An extensive blood culture protocol, including prolonged incubation of cultures, for 215 patients believed to have had endocarditis yielded only 3 clinically relevant results. Twenty-four ...Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella (i.e., HACEK) organisms were recovered from standard 5-day blood cultures during the same time period. Specialized methods and not extended incubation times are recommended for recovery of fastidious agents of septicemia.
Climate change is upon us. The fourth assessment report of the Intergovernmental Panel on Climate Change clearly describes the evidence of a changing climate (IPCC 2007a, b). Although scientists ...disagree about the extent to which these changes will happen, they do agree that there have been and will be changes in average climatic conditions, there will be changes in the frequency and intensity of weather hazards, already variable climates will become less predictable, and there is considerable uncertainty about the distribution and impact of these changes. Actions to reduce the human contribution to the changing climate are slowly happening, but they so far seem too few and too limited to make a significant difference to the climate change scientists predict. What has become clear is that people from all countries, from all income levels, and irrespective of capacity to do so, will have to adapt to these changes. The development and climate research communities have much to learn from each other in helping people with these adaptations.
Ebola virus disease (EVD) is a serious global health concern because case fatality rates are approximately 50% due to recent widespread outbreaks in Africa. Well-defined nonhuman primate (NHP) models ...for different routes of Ebola virus exposure are needed to test the efficacy of candidate countermeasures. In this natural history study, four rhesus macaques were challenged via aerosol with a target titer of 1000 plaque-forming units per milliliter of Ebola virus. The course of disease was split into the following stages for descriptive purposes: subclinical, clinical, and decompensated. During the subclinical stage, high levels of venous partial pressure of carbon dioxide led to respiratory acidemia in three of four of the NHPs, and all developed lymphopenia. During the clinical stage, all animals had fever, viremia, and respiratory alkalosis. The decompensatory stage involved coagulopathy, cytokine storm, and liver and renal injury. These events were followed by hypotension, elevated lactate, metabolic acidemia, shock and mortality similar to historic intramuscular challenge studies. Viral loads in the lungs of aerosol-exposed animals were not distinctly different compared to previous intramuscularly challenged studies. Differences in the aerosol model, compared to intramuscular model, include an extended subclinical stage, shortened clinical stage, and general decompensated stage. Therefore, the shortened timeframe for clinical detection of the aerosol-induced disease can impair timely therapeutic administration. In summary, this nonhuman primate model of aerosol-induced EVD characterizes early disease markers and additional details to enable countermeasure development.
Abstract
Pelagic sargassum (S
fluitans
and S
natans
) algal blooms and beach landings have become a regular occurrence in the Tropical Atlantic Basin since 2011; they have a variety of impacts on the ...marine ecosystem and blue economy. To reduce the impacts and enable effective management, forecasting and monitoring of the blooms are essential. Challenges associated with use of satellite imagery for sargassum detection in the Tropical Atlantic are spatial resolution and cloud cover, which is particularly dense in this region due to the inter-tropical convergence zone, tropical storms and hurricanes. Successful models of forecasting and prediction of pelagic sargassum are hindered by unreliable satellite data, uncertainty around windage and as well as growth and mortality. In the longer term, we aim to improve the forecast models of pelagic sargassum mat movements in open oceans by introducing evidence of the speed of travel, changing mat morphology, and size and health status of sargassum mats. To achieve this, we deployed eight trackers on floating sargassum mats in the Western Tropical Atlantic. In addition, we explore the coincidence of surface currents, wind stress and sea surface temperature as a parameter for growth on the tracker pathways. When used in conjunction with both remote sensing methods and climate data (wind, current and sea temperature), we find that GPS tracker data can facilitate more reliable monitoring of sargassum transport pathways, helps to overcome satellite-based challenges as well as model based uncertainties, and may improve the accuracy and general utility of sargassum early warning systems.
Abstract
Climatic and anthropogenic changes appear to be driving the emergence of new ecosystem and human health risks. As new risks emerge, and the severity or frequency of known risks change, we ...ask: what evidence is there of past adaptations to emergent risks? What scientific and policy processes lead to adaptive solutions that minimise the impacts of these events, and draw out opportunities? We identify science and policy lessons learned from coping with, and responding to, the sudden arrival of brown macroalgae (pelagic sargassum) that has proliferated across the tropical Atlantic since 2011. Drawing on an evidence base developed from a systematic search of literature relating to sargassum seaweed, and using event timelines and word clouds, we provide an analysis of lessons learned from a case study of adaptive responses across three continents to an emergent risk over the course of a decade. We reflect on successes and failures as well as opportunities taken in building adaptive capacity to address the risk in four key domains: policy, knowledge and evidence, monitoring and early warning, and technology and valorisation. Failures include: lack of environmental risk registries; missed opportunities to share monitoring data; and lack of a shared approach to manage the risk. Successes include: development of national management strategies; open-access knowledge hubs, networks and webinars sharing information and best practice; semi-operational early advisory systems using open access remote sensing data; numerous innovations customising clean-up and harvesting equipment, and research and development of new uses and value-added products.
