Na Koronivalu ni Bā: Upland Settlement during the Last Millennium in the Bā River Valley and Vatia Peninsula, Northern Viti Levu Island, Fiji

Former settlements, now abandoned, are found in inland upland locations on many larger islands in the tropical Pacific. In Fiji, such settlements are known today as koronivalu (war-towns) and, as elsewhere in the region, appear to have been established within the same period during the first half of the last millennium. Twenty-seven koronivalu were mapped for this research in the Bā Valley and nearby Vatia Peninsula, northern Viti Levu Island (Fiji); of these, nine were subject to detailed investigation. All koronivalu are in defensible locations, either with exceptional views across the surrounding landscape or hidden within deep narrow valleys. At all koronivalu, evidence for the consumption of marine shellfish was found, even though the sites are often far from the coast. Twenty-four radiocarbon ages from charcoal and shellfish remains were obtained. A single age around a.d. 700 from the farthest inland site (Koroikewa) appears anomalous. The remainder, once adjusted, suggest that most koronivalu in the study area were established a.d. 1200–1750, perhaps separable into early (a.d. 1200–1450) and later (a.d. 1500–1750) phases. While questions remain about the functions of these koronivalu, the fact that, as elsewhere in Fiji and in other western Pacific Island groups, they appear to have been established within the same period suggests that there is a region-wide explanation for the profound settlement-pattern change this implies. Climate change, perhaps expressed through drought and/or sea-level change, appears the only plausible external forcing mechanism

Coastal Geomorphology of the Beqa and Yanuca Islands, South Pacific Ocean, and Its Significance for the Tectonic History of the Vatulele-Beqa Ridge

Data referring to elevations of emerged shoreline indicators along the coasts of Beqa and Yanuca islands in southern Fiji were collected and indicate the presence of former mean sea levels at elevations (and shoreline names) of 0.96 m (MUAI), 1.93 m (BULl), 2.63 m (MUA2), 4.32 m (MUA3), 5.94 m (MUA4), and 7.79 m (MUA5) above present mean sea level. No dates for shoreline formation or emergence are available directly although age is believed to increase with increasing elevation. Investigations of the Beqa lagoon floor and comparison of shoreline levels between eastern Beqa, western Beqa, Yanuca, and Vatulele island (at the western end of the Vatulele-Beqa Ridge) suggest that downfaulting along faults and grabens trending a little west of north has occurred both during and since the time of shoreline emergence. Uplift related perhaps to either compression of the area between the Kadavu Trench (Hunter Fracture Zone) to the south and the Fiji Fracture Zone to the north or the renewal of northward underplating along the Kadavu Trench is believed to be responsible for shoreline emergence, which was probably contemporary along the whole Vatulele-Beqa Ridge and occurred during-the middle and late Quaternary

Peripherality as key to understanding opportunities and needs for effective and sustainable climate - change adaptation: a case study from Viti Levu Island, Fiji

A study of various defining aspects of 11 rural communities along the cross-island road on Viti Levu (Fiji) shows diversity attributable largely to their peripherality, proxied by distance along this 200-km long road. Strong relationships are found between peripherality and both community size and the dependency ratio (percent of young/old dependents), as well as traditional medicine usage (and percent traditional healers), and autonomous community coping after disasters. Two measures are calculated to capture community autonomy, both of which proxy peripherality. Results show the usefulness of peripherality as a way of measuring community diversity in developing-country contexts. Peripherality also correlates with community autonomy, more-peripheral communities having greater autonomous coping abilities/capacity than near-core (less-peripheral) communities. Results also show the unhelpfulness of the default ‘“one-size-fits-all’” approach to communities implicit in many external assistance programs. Yet while traditional coping in such communities may not be able to fully overcome future climate-change challenges, the conservation of the traditional knowledge underpinning this should be encouraged, mainly because of the likelihood that external funding for future adaptation in such communities will be inadequate. The best hope for effective and sustainable adaptation to future climate change, focused on sustaining livelihoods, lies in strengthening autonomous community coping

Raman Quantum Memory with Built-In Suppression of Four-wave Mixing Noise

Quantum memories are essential for large-scale quantum information networks. Along with high efficiency, storage lifetime and optical bandwidth, it is critical that the memory add negligible noise to the recalled signal. A common source of noise in optical quantum memories is spontaneous four-wave mixing. We develop and implement a technically simple scheme to suppress this noise mechanism by means of quantum interference. Using this scheme with a Raman memory in warm atomic vapour we demonstrate over an order of magnitude improvement in noise performance. Furthermore we demonstrate a method to quantify the remaining noise contributions and present a route to enable further noise suppression. Our scheme opens the way to quantum demonstrations using a broadband memory, significantly advancing the search for scalable quantum photonic networks.Comment: 6 pages, 5 figures plus Supplementary Materia

Value of traditional oral narratives in building climate-change resilience: insights from rural communities in Fiji

