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Lower extremity peripheral artery disease is the third leading cause of atherosclerotic cardiovascular morbidity, following coronary artery disease and stroke. This study provides the first comparison of the prevalence of peripheral artery disease between high-income countries (HIC) and low-income or middle-income countries (LMIC), establishes the primary risk factors for peripheral artery disease in these settings, and estimates the number of people living with peripheral artery disease regionally and globally. We did a systematic review of the literature on the prevalence of peripheral artery disease in which we searched for community-based studies since 1997 that defined peripheral artery disease as an ankle brachial index (ABI) lower than or equal to 0·90. We used epidemiological modelling to define age-specific and sex-specific prevalence rates in HIC and in LMIC and combined them with UN population numbers for 2000 and 2010 to estimate the global prevalence of peripheral artery disease. Within a subset of studies, we did meta-analyses of odds ratios (ORs) associated with 15 putative risk factors for peripheral artery disease to estimate their effect size in HIC and LMIC. We then used the risk factors to predict peripheral artery disease numbers in eight WHO regions (three HIC and five LMIC). 34 studies satisfied the inclusion criteria, 22 from HIC and 12 from LMIC, including 112 027 participants, of which 9347 had peripheral artery disease. Sex-specific prevalence rates increased with age and were broadly similar in HIC and LMIC and in men and women. The prevalence in HIC at age 45–49 years was 5·28% (95% CI 3·38–8·17%) in women and 5·41% (3·41–8·49%) in men, and at age 85–89 years, it was 18·38% (11·16–28·76%) in women and 18·83% (12·03–28·25%) in men. Prevalence in men was lower in LMIC than in HIC (2·89% [2·04–4·07%] at 45–49 years and 14·94% [9·58–22·56%] at 85–89 years). In LMIC, rates were higher in women than in men, especially at younger ages (6·31% [4·86–8·15%] of women aged 45–49 years). Smoking was an important risk factor in both HIC and LMIC, with meta-OR for current smoking of 2·72 (95% CI 2·39–3·09) in HIC and 1·42 (1·25–1·62) in LMIC, followed by diabetes (1·88 [1·66–2·14] vs 1·47 [1·29–1·68]), hypertension (1·55 [1·42–1·71] vs 1·36 [1·24–1·50]), and hypercholesterolaemia (1·19 [1·07–1·33] vs 1·14 [1·03–1·25]). Globally, 202 million people were living with peripheral artery disease in 2010, 69·7% of them in LMIC, including 54·8 million in southeast Asia and 45·9 million in the western Pacific Region. During the preceding decade the number of individuals with peripheral artery disease increased by 28·7% in LMIC and 13·1% in HIC. In the 21st century, peripheral artery disease has become a global problem. Governments, non-governmental organisations, and the private sector in LMIC need to address the social and economic consequences, and assess the best strategies for optimum treatment and prevention of this disease. Peripheral Arterial Disease Research Coalition (Europe).

Key Points The ankle–brachial index is the most appropriate measure to use in describing the global distribution of peripheral artery disease (PAD) Worldwide estimates indicate that the greatest numbers of patients with PAD are in Southeast Asia and Western Pacific regions; many individuals are asymptomatic A large proportion of symptomatic patients have atypical leg pain rather than intermittent claudication; patients without pain often have substantial functional impairment Traditional cardiovascular risk factors (smoking, hypertension, diabetes mellitus, and dyslipidaemia) and the ageing of the population are important determinants of PAD in all countries In low-income and middle-income countries especially, environmental factors such as poverty, industrialization, and infection could affect the risk of developing PAD PAD impairs quality of life and is associated with a greatly increased risk of major cardiovascular events and death; PAD is an important cause of amputation worldwide Peripheral artery disease (PAD) is undergoing a major epidemiological transition, with a rapid shift from high-income to low-income and middle-income countries. In this Review, Fowkes et al . describe the measurement of PAD in populations, as well as the worldwide prevalence, risk factors, and burden of the disease. Global populations are undergoing a major epidemiological transition in which the burden of atherosclerotic cardiovascular diseases is shifting rapidly from high-income to low-income and middle-income countries (LMICs). Peripheral artery disease (PAD) is no exception, so that greater focus is now required on the prevention and management of this disease in less-advantaged countries. In this Review, we examine the epidemiology of PAD and, where feasible, take a global perspective. However, the dearth of publications in LMICs means an unavoidable over-reliance on studies in high-income countries. Research to date suggests that PAD might affect a greater proportion of women than men in LMICs. Although factors such as poverty, industrialization, and infection might conceivably influence the development of PAD in such settings, the ageing of the population and increase in traditional cardiovascular risk factors, such as smoking, diabetes mellitus, and hypertension, are likely to be the main driving forces.

