Summary Background Lower extremity peripheral artery disease is the third leading cause of atherosclerotic cardiovascular morbidity, following coronary artery disease and stroke. This study provides ...the first comparison of the prevalence of peripheral artery disease between high-income countries (HIC) and low-income or middle-income countries (LMIC), establishes the primary risk factors for peripheral artery disease in these settings, and estimates the number of people living with peripheral artery disease regionally and globally. Methods We did a systematic review of the literature on the prevalence of peripheral artery disease in which we searched for community-based studies since 1997 that defined peripheral artery disease as an ankle brachial index (ABI) lower than or equal to 0·90. We used epidemiological modelling to define age-specific and sex-specific prevalence rates in HIC and in LMIC and combined them with UN population numbers for 2000 and 2010 to estimate the global prevalence of peripheral artery disease. Within a subset of studies, we did meta-analyses of odds ratios (ORs) associated with 15 putative risk factors for peripheral artery disease to estimate their effect size in HIC and LMIC. We then used the risk factors to predict peripheral artery disease numbers in eight WHO regions (three HIC and five LMIC). Findings 34 studies satisfied the inclusion criteria, 22 from HIC and 12 from LMIC, including 112 027 participants, of which 9347 had peripheral artery disease. Sex-specific prevalence rates increased with age and were broadly similar in HIC and LMIC and in men and women. The prevalence in HIC at age 45–49 years was 5·28% (95% CI 3·38–8·17%) in women and 5·41% (3·41–8·49%) in men, and at age 85–89 years, it was 18·38% (11·16–28·76%) in women and 18·83% (12·03–28·25%) in men. Prevalence in men was lower in LMIC than in HIC (2·89% 2·04–4·07% at 45–49 years and 14·94% 9·58–22·56% at 85–89 years). In LMIC, rates were higher in women than in men, especially at younger ages (6·31% 4·86–8·15% of women aged 45–49 years). Smoking was an important risk factor in both HIC and LMIC, with meta-OR for current smoking of 2·72 (95% CI 2·39–3·09) in HIC and 1·42 (1·25–1·62) in LMIC, followed by diabetes (1·88 1·66–2·14 vs 1·47 1·29–1·68), hypertension (1·55 1·42–1·71 vs 1·36 1·24–1·50), and hypercholesterolaemia (1·19 1·07–1·33 vs 1·14 1·03–1·25). Globally, 202 million people were living with peripheral artery disease in 2010, 69·7% of them in LMIC, including 54·8 million in southeast Asia and 45·9 million in the western Pacific Region. During the preceding decade the number of individuals with peripheral artery disease increased by 28·7% in LMIC and 13·1% in HIC. Interpretation In the 21st century, peripheral artery disease has become a global problem. Governments, non-governmental organisations, and the private sector in LMIC need to address the social and economic consequences, and assess the best strategies for optimum treatment and prevention of this disease. Funding Peripheral Arterial Disease Research Coalition (Europe).
Global populations are undergoing a major epidemiological transition in which the burden of atherosclerotic cardiovascular diseases is shifting rapidly from high-income to low-income and ...middle-income countries (LMICs). Peripheral artery disease (PAD) is no exception, so that greater focus is now required on the prevention and management of this disease in less-advantaged countries. In this Review, we examine the epidemiology of PAD and, where feasible, take a global perspective. However, the dearth of publications in LMICs means an unavoidable over-reliance on studies in high-income countries. Research to date suggests that PAD might affect a greater proportion of women than men in LMICs. Although factors such as poverty, industrialization, and infection might conceivably influence the development of PAD in such settings, the ageing of the population and increase in traditional cardiovascular risk factors, such as smoking, diabetes mellitus, and hypertension, are likely to be the main driving forces.
