Diversification of livelihoods is a commonly applied strategy for coping with economic and environmental shocks and instrumental in poverty reduction. In this paper, we have assessed the role of ...livelihood diversification in household well-being in Humla, a remote mountain district in west Nepal. Employing the data produced from household surveys, we developed a composite household well-being index incorporating four components and 15 indicators, and measured the effect of diversification on it. Results suggested a uniform pattern of diversification in terms of the number of activities undertaken for livelihoods but a highly varying degree of resultant well-being across households. Analysis showed that well-being was not associated with diversification per se but rather on a households' involvement in ‘high return sectors’ such as trade or salaried job. Because involvement in these remunerative sectors is determined by various financial, social and human capitals, poor households were unable to combat the entry barrier and were prevented from getting access to them. In this way, livelihood diversification was found to have a highly skewed effect leading to inequality of income and well-being. This, in turn, is likely to risk depriving the poor households from exploiting new economic opportunities even in the future.
•We assessed the role of livelihood diversification in household well-being in Nepal.•Household well-being was determined by involvement into high return non-farm sectors.•Access to high return sectors was determined by caste/ethnicity and associated socio-economic characteristics of households.•The findings suggest that the returns from livelihood diversification are unequally distributed locally.
Non-invasive ventilation (NIV) and percutaneous gastrostomy (PEG) are guideline-recommended interventions for symptom management in amyotrophic lateral sclerosis (ALS). Their effect on survival is ...controversial and the impact on causes of death is unknown.
To investigate the effect of NIV and PEG on survival and causes of death in ALS patients.
Eighty deceased ALS patients underwent a complete post mortem analysis for causes of death between 2003 and 2015. Forty-two of these patients consented for genetic testing. Effects of NIV and PEG on survival and causes of death were analyzed in a multivariable Cox proportional hazard regression.
Six patients, who requested assisted suicide causing drug-induced hypoxia, were excluded from final analysis. Respiratory failure was the main cause of death in 72 out of 74 patients. Fifteen out of 74 died of aspiration pneumonia 23/74 of bronchopneumonia and 8/74 of a combination of aspiration pneumonia and bronchopneumonia. Twenty died of hypoxia without concomitant infection, and six patients had pulmonary embolism alone or in combination with pneumonia. NIV (p = 0.01) and PEG (p<0.01) had a significant impact on survival. In patients using NIV bronchopneumonia was significantly more frequent (p <0.04) compared to non-NIV patients. This effect was even more pronounced in limb onset patients (p<0.002). Patients with C9orf72 hexanucleotide repeat expansions showed faster disease progression and shorter survival (p = 0.01).
The use of NIV and PEG prolongs survival in ALS. This study supports current AAN and EFNS guidelines which recommend NIV and PEG as a treatment option in ALS. The risk of bronchopneumonia as cause of death may be increased by NIV.
Objective
To evaluate neurofilament light (NfL) as a biomarker of the presymptomatic phase of amyotrophic lateral sclerosis (ALS).
Methods
The study population includes 84 individuals at risk for ...developing ALS, 34 controls, 17 ALS patients, and 10 phenoconverters (at‐risk individuals observed both before and after the emergence of clinically manifest disease). At‐risk individuals are enrolled through Pre‐Symptomatic Familial ALS (Pre‐fALS), a longitudinal natural history and biomarker study of individuals who are carriers of any ALS‐associated gene mutation (in SOD1, C9orf72, TARDBP, FUS, VCP, etc), but who, at the time of enrollment, demonstrated no clinical symptoms or signs (including electromyographic evidence) of manifest disease. NfL in serum and cerebrospinal fluid (CSF) were quantified using an electrochemiluminescence immunoassay.
Results
Serum and CSF NfL are substantially higher in ALS patients compared to controls and at‐risk individuals and remain relatively stable over time. Among phenoconverters, however, NfL levels were elevated (ie, above the range observed in controls) as far back as ∼12 months preceding the emergence of the earliest clinical symptoms or signs of disease.
Interpretation
Serum (and CSF) NfL are informative biomarkers of presymptomatic ALS, providing a new tool to quantify presymptomatic disease progression and to potentially predict the timing of clinical phenoconversion. As such, quantification of NfL may aid the design and implementation of early therapeutic intervention for affected individuals and/or disease prevention trials for individuals at short‐term risk of developing ALS. Ann Neurol 2018 Ann Neurol 2018;83:130–139
Hereditary amyotrophic lateral sclerosis (ALS) encompasses a group of genetic disorders characterized by adult-onset loss of the lower and upper motor neuron systems, often with involvement of other ...parts of the nervous system. Cases of hereditary ALS have been attributed to mutations in 12 different genes, the most common being SOD1, FUS and TARDBP-mutations in the other genes are rare. The identified genes explain 25-35% of cases of familial ALS, but identifying the remaining genes has proved difficult. Only a few genes seem to account for significant numbers of ALS cases, with many others causing a few cases each. Hereditary ALS can be inherited in an autosomal dominant, autosomal recessive or X-linked manner, and families with low disease penetrance are frequently observed. In such families, the genetic predisposition may remain unnoticed, so many patients carry a diagnosis of isolated or sporadic ALS. The only clinical feature that distinguishes recognized hereditary from apparently sporadic ALS is a lower mean age of onset in the former. All the clinical features reported in hereditary cases (including signs of extrapyramidal, cerebellar or cognitive involvement) have also been observed in sporadic cases. Genetic counseling and risk assessment in relatives depend on establishing the specific gene defect and the disease penetrance in the particular family.
This study examines US productivity growth through the lens of R&D‐based growth models. A general R&D‐based model, nesting different model varieties, is developed. These varieties are tested using a ...novel cointegrating relationship and US data for the period 1953–2018. The results provide evidence against the widely used fully endogenous variety and support for other varieties including the semi‐endogenous variety. Further, the results are systematically consistent with the presence of fishing‐out effects in knowledge production, implying that productivity‐enhancing innovations become increasingly harder to achieve as technologies become more advanced. Forecasts suggest that the US productivity growth slowdown continues over the coming decades.
Tuberculosis (TB) vaccine research has reached a unique point in time. Breakthrough findings in both the basic immunology of Mycobacterium tuberculosis infection and the clinical development of TB ...vaccines suggest, for the first time since the discovery of the Mycobacterium bovis bacillus Calmette-Guérin (BCG) vaccine more than a century ago, that a novel, efficacious TB vaccine is imminent. Here, we review recent data in the light of our current understanding of the immunology of TB infection and discuss the identification of biomarkers for vaccine efficacy and the next steps in the quest for an efficacious vaccine that can control the global TB epidemic.
Population growth has two potentially counteracting effects on pollution emissions: (i) more people imply more production and thereby more emissions, and (ii) more people imply a larger research ...capacity which might reduce the emission intensity of production, depending on the direction of research. This study investigates how to achieve a given climate goal in the presence of these two effects. A growth model featuring both directed technical change and population growth is developed. The model allows for simultaneous research in polluting and non-polluting technologies. Both analytical and numerical results indicate that population growth is a burden on the environment, even when all research efforts are directed toward non-polluting technologies. Thus, research subsidies alone cannot ensure environmental sustainability. Instead, the analysis highlights the importance of carbon taxes for climate change mitigation.
The editorial introduces the JBO Special Section on Selected Topics in Biophotonics: Translating Novel Photonics Technology into Clinical Applications.
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