Article 7, paragraph 14 of the Paris Agreement to the United Nations Framework Convention on Climate Change commits Parties to create a five yearly assessment of observed adaptation to track progress ...and enable appropriate future commitments through the Nationally Determined Contributions and National Adaptation Plans. No large‐scale study exists that shows the types of adaptation, the spatial distribution of types of adaptation, and the numbers of people engaging in that adaptation. To address this gap, and to feed into debates about the modalities for the global stocktake, in this paper we propose a new “stocktaking” approach to document the spectrum and prevalence of observed adaptation over large scales. The four‐step stocktaking approach focuses on: (a) obtaining consensus on the objectives of adaptation; (b) agreeing the sources of evidence; (c) agreeing the search method; and (d) categorizing the adaptations. By focusing on documenting rather than evaluating adaptation, the simple approach avoids some of the adaptation heuristic traps. With guidance to countries on how to operationalize, this approach could improve the transparency of adaptation data collection and analysis, ensure comparability of findings across space and time, and inform the Adaptation Communications (Article 7.10)—a prerequisite to strengthening future ambition commitments within the Paris Agreement.
This article is categorized under:
Policy and Governance > International Policy Framework
Vulnerability and Adaptation to Climate Change > Institutions for Adaptation
Before we can evaluate adaptation, we need to consistently document adaptation. Using the sustainable livelihoods framework, disaster risk reduction and ecosystem services theory, we advocate four simple steps in a uniform approach to documenting adaptation.
Helicobacter pylori translocates the protein CagA into gastric epithelial cells and has been linked to peptic ulcer disease and gastric carcinoma. We show that injected CagA associates with the ...epithelial tight-junction scaffolding protein ZO-1 and the transmembrane protein junctional adhesion molecule, causing an ectopic assembly of tight-junction components at sites of bacterial attachment, and altering the composition and function of the apical-junctional complex. Long-term CagA delivery to polarized epithelia caused a disruption of the epithelial barrier function and dysplastic alterations in epithelial cell morphology. CagA appears to target H. pylori to host cell intercellular junctions and to disrupt junction-mediated functions.
Coastal defences have long provided protection from erosion and flooding to cities, towns and villages. In many parts of the world, continued defence is being questioned due to both environmental, ...sustainability and economic considerations. This is exemplified in England and Wales, where strategic Shoreline Management Plans envisage realignment of many protected coasts, often with low population densities, over the coming decades. The policy transition from protection to realignment is often resisted by affected communities and can have high political costs. Whilst some preparations for such transitions have been made, the communities affected are often not fully aware of the implications of policy change, and this brings the potential for blight. In this paper, we investigate the challenges of implementing transitions in coastal policy within England and Wales. The analysis is based on data obtained from three workshops held in 2019 that were attended by council members, engineers, planners, scientists and other relevant professionals. Five conditions are found to promote contention: (i) policy actors with competing priorities and different decision making time frames (immediate to decadal to a century); (ii) divergence between regulations and
ad hoc
political decisions (e.g. in relation to the demand for new housing); (iii) limited or non-existent funding to support policy transition; (iv) community expectation that protection is forever; and (v) a disconnection between people and ongoing coastal change. Our research indicates that transitions can be better supported through: (1) integrated multi-scalar preparedness for coastal change; (2) an accessible evidence base and future vision to nurture political confidence in adaptation; and (3) defined, time-bound and accessible diverse funding streams to achieve transitions. Critically, these generic actions need to be embedded within the local political and planning system to facilitate transition to more sustainable coasts and their communities.
Objectives: Research on older adults often focuses on mitigating health risks, and less is known about protective factors that contribute to longer, healthier lives. We examine longitudinal ...associations between psychological well-being and mortality among a national sample of older adults and test competing hypotheses about whether the education/mortality association depends on the level of psychological well-being. Method: We use six waves (2006-2016) of the Health and Retirement Study, a national sample of adults over age 50 (n = 21,172), with 14 years of mortality follow-up. Psychological well-being is measured up to three times and includes positive affect, life satisfaction, purpose in life, social support, and optimism. Discrete-time survival models examine (a) the association between time-varying psychological well-being and mortality, and (b) interactions between psychological well-being and education on mortality. Results: Higher purpose in life, positive affect, optimism, social support, and life satisfaction predicted lower mortality. A 1 SD increase in most measures of psychological well-being was associated with a 2-4 year increase in life expectancy at age 50. Positive affect and purpose in life moderated the education/mortality association-the inverse association between education and mortality was stronger for those with high psychological well-being. Conclusions: We find strong evidence that psychological well-being predicts lower mortality risk and modifies the association between education and mortality. The inverse association between education and mortality becomes stronger at higher levels of purpose in life and positive affect. Therefore, efforts to promote life satisfaction, social support, and optimism may support longer lives without widening education disparities.
Public participation is commonly advocated in policy responses to climate change. Here we discuss prospects for inclusive approaches to adaptation, drawing particularly on studies of long-term ...coastal management in the UK and elsewhere. We affirm that public participation is an important normative goal in formulating response to climate change risks, but argue that its practice must learn from existing critiques of participatory processes in other contexts. Involving a wide range of stakeholders in decision-making presents fundamental challenges for climate policy, many of which are embedded in relations of power. In the case of anticipatory responses to climate change, these challenges are magnified because of the long-term and uncertain nature of the problem. Without due consideration of these issues, a tension between principles of public participation and anticipatory adaptation is likely to emerge and may result in an overly managed form of inclusion that is unlikely to satisfy either participatory or instrumental goals. Alternative, more narrowly instrumental, approaches to participation are more likely to succeed in this context, as long as the scope and limitations of public involvement are made explicit from the outset.
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