Effects of replacement therapies with clotting factors in patients with hemophilia: A systematic review and meta-analysis

Background Different prophylactic and episodic clotting factor treatments are used in the management of hemophilia. A summarize of the evidence is needed inform decision-making. Objective To compare the effects of factor replacement therapies in patients with hemophilia. Methods We performed a systematic search in PubMed, Central Cochrane Library, and Scopus. We included randomized controlled trials (RCTs) published up to December 2020, which compared different factor replacement therapies in patients with hemophilia. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42021225857). Results Nine RCTs were included in this review, of which six compared episodic with prophylactic treatment, all of them performed in patients with hemophilia A. Pooled results showed that, compared to the episodic treatment group, the annualized bleeding rate was lower in the low-dose prophylactic group (ratio of means [RM]: 0.27, 95% CI: 0.17 to 0.43), intermediate-dose prophylactic group (RM: 0.15, 95% CI: 0.07 to 0.36), and high-dose prophylactic group (RM: 0.07, 95% CI: 0.04 to 0.13). With significant difference between these subgroups (p = 0.003, I2 = 82.9%). In addition, compared to the episodic treatment group, the annualized joint bleeding rate was lower in the low-dose prophylactic group (RM: 0.17, 95% CI: 0.06 to 0.43), intermediate-dose prophylactic group (RM of 0.14, 95% CI: 0.07 to 0.27), and high-dose prophylactic group (RM of 0.08, 95% CI: 0.04 to 0.16). Without significant subgroup differences. The certainty of the evidence was very low for all outcomes according to GRADE methodology. The other studies compared different types of clotting factor concentrates (CFCs), assessed pharmacokinetic prophylaxis, or compared different frequencies of medication administration. Conclusions Our results suggest that prophylactic treatment (at either low, intermediate, or high doses) is superior to episodic treatment for bleeding prevention. In patients with hemophilia A, the bleeding rate seems to have a dose-response effect. However, no study compared different doses of prophylactic treatment, and all results had a very low certainty of the evidence. Thus, future studies are needed to confirm these results and inform decision making.

Understanding NO2 Concentration Dynamics within Tema Metropolitan Area of Ghana Using Generalized Linear Model

The concentration of nitrogen dioxide (NO2) is worsening across the globe alongside growth in industrial and general anthropogenic activities. Due to its serious health implications with long-term exposure, studies on NO2 concentration have gained space in the academic literature. In this study, awareness is created on the levels of NO2 across four (4) locations within the Tema Metropolitan area, with specific interest in selecting locations and periods significantly saturated with NO2 within the study area. NO2 was measured using RKI Eagle, an instrument with a built-in sensor for a specific gas measurement. Measurements were taken day and night at sampling points around 100 meters apart in each location. Data collection was performed over a nine (9)-month period. The Generalized Linear model is explored for selecting locations and periods significantly affected by NO2. From the results, the fourth week (26th–31st) of July 2020, the fourth week (27th–31st) of December 2020, the first week (1st–7th) of January 2021, and the fourth week (24th–31st) of January 2021 recorded severe concentrations of NO2. Additionally, the lives of residents in the Oil Jetty and the VALVO hospital areas were found to be the most endangered, as they recorded significantly high concentrations of NO2. In a developing country such as Ghana, this study is useful for monitoring NO2 concentrations in similar areas to inform decision making and environmental policy formulation.

Measurement and Monitoring of Particulate Matter in Construction Sites: Guidelines for Gravimetric Approach

Studies on particulate matter (PM) from construction activities are still at an early stage. Thus, there is still no consensus on standardized experimental methods for monitoring PM in construction sites, which impedes the advancement of knowledge on this subject. This work proposes guidelines for measuring and monitoring the concentration of suspended PM and the annoyance generated by sedimented particles on construction sites in urban areas. These guidelines aim to reduce the variability and uncertainties that exist during the PM sampling processes at construction sites. This study adopts a literature review strategy in order to update the available scientific literature based on empirical evidence obtained in experimental PM studies and relevant documents from government agencies. The proposed guidelines were applied in a study protocol for gravimetric monitoring PM and annoyance tracking generated by sedimented particles using sticky pads. As a result, this article details sampling techniques, procedures, and instruments, focusing on gravimetric sampling, highlighting their characteristics compared to other monitoring approaches. Additionally, it points out a series of parameters for the measurement and monitoring of PM. This paper seeks to support future researchers in this area, inform decision making for experimental sampling, and provide a benchmark for measuring and monitoring PM at construction sites.