We present a community data set of daily forcing and hydrologic response data for 671 small- to medium-sized basins across the contiguous United States (median basin size of 336 km2) that spans a very wide range of hydroclimatic conditions. Area-averaged forcing data for the period 1980–2010 was generated for three basin spatial configurations – basin mean, hydrologic response units (HRUs) and elevation bands – by mapping daily, gridded meteorological data sets to the subbasin (Daymet) and basin polygons (Daymet, Maurer and NLDAS). Daily streamflow data was compiled from the United States Geological Survey National Water Information System. The focus of this paper is to (1) present the data set for community use and (2) provide a model performance benchmark using the coupled Snow-17 snow model and the Sacramento Soil Moisture Accounting Model, calibrated using the shuffled complex evolution global optimization routine. After optimization minimizing daily root mean squared error, 90% of the basins have Nash–Sutcliffe efficiency scores ≥0.55 for the calibration period and 34% ≥ 0.8. This benchmark provides a reference level of hydrologic model performance for a commonly used model and calibration system, and highlights some regional variations in model performance. For example, basins with a more pronounced seasonal cycle generally have a negative low flow bias, while basins with a smaller seasonal cycle have a positive low flow bias. Finally, we find that data points with extreme error (defined as individual days with a high fraction of total error) are more common in arid basins with limited snow and, for a given aridity, fewer extreme error days are present as the basin snow water equivalent increases.

Paediatric nephropathy, a condition associated with significant morbidity and mortality, is increasing in developing countries. Data on children with renal diseases are insufficient in Ghana despite the risk it poses. This study assessed the pattern, spectrum, outcome, and predictors of dialysis and death among children with renal disease at Korle Bu Teaching Hospital (KBTH), Ghana. A cross-sectional retrospective review was conducted among children aged 0-17 years. Demographic characteristics, clinical and laboratory data, information on dialysis and treatment outcomes were obtained from their medical records and analyzed accordingly using STATA software version 15.1. A total of 332 children with renal diseases were seen (median age of 6 years), with 200(60.98%) being males. The most common renal diseases were nephrotic syndrome 141(42.47%) and acute kidney injury (AKI) 87(26.20%). Idiopathic (unknown) causes (82.98%) and intravascular hemolysis secondary to malaria (41.38%) were the major causes of nephrotic syndrome and acute kidney injury respectively. A death rate of 15.06% resulting mostly from AKI (6.33%) was observed whilst 7.83% underwent dialysis. Predictors of dialysis among those who had dialysis included being a female and having acute on chronic kidney disease whilst having high white blood cell count and acute on chronic kidney disease were significant predictors of death among children with renal diseases. Paediatric renal diseases at KBTH were dominated by nephrotic syndrome and AKI. Timely treatment and prevention of common infectious agents and conditions causing intravascular hemolysis, which can contribute to paediatric renal diseases in Ghana, is needed to help reduce their progression to various forms of kidney disease.

