Interagency Group Research Articles

Understanding the Barriers to Clinical Trial Referral and Enrollment Among Oncology Providers Within the Veterans Health Administration.

Clinical trials are essential for advancing treatment options in oncology while providing cancer patients with innovative care; however, few cancer patients are referred to clinical trials. System-, provider-, and patient-level barriers to clinical trial participation have been described but have not been studied in the Veterans Health Administration (VHA). Although the VHA has engaged in several initiatives to improve Veteran's access to clinical trials, including the National Cancer Institute and VA Interagency Group to Accelerate Trials Enrollment program and VHA work on the White House Cancer Moonshot, further research is needed to understand the multifaceted challenges underlying limited enrollment for Veterans who receive care in the VHA system. This research aims to evaluate VHA oncology providers' attitudes toward and experiences with referral and enrollmentof Veterans with cancer into clinical trials, for the purpose of informing actions that could be taken to enhance Veterans' access to clinical trials as well as the VHA's contributions to clinical research. This research comprised the administration of an electronic 34-item survey and semistructured interviews among oncology care providers in the VHA nationally, between May 2022 and August 2023. The survey was introduced via a presentation at VHA Oncology Office Hours and aimed to capture VHA oncology care providers' perceptions of and experiences with referral and enrollment to clinical trials. The semistructured interviews explored providers' perceived barriers to clinical trial participation and recruitment bias, as well as inquired about potentially modifiable factors for improving clinical trial enrollment at the VHA, such as providers' concerns, motivations for and facilitators of enrollment of patients into clinical trials, and the manner in which they communicate about clinical trials with their patients. Thirty-eight oncology care providers completed the survey, and eight completed the semistructured interview, including 5 staff physicians, 1 fellow, 1 nurse practitioner, and 1 physician assistant. Thirty-four survey respondents identified their specialty as medical oncology, one respondent identified the specialty as radiation oncology, and three identified the specialty as hematology. Nineteen respondents identified as women and 14 as men; the remainder did not provide their gender. Three respondents identified as Hispanic or Latino individuals, 11 as Asians, 3 as Black individuals, and 17 as White individuals. Five interview participants reported holding an individual academic affiliation. Participants identified and described various barriers to clinical trial referral and enrollment at multiple levels, including lack of appropriate trials, strict patient eligibility criteria, difficulties in understanding and managing the referral process for trials outside the VHA system, challenges with obtaining information and identifying available clinical trials, Veterans' financial and logistical concerns, lack of trust in the medical establishment, lack of adequate social support, and Veterans' psychological and physical comorbidities. They also highlighted opportunities for system-level change that can overcome some of these barriers, including academic affiliations, patient support from internal and external nurse navigators, and dedicated research coordinators. The insights gleaned from this research can guide VHA in its efforts to optimize access to clinical trials for Veterans.

Supporting Sustainable Development Goals through Regulation and Maintenance Ecosystem Services

Sustainable development goals (SDGs) have a huge impact on global policies. Contextually, the concept of ecosystem services (ESs) naturally relies on the importance of integrating human activities into a framework in which ecosystems play a fundamental role in supporting upcoming societies. Introducing ESs in the process of SDG evaluation can be useful to facilitate their achievement through national and local planning policies. Nevertheless, this aspect is still poorly addressed. In the present study, an in-depth analysis has been conducted, to associate regulation and maintenance ecosystem services (ReMESs) with the SDGs set by the 2030 Agenda. Based on the available scientific literature, ReMESs have been linked to the SDGs and SDG targets. Specific attention has been paid to deepening linkages with the SDG targets that explicitly address the introduction of ecosystem and biodiversity values into national and local planning. Finally, SDG evaluation has been further investigated, linking the SDG targets to the statistical measures proposed by the Inter-agency and Expert Group on SDGs (UN-IAEG-SDGs). This last step focused on the Italian context, according to the indicators provided by the National Institute of Statistics. The results show that ReMESs are linked to 8 out of 17 SDGs (47%). Connections decrease when considering the SDG targets (20%) and the national statistical measures (18%). It also emerges that some targets, although being connected to ReMESs, do not have the right indicators to be quantified. Ecosystem services prove to be a valid element through which modern sustainable development goals can be accomplished. This study, which highlights several gaps to be filled, wants to offer valuable help in evaluating SDGs and their implementation through ReMESs.

