Impact of an International Training on Interventionists' Expertise in Cleft Palate Speech: Results From Oaxaca, Mexico

PURPOSE

International cleft lip and palate surgical charities recognize that speech therapy is essential for successful care of individuals after palate repair. The challenge is how to ensure that cleft speech interventionists (i.e., speech-language pathologists and other speech therapy providers) provide quality care. This exploratory study investigated effects of a two-stage cleft training in Oaxaca, Mexico, aimed at preparing speech interventionists to provide research-based services to individuals born with cleft palate. Changes in the interventionists' content knowledge and clinical skills were examined.

METHOD

Twenty-three cleft speech interventionists from Mexico, Guatemala, and Nicaragua participated in a hybrid two-stage training, completing an online Spanish cleft speech course and a 5-day in-person training in Oaxaca. In-person training included a didactic component and supervised clinical practice with 14 individuals with repaired cleft palates. Testing of interventionists' content knowledge and clinical skills via questionnaires occurred before the online course (Test 1), immediately before in-person training (Test 2), and immediately after in-person training (Test 3). Qualitative data on experience/practice were also collected.

RESULTS

Significant increases in interventionists' overall content knowledge and clinical skills were found posttraining. Knowledge and clinical skills increased significantly between Tests 1 and 2. Clinical skills, but not knowledge, showed further significant increases between Tests 2 and 3. Posttraining, interventionists demonstrated greater expertise in research-based treatment, and fewer reported they would use nonspeech oral motor exercises (NSOME).

CONCLUSIONS

Findings provide preliminary support for such two-stage international trainings in preparing local speech interventionists to deliver high-quality speech services to individuals born with cleft palate. While content knowledge appears to be acquired primarily from the online course, the two-stage training incorporating in-person supervised practice working with individuals born with cleft palate may best enhance continued clinical skill development, including replacement of NSOME with evidence-based speech treatment. Such trainings contribute to building capacity for sustainable quality services for this population in underresourced regions.

Impact of heat and a rest-shade-hydration intervention program on productivity of piece-paid industrial agricultural workers at risk of chronic kidney disease of nontraditional origin

OBJECTIVES

Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined.

METHODS

We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18-29, 30-44, and >45 years), sex, WBGT (<28, 28-29, 29-30, 30-31, and >31 °C) on the same and preceding day, harvest season (2017-18 to 2021-22), month, and acclimatization status (<1, 1-2, and >2 weeks).

RESULTS

There was an inverse dose-response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC.

CONCLUSION

Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity.

Analysis of recent land management initiatives in Nicaragua from the perspective of the "ecosystem approach"

In the world there are approximately 608 million farms, of which 84% are small farms and produce 35% of the food of the world population. Training programs have been promoted by different organizations to achieve a more sustainable and efficient agricultural practice. Within this context, this article has classified a set of smallholders located in central Nicaragua with regard to how they apply Land Use Management Initiatives (LUMI). The aim is to outline their weaknesses and strengths and thus identify key elements that can contribute to improving soil resource management. We focus on the LUMI carried out in Nicaragua in the municipalities of El Tuma-La Dalia, El Cuá and Waslala between 1992 and 2022. To conduct this study, eight LUMI were identified and analysed, and 25 indicators linked to the Malawi Principles were extracted and selected for the design of a survey in order to collect land use management information from 455 farms in the study area. Simple random sampling was used to select the farms. Subsequently, the collected data were analysed using descriptive statistics and Multivariate Analysis techniques. The results reveal that in the study area, the LUMI incorporate between one and five Malawi Principles. The multivariate analysis techniques employed identified three clusters of farms, with either Active, Moderate or Improvable ecosystem management. The study area as a whole displays strengths in social participation, local capacity building, soil and environmental conservation practices, with the farm as the main source of income. Weaknesses lie in the fact that indicators referring to household income and productivity are less frequent. In terms of farm management, the results revealed that combined male and female management was similar in percentage to male-only management. The results highlight the need to continue with the implementation of environmental goals linked to the design of initiatives that promote productivity, income and gender equity in farm management in an integrated manner. At the same time, existing local capacities for sustainable soil and ecosystem management should be brought together and strengthened.

Resilience in children and youth in street situations in León, Nicaragua

There are tens of millions of children and youth in street situations (CYSS) worldwide, the majority of whom are males living in low- and middle-income countries. Many of these children demonstrate impressive adaptability and resilience. The focus of the current research was on the resilience of male CYSS in León, Nicaragua. Qualitative data were collected through individual interviews and focus groups with CYSS, their family members, community members, and staff of a local nonprofit, with the objective of exploring and consolidating local understandings of resilience. Grounded theory analysis of qualitative data yielded a context-specific conceptual model of resilience as it pertains to CYSS in León. Six qualities were identified to represent the experience of resilience in this group: agency, belonging, flexibility, protection, self-regulation, and self-worth. The knowledge generated from this research can serve as a foundation to develop and implement resilience-promoting interventions for CYSS.

Moral reasoning about gang violence in context: A comparative study with children and adolescents exposed to maras in Honduras and not exposed in Nicaragua

This study examined how youth morally deliberate about conditions of gang violence shaping their communities. Participants (N = 80; 10-11 and 14-15 years; 50% female) exposed to gangs (maras) in Honduras and not exposed to maras in Nicaragua evaluated hypothetical situations of physical harm in contexts of chronic gang violence. Results indicated that mara-exposed youth were more likely to endorse harming a rival gang member in some contexts, but not others. Moreover, in some contexts, males were more likely to endorse harming others as necessary. Few age differences emerged, suggesting comparability among children and adolescents. Discussion focuses on how children and adolescents coordinate different moral and social concepts and concerns pertaining to acts of physical harm in situations involving gangs.

Continental fishes of Nicaragua: diversity, distribution and conservation status; with an annotated and illustrated checklist of species and an identification guide to families

Based on a combination of intensive literature review, electronic database searches, re-identification of museum specimens, and fieldwork, we provide an updated checklist of the continental fishes of Nicaragua. This checklist, systematically arranged at the ordinal and familial level, includes nomenclatural revisions, distributional information, conservation status, and when appropriate, cross-references to previous lists and revisionary works on the fish fauna of the country and region (Central America); illustrations and descriptions to the family level and color photographs of some representative species are also included. According to our results, the native Nicaraguan continental fish fauna is composed of 244 species, divided into 111 genera, 45 families, 24 orders, and two classes; increasing by 60 (i.e., 32.6%) the number of species originally reported by Villa (1982; i.e., the most comprehensive work published to date). The majority of the Nicaraguan native continental fish species, according to their supposed tolerance to salinity, are peripheral (68.9%), followed by secondary freshwater fishes (23.8%), and primary freshwater fishes (only 7.4%). Fish diversity in the 19 major river basins ranged between 21 and 90 species (mean = 58 species, median = 60); the Escondido (Es; 87 species), in the Atlantic, and the Pacfico de Nicaragua (PN; 90), in the Pacific, presented the highest species richness. Most species (188) are restricted to elevations between 0 and 100 meters above sea level (masl); only a few species (18), in contrast, were found at elevations greater than 500 masl (up to 780 masl). Fourteen species in this revision are listed as endemic to Nicaragua. Regarding their conservation status, 22 species (9.0%) are categorized, according to the International Union for Conservation of Nature (IUCN), as Data Deficient, 186 (76.2%) as Least Concern, and seven (2.9%) as Near Threatened; while 24 species (9.8%) are listed as Threatened, thirteen (5.3%) as Vulnerable, two (0.8%) as Endangered, and nine (3.7%) as Critically Endangered. Five species (2.0%) have not yet been evaluated. Six exotic species are also reported. Our results provide a framework for future taxonomic and biogeographic works on fishes from this country and region (Central America), particularly by providing up-to-date knowledge on nomenclature and distributions. In addition, the data provided in this revision will help to monitor fish distributional changes in the future due to human introductions and global change and will aid in conservation decisions concerning Nicaraguan continental fishes.

