Identifying impacts & adaptation strategies for tropical fruit farms affected by extreme weather events in sub-tropical Australia: Stakeholders' insights.

Extreme weather events (EWEs) have significant effects on the productivity, profitability and sustainability of agricultural enterprises and supply chains. Australia is acknowledged as a highly susceptible developed country in relation to experiencing impacts from global climate change. Particularly, the Central Queensland (CQ) region has experienced several recent severe weather events which has made stakeholders worried about the financial resilience and sustainability of their businesses along with the farmers. Although various Australian research has explored the biophysical effects of extreme weather on pome and citrus fruits, very little is known about the business impacts of EWEs on tropical fruits, and how the perceptions of stakeholders can play significant roles in constructing and implementing policies relevant to the tropical fruit farming sector. To fill this gap, this study explored stakeholder insights relating to the impacts of EWEs and relevant adaptation strategies used in tropical fruit farming businesses in sub-tropical Australia. A qualitative research approach was undertaken, involving in-depth interviews with key stakeholders from the tropical fruit farming supply chain, with data being analysed by thematic content analysis. Stakeholders indicated that in the previous five years, EWEs had impacted tropical fruit farming businesses and their related support industries and organisations in multiple ways. This study revealed that farmers' lack of knowledge about available adaptation options, amongst other things, are obstacles preventing the industry from becoming more resilient. Several steps were identified to improve the speed and effectiveness of adaptation at the farm level, including further strategic planning and collaboration amongst state government, local government, farmers and associated industry parties; as well as the importance of farmers being self-prepared for future EWEs. To achieve the latter, stakeholders noted that farmers required industry-level support, including training, tools, and technologies. These findings will be of interest for fruit farming industry stakeholders, policy makers and relevant researchers, particularly for the many tropical coastal communities across the world, now finding themselves being impacted by EWEs.

High Prevalence of Multidrug-Resistant Bacteria in the Trachea of Intensive Care Units Admitted Patients: Evidence from a Bangladeshi Hospital.

Recent research has shown that antibiotic-resistant microorganisms are becoming more prevalent in intensive care units (ICUs) at an exponential rate. Patients in the ICU can get infected by pathogens due to invasive operation procedures and critical health conditions. This study primarily emphasized tracheal samples from ICU patients due to their reliance on ventilators, increasing their susceptibility to Ventilator-Associated Pneumonia (VAP). Moreover, the rise of multidrug-resistant (MDR) pathogens makes treatment strategies more challenging for these patients. In this study, we tested 200 tracheal specimens to determine the prevalence of microorganisms and analyzed the antibiotic susceptibility of these isolates against regular antibiotics, including 4th generation drugs. Among the 273 isolates, 81% were gram-negative bacteria, 10% were gram-positive bacteria, and 9% were fungi. The most prevalent gram-negative bacteria were Acinetobacter spp. (34%), Klebsiella spp. (22%), Pseudomonas spp. (14%), and Escherichia coli (9.2%). The most prevalent gram-positive bacteria were Staphylococcus aureus (5.9%), and the fungi were Candida spp. (7.3%). Among the most prevalent bacteria, except Staphylococcus aureus isolates, around 90% were resistant to multiple drugs, whereas 60% of Acinetobacter spp. and Pseudomonas spp. were extensively drug resistant. Sensitivity analysis against the gram-negative and gram-positive drug panel using a one-way ANOVA test followed by Tukey's post hoc test showed that in the in vitro assay, colistin was the most effective antibiotic against all gram-negative bacteria. In contrast, linezolid, vancomycin, and fusidic acid were most effective against all gram-positive bacteria. Regular monitoring of nosocomial infections and safe management of highly resistant bacteria can help prevent future pandemics.

Marine Protected Area Expansion and Country-Level Age-Standardized Adult Mortality.

Many countries have adopted targets to increase marine protected areas (MPAs) to limit the degradation of water bodies. Although there is evidence that MPAs can conserve marine life and promote biodiversity, there are limited data on the human health implications of MPAs. Using panel data from 1990, 2000, and 2014, we estimated the country-level associations between MPAs (i.e., percentage of territorial waters designated as marine reserves) and age-standardized mortality (i.e., age-standardized probability of dying between 15 and 60 years from all-causes among ages 15-60/100,000 population) by sex, among 110 countries. We fit mixed-effects linear regression models of mortality as a function of current MPA coverage, gross domestic product growth, year, the prior extent of MPA, electricity coverage, governance, and country-level random effects. We observed a significant inverse association between current MPA coverage and adult mortality. For each 5-percentage-point increase in current MPA coverage, a country had 0.982 times the geometric means of female and male mortality [geometric mean ratio: 0.982 (95% CI 0·976, 0·988)] conditional on past %MPA coverage and other modeled variables. The model showed no significant residual association of mortality with past %MPA conditional on current %MPA and other modeled variables. This is one of the first studies to show a positive association between increasing marine conservation and human health. This macro-level study suggests there may be important co-benefits for human health from expanding MPAs that merit further investigation.

