Africa

‘Kangaroo care’ key for prem babies.

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Mothers carrying babies skin-to-skin could significantly cut global death and disability rates from premature birth, a leading expert has said.

Prof Joy Lawn says “kangaroo care“, not expensive intensive care, is the key.

Premature baby in an incubator

The 15 million babies every year born at or before 37 weeks gestation account for about 10% of the global burden of disease, and one million of them die.

Of those who survive, just under 3% have moderate or severe impairments and 4.4% have mild impairments.

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Unless there are those breathing problems, kangaroo care is actually better ”

Prof Joy Lawn London School of Hygiene & Tropical Medicine

Prof Lawn, from the London School of Hygiene and Tropical Medicine (LSHTM), said: “The perception is you need intensive care for pre-term babies,

“But 85% of babies born premature are six weeks early or less. They need help feeding, with temperature control and they are more prone to infection.

“It’s really only before 32 weeks that their lungs are immature and they need help breathing,

She added: “Unless there are those breathing problems, kangaroo care is actually better because it promotes breastfeeding and reduces infection.”

Speaking ahead of World Prematurity Day on Friday, UN Secretary General Ban Ki-moon, who leads the Every Woman Every Child movement, which promotes improvements to healthcare for women and children, said: “Three-quarters of the one million babies who die each year from complications associated with prematurity could have been saved with cost-effective interventions, even without intensive care facilities.”

Duncan Wilbur, from the UK charity Bliss, said, “While kangaroo care saves lives in countries such as Africa, it is also incredibly important for babies born too soon all over the world.

“Here in the UK our medical technology is extremely advanced but simply giving a baby kangaroo care or skin-to-skin can help make a baby’s breathing and heart rate more regular, it can help a baby’s discomfort during certain medical procedures and importantly can benefit breastfeeding and bonding between the baby and parents.”

Pregnancy risks

Studies to be published this weekend in the Pediatric Research journal show boys are 14% more likely to be born prematurely – and boys who are premature are more likely to die or experience disability than girls.

Common disabilities include learning disorders and cerebral palsy.

Prof Lawn said: “One partial explanation for more preterm births among boys is that women pregnant with a boy are more likely to have placental problems, pre-eclampsia, and high blood pressure, all associated with preterm births.”

She added: “Baby boys have a higher likelihood of infections, jaundice, birth complications, and congenital conditions, but the biggest risk for baby boys is due to preterm birth.

“For two babies born at the same degree of prematurity, a boy will have a higher risk of death and disability compared to a girl.

“Even in the womb, girls mature more rapidly than boys, which provides an advantage, because the lungs and other organs are more developed.

Resistance to Malaria Drugs Has Spread in SE Asia.

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International experts raised the alarm Tuesday over the spread of drug-resistant malaria in several Southeast Asian countries, saying it endangers major global gains in fighting the mosquito-borne disease that kills more than 600,000 people annually.

While the disease wreaks its heaviest toll in Africa, it’s in nations along the Mekong River where the most serious threat to treating it has emerged.

The availability of therapies using the drug artemisinin has helped cut global malaria deaths by a quarter in the past decade. But over the same period, resistance to the drug emerged on Thailand’s borders with Myanmar and Cambodia and has spread. It has been detected in southern Vietnam and likely exists in southern Laos, said Prof. Nick White of the Thailand-based Mahidol Oxford Tropical Medicine Research Unit.

White, a leading authority on the subject, said that while there’s no confirmed evidence of resistance in Africa, there’s plenty of risk of transmission by air travelers from affected countries, such as construction laborers, aid workers or soldiers serving on peacekeeping missions.

“We have to take a radical approach to this. It’s like a cancer that’s spreading and we have to take it out now,” White told a conference at the Center for Strategic and International Studies think tank in Washington. He said no alternative anti-malarial drug is on the horizon.

The U.N. World Health Organization, or WHO, is also warning that what seems to be a localized threat could easily get out of control and have serious implications for global health.

Mosquitoes have developed resistance to antimalarial drugs before.

It happened with the drug chloroquine, which helped eliminate malaria from Europe, North America, the Caribbean and parts of Asia and South-Central America during the 1950s. Resistance first began appearing on the Thai-Cambodia border, and by the early 1990s it was virtually useless as an antimalarial in much of the world.

Resistance to artemisinin is caused by various factors, such as use of substandard or counterfeit drugs, or prescribing artemisinin on its own rather than in combination with another longer-acting drug to ensure that all malaria-carrying parasites in a patient’s bloodstream are killed off.

Scientists have been working for decades to develop a malaria vaccine, but none is yet available.

Nowhere are the challenges to countering drug resistance greater than in Myanmar, also known as Burma, which accounts for most of malaria deaths in the Mekong region, according to a report for the conference by Dr. Christopher Daniel, former commander of the U.S. Naval Medical Research Center.

Myanmar’s public health system is ill-equipped to cope, although once-paltry government spending on it has increased significantly under the quasi-civilian administration that took power in 2011.

Dr. Myat Phone Kyaw, assistant director of the Myanmar Medical Research Center, said malaria drug resistance first emerged in the country’s east where migrant workers cross between Myanmar and Thailand, and is assumed to have spread to other regions. Death rates have dropped as effective treatments have become more available, but more aid and research is needed as transient workers in industries like mining and logging pose a continuing transmission risk, he said.

White said it is critical to prevent drug resistance creeping across Myanmar’s northwestern border with densely populated India. “In my view, once it gets into the northeast part of India, that’s it, it’s too late, you won’t be able to stop it,” he said.

The Center for Strategic and International Studies is advocating greater U.S. involvement and aid for health and fighting malaria in the Mekong region, particularly in Myanmar, where Washington has been in the vanguard of ramping up international aid. The think tank says that can increase America’s profile in Southeast Asia in a way that will benefit needy people and not be viewed as threatening to strategic rival, China.

But securing more funds won’t be easy at a time when Washington is cutting back on programs for its own poor. The U.S. is already a major contributor to international anti-malaria efforts, and in Myanmar, is promising $20 million per year in health assistance under its recently resumed bilateral aid program.

White said the problem was less one of lack of funds, than in countries having the will to take quick action to fight a disease that hits the rural poor, which have less of a political voice than urban populations.

He said infection rates have been dropping but the disease needs to be wiped out entirely or it could be distilled to the most resistant parasites and infection rates will rise again. “Once it reaches a higher level of resistance where the drugs don’t work, we are technically stuffed,” White said.

Tuberculosis: Test Speeds Diagnosis, Time to Treatment.

