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Sustainable Development Goal (SDG) 9 is centered on three main pillars: industry, infrastructure and innovation. With 8 targets and 12 indicators, SDG 9 will have multiple impacts on forests, forest-based livelihoods and forest-based economies. Drawing on a comprehensive literature review, we conclude that major trade-offs will exist between SDG 9 and SDG 15 (sustainable use of terrestrial ecosystems), especially if economic expansion and increasing planetary impacts remain coupled. More specifically, the implementation of Target 9.1 and its corresponding indicators (road, infrastructure and transportation expansion) may lead to irreversible and widespread forest degradation and deforestation. As such, the short- and long-term environmental and social costs of this goal need to be better assessed, especially in light of the fact that other SDG 9 targets (e.g. small-scale industry expansion (Target 9.3); access to information and communications technology (Target 9.c)) may have diverse consequences for forests and livelihoods, depending on how they are applied. We call for reforms of SDG 9 to promote and support alternative socio-economic models that are not based on indefinite economic growth, nor reliant on the ongoing expansion of infrastructure, but, rather, necessitate forests and terrestrial ecosystem services to be essential building blocks of a green and sustainable economy.
Frozen raw breaded chicken products (FRBCP) have been identified as a risk factor for Salmonella infection in Canada. In 2017, Canada implemented whole genome sequencing (WGS) for clinical and non-clinical Salmonella isolates, which increased understanding of the relatedness of Salmonella isolates, resulting in an increased number of Salmonella outbreak investigations. A total of 18 outbreaks and 584 laboratory-confirmed cases have been associated with FRBCP or chicken since 2017. The introduction of WGS provided the evidence needed to support a new requirement to control the risk of Salmonella in FRBCP produced for retail sale.
The development of chronologies relies on integrating information from a number of different sources. In addition to direct dating evidence, such as radiocarbon dates, researchers will have contextual information which might be an environmental sequence or the context in an archaeological site. This information can be combined through Bayesian or other types of age-model. Once a chronology has been developed, this information can be used to estimate, for example, chronological uncertainties, rates of change, or the age of material which has not been directly dated.
Dealing with the information associated with chronology building is complicated and re-evaluation of chronologies often requires structured information which is hard to access. Although there are many databases with primary dating information, these often do not contain all of the information needed for a chronology. The Chronological Query Language (CQL) developed for OxCal was intended to be a convenient way of pulling such information together for Bayesian analysis. However, even this does not include much of the associated information required for reusing data in other analyses.
The IntChron initiative builds on the framework set up for the INTIMATE (Integrating Ice core, Marine and Terrestrial Records) chronological database (Bronk Ramsey et al. 2014) and is primarily an information exchange format and data visualization tool which enables users to pull together the types of information needed for chronological analysis. It is intended for use with multiple dating methodologies and while it will be integrated with OxCal, is intended to be an open format suitable for use with other software tools. The file format is JSON which is easily readable in software such as R, Python and MatLab. IntChron is not primarily intended to be a data depository but rather an index of sites where information is stored in the relevant format. As an initial step, databases of radiocarbon dates from the Oxford Radiocarbon Accelerator Unit (including those for the NERC radiocarbon facility), the RESET tephra database, the INTIMATE chronological database and regional radiocarbon databases for Egypt and Southern Africa are all linked. The intention is that users of OxCal will also be able to make published data accessible to others and to store working data, visible only to the user, to be used with the associated analysis tools. The IntChron site allows data from third party sources to be accessed through a representational state transfer (REST) application programming interface (API) in a number of different formats (JSON, csv, txt, oxcal) and associated bibliographic information in BibTeX format.
The aim of the IntChron initiative is to make it easy for users to provide data (in the single JSON format with limited minimum requirements) as well as to access data and tools, while promoting robust chronologies including realistic estimates of uncertainties. It is hoped that this will help to bring the chronological research communities to a point where data access is as easy as it is in some other fields. This is particularly important for Early Career Researchers and for those seeking to use large datasets in novel ways.
