Effect of 50?000 IU vitamin A given with BCG vaccine on mortality in infants in Guinea-Bissau: randomised placebo controlled trial

Objective To investigate the effect of high dose vitamin A supplementation given with BCG vaccine at birth in an African setting with high infant mortality.Design Randomised placebo controlled trial.Setting Bandim Health Project’s demographic surveillance system in Guinea-Bissau, covering approximately 90 000 inhabitants. Participants 4345 infants due to receive BCG.Intervention Infants were randomised to 50 000 IU vitamin A or placebo and followed until age 12 months.Main outcome measure Mortality rate ratios.Results 174 children died during follow-up (mortality=47/1000 person-years). Vitamin A supplementation was not significantly associated with mortality; the mortality rate ratio was 1.07 (95% confidence interval 0.79 to 1.44). The effect was 1.00 (0.65 to 1.56) during the first four months and 1.13 (0.75 to 1.68) from 4 to 12 months of age. The mortality rate ratio in boys was 0.84 (0.55 to 1.27) compared with 1.39 (0.90 to 2.14) in girls (P for interaction=0.10). An explorative analysis revealed a strong interaction between vitamin A and season of administration.Conclusions Vitamin A supplementation given with BCG vaccine at birth had no significant benefit in this African setting. Although little doubt exists that vitamin A supplementation reduces mortality in older children, a global recommendation of supplementation for all newborn infants may not contribute to better survival.Trial registration Clinical trials {"type":"clinical-trial","attrs":{"text":"NCT00168597","term_id":"NCT00168597"}}NCT00168597.     

Exceptional biting capacities of the Early Pleistocene fossil shrew Beremendia fissidens (Soricidae,Eulipotyphla, Mammalia): new taphonomic evidence

The discovery of small, very well-defined and perfectly preserved toothmarks on a humerus of a mole Talpa cf. europaea from level TE9 of Sima del Elefante (Sierra de Atapuerca, Burgos) with a chronology of the Early Pleistocene is extraordinary. In a previous paper, this bite was compared with current small carnivores such as Mustela nivalis molars and with fossil remains of Mustela palerminea and the soricid (Eulipotyphla and Mammalia) Beremendia fissidens with the purpose of identifying the predator. It was hypothesised that Beremendia fissidens could be the bite maker. However, it was not possible to rule out other predators due to the shortage of Beremendia fissidens remains. Recently, new fossil remains of this insectivore have been found in Sima del Elefante levels, allowing the upper dentition to be measured. These new data suggest that effectively Beremendia fissidens may have had the capacity to bite prey larger than itself, even though it did not possess morphological characteristics specialised for the consumption of small mammals. The addition of small vertebrates (like talpids) to complement a diet based on insects could have been a way of responding to the needs of the high metabolic rate characteristic of Beremendia fissidens.     

Does Seeding a Locally Adapted Native Mixture Inhibit Ingress by Exotic Plants?

Non‐native plant species often colonize retired agricultural lands, creating monocultures with low species diversity that provide poor wildlife habitat. We assessed whether sowing a mix of 29 locally adapted native species reduced invasion of non‐native plant species compared to allowing vegetation to colonize naturally following tillage. There was a sampling date × treatment interaction for canopy cover of perennial exotic plant species. Plots that were not sown to natives had two to six times greater canopy cover of exotic species than did plots with both preparation (woody vegetation removed, plowed, and disked) and control (no preparation or sowing) plots. Canopy cover of exotic plants was similar in prepared‐only and control treatments from October 2008 to June 2010, ranging from 8 to 40%. Percent absolute canopy cover of native vegetation was 10–20 times greater on prepared and planted plots than on prepared‐only plots during March 2009 to June 2010. Sowing a mix of locally adapted native species may inhibit encroachment by non‐native species for up to two years after sowing on retired agricultural land in the Lower Rio Grande Valley of Texas.     

Both Very Low- and Very High In Vitro Cytokine Responses Were Associated with Infant Death in Low-Birth-Weight Children from Guinea Bissau

Background

The mechanisms behind heterologous immunity and non-specific effects of vaccines on mortality are not well understood. We examined associations between cytokine responses and subsequent mortality in low-birth-weight infants in Guinea-Bissau.

Methods

A low-birth-weight trial randomized children to Bacille Calmette-Guérin (BCG) at birth or later according to local policy. Blood samples were obtained from a sub-group at age 6 weeks. Interleukin (IL)-5, IL-10, IL-13, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α were measured in whole-blood cell cultures stimulated with lipopolysaccharide (LPS), phytohaemagglutinin (PHA), or purified protein derivative (PPD). The outcome was mortality between bleeding and 1 year of age. Non-linear associations between cytokine responses and mortality were examined.

