Spectrum of cerebral arteriopathies in children with arterial ischemic stroke.

ObjectiveTo determine that children with arterial ischemic stroke (AIS) due to an identifiable arteriopathy are distinct from those without arteriopathy and that each arteriopathy subtype has unique and recognizable clinical features.MethodsWe report a large, observational, multicenter cohort of children with AIS, age 1 month to 18 years, enrolled in the International Pediatric Stroke Study from 2003 to 2014. Clinical and demographic differences were compared by use of the Fisher exact test, with linear step-up permutation min-p adjustment for multiple comparisons. Exploratory analyses were conducted to evaluate differences between cases of AIS with and without arteriopathy and between arteriopathy subtypes.ResultsOf 2,127 children with AIS, 725 (34%) had arteriopathy (median age 7.45 years). Arteriopathy subtypes included dissection (27%), moyamoya (24.5%), focal cerebral arteriopathy-inflammatory subtype (FCA-i; 15%), diffuse cerebral vasculitis (15%), and nonspecific arteriopathy (18.5%). Children with arteriopathic AIS were more likely to present between 6 and 9 years of age (odds ratio [OR] 1.93, p = 0.029) with headache (OR 1.55, p = 0.023), multiple infarctions (OR 2.05, p < 0.001), sickle cell anemia (OR 2.9, p = 0.007), and head/neck trauma (OR 1.93, p = 0.018). Antithrombotic use and stroke recurrence were higher in children with arteriopathy. Among arteriopathy subtypes, dissection was associated with male sex, older age, headache, and anticoagulant use; FCA-i was associated with hemiparesis and single infarcts; moyamoya was associated with seizures and recurrent strokes; and vasculitis was associated with bilateral infarctions.ConclusionSpecific clinical profiles are associated with cerebral arteriopathies in children with AIS. These observations may be helpful indicators in guiding early diagnosis and defining subgroups who may benefit most from future therapeutic trials

Quantifying lifestyle based social equity implications for national sustainable development policy

The aim of this research is to address the challenge of achieving more equitable social outcomes through a reduction and fairer allocation of environmental burdens, and in doing so, contributing to national sustainable development policy. This novel study demonstrates the nature of societal outcomes through the lens of inequity with respect to lifestyle related environmental footprints and stakeholder preferences. Footprints are derived using input-output analysis, while environmental issue preferences and potential remedial actions are identified using a national survey. To highlight the value of the broadly applicable framework, here we demonstrate a case study of Japan, which is interesting due to shifting demographics engendering an aging, shrinking population. Key findings include that the mitigation of environmental footprints in line with household preferences can positively influence both societal equity outcomes and contribute to closing the gap between rich and poor. Importantly, broad participation, i.e. participation irrespective of income level, is shown to be more effective than participation from a single sector. These findings can assist policymakers to develop policies which are responsive to societal preferences and demographic trends while also furthering the debate toward clarifying norms for acceptable levels of social equity

Retrospective household and livelihoods survey in Nyangatom District, South Omo, Ethiopia 2019

These data are from a household survey conducted in Nyangatom District, South Omo Zone, Ethiopia, in 2018/19. The primary research question we sought to address was how the end of the annual flood of the Omo River, which was integral to the flood recession agricultural systems of downstream communities, affected food security. Data relate to agricultural production before and after the end of flood retreat agriculture which followed the construction of the Gibe III dam upstream. [2005 and 2010 in the Ethiopian Calendar]. We also sought to account for changes in non-farm wealth including livestock holdings over the same period.Rapid changes in the natural, social, and economic environment are occurring in Ethiopia's Lower Omo Valley, as part of a state-led development vision of repositioning the region as a major sugar exporter. At the same time, these changes raise risks of environmental degradation, and the emergence of new kinds of inequality and conflict. The Lower Omo is home to a large number of pastoralist groups, and is a major centre of ethnic, linguistic and cultural diversity - reflected in its designation as a UNESCO World Heritage Site (Schlee, 2009; Turton, 1991). While new sugar estates promise to create &gt;150,000 new jobs, they are also drawing labour migrants from other regions, setting up new hierarchies of wealth and opportunity, and raising social tensions (Tewolde and Fana, 2014). As part of its ambitious Growth and Transformation Plans (FDRE 2010, 2015), Ethiopia's government has allocated 175,000 hectares to the sugarcane project (more than the entire area under irrigation in Kenya), and aims to increase national sugar production from 17 million to 42 million tons. Pastoralists who, according to the government, do not use the land optimally, have had their &quot;underutilized&quot; lands repurposed for sugarcane plantations and industrial sites that will produce sugar worth 661.7 million USD and produce alternative energy sources (304,000m3 of ethanol per year and 607 MW electricity). This scenario raises urgent questions about the social justice dimensions of current development models, and their implications for socio-ecological resilience. The following interlinked research questions will structure our exploration of the on-going changes and their consequences: 1. How have recent developments affected the spatial and temporal availability of and access to natural resources in the region? (Environmental sustainability / degradation) 2. How are changing resources affecting conflict dynamics in the region? (Conflict and resilience) 3. How are these changes influencing relations of material in/equality? (Wealth and poverty / resource security) These questions will be addressed by three Working Groups with expertise in the fields of environmental sustainability, conflict studies, and poverty research respectively. The group will first conduct Research involving knowledge generation across disciplines and stakeholder groups, and second work towards Application in the form of knowledge exchange and synthesis. The first step in the research design will accommodate a cycle of stakeholder identification, scoping and testing of research assumptions; followed by an intensive period of data collection using both conventional (survey, focus group) and participatory research methods. Crucially, our tools will include participatory video methods that will be used to stimulate conversations about current models of development that are rarely possible due to barriers of language, distance, and power. The project will thereby facilitate knowledge sharing, processing, and utilisation, and explore how knowledge regarding the environmental changes and their implications for poverty, peace, and security is best integrated in decision-making for diverse stakeholders.</p

