Engaging Local Non-Governmental Organizations (NGOs) in the Response to HIV/AIDS.

During the past few years, a number of key donor programs have scaled up their global response to the crisis of HIV and AIDS. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the President’s Emergency Plan for AIDS Relief (PEPFAR), the United Nations’ Millennium Development Goals (MDGs), the World Bank’s Multi-country HIV/AIDS Program (MAP), and other bilateral donors and charitable foundations have raised significant resources to fight HIV/AIDS. Spending on HIV/AIDS in low- and middle-income countries increased from $1 billion in 2000 to$6.1 billion in 2004. By 2007, global resources for HIV/AIDS are expected to expand to $10 billion. Local non-governmental organizations (NGOs), faith-based organizations (FBOs), and community-based organizations (CBOs) have been at the center of the response to the HIV/AIDS pandemic. In many countries, they have been responsible for the majority of the resources reaching individuals and have played a leading role in developing and implementing sustainable strategies to mitigate and prevent HIV/AIDS. One of PEPFAR’s strategic principles is to encourage and strengthen faithbased and community-based non-governmental organizations. The identification of sustainable and efficient local NGOs and the capacity building of these partners is the cornerstone on which the effective engagement of local NGOs is built. The goal of this paper is to begin a discussion among donors, international and local NGOs, and multilateral and U.S. government representatives on how to effectively engage indigenous partners and transfer much-needed resources

Assessing the Impacts of Federal Farm Bill Programs on Rural Communities

This report summarizes the state of scientific knowledge on the impact of federal farm and food programs on rural communities in the United States. We focus on the impacts of five specific programs of what is commonly referred to as the “farm bill.” These five include farm commodity programs; farm risk management, insurance, and disaster programs; agricultural conservation programs; food and nutrition programs; and rural development programs. Although there is extensive research on the relative merits and effectiveness of specific rural development programs and policies on rural community outcomes, the impacts of the other four main farm bill programs on rural America have received much less empirical scrutiny

Development of scenarios for land cover, population density, impervious cover, and conservation in New Hampshire, 2010–2100

Future changes in ecosystem services will depend heavily on changes in land cover and land use, which, in turn, are shaped by human activities. Given the challenges of predicting long-term changes in human behaviors and activities, scenarios provide a framework for simulating the long-term consequences of land-cover change on ecosystem function. As input for process-based models of terrestrial and aquatic ecosystem function, we developed scenarios for land cover, population density, and impervious cover for the state of New Hampshire for 2020–2100. Key drivers of change were identified through information gathered from six sources: historical trends, existing plans relating to New Hampshire’s land-cover future, surveys, existing population scenarios, key informant interviews with diverse stakeholders, and input from subject-matter experts. Scenarios were developed in parallel with information gathering, with details added iteratively as new questions emerged. The final scenarios span a continuum from spatially dispersed development with a low value placed on ecosystem services (Backyard Amenities) to concentrated development with a high value placed on ecosystem services (the Community Amenities family). The Community family includes two population scenarios (Large Community and Small Community), to be combined with two scenarios for land cover (Protection of Wildlands and Promotion of Local Food), producing combinations that bring the total number of scenarios to six. Between Backyard Amenities and Community Amenities is a scenario based on linear extrapolations of current trends (Linear Trends). Custom models were used to simulate decadal change in land cover, population density, and impervious cover. We present raster maps and proportion of impervious cover for HUC10 watersheds under each scenario and discuss the trade-offs of our translation and modeling approach within the context of contemporary scenario projects

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Community forests as a wealth creation strategy for rural communities

Community forests are presented as a wealth creation strategy for rural communities. The Wealth Creation Framework offers a template for describing forms of capital associated with community forests and discussing their potential as a wealth creation strategy. The paper profiles six projects across northern New England and describes how investments by rural communities in local ownership and management of forestland build capital. While the concept of community ownership of forestland is not a new idea in northern New England, the community forest projects discussed here share characteristics that contribute to building multiple forms of wealth. Many of the projects are relatively young, however, and the opportunity to measure changes in wealth will continue over time. Without longitudinal studies of community forests to demonstrate how community forests build wealth, the paper presents some preliminary information on capital that has been preserved or created and suggests opportunities for further research on and analysis of the role and potential of community forests as a wealth creation strategy

