Linkages among forest, water, and wildlife: a case study from Kalapani community forest in Lamahi bottleneck area in Terai Arc Landscape.

Forest and water are important entities for sustaining life on earth. In a terrestrial ecosystem, linkages between the entities creates a mosaic benefiting the wildlife by creating the suitable habitat. In turn, communities get benefits stemming up from ecosystem services such as fodder, fuelwood, and water. We present a case study from a forest restoration project to assess the linkages between forest, water and wildlife across Lamahi bottleneck area in Terai Arc Landscape. We used combination of surveys such as forest area and canopy cover change (2001-2016) analysis followed by household questionnaire, water hole, camera trapping including process documentation. Forest area has increased by ~20 km2 in last 16 yrs. followed by number of water spouts along the identified tributaries. Water spouts are conserved in the form of conservation pond by the communities living downstream and utilized in the vegetable farming. Communities have benefited financially (~ US$ 1,252) contributing to their income level from the sale of fresh season vegetables in nearby market. Camera trap survey including the assessment of historical records showed presence of wildlife including elephant, hyena and other small carnivores in and around bottleneck forest. Both, motivation and enthusiastic support from local communities followed by the conducive government policies led to improve condition of natural resources over the period. This has also created a mosaic habitat for wildlife forming functional connectivity along the linear Terai Arc Landscape

Promoting gender equality across the sustainable development goals

Gender issues, and gender equality in particular, can be regarded as cross-cutting issues in the implementation of the Sustainable Development Goals (SDGs), even though it is unclear how they are taken into account. This study addresses this information gap by performing an assessment of the emphasis on gender issues across all the other 16 SDGs, in addition to SDG5, through a literature review and case study analysis, the basis for the newly developed framework, highlighting specific actions associated to each SDG. The 13 countries addressed in the 16 case studies include China, India, or Australia and illustrate the inclusion of SDG5 into the SDGs. Using an SDG matrix, the SDG targets are analysed. Those where an emphasis on gender equality is important in allowing them to be achieved are listed. The novelty of our approach resides in offering an in-depth analysis of how gender issues interact with the other SDGs, proposing a new analysis framework clearly identifying SDGs 1, 4, 11, 12, 14 and 16 demanding further attention for successful SD gender implementation and illustrating specific areas where further actions may be necessary, which may be used by policy-makers, raising further awareness on gender equality contribution to achieve the SDGs. A set of recommendations aimed at placing gender matters more centrally in the SDGs delivery are presented as a final contribution. These focus on the need for greater awareness and attention to good practices, to achieve successful implementation initiatives.peer-reviewe

Promoting gender equality across the sustainable development goals.

Gender issues, and gender equality in particular, can be regarded as cross-cutting issues in the implementation of the Sustainable Development Goals (SDGs), even though it is unclear how they are taken into account. This study addresses this information gap by performing an assessment of the emphasis on gender issues across all the other 16 SDGs, in addition to SDG5, through a literature review and case study analysis, the basis for the newly developed framework, highlighting specific actions associated to each SDG. The 13 countries addressed in the 16 case studies include China, India, or Australia and illustrate the inclusion of SDG5 into the SDGs. Using an SDG matrix, the SDG targets are analysed. Those where an emphasis on gender equality is important in allowing them to be achieved are listed. The novelty of our approach resides in offering an in-depth analysis of how gender issues interact with the other SDGs, proposing a new analysis framework clearly identifying SDGs 1, 4, 11, 12, 14 and 16 demanding further attention for successful SD gender implementation and illustrating specific areas where further actions may be necessary, which may be used by policy-makers, raising further awareness on gender equality contribution to achieve the SDGs. A set of recommendations aimed at placing gender matters more centrally in the SDGs delivery are presented as a final contribution. These focus on the need for greater awareness and attention to good practices, to achieve successful implementation initiatives. Supplementary Information: The online version contains supplementary material available at 10.1007/s10668-022-02656-1

Epicardial cells derived from human embryonic stem cells augment cardiomyocyte-driven heart regeneration.

