The reintroduction of large carnivores to the Eastern Cape, South Africa: an assessment

Recently, conservation estate in South Africa's Eastern Cape Province has increased 10-fold resulting in large predators being increasingly reintroduced to restore ecological integrity and maximize tourism. We describe the reintroductions of large carnivores (>10 kg) that have occurred in the Eastern Cape and use various criteria to assess their success. Lion Panthera leo reintroduction has been highly successful with a population of 56 currently extant in the region and problems of overpopulation arising. The African wild dog Lycaon pictus population has increased to 24 from a founder population of 11. Preliminary results for spotted hyaenas Crocuta crocuta also indicate success. Wild populations of leopards Panthera pardus exist on several reserves and have been supplemented by translocated individuals, although deaths of known individuals have occurred and no estimate of reproduction is available. Cheetah Acinonyx jubatus reintroduction has also been less successful with 36 individuals reintroduced and 23 cubs being born but only 41 individuals surviving in 2005. Criteria for assessing the success of reintroductions of species that naturally occur in low densities, such as top predators, generally have limited value. Carrying capacity for large predators is unknown and continued monitoring and intensive management will be necessary in enclosed, and possibly all, conservation areas in the Eastern Cape to ensure conservation success

Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention

OBJECTIVES: This multicenter pragmatic investigation assessed outcomes following clinical implementation of CYP2C19 genotype-guided antiplatelet therapy after percutaneous coronary intervention (PCI). BACKGROUND: CYP2C19 loss-of-function alleles impair clopidogrel effectiveness after PCI. METHODS: After clinical genotyping, each institution recommended alternative antiplatelet therapy (prasugrel, ticagrelor) in PCI patients with a loss-of-function allele. Major adverse cardiovascular events (defined as myocardial infarction, stroke, or death) within 12 months of PCI were compared between patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy. Risk was also compared between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy. Cox regression was performed, adjusting for group differences with inverse probability of treatment weights. RESULTS: Among 1,815 patients, 572 (31.5%) had a loss-of-function allele. The risk for major adverse cardiovascular events was significantly higher in patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy (23.4 vs. 8.7 per 100 patient-years; adjusted hazard ratio: 2.26; 95% confidence interval: 1.18 to 4.32; p = 0.013). Similar results were observed among 1,210 patients with acute coronary syndromes at the time of PCI (adjusted hazard ratio: 2.87; 95% confidence interval: 1.35 to 6.09; p = 0.013). There was no difference in major adverse cardiovascular events between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy (adjusted hazard ratio: 1.14; 95% confidence interval: 0.69 to 1.88; p = 0.60). CONCLUSIONS: These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value

Modification of WHO diagnostic criteria for gestational diabetes: implications for classification of hyperglycemia in pregnancy

Background: Low and medium income countries (LMICs) especially in sub-Saharan Africa face unique challenges in screening and diagnosing hyperglycaemia in pregnancy. The implications of applying the 2013 WHO modifications for assessing hyperglycaemia in pregnancy in low resource settings are not known. We evaluated the significance of these recent changes in classification of hyperglycaemia among pregnant Nigerian women.Methods: We reviewed the records of Oral glucose tolerance test conducted on 600 pregnant women at the Jos University Teaching Hospital (JUTH) between July 2012 and June 2016. The collected data were analyzed using Statistical Package for Social Sciences version 18 (SPSS Inc., Chicago, IL, USA). Test for association was done using Fisher’s exact test. P < 0.05 was set as the level of significance.Results: The results show that 15.9%, 20.2% and 15.7% of the women had GDM according to WHO (1999), IADPSG and WHO (2013) diagnostic criteria respectively while 4.8% of the women had DM in pregnancy by WHO 2013 criteria. Overall, 30.2% and 23.9% of women who were classified as GDM by WHO 1999 criteria and IADPSG criteria respectively were qualified to be classified as DM in pregnancy according to the WHO 2013 criteria.Conclusions: The recent Modifications by the WHO 2013 guideline for classifying hyperglycemia in pregnancy may create non-uniform interpretation of OGTT. The confusion in classifying hyperglycemia among pregnant women referred between health centres may become more pronounced. There is an urgent need for a streamlined globally acceptable approach to assessing and classifying hyperglycemia in pregnant women

Assessment of iron Parameters and Transient Elastography (FibroScan) Pattern amongPatients with Chronic Viral Hepatitis Infection in Jos, Nigeria

Background:The long-termeffect of excess iron deposition in the liver include fibrosis and cirrhosis which may progress to hepatocellular carcinoma. We assessed iron parameters among patients with chronic viral hepatitis B and C infection (CVHBI; CVHCI) to determineif any correlation existed with the degree of fibrosis in the liver. Methods: A cross-sectional descriptive study was carried out on 186 patients, made up of 132 patients withCVHBI and 54 patients with CVHCI. Serum ferritin and C-reactive protein were done by ELISA, serum iron and total iron binding capacity (TIBC) by colorimetric technique while transferrin saturation (Tsat) was calculated using serum iron and TIBC values. Liver fibrosis was assessed using fibroscan.Obtained data wereanalysed using SPSS version 20 and p values &lt; 0.05 were considered statistically significant.&nbsp; Results: The mean values for serum ferritin, iron, TIBC and Tsat were 218.1±325.6µg/L, 25.1±22.8µmol/L, 71.13 ± 35.92µmol/L and 45.2 ± 49.9% respectively. There were no significant differences in iron parameters between patients with CVHBI and CVHCI. Elevated serum ferritin was found in 15.2% and 20.4% of CHBVI and CHCVI patients respectively; while an elevated Tsat was seen in 22.7% and 24.1% of CHBVI and CHCVI patients respectively. Using a combination of elevated serum ferritin and Tsat, the prevalence of iron overload was found to be1.6%. Fibroscan scores did not differ significantly between patients with orwithout elevated iron parameters. Conclusion:Chronic viral hepatitis infection is associated elevated iron parameters though withminimal effect on liver fibrosis. Conflict of interest: Ni

Barriers to evidence use for sustainability: Insights from pesticide policy and practice.

