83 research outputs found
Mesocosm experiments reveal the impact of mosquito control measures on malaria vector life history and population dynamics
The impact of control measures on mosquito vector fitness and demography is usually estimated from bioassays or indirect variables in the field. Whilst indicative, neither approach is sufficient to quantify the potentially complex response of mosquito populations to combined interventions. Here, large replicated mesocosms were used to measure the population-level response of the malaria vector Anopheles arabiensis to long-lasting insecticidal nets (LLINs) when used in isolation, or combined with insecticidal eave louvers (EL), or treatment of cattle with the endectocide Ivermectin (IM). State-space models (SSM) were fit to these experimental data, revealing that LLIN introduction reduced adult mosquito survival by 91% but allowed population persistence. ELs provided no additional benefit, but IM reduced mosquito fecundity by 59% and nearly eliminated all populations when combined with LLINs. This highlights the value of IM for integrated vector control, and mesocosm population experiments combined with SSM for identifying optimal combinations for vector population elimination
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Structural coupling and magnetic tuning in Mn2–x CoxP magnetocalorics for thermomagnetic power generation
Steroid-Refractory Acute GVHD: Predictors and Outcomes
Patients with steroid-resistant acute graft versus host disease (aGVHD) have a dismal prognosis, with mortality rates in excess of 90%. We sought to identify a subgroup of patients less likely to benefit from initial therapy with corticosteroids as well as the impact of response on day 14 on outcome. Retrospective evaluation was performed of patients with biopsy-proven aGVHD treated with corticosteroids after allogeneic HSCT at M.D. Anderson Cancer Center from 1998 through 2002 (N = 287). Overall response to first-line therapy on day 14 was 56%. Grade III-IV aGVHD and hyperacute GVHD were the most significant factors predicting failure. Patients who fail to respond to steroids by day 14 should be considered for clinical trials. Severity of aGVHD, hyperacute GVHD, and sex mismatch could be integrated into prognostic scoring systems which may allow for pretreatment identification of patients unlikely to benefit from standard therapy with corticosteroids
Envisioning environmental equity: climate change, health, and racial justice
Climate change has a broad range of health impacts and tackling climate change could be the greatest opportunity for improving global health this century. Yet conversations on climate change and health are often incomplete, giving little attention to structural discrimination and the need for racial justice. Racism kills, and climate change kills. Together, racism and climate change interact and have disproportionate effects on the lives of minoritised people both within countries and between the Global North and the Global South. This paper has three main aims. First, to survey the literature on the unequal health impacts of climate change due to racism, xenophobia, and discrimination through a scoping review. We found that racially minoritised groups, migrants, and Indigenous communities face a disproportionate burden of illness and mortality due to climate change in different contexts. Second, this paper aims to highlight inequalities in responsibility for climate change and the effects thereof. A geographical visualisation of responsibility for climate change and projected mortality and disease risk attributable to climate change per 100 000 people in 2050 was conducted. These maps visualise the disproportionate burden of illness and mortality due to climate change faced by the Global South. Our third aim is to highlight the pathways through which climate change, discrimination, and health interact in most affected areas. Case studies, testimony, and policy analysis drawn from multidisciplinary perspectives are presented throughout the paper to elucidate these pathways. The health community must urgently examine and repair the structural discrimination that drives the unequal impacts of climate change to achieve rapid and equitable action
Safety and Immunogenicity of an AMA-1 Malaria Vaccine in Malian Adults: Results of a Phase 1 Randomized Controlled Trial
The objective was to evaluate the safety, reactogenicity and immunogenicity of the AMA-1-based blood-stage malaria vaccine FMP2.1/AS02A in adults exposed to seasonal malaria.A phase 1 double blind randomized controlled dose escalation trial was conducted in Bandiagara, Mali, West Africa, a rural town with intense seasonal transmission of Plasmodium falciparum malaria. The malaria vaccine FMP2.1/AS02A is a recombinant protein (FMP2.1) based on apical membrane antigen-1 (AMA-1) from the 3D7 clone of P. falciparum, adjuvanted with AS02A. The comparator vaccine was a cell-culture rabies virus vaccine (RabAvert). Sixty healthy, malaria-experienced adults aged 18-55 y were recruited into 2 cohorts and randomized to receive either a half dose or full dose of the malaria vaccine (FMP2.1 25 microg/AS02A 0.25 mL or FMP2.1 50 microg/AS02A 0.5 mL) or rabies vaccine given in 3 doses at 0, 1 and 2 mo, and were followed for 1 y. Solicited symptoms were assessed for 7 d and unsolicited symptoms for 30 d after each vaccination. Serious adverse events were assessed throughout the study. Titers of anti-AMA-1 antibodies were measured by ELISA and P. falciparum growth inhibition assays were performed on sera collected at pre- and post-vaccination time points. Transient local pain and swelling were common and more frequent in both malaria vaccine dosage groups than in the comparator group. Anti-AMA-1 antibodies increased significantly in both malaria vaccine groups, peaking at nearly 5-fold and more than 6-fold higher than baseline in the half-dose and full-dose groups, respectively.The FMP2.1/AS02A vaccine had a good safety profile, was well-tolerated, and was highly immunogenic in malaria-exposed adults. This malaria vaccine is being evaluated in Phase 1 and 2 trials in children at this site
PDRs4All IV. An embarrassment of riches: Aromatic infrared bands in the Orion Bar
(Abridged) Mid-infrared observations of photodissociation regions (PDRs) are
dominated by strong emission features called aromatic infrared bands (AIBs).