OBJECTIVES/SPECIFIC AIMS: People with metabolically abnormal obesity (MAO), defined as those with insulin resistance and high intrahepatic triglyceride, are at high risk for developing type 2 diabetes and cardiovascular disease. Weight loss through reduced energy intake and increased physical activity has profound impacts on improving cardiometabolic function. However, the specific additional effects of exercise training with diet-induced weight loss on metabolic function are equivocal. METHODS/STUDY POPULATION: A comparative trial is ongoing in MAO adults undergoing 8-10% weight loss induced by a very-low fat plant-based (PB) diet with structured exercise training (n=8) compared to the same weight loss induced by the PB diet alone (n=3). RESULTS/ANTICIPATED RESULTS: Preliminary results indicate that, PB diet with or without exercise training results in significant weight loss concomitant with enhanced insulin sensitivity, reduced intrahepatic triglyceride, reduced 24-hour postprandial glucose response, reduced fat mass, and reduced diastolic blood pressure. Those undergoing PB diet with exercise training had greater improvements in muscular strength and cardiorespiratory fitness than those undergoing PB diet alone. Differences between intervention groups for other cardiometabolic measures are not yet known. DISCUSSION/SIGNIFICANCE OF IMPACT: Each of the interventions resulted in improved cardiometabolic measures; however the extent of the differences between the interventions is not yet clear. It is hypothesized that compared with weight loss induced by a PB diet, the same weight loss induced by a PB diet and structured exercise training will i) cause greater improvement in skeletal muscle insulin sensitivity, ii) will attenuate the usual decline in muscle mass while increasing strength, and iii) result in greater increases in left ventricular diastolic function. The long-term objective of this proposal is to provide a foundation for future studies evaluating mechanisms for the effects of exercise in cardiometabolic disease prevention and therapy.
Discussions at the Health Technology Assessment International (HTAi) Asia Policy Forum (HAPF) aimed to understand the meaning of “high-cost technologies,” and to explore mechanisms to increase access to these technologies in publicly funded health systems in the Asia region.
Discussions and presentations at the 2018 HAPF, informed by a literature review and a premeeting survey of HTA agencies and industry, form the basis of this paper.
Challenges payers in the public health system face when investing in high-cost technologies include a lack of data, especially real-world data, affordability, and the budgetary impact of high-cost technologies. Managed entry schemes (MES) are one means to enable earlier access to high-cost technologies, or at reduced cost to the system. Most countries surveyed had used an MES to introduce a new health technology and most industry representatives had experience with financial-based MES, such as discounts or rebates, with most put in place to increase access to pharmaceuticals. Little experience of outcome-based or evidence-generation MES was reported.
Although it is early days in the implementation of MES in Asia, they have the potential to play an important role enabling access to new, mainly pharmaceutical, health technologies. The development of a “road map” of MES in the region should outline the intent and need for a MES, articulating the “rules of engagement” for all stakeholders—patients, providers, payers, and industry—which will assist countries to clearly identify the problem trying to be solved, and how an MES can be part of the solution.
To establish the factors that determine food fussiness, to explore if child age determines the extent to which these factors influence food fussiness and to identify whether parental neophobia is an independent determinant of food fussiness.
Cross-sectional data from the National Children’s Food Survey (2003–2004). The Children’s Eating Behaviour Questionnaire (CEBQ) assessed eating behaviours in children. The Food Neophobia Scale (FNS) assessed parental food neophobia. Young children were classified as 5–8 years old with older children classified as 9–12 years old.
Republic of Ireland.
Nationally representative sample of Irish children aged 5–12 years (n 594).
Parents identifying child’s food preferences as a barrier to providing their child with a healthy diet was significantly associated with increased food fussiness in younger (P<0·001) and older children (P<0·001). Higher levels of parental neophobia were significantly associated with an increase in food fussiness in younger (P<0·05) and older (P<0·001) children. Food advertising as a barrier to providing a healthy diet was inversely associated with food fussiness in younger children (P<0·05). In older children, there was a significant inverse association between child’s BMI and food fussiness (P<0·05), but not to the extent that a difference in weight status was noted. Family mealtimes in older children were associated with significantly lower levels of food fussiness (P<0·05).