Developing the agroecological niche in Nicaragua: The roles of knowledge flows and intermediaries

Supporting transitions to sustainable, resilient agri-food systems is important to ensure stable food supply in the face of growing climate extremes. Agroecology, or diversified farming systems based on ecological principles, can contribute to such systems. Based on a qualitative case study of Nicaragua, a forerunner in agroecology, this paper unpacks an ongoing transition to agroecology, focusing on how the transition has been shaped by knowledge flows and intermediary actors. Using a niche development framework based on knowledge processes, we analyze the growth of the agroecological niche in Nicaragua over three phases of niche development. The findings show how knowledge processes' emphases have shifted over time, as have functions enacted by intermediaries. Dedicated, diversified intermediaries have been key in creating momentum for agroecology, as have individual actors moving between niche and regime. Agency in niche development has come from both niche and regime actors. Finally, we find that Nicaragua's transition to agroecology has been ambiguous: While the niche has succeeded in changing the mainstream selection environment to its favor in some arenas, transition dynamics lag in others. Drawing lessons from this ambiguity, we suggest entry points for broader systems change, such as market stimulation, value chain development, phase-out policies, and supportive policy in related arenas. We also point out possible actions for niche actors such as integration of financial and commercial actors into niches and creation of dedicated market-focused intermediaries. Our results provide evidence of an ongoing transition and action points for supporting niche development in (sustainable agri-food) transitions around the globe.

Household environment and animal fecal contamination are critical modifiers of the gut microbiome and resistome in young children from rural Nicaragua

BACKGROUND

Early life plays a vital role in the development of the gut microbiome and subsequent health. While many factors that shape the gut microbiome have been described, including delivery mode, breastfeeding, and antibiotic use, the role of household environments is still unclear. Furthermore, the development of the gut antimicrobial resistome and its role in health and disease is not well characterized, particularly in settings with water insecurity and less sanitation infrastructure.

RESULTS

This study investigated the gut microbiome and resistome of infants and young children (ages 4 days-6 years) in rural Nicaragua using Oxford Nanopore Technology's MinION long-read sequencing. Differences in gut microbiome diversity and antibiotic resistance gene (ARG) abundance were examined for associations with host factors (age, sex, height for age z-score, weight for height z-score, delivery mode, breastfeeding habits) and household environmental factors (animals inside the home, coliforms in drinking water, enteric pathogens in household floors, fecal microbial source tracking markers in household floors). We identified anticipated associations of higher gut microbiome diversity with participant age and vaginal delivery. However, novel to this study were the significant, positive associations between ruminant and dog fecal contamination of household floors and gut microbiome diversity. We also identified greater abundance of potential pathogens in the gut microbiomes of participants with higher fecal contamination on their household floors. Path analysis revealed that water quality and household floor contamination independently and significantly influenced gut microbiome diversity when controlling for age. These gut microbiome contained diverse resistome, dominated by multidrug, tetracycline, macrolide/lincosamide/streptogramin, and beta-lactam resistance. We found that the abundance of ARGs in the gut decreased with age. The bacterial hosts of ARGs were mainly from the family Enterobacteriaceae, particularly Escherichia coli.

CONCLUSIONS

This study identified the role of household environmental contamination in the developing gut microbiome and resistome of young children and infants with a One Health perspective. We found significant relationships between host age, gut microbiome diversity, and the resistome. Understanding the impact of the household environment on the development of the resistome and microbiome in early life is essential to optimize the relationship between environmental exposure and human health. Video Abstract.

Migratory destinations and spatial structuring of humpback whales (Megaptera novaeangliae) wintering off Nicaragua

Understanding the migratory patterns of large whales is of conservation importance, especially in identifying threats to specific populations. Migration ecology, including migratory destinations, movements and site fidelity for humpback whales (Megaptera novaeangliae) remain poorly studied in parts of the range of the Central America population, considered endangered under the United States Endangered Species Act. This study aimed to investigate the migratory destinations of humpback whales sighted at two study sites in Nicaragua, which are part of the Central America population. A ten-year photographic database of humpback whales observed off Nicaragua was combined with citizen science contributions and sightings from dedicated research programs. The resulting image collection was compared with available historical photo identifications and databases using an automated image recognition algorithm. This approach yielded 36 years of photographic identification totaling 431 recaptures in Nicaragua (2006-2008 and 2016-2021) and 2539 recaptures (1986-2020) in both feeding and breeding grounds of 176 unique individuals sighted in Nicaragua. Our results showed that photo-identified whales were recaptured between October and April in breeding grounds and year-round in feeding grounds between British Columbia and California, with peak recaptures between June and October. Our study provided first-time evidence on fine-scale site affinity of individual humpback whales within Nicaraguan waters and to other breeding and feeding grounds.

A Causal Mediation Analysis for Investigating the Effect of a Randomized Cash-Transfer Program in Nicaragua

Mediation analysis can be applied to data from randomized trials of health and social interventions to draw causal inference concerning their mechanisms. We used data from a cluster-randomized trial in Nicaragua, fielded between 2000 and 2002, to investigate whether the impact of providing access to a conditional cash-transfer program on child nutritional outcomes was mediated by child health check-ups and household dietary diversity. In a sample of 443 children 6-35 months old, we estimated the controlled direct (CDE) effect of random assignment on measured height-for-age z scores had we intervened so that all children received a health check-up and had the same level of household dietary diversity, using inverse-probability weighted marginal structural models to account for mediator-outcome confounding. Sensitivity analyses corrected the CDE for potential nondifferential error in the measurement of dietary diversity. Treatment assignment increased height-for-age z score by 0.37 (95% CI: 0.05, 0.69) standard deviations. The CDE was 0.20 (95% CI: -0.17, 0.57) standard deviations, suggesting nearly one-half of the program's impact on child nutrition would be eliminated had we intervened on these factors, although estimates were relatively imprecise. This study provides an illustration of how causal mediation analysis can be applied to examine the mechanisms of multifaceted interventions.

The vulnerability of women living homeless in Nicaragua: A comparison between homeless women and men in a low-income country

This article takes a gender perspective approach to a series of issues that may affect the vulnerability of people in a homeless situation in Nicaragua, focusing particularly on women. The study was completed using data obtained from two similarly-sized samples, one of homeless men (n = 32) and the other of homeless women (n = 30). The information was gathered using a structured interview. Results show that there are key similarities in the situation and characteristics of both men and women living homeless in Nicaragua. Results also support the thought that women living homeless - some with dependent children to care for - are in a situation of particular vulnerability, suffering violence, a greater need to find safe places to stay, greater "revolving door to homelessness," more barriers to finding work and more sex work. The analysis of the issues differentiating men from women may be of use in driving forward public policies and social care resources adapted to the specific characteristics and needs of these women and their children. As can be taken from this paper, people living homeless in low-income and high-income countries share a number of similar circumstances, which in turn could facilitate a global approach to the problem.

