National Ministry Research Articles

Inhibition of PIM Kinases in Diffuse Large B-Cell Lymphoma Cells Targets MYC-Dependent Transcriptional Program, Increases CD20 Expression and Augments the Efficacy of Anti-CD20 Antibodies

R-CHOP immunochemotherapy remains standard frontline therapy for newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients. However, this therapy is ineffective in approximately 1/3 of patients, underscoring the need for better treatment modalities. Targeting DLBCL oncogenic drivers is a promising strategy to improve the treatment efficacy and outcome. Although MYC transcription factor is one of the key oncogenes in DLBCL development, direct MYC targeting strategies have been largely ineffective, highlighting the need for other, indirect approaches. For example, MYC expression is stabilized by PIM serine-threonine kinases, indicating that PIM inhibition might be a rational approach to indirectly target MYC. In this study, we assessed the PIM-MYC relationship and the consequences of PIM inhibition in DLBCL. We first evaluated the expression of PIM1-3 and MYC proteins in 57 DLBCL diagnostic sections by immunohistochemistry. In this series, 70.17% of specimens were positive for at least one PIM isoform and 84.22% cases were MYC-positive. 100% of cases with high MYC expression (MYC present in ≥30% of the cells, n=35) were PIM-positive, whereas 86,36% of cases with undetectable or low MYC expression (MYC detected in ≤20% of cells, n= 22) were PIM-negative (Fisher's exact test, p<0.0001). Since the coexpression of MYC and PIMs highlights the functional link between these proteins in DLBCLs, we evaluated the expression of PIM kinases in cell lines following siRNA-mediated MYC knockdown or treatment with MYC-MAX dimerization inhibitor, 10058F4. The genetic or chemical MYC inhibition markedly decreased PIM1-3 expression in six GCB and ABC cell lines. Likewise, knockdown of all three PIM isoforms decreased MYC levels, attenuated proliferation and induced apoptosis. Similarly, PIM blockade with SEL24/MEN1703, a novel pan-PIM/FLT3 inhibitor tested currently in clinical trial in AML patients and exhibiting favorable safety profile, decreased the expression of multiple MYC-dependent genes. To assess the MYC role in PIM inhibitor-mediated toxicity, we generated DHL4 cells expressing degradation-resistant MYC_T58A mutant. MYC_T58A expression partially protected cells from PIM inhibitor-induced proliferation arrest and apoptosis, indicating that the inhibitor's toxicity is at least partially mediated by MYC depletion. The MS4A1 gene, encoding CD20 surface antigen and rituximab target, is regulated by an upstream promoter containing potential MYC-binding sites (E-boxes). MYC association to these regions was confirmed in chromatin immunoprecipitation assays. As expected, in SEL24/MEN1703-treated cells, MYC occupancy at the MS4A1 promoter markedly decreased. To determine the consequences of MYC binding to the MS4A1 promoter, we assessed CD20 levels in a lymphoblastoid cell line carrying tetracycline-regulated (tet-off) MYC. MYC repression markedly elevated transcript and surface CD20 levels in a time-dependent manner, reaching 17.3-fold (transcript) and 3.82-fold (surface) inductions at 96 h. Consistently, the pan-PIM inhibitor decreased MYC expression in DHL4 and RAJI cells and resulted in increased surface CD20 levels up to 3.72-fold of baseline. In cells expressing the MYC_T58A mutant, PIM inhibition did not increase CD20 level, indicating that PIM kinases modulate CD20 surface expression via MYC. Importantly, PIM inhibitors increased CD20 levels also in primary, patient-derived DLBCL cells. These data suggest that indirect MYC targeting via PIM inhibition would lead to increased rituximab activity. Indeed, in PIM inhibitor-treated DHL4 and RAJI cells, rituximab triggered higher complement-dependent toxicity. Likewise, PIM inhibitor potentiated rituximab-dependent uptake of DHL4 and DHL6 cells by human monocyte-derived macrophages in antibody-dependent cellular phagocytosis assay. Taken together, we characterize a PIM-MYC regulatory circuit promoting DLBCL growth and resistance to anti-CD20 antibody. We also demonstrate that PIM inhibition exhibits pleiotropic effects that combine direct cytotoxicity with increased surface CD20 levels and increased susceptibility to anti-CD20 antibody-based therapies. Study supported by Foundation for Polish Science (POIR.04.04.00-00-5C84/17-00), Polish National Science Centre (2016/22/M/NZ5/00668 and 2017/26/D/NZ5/00561) and Ministry of Science and Higher Education in Poland (iONCO) grants. Disclosures Golas: Ryvu Therapeutics: Current Employment. Green:KDAc Therapeutics: Current equity holder in private company. Tomirotti:Menarini Ricerche: Current Employment. Brzózka:Ryvu Therapeutics: Current Employment. Juszczynski:Ryvu Therapeutics: Other: member of advisory board.