Findings from the present study identify that a child’s age does determine the extent to which certain factors influence food fussiness and that parental neophobia is an independent determinant of food fussiness.
Limited research has suggested that higher lambing densities increase interference from foreign ewes at lambing which disrupts the ewe-lamb bond and compromises lamb survival. This may be particularly evident in mobs of twin-bearing ewes compared to single-bearing ewes because a greater number of lambs are born per day. Therefore, we hypothesised that; (i) decreasing the mob size of ewes at lambing has a greater impact on the survival of twin-born lambs than single-born lambs; (ii) the relationship between mob size and lamb survival can be explained by differences in the rate of interaction with foreign ewes and lambs at lambing; and (iii) ewes will utilise a limited area of the paddock at lambing and thus lambing density will be defined by the distribution of ewes in the paddock rather than the paddock area. Merino ewes were allocated into a 2×2 factorial combination of ewe pregnancy status (single- or twin-bearing) and mob size (high (n=130 ewes) or low (n=50 ewes)) on day 140 from the start of joining. Each treatment had two replicates excepting the low mob size for twins which had a third replicate. Ewes lambed at a stocking rate of 11 ewes/ha. Feed-on-offer during lambing exceeded 2400 kg dry matter (DM)/ha. Ewe-lamb behaviour was observed and dead lambs were autopsied over 11 days during the peak of lambing. The distribution of ewes in each paddock was recorded every 2 h during daylight hours by counting the number of ewes occupying 2500 m2 grids. The proportion of ewes and their newborn progeny which interacted with foreign ewes at lambing did not differ between the high and low mob sizes for single- (24.9% v. 20.8%) or twin-bearing ewes (14.3% v. 19.6%; P=0.74). Similarly, interaction with foreign lambs did not differ between the high and low mob sizes for single- (14.5% v. 25.2%) and twin-bearing ewes (34.5% v. 26.4%; P=0.44). The distribution of ewes within the paddock did not differ between treatments (P=0.95). On average, single-bearing ewes which lambed at the high and low mob sizes occupied 34% and 36% of the paddock during daylight hours, and the corresponding values for twin-bearing ewes were 40% and 43%. Survival of twin-born lambs was lower than single-born lambs (75.3% v. 87.9%; P<0.01), however, lamb survival was not influenced by mob size regardless of birth type. These results suggest that higher mob sizes may not compromise lamb survival when feed-on-offer during lambing exceeds 2400 kg DM/ha.
Smallholder livestock systems in Central America are typically based on pastures with traditional grasses and associated management practices, such as pasture burning and extensive grazing. With the rise of the global population and a corresponding increase in demand for meat and milk production, research efforts have focused on the development of improved grasses and the incorporation of legume species that can increase productivity and sustainability of Central American livestock systems. However, farmer adoption remains very limited, in part due to the lack of site-specific evaluation and recommendations by local institutions. Using a multi-site participatory approach, this study examined the potential of five improved grasses and five species of forage legumes as alternatives to the broadly disseminated grass Hyparrhenia rufa (cv. Jaragua) in pasture-based cattle systems in western Honduras and northern El Salvador. Improved grasses (four Brachiaria sp. and Megathyrsus maximus) produced significantly more biomass than H. rufa; also four of the five legume varieties evaluated (Canavalia ensiformis, Canavalia brasiliensis, Vigna unguiculata, and Vigna radiata) demonstrated high adaptability to diverse environmental conditions across sites. Farmer participatory evaluation offers a valuable means to assess performance of forages and will likely contribute to their improved utilization. Future research is needed on more refined management recommendations, pasture system design, costs and environmental benefits associated with the adoption of these forages in local livestock production systems.