Effects of adding household water filters to Rwanda's Community-Based Environmental Health Promotion Programme: a cluster-randomized controlled trial in Rwamagana district.

Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda's Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13-16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74-0.87, p < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57-0.74, p < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35-0.73, p < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.

Remarkably coherent population structure for a dominant Antarctic Chlorobium species.

BACKGROUND: In Antarctica, summer sunlight enables phototrophic microorganisms to drive primary production, thereby "feeding" ecosystems to enable their persistence through the long, dark winter months. In Ace Lake, a stratified marine-derived system in the Vestfold Hills of East Antarctica, a Chlorobium species of green sulphur bacteria (GSB) is the dominant phototroph, although its seasonal abundance changes more than 100-fold. Here, we analysed 413 Gb of Antarctic metagenome data including 59 Chlorobium metagenome-assembled genomes (MAGs) from Ace Lake and nearby stratified marine basins to determine how genome variation and population structure across a 7-year period impacted ecosystem function. RESULTS: A single species, Candidatus Chlorobium antarcticum (most similar to Chlorobium phaeovibrioides DSM265) prevails in all three aquatic systems and harbours very little genomic variation (≥ 99% average nucleotide identity). A notable feature of variation that did exist related to the genomic capacity to biosynthesize cobalamin. The abundance of phylotypes with this capacity changed seasonally ~ 2-fold, consistent with the population balancing the value of a bolstered photosynthetic capacity in summer against an energetic cost in winter. The very high GSB concentration (> 108 cells ml-1 in Ace Lake) and seasonal cycle of cell lysis likely make Ca. Chlorobium antarcticum a major provider of cobalamin to the food web. Analysis of Ca. Chlorobium antarcticum viruses revealed the species to be infected by generalist (rather than specialist) viruses with a broad host range (e.g., infecting Gammaproteobacteria) that were present in diverse Antarctic lakes. The marked seasonal decrease in Ca. Chlorobium antarcticum abundance may restrict specialist viruses from establishing effective lifecycles, whereas generalist viruses may augment their proliferation using other hosts. CONCLUSION: The factors shaping Antarctic microbial communities are gradually being defined. In addition to the cold, the annual variation in sunlight hours dictates which phototrophic species can grow and the extent to which they contribute to ecosystem processes. The Chlorobium population studied was inferred to provide cobalamin, in addition to carbon, nitrogen, hydrogen, and sulphur cycling, as critical ecosystem services. The specific Antarctic environmental factors and major ecosystem benefits afforded by this GSB likely explain why such a coherent population structure has developed in this Chlorobium species. Video abstract.

The Applications of Implementation Science in Water, Sanitation, and Hygiene (WASH) Research and Practice.

BACKGROUND: Delivery of high quality, at-scale, and sustained services is a major challenge in the water, sanitation, and hygiene (WASH) sector, made more challenging by a dearth of evidence-based models for adaption across contexts in low- and middle-income countries. OBJECTIVE: We aim to describe the value of implementation science (IS) for the WASH sector and provide recommendations for its application. METHODS: We review concepts from the growing field of IS-defined as the "scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and hence, to improve the quality and effectiveness of health services"-and we translate their relevance to WASH research, learning, and delivery. DISCUSSION: IS provides a suite of methods and theories to systematically develop, evaluate, and scale evidence-based interventions. Though IS thinking has been applied most notably in health services delivery in high-income countries, there have been applications in low-income settings in fields such as HIV/AIDS and nutrition. Expanding the application of IS to environmental health, specifically WASH interventions, would respond to the complexity of sustainable service delivery. WASH researchers may want to consider applying IS guidelines to their work, including adapting pragmatic research models, using established IS frameworks, and cocreating knowledge with local stakeholders. https://doi.org/10.1289/EHP7762.

Genome Analysis of a Verrucomicrobial Endosymbiont With a Tiny Genome Discovered in an Antarctic Lake.

