Drought Adaptation and Coping Strategies Among the Turkana Pastoralists of Northern Kenya

This study highlights drought characteristics and the many responses to drought stresses employed by Turkana pastoralists of northwestern Kenya. Multiple data sources, including socioeconomic interviews with 302 households, focus group discussions, and informal interviews with pastoralists were used to capture various aspects of drought and drought adaptation and coping practices. Standardized precipitation index derived from long-term rainfall data obtained from the Kenya Meteorological Service was used to quantify different degrees of drought intensity between 1950 and 2012. Results revealed that extreme drought events were increasingly frequent, and have impacted negatively on pastoral livelihoods. In order to adapt to or cope with climatic anomalies, households are using a variety of strategies. In addition to the traditional short-term coping mechanisms, the long-term adaptation strategies used include diversification of livelihood sources; livestock mobility to track forage and water resources; diversification of herd composition to benefit from the varied drought and disease tolerance, as well as fecundity of diverse livestock species; and sending children to school for formal education as a long term investment expected to pay back through income from employment. Policies and development interventions that reduce risks, diminish livelihood constraints, and expand opportunities for increased household resilience to drought are critical complements to the existing pastoral strategies

3D finite compartment modeling of formation and healing of bruises may identify methods for age determination of bruises

Simulating the spatial and temporal behavior of bruises may identify methods that allow accurate age determination of bruises to assess child abuse. We developed a numerical 3D model to simulate the spatial kinetics of hemoglobin and bilirubin during the formation and healing of bruises. Using this model, we studied how skin thickness, bruise diameter and diffusivities affect the formation and healing of circular symmetric bruises and compared a simulated bruise with a natural inhomogeneous bruise. Healing is faster for smaller bruises in thinner and less dense skin. The simulated and natural bruises showed similar spatial and temporal dynamics. The different spatio-temporal dynamics of hemoglobin and bilirubin allows age determination of model bruises. Combining our model predictions with individual natural bruises may allow optimizing our model parameters. It may particularly identify methods for more accurate age determination than currently possible to aid the assessment of child abuse

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial

Background Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. Methods In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. Findings Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18–45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference −1·4%, 95% CI −7·0 to 4·3; hazard ratio 0·96, 0·68–1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3–4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). Interpretation Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia

Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis

BACKGROUND: Isoniazid-resistant, rifampicin-susceptible (INH-R) tuberculosis is the most common form of drug resistance, and is associated with failure, relapse, and acquired rifampicin resistance if treated with first-line anti-tuberculosis drugs. The aim of the study was to compare success, mortality, and acquired rifampicin resistance in patients with INH-R pulmonary tuberculosis given different durations of rifampicin, ethambutol, and pyrazinamide (REZ); a fluoroquinolone plus 6 months or more of REZ; and streptomycin plus a core regimen of REZ. METHODS: Studies with regimens and outcomes known for individual patients with INH-R tuberculosis were eligible, irrespective of the number of patients if randomised trials, or with at least 20 participants if a cohort study. Studies were identified from two relevant systematic reviews, an updated search of one of the systematic reviews (for papers published between April 1, 2015, and Feb 10, 2016), and personal communications. Individual patient data were obtained from authors of eligible studies. The individual patient data meta-analysis was performed with propensity score matched logistic regression to estimate adjusted odds ratios (aOR) and risk differences of treatment success (cure or treatment completion), death during treatment, and acquired rifampicin resistance. Outcomes were measured across different treatment regimens to assess the effects of: different durations of REZ (≤6 months vs >6 months); addition of a fluoroquinolone to REZ (fluoroquinolone plus 6 months or more of REZ vs 6 months or more of REZ); and addition of streptomycin to REZ (streptomycin plus 6 months of rifampicin and ethambutol and 1–3 months of pyrazinamide vs 6 months or more of REZ). The overall quality of the evidence was assessed using GRADE methodology. FINDINGS: Individual patient data were requested for 57 cohort studies and 17 randomised trials including 8089 patients with INH-R tuberculosis. We received 33 datasets with 6424 patients, of which 3923 patients in 23 studies received regimens related to the study objectives. Compared with a daily regimen of 6 months of (H)REZ (REZ with or without isoniazid), extending the duration to 8–9 months had similar outcomes; as such, 6 months or more of (H)REZ was used for subsequent comparisons. Addition of a fluoroquinolone to 6 months or more of (H)REZ was associated with significantly greater treatment success (aOR 2·8, 95% CI 1·1–7·3), but no significant effect on mortality (aOR 0·7, 0·4–1·1) or acquired rifampicin resistance (aOR 0·1, 0·0–1·2). Compared with 6 months or more of (H)REZ, the standardised retreatment regimen (2 months of streptomycin, 3 months of pyrazinamide, and 8 months of isoniazid, rifampicin, and ethambutol) was associated with significantly worse treatment success (aOR 0·4, 0·2–0·7). The quality of the evidence was very low for all outcomes and treatment regimens assessed, owing to the observational nature of most of the data, the diverse settings, and the imprecision of estimates. INTERPRETATION: In patients with INH-R tuberculosis, compared with treatment with at least 6 months of daily REZ, addition of a fluoroquinolone was associated with better treatment success, whereas addition of streptomycin was associated with less treatment success; however, the quality of the evidence was very low. These results support the conduct of randomised trials to identify the optimum regimen for this important and common form of drug-resistant tuberculosis. FUNDING: World Health Organization and Canadian Institutes of Health Research