Levels, trends and inequalities in mortality among 5-19-year-olds in Tanzania: Magu Health and Demographic Surveillance Study (1995-2022).

For the past two decades, health priorities in Tanzania have focussed on children under-five, leaving behind the older children and adolescents (5-19 years). Understanding mortality patterns beyond 5 years is important in bridging a healthy gap between childhood to adulthood. We aimed to estimate mortality levels, trends, and inequalities among 5-19-year-olds using population data from the Magu Health and Demographic Surveillance Site (HDSS) in Tanzania and further compare the population level estimates with global estimates. Using data from the Magu HDSS from 1995 to 2022, from Kaplan Meir survival probabilities, we computed annual mortality probabilities for ages 5-9, 10-14 and 15-19 and determined the average annual rate of change in mortality by fitting the variance weighted least square regression on annual mortality probabilities. We compared 5-19 trends with younger children aged 1-4 years. We further disaggregated mortality by sex, area of residence and wealth tertiles, and we computed age-stratified risk ratios with respective 95% confidence intervals (CIs) using Cox proportional hazard model to determine inequalities. We further compared population-level estimates in all-cause mortality with global estimates from the United Nations Inter-agency Group for Child Mortality Estimation and the Global Burden of Disease study by computing the relative differences to the estimates. Mortality declined steadily among the three age groups from 1995 to 2022, whereby the average annual rate of decline increased with age (2.2%, 2.7%, and 2.9% for 5-9-, 10-14-, and 15-19-year-old age groups, respectively). The pace of this decline was lower than that of younger children aged 1-4 years (4.8% decline). We observed significant mortality inequalities with boys, those residing in rural areas, and those from poorest wealth tertiles lagging behind. While Magu estimates were close to global estimates for the 5-9-year-old age group, we observed divergent results for adolescents (10-19 years), with Magu estimates lying between the global estimates. The pace of mortality decline was lower for the 5-19-year-old age group compared to younger children, with observable inequalities by socio-demographic characteristics. Determining the burden of disease across different strata is important in the development of evidence-based targeted interventions to address the mortality burden and inequalities in this age group, as it is an important transition period to adulthood.

A Review of COVID-19 Hotels in New York City During the Early 2020 Outbreak: An Alternative Care Model.

New York City (NYC) was the epicenter of the early USCOVID-19 pandemic. From March to May 2020, overburdened healthcare centers precipitated an emergent need for non-traditional facilities to meet patient care demands. Given travel restrictions and NYC's underutilized tourist infrastructure, hotels were available to support emergency response needs. This article describes the process by which NYC's non-medical COVID-19 hotel programs were selected, mobilized, and operated, including lessons learned. NYC agencies and organizations collaborated, creating an interagency initiative that activated hotels to provide safe isolation and quarantine spaces for those diagnosed with or exposed to COVID-19, aiming to reduce community spread, increase capacity for NYC's strained healthcare system, and mitigate interagency redundancy. Interagency groups addressed hotel challenges, including infection prevention and control; behavioral health, intellectual, and developmental disorders; social determinants of health; and coordination, operations, and planning. NYC's COVID-19 hotel program successfully supported overburdened hospitals by providing alternate locations for non-inpatient COVID-19 individuals. Community engagement required a methodical approach, balancing quality assurance with efficient access. An interagency coordinating body developed and shared clinical criteria for hotel admissions, infection prevention and control (IPC) procedures, and discharge plans, enhancing the program's ability to scale and address complex needs. Lessons learned from this program can be applied for smoother implementation of similar programs in the future.

Income inequality as a determinant of neonatal mortality in the Americas during 2000–2019: implications for the attainment of Sustainable Development Goal target 3.2

BackgroundThe work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas.MethodsYearly data from 35 countries in the Americas during 2000–2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques.ResultsA positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country’s Gini index during 2000–2019 is associated with a 0.27 (95% CI [− 0.04, 0.57], P =.09) increase in the neonatal mortality rate.ConclusionThe analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000–2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance.

Enhancing Gene Synthesis Security: An Updated Framework for Synthetic Nucleic Acid Screening and the Responsible Use of Synthetic Biological Materials.

