University of Nairobi

Fusarium wilt, caused by Fusarium oxysporum F. sp. phaseoli caused growers to abandon the most popular climbing bean cultivar, Umubano (G2333) in Rwanda. The present objective was to determine the nature of inheritance of fusarium wilt resistance and recommend a breeding strategy to introduce resistance into susceptible cultivars. Two cultivars, vuninkingi (G685) and flora were donors of resistance to fusarium wilt whereas G2333 was highly susceptible. Injured root tips of 10-day old seedlings of the\n parents, progenies of F1 and F2 (G2333 × G685) and (G2333 × Flora), backcrosses F2 (G685 × Flora) were inoculated with 106 conidia ml-1 of Rwandan isolate of F. oxysporum F. sp phaseoli (FOP-RW2) in a glasshouse. The disease severity was rated 28 days later using the CIAT scale of 1 - 9, where 1 - 3 represent resistant, 4 - 6 tolerant and 7 - 9 susceptible reactions. The chi-square analysis was performed to determine the Mendelian segregation ratios of resistant and susceptibility among the inoculated progenies. The F1 and the backcross progenies to the resistant parents segregated in the ratio of 1:0 as\n did the F2 population (G685 × Flora). The F2 progenies segregated in the ratio of 3:1. The backcross progenies to the susceptible parent segregated in the ratio of 1:1. Resistance to fusarium wilt is conditioned by a single highly heritable major dominant gene. The resistance can be achieved by backcross breeding.

BACKGROUND: Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations. METHODS: We conducted a randomized trial of oral antiretroviral therapy for use as preexposure prophylaxis among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda. The HIV-1-seronegative partner in each couple was randomly assigned to one of three study regimens--once-daily tenofovir (TDF), combination tenofovir-emtricitabine (TDF-FTC), or matching placebo--and followed monthly for up to 36 months. At enrollment, the HIV-1-seropositive partners were not eligible for antiretroviral therapy, according to national guidelines. All couples received standard HIV-1 treatment and prevention services. RESULTS: We enrolled 4758 couples, of whom 4747 were followed: 1584 randomly assigned to TDF, 1579 to TDF-FTC, and 1584 to placebo. For 62% of the couples followed, the HIV-1-seronegative partner was male. Among HIV-1-seropositive participants, the median CD4 count was 495 cells per cubic millimeter (interquartile range, 375 to 662). A total of 82 HIV-1 infections occurred in seronegative participants during the study, 17 in the TDF group (incidence, 0.65 per 100 person-years), 13 in the TDF-FTC group (incidence, 0.50 per 100 person-years), and 52 in the placebo group (incidence, 1.99 per 100 person-years), indicating a relative reduction of 67% in the incidence of HIV-1 with TDF (95% confidence interval [CI], 44 to 81; P<0.001) and of 75% with TDF-FTC (95% CI, 55 to 87; P<0.001). Protective effects of TDF-FTC and TDF alone against HIV-1 were not significantly different (P=0.23), and both study medications significantly reduced the HIV-1 incidence among both men and women. The rate of serious adverse events was similar across the study groups. Eight participants receiving active treatment were found to have been infected with HIV-1 at baseline, and among these eight, antiretroviral resistance developed in two during the study. CONCLUSIONS: Oral TDF and TDF-FTC both protect against HIV-1 infection in heterosexual men and women. (Funded by the Bill and Melinda Gates Foundation; Partners PrEP ClinicalTrials.gov number, NCT00557245.).

<h3>Importance</h3> Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. <h3>Objective</h3> To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. <h3>Evidence Review</h3> We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. <h3>Findings</h3> In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). <h3>Conclusions and Relevance</h3> The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

Human activity is leaving a pervasive and persistent signature on Earth. Vigorous debate continues about whether this warrants recognition as a new geologic time unit known as the Anthropocene. We review anthropogenic markers of functional changes in the Earth system through the stratigraphic record. The appearance of manufactured materials in sediments, including aluminum, plastics, and concrete, coincides with global spikes in fallout radionuclides and particulates from fossil fuel combustion. Carbon, nitrogen, and phosphorus cycles have been substantially modified over the past century. Rates of sea-level rise and the extent of human perturbation of the climate system exceed Late Holocene changes. Biotic changes include species invasions worldwide and accelerating rates of extinction. These combined signals render the Anthropocene stratigraphically distinct from the Holocene and earlier epochs.

IMPORTANCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

Assessing Biodiversity Declines Understanding human impact on biodiversity depends on sound quantitative projection. Pereira et al. (p. 1496 , published online 26 October) review quantitative scenarios that have been developed for four main areas of concern: species extinctions, species abundances and community structure, habitat loss and degradation, and shifts in the distribution of species and biomes. Declines in biodiversity are projected for the whole of the 21st century in all scenarios, but with a wide range of variation. Hoffmann et al. (p. 1503 , published online 26 October) draw on the results of five decades' worth of data collection, managed by the International Union for Conservation of Nature Species Survival Commission. A comprehensive synthesis of the conservation status of the world's vertebrates, based on an analysis of 25,780 species (approximately half of total vertebrate diversity), is presented: Approximately 20% of all vertebrate species are at risk of extinction in the wild, and 11% of threatened birds and 17% of threatened mammals have moved closer to extinction over time. Despite these trends, overall declines would have been significantly worse in the absence of conservation actions.

There is extensive evidence showing that improving eye health contributes directly and indirectly to achieving many Sustainable Development Goals, including reducing poverty and improving work productivity, general and mental health, and education and equity. Improving eye health is a practical and cost-effective way of unlocking human potential. Eye health needs to be reframed as an enabling, cross-cutting issue within the sustainable development framework.

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

BACKGROUND: Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age. METHODS: We studied deliveries in 287 facilities in 21 countries that were included in both the WHO Global Survey of Maternal and Perinatal Health (WHOGS; 2004-08) and the WHO Multi-Country Survey of Maternal and Newborn Health (WHOMCS; 2010-11). We used the data from these surveys to establish the average annual percentage change (AAPC) in caesarean section rates per country. Countries were stratified according to Human Development Index (HDI) group (very high/high, medium, or low) and the Robson criteria were applied to both datasets. We report the relative size of each Robson group, the caesarean section rate in each Robson group, and the absolute and relative contributions made by each to the overall caesarean section rate. FINDINGS: The caesarean section rate increased overall between the two surveys (from 26.4% in the WHOGS to 31.2% in the WHOMCS, p=0.003) and in all countries except Japan. Use of obstetric interventions (induction, prelabour caesarean section, and overall caesarean section) increased over time. Caesarean section rates increased across most Robson groups in all HDI categories. Use of induction and prelabour caesarean section increased in very high/high and low HDI countries, and the caesarean section rate after induction in multiparous women increased significantly across all HDI groups. The proportion of women who had previously had a caesarean section increased in moderate and low HDI countries, as did the caesarean section rate in these women. INTERPRETATION: Use of the Robson criteria allows standardised comparisons of data across countries and timepoints and identifies the subpopulations driving changes in caesarean section rates. Women who have previously had a caesarean section are an increasingly important determinant of overall caesarean section rates in countries with a moderate or low HDI. Strategies to reduce the frequency of the procedure should include avoidance of medically unnecessary primary caesarean section. Improved case selection for induction and prelabour caesarean section could also reduce caesarean section rates. FUNDING: None.

CONTEXT: Transmission of human immunodeficiency virus type 1 (HIV-1) is known to occur through breastfeeding, but the magnitude of risk has not been precisely defined. Whether breast milk HIV-1 transmission risk exceeds the potential risk of formula-associated diarrheal mortality in developing countries is unknown. OBJECTIVES: To determine the frequency of breast milk transmission of HIV-1 and to compare mortality rates and HIV-1-free survival in breastfed and formula-fed infants. DESIGN AND SETTING: Randomized clinical trial conducted from November 1992 to July 1998 in antenatal clinics in Nairobi, Kenya, with a median follow-up period of 24 months. PARTICIPANTS: Of 425 HIV-1-seropositive, antiretroviral-naive pregnant women enrolled, 401 mother-infant pairs were included in the analysis of trial end points. INTERVENTIONS: Mother-infant pairs were randomized to breastfeeding (n = 212) vs formula feeding arms (n = 213). MAIN OUTCOME MEASURES: Infant HIV-1 infection and death during the first 2 years of life, compared between the 2 intervention groups. RESULTS: Compliance with the assigned feeding modality was 96% in the breastfeeding arm and 70% in the formula arm (P<.001). Median duration of breastfeeding was 17 months. Of the 401 infants included in the analysis, 94% were followed up to HIV-1 infection or mortality end points: 83% for the HIV-1 infection end point and 93% to the mortality end point. The cumulative probability of HIV-1 infection at 24 months was 36.7% (95% confidence interval [CI], 29.4%-44.0%) in the breastfeeding arm and 20.5% (95% CI, 14.0%-27.0%) in the formula arm (P = .001). The estimated rate of breast milk transmission was 16.2% (95% CI, 6.5%-25.9%). Forty-four percent of HIV-1 infection in the breastfeeding arm was attributable to breast milk. Most breast milk transmission occurred early, with 75% of the risk difference between the 2 arms occurring by 6 months, although transmission continued throughout the duration of exposure. The 2-year mortality rates in both arms were similar (breastfeeding arm, 24.4% [95% CI, 18.2%-30.7%] vs formula feeding arm, 20.0% [95% CI, 14.4%-25.6%]; P = .30). The rate of HIV-1-free survival at 2 years was significantly lower in the breastfeeding arm than in the formula feeding arm (58.0% vs 70.0%, respectively; P = .02). CONCLUSIONS: The frequency of breast milk transmission of HIV-1 was 16.2% in this randomized clinical trial, and the majority of infections occurred early during breastfeeding. The use of breast milk substitutes prevented 44% of infant infections and was associated with significantly improved HIV-1-free survival.