Africanized honeybee population (Apis mellifera L.) in Nicaragua: Forewing length and mitotype lineages

Various subspecies of Apis mellifera L. were introduced to Central America since colonization 500 years ago. Hybridization increased with the entrance of the Africanized bee in Nicaragua in 1984. Rustic beekeeping activities and numerous feral swarms define the genetic pattern, reflected in phenotypic heterogeneity and remarkable differences in the behaviour of the bee colonies, especially the nest defence. Due to these facts, the question emerge about the degree of Africanization of honeybee colonies in Nicaragua. In this study, we identified Africanized honeybee colonies based on the single character "mean forewing length" and we corroborated our results by determining mitotypes using mtDNA analysis. Morphometric and genetic approaches were realized in three different geographical zones of Nicaragua and related to beehive characteristics and management. Worker bee samples were taken from the inside of 146 hives from 26 apiaries. Abdominal colour as phenotypic character was the first examination, followed by measurement of 1460 right forewings to determine corresponding probability of Africanization. More than 60% of the beehives showed phenotypic heterogeneity and mean forewing length of 8.74 mm (SD 0.16 mm) indicated a high degree of Africanization. Those results provided a selection of 96 worker bees to perform PCR of two worker bees per hive. For mitochondrial DNA analysis 14 samples from sentinel apiaries were added. Three from 61 beehives presented bees with different mtDNA. Throughout, three mitotypes of the African (A) lineage were detected; one mitotype is still unidentified. Mitotype A1 A. mellifera iberiensis was represented by 88 bees and mitotype A4 A. mellifera scutellata by 21 bees. Phylogenetic analysis confirmed the PCR findings. No associations were found between mitotypes, forewing length, beehive characteristics and management. A high degree of Africanization in A. mellifera colonies represented by two predominating mitotypes from the A lineage, prevail in Neotropical Nicaragua, with mitotype A4 predominating at higher altitudes.

Resource users as land-sea links in coastal and marine socioecological systems

Coastal zones, which connect terrestrial and aquatic ecosystems, are among the most resource-rich regions globally and home to nearly 40% of the global human population. Because human land-based activities can alter natural processes in ways that affect adjacent aquatic ecosystems, land-sea interactions are increasingly recognized as critical to coastal conservation planning and governance. However, the complex socioeconomic dynamics inherent in coastal and marine socioecological systems (SESs) have received little consideration. Drawing on knowledge generalized from long-term studies in Caribbean Nicaragua, we devised a conceptual framework that clarifies the multiple ways socioeconomically driven behavior can link the land and sea. In addition to other ecosystem effects, the framework illustrates how feedbacks resulting from changes to aquatic resources can influence terrestrial resource management decisions and land uses. We assessed the framework by applying it to empirical studies from a variety of coastal SESs. The results suggest its broad applicability and highlighted the paucity of research that explicitly investigates the effects of human behavior on coastal SES dynamics. We encourage researchers and policy makers to consider direct, indirect, and bidirectional cross-ecosystem links that move beyond traditionally recognized land-to-sea processes.

Is a downwards head tilt a cross-cultural signal of dominance? Evidence for a universal visual illusion

The present pre-registered research provides the first evidence that a downwards head tilt is sufficient to communicate dominance from a neutral facial expression among the Mayangna, members of an unindustrialized, small-scale traditional society in Nicaragua who have had minimal exposure to North American culture. Consistent with the Action Unit imposter effect observed in North American populations (Witkower and Tracy in Psychol Sci 30:893-906, 2019), changes to the appearance of the upper face caused by a downwards head tilt were sufficient to elicit perceptions of dominance among this population. Given that the Mayangna are unlikely to associate a downwards head tilt or related apparent facial changes with dominance as a result of cross-cultural learning, the present results suggest that perceptions of dominance formed from a downwards head tilt, and the visual illusion shaping these perceptions, are a widely generalizable, and possibly universal, feature of human psychology.

Unhappiness and casual attributions of homelessness among people living homeless in León (Nicaragua)

Nicaragua is one of the countries with the lowest levels of development in Latin America, with a collectivist culture, where information on people in a homeless situation is very limited. The study examines a sample of people living homeless in the city of León (Nicaragua), their level of overall happiness, their future expectations, their perception of the evolution of their situation, their causal attributions of homelessness, and the aspects they believe are most important for overcoming their situation. Forty-one of the 68 homeless people contacted in León (Nicaragua) responded to a structured interview. The results show that the interviewees reported very low levels of overall happiness, although their future expectations were positive. The interviewees attributed homelessness situation (their own and other people's) primarily to individualistic causes and problems in family relationships, and they had a tendency to consider both themselves and other people living homeless responsible for their homelessness. The results are compared to the data obtained using similar methodologies and instruments for people living homeless in Madrid (Spain) and trash pickers in León (Nicaragua)-two groups in situations of extreme poverty and social exclusion.

Design and evaluation of a teacher-training program

The article exposes the process of design and implementation of a training program for teachers that teach people with Visual Functional Diversity (VFD), taking into account their needs both in training and in the provision of resources in Nicaragua. To verify the effectiveness of the program, a quasi-experimental design was carried out with a non-equivalent pretest and posttest control group. The experimental group received training while the control group did not receive training. The evaluation of the results obtained after the application of the program was carried out through two instruments: an efficacy questionnaire and a satisfaction questionnaire. The results showed significant differences between the experimental and control group after the application of the program (Z = -4,383; p = 0.000) in favor of the experimental group. It is confirmed that the program is effective in training teachers on inclusive education for the visually impaired as the teachers who took part in the training program significantly increased their knowledge in that issue.

Morphotype and haplotype identification of Varroa destructor (Acari: Varroidae), and its importance for apiculture in Nicaragua

The ectoparasite Varroa (Acari: Varroidae) is considered to be the main pest of honey bees (Apis mellifera L.) in Nicaragua. The aim of this study was to determine morphotypes and mitochondrial haplotypes of the Varroa mites, related to infestation levels in A. mellifera hives in Nicaragua in a cross-sectional study (2013-2016). Samples were taken from 34 sentinel apiaries in five geographical zones; from 713 Varroa females collected during the study, 153 were selected for measurement of various morphometric characters for further classification into morphotypes. The mitochondrial haplotype was assigned to one of the two (Korean or Japanese), using the restriction by SacI of the PCR product of a fragment of the gene CO-I. Morphometric measurement and sequencing revealed the affiliation to the species Varroa destructor with a mean (± SD) body width of 1699.1 ± 60.2 µm and a body length of 1161.1 ± 34.9 µm. Body characters were significantly different among the 34 apiaries. Varroa destructor samples were classified into four morphotypes, with no significant differences in the geographical zones. As GAGCTC SacI enzyme cleavage sequences were not observed, all PCR products were identified as V. destructor Korean haplotype. The CO-I gene nucleotide sequences from two samples V. destructor showed both 100% similarity with the Korean haplotype and 99.8% similarity to the Japanese haplotype. Although the V. destructor mite was identified as a Korean haplotype, host-parasite association in 2 decades has led into a balance without entering into severe losses in the Nicaraguan apiculture.

