Tuberculosis remains a challenge despite economic growth in Panama

Tuberculosis (TB) is a disease associated with inequality, and wise investment of economic resources is considered critical to its control. Panama has recently secured its status as an upper-middle-income country with robust economic growth. However, the prioritisation of resources for TB control remains a major challenge. In this article, we highlight areas that urgently require action to effectively reduce TB burden to minimal levels. Our conclusions suggest the need for fund allocation and a multidisciplinary approach to ensure prompt laboratory diagnosis, treatment assurance and workforce reinforcement, complemented by applied and operational research, development and innovation.Tuberculosis (TB) is a disease associated with inequality, and wise investment of economic resources is considered critical to its control. Panama has recently secured its status as an upper-middle-income country with robust economic growth. However, the prioritisation of resources for TB control remains a major challenge. In this article, we highlight areas that urgently require action to effectively reduce TB burden to minimal levels. Our conclusions suggest the need for fund allocation and a multidisciplinary approach to ensure prompt laboratory diagnosis, treatment assurance and workforce reinforcement, complemented by applied and operational research, development and innovation

A rare-event study of frequency regulation and contingency services from grid-scale batteries

We perform a rare-event study on a simulated power system in which grid-scale batteries provide both regulation and emergency frequency control ancillary services. Using a model of random power disturbances at each bus, we employ the skipping sampler, a Markov Chain Monte Carlo algorithm for rare-event sampling, to build conditional distributions of the power disturbances leading to two kinds of instability: frequency excursions outside the normal operating band, and load shedding. Potential saturation in the benefits, and competition between the two services, are explored as the battery maximum power output increases

Activation of the innate immune receptor Dectin-1 upon formation of a 'phagocytic synapse'.

Innate immune cells must be able to distinguish between direct binding to microbes and detection of components shed from the surface of microbes located at a distance. Dectin-1 (also known as CLEC7A) is a pattern-recognition receptor expressed by myeloid phagocytes (macrophages, dendritic cells and neutrophils) that detects β-glucans in fungal cell walls and triggers direct cellular antimicrobial activity, including phagocytosis and production of reactive oxygen species (ROS). In contrast to inflammatory responses stimulated upon detection of soluble ligands by other pattern-recognition receptors, such as Toll-like receptors (TLRs), these responses are only useful when a cell comes into direct contact with a microbe and must not be spuriously activated by soluble stimuli. In this study we show that, despite its ability to bind both soluble and particulate β-glucan polymers, Dectin-1 signalling is only activated by particulate β-glucans, which cluster the receptor in synapse-like structures from which regulatory tyrosine phosphatases CD45 and CD148 (also known as PTPRC and PTPRJ, respectively) are excluded (Supplementary Fig. 1). The 'phagocytic synapse' now provides a model mechanism by which innate immune receptors can distinguish direct microbial contact from detection of microbes at a distance, thereby initiating direct cellular antimicrobial responses only when they are required

The effects of native plants on non-native plant abundance in a restoration setting : differences among native species and the predictive ability of species traits

Reducing the cover of non-native species is one of the challenges of ecosystem restoration. The goal of this study is to identify native species traits that will increase native species cover and reduce non-native species cover in the first growing season at upland and wetland prairie restoration sites. Native and non-native prairie species were planted in the fall and harvested the following summer at both an upland and a wetland site. Native species traits, such as plant weight, leaf area, relative growth rate, leaf area ratio, leaf weight ratio, net assimilation rate, and specific leaf area were measured under laboratory conditions for 7- and 21-day old seedlings. Germination rate (laboratory) and phenology (field) were also measured. At the upland site, species with a large 7-day plant weight and a high germination rate also had high native cover in the field (P<0.00l, R²=0.83). At the wetland site, high 21-day leaf area, low 21-day leaf weight ratio, and high net assimilation rate predicted increased native cover in the field (P<0.00l, R²=0.87). An abundance of natives, as measured by native cover, native biomass, and number of individuals, likely results in fewer resources (light, nutrients, and water) available for the non-native species growth resulting in a reduction in the non-native cover. Intrinsic traits of native species also predicted the field performance of non-native species, although the amount of variation explained was lower than the amount of variation explained in the models that predicted native cover. In the upland site, native species with high leaf weight ratio (21-day) tended to have lower non-native cover in their field plots (P=0.087, R²=0.23). In the wetland site, the native species traits that predict non-native cover were low 21-day leaf area and high 21-day leaf weight ratio (P<0.00l, R²=0.46). These traits were similar to those that predicted native species cover at the wetland site. This study demonstrates the ability of species traits to predict field performance. Predictive models were generated using native species traits to select species for restoration that will increase native cover and decrease non-native cover in the first growing season. Traits can be measured for species not included in this study and the models generated can be used to predict the field performance of species at similar sites

The California heat island: seasonal trends in maximum and minimum temperatures

This paper summarizes progress in an ongoing study of California's temperature trends. It supplements studies reported at PACLIM in 1984, 1986, and 1987. ... Objectives of this study are twofold: to examine and map the trends in maximum and minimum temperatures for the warm and cool seasons separately, and to examine regional differences in maximum and minimum temperature trends in California

“The System is Well Intentioned, but Complicated and Fallible” Interviews with Caregivers and Decision Makers About Palliative Care in Canada