Development of scenarios for land cover, population density, impervious cover, and conservation in New Hampshire, 2010-2100

Future changes in ecosystem services will depend heavily on changes in land cover and land use, which, in turn, are shaped by human activities. Given the challenges of predicting long-term changes in human behaviors and activities, scenarios provide a framework for simulating the long-term consequences of land-cover change on ecosystem function. As input for process-based models of terrestrial and aquatic ecosystem function, we developed scenarios for land cover, population density, and impervious cover for the state of New Hampshire for 2020-2100. Key drivers of change were identified through information gathered from six sources: historical trends, existing plans relating to New Hampshire's land-cover future, surveys, existing population scenarios, key informant interviews with diverse stakeholders, and input from subject-matter experts. Scenarios were developed in parallel with information gathering, with details added iteratively as new questions emerged. The final scenarios span a continuum from spatially dispersed development with a low value placed on ecosystem services (Backyard Amenities) to concentrated development with a high value placed on ecosystem services (the Community Amenities family). The Community family includes two population scenarios (Large Community and Small Community), to be combined with two scenarios for land cover (Protection of Wildlands and Promotion of Local Food), producing combinations that bring the total number of scenarios to six. Between Backyard Amenities and Community Amenities is a scenario based on linear extrapolations of current trends (Linear Trends). Custom models were used to simulate decadal change in land cover, population density, and impervious cover. We present raster maps and proportion of impervious cover for HUC10 watersheds under each scenario and discuss the trade-offs of our translation and modeling approach within the context of contemporary scenario projects

Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin vs Usual Care

Context: Studies have demonstrated that statins administered to individuals with risk factors for coronary heart disease (CHD) reduce CHD events. However, many of these studies were too small to assess all-cause mortality or outcomes in important subgroups. Objective: To determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolemic, hypertensive participants with at least 1 additional CHD risk factor. Design and Setting: Multicenter (513 primarily community-based North American clinical centers), randomized, nonblinded trial conducted from 1994 through March 2002 in a subset of participants from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Participants: Ambulatory persons (n = 10 355), aged 55 years or older, with low-density lipoprotein cholesterol (LDL-C) of 120 to 189 mg/dL (100 to 129 mg/dL if known CHD) and triglycerides lower than 350 mg/dL, were randomized to pravastatin (n = 5170) or to usual care (n = 5185). Baseline mean total cholesterol was 224 mg/dL; LDL-C, 146 mg/dL; high-density lipoprotein cholesterol, 48 mg/dL; and triglycerides, 152 mg/dL. Mean age was 66 years, 49% were women, 38% black and 23% Hispanic, 14% had a history of CHD, and 35% had type 2 diabetes. Intervention: Pravastatin, 40 mg/d, vs usual care. Main Outcome Measures: The primary outcome was all-cause mortality, with follow-up for up to 8 years. Secondary outcomes included nonfatal myocardial infarction or fatal CHD (CHD events) combined, cause-specific mortality, and cancer. Results: Mean follow-up was 4.8 years. During the trial, 32% of usual care participants with and 29% without CHD started taking lipid-lowering drugs. At year 4, total cholesterol levels were reduced by 17% with pravastatin vs 8% with usual care; among the random sample who had LDL-C levels assessed, levels were reduced by 28% with pravastatin vs 11% with usual care. All-cause mortality was similar for the 2 groups (relative risk [RR], 0.99; 95% confidence interval [CI], 0.89-1.11; P = .88), with 6-year mortality rates of 14.9% for pravastatin vs 15.3% with usual care. CHD event rates were not significantly different between the groups (RR, 0.91; 95% CI, 0.79-1.04; P = .16), with 6-year CHD event rates of 9.3% for pravastatin and 10.4% for usual care. Conclusions: Pravastatin did not reduce either all-cause mortality or CHD significantly when compared with usual care in older participants with well-controlled hypertension and moderately elevated LDL-C. The results may be due to the modest differential in total cholesterol (9.6%) and LDL-C (16.7%) between pravastatin and usual care compared with prior statin trials supporting cardiovascular disease prevention.http://jama.ama-assn.org/content/288/23/2998.abstrac