In the interests of improving engagement with Pacific Island communities to enable development of effective and sustainable adaptation strategies to climate change, we looked at how traditional oral narratives in rural/peripheral Fiji communities might be used to inform such strategies. Interviews were undertaken and observations made in 27 communities; because the custodians of traditional knowledge were targeted, most interviewees were 70-79 years old. The view that oral traditions, particularly those referring to environmental history and the observations/precursors of environmental change, were endangered was widespread and regretted. Interviewees’ personal experiences of extreme events (natural disasters) were commonplace but no narratives of historical (unwitnessed by interviewees) events were found. In contrast, experiences of previous village relocations attributable (mainly) to environmental change were recorded in five communities while awareness of environmentally driven migration was more common. Questions about climate change elicited views dominated by religious/fatalist beliefs but included some more pragmatic ones; the confusion of climate change with climate variability, which is part of traditional knowledge, was widespread. The erosion of traditional environmental knowledge in the survey communities over recent decades has been severe and is likely to continue apace, which will reduce community self-sufficiency and resilience. Ways of conserving such knowledge and incorporating it into adaptation planning for Pacific Island communities in rural/peripheral locations should be explored

Economic evaluation of short treatment for multidrugresistant tuberculosis, Ethiopia and South Africa : the STREAM trial

OBJECTIVE STREAM was a phase-III non-inferiority randomised controlled trial (RCT) to evaluate a shortened regimen for multi-drug resistant tuberculosis (MDR-TB), and included the first-ever within-trial economic evaluation of such regimens, reported here. METHODS We compared the costs of ‘Long’ (20-22 months) and ‘Short’ (9-11 months) regimens in Ethiopia and South Africa. Cost data were collected from trial participants, and health system costs estimated using ‘bottom-up’ and ‘top-down’ costing approaches. A cost-effectiveness analysis was conducted with the trial primary outcome as the measure of effectiveness, including a probabilistic sensitivity analysis (PSA) to illustrate decision uncertainty. FINDINGS The Short-regimen reduced healthcare costs per case by 21% in South Africa (US$8,341 Long vs US$6,619 Short) and 25% in Ethiopia (US$6,097 Long vs US$4,552 Short). The largest component of this saving was medication in South Africa (67%) and social support in Ethiopia (35%). In Ethiopia, participants on the Short-regimen reported reductions in dietary supplementation expenditure (US$225 per case (95$13 (95%CI 11-14), South Africa US$64 (95$19,000 (Ethiopia) or <US$14,500 (South Africa). CONCLUSION The Short-regimen provided substantial health system cost savings and reduced financial burden on participants. Shorter regimens are likely to be cost-effective in most settings, and an effective strategy to support the WHO goal of eliminating catastrophic costs in T

Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis

Supported by the Global Alliance for TB Drug Development with support from the Bill and Melinda Gates Foundation, the European and Developing Countries Clinical Trials Partnership, U.S. Agency for International Development, U.K. Department for International Development, Directorate General for International Cooperation of the Netherlands, Irish Aid, Australia Department of Foreign Affairs and Trade, and National Institutes of Health, AIDS Clinical Trials Group and by grants from the National Institute of Allergy and Infectious Diseases (NIAID) (UM1AI068634, UM1 AI068636, and UM1AI106701) and by NIAID grants to the University of KwaZulu Natal, South Africa, AIDS Clinical Trials Group (ACTG) site 31422 (1U01AI069469); to the Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, South Africa, ACTG site 12301 (1U01AI069453); and to the Durban International Clinical Trials Unit, South Africa, ACTG site 11201 (1U01AI069426); Bayer Healthcare for the donation of moxifloxacin; and Sanofi for the donation of rifampin.Background: Early-phase and preclinical studies suggest that moxifloxacin-containing regimens could allow for effective 4-month treatment of uncomplicated, smear-positive pulmonary tuberculosis. Methods: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to test the noninferiority of two moxifloxacin-containing regimens as compared with a control regimen. One group of patients received isoniazid, rifampin, pyrazinamide, and ethambutol for 8 weeks, followed by 18 weeks of isoniazid and rifampin (control group). In the second group, we replaced ethambutol with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (isoniazid group), and in the third group, we replaced isoniazid with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (ethambutol group). The primary end point was treatment failure or relapse within 18 months after randomization. Results: Of the 1931 patients who underwent randomization, in the per-protocol analysis, a favorable outcome was reported in fewer patients in the isoniazid group (85%) and the ethambutol group (80%) than in the control group (92%), for a difference favoring the control group of 6.1 percentage points (97.5% confidence interval [CI], 1.7 to 10.5) versus the isoniazid group and 11.4 percentage points (97.5% CI, 6.7 to 16.1) versus the ethambutol group. Results were consistent in the modified intention-to-treat analysis and all sensitivity analyses. The hazard ratios for the time to culture negativity in both solid and liquid mediums for the isoniazid and ethambutol groups, as compared with the control group, ranged from 1.17 to 1.25, indicating a shorter duration, with the lower bounds of the 95% confidence intervals exceeding 1.00 in all cases. There was no significant difference in the incidence of grade 3 or 4 adverse events, with events reported in 127 patients (19%) in the isoniazid group, 111 (17%) in the ethambutol group, and 123 (19%) in the control group. Conclusions: The two moxifloxacin-containing regimens produced a more rapid initial decline in bacterial load, as compared with the control group. However, noninferiority for these regimens was not shown, which indicates that shortening treatment to 4 months was not effective in this setting. (Funded by the Global Alliance for TB Drug Development and others; REMoxTB ClinicalTrials.gov number, NCT00864383.)Publisher PDFPeer reviewe

