Assessing the Twinning Model in the Rwandan Human Resources for Health Program: Goal Setting, Satisfaction and Perceived Skill Transfer

Because of the shortage of health professionals, particularly in specialty areas, Rwanda initiated the Human Resources for Health (HRH) Program. In this program, faculty from United States teaching institutions (USF) twin with Rwandan Faculty (RF) to transfer skills. This paper assesses the twinning model, exploring USF and RF goal setting, satisfaction and perceptions of the effectiveness of skill transfer within the twinning model

First insights into the phylogenetic diversity of Mycobacterium tuberculosis in Nepal

BACKGROUND: Tuberculosis (TB) is a major public health problem in Nepal. Strain variation in Mycobacterium tuberculosis may influence the outcome of TB infection and disease. To date, the phylogenetic diversity of M. tuberculosis in Nepal is unknown. METHODS AND FINDINGS: We analyzed 261 M. tuberculosis isolates recovered from pulmonary TB patients recruited between August 2009 and August 2010 in Nepal. M. tuberculosis lineages were determined by single nucleotide polymorphisms (SNP) typing and spoligotyping. Drug resistance was determined by sequencing the hot spot regions of the relevant target genes. Overall, 164 (62.8%) TB patients were new, and 97 (37.2%) were previously treated. Any drug resistance was detected in 50 (19.2%) isolates, and 16 (6.1%) were multidrug-resistant. The most frequent M. tuberculosis lineage was Lineage 3 (CAS/Delhi) with 106 isolates (40.6%), followed by Lineage 2 (East-Asian lineage, includes Beijing genotype) with 84 isolates (32.2%), Lineage 4 (Euro-American lineage) with 41 (15.7%) isolates, and Lineage 1 (Indo-Oceanic lineage) with 30 isolates (11.5%). Based on spoligotyping, we found 45 different spoligotyping patterns that were previously described. The Beijing (83 isolates, 31.8%) and CAS spoligotype (52, 19.9%) were the dominant spoligotypes. A total of 36 (13.8%) isolates could not be assigned to any known spoligotyping pattern. Lineage 2 was associated with female sex (adjusted odds ratio [aOR] 2.58, 95% confidence interval [95% CI] 1.42-4.67, p = 0.002), and any drug resistance (aOR 2.79; 95% CI 1.43-5.45; p = 0.002). We found no evidence for an association of Lineage 2 with age or BCG vaccination status. CONCLUSIONS: We found a large genetic diversity of M. tuberculosis in Nepal with representation of all four major lineages. Lineages 3 and 2 were dominating. Lineage 2 was associated with clinical characteristics. This study fills an important gap on the map of the M. tuberculosis genetic diversity in the Asian reg

Environmental footprint family to address local to planetary sustainability and deliver on the SDGs

The number of publications on environmental footprint indicators has been growing rapidly, but with limited efforts to integrate different footprints into a coherent framework. Such integration is important for comprehensive understanding of environmental issues, policy formulation and assessment of trade-offs between different environmental concerns. Here, we systematize published footprint studies and define a family of footprints that can be used for the assessment of environmental sustainability. We identify overlaps between different footprints and analyse how they relate to the nine planetary boundaries and visualize the crucial information they provide for local and planetary sustainability. In addition, we assess how the footprint family delivers on measuring progress towards Sustainable Development Goals (SDGs), considering its ability to quantify environmental pressures along the supply chain and relating them to the water-energy-food-ecosystem (WEFE) nexus and ecosystem services. We argue that the footprint family is a flexible framework where particular members can be included or excluded according to the context or area of concern. Our paper is based upon a recent workshop bringing together global leading experts on existing environmental footprint indicators

Nitrogen Challenges and Opportunities for Agricultural and Environmental Science in India