Impacts of sediment derived from erosion of partially-constructed road on aquatic organisms in a tropical river: The Río San Juan, Nicaragua and Costa Rica

Throughout the humid tropics, increased land disturbance and concomitant road construction increases erosion and sediment delivery to rivers. Building road networks in developing countries is commonly a priority for international development funding based on anticipated socio-economic benefits. Yet the resulting erosion from roads, which recent studies have shown result in at least ten-fold increases in erosion rates, is not fully accounted for. While effects of road-derived sediment on aquatic ecosystems have been documented in temperate climates, little has been published on the effects of road-induced sediment on aquatic ecosystems in developing countries of the tropics. We studied periphyton biomass and macroinvertebrate communities on the deltas of Río San Juan tributaries, comparing north-bank tributaries draining undisturbed rain forest with south-bank tributaries receiving runoff from a partially-built road experiencing rapid erosion. Periphyton biomass, richness and abundance of macroinvertebrates overall, and richness and abundance of Ephemeroptera, Plecoptera and Trichoptera were higher on the north-bank tributary deltas than the south-bank tributary deltas. These findings were consistent with prior studies in temperate climates showing detrimental effects of road-derived fine sediment on aquatic organisms. A Non-Metric Multidimensional Scaling (NMDS) analysis showed the impacted community on the south-bank deltas was influenced by poorly-sorted substrate with greater proportions of fine sediment and higher water temperatures.

Parallel and non-parallel changes of the gut microbiota during trophic diversification in repeated young adaptive radiations of sympatric cichlid fish

BACKGROUND

Recent increases in understanding the ecological and evolutionary roles of microbial communities have underscored the importance of their hosts' biology. Yet, little is known about gut microbiota dynamics during the early stages of ecological diversification and speciation. We sequenced the V4 region of the 16s rRNA gene to study the gut microbiota of Nicaraguan Midas cichlid fish (Amphilophus cf. citrinellus). Specifically, we tested the hypothesis that parallel divergence in trophic ecology in extremely young adaptive radiations from two crater lakes is associated with parallel changes of their gut microbiota.

RESULTS

Bacterial communities of fish guts and lake water were highly distinct, indicating that the gut microbiota is shaped by host-specific factors. Among individuals of the same crater lake, differentiation in trophic ecology was weakly associated with gut microbiota differentiation, suggesting that diet, to some extent, affects the gut microbiota. However, differences in trophic ecology were much more pronounced across than within species whereas similar patterns were not observed for taxonomic and functional differences of the gut microbiota. Across the two crater lakes, we could not detect conclusive evidence for parallel changes of the gut microbiota associated with trophic ecology.

CONCLUSIONS

A lack of clearly differentiated niches during the early stages of ecological diversification might result in non-parallel changes of gut microbial communities, as observed in our study system as well as in other recently diverged fish species. Video Abstract.

Primary and Secondary Dengue Virus Infections Elicit Similar Memory B-Cell Responses, but Breadth to Other Serotypes and Cross-Reactivity to Zika Virus Is Higher in Secondary Dengue

BACKGROUND

The 4 antigenically distinct serotypes of dengue virus (DENV) share extensive homology with each other and with the closely related Zika flavivirus (ZIKV). The development of polyclonal memory B cells (MBCs) to the 4 DENV serotypes and ZIKV during DENV infection is not fully understood.

METHODS

In this study, we analyzed polyclonal MBCs at the single-cell level from peripheral blood mononuclear cells collected ~2 weeks or 6-7 months postprimary or postsecondary DENV infection from a pediatric hospital-based study in Nicaragua using a Multi-Color FluoroSpot assay.

RESULTS

Dengue virus elicits robust type-specific and cross-reactive MBC responses after primary and secondary DENV infection, with a significantly higher cross-reactive response in both. Reactivity to the infecting serotype dominated the total MBC response. Although the frequency and proportion of type-specific and cross-reactive MBCs were comparable between primary and secondary DENV infections, within the cross-reactive response, the breadth of MBC responses against different serotypes was greater after secondary DENV infection. Dengue virus infection also induced cross-reactive MBC responses recognizing ZIKV, particularly after secondary DENV infection.

CONCLUSIONS

Overall, our study sheds light on the polyclonal MBC response to DENV and ZIKV in naive and DENV-preimmune subjects, with important implications for natural infections and vaccine development.

Evaluation of consistent use, barriers to use, and microbiological effectiveness of three prototype household water treatment technologies in Haiti, Kenya, and Nicaragua

Household water treatment (HWT) can improve drinking water quality and reduce diarrheal disease. New HWT technologies are typically evaluated under ideal conditions; however, health gains depend on consistent, effective household use, which is less often evaluated. We conducted four evaluations of three prototype HWT technologies: two filters and one electrochlorinator. Evaluations consisted of a baseline survey, HWT distribution to households (ranging from 60 to 82), and four visits (ranging from 1 week-14 months after distribution). Each visit included a survey, observation of treated water presence (confirmed use), and microbiological analysis of treated and untreated samples for E. coli. Consistent use was defined as the proportion of total visits with confirmed use. Overall, confirmed use declined 2.54% per month on average, and 2-72% of households demonstrated 100% consistent use. Consistent use was positively associated with baseline HWT knowledge and practice and belief that drinking water was unsafe, and negatively associated with technological problems. Reported barriers to use were behavioral, such as forgetting or when outside the home, and technological failures. Technologies demonstrated 68-96% E. coli reductions, with 18-70% of treated samples having detectable E. coli. Results highlight the importance of household use evaluations within prototype HWT technology design cycles, the need for standard evaluation metrics, and difficulties in achieving both consistent use and microbiological effectiveness with HWT technologies.

Antibody-Dependent Enhancement of Severe Disease Is Mediated by Serum Viral Load in Pediatric Dengue Virus Infections

BACKGROUND

Low preexisting anti-dengue virus (DENV) antibody levels are associated with elevated disease severity. While antibody-dependent enhancement of dengue is thought to be driven by viral load, this has not been conclusively shown. We evaluated the association between preinfection anti-DENV antibody titers, viral load, and disease severity among 133 dengue cases in a Nicaraguan pediatric cohort study.

METHODS

Viral load was quantified in acute-phase serum by real-time reverse transcription polymerase chain reaction and analyzed in relation to preinfection antibody titer (measured by inhibition enzyme-linked immunosorbent assay) and dengue severity, categorized using 3 definitions.

RESULTS

Higher viral load was significantly associated with dengue severity; for each increase of 1.0 log10 copies/mL, the odds of severe dengue increased approximately 50%, regardless of severity definition. Viral load at presentation and the odds of severe disease were highest among patients with low to intermediate preinfection antibody titers and lowest among those with the highest antibody titers. We showed the effect of preinfection antibody titer on disease severity was mediated by viral load for each of 3 dengue severity outcomes.

CONCLUSIONS

This study demonstrates the association between preinfection anti-DENV antibody titer, serum viral load, and disease severity, and provides evidence for the mechanism of antibody-dependent enhancement in dengue cases.

Characterization of antibiotic resistance and host-microbiome interactions in the human upper respiratory tract during influenza infection

BACKGROUND

The abundance and diversity of antibiotic resistance genes (ARGs) in the human respiratory microbiome remain poorly characterized. In the context of influenza virus infection, interactions between the virus, the host, and resident bacteria with pathogenic potential are known to complicate and worsen disease, resulting in coinfection and increased morbidity and mortality of infected individuals. When pathogenic bacteria acquire antibiotic resistance, they are more difficult to treat and of global health concern. Characterization of ARG expression in the upper respiratory tract could help better understand the role antibiotic resistance plays in the pathogenesis of influenza-associated bacterial secondary infection.