A prospective cohort study was conducted to examine the relationship between vaginal colonization with lactobacilli, bacterial vaginosis (BV), and acquisition of human immunodeficiency virus type 1 (HIV-1) and sexually transmitted diseases in a population of sex workers in Mombasa, Kenya. In total, 657 HIV-1-seronegative women were enrolled and followed at monthly intervals. At baseline, only 26% of women were colonized with Lactobacillus species. During follow-up, absence of vaginal lactobacilli on culture was associated with an increased risk of acquiring HIV-1 infection (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.2-3.5) and gonorrhea (HR, 1.7; 95% CI, 1.1-2.6), after controlling for other identified risk factors in separate multivariate models. Presence of abnormal vaginal flora on Gram's stain was associated with increased risk of both HIV-1 acquisition (HR, 1.9; 95% CI, 1.1-3.1) and Trichomonas infection (HR, 1.8; 95% CI, 1.3-2.4). Treatment of BV and promotion of vaginal colonization with lactobacilli should be evaluated as potential interventions to reduce a woman's risk of acquiring HIV-1, gonorrhea, and trichomoniasis.

As outlined in the first part of this bi-partite publication 1, individuals with severe mental illness (SMI) are at an increased risk for a large number of physical disorders that require clinical attention. People with SMI are entitled to the same standards of care as the rest of the population. However, rates of undiagnosed and untreated medical illnesses are higher in SMI individuals, compared to the general population. Despite the fact that the higher morbidity and mortality of physical illnesses in SMI patients are largely due to modifiable lifestyle risk factors 1, there is sufficient evidence that disparities not only in health care access and utilization, but also in health care provision, contribute to these poor physical health outcomes 2,3. According to one recent study, people with psychotic disorders, bipolar disorder, or major depressive disorder have greatly increased odds of reporting difficulties in accessing care (odds ratios, OR=2.5–7.0) 4. Although parity in access to and provision of health care should be conceived as a basic human right, a confluence of patient, provider, treatment and system factors has created a situation in which access to and quality of health care is problematic for individuals with SMI 5. Table 1 summarizes the barriers to the recognition and management of somatic illnesses in SMI patients. In many cases, the SMI patients’ only contact with the health service is through the mental health care team. Moreover, because of their SMI, these patients are less capable than other patients of interpreting physical signs, as well as solving their problems and caring for themselves, which places an increased responsibility on the part of mental care workers to be in the fore front for the physical health care of these patients 6. Two consensus conferences have called on mental health care providers to take responsibility for the physical health of their patients 7,8. However, despite data suggesting that the sensitization of psychiatrists to expand their tasks to include assessments of both mental and physical health in SMI patients can be improved by consensus guidelines 9, many psychiatrists still consider their primary or, even, sole function to provide clinical care in terms of psychiatric symptom control and are reluctant to monitor physical health 6. Although many barriers can be related to the patient and his/her illness, and/or to the clinician and his/her medical treatment, the reintegration of psychiatric care and general somatic services, with an ultimate goal of providing optimal services to this vulnerable patient population, seems to represent one of the most important challenges for psychiatric care today 7,10. However, this is only one part of the broader picture: 37% of 195 countries in the world do not even have a specified budget for mental health, and 25% of the countries (of the 101 countries that reported their mental health budget) spend less than 1% of their total health care budget on mental health 11. In some parts of the world, mental health resources are even poorer. In Africa and in the Western Pacific Regions, a mental health policy was found to be present in only half of the countries 12. Moreover, in developing as well as in developed countries, stigmatization, discrimination, erroneous beliefs and negative attitudes associated with SMI will have to be eliminated to achieve parity in health care access and provision. Due to differences between regions and countries (e.g., level of economic development, budgeting of health care, availability of mental health care personnel, etc.), the majority of actions should be adapted to the local needs and circumstances 7. The excess mortality rates in persons with SMI are largely due to modifiable health risk factors 1. Therefore, the monitoring and treatment of these factors should be a part of clinical routine care of the psychiatrist. Furthermore, to address the problem of suboptimal medical treatment for patients with SMI, changes need to be made in the health care system and delivery 48, wherein the psychiatrist, once again, can and should play a pivotal role. Physical health checks should focus on monitoring 49,50,51: - weight gain and obesity (body mass index, BMI; waist circumference, WC); - blood pressure; - dietary intake; - activity level and exercise; - use of tobacco and alcohol or other substances; - fasting blood levels of glucose; - fasting blood levels of lipids, especially triglycerides and high-density lipoprotein (HDL)-cholesterol; - prolactin levels (if indicated by reproductive system and/or sexual symptoms); - cardiovascular disease (CVD) risk and electrocardiographic (ECG) parameters; - dental health; - liver function tests, blood count, thyroid hormone, electrolytes (periodically, as indicated). Many of these physical health monitoring tests are simple, easy to perform and inexpensive 6,52,53,54, and therefore can/should be implemented in the health care systems of developed as well as developing countries. Moreover, even in developing countries, several of these simple and inexpensive measurements (e.g., body weight and blood pressure) can be routinely done by health workers other than doctors. Screening and assessment of physical health