This brief discussion of United States economic aid to Africa has been compiled as a factual summary rather than an analysis or critical evaluation of present programs. A general description of economic aid, and of the activities of the Agency for International Development, is followed by a more detailed note on a country program in operation, that in the Sudan.

Although not the largest single donor in Africa, the U.S. Government in fiscal 1962 and again in fiscal 1963 provided about $500 million in economic assistance to 34 African countries. Surplus food and fiber under the Food for Peace Program accounted for nearly half of this aid. In contrast, other Free World government sources provided about $1, 200 million, and the Sino-Soviet Bloc extended $200 to $250 million in credits. Thus, the U.S. contributed roughly one-fourth of Africa's $2 billion in annual external economic assistance from government sources. In addition important contributions were made by U.S. private foundations, religious organizations, and other nongovernment groups. U.S. direct investments in “AID Africa” rose to about $800 million in 1962 from about $100 million in 1950.

Background: Nipocalimab (a fully human, effectorless anti-neonatal Fc receptor (FcRn) monoclonal antibody) may ameliorate gMG disease manifestations by selectively targeting FcRn IgG recycling and lowering IgG, including pathogenic autoantibodies in generalized myasthenia gravis (gMG). The objective was to evaluate the effectiveness and safety of intravenous nipocalimab added to background standard-of-care therapy in adolescents with gMG. Methods: Seropositive patients (12-<18 years) with gMG (MGFA Class II-IV) on stable therapy but inadequately controlled, were enrolled in a 24-week open label study. Nipocalimab was administered as a 30 mg/kg IV loading dose followed by 15 mg/kg IV every 2 Weeks. Results: Seven adolescents were enrolled; 5 completed 24-weeks of dosing. The mean(SD) age was 14.1(1.86) years; seven were anti-AChR+, six were female. Mean(SD) baseline MG-ADL/QMG scores were 4.29(2.430)/12.50(3.708). Nipocalimab showed a significant reduction in total serum IgG at week-24; the mean(SD) change from baseline to week-24 for total serum IgG was -68.98%(7.561). The mean(SD) change in MG-ADL/QMG scores at week-24 was -2.40(0.418)/-3.80(2.683); 4 of 5 patients achieved minimum symptom expression (MG-ADL score 0-1) by week-24. Nipocalimab was well-tolerated; there were no serious adverse events. There were no clinically meaningful laboratory changes. Conclusions: Nipocalimab demonstrated efficacy and safety in this 6-month trial in seropositive adolescents with gMG.

The colonisation of Australia around 250 years ago resulted in significant disruptive changes to the lifestyle and diet of Aboriginal and Torres Strait Islander peoples. Traditional foods high in micronutrients, including vitamin D, have been largely replaced with energy-dense foods(1). Sun exposure—a primary source of vitamin D—may be reduced due to changes in clothing and housing structure(2). Consequently, there is a high prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D concentration < 50 nmol/L) and low vitamin D intake among Aboriginal and Torres Strait Islander peoples(2,3). There is a need for a public health strategy to improve vitamin D status. Since few foods naturally contain vitamin D (e.g., fish, eggs, and meat), food fortification could be a suitable public health strategy to increase vitamin D intake without changing consumption behaviour. In Australia, besides food mandated for fortification (e.g., edible oil spreads), few foods permitted for voluntary fortification are routinely fortified. We aimed to model vitamin D food fortification scenarios among Aboriginal and Torres Strait Islander peoples. We used nationally representative food consumption data from the 2012–2013 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (n = 4,109) and analytical vitamin D food composition data(4) to model four food fortification scenarios. Scenario 1 modelled the addition of the maximum permitted amount of vitamin D to all foods permitted for fortification in Australia: i) dairy products and alternatives, ii) butter/margarine/oil spreads, iii) formulated beverages (e.g., water with added sugar, vitamins and minerals), and iv) selected ready-to-eat breakfast cereal. Scenarios 2a–c included vitamin D concentrations higher than permitted in fluid milks/alternatives (1 μg/day) and butter/margarine/oil spreads (20 μg/day). Scenario 2a: i) dairy products and alternatives, ii) butter/margarine/oil spreads, iii) formulated beverages. Scenario 2b: as per Scenario 2a plus selected ready-to-eat breakfast cereals. Scenario 2c: as per Scenario 2b plus bread (not permitted for vitamin D fortification in Australia). Vitamin D fortification of a range of staple foods could potentially increase vitamin D intake among Aboriginal and Torres Strait Islander peoples by ~3–6 μg/day. Scenario 2c showed the highest potential median vitamin D intake increase from baseline of 2 μg/day to ~8 μg/day. Across all scenarios, the vitamin D intake of all participants remained below the Australian Tolerable Upper Intake Level of 80 μg/day. Our findings demonstrated that vitamin D fortification of a range of staple foods could potentially increase vitamin D intake among Aboriginal and Torres Strait Islander peoples in Australia. However, the most impactful vitamin D fortification strategy (Scenario 2c) would require a revision of the Australia New Zealand Food Standards Code to permit the addition of higher amounts of vitamin D than currently permitted and the inclusion of bread as a food vehicle for fortification.