Results

Cytokine measurements were available from 390 children. The mortality rate (MR) was high (6.8/100 person-years-observation (PYO)). Both low and high cytokine responses to LPS and PHA were associated with high mortality (MR up to 25/100 PYO in the lowest 10% and 9.2/100 PYO in the highest 10%). In BCG-vaccinated children, higher IFN-γ responses to PPD were associated with better survival (MR ratio = 0.43 (0.24–0.77)).

Conclusions

Data presented a rare opportunity to explore associations between cytokine responses and mortality. Both low and high cytokine responses were associated with high mortality; a balanced response to invading pathogens seems preferable.     

The Potential Impact of a 20% Tax on Sugar-Sweetened Beverages on Obesity in South African Adults: A Mathematical Model

Background/Objectives

The prevalence of obesity in South Africa has risen sharply, as has the consumption of sugar-sweetened beverages (SSBs). Research shows that consumption of SSBs leads to weight gain in both adults and children, and reducing SSBs will significantly impact the prevalence of obesity and its related diseases. We estimated the effect of a 20% tax on SSBs on the prevalence of and obesity among adults in South Africa.

Methods

A mathematical simulation model was constructed to estimate the effect of a 20% SSB tax on the prevalence of obesity. We used consumption data from the 2012 SA National Health and Nutrition Examination Survey and a previous meta-analysis of studies on own- and cross-price elasticities of SSBs to estimate the shift in daily energy consumption expected of increased prices of SSBs, and energy balance equations to estimate shifts in body mass index. The population distribution of BMI by age and sex was modelled by fitting measured data from the SA National Income Dynamics Survey 2012 to the lognormal distribution and shifting the mean values. Uncertainty was assessed with Monte Carlo simulations.

Results

A 20% tax is predicted to reduce energy intake by about 36kJ per day (95% CI: 9-68kJ). Obesity is projected to reduce by 3.8% (95% CI: 0.6%–7.1%) in men and 2.4% (95% CI: 0.4%–4.4%) in women. The number of obese adults would decrease by over 220 000 (95% CI: 24 197–411 759).

Conclusions

Taxing SSBs could impact the burden of obesity in South Africa particularly in young adults, as one component of a multi-faceted effort to prevent obesity.     

The breeding status of Peregrine Falcons Falco peregrinus in the UK and Isle of Man in 2002

Capsule Numbers of breeding Peregrines are now higher than ever recorded and the recovery of the species within the UK has continued since 1991.

Aims To estimate the current Peregrine breeding population and its changes over time by recording breeding evidence and nesting range occupancy at known and potential Peregrine eyries.

Methods Attempts were made to check all potentially suitable Peregrine nesting locations for signs of Peregrine occupation. Causes of nest failure were documented where possible. Estimates of occupancy of nesting ranges that could not be visited were based on the proportion of ranges occupied from visited nesting ranges in the same region.

Results In 2002, 1530 Peregrine nesting ranges were estimated to be occupied, comprising 1456 pairs or single birds confirmed as in occupation, and 74 estimated extras (5% of total occupied nesting ranges) that were not visited. Including non‐breeding singletons holding nesting ranges, the UK and Isle of Man figure of ‘Ratcliffe pairs’ was 1437. This showed a 12% increase from 1991 and a 64% increase from the 1930s. However, there were geographical differences in change, with rapid expansion in the south of England tempered by declines in northern Scotland.

Conclusions The primary reasons for the population increase is primarily because of range expansion driven by a plentiful food supply and perhaps an increased tolerance of human disturbance. In areas where the species has declined, various factors (separately or in combination) including reduced food supply and persecution are likely to be involved.     

Genetic Diversity in the Lesser Antilles and Its Implications for the Settlement of the Caribbean Basin

Historical discourses about the Caribbean often chronicle West African and European influence to the general neglect of indigenous people’s contributions to the contemporary region. Consequently, demographic histories of Caribbean people prior to and after European contact are not well understood. Although archeological evidence suggests that the Lesser Antilles were populated in a series of northward and eastern migratory waves, many questions remain regarding the relationship of the Caribbean migrants to other indigenous people of South and Central America and changes to the demography of indigenous communities post-European contact. To explore these issues, we analyzed mitochondrial DNA and Y-chromosome diversity in 12 unrelated individuals from the First Peoples Community in Arima, Trinidad, and 43 unrelated Garifuna individuals residing in St. Vincent. In this community-sanctioned research, we detected maternal indigenous ancestry in 42% of the participants, with the remainder having haplotypes indicative of African and South Asian maternal ancestry. Analysis of Y-chromosome variation revealed paternal indigenous American ancestry indicated by the presence of haplogroup Q-M3 in 28% of the male participants from both communities, with the remainder possessing either African or European haplogroups. This finding is the first report of indigenous American paternal ancestry among indigenous populations in this region of the Caribbean. Overall, this study illustrates the role of the region’s first peoples in shaping the genetic diversity seen in contemporary Caribbean populations.