Organic Lake in Antarctica is a marine-derived, cold (-13∘C), stratified (oxic-anoxic), hypersaline (>200 gl-1) system with unusual chemistry (very high levels of dimethylsulfide) that supports the growth of phylogenetically and metabolically diverse microorganisms. Symbionts are not well characterized in Antarctica. However, unicellular eukaryotes are often present in Antarctic lakes and theoretically could harbor endosymbionts. Here, we describe Candidatus Organicella extenuata, a member of the Verrucomicrobia with a highly reduced genome, recovered as a metagenome-assembled genome with genetic code 4 (UGA-to-Trp recoding) from Organic Lake. It is closely related to Candidatus Pinguicocccus supinus (163,218 bp, 205 genes), a newly described cytoplasmic endosymbiont of the freshwater ciliate Euplotes vanleeuwenhoeki (Serra et al., 2020). At 158,228 bp (encoding 194 genes), the genome of Ca. Organicella extenuata is among the smallest known bacterial genomes and similar to the genome of Ca. Pinguicoccus supinus (163,218 bp, 205 genes). Ca. Organicella extenuata retains a capacity for replication, transcription, translation, and protein-folding while lacking any capacity for the biosynthesis of amino acids or vitamins. Notably, the endosymbiont retains a capacity for fatty acid synthesis (type II) and iron-sulfur (Fe-S) cluster assembly. Metagenomic analysis of 150 new metagenomes from Organic Lake and more than 70 other Antarctic aquatic locations revealed a strong correlation in abundance between Ca. Organicella extenuata and a novel ciliate of the genus Euplotes. Like Ca. Pinguicoccus supinus, we infer that Ca. Organicella extenuata is an endosymbiont of Euplotes and hypothesize that both Ca. Organicella extenuata and Ca. Pinguicocccus supinus provide fatty acids and Fe-S clusters to their Euplotes host as the foundation of a mutualistic symbiosis. The discovery of Ca. Organicella extenuata as possessing genetic code 4 illustrates that in addition to identifying endosymbionts by sequencing known symbiotic communities and searching metagenome data using reference endosymbiont genomes, the potential exists to identify novel endosymbionts by searching for unusual coding parameters.

Childhood stunting and cognitive effects of water and sanitation in Indonesia.

Close to 100 million Indonesians lack access to improved sanitation, while 33 million live without improved drinking water. Indonesia is home to the second largest number of open defecators in the world, behind India. Repeated exposure to fecal pathogens, especially common in areas where open defecation is practiced, can cause poor absorption and nutrient loss through diarrhea and poor gut function, leading to undernutrition, growth stunting and irreversible impairment of health, development, learning and earnings - the effects of which outlast a lifetime. Using data from a sample of over six thousand children in the Indonesia Family Life Survey (IFLS), a household socioeconomic panel representative of over 80 percent of the Indonesian population, we examine the relationship between poor household and community water and sanitation services and childhood stunting and cognitive development. We find that children living in households that have access to improved sanitation when they are under 2 years of age are approximately 5 percentage points less likely to end up being stunted. Community rates of sanitation are also important. Children living in open defecation free communities during this critical development window are more than 10 percentage points less likely to be stunted, than children in communities where all other households defecate in the open. Further, cognitive test scores are adversely affected by open defecation. These findings suggest that owning a toilet and living in a community where most of one's neighbors own a toilet are important drivers of child growth and development.

Quantitative assessment of fecal contamination in multiple environmental sample types in urban communities in Dhaka, Bangladesh using SaniPath microbial approach.