The slightest change in rainfall could have a significant impact on rain-fed agriculture in countries like Ghana. This study evaluated for the first time the performance of the statistical downscaling model (SDSM-DC) at 2m spatial resolution in simulating rainfall in Ghana for the base period 1981–2010. It further analysed the projected changes in seasonal rainfall pattern across different agro-ecological zones for the twenty-first century under RCP 4.5 and 8.5 emission scenarios over Ghana. Ensemble mean of simulated rainfall data (2011–2099) generated by 43 GCMs in the Coupled Model Intercomparison Project Phase 5 (CMIP5) were used as base factors for local future climate scenarios generation. Performance analysis of SDSM-DC shows a Nash–Sutcliffe efficiency, percent bias and RMSE observations standard deviation ratio of 0.88, −19 and 0.34, respectively. Generally, seasonal rainfall amount is expected to increase between 10 and 40% in all the agro-ecological zones in Ghana by the end of the twenty-first century. Off-season rainfall in December–February shows more than 100% increase in the Guinea Savannah zone. Rainfall projected under RCP 4.5 was on average 2% higher than RCP 8.5 in all the seasons throughout the century. Based on these results, it is appropriate to suggest a high incidence of flooding across Ghana in the twenty-first century. This could have dire consequences on agriculture which contribute to a large proportion of Ghana’s GDP. Therefore, for sustainable food production and security in the twenty-first century, Ghana needs climate adaptation policies and programmes that encourage the design and implementation of early warning systems of meteorological hazards and the introduction of new crop varieties that are flood tolerant.

The forecast of rainfall and temperature is a difficult task due to their variability in time and space and also the inability to access all the parameters influencing rainfall of a region or locality. Their forecast is of relevance to agriculture and watershed management, which significantly contribute to the economy. Rainfall prediction requires mathematical modelling and simulation because of its extremely irregular and complex nature. Autoregressive integrated moving average (ARIMA) model was used to analyse annual rainfall and maximum temperature over Tordzie watershed and the forecast. Autocorrelation function (ACF) and partial autocorrelation function (PACF) were used to identify the models by aid of visual inspection. Stationarity tests were conducted using the augmented Dickey–Fuller (ADF), Mann–Kendall (MK) and Kwiatkowski–Phillips–Schmidt–Shin (KPSS) tests respectively. The chosen models were evaluated and validated using the Akaike information criterion corrected (AICC) and also Schwartz Bayesian criteria (SBC). The diagnostic analysis of the models comprised of the independence, normality, homoscedascity, and plots of the residuals respectively. The best ARIMA model for rainfall for Kpetoe and Tordzinu were (3, 0, 3) and (3, 1, 3) with values of 190.07 and 178.23. That of maximum temperature for Kpetoe and Tordzinu were (3, 1, 3) and (3, 1, 3) and the corresponding values of 23.81 and 36.10. The models efficiency was checked using sum of square error ( ), mean square error ( ), mean absolute percent error ( ) and root mean square error ( ) respectively. The results of the various analysis indicated that the models were adequate and can aid future water planning projections.

The mosquito Aedes (Ae). aegypti transmits the viruses that cause dengue, chikungunya, Zika and yellow fever. We investigate how choosing alternate emissions and/or socioeconomic pathways may modulate future human exposure to Ae. aegypti. Occurrence patterns for Ae. aegypti for 2061–2080 are mapped globally using empirically downscaled air temperature and precipitation projections from the Community Earth System Model, for the Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios. Population growth is quantified using gridded global population projections consistent with two Shared Socioeconomic Pathways (SSPs), SSP3 and SSP5. Change scenarios are compared to a 1950–2000 reference period. A global land area of 56.9 M km2 is climatically suitable for Ae. aegypti during the reference period, and is projected to increase by 8 % (RCP4.5) to 13 % (RCP8.5) by 2061–2080. The annual average number of people exposed globally to Ae. aegypti for the reference period is 3794 M, a value projected to statistically significantly increase by 298–460 M (8–12 %) by 2061–2080 if only climate change is considered, and by 4805–5084 M (127–134 %) for SSP3 and 2232–2483 M (59–65 %) for SSP5 considering both climate and population change (lower and upper values of each range represent RCP4.5 and RCP8.5 respectively). Thus, taking the lower-emissions RCP4.5 pathway instead of RCP8.5 may mitigate future human exposure to Ae. aegypti globally, but the effect of population growth on exposure will likely be larger. Regionally, Australia, Europe and North America are projected to have the largest percentage increases in human exposure to Ae. aegypti considering only climate change.