Suitability of Different Methods for Measuring Black Carbon Emissions from Marine Engines

Black carbon (BC) emissions intensify global warming and are linked to adverse health effects. The International Maritime Organization (IMO) considers the impact of BC emissions from international shipping. A prerequisite for the anticipated limits to BC emissions from marine engines is a reliable measurement method. The three candidate methods (photoacoustic spectroscopy (PAS), laser-induced incandescence (LII), and filter smoke number (FSN)) selected by the IMO were evaluated with extensive ship exhaust matrices obtained by different fuels, engines, and emission control devices. A few instruments targeted for atmospheric measurements were included as well. The BC concentrations were close to each other with the smoke meters (AVL 415S and 415SE), PAS (AVL MSS), LII (Artium-300), MAAP 5012, aethalometers (Magee AE-33 and AE-42), and EC (TOA). In most cases, the standard deviation between instruments was in the range of 5–15% at BC concentrations below 30 mg Sm−3. Some differences in the BC concentrations measured with these instruments were potentially related to the ratio of light-absorbing compounds to sulphates or to particle sizes and morphologies. In addition, calibrations, sampling, and correction of thermophoretic loss of BC explained differences in the BC results. However, overall differences in the BC results obtained with three candidate methods selected by the IMO were low despite challenging exhaust compositions from marine diesel engines. Findings will inform decision making on BC emission control from marine engines.

Land and Water Systems: Looking to the future and a more resilient and sustainable society and environment

Food, land, and water systems are facing unprecedented change. The world’s population is projected to grow to approximately 10 billion people by 2050, while aging and declining in some regions. Global average incomes are expected to keep increasing at a slow but steady pace. With increasing incomes and the ability of consumers to purchase more and better food in combination with population growth, food demand is projected to grow substantially over the next three decades. Meanwhile, demographic changes and economic development also drive urbanization, migration, and structural transformation of rural communities. At the same time changes to precipitation and temperature as well as the occurrence of extreme events driven by climate change are becoming more prevalent and impacting society and the environment. Currently, humanity is approaching or exceeding planetary boundaries in some areas, with over-use of limited productive natural resources such as water and phosphate, net emissions of greenhouse gases, and decreases in biodiversityMuch is published about food and agriculture and the supporting/underpinning land and water systems, but no single source focuses regularly and systematically on the future of agriculture and food systems, particularly on the challenges and opportunities faced by developing countries. This working paper is part of an effort by the CGIAR foresight team to help fill that gap. The effort recognizes that there is much to learn from past experience, and there are clearly many urgent and immediate challenges, but given the pace and complexity of change we are currently experiencing, there is also an increasing need to look carefully into the future of food, land, and water systems to inform decision making today.

The Future of Food Security, Nutrition and Health for Agri-food Systems Transformation

Global progress towards food security and nutrition has been slow in many places and even reversing in others. Against the background of changes in population, income, technology, climate, and other drivers, the pressures on food systems are daunting. When designing and rolling out future interventions towards these goals it is of vital importance to utilize foresight knowledge to anticipate, shape, and prepare for alternative possible futures. Overcoming current and emerging challenges but also seizing opportunities as they present themselves requires continued efforts to provide robust analysis to inform decision making. Here we collated the latest insights from foresight studies around three central aspects within the food system. First, consumer demand and the changes this is undergoing is a key aspect shaping the food system itself as well as nutritional and environmental outcomes. Second, distributional inequalities and trade-offs within the food system have further been identified as key challenges to tackling adverse health outcomes of the current food system. And third, amplified by the COVID crisis, enhancing the resilience of the food system that is increasingly under threat from multiple risks has risen to the top of the agenda.