Background: Canadian palliative care (PC) philosophy seeks to support individuals in a person-centered and sensitive manner. Unfortunately, philosophy does not necessarily translate into practice and this divide may leave patients without appropriate care at the end of life, causing distress for some families. The primary goal of the study was to identify key factors affecting perceptions of quality PC from the perspective of informal caregivers and decision makers (e.g., program managers) and to understand how their experiences within the health care system may have influenced their perceptions. Methods: Nine caregivers and 11 decision makers from Yukon Territory, British Columbia, Alberta, Ontario, & Nova Scotia shared their experiences in PC via interview or focus group. Audio recordings were transcribed verbatim and qualitatively analyzed for themes. Results: Three themes emerged, including the Caregiver as Anchor, Bewildering System, and Patient, Caregiver, and Family-Centered Care. While these results resembled other studies on caregivers and individuals receiving PC, the present study also uncovered systemic concerns. There was agreement between the two participant groups across most subthemes, however only caregivers reported feelings of being trapped by the health care system and a general lack of respect from health care professionals. Additionally, caregivers stressed the importance of preserving some sort of normalcy in daily life despite the individual\u27s illness. Conclusions: Caregivers are critical. The health care system expects them to help a great deal, but they often do not feel supported or respected and the system is lacking the capacity and resources to meet their needs while they are grieving loss and struggling to meet demands

The helminth product, ES-62, protects against airway inflammation by resetting the Th cell phenotype

We previously demonstrated inhibition of ovalbumin (OVA)-induced allergic airway hyper-responsiveness in the mouse using ES-62, a phosphorylcholine-containing glycoprotein secreted by the filarial nematode, Acanthocheilonema viteae. This inhibition correlated with ES-62-induced mast cell desensitisation, although the degree to which this reflected direct targeting of mast cells remained unclear as suppression of the Th2 phenotype of the inflammatory response, as measured by eosinophilia and IL-4 levels in the lungs, was also observed. We now show that inhibition of the lung Th2 phenotype is reflected in ex vivo analyses of draining lymph node recall cultures and accompanied by a decrease in the serum levels of total and OVA-specific IgE. Moreover, ES-62 also suppresses the lung infiltration by neutrophils that is associated with severe asthma and is generally refractory to conventional anti-inflammatory therapies, including steroids. Protection against Th2-associated airway inflammation does not reflect induction of regulatory T cell (Treg) responses (there is no increased IL-10 or Foxp3 expression) but rather a switch in polarisation towards increased T-bet expression and IFNγ production. This ES-62-driven switch in the Th1/Th2 balance is accompanied by decreased IL-17 responses, a finding in line with reports that IFNγ and IL-17 are counter-regulatory. Consistent with ES-62 mediating its effects via IFNγ-mediated suppression of pathogenic Th2/Th17 responses, we found that neutralising anti-IFNγ antibodies blocked protection against airway inflammation in terms of pro-inflammatory cell infiltration, particularly by neutrophils and lung pathology. Collectively, these studies indicate that ES-62, or more likely small molecule analogues, could have therapeutic potential in asthma, in particular for those subtypes of patients (e.g. smokers, steroid-resistant) who are refractory to current treatments

Potential Quality Indicators for Seriously Ill Home Care Clients: A Cross-Sectional Analysis Using Resident Assessment Instrument for Home Care (RAI-HC) Data for Ontario

Background Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment. Methods Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of less than 6 months to live or the presence of severe health instability. The rates of the QIs were stratified across Ontario’s geographic regions, and across four common life-limiting illnesses to observe variation. Results Within the sample, 14,312 clients were considered to be seriously ill and were more likely to experience negative health outcomes such as cognitive performance (OR = 2.77; 95% CI: 2.66–2.89) and pain (OR = 1.59; 95% CI: 1.53–1.64). Twenty subject matter experts were consulted and a list of seven QIs was developed. Indicators with the highest overall rates were prevalence of falls (50%) prevalence of daily pain (47%), and prevalence of caregiver distress (42%). The range in QI rates was largest across regions for prevalence of caregiver distress (21.5%), the prevalence of falls (16.6%), and the prevalence of social isolation (13.7%). Those with some form of dementia were most likely to have a caregiver that was distressed (52.6%) or to experience a fall (53.3%). Conclusion Home care clients in Ontario who are seriously ill are experiencing high rates of negative health outcomes, many of which are amenable to change. The RAI-HC can be a useful tool in identifying these clients in order to better understand their needs and abilities. These results contribute significantly to the process of creating and validating a standardized set of QIs that can be generated by organizations using the RAI-HC as part of normal clinical practice

Contrasting symbolic and non-symbolic numerical representations in a joint classification task

Both symbolic (digits) and non-symbolic (dots) numerals are spatially coded, with relatively small numbers being responded faster with a left key and large numbers being responded faster with a right key (spatial–numerical association of response codes [SNARC]). The idea of format independent SNARC seems to support the existence of a common system for symbolic and non-symbolic numerical representations, although evidence in the field is still mixed. The aim of the present study is to investigate whether symbolic and non-symbolic numerals interact in the SNARC effect when both information is simultaneously displayed. To do so, participants were presented with dice-like patterns, with digits being used instead of dots. In two separate magnitude classification tasks, participants had to respond either to the number of digits presented on the screen or to their numerical size. In the non-symbolic task, they had to judge whether the digits on the screen were more or less than three, irrespective of the numerical value of the digits. In the symbolic task, participants had to judge whether the digits on the screen were numerically smaller or larger than three, irrespective of the number of digits being present. The results show a consistent SNARC effect in the symbolic task and no effect in the non-symbolic one. Furthermore, congruency between symbolic and non-symbolic numerals did not modulate the response patterns, thus supporting the idea of independent representations and questioning some propositions of current theoretical accounts