Interferon regulatory factors (IRFs) are key elements of antiviral innate responses that regulate the transcription of interferons (IFNs) and IFN-stimulated genes (ISGs). While the sensitivity of human coronaviruses to IFNs has been characterized, antiviral roles of IRFs during human coronavirus infection are not fully understood. Type I or II IFN treatment protected MRC5 cells from human coronavirus 229E infection, but not OC43. Cells infected with 229E or OC43 upregulated ISGs, indicating that antiviral transcription is not suppressed. Antiviral IRFs, IRF1, IRF3 and IRF7, were activated in cells infected with 229E, OC43 or severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2). RNAi knockdown and overexpression of IRFs demonstrated that IRF1 and IRF3 have antiviral properties against OC43, while IRF3 and IRF7 are effective in restricting 229E infection. IRF3 activation effectively promotes transcription of antiviral genes during OC43 or 229E infection. Our study suggests that IRFs may be effective antiviral regulators against human coronavirus infection.

Background Abdominal aortic aneurysm (AAA) is a leading cause of death in the USA. We evaluated the incidence and predictors of AAA in a prospectively followed cohort. Methods We calculated age-adjusted AAA incidence rates (IR) among 18 782 participants aged ≥65 years in the Southern Community Cohort Study who received Medicare coverage from 1999–2012, and assessed predictors of AAA using multivariable Cox proportional hazards models, overall and stratified by sex, adjusting for demographic, lifestyle, socioeconomic, medical and other factors. HRs and 95% CIs were calculated for AAA in relation to factors ascertained at enrolment. Results Over a median follow-up of 4.94 years, 281 cases were identified. Annual IR was 153/100 000, 401, 354 and 174 among blacks, whites, men and women, respectively. AAA risk was lower among women (HR 0.48, 95% CI 0.36 to 0.65) and blacks (HR 0.51, 95% CI 0.37 to 0.69). Smoking was the strongest risk factor (former: HR 1.91, 95% CI 1.27 to 2.87; current: HR 5.55, 95% CI 3.67 to 8.40), and pronounced in women (former: HR 3.4, 95% CI 1.83 to 6.31; current: HR 9.17, 95% CI 4.95 to 17). A history of hypertension (HR 1.44, 95% CI 1.04 to 2.01) and myocardial infarction or coronary artery bypass surgery (HR 1.9, 95% CI 1.37 to 2.63) was negatively associated, whereas a body mass index ≥25 kg/m2 (HR 0.72; 95% CI 0.53 to 0.98) was protective. College education (HR 0.6, 95% CI 0.37 to 0.97) and black race (HR 0.44, 95% CI 0.28 to 0.67) were protective among men. Conclusions Smoking is a major risk factor for incident AAA, with a strong and similar association between men and women. Further studies are needed to evaluate benefits of ultrasound screening for AAA among women smokers.

Sex differences exist in the regulation of arterial pressure and renal function by the renin-angiotensin system (RAS). This may in part stem from a differential balance in the pressor and depressor arms of the RAS. In males, the ACE/AngII/AT 1 R pathways are enhanced, whereas, in females, the balance is shifted towards the ACE2/Ang(1-7)/MasR and AT 2 R pathways. Evidence clearly demonstrates that premenopausal women, as compared to aged-matched men, are protected from renal and cardiovascular disease, and this differential balance of the RAS between the sexes likely contributes. With aging, this cardiovascular protection in women is lost and this may be related to loss of estrogen postmenopause but the possible contribution of other sex hormones needs to be further examined. Restoration of these RAS depressor pathways in older women, or up-regulation of these in males, represents a therapeutic target that is worth pursuing.