should begin with the patient's personal and family history, covering 40: diabetes mellitus (DM), hypertension, CVD (myocardial infarction or cerebrovascular accident, including age at onset), smoking, diet, physical activity. Secondly, as the individual components of the metabolic syndrome (MetS) (see 1) are critical in predicting the morbidity and mortality of CVD, DM, cancer and other related diseases, these, as well as some other non-metabolic parameters, should be checked at baseline and measured regularly thereafter 46,51. Concerning metabolic parameters, one should remember that drug-naïve, first-episode patients, as well as children and adolescents with psychotic disorders, are at higher risk for metabolic side effects of medications 55,56. Higher baseline values of weight and visceral fat distribution, as well as laboratory evidence of impaired glucose and lipid metabolism, have been, although not consistently, reported for these patients 57. Likewise, young drug-naïve patients of non-Caucasian ethnicity with a personal or family history of metabolic risk factors are more likely to develop metabolic side effects 57. Psychiatrists should, regardless of the medication prescribed, monitor and chart BMI and WC of every patient with SMI at every visit, and should encourage patients to monitor and chart their own weight 58. WC seems to be a more useful measurement than BMI. Prospective data in patients with impaired glucose tolerance revealed that central adiposity, having a strong correlation with insulin resistance 59, better predicted future type 2 DM than BMI 60. WC is also a stronger indicator than BMI for systolic blood pressure, HDL-cholesterol, or triglycerides 61, and has been proposed as the best single measure to identify individuals at high risk for CVD and the MetS 52. It is also a simple tool to assess the likelihood of insulin resistance: in one study, a WC <100 cm excluded insulin resistance in 98% of males and 94% of females 61. This assessment can easily be done with a simple and inexpensive waist tape measure. The International Diabetes Federation (IDF) definition (see 1) provides sex- and race-specific criteria for defining elevated WC to identify people with central obesity, thus adapting this criterion to make it also applicable to non-Caucasian populations. However, multiple studies found that WC is rarely measured 62,63,64. The other MetS criteria of blood pressure, fasting plasma glucose and fasting lipid profile should also be assessed, even if WC is normal. As the MetS components seem to cluster, the presence of one component often suggests the presence of the others. High blood pressure in SMI patients is often missed 65. As the cost for measuring blood pressure is low, and hypertension is a relevant CVD risk factor, blood pressure can/ought to be assessed routinely, even at every visit. Hypertension can be defined as a systolic blood pressure $130 mm Hg or a diastolic blood pressure $85 mm Hg 66. This diagnosis requires at least two separate, independent measurements that fall both within the range of hypertension 65. Individuals with a systolic blood pressure of 120 to 130 mm Hg or a diastolic blood pressure of 80 to 85 mm Hg should be considered as pre-hypertensive and require lifestyle modifications to prevent heart disease 67. A baseline measure of plasma glucose level should be collected for all patients before starting treatment 58. In patients starting antipsychotic (AP) treatment, finger prick tests should be carried out at baseline, 6 and 12 weeks to capture early cases of hyperglycemia and then, at minimum, yearly. Formal laboratory tests can be carried out blood glucose measurement should be in the fasting because this is the most measurement for the of developing glucose However, this can problematic to In cases patients present it is to a blood glucose than to the to 6. plasma glucose or suggests the of plasma glucose levels between and values of are of and should also assessment and However, the of need to be excluded by at least one measurement of fasting plasma the is the of fasting plasma glucose measurements needs to be increased to a to assess the of the Likewise, if fasting plasma glucose levels are or values are the of needs to be excluded by at least one measurement of fasting plasma the measurement the this should to a with an or other primary health care for assessment the glucose levels the This is as a goal for treatment but not to in early have risk factors for DM history, BMI WC critical should have their fasting plasma glucose level or at the same as other patients starting medication 6 and but thereafter need to be checked more every are or more of their baseline weight should also have their fasting plasma glucose level or more for every 58. of high should be to and often develop within and and poor weight of and in to metabolic and The of a patient with on the of the (e.g., or patients only of poor or In type 2 DM, and have been for weeks to of which can be through laboratory tests, blood glucose level and a of or triglycerides and should also be assessed at baseline and at with assessments is in of values for total are for patients DM and for patients with lipoprotein values for patients and with DM are and 65. However, the cost and of availability of this assessment not make it as a routine measure in all and patients. The patient's individual CVD risk should be his/her presence or of DM, systolic blood pressure and total or the of total to with to local or risk measurements are simple and easily In the psychiatric it is often to an as as in other medical In less well developed countries, an be even more In these cases, a is to patients should be heart as family history of early in males and in personal history of a heart of medications or or if has an of simple the measurement of as a baseline that the monitoring of patients with SMI has to be as a baseline in to assess the health As a general that every patient should have an measurement to the of on the by a monitoring can be A baseline assessment is especially important in patients with clinical risk factors for with a family history of early personal history of a heart hypertension or at heart and to have a prolactin levels should be measured in all patients at prolactin levels should only be measured in sexual or reproductive system are these need to be and system prolactin level