Rapid urbanization has led to a growing sanitation crisis in urban areas of Bangladesh and potential exposure to fecal contamination in the urban environment due to inadequate sanitation and poor fecal sludge management. Limited data are available on environmental fecal contamination associated with different exposure pathways in urban Dhaka. We conducted a cross-sectional study to explore the magnitude of fecal contamination in the environment in low-income, high-income, and transient/floating neighborhoods in urban Dhaka. Ten samples were collected from each of 10 environmental compartments in 10 different neighborhoods (4 low-income, 4 high-income and 2 transient/floating neighborhoods). These 1,000 samples were analyzed with the IDEXX-Quanti-Tray technique to determine most-probable-number (MPN) of E. coli. Samples of open drains (6.91 log10 MPN/100 mL), surface water (5.28 log10 MPN/100 mL), floodwater (4.60 log10 MPN/100 mL), produce (3.19 log10 MPN/serving), soil (2.29 log10 MPN/gram), and street food (1.79 log10 MPN/gram) had the highest mean log10 E. coli contamination compared to other samples. The contamination concentrations did not differ between low-income and high-income neighborhoods for shared latrine swabs, open drains, municipal water, produce, and street foodsamples. E. coli contamination levels were significantly higher (p <0.05) in low-income neighborhoods compared to high-income for soil (0.91 log10 MPN/gram, 95% CI, 0.39, 1.43), bathing water (0.98 log10 MPN/100 mL, 95% CI, 0.41, 1.54), non-municipal water (0.64 log10 MPN/100 mL, 95% CI, 0.24, 1.04), surface water (1.92 log10 MPN/100 mL, 95% CI, 1.44, 2.40), and floodwater (0.48 log10 MPN/100 mL, 95% CI, 0.03, 0.92) samples. E. coli contamination were significantly higher (p<0.05) in low-income neighborhoods compared to transient/floating neighborhoods for drain water, bathing water, non-municipal water and surface water. Future studies should examine behavior that brings people into contact with the environment and assess the extent of exposure to fecal contamination in the environment through multiple pathways and associated risks.

Prevalence of cardiovascular disease among Bangladeshi adult population: a systematic review and meta-analysis of the studies.

BACKGROUND: Cardiovascular disease (CVD) is a group of conditions affecting the functioning of the heart or blood vessels and is one of the leading causes of death globally. Like other countries, CVD prevalence is also rising among the adults in Bangladesh. Epidemiological studies have shown not only a high CVD prevalence but also a significant increase in its prevalence in Bangladesh in the last few decades. To have a better understanding of the current CVD prevalence scenario, we conducted this systematic review and meta-analysis. Our objective was to assess the prevalence of CVD among the Bangladeshi adult population using evidence from the published scientific literature. METHODS: Electronic databases such as MEDLINE, Embase and PubMed were searched. We also manually checked the references of all relevant publications that describe the prevalence of CVD in Bangladeshi adults. To pool the CVD prevalence, we used random-effects meta-analysis. We assessed heterogeneity using both the formal tests and the subgroup analyses. We also assessed study quality and examined publication bias. RESULTS: We retrieved 755 potentially relevant papers through searches of electronic and gray literature, of which only 13 met inclusion criteria after the screening and were included in this review. Of the studies that met inclusion criteria, three were carried out in rural populations, five in both urban and rural populations and two in strictly urban populations. Male and female participation in the studies was almost equal. The weighted pooled prevalence of CVD was 5.0%, regardless of the types of CVD, gender and geographical location of the study participants. There was also a high heterogeneity in the observed CVD prevalence. Weighted pooled prevalence of overall CVD in the Bangladeshi population was higher in urban areas (8%) compared to rural areas (2%). However, no such difference was observed in terms of gender (3% for both males and females). The highest reported prevalence (21%) was for heart disease, while the lowest reported prevalence (1%) was for stroke. Sources of heterogeneity were often unexplained. The criteria used to assess study quality were fulfilled by only a few studies, and adequate sample size criteria was missed by almost all of them. In addition, there was evidence of small-study effects. CONCLUSION: A high CVD prevalence along with an upward trend was observed in Bangladeshi adults. Proper strategies are required for primary prevention of CVD so that a further increase can be alleviated and the morbidity and mortality associated with it can be reduced.

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries.

A long literature in demography has debated the importance of place for health, especially children's health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.

Attentional biases to foods: The effects of caloric content and cognitive restraint.

The goal of the present study was to determine whether female restrained and unrestrained eaters demonstrated differential levels of attentional bias to high calorie foods when they were presented as distractors in a flanker task. This task consisted of four blocks of 68 trials in which three food pictures were briefly presented simultaneously on a computer screen. On each trial a high or low calorie target food was presented in the center of a pair of high or low calorie food flanker pictures and participants' reaction times to answer a basic question about whether they would consume the target food for breakfast were recorded. In Experiment 1, in which all participants were fed a snack prior to engaging in the flanker task, there was no evidence that restrained (n=29) or unrestrained (n=37) eaters had an attentional bias. However, in Experiment 2, when participants completed the flanker task while hungry, restrained eaters (n=27) experienced response conflict only when low calorie targets were flanked by high calorie distractors, whereas unrestrained eaters (n=46) were distracted by high calorie flankers regardless of the caloric content of the target cue. The results from this implicit task indicate that flankers interfere with hungry participants' responses to varying degrees depending on their cognitive restraint. Whether attentional bias to food cues subsequently affects food choices and eating behavior is a topic for further investigation.