Snakes play a crucial role in natural ecosystems, providing ecological services to people by decreasing rodent populations which may cause disease transmission and impair agricultural production. ...Despite these benefits, snakes are historically a target of persecution and negative attitudes across cultures, and many of them are threatened. Understanding the predictors of snake-human conflicts is essential to improve conservation efforts. We investigated the degree to which emotions, myth beliefs, experience with snakes (via exposure, bites, and knowledge of mortality from a snakebite), and education would predict attitudes toward snakes in a sample of southeastern Nigerian people. We further examined whether attitudes would predict intentional killing of snakes. Ordinal regression analyses revealed that fear, disgust, and belief in the myth that snakes are evil were related to low tolerance of snakes. More frequent encounters with snakes and higher education were associated with higher tolerance of snakes. Furthermore, higher tolerance of snakes was associated with a reduced likelihood of intentionally killing snakes, even when controlling for the influence of the other psychological and experiential variables. Wildlife management education interventions may be important to change attitudes and decrease intentional killing of snakes.
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•Fear and disgust negatively correlated with high tolerance of snakes.•Evil myth beliefs were related to low tolerance of snakes.•High tolerance of snakes correlated with less frequent killing of snakes.•Snakebite experience was associated with a higher probability of killing snakes..
Ion channels represent the molecular entities that give rise to the cardiac action potential, the fundamental cellular electrical event in the heart. The concerted function of these channels leads to ...normal cyclical excitation and resultant contraction of cardiac muscle. Research into cardiac ion channel regulation and mutations that underlie disease pathogenesis has greatly enhanced our knowledge of the causes and clinical management of cardiac arrhythmia. Here we review the molecular determinants, pathogenesis, and pharmacology of congenital Long QT Syndrome. We examine mechanisms of dysfunction associated with three critical cardiac currents that comprise the majority of congenital Long QT Syndrome cases: 1) I
, the slow delayed rectifier current; 2) I
, the rapid delayed rectifier current; and 3) I
, the voltage-dependent sodium current. Less common subtypes of congenital Long QT Syndrome affect other cardiac ionic currents that contribute to the dynamic nature of cardiac electrophysiology. Through the study of mutations that cause congenital Long QT Syndrome, the scientific community has advanced understanding of ion channel structure-function relationships, physiology, and pharmacological response to clinically employed and experimental pharmacological agents. Our understanding of congenital Long QT Syndrome continues to evolve rapidly and with great benefits: genotype-driven clinical management of the disease has improved patient care as precision medicine becomes even more a reality.
We present a community data set of daily forcing and hydrologic response data for 671 small- to medium-sized basins across the contiguous United States (median basin size of 336 km2) that spans a ...very wide range of hydroclimatic conditions. Area-averaged forcing data for the period 1980-2010 was generated for three basin spatial configurations - basin mean, hydrologic response units (HRUs) and elevation bands - by mapping daily, gridded meteorological data sets to the subbasin (Daymet) and basin polygons (Daymet, Maurer and NLDAS). Daily streamflow data was compiled from the United States Geological Survey National Water Information System. The focus of this paper is to (1) present the data set for community use and (2) provide a model performance benchmark using the coupled Snow-17 snow model and the Sacramento Soil Moisture Accounting Model, calibrated using the shuffled complex evolution global optimization routine. After optimization minimizing daily root mean squared error, 90% of the basins have Nash-Sutcliffe efficiency scores greater than or equal to 0.55 for the calibration period and 34% greater than or equal to 0.8. This benchmark provides a reference level of hydrologic model performance for a commonly used model and calibration system, and highlights some regional variations in model performance. For example, basins with a more pronounced seasonal cycle generally have a negative low flow bias, while basins with a smaller seasonal cycle have a positive low flow bias. Finally, we find that data points with extreme error (defined as individual days with a high fraction of total error) are more common in arid basins with limited snow and, for a given aridity, fewer extreme error days are present as the basin snow water equivalent increases.