measurement include or in and/or and in that should prolactin measurement include and/or that with antipsychotic treatment or including or problems with or In these cases, prolactin should be measured every especially the of Although the clinician needs to be that laboratory between in most prolactin values are at for and for A measurement of prolactin levels is the presence of which is but to high prolactin levels as measured by many that the presence of to in as many as of all reported of In cases measured prolactin is reporting of prolactin of can antipsychotic treatment, prolactin levels are most the of these levels is a of is the which has been associated with and The risk for cancer is less seems to be is that prolactin level that to should a treatment to a less prolactin antipsychotic (e.g., or, in patients, of the to out a should only be other for prolactin are excluded (e.g., by by thyroid hormone, and or if prolactin levels are and do not a to a risk or if are the of a Although considered by many as not health needs to be in the same as other physical health problems factors for a poor health (e.g., smoking, medication side and individual care needs should be assessed Physical and monitoring are well by patients and can be implemented in a of to general it is not to most patients to take part in the fasting blood and most are to and the of the Screening patients an monitoring 85 or risk chart is a than the more and guidelines recent both and have developed and monitoring guidelines these seem not to be routinely implemented in the clinical care of patients monitoring should be done at Physical health assessments should be on the and of the assessments compared with of treatment, it is important to measure weight to identify patients gain weight and of all patients on medication at baseline identify individuals and to early of changes in metabolic at the minimum, every guidelines and monitoring at baseline, 12 and patients gain at least of baseline body weight or are at increased risk for health outcomes (e.g., family history of DM or early personal history of or obesity, DM, the patient has central obesity, blood pressure mm plasma glucose or or DM plasma glucose or or triglycerides should be to primary care to these simple lifestyle or and/or to a risk medication can address these medical but not individuals with SMI are of the need to or do not the and to make lifestyle and other of the can and people with SMI to address their including smoking, and through the use of with SMI, as well as their family and should be and should to not need to be by a (e.g., a it require but should be by at the mental health and can be resources within the local service 6. should be and and treatment be to the individual needs of SMI patients dietary and physical activity in terms of weight gain in The on health, even with simple is A diet, physical activity and are the components of the and of modifiable risk However, if lifestyle do not including or be should be and as for the general and are well Moreover, to weight can be most evidence for to with or in Many patients with SMI do not the components of a It is that patients with have a higher in fat higher in in and poor in and Therefore, be should be to and even, as well as high high and poor as and The of as and and in a should be by Although patients well as their family and is patients need to that lifestyle changes should be people weight modifications will to their weight the likelihood of developing many are in fat and a weight in dietary can have has many that are of to SMI patients, including a in risk of DM and CVD, of triglycerides and in and in blood glucose and patients with type 2 However, that address weight management and physical activity have not a routine part of psychiatric care The can the individual with SMI in and that address the of health and which can medical in this population. as the and the for have been to be in people with SMI Table some of to the health of patients with Physical is one of the risk factors that can most easily be and in individuals with SMI People with are more than the general of these patients the health of a of at least physical activity According to the guidelines of the of and the physical activity between and a will provide weight and is in weight of physical activity a can be associated with weight Physical activity can metabolic health even in the of weight is evidence that physical activity with or is and in weight and risk profile in people with However, in patients are physical should be by to achieve weight if a patient for 1 are this is in terms of cardiovascular health, this will not in weight physical as be all these patients should be to in at least of activity least a on most of the 65. A of studies that patients, compared with the general population, have a higher of smoking, and high as well as of risk factors that make more vulnerable to to of individuals with SMI will and/or have a quality of because of a disease of is associated with a in the risk of heart disease and a in the risk of high cardiovascular Therefore, SMI patients should be to However, has important for the management of patients and of is associated with a risk of in patients levels can also found that the of patients with a plasma level increased to within the the despite Therefore, plasma levels be and made in if for at least Moreover, also the risk for In a study, an increased risk for DM that within of but was still 6 The increased risk seems to be by weight of to increased and excess Therefore, should consider (e.g., use of especially for tobacco is in patients with is evidence that people with SMI can Moreover, that in the general to be in SMI patients. The evidence also suggests that tobacco in SMI patients with psychiatric not mental although psychiatric often that a policy have a negative on the treatment this is not the Therefore, at a minimum, psychiatric should assess tobacco use in all patients, all tobacco to patients in developing a and and patients can be to a which can or other 65. blood pressure levels of less than are as smoking, weight and increased be sufficient to elevated blood pressure, although some patients are likely to require 65. guidelines the of best to the individual patient's needs health and should be to SMI patients, to their and treatment need to be to the individual needs of patients with and