Performance of the ESC 0/3-hour algorithm for rapid triage of myocardial infarction: systematic review and meta-analysis

Abstract Objective The European Society of Cardiology (ESC) 0/3-hour algorithm is one of the most widely strategies used for rule-out or rule-in of acute myocardial infarction (AMI). However, a systematic evaluation of its performance has not been conducted. Furthermore, recent studies showed that the 0/3-hour algorithm is non-superior to the 0/1-hour algorithm. Purpose This study aims to summarize the safety and efficacy of the 0/3-hour algorithm and its comparative performance with the 0/1-hour algorithm. Methods We conducted literature search on PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between 1 January 2008 and 31 May 2019. A bivariate random-effects meta-analysis was used to estimate the primary and secondary outcomes, defined as index myocardial infarction and triage efficacy, major adverse cardiac event (MACE) or mortality at 30 days, respectively. Results A total of 10,832 patients from 9 studies with a pooled AMI prevalence of 16% were analyzed. The 0/3-hour algorithm ruled out 69% of the patients with a pooled sensitivity of 94.2% [95% CI: 87.6%–97.4%] and negative predictive value of 98.6% [95% CI: 97.0%–99.4%]; 17% of the patients were ruled in with a pooled specificity of 94.9% [95% CI: 88.6%–97.8%] and positive predictive value of 72.9% [95% CI: 54.6%–85.7%]. The 30-day mortality and 30-day MACE for patients that were ruled out were 0.0% [95% CI: 0.0%–0.0%] and 1.4% [95% CI: 0.9%–2.0%], respectively. In a pooled analysis of 3 cohorts, the 0/3-hour algorithm had a non-superior sensitivity compared with the 0/1-hour algorithm (94.4% [95% CI: 87.0%–97.7%] vs. 98.4% [95% CI: 95.4%–99.7%]). The 0/3-hour algorithm also had a similar rule-out efficacy compared with the 0/1-hour algorithm (52% [95% CI: 39%–65%] vs. 53% [95% CI: 42%–64%]). Conclusion The widely used 0/3-hour algorithm has sensitivity substantially below the consensus goal of 99% and may not be sufficiently safe for triage of myocardial infarction. Furthermore, the 0/3-hour algorithm is not superior to the 0/1-hour algorithm despite the additional triage time. Performance of ESC 0/3-hour algorithm Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Taiwan National Ministry of Science and Technology Grants

A reproducible picture of open access health facility data in Africa and R tools to support improvement

