatment intravenous fibrinolysis, potentially disrupting thrombus structural integrity; atrial fibrillation, possibly reflecting larger target thrombus burden; lower diastolic blood pressure, suggestive of impaired embolic washout; and pretreatment target occlusion SVS sign, indicating erythrocyte-rich, friable target thrombus.

This study aimed to demonstrate the use of geographic information systems (GIS) in identifying factors contributing to schistosomiasis endemicity and identifying high-risk areas in a schistosomiasis- endemic municipality in the Philippines, which was devastated by Typhoon Haiyan in 2013. Data on schistosomiasis determinants, obtained through literature review, the Philippine Department of Health, and concerned local government units, were standardized and incorporated into a GIS map using ArcGIS. Data gathered included modifiable [agriculture, poverty, sanitation, presence of intermediate and reservoir hosts, disease prevalence and mass drug administration (MDA) coverage] and nonmodifiable (geography and climate) determinants for schistosomiasis. Results showed that most barangays (villages) are characterized by favourable conditions for schistosomiasis transmission which include being located in flood-prone areas, presence of vegetation, low sanitary toilet coverage, presence of snail intermediate host, high carabao (water buffalo) population density, previously reported ≥1% prevalence using Kato-Katz technique, and low MDA coverage. Similarly, barangays not known to be endemic for schistosomiasis but also characterized by the same favourable conditions for schistosomiasis as listed above and may therefore be considered as potentially endemic, even if not being high-risk areas. This study demonstrated the importance of GIS technology in characterizing schistosomiasis transmission. Maps generated through application of GIS technology are useful in guiding program policy and planning at the local level for an effective and sustainable schistosomiasis control and prevention.

BackgroundAssessing safety and efficacy of Covid-19 vaccines in different populations is essential, as is investigation of efficacy against emerging SARS-CoV-2 variants of concern including the B.1.351 (501Y.V2) variant first identified in South Africa.MethodsWe conducted a randomized multicentre, double blinded controlled trial on safety and efficacy of ChAdOx1-nCoV19 in HIV-uninfected people in South Africa. Participants age 18 to 10viral particles or placebo (0.9%NaCl) 21-35 days apart. Post 2nd-dose serum samples (n=25) were tested by pseudotyped (PSVNA) and live virus (LVNA) neutralization assays against the D614G and B.1.351 variants. Primary endpoints were safety and vaccine efficacy (VE) >14 days following second dose against laboratory confirmed symptomatic Covid-19.Results2026 HIV-uninfected adults were enrolled between June 24thand Nov 9th, 2020; 1010 and 1011 received at least one dose of placebo or vaccine, respectively. Median age was 31 years. The B.1.351 variant showed increased resistance to vaccinee sera using the PSVNA and LVNA. In the primary endpoint analysis, 23/717 (3.2%) placebo and 19/750 (2.5%) vaccine recipients developed mild-moderate Covid-19; VE 21.9% (95%Confidence Interval: −49.9; 59.8). Of the primary endpoint cases, 39/42 (92.9%) were the B.1.351 variant; against which VE was 10.4% (95%CI: −76.8; 54.8) analyzed as a secondary objective. The incidence of serious adverse events was balanced between the vaccine and placebo groups.ConclusionsA two-dose regimen of ChAdOx1-nCoV19 did not show protection against mild-moderate Covid-19 due to B.1.351 variant, however, VE against severe Covid-19 is undetermined.(Funded by The Bill & Melinda Gates Foundation and South African Medical Research Council; ClinicalTrails.gov number,NCT04444674).

We report a case of a male neonate delivered urgently via cesarean at thirty-five 5/7 weeks gestation for non-reassuring fetal monitoring who was found to have severe anemia at birth that could not be explained by acute blood loss. He was born to a 24-year-old mother, whose pregnancy was complicated by abnormal ultrasound findings, including a radial ray defect and fetal growth restriction. Trio rapid whole-exome sequencing (rWES) confirmed Diamond-Blackfan anemia in both the neonate and mother. This case highlights the importance of fetal surveillance and the clinical utility of rWES in the neonatal intensive care setting.

Background: Long-term persistence of Ebola virus (EBOV) in immunologically privileged sites has been implicated in recent outbreaks of Ebola Virus Disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to better understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. Methods: In 2017, a cohort of 131 male survivors of the 2014-2016 outbreak of EVD in Liberia were recruited from a national semen testing program into this case-case study. “Early clearers” were defined as those with two consecutive negative EBOV semen tests by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) at least two weeks apart within 1 year after discharge from the Ebola Treatment Unit (ETU). “Late clearers” had detectable EBOV RNA by rRT-PCR more than one year after ETU discharge. Retrospective histories of their EVD clinical course were collected by questionnaire, followed by complete physical exams and blood work including chemistries, blood counts, hemoglobinopathies, human leukocyte antigen typing, and immunologic/inflammatory markers. Findings: Among 131 participants, 30 demonstrated long-term detection of EBOV RNA in semen by rRT-PCR, up to 852 days after ETU discharge. Compared to early clearers, late clearers were more likely to be older (median 42.5 years, p=0.0001) and reported having experienced fewer severe clinical symptoms (median 2, p=0.006). Late clearers were found to more frequently have lens opacifications (OR 3.9, 95%CI 1.1-13.3, p=0.03), after accounting for age. Finally, late clearers also exhibited elevated total serum IgG3 titers (p=0.007) and increased expression of the HLA-C*03:04 allele (OR 0.14, 95% CI 0.02-0.70, p=0.007). Interpretation: Older age and decreased illness severity may play a significant role in determining the clearance of EBOV from the semen of survivors. Immune and host genetic factors including total serum IgG3 and HLA-C*03:04 may mediate that interaction. In addition, our finding that late clearers were more likely to have lens opacifications after accounting for age suggests that individuals with EBOV persistence in semen may also have EBOV persistence in other immunologically protected sites, such as the eye. Identifying risk factors for viral persistence in semen among male survivors is critical to inform screening efforts and prevent recurrent outbreaks of EBOV. Funding Information: This was work was supported by funds from the CDC Foundation and the Centers for Disease Control and Prevention. This project has also been funded in whole or in part with federal funds from the Frederick National Laboratory for Cancer Research, under Contract No. HHSN261200800001E. Declaration of Interests: The authors report no competing interests. Ethics Approval Statement: The study protocol was approved by the CDC and Liberia MoH Institutional Review Boards and Meharry Medical College (for hemoglobinopathy testing).