The epicardium and its derivatives provide trophic and structural support for the developing and adult heart. Here we tested the ability of human embryonic stem cell (hESC)-derived epicardium to augment the structure and function of engineered heart tissue in vitro and to improve efficacy of hESC-cardiomyocyte grafts in infarcted athymic rat hearts. Epicardial cells markedly enhanced the contractility, myofibril structure and calcium handling of human engineered heart tissues, while reducing passive stiffness compared with mesenchymal stromal cells. Transplanted epicardial cells formed persistent fibroblast grafts in infarcted hearts. Cotransplantation of hESC-derived epicardial cells and cardiomyocytes doubled graft cardiomyocyte proliferation rates in vivo, resulting in 2.6-fold greater cardiac graft size and simultaneously augmenting graft and host vascularization. Notably, cotransplantation improved systolic function compared with hearts receiving either cardiomyocytes alone, epicardial cells alone or vehicle. The ability of epicardial cells to enhance cardiac graft size and function makes them a promising adjuvant therapeutic for cardiac repair.: This work was supported by the British Heart Foundation (BHF; Grants NH/11/1/28922, G1000847, FS/13/29/30024 and FS/18/46/33663), Oxford-Cambridge Centre for Regenerative Medicine (RM/13/3/30159), the UK Medical Research Council (MRC) and the Cambridge Hospitals National Institute for Health Research Biomedical Research Centre funding (SS), as well as National Institutes of Health Grants P01HL094374, P01GM081619, R01HL12836 and a grant from the Fondation Leducq Transatlantic Network of Excellence (CEM). J.B. was supported by a Cambridge National Institute for Health Research Biomedical Research Centre Cardiovascular Clinical Research Fellowship and subsequently, by a BHF Studentship (Grant FS/13/65/30441). DI received a University of Cambridge Commonwealth Scholarship. LG is supported by BHF Award RM/l3/3/30159 and LPO is funded by a Wellcome Trust Fellowship (203568/Z/16/Z). NF was supported by BHF grants RG/13/14/30314. NL was supported by the Biotechnology and Biological Sciences Research Council (Institute Strategic Programmes BBS/E/B/000C0419 and BBS/E/B/000C0434). SS and MB were supported by the British Heart Foundation Centre for Cardiovascular Research Excellence. Core support was provided by the Wellcome-MRC Cambridge Stem Cell Institute (203151/Z/16/Z), The authors thank Osiris for provision of the primary mesenchymal stem cells (59

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Engineering a Novel Device to Implement Afterload on Human Stem Cell-Derived Cardiac Tissues

Thesis (Master's)--University of Washington, 2015Cardiac tissue engineering is a promising approach towards regenerating healthy myocardium and restoring the function of infarcted hearts. Using human embryonic stem cell (hESC) derived cardiomyocytes seeded in a collagen or fibrin scaffold, we have previously been able to generate engineered heart tissues (EHTs) that spontaneously contract, but with an amplitude that is far inferior to that of the native myocardium. In order to improve tissue maturation, our goal is to exercise and strengthen EHTs by applying the same mechanical load that the left ventricle faces during contractions—cardiac afterload. My investigation focuses on designing, building, and optimizing a device to apply cardiac afterload on hESC-EHTs. The afterload system involves anchoring tissues between two flexible posts made from polydimethylsiloxane: a rigid post that positions the tissue, and a flexible post containing a neodymium cube magnet that can be manipulated by an external bar magnet. The device is capable of providing a tunable resistance to tissue contractions that models the levels of afterload occurring in the developing heart at particular time points. We tested the load and rate dependency of afterload conditioning on constructs and found that tissues treated with afterload displayed 12.5-fold higher active stresses compared to unloaded controls, and were comparable with tissues undergoing isometric contractions (i.e. infinite afterload). The afterload device has provided us with an insight into the role of mechanical stimuli in promoting the maturation of hESC-EHTs. Our findings suggest that both static loads at 2 and 4 kPa, and steady increases in resistive loads from 0 to 8 kPa do not promote tissue contractility compared with isometric controls. Future work includes testing different static and dynamic loading regimes to identify the optimum level of afterload to promote construct maturation. In summary, we were able to engineer a novel system that applies physiological levels of afterload onto hESC-EHTs. With this new system, we performed the first studies to investigate the role of afterload conditioning in promoting the maturation of hESC-EHTs

From birth till palatoplasty: Prosthetic procedural limitations and safeguarding infants with palatal cleft

The most imminent issue to be addressed in a child born with cleft lip and/or palate is restoration of normal feeding. Early surgical treatment for cleft repair is crucial but may need to be postponed until certain age and weight gain is attained in an infant. When other feeding interventions fail in these children, prosthetic obturation of the defect with feeding instructions in the interim period is indicated to ward off the prevailing concerns. However, the entire prosthetic management presents a significant challenge with respect to the child's age, scope of iatrogenic injury to the delicate oral tissues, and potential for life-threatening situation during the procedures. This article draws attention toward preemptive measures which should be undertaken in the clinical setting during the fabrication of obturator to ascertain a desirable outcome without experiencing a grave complication that may arise due to ignorance and/or lack of facilities

Presentation of GIST as jejuno-jejunal intussusception

Gastrointestinal stromal tumours (GISTs) are rare tumour. It comprises 0.2% of gastrointestinal tumours and only 0.04% of small intestinal tumours. Usually this tumour is found in people in their 60s.These tumours can be found anywhere in the gastrointestinal tract but most commonly found in the stomach (40–60%). Patients with GISTs usually have vague and nonspecific symptoms. We present a 17year-old with complain of abdominal pain, distension, and few episodes of vomiting. All laboratory investigations were normal. The ultrasonography (USG) and computed tomography (CT) were suggestive of jejuno-jejunal intussusception. The patient had emergency exploratory laparotomy with resection of the segment with five cm healthy margin, and end to end anastomosis. Patient was discharged after 4 days and remains well. This case report highlights the rarity of GISTs in the concern of age (17 year old), site (Jejunum) as well as presentation (intussusception)