Background: Open data on the locations and services provided by health facilities have, in some countries, allowed the development of software tools contributing to COVID-19 response. The UN and WHO encourage countries to make health facility location data open, to encourage use and improvement. We provide a summary of open access health facility location data in Africa using re-useable R code. We aim to support data analysts developing software tools to address COVID-19 response in individual countries. In Africa there are currently three main sources of such open data; 1) direct from national ministries of health, 2) a database for sub-Saharan Africa collated and published by a team from KEMRI-Wellcome Trust Research Programme and now hosted by WHO, and 3) The Global Healthsites Mapping Project in collaboration with OpenStreetMap. Methods: We searched for and documented official national facility location data that were openly available. We developed re-useable open-source R code to summarise and visualise facility location data by country from the three sources. This re-useable code is used to provide a web user interface allowing data exploration through maps and plots of facility type. Results: Out of 52 African countries, seven currently provide an official open facility list that can be downloaded and analysed reproducibly. Considering all three sources, there are over 185,000 health facility locations available for Africa. However, there are differences and overlaps between sources and a lack of data on capacities and service provision. Conclusions: These summaries and software tools can be used to encourage greater use of existing health facility location data, incentivise further improvements in the provision of those data by national suppliers, and encourage collaboration within wider data communities. The tools are a part of the afrimapr project, actively developing R building blocks to facilitate the use of health data in Africa.

Forests, peoples, and governments: Persistent land-use conflict in Northern Thailand

Land-use conflict in Northern Thailand has led to large-scale deforestation. This article suggests two reasons why this conflict has not been resolved despite the many legal and institutional approaches taken by Thai governments over the decades. First, conflicting directions embedded within the national policymaking level caused uncertainty for policy implementors at ministerial levels. Second, policy-drivers at the local level interacted with the specific socioeconomic context of upland residents in a way to make land-use conflict persistent. Contradictory messages by top policymakers, combined with the national ministries’ focus on purely functional tasks, diminished the importance of a local area-based approach necessary for land-use conflict resolution. Additionally, vested interests favoring agricultural expansion into the forests have been more diverse and influential than those favoring forest conservation; the former having tools at hand to incentivize smallholders to encroach into forested areas. Further driving agricultural expansion was that, in a management vacuum, local private sector actors acted as the de facto policy coordinators for the fragmented government local operations; however, on the forest conservation front, there was no coordinating body. This imbalanced situation has proved fertile soil for conflict.

Contribution of Road Design to Road Accidents along Thika Superhighway, Kenya

The construction of Thika Superhighway was aimed at addressing road safety by improving transportation and reducing traffic accidents. Despite this effort, the numbers of accidents along this road still continue to occur claiming more lives. The study sought to examine the contribution of road design on road accidents on Thika Superhighway. Accident Cessation Theory and the Reciprocal Determinism Theory were used to guide the study. The study adopted descriptive and exploratory research designs to collect quantitative and qualitative primary data. The study was carried out along Thika superhighway in 2016. The study targeted a population of 249 respondents drawn from traffic police officers, road safety personnel, senior officers from traffic police, officers in the National Transport Safety Authority and Ministry of Transport and Infrastructure, drivers and pedestrians. Questionnaires, interview schedules and focus group discussions were used to collect primary data. Qualitative data was analysed using thematic method, while quantitative data was analysed using descriptive statistics. The analysed data was presented in tables and charts to represent quantitative findings while qualitative findings were presented in narratives, verbatim reporting, discussions and inferences. Results showed that poor road design is a major contributor of traffic road accidents. The study recommends for redesigning of defective road sections and construction of additional footbridges that will ensure safety on the highway. It is hoped that the study findings will benefit all stakeholders and users of roads in an effort to ensure safety on Kenyan roads.

Culture as care: Argentina’s cultural policy response to Covid-19

ABSTRACT This article analyses cultural policy responses to Covid-19 in Argentina with a focus on the matter of care. It asks: What actions is the government taking in order to care for cultural organisations, cultural workers and the communities they serve? What local understandings of culture underpin such policy decisions? And finally, what have been the results and responses to such policies so far? In order to answer these questions we focus mainly on a central programme of the National Ministry of Culture, Puntos de Cultura [Points of Culture], which provides support to community cultural projects. As a notable, institutionalised example of the Latin American tradition of community arts, a focus on Puntos de Cultura provides an entry point to Latin American perspectives on the social and caring role of culture, thus allowing a contextualised analysis of culture and care at a time of crisis.

Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer (2020 edition)

Colorectal cancer (CRC) is one of the most common malignant tumors in China. In recent years, the incidence and mortality of CRC in China have been on the rise. According to the China cancer statistics report in 2018, the incidence and mortality of CRC in China ranked the third and fifth among all malignant tumors, with 376,000 new cases and 191,000 deaths. China has become the country with the highest number of new cases and deaths of CRC every year in the world, which seriously threatens the health of Chinese residents. In 2010, the National Ministry of Health organized colorectal cancer expertise of the Chinese Medical Association to write the Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer (2010 edition) and publish it publicly. Since 2010, the National Health and Family Planning Commission has organized experts to revise the protocol in 2015 and 2017, while the National Health Commission revised it in 2020. The revised part of Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer (2020 edition) involves new progress in the field of imaging examination, pathological evaluation, surgery, chemotherapy and radiotherapy. The 2020 edition of the protocol not only referred to the contents of the international guidelines, but also combined with the specific national conditions and clinical practice in China, and also included many evidence-based clinical data in China recently. The 2020 edition of the protocol would further promote the standardization of diagnosis and treatment of CRC in China, improve the survival and prognosis of patients, and benefit millions of CRC patients and their families.

Observations of the global epidemiology of COVID-19 from the prepandemic period using web-based surveillance: a cross-sectional analysis

BackgroundScant data are available about global patterns of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread and global epidemiology of early confirmed cases of COVID-19 outside mainland China. We describe the global spread of SARS-CoV-2 and characteristics of COVID-19 cases and clusters before the characterisation of COVID-19 as a pandemic.MethodsCases of COVID-19 reported between Dec 31, 2019, and March 10, 2020 (ie, the prepandemic period), were identified daily from official websites, press releases, press conference transcripts, and social media feeds of national ministries of health or other government agencies. Case characteristics, travel history, and exposures to other cases were abstracted. Countries with at least one case were classified as affected. Early cases were defined as those among the first 100 cases reported from each country. Later cases were defined as those after the first 100 cases. We analysed reported travel to affected countries among the first case reported from each country outside mainland China, demographic and exposure characteristics among cases with age or sex information, and cluster frequencies and sizes by transmission settings.FindingsAmong the first case reported from each of 99 affected countries outside of mainland China, 75 (76%) had recent travel to affected countries; 60 (61%) had travelled to China, Italy, or Iran. Among 1200 cases with age or sex information, 874 (73%) were early cases. Among 762 early cases with age information, the median age was 51 years (IQR 35–63); 25 (3%) of 762 early cases occurred in children younger than 18 years. Overall, 21 (2%) of 1200 cases were in health-care workers and none were in pregnant women. 101 clusters were identified, of which the most commonly identified transmission setting was households (76 [75%]; mean 2·6 cases per cluster [range 2–7]), followed by non-health-care occupational settings (14 [14%]; mean 4·3 cases per cluster [2–14]), and community gatherings (11 [11%]; mean 14·2 cases per cluster [4–36]).InterpretationCases with travel links to China, Italy, or Iran accounted for almost two-thirds of the first reported COVID-19 cases from affected countries. Among cases with age information available, most were among adults aged 18 years and older. Although there were many clusters of household transmission among early cases, clusters in occupational or community settings tended to be larger, supporting a possible role for physical distancing to slow the progression of SARS-CoV-2 spread.FundingNone.

Midiendo la estabilidad ministerial en los inicios del Estado argentino (1862-1898)