The private sector, encompassing a range of actors, is increasingly exposed to climate change and related disaster risks which are disrupting business operations. These risks are also posing a threat to human security at large, given the key role of the private sector in economic growth, job generation, and poverty reduction. While the role of the private sector in climate change adaptation (CCA) and disaster risk reduction and management (DRRM) is becoming more prominent, there are few literatures on how their initiatives help confront the challenges posed by climate change and disaster risks on human security. This chapter highlights two cases from the Philippines which describes private sector initiatives, entry points for private sector engagement, and actual practices on the ground. Key informant interviews and small group discussions were conducted to validate the gathered information from secondary data. The essential requirements common to these two private sector experiences in order to successfully carry out CCA and DRRM-related programs that contribute to human security are awareness and understanding of the climate change risks to business operations and value chains; recognition of the capacities to enable solutions and sustain action; and strong commitment to actively cooperate with the government, community, and other actors in collectively sharing resources to achieve mutual interests and goals. The stories suggest lessons on how the sector can maximize its resources and enhance its role as a key player in recognizing and adapting to climate change and making unique contribution to ensure a human-secured, progressive, sustainable, and resilient future.

HIV infection alters the immune response and can compromise protective immunity to multiple pathogens following vaccination. We investigated the impact of HIV on the immune response to SARS-CoV-2 using longitudinal samples from 124 participants from KwaZulu-Natal, South Africa, an area of extremely high HIV prevalence. 44% of participants were people living with HIV (PLWH) and commonly had other co-morbidities, including obesity, hypertension, and diabetes. The majority of PLWH but not HIV negative participants showed CD8 T cell expansion above the normal range post-SARS-CoV-2. Yet, in participants with HIV suppressed by antiretroviral therapy (ART), CD8 expansion was associated with milder COVID-19 disease. There were multiple differences in T cell, B cell, and natural killer cell correlations in PLWH compared to HIV negative participants, including lower tissue homing CXCR3+ CD8 T cells in the presence of SARS-CoV-2 RNA in PLWH but not HIV negative and a pronounced early antibody secreting cell (ASC) expansion in HIV negative but not PLWH. These changes were COVID-19 associated: low CXCR3 correlated with increased COVID-19 disease severity across groups, and high ASC correlated with increased disease severity in HIV negative participants and waned when SARS-CoV-2 was cleared. Despite the altered response of immune cell subsets, COVID-19 disease in PLWH was mostly mild and similar to HIV negative participants. This likely reflects the heterogeneity of an effective COVID-19 immune response. Whether the differences in immune cell dynamics in PLWH will lead to different long-term consequences or compromise vaccination is yet to be determined.

Background After acute coronary syndrome, guidelines recommend dual antiplatelet therapy with aspirin and a P2Y12 inhibitor for a period of 12 months for the prevention of secondary cardiovascular events. However, the risk of recurrent ischemic events can persist beyond 12 months, and there has been much debate regarding the benefits of prolonging dual antiplatelet therapy in certain patient populations. Purpose The purpose of this review was to investigate the optimal duration of dual antiplatelet therapy in the post-acute coronary syndrome patient. Conclusion Extended dual antiplatelet therapy has been associated with an increased risk of bleeding, which must be considered along with the anti-ischemic benefits of dual antiplatelet therapy when deciding on the optimal treatment duration for individual patients. Clinical implications Treatment duration must be tailored to the patient after a thorough evaluation of individual ischemic and bleeding risk factors.

To meet the growing demand for climate change information to guide national and local adaptation decision-making in the Philippines, the climate science and services community is producing an increasing volume of future climate data using a range of modelling approaches. However, there is a significant methodological challenge in how to best compare and combine information produced using different models and methods. In this paper, we present the landscape of climate model data available in the Philippines and show how multi-model, multi-method climate projections are being used and communicated to inform climate change policy and planning, focusing on the agriculture sector. We highlight the importance of examining and communicating methodological strengths and weaknesses as well as understanding the needs and capabilities of different user communities. We discuss the assessment of projections from different methods, including global and regional downscaled simulations, and discuss ways to summarise and communicate this information to stakeholders using co-production approaches. The paper concludes with perspectives on how to best use an “ensemble of opportunity” to construct defensible, plausible and usable climate projections.

We present a broadband tunable MEMS filter functional in a spectral range between 900 nm and 1650 nm. It is based on a double-membrane Fabry-Perot interferometer (FPI) operating in first interference order comprising two symmetric Si/Air Bragg mirrors and a long range electrostatic actuation. The double-membrane approach allows optical gap and actuation gap to be separated, enabling independent adjustment of initial transmission wavelength and maximum mirror travel range. Additionally, this approach improves mirror parallelism. To our best knowledge, it is the first time an FPI based on Si/Air mirrors is tuned over the first order free spectral range unlocking the full potential of these high quality broadband reflectors.

