Territorial and Trans-Territorial Community-Institutional Partnerships to Build Healthier Communities in Developing Countries: Lessons Learned from a Dominican Republic Low-Resource Community

This descriptive case study examines the value of multi-level partnerships to foster a Building a Healthier Community (BHC) process in a low-resource community in the Dominican Republic. Partnerships developed for this BHC project were categorized under the Global Health Education Framework. Partners included a U.S-based university (trans-territorial partnership), a Dominican university, and various governmental, non-governmental, and community organizations in the Dominican Republic (territorial partnerships). Las Malvinas BHC project is an interdisciplinary and holistic approach to community health and well-being improvement that supports community members’ efforts and at the same time promotes participating students’ global health competence. Strategies, methods, the value of community-institutional partnerships, lessons learned, challenges and opportunities are discussed. Partnerships facilitated identification of public health priorities and strategies to improve community’s health and well-being. Lessons learned included the importance of engaging community member’s voices and talents, the value of building relationships based on trust, the relevance of community capacity building, the role of the government in achieving outcomes in a low-resource context, and the importance of incorporating community assets in the process. Important challenges included a continuous availability of governmental funds and resources, community members’ time constraints and changes in community structure. Opportunities included the value of partnerships in promoting the exchange of assets, theories, and innovation in order to identify and begin remedying social determinants of health affecting Las Malvinas. Process outcomes resulting from this project demonstrate the value of mutually beneficial community-based participatory research and intervention alliances at the territorial and trans-territorial dimensions

The utility of convection-permitting ensembles for the prediction of stationary convective bands

This study examines convection-permitting numerical simulations of four cases of terrain-locked quasi-stationary convective bands over the UK. For each case, a 2.2-km grid-length 12-member ensemble and 1.5-km grid-length deterministic forecast are analyzed, each with two different initialization times. Object-based verification is applied to determine whether the simulations capture the structure, location, timing, intensity and duration of the observed precipitation. These verification diagnostics reveal that the forecast skill varies greatly between the four cases. Although the deterministic and ensemble simulations captured some aspects of the precipitation correctly in each case, they never simultaneously captured all of them satisfactorily. In general, the models predicted banded precipitation accumulations at approximately the correct time and location, but the precipitating structures were more cellular and less persistent than the coherent quasi-stationary bands that were observed. Ensemble simulations from the two different initialization times were not significantly different, which suggests a potential benefit of time-lagging subsequent ensembles to increase ensemble size. The predictive skill of the upstream larger-scale flow conditions and the simulated precipitation on the convection-permitting grids were strongly correlated, which suggests that more accurate forecasts from the parent ensemble should improve the performance of the convection-permitting ensemble nested within it

Climatology of size, shape and intensity of precipitation features over Great Britain and Ireland

A climatology of precipitation features (or objects) from the Great Britain and Ireland radar-derived precipitation mosaic from 2006–2015 is constructed, with features defined as contiguous areas of nonzero precipitation rates. Over the ten years, there are 54,811,747 non-unique precipitating features over 100 km2 in area, with a median precipitation-feature area of 249 km2, median major axis length of 29.2 km, median aspect ratio of 2.0, median feature mean precipitation rate of 0.49 mm h-1, and median feature maximum precipitation rate of 2.4 mm h-1. Small-scale precipitating systems are most common, but larger systems exceeding 10,000 km2 contribute close to 70% of the annual precipitation across the study region. Precipitation feature characteristics are sensitive to changes in annual and diurnal environment, with feature intensities peaking during the afternoon in summer and the largest precipitation features occurring during winter. Precipitation intensities less than 5 mm h-1 comprise 97.3% of all precipitation occurrence and contribute 83.6% of the total precipitation over land. Banded-precipitation features (defined as precipitation features with aspect ratio at least 3:1 and major axis length at least 100 km) comprise 3% of all precipitation features by occurrence, but contribute 23.7% of the total precipitation. Mesoscale banded features (defined as banded-precipitation features with major axis length at least 100 km and total area not exceeding 10,000 km2) and mesoscale convective banded features (defined as banded-precipitation features with at least 100 km2 of precipitation rates exceeding 10 mm h-1) are most prevalent in southwestern England with mesoscale convective banded features contributing up to 2% of precipitation

Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda

BACKGROUND: The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda. METHOD: The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. RESULTS: At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. CONCLUSION: Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment

Climatology of banded precipitation over the contiguous United States

A climatology of banded-precipitation features over the contiguous United States from 2003–2014 is constructed. A band is defined as a precipitation feature with a major axis of 100 km or greater and a ratio of major axis length to minor axis length (hereafter, aspect ratio) of 3:1 or greater. By applying an automated feature-based detection algorithm to composite radar imagery, a database of 48,916,844 precipitation features is created, of which 7,213,505 (14.8%) are bands. This algorithm produces the first climatology of precipitation bands over the contiguous United States. Banded precipitation occurrence is broadly similar to total precipitation occurrence, with a maximum of 175 hours of banded precipitation annually over the Ohio River Valley. In the warm season, there is a strong diurnal signature associated with convective storm development for both precipitation feature area and total area covered by precipitation, but little diurnal signature in aspect ratio. A strong west-east gradient in both precipitation occurrence and banded precipitation occurrence exist, as areas west of the Rockies receive less frequent precipitation, which is much less likely to be banded. East of the Rockies, precipitation features are banded 30% of the time, versus 10–15% west of the Rockies. Areas downwind of the Great Lakes show prominent late autumn and winter maxima in banded precipitation associated with lake-effect snowbands. Local maxima of banded precipitation percentage occur in the Dakotas and east of the Colorado Rockies during winter. Although banded-precipitation features comprise only 14.8% of all precipitation features, they contribute 21.9% of the annual precipitation occurrence over the contiguous United States

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London