The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Platinum degradation mechanisms in proton exchange membrane fuel cell (PEMFC) system: A review

Proton Exchange Membrane Fuel Cells (PEMFCs) have the perspective to intensely decrease global emission through environmentally-friendly potential. This review paper summarizes the degradation of platinum catalyst layer that has become a significant issue in the improvement of PEMFCs. The review intends to categorise and provide a clear understanding between disintegration and agglomerate that occurs during platinum degradation. In each process, different degradation mechanisms and their migration processes are presented. The improvement in platinum degradation as a function of increasing the performance of PEMFC is established. Prospects for addressing platinum degradation through the exploration of further experimental and numerical research are recommended. Lastly, this paper through recommendation attempts to prevent platinum degradation and reduces high costs associated with the replacement of catalysts in the PEMFCs

A review of bipolar plates materials and graphene coating degradation mechanism in proton exchange membrane fuel cell

Proton exchange membrane fuel cells (PEMFCs) have the perception to strongly reduce global emissions through an environmentally friendly perspective. Graphene has drawn global attention and has positioned itself as a potential material for bipolar plates application. This study reviews the application of graphene and summarizes the degradation of graphene coating that has become a significant issue in the improvement of PEMFC's performance. In the analysis, the degradation and its dissolution processes are presented. The need to improve the material selection focused mitigation on fabrication defects that act as initiation sites for graphene coating degradation is recommended. Finally, this review through recommendation endeavors to prevent graphene coating degradation and reduces high costs associated with the replacement of bipolar plates in the PEMFCs

The external genital conformation of a 4-month old German shepherd intersex dog: a case report

Intersex is usually a rare condition affecting both humans and animals. Reports of intersex in dogs are very few. In this report, we highlighted a case of intersex in a 4-month-old German shepherd dog. The dog was purchased at four weeks of age with intention of breeding following attainment of puberty. Physical observation revealed that the dog had a vulva that was located at inguinal region, and a small penile-like structure of 5 cm which contained an os and ventral urethral opening. No further evaluation was done to ascertain the internal genitalia composition. The present observation of intersex in a dog suggests the need to carefully examine any dog intended for breeding so that abnormalities such as intersex will not be propagated in any dog breeding program

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)