Aims Infants born to women with Type 2 Diabetes Mellitus (T2DM) are at risk of being born large for gestational age due to excess fetal fat accretion. Placental nutrient transport determines fetal nutrient availability, impacting fetal growth. The aims of the study were to evaluate the effect of T2DM on placental insulin signaling, placental nutrient transporters and neonatal adiposity. Methods Placentas were collected from BMI-matched normoglycemic controls (NGT, n = 9) and T2DM (n = 9) women. Syncytiotrophoblast microvillous (MVM) and basal (BM) plasma membranes were isolated. Expression of glucose (GLUT1, -4), fatty acid (FATP2, -4, -6, FAT/CD36), amino acid (SNAT1, -2, -4, LAT1, -2) transporters, insulin signaling, and System A transporter activity was determined. Neonatal fat mass (%) was measured in a subset of neonates born to T2DM women. Results GLUT1 protein expression was increased (p = 0.001) and GLUT4 decreased (p = 0.006) in BM from T2DM. MVM FATP6 expression was increased (p = 0.02) and correlated with birth weight in both T2DM and NGT groups (r = 0.65, p = 0.02). BM FATP6 expression was increased (p = 0.01) in T2DM. In MVM of T2DM placentas, SNAT1 expression was increased (p = 0.05) and correlated with birth weight (r = 0.84, p = 0.004); SNAT2 was increased (p = 0.01), however System A transporter activity was not different between groups. MVM LAT1 expression was increased (p = 0.01) in T2DM and correlated with birth weight (r = 0.59, p = 0.04) and neonatal fat mass (r = 0.76, p = 0.06). Conclusion In pregnancies complicated by T2DM placental protein expression of transporters for glucose, amino acids and fatty acids is increased, which may contribute to increased fetal growth and neonatal adiposity.

During November 3, 2014-December 27, 2015, CDC implemented guidance on movement and monitoring of persons in the United States with potential exposure to Ebola virus (Ebola) (1). Monitoring was concluded in December 2015. After CDC modified the guidance for monitoring travelers from Guinea (the last country for which monitoring of travelers was recommended) in late December 2015, jurisdictional reports were no longer collected by CDC. This report documents the number of persons monitored as part of the effort to isolate, test, and, if necessary, treat symptomatic travelers and other persons in the United States who had risk for exposure to Ebola during the period the guidance was in effect. Sixty jurisdictions, including all 50 states, two local jurisdictions, and eight territories and freely associated states, reported a total of 29,789 persons monitored, with >99% completing 21-day monitoring with no loss to follow-up exceeding 48 hours. No confirmed cases of imported Ebola were reported once monitoring was initiated. This landmark public health response demonstrates the robust infrastructure and sustained monitoring capacity of local, state, and territorial health authorities in the United States as a part of a response to an international public health emergency.

Purpose To critically evaluate current literature, review pharmacology, and discuss clinical role of ivabradine for patients with heart failure (HF) with reduced ejection fraction. Data sources A PubMed search was conducted using the search terms ivabradine and HF. All human studies analyzing the use of ivabradine in patients with HF with reduced ejection fraction and prescribing information were evaluated. Conclusions Greater benefit was seen in the prespecified subgroup with heart rate (HR) > 70 beats per minute (bpm) in the BEAUTIFUL study. Therefore, SHIFT examined the effect of ivabradine on patients with higher resting HR, lower ejection fraction, who had been hospitalized for HF within the previous year. A significant difference was found in the composite primary endpoint of cardiovascular death and hospitalizations for worsening HF in patients with HF and left ventricular systolic dysfunction, driven primarily by reduction in hospitalizations for worsening HF. The most common adverse effect was bradycardia. Implications for practice Ivabradine is a safe and effective medication for HR reduction to reduce hospitalizations in patients with stable, symptomatic HF (ejection fraction 70 bpm.

Sacubitril/valsartan, an angiotensin-receptor neprilysin inhibitor, was recently approved by the United States Food and Drug Administration for reduction of morbidity and mortality in patients with heart failure with reduced ejection fraction. Sacubitril is the first drug in the neprilysin inhibitor class that assists with volume regulation by inhibiting the breakdown of brain natriuretic peptide. When compared with an angiotensin-converting enzyme inhibitor, sacubitril/valsartan demonstrated reductions in rehospitalization and all-cause mortality. Sacubitril/valsartan could replace angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers

Cesarean delivery is the most common major surgical procedure performed in the United States. Women with class III obesity have an increased risk of cesarean delivery and have wound complication rates higher than healthy body mass index counterparts. Available evidence regarding optimal wound closure is lacking specific to the population of women with class III obesity despite a known increased rate of wound complications.This study aimed to compare rates of postoperative wound complications among women with class III obesity (body mass index of ≥40 kg/mPatients were randomly assigned to skin closure by nonabsorbable stainless steel surgical staples or subcuticular suture of the surgeon's choice at the time of cesarean delivery at 2 university hospitals. Randomization was stratified for scheduled vs unscheduled cesarean delivery and for the 2 study sites. The primary outcome was the rate of any documented wound complication during the first 6 weeks after delivery. Any predictors of the composite outcome that in univariate analysis had a P.20 were entered into a forward logistic regression. Sample size was calculated based on published literature and estimating the rate of wound complications within 6 weeks of follow-up at 20% with staples and 10% with sutures. For a power of 0.80 with a 2-tailed of 0.05, a total of 199 participants per group were required.From September 2015 to May 2019, 232 women were randomized to staples (n=117) or sutures (n=115). Nearing the planned interim analysis, enrollment in the study was concluded administratively owing to low enrollment. With loss to follow-up and exclusions, a total of 90 women were analyzed in each group. In the suture group, one-third was closed with braided suture and two-thirds were closed with monofilament suture. Median staple removal was 5 days postoperatively. Fewer composite wound complications were noted in the surgical staples group than the subcuticular suture group (20.0% vs 27.6%), although this difference was not statistically significant (P≥.5). The rate of surgical site infection was significantly lower in the staples group (10.5% vs 22.7%; P=.041). In the multiple logistic regression, the 3 significant independent predictors of the outcome were body mass index (odds ratio, 1.08; P=.004), scheduled vs unscheduled cesarean delivery (odds ratio, 0.40; P=.018), and study site (odds ratio, 0.36; P=.028).Surgical staples or subcuticular suture for skin closure at the time of cesarean delivery in women with a body mass index of ≥40 kg/m

HIV infection can be cleared with antiretroviral drugs if they are administered before exposure, where exposure occurs at low viral doses which infect one or few cells. However, infection clearance does not happen once infection is established, and this may be because of the very early formation of a reservoir of latently infected cells. Here we investigated whether initial low dose infection could be cleared with sub-optimal drug inhibition which allows ongoing viral replication, and hence does not require latency for viral persistence. We derived a model for infection clearance with inputs being drug effects on ongoing viral replication and initial number of infected cells. We experimentally tested the model by inhibiting low dose infection with the drug tenofovir, which interferes with initial infection, and atazanavir, which reduces the cellular virion burst size and hence inhibits replication only after initial infection. Drugs were used at concentrations which allowed infection to expand. Under these conditions, tenofovir dramatically increased clearance while atazanavir did not. Addition of latency to the model resulted in a minor decrease in clearance probability if the drug inhibited initial infection. If not, latency strongly decreased clearance even at low latent cell frequencies. Therefore, the ability of drugs to clear initial but not established infection can be recapitulated without latency and depends only on the ability to target initial infection. The presence of latency can dramatically decrease infection clearance, but only if the drug is unable to interfere with infection of the first cells., Author summary A feature of viral infections such as HIV is that successful transmission occurs with low probability and is preventable by administration of drugs before exposure to the virus. Yet, once established, the infection is difficult or impossible to eradicate within its host. In the case of HIV, this may be explained by the establishment of a latent reservoir of infected cells insensitive to antiretroviral drugs. Here we use a combined modelling and experimental approach to determine whether low dose HIV infection can be cleared at drug concentrations which allow the expansion of HIV infection once established. We show that such sub-optimal drug levels are effective at clearing infection, provided they target the virus before it infects the first set of cells. The difference in the effect of drugs before and after the initial cells are infected does not require the establishment of viral latency. Rather, it is a quantitative effect, where the low infection dose can be cleared before amplifying viral numbers by infecting the first cells.

The bulk of SMS that the Quick Response Team and Rescue Agencies received during disasters made it hard for them to categorize responses based on priorities. This paper provides a method that classifies SMS received by the agency as Spam, Invalid, Alert 1 Alert 2, and Alert 3. This method allows proper response to be extended to those asking for it based on prevailing needs. This also provides a chance to ignore insignificant messages and save precious time that may be incurred by merely dealing with unimportant messages. The implementation of Naive Bayes Algorithm, a self-learning algorithm, and together with Natural Language Processing was utilized in this research. Extension of the method is however devised in order to cover the irregularity of the data to process. Test results of the classification method showed success in its implementation and since it is a self-learning process, the method gets better and became more accurate through time.

Pre-exposure prophylaxis (PrEP) uses relatively weak HIV inhibition to reduce transmission between individuals. Why this approach is successful is unclear. Here we derive and experimentally validate a mathematical model for predicting infection clearance with PrEP based on the measured effect of a drug on the HIV replication ratio and number of initial infected cells. We tested the model by inhibiting low dose HIV infection with tenofovir, which reduces infection frequency per cell, and atazanavir, which reduces the cellular burst size of viable virions. Both drugs were at concentrations which allowed similar HIV replication. Reducing infection frequency dramatically increased infection clearance, while reducing burst size did not. This indicates that initial infection is vulnerable to inhibition before it infects the first cell, but not thereafter. Our model explains why PrEP is potent at drug concentrations which are ineffective against established infection, and provides a framework to test drug effectiveness for PrEP.

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 (1). The checklist summarized recommendations covering topics from the seven task forces. In July 2016, CDC's Office of Public Health Preparedness and Response (OPHPR) awarded $25 million in supplemental funding to 53 jurisdictions (41 states, eight territories, and four metropolitan areas) to support Zika preparedness and response activities. In December 2016, CDC awarded an additional $25 million to 21 of the 53 jurisdictions at the greatest risk for seeing Zika in their communities based on the presence of the mosquito responsible for spreading Zika, history of local transmission, or a high volume of travelers from Zika-affected areas. The additional $25 million was part of the $350 million in Zika supplemental funding provided to CDC by Congress in 2016* (2,3). Funded jurisdictions reported progress through the checklist at five quarterly points throughout the response. Data were analyzed to assess planning and response activities. Among the 53 jurisdictions, the percentage that reported having a Zika virus readiness, response, and recovery plan increased from 26% in June 2016 to 64% in July 2017. Overall, Zika planning and response activities increased among jurisdictions from June 2016 to July 2017. The recent Zika virus outbreak underscores the importance of strengthening state, local, and territorial health department capacity for rapid response to emerging threats.