Low vitamin D status (circulating 25-hydroxyvitamin D [25(OH)D] concentration < 50 nmol/L) affects nearly one in four Australian adults(1). The primary source of vitamin D is sun exposure; however, a safe level of sun exposure for optimal vitamin D production has not been established. As supplement use is uneven, increasing vitamin D in food is the logical option for improving vitamin D status at a population level. The dietary supply of vitamin D is low since few foods are naturally rich in vitamin D. While there is no Australia-specific estimated average requirement (EAR) for vitamin D, the Institute of Medicine recommends an EAR of 10 μg/day for all ages. Vitamin D intake is low in Australia, with mean usual intake ranging from 1.8–3.2 μg/day across sex/age groups(2), suggesting a need for data-driven nutrition policy to improve the dietary supply of vitamin D. Food fortification has proven effective in other countries. We aimed to model four potential vitamin D fortification scenarios to determine an optimal strategy for Australia. We used food consumption data for people aged ≥ 2 years (n = 12,153) from the 2011–2012 National Nutrition and Physical Activity Survey, and analytical food composition data for vitamin D3, 25(OH)D3, vitamin D2 and 25(OH)D2(3). Certain foods are permitted for mandatory or voluntary fortification in Australia. As industry uptake of the voluntary option is low, Scenario 1 simulated addition of the maximum permitted amount of vitamin D to all foods permitted under the Australia New Zealand Food Standards Code (dairy products/plant-based alternatives, edible oil spreads, formulated beverages and permitted ready-to-eat breakfast cereals (RTEBC)). Scenarios 2–4 modelled higher concentrations than those permitted for fluid milk/alternatives (1 μg/100 mL) and edible oil spreads (20 μg/100 g) within an expanding list of food vehicles: Scenario 2—dairy products/alternatives, edible oil spreads, formulated beverages; Scenario 3—Scenario 2 plus RTEBC; Scenario 4—Scenario 3 plus bread (which is not permitted for vitamin D fortification in Australia). Usual intake was modelled for the four scenarios across sex and age groups using the National Cancer Institute Method(4). Assuming equal bioactivity of the D vitamers, the range of mean usual vitamin D intake across age groups for males for Scenarios 1 to 4, respectively, was 7.2–8.8, 6.9–8.3, 8.0–9.7 and 9.3–11.3 μg/day; the respective values for females were 5.8–7.5, 5.8–7.2, 6.4–8.3 and 7.5–9.5 μg/day. No participant exceeded the upper level of intake (80 μg/day) under any scenario. Systematic fortification of all foods permitted for vitamin D fortification could substantially improve vitamin D intake across the population. However, the optimal strategy would require permissions for bread as a food vehicle, and addition of higher than permitted concentrations of vitamin D to fluid milks/alternatives and edible oil spreads.