Este artí­culo forma parte de una investigación más amplia que se propone relevar y analizar la composición y rotación de los gabinetes de ministros de los titulares del ejecutivo nacional argentino en el periodo 1862-1952. En este paper abordaremos especí­ficamente el primer tramo de dicho periodo, entre 1862 y1898, en el cual tanto la cantidad (cinco) como las áreas de los ministerios (del Interior, Relaciones Exteriores, Justicia, Culto e Instrucción Pública, Guerra y Marina, y Hacienda) estaban prefijadas por la Constitución nacional. El objetivo de este trabajo es por un lado descriptivo, y consiste en dar cuenta de: qué ministros fueron designados a nivel nacional en la Argentina, por qué presidentes, al frente de qué carteras y por cuánto tiempo. La fuente principal de información a utilizar serán los Libros de Actas de Juramentos de los Miembros del Gobierno de la Nación Argentina, pertenecientes a la Escribaní­a General del Gobierno de la Nación. Por otro lado, se analizará la estabilidad/inestabilidad de los gabinetes, medidas a partir de una herramienta especí­fica aquí­ propuesta: el índice de Estabilidad de Gabinetes (IEG), que procura convertirse en un instrumento útil para futuros análisis sobre otros periodos y/o regí­menes presidencialistas. Finalmente, formularemos hipótesis que intenten dar cuenta de las principales variaciones observadas bajo una perspectiva politológica que, a su vez, articule la consideración histórica de la época.

A rapid and reproducible picture of open access health facility data in Africa to support the COVID-19 response.

Background: Open data on the locations and services provided by health facilities in some countries have allowed the development of software tools contributing to COVID-19 response. The UN and WHO encourage countries to make health facility location data open, to encourage use and improvement. We provide a summary of open access health facility location data in Africa using re-useable code. We aim to support data analysts developing software tools to address COVID-19 response in individual countries. In Africa there are currently three main sources of such data; 1) direct from national ministries of health, 2) a database for sub-Saharan Africa collated and published by a team from KEMRI-Wellcome Trust Research Programme and now hosted by WHO, and 3) The Global Healthsites Mapping Project in collaboration with OpenStreetMap. Methods: We searched for and documented official national facility location data that were openly available. We developed re-useable open-source R code to summarise and visualise facility location data by country from the three sources. This re-useable code is used to provide a web user interface allowing data exploration through maps and plots of facility type. Results: Out of 53 African countries, seven provide an official open facility list that can be downloaded and analysed reproducibly. Considering all three sources, there are over 185,000 health facility locations available for Africa. However, there are differences and overlaps between sources and a lack of data on capacities and service provision. Conclusions: We suggest that these summaries and tools will encourage greater use of existing health facility location data, incentivise further improvements in the provision of those data by national suppliers, and encourage collaboration within wider data communities. The tools are a part of the afrimapr project, actively developing R building blocks to facilitate the use of health data in Africa.

Source Apportionment and Integrated Assessment Modelling for Air Quality Planning

In Northern Italy a large fraction of the population is exposed to PM10 and PM2.5 concentrations that exceed the European limit values and the stricter WHO air quality guidelines. For this reason, in 2017 four Regions (Piemonte, Lombardia, Veneto, and Emilia Romagna) and the national Ministry of the Environment adopted a set of joint measures, namely the “Po Basin air quality plan”. The plan mainly tackles emission from road transport, residential heating, and agriculture. Air quality plans at regional and local scale are usually implemented defining a set of emission abatement measures, starting from experts’ knowledge. The aim of this work is to define a methodology that helps decision makers in air quality planning, combining two different approaches: Source-Apportionment techniques (SA) and Integrated Assessment Modelling (IAM). These techniques have been applied over a domain in Northern Italy to analyze the contribution of emission sources on PM10 concentration and to compute an optimal policy, obtained through a multi-objective optimization approach that minimizes both the PM10 yearly average concentration and the policy implementation costs. The results are compared to the Po Basin air quality plan impacts. The source-apportionment technique and the IAM optimization approach show intervention priorities in three main sectors: residential heating, agriculture, and road transport. The Po Basin air quality plan is effective in reducing PM10 concentrations, but not efficient, as a matter of fact the cost-effective policy at the same cost has a higher impact on air quality and on greenhouse gases emissions reduction.