Climate Information and Capacity Needs for Ecosystem Management under a Changing Climate

The paper demonstrates the need to integrate across information types (i.e. weather, climate, socio-economic, policy and ecology) to better inform those involved in decision-making for ecosystem management. The provision of climate information and an understanding of ecosystem responses to climate change and variability urgently need to underpin any planning for the future. Integrating climatic information into risk assessment frameworks and adaptation planning is essential as it will enable better informed decision making in planning to ensure the adequate provision of ecosystem services (water, food, air quality, shelter etc) and appropriate adaptation and mitigation strategies for the well being of both people and nature. A substantial mindset shift to fully recognize the fundamental role of ecosystems as life-supporting systems is urgently needed. The value given to ecosystems and the magnitude of effort to manage them has to be based on this mere fact and indeed, it should be an integral part of any climate change agreement.This article is published as Munang, R., M. Rivington, E. S. Takle, Brendan Mackey, I. Thiaw, and J. Liu. "Climate information and capacity needs for ecosystem management under a changing climate." Procedia Environmental Sciences 1 (2010): 206-227. DOI:10.1016/j.proenv.2010.09.014. Posted with permission.</p

Climate Information and Capacity Needs for Ecosystem Management under a Changing Climate

AbstractThe paper demonstrates the need to integrate across information types (i.e. weather, climate, socio-economic, policy and ecology) to better inform those involved in decision-making for ecosystem management. The provision of climate information and an understanding of ecosystem responses to climate change and variability urgently need to underpin any planning for the future. Integrating climatic information into risk assessment frameworks and adaptation planning is essential as it will enable better informed decision making in planning to ensure the adequate provision of ecosystem services (water, food, air quality, shelter etc) and appropriate adaptation and mitigation strategies for the well being of both people and nature. A substantial mindset shift to fully recognize the fundamental role of ecosystems as life-supporting systems is urgently needed. The value given to ecosystems and the magnitude of effort to manage them has to be based on this mere fact and indeed, it should be an integral part of any climate change agreement

Climate Information and Capacity Needs for Ecosystem Management under a Changing Climate

The paper demonstrates the need to integrate across information types (i.e. weather, climate, socio-economic, policy and ecology) to better inform those involved in decision-making for ecosystem management. The provision of climate information and an understanding of ecosystem responses to climate change and variability urgently need to underpin any planning for the future. Integrating climatic information into risk assessment frameworks and adaptation planning is essential as it will enable better informed decision making in planning to ensure the adequate provision of ecosystem services (water, food, air quality, shelter etc) and appropriate adaptation and mitigation strategies for the well being of both people and nature. A substantial mindset shift to fully recognize the fundamental role of ecosystems as life-supporting systems is urgently needed. The value given to ecosystems and the magnitude of effort to manage them has to be based on this mere fact and indeed, it should be an integral part of any climate change agreement