South Africa\u27s National Credit Act: A Possible Model for the Proper Role of Interest Rate Ceilings for Microfinance

This comment will discuss the current debate regarding the proper role of interest rate ceilings in microfinance and how the South African National Credit Act should serve as a model for future studies of microcredit systems in developing countries. Part II will discuss the controversy over interest rate ceilings in microfinance, setting concerns regarding the effect of ceilings on the viability of microfinance institutions against the need to protect marginalized consumers from predatory lending. Part III will analyze various alternatives to usury laws that microfinance experts have proposed, with an emphasis on supervisory and regulatory systems as the most promising option. Part IV will discuss South Africa\u27s National Credit Act of 2005, a sophisticated supervisory and regulatory system which the South African government enacted as a response to decades of ineffective policies regarding usury laws. The comment concludes by explaining how the new South African model attempts to resolve many of the issues expressed in Parts II and III, and if successful, may provide a critical example of how interest rate ceilings and microfinance can co-exist in a symbiotic relationship

South Africa\u27s National Credit Act: A Possible Model for the Proper Role of Interest Rate Ceilings for Microfinance

This comment will discuss the current debate regarding the proper role of interest rate ceilings in microfinance and how the South African National Credit Act should serve as a model for future studies of microcredit systems in developing countries. Part II will discuss the controversy over interest rate ceilings in microfinance, setting concerns regarding the effect of ceilings on the viability of microfinance institutions against the need to protect marginalized consumers from predatory lending. Part III will analyze various alternatives to usury laws that microfinance experts have proposed, with an emphasis on supervisory and regulatory systems as the most promising option. Part IV will discuss South Africa\u27s National Credit Act of 2005, a sophisticated supervisory and regulatory system which the South African government enacted as a response to decades of ineffective policies regarding usury laws. The comment concludes by explaining how the new South African model attempts to resolve many of the issues expressed in Parts II and III, and if successful, may provide a critical example of how interest rate ceilings and microfinance can co-exist in a symbiotic relationship

In vitro inhibition and reversal of Plasmodium falciparum cytoadherence to endothelium by monoclonal antibodies to ICAM-1 and CD36

Background Sequestration of parasitized red blood cells from the peripheral circulation during an infection with Plasmodium falciparum is caused by an interaction between the parasite protein PfEMP1 and receptors on the surface of host endothelial cells, known as cytoadherence. Several lines of evidence point to a link between the pathology of severe malaria and cytoadherence, therefore blocking adhesion receptors involved in this process could be a good target to inhibit pRBC sequestration and prevent disease. In a malaria endemic setting this is likely to be used as an adjunct therapy by reversing existing cytoadherence. Two well-characterized parasite lines plus three recently derived patient isolates were tested for their cytoadherence to purified receptors (CD36 and ICAM-1) as well as endothelial cells. Monoclonal antibodies against human CD36 and ICAM-1 were used to inhibit and reverse infected erythrocyte binding in static and flow-based adhesion assays. Results Anti-ICAM-1 and CD36 monoclonal antibodies were able to inhibit and reverse P. falciparum binding of lab and recently adapted patient isolates in vitro. However, reversal of binding was incomplete and varied in its efficiency between parasite isolates. Conclusions The results show that, as a proof of concept, disturbing existing ligand–receptor interactions is possible and could have potential therapeutic value for severe malaria. The variation seen in the degree of reversing existing binding with different parasite isolates and the incomplete nature of reversal, despite the use of high affinity inhibitors, suggest that anti-adhesion approaches as adjunct therapies for severe malaria may not be effective, and the focus may need to be on inhibitory approaches such as vaccines

Optimising text messaging to improve adherence to web-based smoking cessation treatment: a randomised control trial protocol

Introduction Millions of smokers use the Internet for smoking cessation assistance each year; however, most smokers engage minimally with even the best designed websites. The ubiquity of mobile devices and their effectiveness in promoting adherence in other areas of health behaviour change make them a promising tool to address adherence in Internet smoking cessation interventions. Text messaging is used by most adults, and messages can proactively encourage use of a web-based intervention. Text messaging can also be integrated with an Internet intervention to facilitate the use of core Internet intervention components. Methods and analysis We identified four aspects of a text message intervention that may enhance its effectiveness in promoting adherence to a web-based smoking cessation programme: personalisation, integration, dynamic tailoring and message intensity. Phase I will use a two-level full factorial design to test the impact of these four experimental features on adherence to a web-based intervention. The primary outcome is a composite metric of adherence that incorporates general utilisation metrics (eg, logins, page views) and specific feature utilisation shown to predict abstinence. Participants will be N=860 adult smokers who register on an established Internet cessation programme and enrol in its text message programme. Phase II will be a two-arm randomised trial to compare the efficacy of the web-based cessation programme alone and in conjunction with the optimised text messaging intervention on 30-day point prevalence abstinence at 9 months. Phase II participants will be N=600 adult smokers who register to use an established Internet cessation programme and enrol in text messaging. Secondary analyses will explore whether adherence mediates the effect of treatment condition on outcome. Ethics and dissemination This protocol was approved by Chesapeake IRB. We will disseminate study results through peer-reviewed manuscripts and conference presentations related to the methods and design, outcomes and exploratory analyses. Trial registration number NCT02585206