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The Xpert MTB/RIF (Cepheid) test improved tuberculosis (TB) diagnosis and reduced time to treatment, but not long-term TB-related morbidity, according to the results of a multicenter, randomized, controlled trial.

“Despite already being rolled-out in many countries, our study is the first to look at the feasibility of the Xpert test in a real-life clinical setting in southern Africa,” lead author Keertan Dheda, MBBcH, from the Department of Medicine, University of Cape Town, South Africa, said in a news release. The study results were published online October 28 in the Lancet.

The researchers enrolled adult patients with symptoms suggestive of active TB at 5 primary care facilities in South Africa, Zimbabwe, Zambia, and Tanzania. They randomly assigned patients to either Xpert MTB/RIF testing, performed at the clinic by a nurse who received 1 day of training, or to sputum smear microscopy. On the basis of local World Health Organization–compliant guidelines, participants with a negative test result were managed empirically.

The main study endpoint, analyzed by intention to treat, was TB-related morbidity, measured with the TB score and Karnofsky performance score at 2 months and 6 months after randomization in culture-positive patients who had started anti-TB treatment.

Of 758 assigned patients to smear microscopy between April 12, 2011, and March 30, 2012, 182 were culture positive, as were 185 of 744 patients assigned to Xpert MTB/RIF. Among culture-positive patients, median TB score and median Karnofsky performance score in culture-positive patients did not differ between groups at 2 or at 6 months.

Diagnostic Performance of Point-of-Care MTB/RIF

Compared with microscopy, point-of-care MTB/RIF had higher sensitivity (83% vs 50%; P = .0001), but similar specificity (95% vs 96%; P = .25). Compared with laboratory-based MTB/RIF, point-of-care MTB/RIF had similar sensitivity (83%; P = .99), but higher specificity (92%; P = .0173).

Of 744 tests with point-of-care MTB/RIF, 34 (5%) failed, as did 82 (6%) of 1411 with laboratory-based MTB/RIF (P = .22). More patients in the MTB/RIF group than in the microscopy group had a same-day diagnosis (24% vs 13%; P < .0001) and same-day treatment initiation (23% vs 15%; P = .0002).

Because of the lower dropout rate, more culture-positive patients in the MTB/RIF group were receiving treatment by study end (8% untreated in the MTB/RIF group vs 15% in the microscopy group; P = .0302). By day 56, however, the proportions of all patients receiving treatment were similar (43% vs 42%, respectively; P = .6408).

“Although earlier diagnosis by the Xpert test did not reduce overall severity of TB-related illness, and moreover did not reduce the overall number TB cases treated over the course of the study, it has substantial benefits over smear microscopy including improved rates of same-day diagnosis and reducing treatment drop-out,” Dr. Dheda said in the release.

Cost-Effectiveness May Be a Concern

Limitations of this study include about 20% loss to follow-up of patients with culture-confirmed TB, mostly resulting from staffing problems at 1 site, and possible lack of generalizability to seriously ill patients or those with extrapulmonary TB.

“Whilst Xpert may not be the ideal point of care TB test in particularly poorly resourced settings, in countries like South Africa where the clinic infrastructure is relatively good, rates of drug-resistant TB are high, and patient drop-out are significant problems, within clinic placement of Xpert in TB hotspots might be appropriate and enable earlier diagnosis of drug-resistant TB thus likely reducing community-based transmission,” Dr. Dheda noted. “Nevertheless, prevention of TB and adherence to TB treatment is critical and remains a major priority.”

In an accompanying comment, Christian Wejse, MD, PhD, associate professor, GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Denmark, wonders about the cost-effectiveness of Xpert testing.

“At a cassette cost of US$10 (reduced price for low-resource settings), testing large numbers of people with suspected tuberculosis will put substantial pressure on already resource-limited tuberculosis programmes in which the drugs for treatment might not always be available,” Dr. Wejse writes. “Hence, the provocative question raised by this study is whether tuberculosis elimination is most likely to be advanced by distributing GeneXpert machines to all peripheral health facilities in the world, or by investing the same amount in ensuring that health facilities have the set-up available in this study—ie, well trained and paid staff, electricity, and reagents.”

Tuberculosis: Test Speeds Diagnosis, Time to Treatment.

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The Xpert MTB/RIF (Cepheid) test improved tuberculosis (TB) diagnosis and reduced time to treatment, but not long-term TB-related morbidity, according to the results of a multicenter, randomized, controlled trial.

“Despite already being rolled-out in many countries, our study is the first to look at the feasibility of the Xpert test in a real-life clinical setting in southern Africa,” lead author Keertan Dheda, MBBcH, from the Department of Medicine, University of Cape Town, South Africa, said in a news release. The study results were published online October 28 in the Lancet.

The researchers enrolled adult patients with symptoms suggestive of active TB at 5 primary care facilities in South Africa, Zimbabwe, Zambia, and Tanzania. They randomly assigned patients to either Xpert MTB/RIF testing, performed at the clinic by a nurse who received 1 day of training, or to sputum smear microscopy. On the basis of local World Health Organization–compliant guidelines, participants with a negative test result were managed empirically.

The main study endpoint, analyzed by intention to treat, was TB-related morbidity, measured with the TB score and Karnofsky performance score at 2 months and 6 months after randomization in culture-positive patients who had started anti-TB treatment.

Of 758 assigned patients to smear microscopy between April 12, 2011, and March 30, 2012, 182 were culture positive, as were 185 of 744 patients assigned to Xpert MTB/RIF. Among culture-positive patients, median TB score and median Karnofsky performance score in culture-positive patients did not differ between groups at 2 or at 6 months.

Diagnostic Performance of Point-of-Care MTB/RIF

Compared with microscopy, point-of-care MTB/RIF had higher sensitivity (83% vs 50%; P = .0001), but similar specificity (95% vs 96%; P = .25). Compared with laboratory-based MTB/RIF, point-of-care MTB/RIF had similar sensitivity (83%; P = .99), but higher specificity (92%; P = .0173).

Of 744 tests with point-of-care MTB/RIF, 34 (5%) failed, as did 82 (6%) of 1411 with laboratory-based MTB/RIF (P = .22). More patients in the MTB/RIF group than in the microscopy group had a same-day diagnosis (24% vs 13%; P < .0001) and same-day treatment initiation (23% vs 15%; P = .0002).

Because of the lower dropout rate, more culture-positive patients in the MTB/RIF group were receiving treatment by study end (8% untreated in the MTB/RIF group vs 15% in the microscopy group; P = .0302). By day 56, however, the proportions of all patients receiving treatment were similar (43% vs 42%, respectively; P = .6408).