In response to continuous advancements in synthetic biotechnologies and in the availability of synthetic nucleic acids to the biological research community since the publication of the 2010 HHS synthetic double-stranded DNA (dsDNA) screening framework, the U.S. government undertook a comprehensive and stakeholder-driven review and revision process. This culminated in the publication of a new screening framework for synthetic nucleic acids in October 2023, followed by an Executive Order directing departments and agencies of the U.S. government to take certain measures in support of implementing the screening framework. This review provides an overview of the process by which stakeholder comments were considered and by which the 2023 screening framework was drafted. A summary of expected impacts on the life sciences research community is also provided. Comments were solicited from synthetic biology stakeholders through the publication of two Federal Register Notices, in 2020 and 2022. The 2020 Notice elicited 15 unique responses totaling 220 pages, and the 2022 Notice elicited 26 unique responses totaling 79 pages. These were considered by a deliberative interagency group, resulting in a revised screening framework in 2023. The adoption of the 2023 screening framework, and related provisions in the Executive Order that followed, will impact researchers and biosafety officers across the U.S. bioeconomy. For instance, this screening framework is no longer limited in its recommendations to providers of synthetic dsDNA containing sequences unique to regulated pathogens or toxins, but now includes recommendations to all entities involved in the sale, use, and transfer of all forms of synthetic nucleic acids encoding genetic sequences that contribute to pathogenicity or toxicity-whether from regulated agents or not. Biosafety professionals are emerging as a critical resource for establishing and fostering a culture of biosecurity surrounding synthetic nucleic acids containing these high consequence genetic sequences. The work presented is significant because the scope of the 2010 screening framework has been expanded to include roles and responsibilities for new entities across the life sciences research landscape. This will likely impact biosafety professionals, who may be well positioned in their institutions to coordinate these new responsibilities.

A Bayesian Approach to Estimate Maternal Mortality Globally Using National Civil Registration Vital Statistics Data Accounting for Reporting Errors

Estimation and monitoring of mortality, across multiple population-periods, is vital to improving national and global health outcomes. Reducing maternal mortality is a key part of the Sustainable Development Goals (SGDs), which commit countries and international agencies to monitor progress toward improvement of global maternal health outcomes. Country-specific estimates of maternal mortality are used for monitoring country progress. Civil registration vital statistics (CRVS) data provide valuable information on maternal mortality but are often subject to substantial reporting errors due to misclassification of maternal deaths or incompleteness of CRVS-reporting on deaths to women of reproductive age. Motivated by the challenge of estimating maternal mortality using error-prone CRVS data, this article introduces a Bayesian two-stage approach to obtain country-specific trends in maternal mortality ratios (MMRs), accounting for CRVS-related misclassification errors. In the first stage, we produce country-specific trends of CRVS-related data quality metrics, in terms sensitivity and specificity, through a Bayesian hierarchical misclassification model. In the second stage, we produce data-driven country trends in MMRs and proportion maternal deaths out of all-cause deaths, which are constructed using a Bayesian maternal mortality estimation model, accounting for CRVS-related data quality assessed in Stage 1. We present the approach to estimating maternal mortality and illustrate its use for several country case studies. This approach is used by the United National Maternal Mortality Interagency Group (UN-MMEIG) to produce maternal mortality estimates for global monitoring.

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The article proposes an approach to developing a method of using an interagency grouping of troops (forces) for stabilization operations in the de-occupied territories, which, unlike the known ones, takes into account the current conditions and peculiarities of performing tasks, combines the best domestic and foreign practices. It makes it possible to determine a balanced list of tasks and activities of law enforcement agencies and public authorities at various levels of government to create an interagency group of the appropriate composition. The proposed approach can be used by the military command and control bodies of the National Guard of Ukraine to plan the use of its formations, as well as to create groups and tactical teams of appropriate composition.

Effect Of Abdominal Stretching Exercises Toward The Intensity Of Menstrual Pain (Dismenorea) Of Adolescent Women

Menstrual pain (dysmenorrhea) is one of the menstrual disorders that most women experience in adolescents. With one of the nonpharmacological practice stretching techniques can be done with the goal of knowing if there is an application effect on the intensity of menstrual pain (dysmenorrhea) in adolescents women. The type of research is an experimental design with the design approach used is the pre test- post test control group design, which is done in University Megarezky with 32 people research respondents, according to the two-split criteria for interagency and control groups as the pre-and post data processing technique on each group. Based on data normality tests, non-distribution of normal results, the tests used were wilcoxon tests. Furthermore, the pre-post normality test of unregulated data control interventions using the mann-whitney test. Research shows that test results on the pre post interventions using wilcoxon tests came p value (0,000 < 0.05). control groups using mann-whitney tests got p value (0,000<0.05). Thus it may be determined that there is an intermediate effect on the intensity of menstrual pain (dysmenorrhea). Based on the results of this study is expected for all elements that include educational agencies, subsequent researchers, teenagers and communities are able to provide information about abdominal tracks exercises as non-pharmacological therapy to reduce the intensity of hairsty pain (dysmenornea).