Public health messages during a global emergency through an online community: a discourse and sentiment analysis

The growing popularity of social media and its ubiquitous presence in our lives brings associated risks such as the spread of mis- and disinformation, particularly when these may be unregulated in times of global crises. Online communities are able to provide support by enabling connection with others and also provide great potential for dynamic interaction and timely dissemination of information compared with more traditional methods. This study evaluates interactions within the Essex Coronavirus Action/Support Facebook private group, which set out to prevent the spread of COVID-19 infection by informing Essex residents of guidance and helping vulnerable individuals. At the outset, 18 community administrators oversaw the group, which attracted approximately 37,900 members. Longitudinal Facebook group interactions across five periods spanning the UK lockdowns 2020–2021 were analysed using psychological discourse analysis and supplementary computed-mediated analysis to further explore sentiment and linguistic features. The findings endorsed that the group provided a protected space for residents to express their feelings in times of crises and an opportunity to address confusion and concern. The effective communication of public health messages was facilitated by promoting desired interaction and the construction of group identities. Administrators worked with group members to achieve a shared understanding of others' perspectives and the COVID-19 evidence base, which led to a mobilisation of the provision of support in the community. This was accomplished through the application of rhetorical and interactional devices. This study demonstrates how online groups can employ discursive strategies to engage audiences, build cohesion, provide support, and encourage health protective behaviours. This has implications for public health teams in terms of designing, implementing, or evaluating such interventions

The Detectability of Rocky Planet Surface and Atmosphere Composition with JWST: The Case of LHS 3844b

The spectroscopic characterization of terrestrial exoplanets will be made possible for the first time with JWST. One challenge to characterizing such planets is that it is not known a priori whether they possess optically thick atmospheres or even any atmospheres altogether. But this challenge also presents an opportunity - the potential to detect the surface of an extrasolar world. This study explores the feasibility of characterizing the atmosphere and surface of a terrestrial exoplanet with JWST, taking LHS 3844b as a test case because it is the highest signal-to-noise rocky thermal emission target among planets that are cool enough to have non-molten surfaces. We model the planetary emission, including the spectral signal of both atmosphere and surface, and we explore all scenarios that are consistent with the existing Spitzer 4.5 $\mu$m measurement of LHS 3844b from Kreidberg et al. (2019). In summary, we find a range of plausible surfaces and atmospheres that are within 3 $\sigma$ of the observation - less reflective metal-rich, iron oxidized and basaltic compositions are allowed, and atmospheres are restricted to a maximum thickness of 1 bar, if near-infrared absorbers at $\gtrsim$ 100 ppm are included. We further make predictions on the observability of surfaces and atmospheres, perform a Bayesian retrieval analysis on simulated JWST data and find that a small number, ~3, of eclipse observations should suffice to differentiate between surface and atmospheric features. However, the surface signal may make it harder to place precise constraints on the abundance of atmospheric species and may even falsely induce a weak H$_2$O detection.Comment: 33 pages, 20 figure

Safety and immunogenicity of an FP9-vectored candidate tuberculosis vaccine (FP85A), alone and with candidate vaccine MVA85A in BCG-vaccinated healthy adults: a phase I clinical trial.

The safety and immunogenicity of a new candidate tuberculosis (TB) vaccine, FP85A was evaluated alone and in heterologous prime-boost regimes with another candidate TB vaccine, MVA85A. This was an open label, non-controlled, non-randomized Phase I clinical trial. Healthy previously BCG-vaccinated adult subjects were enrolled sequentially into three groups and vaccinated with FP85A alone, or both FP85A and MVA85A, with a four week interval between vaccinations. Passive and active data on adverse events were collected. Immunogenicity was evaluated by Enzyme Linked Immunospot (ELISpot), flow cytometry and Enzyme Linked Immunosorbent assay (ELISA). Most adverse events were mild and there were no vaccine-related serious adverse events. FP85A vaccination did not enhance antigen 85A-specific cellular immunity. When MVA85A vaccination was preceded by FP85A vaccination, cellular immune responses were lower compared with when MVA85A vaccination was the first immunisation. MVA85A vaccination, but not FP85A vaccination, induced anti-MVA IgG antibodies. Both MVA85A and FP85A vaccinations induced anti-FP9 IgG antibodies. In conclusion, FP85A vaccination was well tolerated but did not induce antigen-specific cellular immune responses. We hypothesize that FP85A induced anti-FP9 IgG antibodies with cross-reactivity for MVA85A, which may have mediated inhibition of the immune response to subsequent MVA85A. ClinicalTrials.gov identification number: NCT00653770

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead