Low-cost adaptation options to support green growth in agriculture, water resources, and coastal zones.

The regional climate as it is now and in the future will put pressure on investments in sub-Saharan Africa in water resource management, fisheries, and other crop and livestock production systems. Changes in oceanic characteristics across the Atlantic Ocean will result in remarkable vulnerability of coastal ecology, littorals, and mangroves in the middle of the twenty-first century and beyond. In line with the countries' objectives of creating a green economy that allows reduced greenhouse gas emissions, improved resource efficiency, and prevention of biodiversity loss, we identify the most pressing needs for adaptation and the best adaptation choices that are also clean and affordable. According to empirical data from the field and customized model simulation designs, the cost of these adaptation measures will likely decrease and benefit sustainable green growth in agriculture, water resource management, and coastal ecosystems, as hydroclimatic hazards such as pluviometric and thermal extremes become more common in West Africa. Most of these adaptation options are local and need to be scaled up and operationalized for sustainable development. Governmental sovereign wealth funds, investments from the private sector, and funding from global climate funds can be used to operationalize these adaptation measures. Effective legislation, knowledge transfer, and pertinent collaborations are necessary for their success.

Exercise-induced laryngeal obstruction in children and adolescents: are we listening?

Exertional dyspnoea among children and adolescents is a common presenting complaint to general practitioners. Exertional dyspnoea is most commonly attributed to exercise-induced bronchoconstriction (EIB), but there are several other causes including hyperventilation syndrome, breathlessness associated with normal exercise limitation and exercise-induced laryngeal obstruction (EILO). The symptoms of EILO include stridor, throat tightness and difficulty on inspiration. If these are mistaken for EIB, children will receive asthma therapy. The underlying mechanism of EILO includes closure of the larynx during high-intensity exercise, which causes a reduction in airflow and breathlessness. This phenomenon is often associated with a background of psychological stress. Historically, a diagnosis of EILO has been considered 'rare' though this may be a reflection of under-recognition. Direct visual observation via laryngoscopy is the gold standard for diagnosis of EILO; however, this is rarely available even in specialised centres. Nevertheless, the diagnosis can usually be made by recognising the characteristic clinical pattern. Here we provide recommendations for appropriate investigations for the determination of EILO, together with suggested treatment.

The effects of anthropogenic and volcanic aerosols and greenhouse gases on twentieth century Sahel precipitation.

There is little scientific consensus on the importance of external climate forcings-including anthropogenic aerosols, volcanic aerosols, and greenhouse gases (GHG)-relative to each other and to internal variability in dictating past and future Sahel rainfall. We address this query by relating a 3-tiered multi-model mean (MMM) over the Climate Model Intercomparison Project phase 5 "twentieth century" and pre-Industrial control simulations to observations. The comparison of single-forcing and historical simulations highlights the importance of anthropogenic and volcanic aerosols over GHG in generating forced Sahel rainfall variability in models. However, the forced MMM only accounts for a small fraction of observed variance. A residual consistency test shows that simulated internal variability cannot explain the residual observed multidecadal variability, and points to model deficiency in simulating multidecadal variability in the forced response, internal variability, or both.

The role of aerosols and greenhouse gases in Sahel drought and recovery.