International progress on stillbirth reduction: Changes in Stillbirth Rates in Selected Low and Middle-Income Countries from 2000 to 2021

In this paper, we attempted to determine if there were reductions in low and middle – income country stillbirth rates since 2000 - focusing on sub-Saharan Africa, Asia and Latin America and the Caribbean. We used data made available by the United Nations Inter-agency Group for Child Mortality Estimation and the World Health Organization as well as the National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research.. Overall, nearly every country evaluated had at least a small reduction in stillbirth rate from the year 2000 to 2021, but the reductions varied substantially between regions. Asia and Latin America/Caribbean had similar levels of reductions with a number of countries in each of those regions having rates in 2021 that were 40 % or more lower than those documented in 2000. No country in Africa documented a reduction in stillbirths of 40 % and many had stillbirth reductions of less than 15 %.

Spatiotemporal analysis of the effect of global development indicators on child mortality

BackgroundChild mortality continue to be a major public health issue in most developing countries; albeit there has been a decline in global under-five deaths. The differences in child mortality can best be explained by socioeconomic and environmental inequalities among countries. In this study, we explore the effect of country-level development indicators on under-five mortality rates. Specifically, we examine potential spatio-temporal heterogeneity in the association between major world development indicators on under-five mortality, as well as, visualize the global differential time trend of under-five mortality rates.MethodsThe data from 195 countries were curated from the World Bank’s World Development Indicators (WDI) spanning from 2000 to 2017 and national estimates for under-five mortality from the UN Inter-agency Group for Child Mortality Estimation (UN IGME).We built parametric and non-parametric Bayesian space-time interaction models to examine the effect of development indicators on under-five mortality rates. We also used employed Bayesian spatio-temporal varying coefficient models to assess the spatial and temporal variations in the effect of development indicators on under-five mortality rates.ResultsIn both parametric and non-parametric models, the results show indicators of good socioeconomic development were associated with a reduction in under-five mortality rates while poor indicators were associated with an increase in under-five mortality rates. For instance, the parametric model shows that gross domestic product (GDP) (β = − 1.26, [CI − 1.51; − 1.01]), current healthcare expenditure (β = − 0.40, [CI − 0.55; − 0.26]) and access to basic sanitation (β = − 0.03, [CI − 0.05; − 0.01]) were associated with a reduction under-five mortality. An increase in the proportion practising open defecation (β = 0.14, [CI 0.08; 0.20]) an increase under-five mortality rate. The result of the spatial components spatial variation in the effect of the development indicators on under-five mortality rates. The spatial patterns of the effect also change over time for some indicators, such as PM2.5.ConclusionThe findings show that the burden of under-five mortality rates was considerably higher among sub-Saharan African countries and some southern Asian countries. The findings also reveal the trend in reduction in the sub-Saharan African region has been slower than the global trend.

Establishing an Approach for Designation of Evolving and Emerging Drug Threats.

Establishing an Approach for Designation of Evolving and Emerging Drug Threats.

Economic security guaranteeing entities

The article studies the features and establishment of specific features of law enforcement agencies and the peculiarities of financing the activities of entities ensuring the implementation of law enforcement functions and determines strategic directions for reforming the activities of the entities ensuring the implementation of law enforcement functions. The concept of “law enforcement agency” and signs and vectors of institutional support for the implementation of state policy in the field of law enforcement are defined, including 1) creation of special law enforcement agencies to prevent and counter the most important social problems: cybercrime; distribution and production of drugs; 2) shaping a communication strategy for the interaction of law enforcement agencies; 3) establishment of a permanent representation of Europol. An analysis of state budgets for 2019-2023 is carried out to assess the level of financial support for law enforcement agencies and state authorities performing law enforcement functions. The role and main tasks of the Bureau of Economic Security are determined. Priority directions for expanding the activities of law enforcement agencies in the context of preventing and countering economic crime are proposed. Ways of organizing joint activities of law enforcement agencies are proposed: creation of joint investigation groups, involvement of specialists, joint use of resources, exchange of information, and consultations. The state of financing the activities of law enforcement agencies is studied, and the following areas of improvement of this process are suggested: forecasting the covert expenditures for special operations; reporting to the profile committee of the Parliament of Ukraine; development of a financing mechanism for joint operations; financing the interaction of law enforcement agencies with international police organizations; financing the continuous education of law enforcement officers; financing the retraining of law enforcement officers of working age who stop working in the law enforcement system; provision of funding for the creation of scientific laboratories; financing the temporary joint investigative interagency groups; financing the study of economic and financial aspects of war crimes. The article proposes directions for the expansion of the activities of law enforcement agencies, in particular: the priority areas of joint activity of law enforcement agencies in the implementation of the state policy of prevention and counteraction of economic crime are defined; the form of organization of joint activity of law enforcement agencies in the implementation of the state policy of prevention and counteraction of economic crime is substantiated.