RESULTS

Thirty-seven individuals participating in the Household Influenza Transmission Study (HITS) in Managua, Nicaragua, were selected for this study. We performed metatranscriptomics and 16S rRNA gene sequencing analyses on nasal and throat swab samples, and host transcriptome profiling on blood samples. Individuals clustered into two groups based on their microbial gene expression profiles, with several microbial pathways enriched with genes differentially expressed between groups. We also analyzed antibiotic resistance gene expression and determined that approximately 25% of the sequence reads that corresponded to antibiotic resistance genes mapped to Streptococcus pneumoniae and Staphylococcus aureus. Following construction of an integrated network of ARG expression with host gene co-expression, we identified several host key regulators involved in the host response to influenza virus and bacterial infections, and host gene pathways associated with specific antibiotic resistance genes.

CONCLUSIONS

This study indicates the host response to influenza infection could indirectly affect antibiotic resistance gene expression in the respiratory tract by impacting the microbial community structure and overall microbial gene expression. Interactions between the host systemic responses to influenza infection and antibiotic resistance gene expression highlight the importance of viral-bacterial co-infection in acute respiratory infections like influenza. Video abstract.

Enhanced, coordinated conservation efforts required to avoid extinction of critically endangered Eastern Pacific leatherback turtles

Failure to improve the conservation status of endangered species is often related to inadequate allocation of conservation resources to highest priority issues. Eastern Pacific (EP) leatherbacks are perhaps the most endangered sea turtle population in the world, and continue on a path to regional extinction. To provide coherent, regional conservation targets, we developed a population viability analysis and examined hypothetical scenarios describing effects of conservation activities that either reduced mortality or increased production of hatchlings (or both). Under status quo conditions, EP leatherbacks will be extirpated in <60 yr. To ensure a positive, long-term population trajectory, conservation efforts must increase adult survivorship (i.e., reduce adult mortality) by ≥20%, largely through reduction of fisheries bycatch mortality. Positive trajectories can be accelerated by increased production of hatchlings through enhanced nest protection and treatment. We estimate that these efforts must save approximately 200-260 adult and subadult leatherbacks and produce approximately 7,000-8,000 more hatchlings annually. Critically, reductions in late-stage mortality must begin within 5 years and reach 20% overall within the next 10-15 years to ensure population stabilization and eventual increase. These outcomes require expanded, sustained, coordinated, high-priority efforts among several entities working at multiple scales. Fortunately, such efforts are underway.

Cost-effectiveness of community mobilization (Camino Verde) for dengue prevention in Nicaragua and Mexico: A cluster randomized controlled trial

BACKGROUND

We assessed the cost-effectiveness of Camino Verde, a community-based mobilization strategy to prevent and control dengue and other mosquito-borne diseases. A cluster-randomized controlled trial in Managua, Nicaragua, and in three coastal regions in Guerrero, Mexico (75 intervention and 75 control clusters), Camino Verde used non-governmental community health workers, called brigadistas, to support community mobilization. This donor-funded trial demonstrated reductions of 29.5% (95% confidence interval, CI: 3.8%-55.3%) on dengue infections and 24.7% (CI: 1.8%-51.2%) on self-reported cases.

METHODS

We estimated program costs through a micro-costing approach and semi-structured questionnaires. We show results as incremental cost-effectiveness ratios (ICERs) for costs per disability-adjusted life-year (DALYs) averted and conducted probabilistic sensitivity analyses.

FINDINGS

The Camino Verde trial spent US$16.72 in Mexico and $7.47 in Nicaragua per person annually. We found an average of 910 (CI: 487-1 353) and 500 (CI: 250-760) dengue cases averted annually per million population in Mexico and Nicaragua, respectively, compared to control communities. The ICER in Mexico was US$29 618 (CI: 13 869-66 898) per DALY averted, or 3.0 times per capita GDP. For Nicaragua, the ICER was US$29 196 (CI: 14294-72181) per DALY averted, or 16.9 times per capita GDP.

INTERPRETATION

Camino Verde, as implemented in the research context, was marginally cost-effective in Mexico, and not cost-effective in Nicaragua, from a healthcare sector perspective. Nicaragua's low per capita GDP and the use of grant-funded management personnel weakened the cost-effectiveness results. Achieving efficiencies by incorporating Camino Verde activities into existing public health programs would make Camino Verde cost-effective.

Reliability of Tablet-based Hearing Testing in Nicaraguan Schoolchildren: A Detailed Analysis

OBJECTIVE

Determine whether an electronic tablet-based Wireless Automated Hearing-Test System can perform high-quality audiometry to assess schoolchildren for hearing loss in the field in Nicaragua.

STUDY DESIGN

Cross-sectional.

SETTING

A school and hospital-based audiology clinic in Jinotega, Nicaragua.

SUBJECTS AND METHODS

Second and third graders (n = 120) were randomly selected for hearing testing in a school. Air conduction hearing thresholds were obtained bilaterally using a Wireless Automated Hearing-Test System at 1000, 2000, and 4000 Hz. Referral criteria were set at more than 25 dBHL at one or more frequencies. A cohort of children was retested with conventional audiometry in a hospital-based sound booth. Factors influencing false-positive examinations, including ambient noise and behavior, were examined.

RESULTS

All children with hearing loss were detected using an automated, manual, or two-step (those referred from automated testing were tested manually) protocol in the school (sensitivity = 100%). Specificity was 76% for automated testing, 97% for manual testing, and 99% for the two-step protocol. The variability between thresholds obtained with automated testing was greater than manual testing when compared with conventional audiometry. The percentage of participant responses when no stimulus tone was presented during automated testing was higher in children with false-positive examinations.

CONCLUSION

A Wireless Automated Hearing-Test System identified all children with hearing loss in a challenging field setting. A two-step protocol (those referred from automated testing are tested manually) reduced false-positive examinations and unnecessary referrals. Children who respond frequently when no tone is presented are more likely to have false-positive automated examinations and should be tested manually.

Influence of the history of abuse and suicidal attempts behavior among women victims of violence in Nicaragua

Suffering traumatic experiences linked to violence seems to be related to suicide attempts, especially, when the physical or sexual abuse has been experienced at an early age. This study examines the relationship between the history of abuse and suicide attempts among women victims of violence living in poverty in Nicaragua. This sample was subjected to a particularly serious range of stressful situations and experiences related to violence throughout their lives. The results show that women who experienced abuse during childhood were more likely to report a history of suicide attempts than women without a history of childhood abuse. Therefore, suicide attempts seem to be related more to those traumatic experiences during childhood than to violence suffered afterward. Identifying this type of abuse is particularly important because of its implications for the victims' health, as suicide attempts are maladaptive behaviors with which the women in the sample could have been addressing the trauma they experienced in their childhood. It is, therefore, necessary to highlight this problem in a developing country, which has been the focus of a limited number of studies, and where there are no support mechanisms for victims whose rights have been violated.

Age-dependent manifestations and case definitions of paediatric Zika: a prospective cohort study

BACKGROUND

Paedeatric Zika remains an understudied topic. WHO and the Pan American Health Organization (PAHO) Zika case definitions have not been assessed in children. We aimed to characterise clinical profiles and evaluate the diagnostic performance of the WHO and PAHO case definitions in a large cohort of paediatric Zika cases.