We exploit the multi-model ensemble produced by phase 5 of the Coupled Model Intercomparison Project (CMIP5) to synthesize current understanding of external forcing of Sahel rainfall change, past and future, through the lens of oceanic influence. The CMIP5 multi-model mean simulates the twentieth century evolution of Sahel rainfall, including the mid-century decline toward the driest years in the early 1980s and the partial recovery since. We exploit a physical argument linking anthropogenic emissions to the change in the temperature of the sub-tropical North Atlantic Ocean relative to the global tropical oceans to demonstrate indirect attribution of late twentieth century Sahel drought to the unique combination of aerosols and greenhouse gases that characterized the post-World War II period. The subsequent reduction in aerosol emissions around the North Atlantic that resulted from environmental legislation to curb acid rain, occurring as global tropical warming continued unabated, is consistent with the current partial recovery and with projections of future wetting. Singular Value Decomposition (SVD) applied to the above-mentioned sea surface temperature (SST) indices provides a succinct description of oceanic influence on Sahel rainfall and reveals the near-orthogonality in the influence of emissions between twentieth and twenty-first centuries: the independent effects of aerosols and greenhouse gases project on the difference of SST indices and explain past variation, while the dominance of greenhouse gases projects on their sum and explains future projection. This result challenges the assumption that because anthropogenic warming had a hand in past Sahel drought, continued warming will result in further drying. In fact, the twenty-first century dominance of greenhouse gases, unchallenged by aerosols, results in projections consistent with warming-induced strengthening of the monsoon, a response that has gained in coherence in CMIP5 compared to prior multi-model exercises.

High Blood caffeine levels in MCI linked to lack of progression to dementia.

Although both human epidemiologic and animal model studies have suggested that caffeine/coffee protects against Alzheimer's disease, direct human evidence for this premise has been lacking. In the present case-control study, two separate cohorts consisting of 124 total individuals (65-88 years old) were cognitively assessed and a blood sample taken for caffeine/biomarker analysis. Subjects were then monitored for cognitive status over the ensuing 2-4 year period to determine the extent to which initial plasma caffeine/biomarkers levels would be predictive of changes in cognitive status. Plasma caffeine levels at study onset were substantially lower (-51%) in mild cognitive impairment (MCI) subjects who later progressed to dementia (MCI→DEM) compared to levels in stable MCI subjects (MCI→MCI). Moreover, none of the MCI→DEM subjects had initial blood caffeine levels that were above a critical level of 1200 ng/ml, while half of stable MCI→MCI subjects had blood caffeine levels higher than that critical level. Thus, plasma caffeine levels greater than 1200 ng/ml (≈6 µM) in MCI subjects were associated with no conversion to dementia during the ensuing 2-4 year follow-up period. Among the 11 cytokines measured in plasma, three of them (GCSF, IL-10, and IL-6) were decreased in MCI→DEM subjects, but not in stable MCI→MCI subjects with high plasma caffeine levels. Coffee would appear to be the major or perhaps only source of caffeine for such stable MCI patients. This case-control study provides the first direct evidence that caffeine/coffee intake is associated with a reduced risk of dementia or delayed onset, particularly for those who already have MCI.

Pain perception of children undergoing nasendoscopy for investigation of voice and resonance disorders.

The primary objective of this descriptive and correlational study was to determine the level of pain and discomfort perceived by children undergoing nasendoscopy for investigation of voice and resonance disorders. The secondary objective was to explore whether gender, age, previous experience of painful or distressing medical procedures, and previous experience of nasendoscopy influenced the perception of pain during nasendoscopy. Twenty-three children self-reported the degree of pain perceived during nasendoscopy using the Wong-Baker Faces Pain Rating Scale. Parents also used this scale to rate their child's perceived pain. Otolaryngologists and speech pathologists rated the intensity and frequency of observed pain-related behaviors using the Child-Adult Medical Procedure Interaction Scale-Revised and the Procedure Behavior Checklist. Children perceived the procedure, on average, to be moderately painful, as did their parents. Only two children reported perceiving no pain during the procedure. The most frequently observed pain-related behaviors were muscle tension (86.96%), physical resistance (69.57%), requiring physical restraint (60.87%), crying (43.48%), and expressions of verbal pain (39.13%). No significant correlations were found between self-reported pain or observed pain and the variables of age, gender, previous experience of nasendoscopy, and previous experience of painful or distressing medical procedures, although children aged 4-7 years reported significantly more pain than children aged 8-18 years. Most children perceive nasendoscopy to be painful to some degree. This perceived pain occurred in conjunction with several observable pain-related behaviors that have the potential to interfere with the success of the procedure.