The mosquito
Aedes
(
Ae
)
. aegypti
transmits the viruses that cause dengue, chikungunya, Zika and yellow fever. We investigate how choosing alternate emissions and/or socioeconomic pathways may ...modulate future human exposure to
Ae. aegypti
. Occurrence patterns for
Ae. aegypti
for 2061–2080 are mapped globally using empirically downscaled air temperature and precipitation projections from the Community Earth System Model, for the Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios. Population growth is quantified using gridded global population projections consistent with two Shared Socioeconomic Pathways (SSPs), SSP3 and SSP5. Change scenarios are compared to a 1950–2000 reference period. A global land area of 56.9 M km
2
is climatically suitable for
Ae. aegypti
during the reference period, and is projected to increase by 8 % (RCP4.5) to 13 % (RCP8.5) by 2061–2080. The annual average number of people exposed globally to
Ae. aegypti
for the reference period is 3794 M, a value projected to statistically significantly increase by 298–460 M (8–12 %) by 2061–2080 if only climate change is considered, and by 4805–5084 M (127–134 %) for SSP3 and 2232–2483 M (59–65 %) for SSP5 considering both climate and population change (lower and upper values of each range represent RCP4.5 and RCP8.5 respectively). Thus, taking the lower-emissions RCP4.5 pathway instead of RCP8.5 may mitigate future human exposure to
Ae. aegypti
globally, but the effect of population growth on exposure will likely be larger. Regionally, Australia, Europe and North America are projected to have the largest percentage increases in human exposure to
Ae. aegypti
considering only climate change.
Background Abdominal aortic aneurysm (AAA) is a leading cause of death in the USA. We evaluated the incidence and predictors of AAA in a prospectively followed cohort. Methods We calculated ...age-adjusted AAA incidence rates (IR) among 18 782 participants aged ≥65 years in the Southern Community Cohort Study who received Medicare coverage from 1999–2012, and assessed predictors of AAA using multivariable Cox proportional hazards models, overall and stratified by sex, adjusting for demographic, lifestyle, socioeconomic, medical and other factors. HRs and 95% CIs were calculated for AAA in relation to factors ascertained at enrolment. Results Over a median follow-up of 4.94 years, 281 cases were identified. Annual IR was 153/100 000, 401, 354 and 174 among blacks, whites, men and women, respectively. AAA risk was lower among women (HR 0.48, 95% CI 0.36 to 0.65) and blacks (HR 0.51, 95% CI 0.37 to 0.69). Smoking was the strongest risk factor (former: HR 1.91, 95% CI 1.27 to 2.87; current: HR 5.55, 95% CI 3.67 to 8.40), and pronounced in women (former: HR 3.4, 95% CI 1.83 to 6.31; current: HR 9.17, 95% CI 4.95 to 17). A history of hypertension (HR 1.44, 95% CI 1.04 to 2.01) and myocardial infarction or coronary artery bypass surgery (HR 1.9, 95% CI 1.37 to 2.63) was negatively associated, whereas a body mass index ≥25 kg/m2 (HR 0.72; 95% CI 0.53 to 0.98) was protective. College education (HR 0.6, 95% CI 0.37 to 0.97) and black race (HR 0.44, 95% CI 0.28 to 0.67) were protective among men. Conclusions Smoking is a major risk factor for incident AAA, with a strong and similar association between men and women. Further studies are needed to evaluate benefits of ultrasound screening for AAA among women smokers.
Interferon regulatory factors (IRFs) are key elements of antiviral innate responses that regulate the transcription of interferons (IFNs) and IFN-stimulated genes (ISGs). While the sensitivity of ...human coronaviruses to IFNs has been characterized, antiviral roles of IRFs during human coronavirus infection are not fully understood. Type I or II IFN treatment protected MRC5 cells from human coronavirus 229E infection, but not OC43. Cells infected with 229E or OC43 upregulated ISGs, indicating that antiviral transcription is not suppressed. Antiviral IRFs, IRF1, IRF3 and IRF7, were activated in cells infected with 229E, OC43 or severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2). RNAi knockdown and overexpression of IRFs demonstrated that IRF1 and IRF3 have antiviral properties against OC43, while IRF3 and IRF7 are effective in restricting 229E infection. IRF3 activation effectively promotes transcription of antiviral genes during OC43 or 229E infection. Our study suggests that IRFs may be effective antiviral regulators against human coronavirus infection.