of mental should include dietary smoking, and side effects of and on the dietary control of and the of to the of a are to the side effects of some Psychiatrists should be made more of the of health Therefore, for in the of health risk factors as and of side effects of and on is patients with SMI need and to make use of dental are by dental care The should for do not patients and are to take care of this vulnerable population. the for of dental care should be Formal for the dental and of mental illness and medication side effects can be or to be associated with should not be for SMI patients with heart a personal history of a family history of at an early age if both or syndrome (see of and of are in patients with treatment, the SMI patient should be related to elevated as of and or patients are medications to be associated with prolactin these baseline should be at every starting the medication or the is sexual is management include the to a or sexual function by as or a should be considered prolactin is even a elevated level for more than or to a medication should be a has the of the and levels are or the patient has of a other than to an is psychiatrists should also be that even to can be the of a as a 58. there are more data on the of on and development, the clinician will to in a of individual clinical the of the is and should be made on a The and be for patient on an individual In the use of medication is indicated risk to the to this medication is by the of untreated or psychiatric illness in the require treatment should the and of with their if it is that treatment should be the will be of in this important on and should also be as part of routine mental health care Many psychiatrists are reluctant to despite the presence of physical health 6. should be to and/or medication a SMI patient of weight of or or other effects (e.g., side The should, consider the psychiatric and physical of the patient and the of both is to a to or prevent the (e.g., or to weight gain in patients DM or severe physical illness has been the SMI patient should be to services, including and to the health are at two levels of system level and health care and individual level patients, the with SMI as a health population. is still a of of the physical health and health care access problems for people with Therefore, and health care first have to identify and people with SMI as a health before the problem can be Psychiatrists can play an important in this of by the with policy and budget the health care and local should be implemented to physical health in persons with SMI and to encourage of the the health care In to mental health care also need to be in and measuring CVD health and other (e.g., health in SMI should be to primary care access to and care of physical health of the SMI population. and health care should access to and care of physical health of the SMI to and treatment of general health care have to to the physical health care needs of the SMI population. and is a and major access for people with It the of the health services and people with SMI to or to treatment and personal contact with persons with SMI can be to and should be and be implemented to access to health the between physical and mental health care and a policy of and mental and physical health care for persons with The reintegration of psychiatric care and general somatic services, with an ultimate goal of providing optimal services to this vulnerable patient population, seems to represent the most important for psychiatric care today for these service and provide for the health assessment and service In developing countries this to be or responsibility for the physical health of the SMI there is a provision of general somatic health care services for SMI patients, the should responsibility for the somatic health of his/her patients. has to a on the as SMI patients not the problem is or not be of physical monitoring and have been the patient's personal and family history at baseline to identify patients and to early of changes in critical patients with a personal or family history of obesity, high blood pressure, DM, heart disease or cerebrovascular accident, or with high or values on metabolic with risk of effects should be of the health of SMI patients should include monitoring of blood pressure, fasting plasma fasting lipids, smoking, physical diet, and sexual health, as well as effects of the an monitoring or risk chart the patient's This is a and better than the more and guidelines to monitor the physical health of the SMI weight gain of glucose or other effects consider to medications with risk higher to risk medications has been to cardiovascular and risk factors but needs to be done in a and monitoring to the primary care and services, including and that people with SMI have been to be at risk of developing CVD and/or DM be People with SMI have CVD and/or DM should be in primary stronger with these medical and other health care and physical care of patients with SMI has the of their physical health care outcomes should to develop at the of primary care SMI patients, to and erroneous as well as the of the psychiatrist, to better monitor and physical illness in SMI patients. care should be include of services a primary health care to mental health services, with between primary care and mental health is in the physical health of with having one service on a or to between services and the care for the a of health workers including medical as well as psychiatrists lifestyle modifications and treatment for SMI patients. and should be and to the SMI population. to encourage and the patient's to medical and personal and individual responsibility in patients with SMI, to make for and their individual (e.g., the and to people with SMI to more of their a range of and health including patient and likelihood of primary care medical services The of these in Table health care systems the world on local will contribute to a in the medical and related psychiatric health of patients with The improved physical health outcomes in SMI patients will both patients and This will and and physical health care that and patients with physical illnesses on the presence and effects of psychiatric changes in the monitoring and management of physical disorders that do not have to be can make a in this and patient The of this is part of the and has been by the the of and