Intro: Given little consensus on screening/diagnosis for early GDM despite rapidly evolving expert opinion, providers are legitimately confused about who, how and when to screen. In 2017, the ADA modified their risk-based screening guidelines which were adopted by ACOG but implementation of these guidelines is largely unstudied. We compared rates of documented risk assessment before and after ACOG expanded screening criteria to determine rates of early testing and evaluate if an electronic screening form could increase documentation. Methods: This QI study assessed provider screening practices before and after implementation of a new screening tool. Our academic center includes midwives, residents and OB/MFM faculty. In Oct 2017, in-person education and email surveys informed providers of a new electronic screening tool to promote GDM risk assessment. We reviewed initial visits at Results: A random number sequence was used to identify 50 qualifying subjects by coding Nov 2016 and 2017 for a total of 100 patients. Prior to the screening tool 15/50 (30%) had documented risk assessment and 2/3 of these had testing ordered compared to 17/50 (34%) after the screening tool in which 1/2 were tested. A 1 hour, 50g test was ordered in 80% (2016) and in 88% (2017) and an A1c was ordered for the remaining. Of the 100 patients reviewed, 29 would have qualified for early testing based on race, ethnicity and BMI alone, but only 12 were tested. Discussion: Unexpectedly, we found that early DM/GDM risk assessment is inadequately documented at our academic center and providing an electronic screening tool did little to increase documentation or adherence. Low rates of testing ( Disclosure R. Rodel: None. S.A. Reeves: None. L.A. Barbour: None.

Objective To identify the effects of the consumption of non-nutritive sweeteners on memory retention and on the histology of the hippocampus. Methods In this study, 20 mice were used to determine if there is an effect of consuming the maximum allowable dose of the non-nutritive sweeteners on the memory retention and on the histology of the hippocampus. The mice were distributed into four groups and the treatments were given via oral gavage: Group 1 (water), Group 2 (aspartame: 1 000 mg/kg), Group 3 (stevia: 1 000 mg/kg) and Group 4 (sucralose: 16 000 mg/kg). Treatments were administered to the different experimental groups for 32 days, after which memory retention was tested using the two-day water maze protocol. After the tests, the mice were sacrificed and the brain was analyzed histologically for neurotrophic effects. Results Based on the results of the two-day water maze protocol, there were no differences between the non-nutritive sweeteners and the control group. However, stevia showed high cellular apoptosis followed by aspartame, sucralose and control group. Conclusions There was no significant effect on the memory of the mice. It showed histologically however, that stevia had a significant neurotropic effect compared to the other sweeteners.

The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non–ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration. Nurses caring for patients with acute coronary syndrome must have a good understanding of the current treatment guidelines for such patients, to help ensure delivery of evidence-based care. This review article uses a case study–based approach to describe how the new guidelines affect clinical decision making when choosing appropriate antiplatelet therapy for patients with NSTE-ACS or STEMI, depending on the patient’s clinical history and presenting characteristics.

Recent studies have highlighted the importance of trees and agroforestry in climate change adaptation and mitigation. This paper analyzes how farmers, members of their households, and community leaders in the Wahig–Inabanga watershed, Bohol province in the Philippines perceive of climate change, and define and value the roles of trees in coping with climate risks. Focus group discussions revealed that farmers and community leaders had observed changes in rainfall and temperature over the years. They also had positive perceptions of tree roles in coping with climate change, with most timber tree species valued for regulating functions, while non-timber trees were valued as sources of food and income. Statistical analysis of the household survey results was done through linear probability models for both determinants of farmers' perceived changes in climate, and perceived importance of tree roles in coping with climate risks. Perceiving of changes in rainfall was more likely among farmers who had access to electricity, had access to water for irrigation, and derived climate information from government agencies and mass media, and less likely among farmers who were members of farmers' organizations. On the other hand, perceiving of an increase in temperature was more likely among famers who were members of women's organizations and had more off/non-farm sources of income, and less likely among those who derived climate information from government agencies. Meanwhile, marginal effects of the regression on perceived importance of trees in coping with climate change revealed positively significant relationships with the following predictor variables: access to electricity, number of off/non-farm sources of income, having trees planted by household members, observed increase in temperature and decline in yield, and sourcing climate information from government agencies. In contrast, a negatively significant relationship was observed between recognition of the importance of tree roles, and level of education, and deriving income from tree products. In promoting tree-based adaptation, we recommend improving access to necessary inputs and resources, exploring the potentials of farmer-to-farmer extension, using participatory approaches to generate farmer-led solutions based on their experiences of climate change, and initiating government-led extension to farmers backed by non-government partners.

Forests are important sources of livelihoods to millions of people and contribute to national economic development of many countries. In addition, they are vital sources and sinks of carbon and contribute to the rate of climate change. The UN Food and Agriculture Organization has been collecting and presenting data on global forest resources and forest cover since 1948. This paper builds on data from FAO’s 2015 Global Forest Resource Assessment (FRA) and presents information on growing stock, biomass, carbon stock, wood removals, and changes of forest area primarily designated for production and multiple use of the world’s forests. Between 1990 and 2015, the total growing stock volume has increased in East Asia, Caribbean, Western and Central Asia, North America, Europe (including the Russian Federation), and Oceania with the highest relative increase in East Asia and the Caribbean. In all other subregions the total growing stock volume decreased. North and Central America, Europe and Asia report forest C stock increases while South America and Africa report strong decreases and Oceania reports stable forest C stocks. The annual rate of decrease of forest C stock weakened between 1990 and 2015. The total volume of annual wood removals including woodfuel removals increased between 1990 and 2011, but shows a remarkable decline during the 2008–2009 economic crisis. Forest areas designated for production purposes differ considerably between subregions. The percentage of production area out of total forest area ranges between 16 percent in South America and 53 percent in Europe. Globally about one quarter of the forest area is designated to multiple use forestry. The balance between biomass growth and removals shows considerable sub-regional differences and related implications for the sustainable use of forests.