“Although earlier diagnosis by the Xpert test did not reduce overall severity of TB-related illness, and moreover did not reduce the overall number TB cases treated over the course of the study, it has substantial benefits over smear microscopy including improved rates of same-day diagnosis and reducing treatment drop-out,” Dr. Dheda said in the release.

Cost-Effectiveness May Be a Concern

Limitations of this study include about 20% loss to follow-up of patients with culture-confirmed TB, mostly resulting from staffing problems at 1 site, and possible lack of generalizability to seriously ill patients or those with extrapulmonary TB.

“Whilst Xpert may not be the ideal point of care TB test in particularly poorly resourced settings, in countries like South Africa where the clinic infrastructure is relatively good, rates of drug-resistant TB are high, and patient drop-out are significant problems, within clinic placement of Xpert in TB hotspots might be appropriate and enable earlier diagnosis of drug-resistant TB thus likely reducing community-based transmission,” Dr. Dheda noted. “Nevertheless, prevention of TB and adherence to TB treatment is critical and remains a major priority.”

In an accompanying comment, Christian Wejse, MD, PhD, associate professor, GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Denmark, wonders about the cost-effectiveness of Xpert testing.

“At a cassette cost of US$10 (reduced price for low-resource settings), testing large numbers of people with suspected tuberculosis will put substantial pressure on already resource-limited tuberculosis programmes in which the drugs for treatment might not always be available,” Dr. Wejse writes. “Hence, the provocative question raised by this study is whether tuberculosis elimination is most likely to be advanced by distributing GeneXpert machines to all peripheral health facilities in the world, or by investing the same amount in ensuring that health facilities have the set-up available in this study—ie, well trained and paid staff, electricity, and reagents.”

Source: Lancet

Deep engines of earthquakes and volcanoes.

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Plate tectonics can’t explain all the earthquakes, volcanoes and landscapes of Earth, so what else is shaping its surface?

“A LOT of people thinks that the devil has come here. Some thinks that this is the beginning of the world coming to a end.”

To George Heinrich Crist, who wrote this on 23 January 1812, the series of earthquakes that had just ripped through the Mississippi river valley were as inexplicable as they were deadly. Two centuries on and we are no closer to an understanding. According to our established theory of Earth’s tectonic activity, the US Midwest is just not the sort of place such tremors should occur.

Hawaii's volcanoes pose a problem for traditional theories of plate tectonics <i>(Richard A. Cooke III/Getty Images)</i>

That’s not the only thing we are struggling to explain. Submerged fossil landscapes off the west coast of Scotland, undersea volcanoes in the south Pacific, the bulging dome of land that is the interior of southern Africa: all over the world we see features that plate tectonics alone is hard pressed to describe.

So what can? If a new body of research is to be believed, the full answer lies far deeper in our planet. If so, it could shake up geology as fundamentally as the acceptance of plate tectonics did half a century ago.

The central idea of plate tectonics is that Earth’s uppermost layers – a band of rock between 60 and 250 kilometres thick known as the lithosphere – is divided into a mosaic of rigid pieces that float and move atop the viscous mantle immediately beneath. The theory surfaced in 1912, when German geophysicist Alfred Wegener argued on the basis of fossil distributions that today’s continents formed from a single supercontinent, which came to be called Pangaea, that broke up and began drifting apart 200 million years ago.

Wegener lacked a mechanism to make his plates move, and the idea was at first ridiculed. But evidence slowly mounted that Earth’s surface was indeed in flux. In the 1960s people finally came to accept that plate tectonics could not only explain many features of Earth’s topography, but also why most of the planet’s seismic and volcanic activity is concentrated along particular strips of its surface: the boundaries between plates. At some of these margins plates move apart, creating rift valleys on land or ridges on ocean floors where hotter material wells up from the mantle, cools and forms new crust. Elsewhere, they press up against each other, forcing up mountain chains such as the Himalayas, or dive down beneath each other at seismically vicious subduction zones such as the Sunda trench, the site of the Sumatra-Andaman earthquake in December 2004.

And so plate tectonics became the new orthodoxy. But is it the whole truth? “Because it was so hugely successful as a theory, everybody became a bit obsessed with horizontal motions and took their eye off an interesting ball,” says geologist Nicky White at the University of Cambridge.

That ball is what is happening deep within Earth, in regions far beyond the reach of standard plate-tectonic theory. The US geophysicist Jason Morganwas a pioneer of plate tectonics, but in the 1970s he was also one of the first to find fault with the theory’s explanation for one particular surface feature, the volcanism of the Hawaiian islands. These islands lie thousands of kilometres away from the boundaries of the Pacific plate on which they sit. The plate-tectonic line is that their volcanism is caused by a weakness in the plate that allows hotter material to well up passively from the mantle. Reviving an earlier idea of the Canadian geophysicist John Tuzo Wilson, Morgan suggested instead that a plume of hot mantle material is actively pushing its way up from many thousands of kilometres below and breaking through to the surface.

Mapping the underworld

That went against the flow, and it wasn’t until the mid-1980s that others began to think Morgan might have a point. The turnaround came when seismic waves unleashed by earthquakes began to reveal some of our underworld’s structure as they travelled through Earth’s interior. Seismic waves travel at different velocities through materials of different densities and temperatures. By timing their arrival at sensors positioned on the surface we could begin to construct a 3D view of what sort of material is where.

The resulting images are rough and fuzzy, but seem to reveal a complex, dynamic mantle. Most dramatically, successive measurements have exposed two massive piles of very hot, dense thermochemical material sitting at the bottom of the mantle near its boundary with Earth’s molten core. One is under the southern Pacific Ocean, and one beneath Africa. Each is thousands of kilometres across, and above each a superplume of hotter material seems to be rising towards the surface.

That could explain why the ocean floor in the middle of the southern Pacific lies some 1000 metres above the surrounding undersea topography, another thing plate tectonics has difficulty explaining. Something similar goes for the African plume. “If you go south of the Congo all the way down to southern South Africa, including Madagascar, that whole region is propped up by this superplume,” says White.

Seismic imaging reveals smaller plume-like features extending upwards in the upper reaches of the mantle beneath Iceland and Hawaii – perhaps explaining both these islands’ existence and their volcanism. Off the coast of Argentina, meanwhile, the sea floor plunges down almost a kilometre, directly above a mantle region that seismic imaging identifies to be cold and downwelling. And although southern Africa is being propped up by its superplume, smaller hot upwellings and cold downwellings at the top of that plume seem to correspond with local surface topography. The Congo basin, for instance, lies on a cold area and is hundreds of metres lower than its surroundings. “Africa has quite an egg-box shape,” says White.

