Climate change adaptation in disaster-prone communities in Cambodia and Fiji

This article examines how rural communities living in flood-prone river basins of Cambodia and Fiji have responded to increasing variability of floods and other natural hazards under the influence of climate change and other risk factors. Particular emphasis is placed on risk perceptions and adaptive strategies of households and communities with regard to regular and catastrophic floods and how the livelihoods of vulnerable groups are affected by floods and other climate-induced disasters. Our research approach integrates the food, water and energy security nexus with the rural livelihood framework. The study aims at identifying the spatial extent and dynamics of flood events and determining the factors that enhance adaptive capacities of flood-affected communities and households. Our study finds that access to resources as well as local socio-cultural contexts are important determinants of coping and adaptation practices at the community and household level in the two countries. Findings also suggest that research participants had a profound understanding of flood flows, extent and impacts that complements knowledge gained from hydrological and remote sensing methods. We conclude that blending local and scientific knowledge is a promising approach to enhancing adaptive capacity and resilience

Environmental Livelihood Security in Southeast Asia and Oceania: A Water-Energy-Food-Livelihoods Nexus Approach for Spatially Assessing Change

This document addresses the need for explicit inclusion of livelihoods within the environment nexus (water-energy-food security), not only responding to literature gaps but also addressing emerging dialogue from existing nexus consortia. We present the first conceptualization of ‘environmental livelihood security’, which combines the nexus perspective with sustainable livelihoods. The geographical focus of this paper is Southeast Asia and Oceania, a region currently wrought by the impacts of a changing climate. Climate change is the primary external forcing mechanism on the environmental livelihood security of communities in Southeast Asia and Oceania which, therefore, forms the applied crux of this paper. Finally, we provide a primer for using geospatial information to develop a spatial framework to enable geographical assessment of environmental livelihood security across the region. We conclude by linking the value of this research to ongoing sustainable development discussions, and for influencing policy agenda

Sustainable development and the water–energy–food nexus: A perspective on livelihoods

AbstractThe water–energy–food nexus is being promoted as a conceptual tool for achieving sustainable development. Frameworks for implementing nexus thinking, however, have failed to explicitly or adequately incorporate sustainable livelihoods perspectives. This is counterintuitive given that livelihoods are key to achieving sustainable development. In this paper we present a critical review of nexus approaches and identify potential linkages with sustainable livelihoods theory and practice, to deepen our understanding of the interrelated dynamics between human populations and the natural environment. Building upon this review, we explore the concept of ‘environmental livelihood security’ – which encompasses a balance between natural resource supply and human demand on the environment to promote sustainability – and develop an integrated nexus-livelihoods framework for examining the environmental livelihood security of a system. The outcome is an integrated framework with the capacity to measure and monitor environmental livelihood security of whole systems by accounting for the water, energy and food requisites for livelihoods at multiple spatial scales and institutional levels. We anticipate this holistic approach will not only provide a significant contribution to achieving national and regional sustainable development targets, but will also be effective for promoting equity amongst individuals and communities in local and global development agendas

Climate Change Adaptation in Post-Disaster Recovery Processes: Flood-Affected Communities in Cambodia and Fiji

By adopting an integrated and participatory action-research approach, this project explores how rural communities living in flood-prone river basins of Cambodia and Fiji respond to increasing variability of flood incidences and other natural hazards under the influence of climate change and other risk factors, such as hydro-electric power development, forest conversion and environmental degradation. Particular emphasis is placed on risk perceptions and adaptive strategies of individuals, families and social groups with regard to regular and catastrophic floods and how the livelihoods of vulnerable groups are affected by floods and other disasters. Our research approach integrates the food, water and energy security nexus with the rural livelihood framework. The objectives of the project are to (1) identify the spatial extent and dynamics of flood hazards as a result of multiple risk factors; (2) determine the various factors that can enhance resilience and adaptive capacities of flood-affected communities in a changing environment, and (3) provide examples of successful community-based flood management and climate change adaptation that can serve as best-practice models for other flood affected communities in the Asia-Pacific region

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Climate adaptation strategies in Fiji: The role of social norms and cultural values

The Fiji Islands in the South Pacific are highly exposed to climate-induced hazards and have experienced several flood and cyclone events in recent years. Drawing on a series of field studies in the lower Ba River Catchment on Fiji’s main island Viti Levu, the objective of this paper is to determine how climate adaptation strategies – employed by indigenous Fijian communities and households – are influenced by socio-cultural values and access to resources, information and power. Our multi-method approach has been conceptually informed by Agrawal and Perrin’s (2008) climate adaptation framework and included semi-structured interviews at the household level, and participatory hazard mapping with diverse focus groups at the community level. Our study finds that due to diverse value-based assessments of livelihood opportunities and climate-related risks, communal and household adaptive strategies can differ widely, even in a very localized cultural context. We also show how decisions to relocate from ‘risky environments’ are influenced by a combination of local power relations, attachment to cultural and social space, and the provision of external assistance. Our findings comment on the need for disaster risk reduction strategies to recognize how different groups and households respond to climate-related events in distinct socially determined ways