Despite high UVB radiation from the sun in Australia (the primary source of vitamin D), vitamin D deficiency (serum 25-hydroxyvitamin D concentrations [25(OH)D] <50 nmol/L) is prevalent among Aboriginal and Torres Strait Islander peoples (27% of adults nationally; 39% of adults living in remote areas)(1). Vitamin D deficiency affects musculoskeletal health and may be associated with non-communicable diseases, such as type 2 diabetes and cardiovascular diseases, prevalent in Aboriginal and Torres Strait Islander peoples.(2, 3) Alternative to UVB radiation, vitamin D can also be obtained from foods (e.g., fish, eggs, and meat) and supplements. However, vitamin D intake in Aboriginal and Torres Strait Islander peoples is currently unknown. Hence, we aimed to provide the first estimate of absolute vitamin D intake in Aboriginal and Torres Strait Islander peoples. We used food consumption data from the 2012-2013 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey and vitamin D food composition data for vitamin D3, 25(OH)D3, vitamin D2, and 25(OH)D2. Absolute vitamin D intake was estimated by sex and remote and non-remote areas using bioactivity factors (BF) of 1 and 5 for 25(OH)D, which may be up to five times more bioactive than vitamin D. The estimated average requirement for vitamin D intake recommended by the Institute of Medicine is 10 μg/day(4). The estimated absolute vitamin D intake from food and beverages was low for Aboriginal and Torres Strait Islander peoples. The mean estimated absolute vitamin D intake of Aboriginal and Torres Strait Islander peoples was 2.9 μg/day and 5.3 μg/day for BF 1 and 5, respectively. Males had a higher mean intake (3.2 μg/day, BF 1 and 5.9 μg/day, BF 5) than females (2.6 μg/day, BF 1 and 4.7 μg/day, BF 5). Vitamin D intake was 2.9 μg/day (BF 1) and 5.2 μg/day (BF 5) in non-remote and 2.8 μg/day (BF 1) and 5.4 μg/day (BF 5) in remote areas. The high prevalence of vitamin D deficiency and low vitamin D intake highlights a need to promote vitamin D sufficiency through public health policies. The results from this study can be used to model food fortification strategies to provide evidence for the development of nutrition policies to improve the vitamin D status of the Aboriginal and Torres Strait Islander population.

Background: Saccade and pupil responses are potential neurodegenerative disease biomarkers due to overlap between oculomotor circuitry and disease-affected areas. Instruction-based tasks have previously been examined as biomarker sources, but are arduous for patients with limited cognitive abilities; additionally, few studies have evaluated multiple neurodegenerative pathologies concurrently. Methods: The Ontario Neurodegenerative Disease Research Initiative recruited individuals with Alzheimer’s disease (AD), mild cognitive impairment (MCI), amyotrophic lateral sclerosis (ALS), frontotemporal dementia, progressive supranuclear palsy, or Parkinson’s disease (PD). Patients (n=274, age 40-86) and healthy controls (n=101, age 55-86) viewed 10 minutes of frequently changing video clips without instruction while their eyes were tracked. We evaluated differences in saccade and pupil parameters (e.g. saccade frequency and amplitude, pupil size, responses to clip changes) between groups. Results: Preliminary data indicates low-level behavioural alterations in multiple disease cohorts: increased centre bias, lower overall saccade rate and reduced saccade amplitude. After clip changes, patient groups generally demonstrated lower saccade rate but higher microsaccade rate following clip change to varying degrees. Additionally, pupil responses were blunted (AD, MCI, ALS) or exaggerated (PD). Conclusions: This task may generate behavioural biomarkers even in cognitively impaired populations. Future work should explore the possible effects of factors such as medication and disease stage.