Almost everywhere we look, there is evidence of vertical movements within Earth reshaping its surface. “At the time plate tectonics was formed, the deep interior was unknown, so people drew cartoons,” says Shun-ichiro Karato, a geophysicist at Yale University. “This is beyond cartoons.”

What is less clear is how the mechanisms work. Standard plate-tectonic theory has it that material plunging into the mantle at subduction zones is recycled in the shallow mantle, reappearing through volcanic activity near the subduction zone itself or further afield at boundaries where two plates are being pushed apart. Blurry yet tantalising images, however, show sections of subducted plates at various stages of descent through Earth’s interior towards the lower mantle (see diagram).

That material clearly can’t all stay down. “You need to preserve the mass balance of the mantle,” says Dietmar Müller of the University of Sydney, Australia. “As you are stuffing plates down into the mantle, that initiates a return flow of material going up.”

But how exactly? Simulations performed last year by Bernhard Steinberger at the GFZ German Research Centre for Geosciences in Potsdam and his colleagues show how a subducted slab, once it arrives at the boundary between the mantle and the core, can bulldoze material along that layer. When this material meets a thermochemical pile, plumes begin to form above. “We can see plumes developing at more or less the right places,” says Steinberger. For example, their model shows that slabs being subducted beneath the Aleutian Islands near Alaska could trigger a plume beneath Hawaii, creating a hotspot that fuels the Hawaiian volcanoes (Geochemistry Geophysics Geosystems, vol 13, p Q01W09).

Fossil landscape

Meanwhile, Clint Conrad at the University of Hawaii at Manoa and his colleagues have modelled the effect of a tectonic plate moving one way while the mantle beneath is moving in the other direction. They found that if this “shearing” effect occurs in a region where the mantle varies in density or the overlying plate changes in thickness, it can cause mantle material to melt and rise. This model accurately predicts that volcanic seamounts are present on the west but not the east of the East Pacific Rise, a mid-ocean ridge that runs roughly parallel to the western coast of South America. Seismic measurements indicate that the mantle and the plate to the west are moving in opposite directions; to the east they are not. The model also predicts that the shearing effect is largest under the western US, southern Europe, eastern Australia and Antarctica – all areas of volcanic activity away from plate boundaries.

If the dynamics of the deep Earth can change surface topography today, the same must have been true in the past. But while fossil and geological records tell us how drifting plates remapped the planet’s surface over eons, seismic imaging only works for the here and now. “It’s more difficult to decipher the history of the Earth in deep time, over hundreds of millions of years,” says Müller.

White and his colleagues found some clues to a small part of the story off the west coast of Scotland last year. They set off explosions from a ship and recorded the reflected waves, to get a sense of what lies beneath the sea floor. What they saw buried under more recent layers of rock and sediment were fossil landscapes some 55 million years old, replete with hills, valleys and networks of rivers. “They look just like somewhere you could go for an afternoon walk,” says White – only they are 2 kilometres beneath the seabed (Nature Geoscience, vol 4, p 562).

By analysing the way these rivers had changed course over time, the team showed that the region was once pushed almost a kilometre above sea level before being buried again, all in the space of a million years. That is far too quick for plate tectonics to throw up a mountain range and have erosion wear it down again. Instead, White points his finger at a blob of hot, mantle materialthat he says travelled radially outwards from the mantle plume that is possibly fuelling the volcanoes in nearby Iceland. “If the plate is like a carpet, rats running underneath the carpet would make it go up and down,” he says.

Müller’s team have identified similarly precipitous vertical movements of the land that is now in eastern Australia, during the Cretaceous period between 145 and 65 million years ago. Again, the timescales involved more or less discount simple plate tectonics. “We are pretty sure this has something to do with a convecting mantle,” says Müller.

Even iconic events of Earth’s tectonic past might not be all they seem. The Himalayas had formed by 35 million years ago, after the Indian plate separated from the supercontinent Gondwana, sped north and slammed into the Eurasian plate. That is still the broad picture, but plate tectonics fails to explain why India zoomed towards its target at speeds of up to 18 centimetres per year. Today, plates only reach speeds of about 8 centimetres per year, a limit set by how fast subducting slabs can sink into the mantle.

Steven Cande and Dave Stegman of the Scripps Institution of Oceanography in La Jolla, California, think they have the answer. Last year they used computer models to argue controversially that the horizontal force exerted by the mushrooming head of the Reunion plume, thought to be the source of the massive outpouring of lava that formed the Deccan Traps in western India about 67 million years ago, sent India on its headlong path (Nature, vol 475, p 47).

The anomalous and periodically devastating seismicity of the US Midwest, meanwhile, might be explained by plate tectonics and the propagation of surface stresses (New Scientist, 14 January, p 34) – or the root causes might go deeper. In 2007, Alessandro Forte of the University of Quebec at Montreal, Canada, and his colleagues implicated the ancient Farallon plate, which started slipping into the mantle along the west coast of North America during the Cretaceous. Their model suggests that the plate has now burrowed deep enough to cause a downwelling below the mid-Mississippi river valley, deforming the overlying lithosphere sufficiently to trigger the disastrous events of two centuries ago (Geophysical Research Letters, vol 34, p L04308).

It all adds up to a picture where more than plate tectonics is at work in shaping our planet’s past, present and future. “It’s just amazing to think that Earth’s surface is rather less stable than plate tectonics in its simplest form would have it,” says White.

Iceland’s anomalies

Not everyone is convinced. Gillian Foulger of the University of Durham, UK, argues that the region around Iceland, for example, is no hotter than the rest of the mid-Atlantic ridge, a diverging plate margin on which the island also sits. Iceland’s topography and volcanic activity can be adequately explained by the tectonic activity at such a plate boundary without invoking a plume-driven hotspot (Science, vol 300, p 921). She and fellow “aplumatics” also point out that, while seismic waves do travel slower in the shallow mantle beneath Iceland, Hawaii and other supposed hotspots, these velocity anomalies don’t extend all the way down to the bottom of the mantle where according to the theories that have been advanced the plumes supposedly begin their journey. “That’s never been seen, not one single time, in a reliable way,” she says.