Sustainable development and the water–energy–food nexus: a perspective on livelihoods

The water–energy–food nexus is being promoted as a conceptual tool for achieving sustainable development. Frameworks for implementing nexus thinking, however, have failed to explicitly or adequately incorporate sustainable livelihoods perspectives. This is counterintuitive given that livelihoods are key to achieving sustainable development. In this paper we present a critical review of nexus approaches and identify potential linkages with sustainable livelihoods theory and practice, to deepen our understanding of the interrelated dynamics between human populations and the natural environment. Building upon this review, we explore the concept of ‘environmental livelihood security’ – which encompasses a balance between natural resource supply and human demand on the environment to promote sustainability – and develop an integrated nexus-livelihoods framework for examining the environmental livelihood security of a system. The outcome is an integrated framework with the capacity to measure and monitor environmental livelihood security of whole systems by accounting for the water, energy and food requisites for livelihoods at multiple spatial scales and institutional levels. We anticipate this holistic approach will not only provide a significant contribution to achieving national and regional sustainable development targets, but will also be effective for promoting equity amongst individuals and communities in local and global development agenda

Filovirus Virulence in Interferon α/β and γ Double Knockout Mice, and Treatment with Favipiravir

The 2014 Ebolavirus outbreak in West Africa highlighted the need for vaccines and therapeutics to prevent and treat filovirus infections. A well-characterized small animal model that is susceptible to wild-type filoviruses would facilitate the screening of anti-filovirus agents. To that end, we characterized knockout mice lacking α/β and γ interferon receptors (IFNAGR KO) as a model for wild-type filovirus infection. Intraperitoneal challenge of IFNAGR KO mice with several known human pathogenic species from the genus Ebolavirus and Marburgvirus, except Bundibugyo ebolavirus and Taï Forest ebolavirus, caused variable mortality rate. Further characterization of the prototype Ebola virus Kikwit isolate infection in this KO mouse model showed 100% lethality down to a dilution equivalent to 1.0 × 10−1 pfu with all deaths occurring between 7 and 9 days post-challenge. Viral RNA was detectable in serum after challenge with 1.0 × 102 pfu as early as one day after infection. Changes in hematology and serum chemistry became pronounced as the disease progressed and mirrored the histological changes in the spleen and liver that were also consistent with those described for patients with Ebola virus disease. In a proof-of-principle study, treatment of Ebola virus infected IFNAGR KO mice with favipiravir resulted in 83% protection. Taken together, the data suggest that IFNAGR KO mice may be a useful model for early screening of anti-filovirus medical countermeasures

STAT-1 Knockout Mice as a Model for Wild-Type Sudan Virus (SUDV)

Currently there is no FDA-licensed vaccine or therapeutic against Sudan ebolavirus (SUDV) infections. The largest ever reported 2014–2016 West Africa outbreak, as well as the 2021 outbreak in the Democratic Republic of Congo, highlight the critical need for countermeasures against filovirus infections. A well-characterized small animal model that is susceptible to wild-type filoviruses would greatly add to the screening of antivirals and vaccines. Here, we infected signal transducer and activator of transcription-1 knock out (STAT-1 KO) mice with five different wildtype filoviruses to determine susceptibility. SUDV and Marburg virus (MARV) were the most virulent, and caused 100% or 80% lethality, respectively. Zaire ebolavirus (EBOV), Bundibugyo ebolavirus (BDBV), and Taï Forest ebolavirus (TAFV) caused 40%, 20%, and no mortality, respectively. Further characterization of SUDV in STAT-1 KO mice demonstrated lethality down to 3.1 × 101 pfu. Viral genomic material was detectable in serum as early as 1 to 2 days post-challenge. The onset of viremia was closely followed by significant changes in total white blood cells and proportion of neutrophils and lymphocytes, as well as by an influx of neutrophils in the liver and spleen. Concomitant significant fluctuations in blood glucose, albumin, globulin, and alanine aminotransferase were also noted, altogether consistent with other models of filovirus infection. Finally, favipiravir treatment fully protected STAT-1 KO mice from lethal SUDV challenge, suggesting that this may be an appropriate small animal model to screen anti-SUDV countermeasures