Quantifying the marine radiocarbon reservoir effect, offsets (ΔR), and ΔR variability over time is critical to improving dating estimates of marine samples while also providing a proxy of water mass dynamics. In the northeastern Pacific, where no high-resolution time series of ΔR has yet been established, we sampled radiocarbon (14C) from exactly dated growth increments in a multicentennial chronology of the long-lived bivalve, Pacific geoduck (Paneopea generosa) at the Tree Nob site, coastal British Columbia, Canada. Samples were taken at approximately decadal time intervals from 1725 CE to 1920 CE and indicate average ΔR values of 256 ± 22 years (1σ) consistent with existing discrete estimates. Temporal variability in ΔR is small relative to analogous Atlantic records except for an unusually old-water event, 1802–1812. The correlation between ΔR and sea surface temperature (SST) reconstructed from geoduck increment width is weakly significant (r2 = .29, p = .03), indicating warm water is generally old, when the 1802–1812 interval is excluded. This interval contains the oldest (–2.1σ) anomaly, and that is coincident with the coldest (–2.7σ) anomalies of the temperature reconstruction. An additional 32 14C values spanning 1952–1980 were detrended using a northeastern Pacific bomb pulse curve. Significant positive correlations were identified between the detrended 14C data and annual El Niño Southern Oscillation (ENSO) and summer SST such that cooler conditions are associated with older water. Thus, 14C is generally relatively stable with weak, potentially inconsistent associations to climate variables, but capable of infrequent excursions as illustrated by the unusually cold, old-water 1802–1812 interval.

Background: Eye movements reveal neurodegenerative disease processes due to overlap between oculomotor circuitry and disease-affected areas. Characterizing oculomotor behaviour in context of cognitive function may enhance disease diagnosis and monitoring. We therefore aimed to quantify cognitive impairment in neurodegenerative disease using saccade behaviour and neuropsychology. Methods: The Ontario Neurodegenerative Disease Research Initiative recruited individuals with neurodegenerative disease: one of Alzheimer’s disease, mild cognitive impairment, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, or cerebrovascular disease. Patients (n=450, age 40-87) and healthy controls (n=149, age 42-87) completed a randomly interleaved pro- and anti-saccade task (IPAST) while their eyes were tracked. We explored the relationships of saccade parameters (e.g. task errors, reaction times) to one another and to cognitive domain-specific neuropsychological test scores (e.g. executive function, memory). Results: Task performance worsened with cognitive impairment across multiple diseases. Subsets of saccade parameters were interrelated and also differentially related to neuropsychology-based cognitive domain scores (e.g. antisaccade errors and reaction time associated with executive function). Conclusions: IPAST detects global cognitive impairment across neurodegenerative diseases. Subsets of parameters associate with one another, suggesting disparate underlying circuitry, and with different cognitive domains. This may have implications for use of IPAST as a cognitive screening tool in neurodegenerative disease.

Background: Candida auris is an emerging multidrug-resistant yeast that is transmitted in healthcare facilities and is associated with substantial morbidity and mortality. Environmental contamination is suspected to play an important role in transmission but additional information is needed to inform environmental cleaning recommendations to prevent spread. Methods: We conducted a multiregional (Chicago, IL; Irvine, CA) prospective study of environmental contamination associated with C. auris colonization of patients and residents of 4 long-term care facilities and 1 acute-care hospital. Participants were identified by screening or clinical cultures. Samples were collected from participants’ body sites (eg, nares, axillae, inguinal creases, palms and fingertips, and perianal skin) and their environment before room cleaning. Daily room cleaning and disinfection by facility environmental service workers was followed by targeted cleaning of high-touch surfaces by research staff using hydrogen peroxide wipes (see EPA-approved product for C. auris, List P). Samples were collected immediately after cleaning from high-touch surfaces and repeated at 4-hour intervals up to 12 hours. A pilot phase (n = 12 patients) was conducted to identify the value of testing specific high-touch surfaces to assess environmental contamination. High-yield surfaces were included in the full evaluation phase (n = 20 patients) (Fig. 1). Samples were submitted for semiquantitative culture of C. auris and other multidrug-resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase–producing Enterobacterales (ESBLs), and carbapenem-resistant Enterobacterales (CRE). Times to room surface contamination with C. auris and other MDROs after effective cleaning were analyzed. Results: Candida auris colonization was most frequently detected in the nares (72%) and palms and fingertips (72%). Cocolonization of body sites with other MDROs was common (Fig. 2). Surfaces located close to the patient were commonly recontaminated with C. auris by 4 hours after cleaning, including the overbed table (24%), bed handrail (24%), and TV remote or call button (19%). Environmental cocontamination was more common with resistant gram-positive organisms (MRSA and, VRE) than resistant gram-negative organisms (Fig. 3). C. auris was rarely detected on surfaces located outside a patient’s room (1 of 120 swabs; <1%). Conclusions: Environmental surfaces near C. auris–colonized patients were rapidly recontaminated after cleaning and disinfection. Cocolonization of skin and environment with other MDROs was common, with resistant gram-positive organisms predominating over gram-negative organisms on environmental surfaces. Limitations include lack of organism sequencing or typing to confirm environmental contamination was from the room resident. Rapid recontamination of environmental surfaces after manual cleaning and disinfection suggests that alternate mitigation strategies should be evaluated.