Enthusiasts for a deeper explanation of Earth’s surface activity think it is only a matter of time and better seismic imaging before these objections are also countered. Efforts to improve imaging are already under way in the form ofEarthscope, an ongoing project to blanket the US with seismographs, giving geologists a fine-grained look at the mantle underneath (New Scientist, 11 April 2009, p 26). What is needed, however, are similar projects to understand crucial regions of the mantle such as those below Africa and the Pacific Ocean. “If you can design a grand whole-Earth experiment, where you have seismometers scattered evenly all over Earth’s surface, at sea and on land, you can do a brilliant job in making better sharp tomographic images,” says White.

If we can do that, will history repeat itself, the doubters be won over, and another hotly disputed model become the new orthodoxy? Müller certainly thinks so: “Geology is on the cusp of another revolution like plate tectonics.”

Nutritional interventions for reducing morbidity and mortality in people with HIV.

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HIV/AIDS has long been synonymous with wasting and weight loss. For example, in South Africa, it was known as “slims” disease. Coupled with this, it’s known that adequate nutrition is important for optimal immune and metabolic function and, so, one might expect that dietary support would improve clinical outcomes in HIV-infected individuals by reducing HIV-related complications and attenuating progression of HIV disease. This should lead to better quality of life and, ultimately, less disease-related mortality. Therefore, this Cochrane Review from February 2013 examines the experimental evidence for the effects of nutritional interventions given orally on important clinical outcomes for adults and children with HIV infection and finds that there is relatively little research to help decision makers.

The authors searched many databases, trawled through references and contacted people working in the area. However, only 14 relatively small, randomized trials came to light, which met their inclusion criteria. Just three of these reported on mortality, two that had recruited adults and the other, from South Africa, had recruited children.

A wide range of macronutrient supplements were studied with just two of the trials (one in adults and one in children) studying the same one, a food supplement called Spirulina. There was also wide variation in other aspects of the trials, including the outcomes that were measured and reported and the types of people who took part, in relation to stage of HIV, HIV treatment status and general nutrient status. When the authors assessed the quality of the trials, none of the trials were graded as providing strong evidence. This was mostly because the trials were small and had a high risk of bias due to a lack of blinding and the large proportion of people who left the trials early.

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The latest version of the review is an update of the earlier review from 2007, which had included 8 trials from high-income countries, with fewer than 500 HIV+ adults in total. Patients with confirmed secondary infections or other signs and symptoms of infection, such as fever, chills, or persistent diarrhea, were not eligible for any of those trials. This made it difficult to determine the applicability of the findings to the types of people who are most likely to need effective macronutrient supplementation. Six new studies have been added in the update, bringing the number of participants to more than 1700 adults and nearly 300 children. Four of the new trials are from Africa, and there is one from Brazil and one from India. The new trials also include two trials that had recruited participants with opportunistic infections (tuberculosis and persistent diarrhea).

Bringing the evidence together and, where possible, combining the findings of similar trials in meta-analyses identified no significant benefits for supplementary food, daily supplement of Spirulina or a nutritional supplement enhanced with protein with respect to death in HIV+ adults and children. In HIV+ adults with weight loss, nutritionally balanced macronutrient supplements aimed at improving energy intake by 600-960 kcal/day increased intakes of energy and protein compared with no supplement or nutrition counselling alone, but had no effect on other anthropometric or immunologic parameters. From the meta-analyses, supplementation with macronutrient formulas given to provide protein, energy or both and fortified with micronutrients, in conjunction with nutrition counselling, significantly improved energy intake (3 trials; n=131; MD 394 kcal/day; 95% CI: 225 to 562; p<0.00001) and protein intake (2 trials; n=81; MD 23.5 g/day; 95% CI: 12.7 to 34.0; p<0.00001) compared with no nutritional supplementation or nutrition counselling alone.

The authors conclude that supplementation with specific macronutrients such as amino acids, whey protein concentrate or Spirulina did not significantly alter clinical, anthropometric or immunological outcomes in HIV-infected adults and children. They call for future research that takes better account of the needs and resources of the HIV+ individual, the clinician treating them and the people caring for them. They highlight areas of ongoing uncertainty, including the choice between using resources for antiretroviral treatment for HIV+ people or nutritional interventions, the populations that might benefit most (e.g. malnourished HIV+ people, HIV+ people with uncontrolled weight loss, HIV+ people with opportunistic infections or HIV+ lactating mothers), the role of nutritional counseling compared to nutritional interventions in well-resourced settings, and how the use of anti-retroviral therapy might make it difficult to detect the effects of nutritional interventions.

Soure: Cochrane Library

Detection of Tuberculosis in HIV-Infected and -Uninfected African Adults Using Whole Blood RNA Expression Signatures: A Case-Control Study.

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Abstract

Background

A major impediment to tuberculosis control in Africa is the difficulty in diagnosing active tuberculosis (TB), particularly in the context of HIV infection. We hypothesized that a unique host blood RNA transcriptional signature would distinguish TB from other diseases (OD) in HIV-infected and -uninfected patients, and that this could be the basis of a simple diagnostic test.

Methods and Findings

Adult case-control cohorts were established in South Africa and Malawi of HIV-infected or -uninfected individuals consisting of 584 patients with either TB (confirmed by culture ofMycobacterium tuberculosis [M.TB] from sputum or tissue sample in a patient under investigation for TB), OD (i.e., TB was considered in the differential diagnosis but then excluded), or healthy individuals with latent TB infection (LTBI). Individuals were randomized into training (80%) and test (20%) cohorts. Blood transcriptional profiles were assessed and minimal sets of significantly differentially expressed transcripts distinguishing TB from LTBI and OD were identified in the training cohort. A 27 transcript signature distinguished TB from LTBI and a 44 transcript signature distinguished TB from OD. To evaluate our signatures, we used a novel computational method to calculate a disease risk score (DRS) for each patient. The classification based on this score was first evaluated in the test cohort, and then validated in an independent publically available dataset (GSE19491).

In our test cohort, the DRS classified TB from LTBI (sensitivity 95%, 95% CI [87–100]; specificity 90%, 95% CI [80–97]) and TB from OD (sensitivity 93%, 95% CI [83–100]; specificity 88%, 95% CI [74–97]). In the independent validation cohort, TB patients were distinguished both from LTBI individuals (sensitivity 95%, 95% CI [85–100]; specificity 94%, 95% CI [84–100]) and OD patients (sensitivity 100%, 95% CI [100–100]; specificity 96%, 95% CI [93–100]).

Limitations of our study include the use of only culture confirmed TB patients, and the potential that TB may have been misdiagnosed in a small proportion of OD patients despite the extensive clinical investigation used to assign each patient to their diagnostic group.