Objectives: Reduced functional capacity is associated with poor prognosis. In patients with chronic kidney disease the factors that contribute to low cardiorespiratory fitness are unclear. The objective of this study was to evaluate the cardiorespiratory and cardiovascular response to exercise in chronic kidney disease patients, and secondly investigate the relationships between cardiorespiratory fitness and cardiovascular burden. Design: Cross-sectional analysis. Methods: Baseline demographic, anthropometric and biochemical data were examined in 136 patients withmoderate chronic kidneydisease (age 59.7 ± 9.6 yrs, eGFR40 ± 9 ml/min/1.73 m2, 55%male, 39% with a history of cardiovascular disease, 38% diabetic and 17% current smokers). Cardiorespiratory fitness was measured as peak VO2, left ventricular morphology and function using echocardiography, central arterial stiffness by aortic pulse wave velocity and left ventricular afterload using augmentation index. Physical activity levels were assessed using the Active Australia questionnaire. Results: Peak VO2 (22.9 ± 6.5 ml/kg/min) and peak heart rate (148 ± 22 bpm) were 17% and 12% lower than the age-predicted values, respectively. The low fit group were significantly older, and were more likely to have type II diabetes, cardiovascular disease, a higher BMI and be less active than the high fit group (P < 0.05). The independent predictors of peak VO2 were age, type II diabetes, hemoglobin level, physical activity, aortic pulse wave velocity, augmentation index, and global longitudinal strain. Conclusions: In patients with chronic kidney disease, the peak VO2 and heart rate response is markedly impaired. Reduced cardiorespiratory fitness is independently associated with increased aortic stiffness, increased left ventricle afterload, poor left ventricle function and higher burden of cardiovascular risk.

New imaging techniques have permitted the detection of subclinical LV dysfunction (LVD) in up to half of patients with type 2 diabetes mellitus (DM) with a normal EF. However, the connection between early LVD and prognosis is unclear. This study aimed to define the long-term outcome of LVD associated with type 2 DM.In this prospective cohort study, 230 asymptomatic patients with type 2 DM underwent measurement of global longitudinal 2D strain (GLS) for detection of LVD and were followed for up to 10 years. All subjects had normal EF (≥50%) and no evidence of coronary artery disease at recruitment. Outcome data were obtained through centralised state-wide death and hospital admission registries. The primary endpoint was all-cause mortality and hospitalisation.On study entry, almost half (45%) of the cohort had evidence of LVD as detected by GLS. Over a median follow-up of 7.4±2.6 years (range 0.6-9.7 years), 68 patients (30%) met the primary endpoint (LVD: 37%; normal LV function: 24%). GLS was independently associated with the primary endpoint (HR=1.10; p=0.04), as was systolic blood pressure (HR=1.02; p0.001) and levels of glycosylated haemoglobin (HR=1.28; p=0.011). Patients with LVD had significantly worse outcome than those without (χ(2)=4.73; p=0.030).Subclinical LVD is common in asymptomatic patients with type 2 DM, is readily detectable by GLS imaging and is independently associated with adverse outcome.Australian and New Zealand Clinical Trials Registry (ACTRN12612001178831).

Swidden agriculture or shifting cultivation has been practised in the uplands of Southeast Asia for centuries and is estimated to support up to 500 million people – most of whom are poor, natural resource reliant uplanders. Recently, however, dramatic land-use transformations have generated social, economic and ecological impacts that have affected the extent, practice and outcomes of swidden in the region. While certain socio-ecological trends are clear, how these broader land-use changes impact upon local livelihoods and ecosystem services remains uncertain. This systematic review protocol therefore proposes a methodological approach to analysing the evidence on the range of possible outcomes such land-use changes have on swidden and associated livelihood and ecosystem services over time and space.

The Near-Infrared Spectrograph (NIRSpec) is one of the four instruments on the James Webb Space Telescope (JWST) scheduled for launch in 2018. NIRSpec has been manufactured and tested by an European industrial consortium led by Airbus Defence and Space and delivered to the European Space Agency (ESA) and NASA in September 2013. Since then it has successfully been integrated into the JWST Integrated Science Instrument Module (ISIM) and is currently in ISIM Cryo-Vacuum Test#2. Since however two of its most important assemblies, the Focal Plane Assembly (FPA) and the Micro-Shutter Assembly (MSA) need to be replaced by new units we will present the status of the instrument, the status of its new flight assemblies in manufacturing and testing and give an outlook on the planned exchange activities and the following instrument re-verification.

There is increasing interest to combine adaptation and mitigation measures that provide win–win solutions to climate change. Agroforestry systems offer compelling synergies between adaptation and mitigation. This article reviews the empirical evidence from various studies on how trees and agroforestry systems enhance smallholders' capacity to adapt to climate risks. Agroforestry systems improve resilience of smallholder farmers through more efficient water utilization, improved microclimate, enhanced soil productivity and nutrient cycling, control of pests and diseases, improved farm productivity, and diversified and increased farm income while at the same time sequestering carbon. Although these seems very promising, tradeoffs may arise both at the farm and landscape scales. WIREs Clim Change 2014, 5:825–833. doi: 10.1002/wcc.301 Conflict of interest: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.