METHODS

From January, 2016 to February, 2017, encompassing the major 2016 Zika epidemic, participants in the Pediatric Dengue Cohort Study (PDCS) in Managua, Nicaragua, were encouraged to visit the study health centre at first indication of any illness. PDCS participants were aged 2-14 years, healthy at enrolment, and recruited before the initiation of the present study. Molecular and serological assays were used to test participants exhibiting any of four broad clinical profiles suspected of resulting from a symptomatic Zika virus infection. These clinical profiles were: fever and at least two of headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations, and leukopenia; fever and at least two of nausea or vomiting, rash, aches and pains, positive tourniquet test, leukopenia, and any dengue warning sign; undifferentiated fever without evident cause, with or without any other clinical finding; and afebrile rash with or without any other clinical finding. We characterised acute clinical findings (signs, symptoms, and complete blood counts) in both Zika cases and non-Zika cases.

FINDINGS

We prospectively followed a cohort of about 3700 children, of which 1110 were deemed eligible for inclusion. Four participants with laboratory-confirmed Zika (three co-infections with dengue virus, one missing complete blood count data) and two participants who were non-Zika cases (missing complete blood count data) were excluded from analysis. We analysed 556 laboratory-confirmed Zika and 548 non-Zika cases. The WHO case definition captured 176 confirmed Zika cases, and the PAHO definition 109 confirmed Zika cases, who presented with the most clinical findings and a dengue-like clinical profile. The remaining two thirds of Zika cases, principally characterised by undifferentiated fever or afebrile rash, were missed. Among Zika cases, rash (n=440)-particularly generalised erythematous rash (n=334)-fever (n=333), leukopenia (n=217), and headache (n=203) were most common and peaked within 3 days of illness onset. The most common Zika presentation over the first week of illness was rash only (n=80). The sensitivity of Zika case definitions increased across paediatric age (from 11·3% to 56·1% for the WHO case definition and from 6·0% to 36·6% for the PAHO case definition), as the prevalence of most clinical findings (particularly arthralgia) increased with age, irrespective of previous dengue virus infection. Consequently, Zika manifested differently across paediatric age; older Zika cases presented with a dengue-like clinical profile while younger Zika cases presented with undifferentiated fever or afebrile rash.

INTERPRETATION

We provide the most thorough description of paediatric Zika to date. Most paediatric Zika cases go undetected under the WHO and PAHO case definitions, suggesting that current standards for Zika case ascertainment require revision. Zika manifests with mild but differing clinical profiles across paediatric age, presenting major challenges to diagnosis, surveillance, and efforts to control future Zika epidemics.

FUNDING

US National Institutes of Health.

(Copepoda: Ergasilidae) from freshwater fishes in a Nicaraguan crater lake based on morphological and molecular evidence

The ergasilid copepod Acusicola margulisae n. sp. is described based on material from three species of cichlid, Amphilophus citrinellus (Günther), Parachromis managuensis (Günther), and Oreochromis sp., and from the poecilid Poecilia mexicana (Steindachner), in the crater Lake Asososca León, Nicaragua. This constitutes the 15th species described in the genus Acusicola Cressey, 1970. The new species differs from all its congeners by the relatively longer first endopodal segment of leg 1, and the size and number of setae on second endopodal segment of leg 1. We provide the first gene sequence for a species of Acusicola. To examine the intraspecific genetic variation of the new species collected from different host species, sequences of the mitochondrial barcode region cox1 were generated. In addition, partial regions of the 18S and 28S ribosomal RNA genes were sequenced and used to infer the phylogenetic relationships of the genus Acusicola within the family Ergasilidae Burmeister, 1835. The phylogenetic trees yielded the isolates of Acusicola margulisae n. sp. as a reciprocally monophyletic lineage, and as the sister taxa of five genera of ergasilid copepods. The genus Ergasilus von Nordmann, 1832 was recovered as a paraphyletic group. These analyses indicate that phylogenetic relationships are not yet well resolved and more representative species and genera of the family are required to provide a robust classification of this highly diverse group of copepods.

A geographical cline in craniofacial morphology across populations of Mesoamerican lake-dwelling fishes

Together, the complex geological history and climatic diversity of Mesoamerica create a rich source of biodiversity from which evolutionary processes can be studied. Here, we discuss highly divergent morphs of lake-dwelling fishes distributed across Mexico and Central America, originally recognized as members of different genera (Astyanax and "Bramocharax"). Recent phylogenetic studies, however, suggest these morphs group within the same genus and readily hybridize. Despite genetic similarities, Bramocharax morphs exhibit stark differences in cranial shape and dentition. We investigated the evolution of several cranial traits that vary across morphs collected from four lakes in Mexico and Nicaragua and discovered an ecomorphological cline from northern to southern lakes. Northern populations of sympatric morphs exhibit a similar cranial shape and tooth morphology. Southern populations of Bramocharax morphs, however, showed a larger disparity in maxillary teeth, length and frequency of unicuspid teeth, an elongated snout, and a streamlined cranium compared to Astyanax morphs. This divergence of craniofacial morphology likely evolved in association with differences in trophic niches. We discuss the morphological differences across the four lake systems in terms of geological history and trophic dynamics. In summary, our study suggests that Bramocharax morphs are likely locally adapted members derived from independent Astyanax lineages, highlighting an interesting parallel evolutionary pattern within the Astyanax genus.

Is Parent-Adolescent Drug Talk Always Protective? Testing A New Scale of Drug Talk Styles in Relation to Adolescent Personal Norms, Parental Injunctive Norms, Substance Use Intentions, and Behaviors

According to parent-offspring drug talk (PODT) model, the specificity of drug talk styles is identified by the timing and directness of communication about substance use between parent and adolescent (e.g., situated direct, ongoing direct, situated indirect, and ongoing indirect talk style). Given the limitation of the original, single item measure for drug talk styles with a categorical response option, the current study proposed a new scale of drug talk styles and tested its concurrent validity. Using cross-sectional survey data (N = 2,035), confirmatory factor analysis was conducted to test the factor structure of the scale. Consistent with PODT model, the analysis yielded support for a four-factor structure for the drug talk styles. Next, a path analysis was employed to validate the scale. The findings suggested that situated direct talk was positively related to personal anti-substance-use norms and parental anti-substance-use injunctive norms but negatively related to smoking intention, as well as alcohol use in the past 30 days. Ongoing direct talk, however, was found to be positively associated with alcohol and marijuana use in the past 30 days. Research implications and future directions are discussed.

C-reactive protein from dried blood spots: Application to household air pollution field studies

Household air pollution (HAP) is estimated to be an important risk factor for cardiovascular disease, but little clinical evidence exists and collecting biomarkers of disease risk is difficult in low-resource settings. Among 54 Nicaraguan women with woodburning cookstoves, we evaluated cross-sectional associations between 48-hour measures of HAP (eg, fine particulate matter, PM_2.5 ) and C-reactive protein (CRP) via dried blood spots; secondary analyses included seven additional biomarkers of systemic injury and inflammation. We conducted sub-studies to calculate the intraclass correlation coefficient (ICC) in biomarkers collected over four consecutive days in Nicaragua and to assess the validity of measuring biomarkers in dried blood by calculating the correlation with paired venous-drawn samples in Colorado. Measures of HAP were associated with CRP (eg, a 25% increase in indoor PM_2.5 was associated with a 7.4% increase in CRP [95% confidence interval: 0.7, 14.5]). Most of the variability in CRP concentrations over the 4-day period was between-person (ICC: 0.88), and CRP concentrations were highly correlated between paired dried blood and venous-drawn serum (Spearman ρ = .96). Results for secondary biomarkers were primarily consistent with null associations, and the sub-study ICCs and correlations were lower. Assessing CRP via dried blood spots provides a feasible approach to elucidate the association between HAP and cardiovascular disease risk.