Three Consecutive Waves of Cholera Outbreak in Ethiopia (2015- 2017): Explanatory Analysis

BACKGROUND: Cholera is an acute epidemic infectious disease. It is characterized by watery diarrhea, extreme loss of fluid and electrolytes, and severe dehydration. Ethiopia faced three consecutive waves of cholera outbreaks: nearly all regional states and city administrations, with the exception of one, were affected. The study was conducted with the aim of describing the epidemiology of the outbreak within the defined three years.METHODS: Secondary data review was conducted along with explanatory methods of analysis individual patient data reported from different corners of the country in the time period of 2015 –2017. Cases were identified using the case definition stated on the national guideline for cholera control in Ethiopia.RESULT: A total of 36,154 cholera cases and 246 deaths were reported (overall case-fatality rate [CFR=0.7%] affecting all regions of the country except Gambella). The outbreak began in 2015 with 238 cases and 2 deaths [CFR=0.8%]. The largest outbreak during the period under this study occurred in 2016, with 29,338 cases and 188 deaths [CFR=0. 6%]. Following a decline in disease occurrence, the country experienced a resurgence of epidemic cholera during 2017 (6,578 cases and 56 deaths; CFR, 0.9%), which declined rapidly to a few cases. AR was higher in males [37.01/100,000] and persons in the age group of 15–44years [44.10/100,000] in 2016.CONCLUSION: The outbreak affected nearly every corner of the country. Taken together, the epidemiological trends of cholera in Ethiopia showed an annual decrement in frequency and length of outbreaks during the 3 years under review. The recent decreases in cholera case counts may reflect cholera control measures put in place by public health authorities of the national Ministry of Health.

La enseñanza de la familia en los tiempos de la Ley de Educación Sexual Integral (26.150) en Argentina: tensiones entre representaciones, discursos y prácticas docentes

Resumen: Objetivo. En el presente artículo se analizan los modos de enseñanza de la familia en el primer año en escuelas primarias de la ciudad de Mar del Plata. Metodología. A través de una metodología cualitativa se realizaron entrevistas a docentes, así como observaciones de clases en instituciones educativas.También se analizaron los recursos literarios utilizados por las maestras y los contenidos propuestos por el Ministerio Nacional de Educación en el marco de la Ley de Educación Sexual Integral (26.150). Resultados y conclusión. Es posible identificar una tensión entre las prácticas heterogéneas de las docentes y las propuestas promovidas por el Estado Nacional y Provincial. Asimismo, advertimos que la heterosexualidad entendida como norma se perpetúa no solo en los textos literarios, y en la mayoría de los discursos y las prácticas docentes, sino también en documentos diseñados por el Estado.

Early Nutrition eAcademy Southeast Asia e-Learning for Enhancing Knowledge on Nutrition during the First 1000 Days of Life.

Background: The double burden of both under- and overnutrition during the first 1000 days is highly prevalent in Southeast Asia (SEA), with major implications for lifelong health. Tackling this burden requires healthcare professionals (HCPs) to acquire evidence-based current knowledge and counselling skills. We assessed the needs of HCPs in SEA and developed a continuing medical education/professional development (CME/CPD) program using an e-learning platform to reduce existing gaps. Methods: European, Thai and Malaysian universities collaborated with SEA national nutrition associations in the Early Nutrition eAcademy Southeast Asia (ENeA SEA) project. We assessed HCPs’ needs using questionnaires and mapped CME/CPD programmes and regulations through stakeholder questionnaires. Using a co-creation approach, we established an e-learning platform. Evaluation in users was undertaken using questionnaires. Results: HCPs in SEA reported major training gaps relating to the first 1000 days of nutrition and limited impact of existing face-to-face training. Existing pre/postgraduate, residency and CME/CPD programmes did not adequately address the topic. To address these gaps, we produced a targeted e-learning platform with six modules and CME-tests. National ministries, Thai and Malaysian universities, and professional associations endorsed the training platform. To date, over 2600 HCPs have registered. Evaluation shows high acceptance and a very positive assessment. Conclusions: Dedicated e-learning can reduce major gaps in HCP training in SEA regarding nutrition during the first 1000 days of life at scale and is highly valued by both users and key stakeholders.