Estimating the stillbirth rate for 195 countries using a Bayesian sparse regression model with temporal smoothing

Estimation of stillbirth rates globally is complicated because of the paucity of reliable data from countries where most stillbirths occur. We compiled data and developed a Bayesian hierarchical temporal sparse regression model for estimating stillbirth rates for 195 countries from 2000 to 2019. The model combines covariates with a temporal smoothing process so that estimates are data-driven in country-periods with high-quality data and determined by covariates for country-periods with limited or no data. Horseshoe priors are used to encourage sparseness. The model adjusts observations with alternative stillbirth definitions and accounts for various sources of uncertainty. In-sample goodness of fit and out-of-sample validation results suggest that the model is reasonably well calibrated. The model is used by the UN Interagency Group for Child Mortality Estimation to monitor the stillbirth rate for 195 countries.

Variants of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Vaccine Effectiveness.

The incidence and death toll due to SARS-CoV-2 infection varied time-to-time; and depended on several factors, including severity (viral load), immune status, age, gender, vaccination status, and presence of comorbidities. The RNA genome of SARS-CoV-2 has mutated and produced several variants, which were classified by the SARS-CoV-2 Interagency Group (SIG) into four major categories. The first category; “Variant Being Monitored (VBM)”, consists of Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), Epsilon (B.1.427, B.1.429), Eta (B.1.525), Iota (B.1.526), Kappa (B.1.617.1), Mu (B.1.621), and Zeta (P.2); the second category; “Variants of Concern” consists of Omicron (B.1.1.529). The third and fourth categories include “Variants of Interest (VOI)”, and “Variants of High Consequence (VOHC)”, respectively, and contain no variants classified currently under these categories. The surge in VBM and VOC poses a significant threat to public health globally as they exhibit altered virulence, transmissibility, diagnostic or therapeutic escape, and the ability to evade the host immune response. Studies have shown that certain mutations increase the infectivity and pathogenicity of the virus as demonstrated in the case of SARS-CoV-2, the Omicron variant. It is reported that the Omicron variant has >60 mutations with at least 30 mutations in the Spike protein (“S” protein) and 15 mutations in the receptor-binding domain (RBD), resulting in rapid attachment to target cells and immune evasion. The spread of VBM and VOCs has affected the actual protective efficacy of the first-generation vaccines (ChAdOx1, Ad26.COV2.S, NVX-CoV2373, BNT162b2). Currently, the data on the effectiveness of existing vaccines against newer variants of SARS-CoV-2 are very scanty; hence additional studies are immediately warranted. To this end, recent studies have initiated investigations to elucidate the structural features of crucial proteins of SARS-CoV-2 variants and their involvement in pathogenesis. In addition, intense research is in progress to develop better preventive and therapeutic strategies to halt the spread of COVID-19 caused by variants. This review summarizes the structure and life cycle of SARS-CoV-2, provides background information on several variants of SARS-CoV-2 and mutations associated with these variants, and reviews recent studies on the safety and efficacy of major vaccines/vaccine candidates approved against SARS-CoV-2, and its variants.