Conclusions

In our study, blood transcriptional signatures distinguished TB from other conditions prevalent in HIV-infected and -uninfected African adults. Our DRS, based on these signatures, could be developed as a test for TB suitable for use in HIV endemic countries. Further evaluation of the performance of the signatures and DRS in prospective populations of patients with symptoms consistent with TB will be needed to define their clinical value under operational conditions.

Discussion

We have identified a host blood transcriptomic signature that distinguishes TB from a wide range of OD prevalent in HIV-infected and -uninfected African patients. We found that patients with TB can be distinguished from LTBI with only 27 transcripts and from OD with 44 transcripts. Our findings appear robust as the results are reproducible in both HIV-infected and -uninfected cohorts, in different geographic locations, and in an independent TB patient dataset. The high sensitivity and specificity of the signatures in distinguishing TB from OD, even in the HIV-infected patients that have differing levels of T cell depletion and a wide spectrum of opportunistic infections as well as HIV-related complications, suggests that the signatures are promising biomarkers of TB. The relatively small number of transcripts in our signatures may increase the potential for using transcriptional profiling as a clinical diagnostic tool from a single peripheral blood sample (i.e., using a multiplex assay [35],[36]).

The major challenge for diagnosis of TB in Africa is how to distinguish this disease from the range of other conditions that show similar symptoms in countries where TB and HIV are co-endemic. Previous TB biomarker studies have focused on distinguishing patients with TB from healthy controls, or from LTBI [21],[22],[24], or have used other disease controls that may not represent the “real world” disease spectra from which TB should be clinically differentiated [19],[25]. Furthermore, these TB biomarker studies have also excluded HIV co-infected patients who are the group that most need new diagnostics. Our study design should ensure that our signatures are applicable in TB/HIV endemic countries as we recruited patients with TB concurrently with patients with a range of conditions that present with similar clinical features to TB, as well as recruiting both HIV-infected and -uninfected individuals.

We have identified separate signatures for distinguishing TB/OD and TB/LTBI, which only overlap in three transcripts. In practice the clinical applications of these signatures might be distinct as the TB/LTBI signature would be of value in contact screening, where the concern is distinguishing active disease from previous exposure in minimally symptomatic individuals. The TB/OD signature would be of most value in evaluating symptomatic patients presenting to medical services with symptoms of TB. We have also explored whether a single signature might be used to distinguish TB from both LTBI and OD. The combined signature showed lower performance to the separate TB/LTBI and TB/OD signatures. Further exploration of the operational performance of a combined signature or separate signatures is needed to establish the best strategy.

Although our signatures and DRS distinguished the majority of patients with TB from those with LTBI or OD, a proportion of patients were not correctly classified. There is increasing recognition that TB and LTBI may represent a dynamically evolving continuum, particularly in HIV-infected patients and thus failure to culture M.TB is not absolute proof that TB is not present. Some false assignment by our current “gold standard” is to be expected as noted by post mortem studies at which undiagnosed TB is confirmed [14],[15]. All patients in the OD group presented with symptoms for which TB was included in the differential diagnosis, and it is possible that TB may have been misdiagnosed in a small proportion of OD patients despite the extensive clinical investigation used to assign each patient to each diagnostic group. Some improvement in sensitivity and specificity of our DRS may also be achieved by weighting the signal from the most discriminatory transcripts, and this could be explored in subsequent refinements of the method.

A major concern in using transcriptional signatures as a clinical diagnostic tool in resource poor settings is the complexity, as well as cost, of the current methodologies. Our results have shown that transcriptional signatures can be used to distinguish TB from OD in an African setting. We explored the feasibility of a simplified method for disease categorization that may facilitate development of a diagnostic test based on our signatures. Our DRS provides a new approach that enables the use of multi-transcript signatures for individual disease risk assignment without the requirement for complex analysis. Our method could be used to develop a simple test in which the transcripts comprising the diagnostic signature (separated into those that are either up- or down-regulated in TB relative to controls) are each measured using a suitable detection system [35], and the combined signature used to identify each patient’s risk of TB. For example, a simple test using the TB/OD signature probes that show increased transcript expression in TB relative to OD could be located in a single well or tube, and those probes that show reduced transcript expression in TB located in a second well or tube. Binding of RNA from a patient’s blood to these probes could be detected as a combined signal from each tube using one of the aforementioned detection systems. To allow normalization, expression of up- or down-regulated transcripts in an individual patient could be compared with that of housekeeping genes, which do not show variation between healthy and disease states. There are methods for rapid detection of multi-transcript signatures including lateral flow reverse transcription (RT)-PCR based systems, nano-pore technology [37], nano-particle enzyme linked detection [38],[39], and detection using nano-wires and electrical impedance [40]. Some of these may be suitable for direct analysis of multiple transcript signatures in blood and at a relatively low cost.

While this study provides a proof of principle that relatively small numbers of RNA transcripts can be used to discriminate active TB from latent TB infection and OD in Africa, limitations remain that need to be addressed in order to translate these results into a clinical test. One such limitation is that our study has not assessed performance of our DRS in patients treated for TB solely on the basis of clinical suspicion, without any microbiological confirmation. Amongst these “probable/possible” patients with TB, there is no gold standard to evaluate any new biomarker. Exclusion of probable/possible patients with TB may have produced better estimates of sensitivity and specificity than would be achieved in a prospective “all comers” study including the entire cohort of patients in whom TB is included in the differential diagnosis. Thus, further evaluation using a prospective population based study in which the decision whether and when to initiate TB treatment is evaluated against the new biomarker is required. Future studies will also be required to refine the use of these biomarkers in a clinical decision process either as an initial screening tool, or in conjunction with more detailed culture based diagnostics.

From a clinical perspective a simple transcriptome-based test that reliably diagnoses or excludes TB in the majority of patients undergoing investigation for suspected TB, using a single blood sample, would be of great value, allowing scarce hospital resources to be focused on the small proportion of patients where the result was indeterminate. The challenge for the academic research community and for industry is to develop innovative methods to translate multi-transcript signatures into simple, cheap tests for TB suitable for use in African health facilities.

SOURCE: PLOS

Modelling the Strategic Use of Antiretroviral Therapy for the Treatment and Prevention of HIV.

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The impact of increased access to antiretroviral therapy (ART) has principally been measured in lives saved, and justifiably so: over the last decade the scale-up of ART has averted over 4 million deaths in low- and middle-income countries [1]. Almost 10 million people in these countries are currently receiving ART, and widespread access to treatment has transformed HIV from a life-threating infection to a chronic disease. Less than 20 years ago, patients presenting at clinics in Africa with an AIDS-defining illness would on average have just 9 months to live [2]. Today, people living with HIV in Africa can, with timely and continuous access to effective ART, have a relatively normal life expectancy [3],[4].