A comparison of liquid and solid culture for determining relapse and durable cure in phase III TB trials for new regimens

Supported by the Global Alliance for TB Drug Development with support from the Bill & Melinda Gates Foundation, the Medical Research Council (MC_UU_12023/27), the European and Developing Countries Clinical Trials Partnership (grant IP.2007.32011.011), the US Agency for International Development, the UK Department for International Development, the Directorate General for International Cooperation of the Netherlands, Irish Aid, the Australia Department of Foreign Affairs and Trade and National Institutes of Health, AIDS Clinical Trials Group and by grants from the National Institute of Allergy and Infectious Diseases (NIAID) (UM1AI068634, UM1 AI068636 and UM1AI106701) and by NIAID grants to the University of KwaZulu Natal, South Africa, AIDS Clinical Trials Group (ACTG) site 31422 (1U01AI069469); to the Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, South Africa, ACTG site 12301 (1U01AI069453); and to the Durban International Clinical Trials Unit, South Africa, ACTG site 11201 (1U01AI069426); Bayer Healthcare for the donation of moxifloxacin; and Sanofi for the donation of rifampin. Additional grants were from Chief Scientist Office, Scottish Government, British Society of Antimicrobial Chemotherapy.Background:  Tuberculosis kills more people than any other infectious disease, and new regimens are essential. The primary endpoint for confirmatory phase III trials for new regimens is a composite outcome that includes bacteriological treatment failure and relapse. Culture methodology is critical to the primary trial outcome. Patients in clinical trials can have positive cultures after treatment ends that may not necessarily indicate relapse, which was ascribed previously to laboratory cross-contamination or breakdown of old lesions. Löwenstein-Jensen (LJ) medium was the previous standard in clinical trials, but almost all current and future trials will use the Mycobacteria Growth Indicator Tube (MGIT) system due to its simplicity and consistency of use, which will affect phase III trial results. LJ was used for the definition of the primary endpoint in the REMoxTB trial, but every culture was also inoculated in parallel into the MGIT system. The data from this trial, therefore, provide a unique opportunity to investigate and compare the incidence of false ‘isolated positives’ in liquid and solid media and their potential impact on the primary efficacy results. Methods:  All post-treatment positive cultures were reviewed in the REMoxTB clinical trial. Logistic regression models were used to model the incidence of isolated positive cultures on MGIT and LJ. Results:  A total of 12,209 sputum samples were available from 1652 patients; cultures were more often positive on MGIT than LJ. In 1322 patients with a favourable trial outcome, 126 (9.5%) had cultures that were positive in MGIT compared to 34 (2.6%) patients with positive cultures on LJ. Among patients with a favourable outcome, the incidence of isolated positives on MGIT differed by study laboratory (p < 0.0001) with 21.9% of these coming from one laboratory investigating only 4.9% of patients. No other baseline factors predicted isolated positives on MGIT after adjusting for laboratory. There was evidence of clustering of isolated positive cultures in some patients even after adjusting for laboratory, p < 0.0001. The incidence of isolated positives on MGIT did not differ by treatment arm (p = 0.845, unadjusted). Compared to negative MGIT cultures, positive MGIT cultures were more likely to be associated with higher grade TB symptoms reported within 7 days either side of sputum collection in patients with an unfavourable primary outcome (p < 0.0001) but not in patients with a favourable outcome (p = 0.481). Conclusions:  Laboratory cross-contamination was a likely cause of isolated positive MGIT cultures which were clustered in some laboratories. Certain patients had repeated positive MGIT cultures that did not meet the definition of a relapse. This pattern was too common to be explained by cross-contamination only, suggesting that host factors were also responsible. We conclude that MGIT can replace LJ in phase III TB trials, but there are implications for the definition of the primary outcome and patient management in trials in such settings. Most importantly, the methodologies differ in the incidence of isolated positives and in their capacity for capturing non-tuberculosis mycobacteria. It emphasises the importance of effective medical monitoring after treatment ends and consideration of clinical signs and symptoms for determining treatment failure and relapse.Publisher PDFPeer reviewe