Protected areas are central to global efforts to prevent species extinctions, with many countries investing heavily in their establishment. Yet the designation of protected areas alone can only abate certain threats to biodiversity. Targeted management within protected areas is often required to achieve fully effective conservation within their boundaries. It remains unclear what combination of protected area designation and management is needed to remove the suite of processes that imperil species. Here, using Australia as a case study, we use a dataset on the pressures facing threatened species to determine the role of protected areas and management in conserving imperilled species. We found that protected areas that are not resourced for threat management could remove one or more threats to 1,185 (76%) species and all threats to very few (n = 51, 3%) species. In contrast, a protected area network that is adequately resourced to manage threatening processes within their boundary could remove one or more threats to almost all species (n = 1,551; c. 100%) and all threats to almost half (n = 740, 48%). However, 815 (52%) species face one or more threats that require coordinated conservation actions that protected areas alone could not remove. This research shows that investing in the continued expansion of Australia's protected area network without providing adequate funding for threat management within and beyond the existing protected area network will benefit few threatened species. These findings highlight that as the international community expands the global protected area network in accordance with the 2020 Strategic Plan for Biodiversity, a greater emphasis on the effectiveness of threat management is needed.
Pediatric bone marrow transplants represent a medically stressful, potentially traumatic experience for children and caregivers, and psychological support for parental caregivers is paramount to their long-term well-being. However, many medical centers do not have protocols in place to sustain caregiver well-being during these distressing experiences.
We report on a case of a 10-month-old infant with Wiskott Aldrich Syndrome who was hospitalized for bone marrow transplantation.
We describe the significant burden that fell upon caregivers during and after a bone marrow transplantation.
Significance of results:
This case helped guide our suggestions to improve care for caregivers. Several logistical hurdles could be overcome to alleviate some of these burdens. We suggest that a child psychologist or psychiatrist should be on patient care teams and be attentive to parental stress, impairments, or impediments to self-care, and signs of emergency of mental illness in this setting of medical trauma. Additionally, promotion of sleep hygiene and linkage to support systems can maximize resiliency. Finally, we believe that hospital administrators should partner with clinicians to facilitate routine support during highly stressful transitions of care.
Health systems in the Asia region seek to achieve universal health care (UHC) by increasing access to essential healthcare services, while reducing health inequalities and out-of-pocket expenditure. With this in mind, the discussion for the 2017 Health Technology Assessment International (HTAi) Asia Policy Forum (APF) centered around the topic of ‘Universal Healthcare in the Asia Region: Overcoming the Barriers using HTA and Real World Data’.
As part of the background paper prepared to inform discussions at the APF, attendees from public sector HTA agencies from nine countries, and industry attendees from eight companies, were surveyed to explore issues on the barriers and challenges of establishing UHC in the region and use of real world data (RWD).
Most countries used evidence-based decision-making when considering which technologies to add to healthcare benefit packages; however, this was at times inconsistently applied. Prioritization criteria included burden of disease, unmet clinical need, clinical effectiveness, cost effectiveness and affordability. The political agenda and deference to expert opinion also played a role. Although all countries reported using RWD to inform decision-making, they also reported issues including lack of capacity, poor quality data and lack of collaboration between private and public sectors, as well as a conservative approach to data-linkage. It became apparent that a disconnect had been identified, as industry overwhelmingly identified access to RWD in the region as a major issue.
Discussing the differences in opinion between HTA agencies and industry led to a greater understanding of issues in the Asia region, and will lead to increased dialogue and opportunities to collaborate in the future. Building capacity in the region will assist countries to deliver on their goal of achieving UHC.
Technology advances have resulted in cheaper and quicker genomic sequencing (panels, exomes, whole genomes). Uptake into clinical practice has been rapid despite limited consideration of workforce, patient safety, consent, practice standards, guidelines and cost benefit. AUD 150M (USD 113M) has been independently allocated to genomic initiatives by Australian state and federal governments that don't reflect a national approach to genomics.