Student-reported value of a short-term service-learning trip to Nicaragua

BACKGROUND

The purpose of this qualitative study was to assess the student-reported professional and personal value of a one-week service-learning trip to a Nicaraguan community.

METHODS

Five pharmacy students who participated in a one-week service-learning trip to Jinotepe, Nicaragua were invited to participate in this study. Individual, semi-structured interviews were conducted following the trip.

RESULTS

A variety of themes and subthemes surfaced, demonstrating the student-reported professional and personal value of the short-term service-learning experience. While each pharmacy student was impacted differently, common themes demonstrated transformative pharmacy student learning. These themes included recognition that every individual has a unique story that is essential to understanding how to care properly for that individual; the benefit of establishing a relationship with a community to more effectively and compassionately serve them; the importance of determining community-specific needs to ensure that service provided is beneficial; and recognition that those who are served have wisdom to offer healthcare providers.

CONCLUSIONS

Short-term service-learning opportunities can provide impactful learning for pharmacy students. Established service-learning visits with a consistent host site allow for deeper and more trusting relationships, resulting in the ability to respond to the needs and requests of the partner organization in developing communities and not impose agendas. Organizers of service-learning trips must cater to the needs of the developing community to ensure that the trip is effective in providing value to the host site rather than creating unnecessary burdens and unanticipated hardship.

Prolonged Shedding of Zika Virus RNA in Vaginal Secretions, Nicaragua

Zika virus, an arthropod-borne flavivirus pathogen in humans, is unusual because it can be sexually transmitted and can be shed for prolonged periods in semen. We report viral shedding in vaginal secretions for up to 6 months, indicating the potential for sexual and vertical transmission by infected women.

Television consumption drives perceptions of female body attractiveness in a population undergoing technological transition

Perceptions of physical attractiveness vary across cultural groups, particularly for female body size and shape. It has been hypothesized that visual media propagates Western "thin ideals." However, because cross-cultural studies typically consider groups highly differentiated on a number of factors, identifying the causal factors has thus far been impossible. In the present research, we conducted "naturalistic" and controlled experiments to test the influence of media access on female body ideals in a remote region of Nicaragua by sampling from villages with and without regular TV access. We found that greater TV consumption remained a significant predictor of preferences for slimmer, curvier female figures after controlling for a range of other factors in an ethnically balanced sample of 299 individuals (150 female, aged 15-79) across 7 villages. Within-individual analyses in 1 village over 3 years also showed an association between increased TV consumption and preferences for slimmer figures among some participants. Finally, an experimental study in 2 low-media locations demonstrates that exposure to media images of fashion models can directly impact participants' body size ideals. We provide the first converging cross-sectional, longitudinal, and experimental evidence from field-based research, that media exposure can drive changes in perceptions of female attractiveness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Livelihoods, precarity, and disaster vulnerability: Nicaragua and Hurricane Mitch

How livelihoods determine vulnerability to disasters is a recent topic of inquiry. Few quantitative works have been produced to date. The empirical analysis that follows draws on household-level data available for Nicaragua, preceding and following Hurricane Mitch, a devastating Category 5 storm that made landfall in Central America in October 1998, to examine differentials in disaster recovery outcomes vis-à-vis household livelihood profiles. Livelihoods are distinguished according to economic sector along with ownership of productive means, a central mechanism of vulnerability under sociological labour frameworks. The findings indicate uneven recovery outcomes in relation to livelihoods. During the year immediately following the event, agricultural wage earners and agricultural owner-producers experienced marked losses owing to the disaster, whereas business owners saw an improvement in condition. Analysis of long-term recovery reveals that households reliant on agricultural wage employment exhibit lagged recovery relative to other livelihood profiles. The findings are discussed with respect to the dynamic pressures posed by contemporary developmental processes.

Decarbonizing the transport sector: The promethean responsibility of Nicaragua

The transport sector is the second largest energy consumer in Nicaragua, and it relies solely on oil derivatives. It is growing at an unsustainable rate and Nicaragua must explore alternative transport pathways to decarbonize this sector. This study developed 5 scenarios to assess transport alternatives for Nicaragua such as a mass public transport system for the country's capital, the adoption of electric vehicles, and a shift to electrofuels. The scenarios reflect the Nicaraguan energy system in 2030 after the implementation of these alternatives. The results show that stabilizing the transport demand via public transport is a key aspect to achieve decarbonization cost-effectively. Furthermore, the results highlight the direct link between the decarbonization of the transport sector and of the power sector. The adoption of electric vehicles and the production of electrofuels create synergies between the two sectors making them suitable options to integrate higher shares of variable renewable energy in the generation matrix. These synergies increase the overall efficiency of the system and reduce operating costs and CO₂ emissions.

The respiratory microbiota: associations with influenza symptomatology and viral shedding

PURPOSE

Manifestations of infection and the degree of influenza virus vary. We hypothesized that the nose/throat microbiota modifies the duration of influenza symptoms and viral shedding. Exploring these relationships may help identify additional methods for reducing influenza severity and transmission.

METHODS

Using a household transmission study in Nicaragua, we identified secondary cases of influenza virus infection, defined as contacts with detectable virus or a greater than 4-fold change in hemagglutinin inhibition antibody titer. We characterized the nose/throat microbiota of secondary cases before infection and explored whether the duration of symptoms and shedding differed by bacterial community characteristics.

RESULTS

Among 124 secondary cases of influenza, higher bacterial community diversity before infection was associated with longer shedding duration (Shannon acceleration factor [AF]: 1.61, 95% confidence interval [CI]: 1.24, 2.10) and earlier time to infection (Shannon AF: 0.72, 95% CI: 0.53, 0.97; Chao1 AF: 0.992, 95% CI: 0.986, 0.998). Neisseria and multiple other oligotypes were significantly associated with symptom and shedding durations and time to infection.

CONCLUSIONS

The nose/throat microbiota before influenza virus infection was associated with influenza symptoms and shedding durations. Further studies are needed to determine if the nose/throat microbiota is a viable target for reducing influenza symptoms and transmission.

