The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reactive spectrum handoff combined with random target channel selection in cognitive radio networks with prioritized secondary users

Cognitive radio aims at improving spectrum utilization by allowing secondary users to access primary user’s spectrum. The delay time of secondary users due to multiple interruptions from primary users is considered a crucial issue. In this work, to reduce secondary user delay time, we propose a mixed preemptive/non-preemptive resume priority model where secondary user priority increases with each interruption by the primary user. We consider reactive spectrum handoff combined with random target channel selection for the case of all-busy channels. We derive closed form expressions of the average cumulative delay time and the extended data delivery time for each secondary user class. Numerical results show that the proposed approach reduces the secondary user delay time per class compared to other models in case of light loaded networks. Keywords: Cognitive radio, Spectrum handoff, Queueing theory, Priority scheme

Salt accumulation in irrigated loamy soil; Lower Euphrates Valley, Syria

In arid and semi-arid regions, soil salinity is a common problem threatening fertility of irrigated lands. The Lower Euphrates valley in Syria suffers from salt accumulation in soil because of the inappropriate climatic conditions, using the traditional methods in irrigation; flood irrigation. HYDRUS 1-D model was used to simulate water flow, salt transport and root water uptake processes in this area. Data from seventy soil profiles were acquired from the pedological reports obtained from the Ministry of Irrigation in Syria. Representative monthly evapotranspiration (ET0) values in Deir Ez-Zor were taken from the FAO CLIMWAT database. The seventy soil profiles were grouped in fourteen zones distributed over the study area. For each zone, the monthly recharge and its salt concentration was estimated. The model was run for 24-month duration. The results showed increasing in soil salinity and, consequently, increasing in salts load transmitted into groundwater. Accordingly, mitigation measures have been suggested

Recent progress in marine foul-release polymeric nanocomposite coatings

Progress in materials science is associated with the development of nanomaterials in terms of energy-saving, environmentally friendly, and low-cost methods. Since the use of tributyltin compounds in antifouling coatings was banned in 2003, the search for ecofriendly alternatives has been promoted. Foul-release (FR) nanocoatings have been extensively investigated because of their non-stick, ecological, and economic advantages. Such nanocomposite systems are dynamic non-stick surfaces that deter any fouling attachment through physical anti-adhesion terminology. Instead of biocidal solutions, several functional FR nanocomposite coatings have been developed to counter biofouling and biocorrosion with ecological and ecofriendly effects. Selected inorganic nanofillers have been incorporated because of their enhanced interaction at the filler‐polymer interface for nanocomposites. Metallic nanoparticles and their oxides have also been widely explored because of their unique morphological characteristics and size-dependent, self-cleaning properties. In modeling a novel series of FR nanocoatings, two modes of prevention are combined: chemical inertness and physical microfouling repulsion for maritime navigation applications. Long-term durability and self-cleaning performance are among the advantages of developing effective, stable, and ecofriendly modeling alternatives. This review provides a holistic overview of nano-FR research achievements and describes recent advancements in non-stick marine nanocoatings for ship hulls. This review highlights the key issues of nanocomposite structures and their features in improving the biological activity and surface self-cleaning performance of ship hulls. This review may also open new horizons toward futuristic developments in FR nanocomposites for maritime navigations

Nitrogen-doped carbon-embedded TiO 2 nanofibers as promising oxygen reduction reaction electrocatalysts

The development of inexpensive and effective electrocatalysts for oxygen reduction reaction (ORR) as a substitute for commercial Pt/C catalyst is an important issue in fuel cells. In this paper, we report on novel fabrication of self-supported nitrogen-doped carbon-supported titanium nanofibers (N[sbnd]TiO2@C) and carbon-supported titanium (TiO2@C) electrocatalysts via a facile electrospinning route. The nitrogen atom integrates physically and homogenously into the entire carbon–titanium structure. We demonstrate the catalytic performance of N[sbnd]TiO2@C and TiO2@C for ORR under alkaline conditions in comparison with Pt/C catalyst. The N[sbnd]TiO2@C catalyst shows excellent ORR reactivity and durability. Interestingly, among all the catalysts used in this ORR, N[sbnd][email protected] exhibits remarkable competitive oxygen reduction activity in terms of current density and onset potential, as well as superior methanol tolerance. Such tolerance attributes to maximizing the diffusion of trigger pulse electrons during catalytic reactions because of enhanced electronic features. Results indicate that our fabrication strategy can provide an opportunity to produce a simple, efficient, cost-effective, and promising ORR electrocatalyst for practical applications in energy conversion and storage technologies

Extracellular biosynthesis of silver nanoparticles using Rhizopus stolonifer

Synthesis of silver nanoparticles (AgNPs) has become a necessary field of applied science. Biological method for synthesis of AgNPs by Rhizopus stolonifer aqueous mycelial extract was used. The AgNPs were identified by UV–visible spectrometry, X-ray diffraction (XRD), transmission electron microscopy (TEM) and Fourier transform infrared spectrometry (FT-IR). The presence of surface plasmon band around 420 nm indicates AgNPs formation. The characteristic of the AgNPs within the face-centered cubic (fcc) structure are indicated by the peaks of the X-ray diffraction (XRD) pattern corresponding to (111), (200) and (220) planes. Spherical, mono-dispersed and stable AgNPs with diameter around 9.47 nm were prepared and affirmed by high-resolution transmission electron microscopy (HR-TEM). Fourier Transform Infrared (FTIR) shows peaks at 1426 and 1684 cm−1 that affirm the presence of coat covering protein the AgNPs which is known as capping proteins. Parameter optimization showed the smallest size of AgNPs (2.86 ± 0.3 nm) was obtained with 10−2 M AgNO3 at 40 °C. The present study provides the proof that the molecules within aqueous mycelial extract of R. stolonifer facilitate synthesis of AgNPs and highlight on value-added from R. stolonifer for cost effectiveness. Also, eco-friendly medical and nanotechnology-based industries could also be provided. Size of prepared AgNPs could be controlled by temperature and AgNO3 concentration. Further studies are required to study effect of more parameters on size and morphology of AgNPs as this will help in the control of large scale production of biogenic AgNPs