Modified horizon scanning (HS) methodology identified issues around genomic sequencing to be considered by governments regarding their support, or otherwise, before appropriate implementation and diffusion into local healthcare systems. A national jurisdictional advisory group was subsequently established that undertook extensive stakeholder consultation across Australia, including written submissions, over a four-month period.
HS identified that genomic sequencing is diffusing rapidly through the health system and flagged issues of pressing concern, including: workforce requirements; education, training and literacy for the medical workforce and community; infrastructure; data; and ethical, legal and social implications (ELSI). HealthPACT recommended a national coordinated approach to policy development across jurisdictional boundaries to ensure appropriate adoption of genomics. Stakeholder consultation confirmed overwhelming support for greater national coordination of the application of genomic knowledge in healthcare. Five strategic priorities were developed to support appropriate integration of genomics into health care for Australians: person-centered approach; workforce; financing; services; and, data. Three principles underpin strategic priorities: i) application of genomic knowledge is ethically, legally and socially responsible and community trust is promoted; ii) access and equity are promoted for vulnerable populations; and, iii) application of genomic knowledge to health care is supported and informed by evidence and research.
HS identified significant policy, workforce, funding and sustainability issues already facing state and territory governments that would, in time, face the federal government. The National Health Genomics Policy Framework outlines an agreed high-level national approach to policy, regulatory and investment decision-making for genomics and was approved by all Australian health Ministers in November 2017.
The Health Technology Assessment International (HTAi) Asia Policy Forum (HAPF) met to discuss the challenges of achieving universal health care (UHC) in Asia.
Group discussions and presentations at the 2017 HAPF, informed by a background paper, including a literature review and the results of pre-meeting surveys of health technology assessment (HTA) agencies and industry, formed the basis of this article.
Affordability was identified as the greatest barrier to establishing UHC; however, other impediments include the lack of political will to implement UHC, and the cultural issue of deference to expert opinion instead of evidence-based assessments. Although HTA was identified as an important prioritization tool when adding new technologies to benefit packages, it is used inconsistently in the region, resulting in a less transparent decision-making process for stakeholders. Although regional challenges exist around real-world data (RWD), including a lack of capacity to enable information and data sharing, most policy or funding decision makers in the region have access to data. However, there appears to be a disconnect with the experience of industry, whose representatives identify the lack of RWD as their primary issue. To overcome these issues, both HTA agencies and industry agree that collaboration and transparency should be fostered to support the development of robust evidence generation in the region.
There is a willingness for HTA agencies and industry to collaborate to develop HTA methodology for the prioritization of technologies in the Asia region that support healthcare systems to achieve the ultimate outcome of UHC.
Universal health care (UHC) leads to better health, educational outcomes and productivity. However, Asian healthcare systems are experiencing huge pressures and are striving to achieve UHC. With this in mind, the Health Technology Assessment International (HTAi) Asia Policy Forum (APF) tackled, ‘Universal Health Care in the Asia Region: Overcoming the Barriers using HTA and Real World Data (RWD)’.
The HTAi APF convened forty-four senior representatives from HTA agencies and industry from Asia. Through a mixture of keynote presentations and guided group discussions, APF members spent two days grappling with the topic.
There were a number of key messages from the APF, plus actions that were identified by APF members. The actions included: (i) A standardized HTA methodology for the prioritization of technologies in the Asia region should be developed to support health care systems; (ii) HTAi need to define what real-world data means in the HTA glossary; (iii) Members of the APF should develop a catalogue of what public and private data is available across countries in the region; (iv) A policy statement that agencies can use with a common approach to the release of data needs to be developed.
HTA and access to RWD were identified as essential tools to be used in achieving the goal of UHC; this goal should indeed be pursued in the Asia region. However, issues such as transparency and accountability of HTA, and trust and collaboration between the public and private sectors are important concerns which need to be addressed in order to progress this goal. The recommendations for actions resulting from this successful APF update on progress towards these identified actions will be presented.