Yet the benefits of ART extend beyond saving lives, and increasingly attention is being given to the potential for ART to prevent new HIV infections. The specific contribution of ART to reducing HIV infection through mother-to-child transmission of HIV is well described—over 800,000 children have avoided infection over the last decade [1]—but the extent to which ART prevents sexual transmission has until recently been less clear. Data from several observational studies have suggested decreased acquisition of HIV among sexual partners of people on ART [5],[6], an association convincingly confirmed by the results of the HPTN 052 trial demonstrating significantly reduced rates of sexual transmission with early ART initiation [7]. At the population level, increased access to ART has been associated with reductions in sexual transmission in ecological studies [8], but the overall proportion of new infections that have been averted by ART is not known. In the absence of such data, mathematical modelling has made an essential contribution.

Models have been used to predict the potential impact of widespread ART on HIV transmission for over two decades [9], but the potential preventive impact of widespread ART access captured international attention only recently, with the landmark publication of what has become known as the “Granich” model in 2009 [10]. Assuming high rates of treatment uptake, coverage, and adherence this model put forward the notion that universal HIV testing and treatment, combined with other interventions, could reduce transmission to low levels such that epidemic would eventually decrease towards elimination. Subsequent models have all pointed in the same direction of reduced incidence with expanded ART access, albeit with varying assumptions and timeframes [11].

In this issue of PLOS Medicine Jan Hontelez and colleagues systematically assessed the universal test and treat intervention suggested by Granich and colleagues by running nine different models with increasing degrees of complexity and realism—including sexual networks, HIV stages with different degrees of infectiousness, and updated treatment effectiveness assumptions—to explore how different scientific approaches to modelling would influence the results [12]. Encouragingly, all models were found to predict that HIV would eventually be eliminated through universal HIV testing and treatment, although timeframes for reaching the elimination phase ranged from 7 to 39 years depending on assumptions about demography, sexual behavior, transmission and natural history, coverage of other prevention interventions (male medical circumcision and condom use), and sexually transmitted infection (STI) co-factors[12]. Of particular note, while previous models have suggested reduced incidence even if treatment is started at a lower CD4 threshold of 350 cells/mm3 [11], this is the first study to predict that the elimination phase will eventually be reached at this threshold, albeit within a longer time horizon and provided very high treatment coverage is attained.

The notion that ART could help curb the HIV epidemic has fundamentally reframed the global HIV response over the past 5 years. For donors, the clinical and public health benefits provided by expanded ART access make a clear case that ART is a good investment [13], while for care providers the possibility that ART could help control or even eliminate the HIV epidemic has provided a renewed impetus to further expand coverage [14].

The latest ART guidelines released by the World Health Organization (WHO) in June 2013 recognize the multiple benefits of ART for both treatment and prevention of HIV, and provide a number of recommendations for expanded eligibility [15]. ART initiation is recommended at CD4 <500 cells/mm3 (with priority given to those with a CD4 <350 cells/mm3) and three new recommendations are made to provide immediate ART initiation based on clinical benefits and programmatic and prevention considerations: pregnant women, people in serodiscordant couples, and children under 5 years of age. Similar to previous guidelines, people co-infected with tuberculosis and hepatitis B infection are also eligible for immediate ART after diagnosis. In order to develop these guidelines WHO commissioned a series of modelling studies done by the HIV Modelling Consortium, which showed that expanding the criterion for ART eligibility to CD4 cell count ≤500 cells/mm3 was highly cost-effective in low- and middle-income settings, in particular if expanded eligibility was coupled with a large increase in HIV testing and linkage to care [16].

With the preventive benefit of ART firmly established in evidence and policy, what could be the future contribution of modelling to treatment scale-up? Rather than continuing to model the magnitude and speed of the preventive impact of ART, modelling efforts could be redirected towards helping programmes make choices about which interventions need to be prioritized in order to achieve the levels of enrolment and retention in care required to achieve optimal prevention benefit. There are three key areas where modelling could help, and encouragingly early work has already started in some of these areas.

First, modelling can help define actions to improve access and retention in care. A positive consequence of the recent focus on universal HIV testing and treatment has been to direct attention on the cascade of care. While much of the modelling work to date has focused on refining the horizons for achieving HIV elimination through ART provision, individuals involved in programme implementation have expressed concern about the feasibility of achieving the high rates of ART uptake, coverage, retention, and adherence upon which these models are based[14]. Recent systematic reviews have highlighted substantial patient attrition at every step from HIV testing to ART initiation to long term retention on treatment [17],[18]. A number of interventions have recently shown promising results in increasing uptake in HIV testing [19], speeding up eligibility assessments for ART [20], and reducing attrition on ART [21]. Modelling work has already been done to help provide a more nuanced understanding of the dynamics of the treatment cascade [22]. Drawing on data from trials underway to assess the impact of ART initiation on HIV transmission [23], future modelling work could assist decision making about where and how to intervene along the treatment cascade to maximize the treatment and prevention benefits of ART.

Second, modelling can help inform country decisions about who should be treated early in priority for maximum prevention benefit. Implementation of the new WHO recommendations for early ART initiation will require countries to make strategic choices around how best to use ART for treatment and prevention according to resource constraints, epidemic dynamics, and societal factors. WHO’s guidelines include a chapter on decision making for programme managers that outlines how modelling can help support costing and planning [15]. Modelling studies have already assessed the preventive impact of immediate ART initiation among pregnant women and serodiscordant couples [24], and key populations [25],[26]. This work will continue to be critical to informing country choices in the strategic use of ART.

Finally, ongoing research will provide further data on the clinical and public health benefits of ART, and future guidelines will likely lead to a continued policy evolution towards earlier initiation. Modelling will make a key contribution to informing future WHO guidance and country decisions about how best to strategically provide ART as a broader package of interventions to save lives, reduce illness, and prevent new infections.

The case for ART impact on HIV transmission is proven. The priority now is to translate this concept into benefits for patients and communities by identifying and implementing approaches that work to maximize early HIV testing and ART uptake and long-term retention in care.

Source:PLOS

 

Elephants ‘understand human gesture’

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In this brief clip of two of the trials, Professor Richard Byrne describes how the elephants got the point from the first test.

African elephants have demonstrated what appears to be an instinctive understanding of human gestures, according to UK scientists.

In a series of tests, researcher Ann Smet, of the University of St Andrews, offered the animals a choice between two identical buckets, then pointed at the one containing a hidden treat.

