Famine in Malawi: Causes and Consequences

human development, climate change

Data Ecosystems for Sustainable Development: An Assessment of Six Pilot Countries

A data revolution for sustainable development is underway, reshaping how knowledge is produced and used, policy is formulated, and governance is redefined and enacted around the world. At its core, it is about people—as users, producers, beneficiaries, and owners of data—who must be at the centre of accountability and participatory mechanisms for the 2030 Agenda and in turn be closely involved in the delivery of the new development agenda. To this end, UNDP has sought to facilitate interactions, synergies and partnerships among different stakeholders, governments, civil society, international development organizations and the private sector that are grounded in perspectives of, and meaningful participation from, people. UNDP particularly seeks to ensure that development experience from the grassroots informs global discussions, and that the data revolution is actionable at the national level.While significant strides have been made with respect to upgrading data and statistical systems since the adoption of the MDGs, the 2030 Agenda encompasses a far broader ambition requiring better, more timely and reliable data on a wider variety of indicators. Thus its adoption by countries around the world necessitates an even more significant increase in the data that is available to, and used by, governments, civil society, the private sector, academia and international organizations to begin tracking progress towards the achievement of the SDGs.This synthesis report presents the findings of six pilot case studies assessing the readiness of national data ecosystems to harness the data revolution for the implementation and monitoring of the 2030 Agenda. This assessment focuses on the legal and policy frameworks and capacities for official statistics; entry points for action and obstacles for multi-stakeholder engagement on data for SDG implementation and monitoring; innovation and new technologies for plugging data gaps; and the infrastructure requirements for improved collection, dissemination and use of data for sustainable development

INA: An Integrative Approach for Enhancing Negotiation Strategies with Reward-Based Dialogue System

In this paper, we propose a novel negotiation dialogue agent designed for the online marketplace. Our agent is integrative in nature i.e, it possesses the capability to negotiate on price as well as other factors, such as the addition or removal of items from a deal bundle, thereby offering a more flexible and comprehensive negotiation experience. We create a new dataset called Integrative Negotiation Dataset (IND) to enable this functionality. For this dataset creation, we introduce a new semi-automated data creation method, which combines defining negotiation intents, actions, and intent-action simulation between users and the agent to generate potential dialogue flows. Finally, the prompting of GPT-J, a state-of-the-art language model, is done to generate dialogues for a given intent, with a human-in-the-loop process for post-editing and refining minor errors to ensure high data quality. We employ a set of novel rewards, specifically tailored for the negotiation task to train our Negotiation Agent, termed as the Integrative Negotiation Agent (INA). These rewards incentivize the chatbot to learn effective negotiation strategies that can adapt to various contextual requirements and price proposals. By leveraging the IND, we train our model and conduct experiments to evaluate the effectiveness of our reward-based dialogue system for negotiation. Our results demonstrate that the proposed approach and reward system significantly enhance the agent's negotiation capabilities. The INA successfully engages in integrative negotiations, displaying the ability to dynamically adjust prices and negotiate the inclusion or exclusion of items in a bundle dea

Recombinant Probiotic Expressing Listeria Adhesion Protein Attenuates Listeria monocytogenes Virulence In Vitro

BACKGROUND: Listeria monocytogenes, an intracellular foodborne pathogen, infects immunocompromised hosts. The primary route of transmission is through contaminated food. In the gastrointestinal tract, it traverses the epithelial barrier through intracellular or paracellular routes. Strategies to prevent L. monocytogenes entry can potentially minimize infection in high-risk populations. Listeria adhesion protein (LAP) aids L. monocytogenes in crossing epithelial barriers via the paracellular route. The use of recombinant probiotic bacteria expressing LAP would aid targeted clearance of Listeria from the gut and protect high-risk populations from infection. METHODOLOGY/PRINCIPAL FINDINGS: The objective was to investigate the ability of probiotic bacteria or LAP-expressing recombinant probiotic Lactobacillus paracasei (Lbp(LAP)) to prevent L. monocytogenes adhesion, invasion, and transwell-based transepithelial translocation in a Caco-2 cell culture model. Several wild type probiotic bacteria showed strong adhesion to Caco-2 cells but none effectively prevented L. monocytogenes infection. Pre-exposure to Lbp(LAP) for 1, 4, 15, or 24 h significantly (P<0.05) reduced adhesion, invasion, and transepithelial translocation of L. monocytogenes in Caco-2 cells, whereas pre-exposure to parental Lb. paracasei had no significant effect. Similarly, Lbp(LAP) pre-exposure reduced L. monocytogenes translocation by as much as 46% after 24 h. Lbp(LAP) also prevented L. monocytogenes-mediated cell damage and compromise of tight junction integrity. Furthermore, Lbp(LAP) cells reduced L. monocytogenes-mediated cell cytotoxicity by 99.8% after 1 h and 79% after 24 h. CONCLUSIONS/SIGNIFICANCE: Wild type probiotic bacteria were unable to prevent L. monocytogenes infection in vitro. In contrast, Lbp(LAP) blocked adhesion, invasion, and translocation of L. monocytogenes by interacting with host cell receptor Hsp60, thereby protecting cells from infection. These data show promise for the use of recombinant probiotics in preventing L. monocytogenes infection in high-risk populations