The mushroom industry in the Philippines has exacerbated since 1995, and the lowest production volume was 355 metric tons (MT) in 2009. Most of the mushroom consumed were imported from the different countries of South East Asia like China, Taiwan, Thailand, Malaysia, Korea and Japan. Growing mushrooms in the Philippines is economically feasible due to low- production cost, abundance of cheap substrates from agro wastes and high demand, which will be profitable to the mushroom growers. The study aimed to assess the production of mushroom in some parts of the Philippines, assess their potentials and introduce the non-sterile fermentation method of growing mushroom to the Philippine mushroom industry. There are ten varieties of edible and medicinal mushrooms grown in the Philippines such as Paddy straw mushroom, Oyster mushroom, Shiitake mushroom, Button mushroom, Ear fungi mushroom, Milky mushroom, Yellowish oyster mushroom, Reishi mushroom, Lion`s mane mushroom, and King tuber oyster mushroom. Supporting the mushroom industry is vital in developing the rural economy, enhancing employment and income opportunity in the rural communities as well as providing income to the small farmers. Keywords—Agriculture, mushroom, characteristics of prospect ten varieties, non-sterile using fermentation, SWOT analysis, Philippines

One of the most limiting constraints for improving the profitability of smallholder vegetable farmers is poor marketing. With the lack of knowledge and inability to negotiate with downstream buyers, farmers have little option other than to sell their products to the traditional market. To facilitate access to technical information, credit and institutional markets, smallholder farmers are forming collaborative marketing groups. Clustering is one form of collaborative marketing in which smallholder farmers are organized into small groups within a defined territory or geographic area. Using the CRS Eight Step Plan for Agro-enterprise Development, 29 clusters were formed in three provinces in the Southern Philippines. This study explores the various marketing benefits smallholder farmers have achieved after joining the cluster. After interviewing 61 vegetable farmers from 10 clusters using a structured questionnaire, results show that upon joining the cluster, farmers became more aware of their buyer’s preference for product quality and gained knowledge on how to properly handle and package their produce. Cluster farmers increased their income from vegetable farming by selling a greater product variety, a larger volume and gaining access to high value markets.

CKD is associated with poor cardiorespiratory fitness (CRF). This predefined substudy determined the effect of exercise training and lifestyle intervention on CRF and explored the effect on cardiovascular risk factors and cardiac and vascular function.Between February 2008 and March 2010, 90 patients with stage 3-4 CKD were screened with an exercise stress echocardiogram before enrollment. Patients (n=83) were randomized to standard care (control) or lifestyle intervention. The lifestyle intervention included multidisciplinary care (CKD clinic), a lifestyle program, and aerobic and resistance exercise training for 12 months. CRF (peak Vo2), left ventricular function, arterial stiffness, anthropometric, and biochemical data were collected at baseline and 12 months.Ten percent of randomized patients had subclinical myocardial ischemia at screening and completed the study without incident. There was no baseline difference among 72 patients who completed follow-up (36 in the lifestyle intervention group and 36 in the control group). The intervention increased peak Vo2 (2.8±0.7 ml/kg per minute versus -0.3±0.9 ml/kg per minute; P=0.004). There was small weight loss (-1.8±4.2 kg versus 0.7±3.7 kg; P=0.02) but no change in BP or lipids. Diastolic function improved (increased e' of 0.75±1.16 cm/s versus -0.47±1.0 cm/s; P=0.001) but systolic function was well preserved and did not change. The change in arterial elastance was attenuated (0.11±0.76 mmHg/ml versus 0.76±0.96 mmHg/ml; P=0.01). Δ peak Vo2 was associated with group allocation and improved body composition.Exercise training and lifestyle intervention in patients with CKD produces improvements in CRF, body composition, and diastolic function.

Office blood pressure (BP) is recommended to be measured after 5 min of seated rest, but it may decrease for 10 min of seated rest. This study aimed to determine the change (and its clinical relevance) in brachial and central BP from 5 to 10 min of seated rest. Office brachial and central BP (measured after 5 and 10 min), left ventricular (LV) mass index, 7-day home and ambulatory BP were measured in 250 participants with treated hypertension. Office brachial and central BP were significantly lower at 10-min compared with 5-min BP (P

Global economic change and policy interventions are driving transitions from long-fallow swidden (LFS) systems to alternative land uses in Southeast Asia’s uplands. This study presents a systematic review of how these transitions impact upon livelihoods and ecosystem services in the region. Over 17 000 studies published between 1950 and 2015 were narrowed, based on relevance and quality, to 93 studies for further analysis. Our analysis of land-use transitions from swidden to intensified cropping systems showed several outcomes: more households had increased overall income, but these benefits came at significant cost such as reductions of customary practice, socio-economic wellbeing, livelihood options, and staple yields. Examining the effects of transitions on soil properties revealed negative impacts on soil organic carbon, cation-exchange capacity, and aboveground carbon. Taken together, the proximate and underlying drivers of the transitions from LFS to alternative land uses, especially intensified perennial and annual cash cropping, led to significant declines in pre-existing livelihood security and the ecosystem services supporting this security. Our results suggest that policies imposing land-use transitions on upland farmers so as to improve livelihoods and environments have been misguided; in the context of varied land uses, swidden agriculture can support livelihoods and ecosystem services that will help buffer the impacts of climate change in Southeast Asia. Electronic supplementary material The online version of this article (doi:10.1007/s13280-016-0836-z) contains supplementary material, which is available to authorised users.