Funding: None

Disclosures: None

Recent excavations by the Ancient Southwest Texas Project of Texas State University sampled a previously undocumented Younger Dryas component from Eagle Cave in the Lower Pecos Canyonlands of Texas. This stratified assemblage consists of bison (Bison antiquus) bones in association with lithic artifacts and a hearth. Bayesian modeling yields an age of 12,660–12,480 cal BP, and analyses indicate behaviors associated with the processing of a juvenile bison and the manufacture and maintenance of lithic tools. This article presents spatial, faunal, macrobotanical, chronometric, geoarchaeological, and lithic analyses relating to the Younger Dryas component within Eagle Cave. The identification of the Younger Dryas occupation in Eagle Cave should encourage archaeologists to revisit previously excavated rockshelter sites in the Lower Pecos and beyond to evaluate deposits for unrecognized, older occupations.

The state courts of last resort are vital components of American judicial system, disposing of many important legal matters. The chief justices of these courts serve consequential roles in these institutions. Although scholars have examined the selection and duties of states' chief justices, their interactions with the elected branches are understudied. We focus on how chief justices on state high courts use their roles to encourage judicial reform. Specifically, we examine the determinants of chief justices' successes or failures as advocates for their justice systems. To analyze why chief justices succeed or fail as reform advocates, we analyze the fate of reform proposals offered in state of the judiciary addresses. Our results indicate that greater ideological similarity between the state legislature and chief justice or state supreme court median increases the odds of an agenda item being enacted. We also find that the scope of a policy request influences the likelihood it will be granted.

Essential variables to consider for an efficient control strategy for invasive plants include dispersion pattern (i.e., satellite or invasion front) and patch expansion rate. These variables were demonstrated for buffelgrass [Pennisetum ciliare (L.) Link], a C4 perennial grass introduced from Africa, which has invaded broadly around the world. The study site was along a roadway in southern Arizona (USA). The P. ciliare plant distributions show the pattern of clumping associated with the satellite (nascent foci) colonization pattern (average nearest neighbor test, z-score −47.2, P<0.01). The distance between patches ranged from 0.743 to 12.8 km, with an average distance between patches of 5.6 km. Median patch expansion rate was 271% over the 3-yr monitoring period versus 136% found in other studies of established P. ciliare patches. Targeting P. ciliare satellite patches as a control strategy may exponentially reduce the areal doubling time, while targeting the largest patches may have less effect on the invasion speed.

The epidemic of prescription and non-prescription opioid misuse is of particular importance in pregnancy. The Society of Obstetricians and Gynaecologists of Canada currently recommends opioid replacement therapy with methadone or buprenorphine for opioid-dependent women during pregnancy. This vulnerable segment of the population has been shown to be at increased risk of blood-borne infectious diseases, nutritional insecurity and stress. The objective of this study was to describe an urban cohort of pregnant women on opioid replacement therapy and to evaluate potential effects on the fetus. A retrospective chart review of all women on opioid replacement therapy and their infants who delivered at The Ottawa Hospital General and Civic campuses between January 1, 2013 and March 24, 2017 was conducted. Data were collected on maternal characteristics, pregnancy outcomes, neonatal outcomes and corresponding placental pathology. Maternal comorbidities identified included high rates of infection, tobacco use and illicit substance use, as well as increased rates of placental abruption compared with national averages. Compared with national baseline averages, the mean neonatal birth weight was low, and the incidence of small for gestational age infants and congenital anomalies was high. The incidence of NAS was comparable with estimates from other studies of similar cohorts. Findings support existing literature that calls for a comprehensive interdisciplinary risk reduction approach including dietary, social, domestic, psychological and other supports to care for opioid-dependent women in pregnancy.