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

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

Determinants of Parental Beliefs: The Role of Proximal Influences in the Maintenance and Revision of Parental Beliefs

Culture has been recognized to play an important role in the formation of parental beliefs, but the question still remains of whether beliefs are maintained or revised over time, and how. The present study examined how proximal influences impacted parental beliefs in an immigrant sample of parents, the thesis being that distal influences have more to do with the formation of parental beliefs while proximal influences have more to do with maintaining or revising them. Effects of the proximal influences of education, occupation status, information networks, and parental agreement about childrearing, on parental beliefs of Mexican-origin fathers and mothers around cultural values of familism/respeto, simpatía, and individualism were tested longitudinally. The research questions were two-fold in nature, looking at within-time effects of the proximal influences on parental beliefs; as well as over-time effects of proximal influences on change in parental beliefs. The within-time questions were answered using hierarchical regression analyses while the over-time questions were answered using repeated measures MANCOVAs. Overall, the beliefs of parents in this study were seen to not change significantly over the course of the three years that they were assessed, and so the study did not yield the results expected in terms of the effects of proximal influences on parental beliefs. However, information networks and fathers' occupation status did emerge as promising proximal influences on parental beliefs, and the results also revealed maternal beliefs to be more responsive to the proximal influences of education, fathers' occupation status, information networks, and parental agreement about childrearing, than paternal beliefs

Land-Pooling In Andhra Pradesh, India: A study of protracted dispossession and manufactured compliance in Amaravati

After the bifurcation of Andhra Pradesh into Telangana and residual Andhra in 2014, the ruling TDP government announced plans to build an ambitious new capital city, christened Amaravati, on the southern banks of the Krishna River in Guntur district. This purported “pioneer smart city of India” and “dream capital” was expected to not only serve as an engine of growth and development for the rest of Andhra, but to also fill the emotional void left behind by the loss of Hyderabad, to Telangana. The government sought to build the city through an alternate method of land assembly called the land pooling scheme, which it claimed would make farmers in the region “shareholders of development.” This was contrasted against the more arduous processes involved under the Central government’s Right to Fair Compensation and Transparency in Land Acquisition, Rehabilitation and Resettlement Act, 2013. However, through fieldwork conducted in the 25 villages and four hamlets that comprise the capital region, this dissertation demonstrates how land pooling has characteristics of previous episodes of enclosures, whilst also demonstrating new features or variations in the manner in which land is appropriated and used. Specifically, in the context of Amaravati, it amounts to a continuous process of strategizing and negotiation, generating a protracted and continuous process of dispossession stretching over years. Furthermore, the announcement of the capital city had intensely differentiated impacts on the residents there as the convergence of an exclusionary economic growth and urbanization plan with pre-existing caste-based agrarian inequalities exacerbated the socioeconomic inequalities between dominant landed castes and more marginalized castes. Thus, the large contingent of landless people (mostly Dalits), who had previously enjoyed reliable work cultivating rich, multi-cropped and irrigated lands in the ‘rice bowl’ of the State, were made worse off in absolute terms through mass job loss. Even where some Dalits had gained access to land (through for example, being assigned ceiling or lanka lands), land pooling became a vehicle for the politics of co-option, intimidation and elite-capture. This ultimately amounted to a reversal of historical gains made earlier in Andhra from land distribution policies designed to uplift poorer segments of society

Fine needle aspiration cytology as an aid to diagnosis, categorization and treatment when pure neuritic leprosy presents as nerve abscess

Background: Pure neuritic leprosy (PNL) usually presents with neurological symptoms without skin involvement. Fine needle aspiration can play an important role in the management of PNL cases presenting as nerve abscesses. Aim: To assess the role of fine needle aspiration cytology (FNAC) in diagnosing and categorizing PNL cases presenting as nerve abscesses in the absence of neurological symptoms. Materials and Methods: Five patients with subcutaneous nerve related swellings without clinically evident neurological deficits were subjected to FNAC. As the cytological features were suggestive of nerve abscesses due to leprosy, Fite stain was performed in all cases. As none of the patients had any leprosy skin lesions, they were diagnosed as cases of PNL. Features like cellularity, caseous necrosis, presence or absence of lymphocytes, macrophages, epithelioid cells, granulomas, Langhans giant cells and nerve elements were analyzed with the bacteriological index, to categorize PNL according to the Ridley-Jopling classification. Results: Based on the cytological features and bacteriological indices, 3 cases were cytologically categorized into tuberculoid (TT)/borderline tuberculoid (BT) leprosy and the other two, as BT/borderline lepromatous (BL) and BL leprosy respectively in spite of having similar clinical presentation. Based on the cytological diagnoses, category-specific treatment could be instituted with clinical improvement. Conclusions: The simple and minimally invasive FNAC procedure allows diagnosis and a reasonably accurate categorization of PNL presenting as nerve abscess and therefore, highly useful in its clinical management