Exaggerated exercise blood pressure (BP) predicts mortality. Some studies suggest this could be explained by chronic hyperlipidemia, but whether acute-hyperlipidemia effects exercise BP has never been tested, and was the aim of this study.Intravenous infusion of saline (control) and Intralipid were administered over 60 min in 15 healthy men by double-blind, randomized, cross-over design. Brachial and central BP (including, pulse pressure, augmentation pressure and augmentation index), cardiac output and systemic vascular resistance were recorded at rest and during exercise.Compared with control, Intralipid caused significant increases in serum triglycerides, very low density lipoproteins and free fatty acids (p 0.001 for all). However, there was no significant difference for any exercise hemodynamic variable (p 0.05 for all).Acute-hyperlipidemia does not significantly change exercise hemodynamics in healthy males. Therefore, the association between raised lipids and increased exercise BP is likely due to the chronic effects of hyperlipidemia.

The emergence of cloud computing allowed different IT services to be outsourced to cloud service providers (CSP). This includes the management and storage of user's structured data called Database as a Service (DBaaS). However, DBaaS requires users to trust the CSP to protect their data, which is inherent in all cloud-based services. Enterprises and Small-to-Medium Businesses (SMB) see this as a roadblock in adopting cloud services (and DBaaS) because they do not have full control of the security and privacy of the sensitive data they are storing on the cloud. One of the solutions is for the data owners to store their sensitive data in the cloud's storage services in encrypted form. However, to take full advantage of DBaaS, there should be a solution to manage the structured data while it is encrypted. Upcoming technologies like Secure Multi-Party Computing (MPC) and Fully Homomorphic Encryption (FHE) are recent advances in security that allow computation on encrypted data. FHE is considered as the holy grail of cryptography and the original blue print's processing performance is in the order of 1014 times longer than without encryption. Our work gives an insight on how far the state-of-the-art is into realizing it into a practical and viable solution for cloud computing data services. We achieved this by comparing two types of encrypted database management system (DBMS). We performed well-known complex database queries and measured the performance results of the two DBMS. We used an FHE-encrypted relational DBMS (RDBMS) and for specific query sets it takes only a few milliseconds, and the highest is in the order of 104 times longer than encrypted object-oriented DBMS (OODBMS). Aside from focusing on performance of the two databases, we also evaluated the network resource usage, standards availability, and application integration.

With the advent of new microelectronic fabrication technologies new hardware devices are emerging which suffer from an intrinsically higher susceptibility to faults than previous devices. This leads to a substantially lower degree of reliability and demands further improvements of error detection methods. However, any attempt to cover all errors for all theoretically possible scenarios that a system might be used in can easily lead to excessive costs. Instead, an application-dependent approach should be taken, i.e., strategies for test and error resilience must target only those errors that can actually have an effect in the situations in which the hardware is being used. In this paper, we propose a method to inject faults into hardware and to formally analyze their effects on the software behavior. We describe how this analysis can be implemented based on a recently proposed hardware-dependent software model called program netlist. We show how program netlists can be extended to formally model the behavior of a program in the event of one or more hardware faults. First experimental results are presented to demonstrate the feasibility of our approach.

There is a high level of interest in reducing emissions from deforestation and forest degradation plus (REDD+) carbon (C) financing as a way to accelerate forest conservation and development. However, there is very limited information on the potential costs and benefits of REDD+ in developing countries like the Philippines. In this paper, we estimated the range of likely financial benefits of REDD+ implementation in the country under various forest degradation and mitigation scenarios. Our findings show that reducing the rate of forest degradation by a modest 5 to 15 % annually while increasing the doubling the rate of reforestation to 1.5 % annually could reduce C emissions by up to about 60 million t C by 2030. These are equivalent to US$ 97 to 417 million of mean C credits annually at US$ 5 per ton C. These figures are much higher than the total budget of the government and official development assistance for forestry activities in the country which amounted to US$ 46 million in 2005 and US$ 12 million in 2006, respectively. We conclude that REDD+ C credits could be a significant source of financing for forestry projects in developing countries like the Philippines.

Background A hypertensive response to exercise (HRE; defined as normal clinic blood pressure (BP) and exercise systolic BP (SBP) ≥210 mm Hg in men or ≥190 mm Hg in women, or diastolic BP (DBP) ≥105 mm Hg) independently predicts mortality. The mechanisms remain unclear but may be related to masked hypertension. This study aimed to assess the prevalence of masked hypertension and its association with cardiovascular risk factors, including left ventricular (LV) mass, in patients with a HRE. Methods Comprehensive clinical and echocardiographic evaluation (including central BP, aortic pulse wave velocity by tonometry) and 24-h ambulatory BP monitoring (ABPM) were performed in 72 untreated patients with HRE (aged 54 ± 9 years; 60% male; free from coronary artery disease confirmed by exercise stress echocardiography). Masked hypertension was defined according to guidelines as daytime ABPM ≥135/85 mm Hg and clinic BP 0.05 for both). The strongest independent determinant of LV mass index was the presence of masked hypertension (unstandardized β = 5.6; P = 0.007), which was also independently related to LV RWT (unstandardized β = 0.04; P = 0.03). Conclusions Masked hypertension is highly prevalent in HRE patients with a normal resting office BP and is associated with increased LV mass index and RWT. Clinicians should consider measuring ABPM or home BP in HRE patients.