The most prominent AIBs are found at 3.3, 6.2, 7.7, 8.6, and 11.2 m. The
most sensitive, highest-resolution infrared spectral imaging data ever taken of
the prototypical PDR, the Orion Bar, have been captured by JWST. We provide an
inventory of the AIBs found in the Orion Bar, along with mid-IR template
spectra from five distinct regions in the Bar: the molecular PDR, the atomic
PDR, and the HII region. We use JWST NIRSpec IFU and MIRI MRS observations of
the Orion Bar from the JWST Early Release Science Program, PDRs4All (ID: 1288).
We extract five template spectra to represent the morphology and environment of
the Orion Bar PDR. The superb sensitivity and the spectral and spatial
resolution of these JWST observations reveal many details of the AIB emission
and enable an improved characterization of their detailed profile shapes and
sub-components. While the spectra are dominated by the well-known AIBs at 3.3,
6.2, 7.7, 8.6, 11.2, and 12.7 m, a wealth of weaker features and
sub-components are present. We report trends in the widths and relative
strengths of AIBs across the five template spectra. These trends yield valuable
insight into the photochemical evolution of PAHs, such as the evolution
responsible for the shift of 11.2 m AIB emission from class B in
the molecular PDR to class A in the PDR surface layers. This
photochemical evolution is driven by the increased importance of FUV processing
in the PDR surface layers, resulting in a "weeding out" of the weakest links of
the PAH family in these layers. For now, these JWST observations are consistent
with a model in which the underlying PAH family is composed of a few species:
the so-called 'grandPAHs'.Comment: 25 pages, 10 figures, to appear in A&
PDRs4All II: JWST's NIR and MIR imaging view of the Orion Nebula
The JWST has captured the most detailed and sharpest infrared images ever
taken of the inner region of the Orion Nebula, the nearest massive star
formation region, and a prototypical highly irradiated dense photo-dissociation
region (PDR). We investigate the fundamental interaction of far-ultraviolet
photons with molecular clouds. The transitions across the ionization front
(IF), dissociation front (DF), and the molecular cloud are studied at
high-angular resolution. These transitions are relevant to understanding the
effects of radiative feedback from massive stars and the dominant physical and
chemical processes that lead to the IR emission that JWST will detect in many
Galactic and extragalactic environments. Due to the proximity of the Orion
Nebula and the unprecedented angular resolution of JWST, these data reveal that
the molecular cloud borders are hyper structured at small angular scales of
0.1-1" (0.0002-0.002 pc or 40-400 au at 414 pc). A diverse set of features are
observed such as ridges, waves, globules and photoevaporated protoplanetary
disks. At the PDR atomic to molecular transition, several bright features are
detected that are associated with the highly irradiated surroundings of the
dense molecular condensations and embedded young star. Toward the Orion Bar
PDR, a highly sculpted interface is detected with sharp edges and density
increases near the IF and DF. This was predicted by previous modeling studies,
but the fronts were unresolved in most tracers. A complex, structured, and
folded DF surface was traced by the H2 lines. This dataset was used to revisit
the commonly adopted 2D PDR structure of the Orion Bar. JWST provides us with a
complete view of the PDR, all the way from the PDR edge to the substructured
dense region, and this allowed us to determine, in detail, where the emission
of the atomic and molecular lines, aromatic bands, and dust originate
PDRs4All III: JWST's NIR spectroscopic view of the Orion Bar
(Abridged) We investigate the impact of radiative feedback from massive stars
on their natal cloud and focus on the transition from the HII region to the
atomic PDR (crossing the ionisation front (IF)), and the subsequent transition
to the molecular PDR (crossing the dissociation front (DF)). We use
high-resolution near-IR integral field spectroscopic data from NIRSpec on JWST
to observe the Orion Bar PDR as part of the PDRs4All JWST Early Release Science
Program. The NIRSpec data reveal a forest of lines including, but not limited
to, HeI, HI, and CI recombination lines, ionic lines, OI and NI fluorescence
lines, Aromatic Infrared Bands (AIBs including aromatic CH, aliphatic CH, and
their CD counterparts), CO2 ice, pure rotational and ro-vibrational lines from
H2, and ro-vibrational lines HD, CO, and CH+, most of them detected for the
first time towards a PDR. Their spatial distribution resolves the H and He
ionisation structure in the Huygens region, gives insight into the geometry of
the Bar, and confirms the large-scale stratification of PDRs. We observe
numerous smaller scale structures whose typical size decreases with distance
from Ori C and IR lines from CI, if solely arising from radiative recombination
and cascade, reveal very high gas temperatures consistent with the hot
irradiated surface of small-scale dense clumps deep inside the PDR. The H2
lines reveal multiple, prominent filaments which exhibit different
characteristics. This leaves the impression of a "terraced" transition from the
predominantly atomic surface region to the CO-rich molecular zone deeper in.
This study showcases the discovery space created by JWST to further our
understanding of the impact radiation from young stars has on their natal
molecular cloud and proto-planetary disk, which touches on star- and planet
formation as well as galaxy evolution.Comment: 52 pages, 30 figures, submitted to A&
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely
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