Calls for supporting sustainability through more and better research rest on an incomplete understanding of scientific evidence use. We argue that a variety of barriers to a transformative impact of evidence arises from diverse actor motivations within different stages of evidence use. We abductively specify this variety in policy and practice arenas for three actor motivations (truth-seeking, sense-making, and utility-maximizing) and five stages (evidence production, uptake, influence on decisions, effects on sustainability outcomes, and feedback from outcome evaluations). Our interdisciplinary synthesis focuses on the sustainability challenge of reducing environmental and human health risks of agricultural pesticides. It identifies barriers resulting from (1) truth-seekers' desire to reduce uncertainty that is complicated by evidence gaps, (2) sense-makers' evidence needs that differ from the type of evidence available, and (3) utility-maximizers' interests that guide strategic evidence use. We outline context-specific research-policy-practice measures to increase evidence use for sustainable transformation in pesticides and beyond

Barriers to evidence use for sustainability: Insights from pesticide policy and practice

Calls for supporting sustainability through more and better research rest on an incomplete understanding of scientific evidence use. We argue that a variety of barriers to a transformative impact of evidence arises from diverse actor motivations within different stages of evidence use. We abductively specify this variety in policy and practice arenas for three actor motivations (truth-seeking, sense-making, and utility-maximizing) and five stages (evidence production, uptake, influence on decisions, effects on sustainability outcomes, and feedback from outcome evaluations). Our interdisciplinary synthesis focuses on the sustainability challenge of reducing environmental and human health risks of agricultural pesticides. It identifies barriers resulting from (1) truth-seekers’ desire to reduce uncertainty that is complicated by evidence gaps, (2) sense-makers’ evidence needs that differ from the type of evidence available, and (3) utility-maximizers’ interests that guide strategic evidence use. We outline context-specific research–policy–practice measures to increase evidence use for sustainable transformation in pesticides and beyond

Comparison of Intermediate-Dose Methotrexate with Cranial Irradiation for the Post-Induction Treatment of Acute Lymphocytic Leukemia in Children

Abstract We compared two regimens with respect to their ability to prolong disease-free survival in 506 children and adolescents with acute lymphocytic leukemia. All responders to induction therapy were randomized to treatment with 2400 rad of cranial irradiation plus intrathecal methotrexate or to treatment with intermediate-dose methotrexate plus intrathecal methotrexate, as prophylaxis for involvement of the central nervous system and other sanctuary areas. Patients were then treated with a standard maintenance regimen. Complete responders were stratified into either standard-risk or increased-risk groups on the basis of age and white-cell count at presentation. Among patients with standard risk, hematologic relapses occurred in 9 of 117 given methotrexate and 24 of 120 given irradiation (P\u3c0.01). The rate of Central-nervous-system relapse was higher in the methotrexate group (23 of 117) than in the irradiation group (8 of 120) (P = 0.01). Among patients with increased risk, radiation offered greater protection to the central nervous system than methotrexate (P = 0.03); there was no difference in the rate of hematologic relapse. In both risk strata the frequency of testicular relapse was significantly lower in the methotrexate group (1 patient) than the radiation group (10 patients) (P = 0.01). Methotrexate offered better protection against systemic relapse in standard-risk patients and better protection against testicular relapse overall, but it offered less protection against relapses in the central nervous system than cranial irradiation. (N Engl J Med. 1983; 308:477–84.

Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention

OBJECTIVES: This multicenter pragmatic investigation assessed outcomes following clinical implementation of CYP2C19 genotype-guided antiplatelet therapy after percutaneous coronary intervention (PCI). BACKGROUND: CYP2C19 loss-of-function alleles impair clopidogrel effectiveness after PCI. METHODS: After clinical genotyping, each institution recommended alternative antiplatelet therapy (prasugrel, ticagrelor) in PCI patients with a loss-of-function allele. Major adverse cardiovascular events (defined as myocardial infarction, stroke, or death) within 12 months of PCI were compared between patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy. Risk was also compared between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy. Cox regression was performed, adjusting for group differences with inverse probability of treatment weights. RESULTS: Among 1,815 patients, 572 (31.5%) had a loss-of-function allele. The risk for major adverse cardiovascular events was significantly higher in patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy (23.4 vs. 8.7 per 100 patient-years; adjusted hazard ratio: 2.26; 95% confidence interval: 1.18 to 4.32; p = 0.013). Similar results were observed among 1,210 patients with acute coronary syndromes at the time of PCI (adjusted hazard ratio: 2.87; 95% confidence interval: 1.35 to 6.09; p = 0.013). There was no difference in major adverse cardiovascular events between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy (adjusted hazard ratio: 1.14; 95% confidence interval: 0.69 to 1.88; p = 0.60). CONCLUSIONS: These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value