From the first trial, the elephants chose the correct bucket.

Animal keeper Rachel Melling describes the bond she feels with the elephants she works with and how they “respond to body language”.

The scientists worked with captive elephants at a lodge in Zimbabwe.

Prof Richard Byrne, a co-author on the research, said the elephants had been rescued from culling operations and trained for riding.

“They specifically train the elephants to respond to vocal cues. They don’t use any gestures at all,” said Prof Byrne.

“The idea is that the handler can walk behind the elephant and just tell it what to do with words.”

Despite this, the animals seemed to grasp the meaning of pointing from the outset. This makes them the only non-human animals to understand the gesture without being trained to do so.

In previous studies, Prof Byrne said, our closest primate cousins, the chimpanzees, proved to be “hopeless” at at similar task.

Ms Smet added that she had been impressed by the animals’ apparently innate understanding of the gesture.

“Of course we had hoped that the elephants would be able to learn to follow human pointing, or we wouldn’t have done the experiment in the first place,” she said.

“But it was really surprising that they didn’t seem to have to learn anything.

“It seems that understanding pointing is an ability elephants just possess naturally and they are cognitively much more like us than has been realised.”

Nature’s giants

  • African elephants are the largest living land animals
  • Until recently there was one species of elephant in Africa – but they are now classified as either forest or bush (or savannah) elephants
  • Forest elephants, as the name suggests, are found in equatorial forests and have straighter trunks and rounded ears
  • Bush elephants are more widespread, mostly south of the Sahara in a range of habitats including savannah, swamps and deserts

Prof Byrne said studying elephants helped build a map of part of the evolutionary tree that is very distant from humans.

“They’re so unrelated to us,” he told BBC News. “So if we find human-like abilities in an animal like an elephant, that hasn’t shared a common ancestor with people for more than 100 million years , we can be pretty sure that it’s evolved completely separately, by what’s called convergent evolution.”

The researchers said their findings might explain how elephants have successfully been tamed and have “historically had a close bond with humans, in spite of being potentially dangerous and unmanageable due to their great size”.

But the scientists added the results could be a hint that the animals gesture to one another in the wild with their “highly controllable trunks”.

Ms Smet told BBC News: “The next step [in our research] is to test whether when an elephant extends its trunk upwards and outwards – as they regularly do, such as when detecting a predator, this functions as a point.”

Ten years in: taking stock of the biosafety protocol.

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Speed read

·         The Cartagena protocol covers the safe transfer and use of GM organisms

·         But most of its 164 signatories have still not fully implemented it

·         Industry has been making efforts to work with governments within the protocol

Many challenges lie ahead for the Cartagena protocol to be effective, Maria Elena Hurtado reports.


  Ten years after the Cartagena Protocol on Biosafety entered into force to detail the safe handling, transfer and use of living genetically modified organisms, vast majority of its 164 signatories have not fully implemented it.  

Yet in recent years, researchers have started producing genetically modified fish in Panama for human consumption, and releasing genetically modified mosquitoes into the wild in Brazil and elsewhere to try and prevent dengue fever, sometimes with unclear safety and regulatory oversight.

The protocol commits signatory countries to appoint a national authority to administer the protocol, to create national biosafety frameworks and regulations, and to build capacity for risk assessment and the safe handling and transport of living modified organisms (LMOs).

HNE00022PHI

Fifty-two countries have domestic regulations fully in place, 75 have one or more biosafety laws and almost all of them have national authorities for administrating it, reports an article published in the anniversary edition of the protocol’s newsletter.

“But still there is a long way to go to make sure the national biosafety rules and regulations in place are workable and countries have the necessary capacity to enforce them,” Braulio Ferreira de Souza Dias, executive secretary to the Secretariat of the Convention on Biological Diversity, tellsSciDev.Net.

“For example, the effectiveness of biosafety regulations will be minimal unless countries have the necessary tools to detect and identify LMOs.”


Challenges ahead


And for the protocol to be fully effective, “we need to work towards achieving its universal membership”, said de Souza Dias, in a press release published earlier this month (10 September). “I call upon all countries that have not yet done so to fast track their national processes to ratify or accede to the Cartagena protocol … as soon as possible.”

“The absence of legal certainty in many countries has been commonly regarded as one of the most serious stumbling blocks in the path of biodiscovery.”

Braulio Ferreira de Souza Dia, Convention on Biological Diversity

Also, the speed of implementation has decreased over the last three years, Stefan Jungcurt of the Canada-based International Institute on Sustainable Development, tells SciDev.Net.

“As more and more countries approve LMOs for cultivation and import, the political priority given to biosafety is diminishing, which translates into a lack of financial and other support to implement the protocol on a national level,” he says.

In his view, a key pending issue is approving UN guidelines for risk assessment and risk management. Claudio Chiarolla, director of biodiversity governance at the Institute for Sustainable Development and International Relations, a non-profit policy research institute based in France, agrees.  

Both Jungcurt and Chiarolla tell SciDev.Net that one of the most important issues will be to determine  the protocol’s scope regarding the potential socioeconomic impact that LMOs pose for the sustainable use and conservation of biodiversity, and what appropriate action can be taken.

“The protocol will also have to deal with other types of LMOs such as genetically modified mosquitoes, aquatic species, microorganisms orproducts of synthetic biology, which are different to LMO crops,” Jungcurt adds.

A new international treaty was adopted at a 2010 meeting in Japan, called the Nagoya – Kuala Lumpur Supplementary Protocol on Liability and Redress to the Cartagena Protocol on Biosafety.
This treaty deals with potential damages resulting from the export and import of LMOs.

Jungcurt says: “The most immediate challenge here is achieving its coming into force and its national implementation, as well as establishing rules and procedures on who is liable if damage occurs during transboundary movements”.


A fair share


De Souza Dias told a meeting in Denmark this month (4 September) that the Nagoya protocol “put an end to the mistrust among industry, indigenous and local communities over the equitable sharing of benefits”.

“The absence of legal certainty in many countries has been commonly regarded as one of the most serious stumbling blocks in the path of biodiscovery,” he adds. “The Nagoya protocol seeks to address this concern.”

He recognises the high stakes involved for different groups. “Over the last two decades, the issue of free trade in LMOs on the one hand, and biosafety on the other, have led to heated debates and, at times, to tense legal disputes.”

But he believes industry has been making efforts to work with governments within the process of the biosafety protocol.

“The participation of representatives of industry and civil society in the Cartagena protocol process has been helpful to maintain transparency and balance in taking decisions,” he says.