An innovative ‘simultaneous’ bilingual approach in Senegal: promoting interlinguistic transfer while contributing to policy change

ABSTRACT This paper describes an innovative bilingual education program developed and implemented in 208 primary classes in Senegal from 2009 to 2018 by a Senegalese NGO working with the national Ministry of Education to address issues of quality in primary education. L’approche simultanée or simultaneous approach, also known as bilinguisme en temps réel or real-time bilingualism, developed organically through a consultative process between NGO development actors, university linguists and educators. Unlike the early-exit transitional bilingual programs previously piloted in Senegal that are common throughout West Africa, this program taught literacy, mathematics and the sciences in both a national language (Wolof or Pulaar) and French from the first year of primary school. Using data collected for an external evaluation conducted in 2018, along with follow-up research conducted in 2019 with designers and implementers of the simultaneous approach, this paper analyzes the effectiveness of the program and its implications for Senegal, where the Ministry of Education appears close to adopting a national language-in-education policy. There are also implications for the field of L1-based multilingual education, as ARED’s simultaneous approach provides a refreshing new perspective on teaching and learning non-dominant and dominant languages.

Knowledge Claims and Struggles in Decentralized Large Carnivore Governance: Insights From Norway and Sweden

Keywords: large carnivore management1, pastoral communities2, decentralization3, knowledge spheres4, conflicts5. Ensuring sustainable carnivore populations while simultaneously sustaining active and viable pastoral communities creates conflicts that are difficult to resolve. This article examines how different knowledge systems meet and interact in large carnivore governance in Norway and Sweden. Drawing on a broad range of sources, including observations in meetings, public documents, reports and interviews, in addition to local and national newspaper clippings and Internet sites, we study two processes of regional carnivore management (Nordland, Norway and Jämtland, Sweden). We explore how different forms of knowledge have been mobilized, reproduced, transferred and legitimized in policies and regulations in these two processes. Further, we examine the interplay between scientific and experience-based knowledge at different levels and scales in both of the countries. In Norway, ‘clear zoning’ has been established as a basic management instrument to achieve national ‘population goals’ for carnivores. We show how the locally situated knowledge – in our account represented through the Regional Large Carnivore Committee, which includes political parties’ and Sami Parliament representatives – experiences real barriers by being overrun by the national Ministry of Climate and Environment, in their process of revising the carnivore management plan. In Sweden where the management of large carnivores is devolved to regional authorities and stakeholder-based Wildlife Management Delegations, attempts to regionally solve conflicts are often overthrown by the national environmental protection agency or through court cases initiated by the environmental movement. Hence, compromises that potentially could solve conflicts are undermined. The analysis shows that while carnivore governance in both countries are founded on decentralized management authority at the regional level, local actors struggle for their views, experiences and knowledge to be acknowledged and counted as valid in the management process. While the decentralized management model opens for inclusion of different knowledge systems, this system has yet to acknowledge the challenges of knowledge being dismissed or marginalized across governance levels and scales.

Discussion on high quality development and authentication system construction of Dao-di herbs based on blockchain

Dao-di herbs are an important part of clinical medicine in traditional Chinese medicine. They are also precious wealth left to human beings from history, which contain deep traditional Chinese cultural connotations and play an important role in supporting and serving the Chinese medicine business. The relevant policy documents introduced by various national ministries and commissions have many contents and requirements related to the promotion of Dao-di herbs protection and industrial development. Due to the Dao-di herbs industry has a series of characteristics, such as a long chain, many involved links, long cycles, multiple production entities, multiple locations, and various types, the high-quality development of the industry has put forward higher requirements on the linkage between upstream and downstream, production entities, traceability of the whole process and information sharing. This article takes Dao-di herbs certification work as an application scenario and entry point, and discusses it from the perspective of block chain and information technology. It proposes the following work ideas: establish multi-party consensus from the macro-organizational management, business, and operational technical levels, and unblock channels for data and information, to achieve institutionalization of certification; establish certification-related standards and specifications to achieve certification standardization; build a certification hardware system to achieve certification networking; build a certification software system to develop functions for specific information content such as identity, origin, production, production process, quality, product and brand of authentic medicinal material production interactively, and realize certification programmatic; data security and sharing of related production activities to achieve socialization of certification. Make full use of modern technologies such as blockchain, the internet of things, big data and information technology, and through the joint participation of management, production, use and the public, the whole process information of Daodi herbs is integrated to form an interconnected information sharing application mode, thus, to serve and promote the high-quality development of Dao-di herbs industry.