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The use of plant growth promoting bacterial inoculants as live microbial biofertilizers provides a promising alternative to chemical fertilizers and pesticides. Inorganic phosphate solubilization is one of the major mechanisms of plant growth promotion by plant associated bacteria. This involves bacteria releasing organic acids into the soil which solubilize the phosphate complexes converting them into ortho-phosphate which is available for plant up-take and utilization. The study presented here describes the ability of endophytic bacteria to produce gluconic acid (GA), solubilize insoluble phosphate, and stimulate the growth of Pisum sativum L. plants. This study also describes the genetic systems within three of these endophyte strains thought to be responsible for their effective phosphate solubilizing abilities. The results showed that many of the endophytic strains produced GA (14-169 mM) and have moderate to high phosphate solubilization capacities (~400-1300 mg L(-1)). When inoculated into P. sativum L. plants grown in soil under soluble phosphate limiting conditions, the endophytes that produced medium-high levels of GA displayed beneficial plant growth promotion effects.

OBJECTIVES: To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic. DESIGN: Systematic review. METHODS: Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence. OUTCOME MEASURES: Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed. RESULTS: A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). CONCLUSIONS: COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.

In a study of human immunodeficiency virus type 1 (HIV-1)-uninfected African prostitutes, 83 (67%) of 124 seroconverted to HIV-1. Oral contraceptive use (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1-8.6; P less than .03), genital ulcers (mean annual episodes, 1.32 +/- 0.55 in seroconverting women vs. 0.48 +/- 0.21 in seronegative women; P less than .02) and Chlamydia trachomatis infections (OR, 3.6; CI, 1.3-11.0; P less than .02) were associated with increased risk of HIV-1 infection. Condom use reduced the risk of HIV-1 infection (OR, 0.11; CI, 0.05-0.27; P less than .0001). Stepwise logistic regression analysis confirmed independent associations between HIV-1 infection and oral contraceptive use, condom use, genital ulcers, and C. trachomatis. The presence of other sexually transmitted diseases may in part explain the heterosexual HIV-1 epidemic in Africa and may represent important targets for intervention to control HIV-1 infection.