Cardiovascular disease (CVD) has been the leading cause of death in developed countries for most of the last century. Most CVD deaths, however, occur in low- and middle-income, developing countries ...(LMICs) and there is great concern that CVD mortality and burden are rapidly increasing in LMICs as a result of population growth, ageing and health transitions. In sub-Saharan Africa (SSA), where all countries are part of the LMICs, the pattern, magnitude and trends in CVD deaths remain incompletely understood, which limits formulation of data-driven regional and national health policies.
The aim was to estimate the number of deaths, death rates, and their trends for CVD causes of death in SSA, by age and gender for 1990 and 2013.
Age- and gender-specific mortality rates for CVD were estimated using the Global Burden of Disease (GBD) 2010 methods with some refinements made by the GBD 2013 study to improve accuracy. Cause of death was estimated as in the GBD 2010 study and updated with a verbal autopsy literature review and cause of death ensemble modelling (CODEm) estimation for causes with sufficient information. For all quantities reported, 95% uncertainty intervals (UIs) were also computed.
In 2013, CVD caused nearly one million deaths in SSA, constituting 38.3% of non-communicable disease deaths and 11.3% of deaths from all causes in that region. SSA contributed 5.5% of global CVD deaths. There were more deaths in women (512,269) than in men (445,445) and more deaths from stroke (409,840) than ischaemic heart disease (258,939). Compared to 1990, the number of CVD deaths in SSA increased 81% in 2013. Deaths for all component CVDs also increased, ranging from a 7% increase in incidence of rheumatic heart disease to a 196% increase in atrial fibrillation. The age-standardised mortality rate (per 100,000) in 1990 was 327.6 (CI: 306.2-351.7) and 330.2 (CI: 312.9-360.0) in 2013, representing only a 1% increase in more than two decades.
In SSA, CVDs are neither epidemic nor among the leading causes of death. However, a significant increase in the number of deaths from CVDs has occurred since 1990, largely as a result of population growth, ageing and epidemiological transition. Contrary to what has been observed in other world regions, the age-adjusted mortality rate for CVD has not declined. Another important difference in CVD deaths in SSA is the predominance of stroke as the leading cause of death. Attention to aggressive efforts in cardiovascular health promotion and CVD prevention, treatment and control in both men and women are warranted. Additionally, investments to improve directly enumerated epidemiological data for refining the quantitation of risk exposures, death certification and burden of disease assessment will be crucial.
Long short‐term memory (LSTM) networks offer unprecedented accuracy for prediction in ungauged basins. We trained and tested several LSTMs on 531 basins from the CAMELS data set using k‐fold ...validation, so that predictions were made in basins that supplied no training data. The training and test data set included ∼30 years of daily rainfall‐runoff data from catchments in the United States ranging in size from 4 to 2,000 km2 with aridity index from 0.22 to 5.20, and including 12 of the 13 IGPB vegetated land cover classifications. This effectively “ungauged” model was benchmarked over a 15‐year validation period against the Sacramento Soil Moisture Accounting (SAC‐SMA) model and also against the NOAA National Water Model reanalysis. SAC‐SMA was calibrated separately for each basin using 15 years of daily data. The out‐of‐sample LSTM had higher median Nash‐Sutcliffe Efficiencies across the 531 basins (0.69) than either the calibrated SAC‐SMA (0.64) or the National Water Model (0.58). This indicates that there is (typically) sufficient information in available catchment attributes data about similarities and differences between catchment‐level rainfall‐runoff behaviors to provide out‐of‐sample simulations that are generally more accurate than current models under ideal (i.e., calibrated) conditions. We found evidence that adding physical constraints to the LSTM models might improve simulations, which we suggest motivates future research related to physics‐guided machine learning.
Key Points
Overall accuracy of LSTMs in ungauged basins is comparable to standard hydrology models in gauged basins
There is sufficient information in catchment characteristics data to differentiate between catchment‐specific rainfall‐runoff behaviors
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