Gendered health institutions: examining the organization of health services and men's use of HIV testing in Malawi.

IntroductionMen in sub‐Saharan Africa are less likely to use HIV testing services than their female counterparts. Norms of masculinity are frequently cited as the main barrier to men’s use of HIV testing services, but very little is known about how health institutions are organized to facilitate or impede men’s care. We examined the organization of health institutions in Malawi, and implications for men’s use of HIV testing services.MethodsA mixed methods ethnography was conducted in Malawi between October 2013 and September 2014. National Ministry of Health guidelines from 2012 to 2014 were analysed, counting the frequency of recommended preventative services by sex. In‐depth interviews were conducted with 18 healthcare workers and 11 national key informants (29 total). Five rural health facilities participated in direct observation and 52 observational journals were completed to document the structure and implementation of HIV services within local facilities. All data were analysed using the theory of gendered organization. Findings were grouped into one of the three theoretical levels of organization: (1) organizational policy; (2) organizational practice; and (3) structure of gendered expectations.ResultsHealth institutions were gendered across three levels. Organizational policy: National guidelines omitted young and adult men’s health during reproductive years (176‐433 recommended visits for women vs. 32 visits for men). Health education strategies focused on reproductive and child health services, with little education strategies targeting men. Organizational practice: HIV testing was primarily offered during reproductive and child health services and located near female‐focused departments within health facilities. As these departments were women’s spaces, others could easily tell that men were using HIV services. Structure of gendered expectations: Clients who successfully accessed HIV testing services were perceived as exemplifying characteristics that were traditionally considered feminine: compliance (obeying instructions without explanation); deference (respecting providers regardless of provider behaviour); and patience (“waiting like a woman”).ConclusionsHealth institutions in Malawi were organized in ways that created substantial, multilevel barriers to men’s HIV testing and reinforced perceptions of absent, difficult men. Future research should prioritize a gendered organization framework to understand and address the complex realities of men’s constrained access to HIV services.

Hypertension and selected indicators of health assessment in a population of 19-year-old men subject to military qualifications.

Assessment the prevalence of hypertension and its relation to selected indicators of health status and performance, including classification of BMI, obesity classifications, and body structure in a large test group of 19-year-old men.The study was observational-retrospective, and included a group of 17,282 men, aged 19, from the Małopolska region. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense-spiral-ZINT. Data collection and analysis were carried out from April 1, 2018 to August 31, 2018.Hypertension was found at 0.6%, weak body structure at 0.8% and obesityco-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents and it was more frequent in the recruiters from HT II than I. The underweight concerned almost 7%, and the overweight and obesity of 1/4 of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight.

Progress in watershed geography in the Yangtze River Basin and the affiliated ecological security perspective in the past 20 years, China

Bibliometrics was used to statistically analyze key zones within the Yangtze River Basin (YRB) funded by the National Natural Science Foundation of China (NSFC) and national ministries over the past 20 years. This study determined that funds that derived from national ministries have mainly focused on issues related to environmental pollution, ecological security, technological water regulations, and river basin ecosystems, which offer a better understanding of the national requirements and the scientific knowledge of the YRB in combination with data from the NSFC. Under a background of bolstering the construction of green ecological corridors in the economic belt of the YRB, this study proposes future conceptual watershed research initiatives in this region as a study objective by reinforcing the implementation of the Chinese Ecosystem Research Network (CERN) and by emphasizing the use of new technologies, new methods, and new concepts for the prospective design of frontier research under the perspective of geoscience and earth system science. This study promotes large-scale scientific field and research objectives based on big science and big data.