A U.S. Government-Coordinated Effort to Leverage Non-Human Primate Data to Facilitate Ebolavirus Vaccine Development

A United States Government (USG) interagency group, the Filovirus Animal Non-Clinical Group (FANG), has been established to support the development of biodefense medical countermeasures (MCMs). As both vaccines and therapeutics are licensed using “non-traditional pathways”, such as the U.S. Food and Drug Administration’s (FDA) Animal Rule (AR), non-human primate (NHP) models and associated assays have been developed and standardized across BSL4 testing sites to evaluate candidate products. Vaccine candidates are evaluated using these NHP models, and through this public–private partnership, a meta-analysis of NHP control data has been conducted and submitted to the FDA as a master file. This is an example of how existing NHP control data can be leveraged in lieu of conducting separate natural history studies at multiple testing facilities to demonstrate the consistency of a standardized animal model for vaccine development. As a result, animal use can be minimized and the duplication of effort avoided, thus reducing the amount of time needed to conduct additional studies, as well as the cost of vaccine candidate development. This successful strategy may be applied to other pathogens of high consequence for vaccine development, and shows how strategic preparedness for biodefense can be leveraged in response to outbreaks and public health emergencies.

Maternal Height-standardized Prevalence of Stunting in 67 Low- and Middle-income Countries.

BackgroundPrevalence of stunting is frequently used as a marker of population-level child undernutrition. Parental height varies widely in low- and middle-income countries (LMIC) and is also a major determinant of stunting. While stunting is a useful measure of child health, with multiple causal components, removing the component attributable to parental height may in some cases be helpful to identify shortcoming in current environments.MethodsWe estimated maternal height-standardized prevalence of stunting (SPS) in 67 LMICs and parental height-SPS in 20 LMICs and compared with crude prevalence of stunting (CPS) using data on 575,767 children under-five from 67 Demographic and Health Surveys (DHS). We supplemented the DHS with population-level measures of other child health outcomes from the World Health Organization’s (WHO) Global Health Observatory and the United Nations’ Inter-Agency Group for Child Mortality Estimation. Prevalence of stunting was defined as percentage of children with height-for-age falling below −2 z-scores from the median of the 2006 WHO growth standard.ResultsThe average CPS across countries was 27.8% (95% confidence interval [CI], 27.5–28.1%) and the average SPS was 23.3% (95% CI, 23.0–23.6%). The rank of countries according to SPS differed substantially from the rank according to CPS. Guatemala, Bangladesh, and Nepal had the biggest improvement in ranking according to SPS compared to CPS, while Gambia, Mali, and Senegal had the biggest decline in ranking. Guatemala had the largest difference between CPS and SPS with a CPS of 45.2 (95% CI, 43.7–46.9%) and SPS of 14.1 (95% CI, 12.6–15.8%). Senegal had the largest increase in the prevalence after standardizing maternal height, with a CPS of 28.0% (95% CI, 25.8–30.2%) and SPS of 31.6% (95% CI, 29.5–33.8%). SPS correlated better than CPS with other population-level measures of child health.ConclusionOur study suggests that CPS is sensitive to adjustment for maternal height. Maternal height, while a strong predictor of child stunting, is not amenable to policy interventions. We showed the plausibility of SPS in capturing current exposures to undernutrition and infections in children.

Microbial antigen in human milk: a natural vaccine?

Microbial antigen in human milk: a natural vaccine?

Advancing the pursuit of the United Nations Sustainable Development Goals: Initiatives of selected publicly listed companies in the Philippines

Advancing the pursuit of the United Nations Sustainable Development Goals: Initiatives of selected publicly listed companies in the Philippines

Defining the risk of SARS-CoV-2 variants on immune protection.

The global emergence of many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants jeopardizes the protective antiviral immunity induced after infection or vaccination. To address the public health threat caused by the increasing SARS-CoV-2 genomic diversity, the National Institute of Allergy and Infectious Diseases within the National Institutes of Health established the SARS-CoV-2 Assessment of Viral Evolution (SAVE) programme. This effort was designed to provide a real-time risk assessment of SARS-CoV-2 variants that could potentially affect the transmission, virulence, and resistance to infection- and vaccine-induced immunity. The SAVE programme is a critical data-generating component of the US Government SARS-CoV-2 Interagency Group to assess implications of SARS-CoV-2 variants on diagnostics, vaccines and therapeutics, and for communicating public health risk. Here we describe the coordinated approach used to identify and curate data about emerging variants, their impact on immunity and effects on vaccine protection using animal models. We report the development of reagents, methodologies, models and notable findings facilitated by this collaborative approach and identify future challenges. This programme is a template for the response to rapidly evolving pathogens with pandemic potential by monitoring viral evolution in the human population to identify variants that could reduce the effectiveness of countermeasures.