In the last six decades, the consumption of reactive nitrogen (Nr) in the form of fertilizer in India has been growing rapidly, whilst the nitrogen use efficiency (NUE) of cropping systems has been decreasing. These trends have led to increasing environmental losses of Nr, threatening the quality of air, soils, and fresh waters, and thereby endangering climate-stability, ecosystems, and human-health. Since it has been suggested that the fertilizer consumption of India may double by 2050, there is an urgent need for scientific research to support better nitrogen management in Indian agriculture. In order to share knowledge and to develop a joint vision, experts from the UK and India came together for a conference and workshop on “Challenges and Opportunities for Agricultural Nitrogen Science in India.” The meeting concluded with three core messages: (1) Soil stewardship is essential and legumes need to be planted in rotation with cereals to increase nitrogen fixation in areas of limited Nr availability. Synthetic symbioses and plastidic nitrogen fixation are possibly disruptive technologies, but their potential and implications must be considered. (2) Genetic diversity of crops and new technologies need to be shared and exploited to reduce N losses and support productive, sustainable agriculture livelihoods. Móring et al. Nitrogen Challenges and Opportunities (3) The use of leaf color sensing shows great potential to reduce nitrogen fertilizer use (by 10–15%). This, together with the usage of urease inhibitors in neem-coated urea, and better management of manure, urine, and crop residues, could result in a 20–25% improvement in NUE of India by 2030

The value of manure - Manure as co-product in life cycle assessment

Research ArticleLivestock production is important for food security, nutrition, and landscape maintenance, but it is associated with several environmental impacts. To assess the risk and benefits arising from livestock production, transparent and robust indicators are required, such as those offered by life cycle assessment. A central question in such approaches is how environmental burden is allocated to livestock products and to manure that is re-used for agricultural production. To incentivize sustainable use of manure, it should be considered as a co-product as long as it is not disposed of, or wasted, or applied in excess of crop nutrient needs, in which case it should be treated as a waste. This paper proposes a theoretical approach to define nutrient requirements based on nutrient response curves to economic and physical optima and a pragmatic approach based on crop nutrient yield adjusted for nutrient losses to atmosphere and water. Allocation of environmental burden to manure and other livestock products is then based on the nutrient value from manure for crop production using the price of fertilizer nutrients. We illustrate and discuss the proposed method with two case studiesinfo:eu-repo/semantics/publishedVersio

A framework to assess life cycle nitrogen use efficiency along livestock supply chains

to the significant contribution of the livestock sector to nitrogen (N) losses, improving N use efficiency (NUE-N) along the life cycle of livestock products is one of the important step towards increasing production performance and reduction of its environmental impacts. We developed a comprehensive framework and novel metrics to assess NUE-N along the livestock supply chain (i.e. -to-primary- ). Our framework was illustrated for the case study of mixed dairy production in Western Europe. Metrics developed included the life cycle NUE-N; total N losses to the environment per unit of N in the final co-products; and the N hotspot index (NHI-N), defined as the relative evenness of the N losses along the supply chain. Averaged across countries, the life cycle NUE-N was 36¿3.1%, N losses were 6.6¿1.8 g N per g N in the final animal co-products, and NHI-N of 1.0¿0.1. The N losses and NHI-N also revealed large differences in hotspots across supply chains, and allowed to identify priority areas where improvement actions are necessary to enhance the efficiency. We show that the combination of life cycle NUE-N, N losses and NHI-N gives valuable information to guide N management in livestock supply chain

Nitrogen pollution policy beyond the farm

Nitrogen is a crucial input to food production and yet its oversupply in many parts of the world contributes to a number of environmental problems. Most policies dedicated to reducing agricultural nitrogen pollution focus on changing farmer behaviour. However, farm-level policies are challenging to implement and farmers are just one of several actors in the agri-food chain. The activities of other actors — from fertilizer manufacturers to wastewater treatment companies — can also impact nitrogen losses at the farm level and beyond. Consequently, policymakers have a broader range of policy options than traditionally thought to address nitrogen pollution from field to fork. Inspired by the concept of full-chain nitrogen use efficiency, this Perspective introduces the major actors common in agri-food chains from a nitrogen standpoint, identifies nitrogen policies that could be targeted towards them and proposes several new criteria to guide ex-ante analysis of the feasibility and design of different policy interventions. Sustainably feeding ten billion people by 2050 will require fundamental changes in the global food system — a broad portfolio of policy options and a framework for how to select them is essential