This series of four papers investigates the link between the energetics and the mechanics of terrestrial locomotion. Two experimental variables are used throughout the study: speed and body size. Mass-specific metabolic rates of running animals can be varied by about tenfold using either variable. This first paper considers metabolic energy consumed during terrestrial locomotion. New data relating rate of oxygen consumption and speed are reported for: eight species of wild and domestic artiodactyls; seven species of carnivores; four species of primates; and one species of rodent. These are combined with previously published data to formulate a new allometric equation relating mass-specific rates of oxygen consumed (VO2/Mb) during locomotion at a constant speed to speed and body mass (based on data from 62 avian and mammalian species): VO2/Mb = 0.533 Mb-0.316.vg + 0.300 Mb-0.303 where VO2/Mb has the units ml O2 s-1 kg-1; Mb is in kg; and vg is in m s-1. This equation can be expressed in terms of mass-specific rates of energy consumption (Emetab/Mb) using the energetic equivalent of 1 ml O2 = 20.1 J because the contribution of anaerobic glycolysis was negligible: Emetab/Mb = 10.7 Mb-0.316.vg + 6.03 Mb-0.303 where Emetab/Mb has the units watts/kg. This new relationship applies equally well to bipeds and quadrupeds and differs little from the allometric equation reported 12 years ago by Taylor, Schmid-Nielsen & Raab (1970). Ninety per cent of the values calculated from this genera equation for the diverse assortment of avian and mammalian species included in this regression fall within 25% of the observed values at the middle of the speed range where measurements were made. This agreement is impressive when one considers that mass-specific rates of oxygen consumption differed by more than 1400% over this size range of animals.

Nanocrystalline porous nitrogen doped titanium dioxide (TiO2) thin films were prepared by DC magnetron sputtering. Films were deposited in a plasma of argon, oxygen, and nitrogen, with varying nitrogen contents. The films were characterized by X-ray diffraction, scanning electron microscopy, and optical- and photoelectrochemical (PEC) measurements. These studies showed that the films were porous and displaying rough surfaces with sharp, protruding nodules having a crystal structure varying from rutile to anatase depending on the nitrogen content. All nitrogen doped films showed visible light absorption in the wavelength range from 400 to 535 nm. The PEC properties of the thin film electrodes were determined on as-deposited as well as dye-sensitized films. The nitrogen doped TiO2 generated an incident photon-to-current efficiency response in good agreement with the optical spectra. The PEC measurements on dye-sensitized films showed that the electron-transfer properties in the conduction band were similar to those of undoped TiO2. It was also experimentally confirmed that the states introduced by nitrogen lie close to the valence band edge. For the best nitrogen doped TiO2 electrodes, the photoinduced current due to visible light and at moderate bias was increased around 200 times compared to the behavior of pure TiO2 electrodes. There is an optimum in introduced nitrogen where the response is highest.

BACKGROUND: In-home iron fortification for infants in developing countries is recommended for control of anaemia, but low absorption typically results in >80% of the iron passing into the colon. Iron is essential for growth and virulence of many pathogenic enterobacteria. We determined the effect of high and low dose in-home iron fortification on the infant gut microbiome and intestinal inflammation. METHODS: We performed two double-blind randomised controlled trials in 6-month-old Kenyan infants (n=115) consuming home-fortified maize porridge daily for 4 months. In the first, infants received a micronutrient powder (MNP) containing 2.5 mg iron as NaFeEDTA or the MNP without iron. In the second, they received a different MNP containing 12.5 mg iron as ferrous fumarate or the MNP without the iron. The primary outcome was gut microbiome composition analysed by 16S pyrosequencing and targeted real-time PCR (qPCR). Secondary outcomes included faecal calprotectin (marker of intestinal inflammation) and incidence of diarrhoea. We analysed the trials separately and combined. RESULTS: At baseline, 63% of the total microbial 16S rRNA could be assigned to Bifidobacteriaceae but there were high prevalences of pathogens, including Salmonella Clostridium difficile, Clostridium perfringens, and pathogenic Escherichia coli. Using pyrosequencing, +FeMNPs increased enterobacteria, particularly Escherichia/Shigella (p=0.048), the enterobacteria/bifidobacteria ratio (p=0.020), and Clostridium (p=0.030). Most of these effects were confirmed using qPCR; for example, +FeMNPs increased pathogenic E. coli strains (p=0.029). +FeMNPs also increased faecal calprotectin (p=0.002). During the trial, 27.3% of infants in +12.5 mgFeMNP required treatment for diarrhoea versus 8.3% in -12.5 mgFeMNP (p=0.092). There were no study-related serious adverse events in either group. CONCLUSIONS: In this setting, provision of iron-containing MNPs to weaning infants adversely affects the gut microbiome, increasing pathogen abundance and causing intestinal inflammation. TRIAL REGISTRATION NUMBER: NCT01111864.

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries. CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.