Retrospective household and livelihoods survey in Nyangatom District, South Omo, Ethiopia 2019

These data are from a household survey conducted in Nyangatom District, South Omo Zone, Ethiopia, in 2018/19. The primary research question we sought to address was how the end of the annual flood of the Omo River, which was integral to the flood recession agricultural systems of downstream communities, affected food security. Data relate to agricultural production before and after the end of flood retreat agriculture which followed the construction of the Gibe III dam upstream. [2005 and 2010 in the Ethiopian Calendar]. We also sought to account for changes in non-farm wealth including livestock holdings over the same period.Rapid changes in the natural, social, and economic environment are occurring in Ethiopia's Lower Omo Valley, as part of a state-led development vision of repositioning the region as a major sugar exporter. At the same time, these changes raise risks of environmental degradation, and the emergence of new kinds of inequality and conflict. The Lower Omo is home to a large number of pastoralist groups, and is a major centre of ethnic, linguistic and cultural diversity - reflected in its designation as a UNESCO World Heritage Site (Schlee, 2009; Turton, 1991). While new sugar estates promise to create &gt;150,000 new jobs, they are also drawing labour migrants from other regions, setting up new hierarchies of wealth and opportunity, and raising social tensions (Tewolde and Fana, 2014). As part of its ambitious Growth and Transformation Plans (FDRE 2010, 2015), Ethiopia's government has allocated 175,000 hectares to the sugarcane project (more than the entire area under irrigation in Kenya), and aims to increase national sugar production from 17 million to 42 million tons. Pastoralists who, according to the government, do not use the land optimally, have had their &quot;underutilized&quot; lands repurposed for sugarcane plantations and industrial sites that will produce sugar worth 661.7 million USD and produce alternative energy sources (304,000m3 of ethanol per year and 607 MW electricity). This scenario raises urgent questions about the social justice dimensions of current development models, and their implications for socio-ecological resilience. The following interlinked research questions will structure our exploration of the on-going changes and their consequences: 1. How have recent developments affected the spatial and temporal availability of and access to natural resources in the region? (Environmental sustainability / degradation) 2. How are changing resources affecting conflict dynamics in the region? (Conflict and resilience) 3. How are these changes influencing relations of material in/equality? (Wealth and poverty / resource security) These questions will be addressed by three Working Groups with expertise in the fields of environmental sustainability, conflict studies, and poverty research respectively. The group will first conduct Research involving knowledge generation across disciplines and stakeholder groups, and second work towards Application in the form of knowledge exchange and synthesis. The first step in the research design will accommodate a cycle of stakeholder identification, scoping and testing of research assumptions; followed by an intensive period of data collection using both conventional (survey, focus group) and participatory research methods. Crucially, our tools will include participatory video methods that will be used to stimulate conversations about current models of development that are rarely possible due to barriers of language, distance, and power. The project will thereby facilitate knowledge sharing, processing, and utilisation, and explore how knowledge regarding the environmental changes and their implications for poverty, peace, and security is best integrated in decision-making for diverse stakeholders.</p

Comparative study of posterior and anterior circulation stroke in childhood: Results from the International Pediatric Stroke Study

OBJECTIVE: To compare risk factors, clinical presentation, and outcomes after posterior circulation arterial ischemic stroke (PCAIS) and anterior circulation arterial ischemic stroke (ACAIS) in neonates and children. METHODS: In this international multicenter observational study including neonates and children up to 18 years of age with arterial ischemic stroke (AIS), we compared clinical and radiologic features according to stroke location. RESULTS: Of 2,768 AIS cases, 507 (18%) were located in the posterior circulation, 1,931 (70%) in the anterior circulation, and 330 (12%) involved both. PCAIS was less frequent in neonates compared to children (8.8% vs 22%, p < 0.001). Children with PCAIS were older than children with ACAIS (median age 7.8 [interquartile range (IQR) 3.1-14] vs 5.1 [IQR 1.5-12] years, p < 0.001), and more often presented with headache (54% vs 32%, p < 0.001) and a lower Pediatric NIH Stroke Scale score (4 [IQR 2-8] vs 8 [IQR 3-13], p = 0.001). Cervicocephalic artery dissections (CCAD) were more frequent (20% vs 8.5%, p < 0.001), while cardioembolic strokes were less frequent (19% vs 32%, p < 0.001) in PCAIS. Case fatality rates were equal in both groups (2.9%). PCAIS survivors had a better outcome (normal neurologic examination at hospital discharge in 29% vs 21%, p = 0.002) than ACAIS survivors, although this trend was only observed in children and not in neonates. CONCLUSION: PCAIS is less common than ACAIS in both neonates and children. Children with PCAIS are older and have a higher rate of CCAD, lower clinical stroke severity, and better outcome than children with ACAIS