Improved Pastures Support Early Indicators of Soil Restoration in Low-input Agroecosystems of Nicaragua

Pasture degradation hinders livestock production and ecosystem services that support rural smallholder communities throughout Latin America. Silvopastoral systems, with improved pasture cultivars (especially Brachiaria spp.) and multipurpose trees, offer a promising strategy to restore soils and improve livelihoods in the region. However, studies evaluating the impact of such systems on pasture productivity and soil health under realistic smallholder constraints are lacking. We evaluated the impact of improved pasture grass and tree establishment on a suite of soil health indicators in actively grazed, low-input, farmer-managed silvopastoral systems. In August 2013, paired pasture treatments (improved grass with trees vs. traditional pastures) were established on nine farms with similar land-use histories near Matagalpa, Nicaragua. On each farm, one treatment was left as traditional pasture with naturalized grass (Hyparrhenia rufa), while the adjacent treatment was sown with the improved grass (Brachiaria brizantha cv. Marandu) and planted with tree saplings without fertilizer. In August 2015, we measured standing biomass and a suite of chemical, biological, and physical soil health variables. Improved silvopastoral systems with B. brizantha produced more standing grass biomass and supported higher levels of earthworm populations and permanganate oxidizable carbon (POXC) compared to the traditional control. Correlations suggest that earthworms and POXC were associated with incipient improvements to soil aggregate stability and water holding capacity. We report measurable improvements to soil health just two years following the establishment of improved pasture systems under common smallholder management practices and suggest that these systems, even with minimal fertility inputs, have the potential to enhance regional sustainability.

Building a Data Platform for Cross-Country Urban Health Studies: the SALURBAL Study

Studies examining urban health and the environment must ensure comparability of measures across cities and countries. We describe a data platform and process that integrates health outcomes together with physical and social environment data to examine multilevel aspects of health across cities in 11 Latin American countries. We used two complementary sources to identify cities with ≥ 100,000 inhabitants as of 2010 in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, and Peru. We defined cities in three ways: administratively, quantitatively from satellite imagery, and based on country-defined metropolitan areas. In addition to "cities," we identified sub-city units and smaller neighborhoods within them using census hierarchies. Selected physical environment (e.g., urban form, air pollution and transport) and social environment (e.g., income, education, safety) data were compiled for cities, sub-city units, and neighborhoods whenever possible using a range of sources. Harmonized mortality and health survey data were linked to city and sub-city units. Finer georeferencing is underway. We identified 371 cities and 1436 sub-city units in the 11 countries. The median city population was 234,553 inhabitants (IQR 141,942; 500,398). The systematic organization of cities, the initial task of this platform, was accomplished and further ongoing developments include the harmonization of mortality and survey measures using available sources for between country comparisons. A range of physical and social environment indicators can be created using available data. The flexible multilevel data structure accommodates heterogeneity in the data available and allows for varied multilevel research questions related to the associations of physical and social environment variables with variability in health outcomes within and across cities. The creation of such data platforms holds great promise to support researching with greater granularity the field of urban health in Latin America as well as serving as a resource for the evaluation of policies oriented to improve the health and environmental sustainability of cities.

Building resilience to El Niño-related drought: experiences in early warning and early action from Nicaragua and Ethiopia

Forecast-based drought early warning/early action has been hampered by both inadequate decision-making frameworks and a lack of appropriate funding mechanisms. Rural communities in Nicaragua and Ethiopia that have participated in resilience-building interventions of varying durations demonstrate the value of community-based actions informed by early warning, forecasts and drought management advice, both before and during the agricultural season. While drought affected all crops negatively, participants were better able to mitigate impacts, were more organised in accessing relief and recovered more effectively. These results are consistent with other research on the cost/benefit of anticipatory actions, use of climate services and appropriate drought management advice. They also confirm the importance of embedding short-term early action in long-term resilience-building. Despite this, formal systems, national and local, remain essentially unimplemented. Systems being developed at global level now need to be operationalised and translated into effective local drought management standard operating procedures for the most vulnerable.

Arsenic contamination of rural community wells in Nicaragua: A review of two decades of experience

Several surveys have been conducted in Nicaragua between 1996 and 2015 confirming the presence of high levels of arsenic (>10 μg/L). In this paper, these peer-reviewed (n = 2) and non-peer reviewed sources (n = 14) have been combined to provide an extensive overview of the arsenic contamination of drinking water sources in Nicaragua. So far, arsenic contamination has been detected in over 80 rural communities located in 34 municipalities of the country and arsenic poisoning has been identified in at least six of those communities. The source of arsenic contamination in Nicaragua is probably volcanic in origin, both from volcanic rocks and geothermal fluids which are distributed across the country. Arsenic may have directly entered into the groundwater by geothermally-influenced water bodies, or indirectly by reductive dissolution or alkali desorption, depending on the local geochemical conditions.

Epidemiological Evidence for Lineage-Specific Differences in the Risk of Inapparent Chikungunya Virus Infection

In late 2013, chikungunya virus (CHIKV) was introduced into the Americas, leading to widespread epidemics. A large epidemic caused by the Asian chikungunya virus (CHIKV) lineage occurred in Managua, Nicaragua, in 2015. Literature reviews commonly state that the proportion of inapparent CHIKV infections ranges from 3 to 28%. This study estimates the ratio of symptomatic to asymptomatic CHIKV infections and identifies risk factors of infection. In October to November 2015, 60 symptomatic CHIKV-infected children were enrolled as index cases and prospectively monitored, alongside 236 household contacts, in an index cluster study. Samples were collected upon enrollment and on day 14 or 35 and tested by real-time reverse transcription-PCR (rRT-PCR), IgM capture enzyme-linked immunosorbent assays (IgM-ELISAs), and inhibition ELISAs to detect pre- and postenrollment CHIKV infections. Of 236 household contacts, 55 (23%) had experienced previous or very recent infections, 41 (17%) had active infections at enrollment, and 21 (9%) experienced incident infections. Vehicle ownership (multivariable-adjusted risk ratio [aRR], 1.58) increased the risk of CHIKV infection, whereas ≥4 municipal trash collections/week (aRR, 0.38) and having externally piped water (aRR, 0.52) protected against CHIKV infection. Among 63 active and incident infections, 31 (49% [95% confidence interval {CI}, 36%, 62%]) were asymptomatic, yielding a ratio of symptomatic to asymptomatic infections of 1:0.97 (95% CI, 1:0.56, 1:1.60). Although our estimate is outside the 3% to 28% range reported previously, Bayesian and simulation analyses, informed by a systematic literature search, suggested that the proportion of inapparent CHIKV infections is lineage dependent and that more inapparent infections are associated with the Asian lineage than the East/Central/South African (ECSA) lineage. Overall, these data substantially improve knowledge regarding chikungunya epidemics.IMPORTANCE Chikungunya virus (CHIKV) is an understudied threat to human health. During the 2015 chikungunya epidemic in Managua, Nicaragua, we estimated the ratio of symptomatic to asymptomatic CHIKV infections, which is important for understanding transmission dynamics and the public health impact of CHIKV. This index cluster study identified and monitored persons at risk of infection, enabling capture of asymptomatic infections. We estimated that 31 (49%) of 63 at-risk participants had asymptomatic CHIKV infections, which is significantly outside the 3% to 28% range reported in literature reviews. However, recent seroprevalence studies, including two large pediatric cohort studies in the same setting, had also found percentages of inapparent infections outside the 3% to 28% range. Bayesian and simulation analyses, informed by a systematic literature search, revealed that the percentage of inapparent infections in epidemic settings varies by CHIKV phylogenetic lineage. Our study quantifies and provides the first epidemiological evidence that chikungunya epidemic characteristics are strongly influenced by CHIKV lineage.

Prospective biomonitor and sentinel bivalve species for pollution monitoring and ecosystem health disturbance assessment in mangrove-lined Nicaraguan coasts

This research aims at contributing to the use of Polymesoda arctata, Anadara tuberculosa, and Larkinia grandis as prospective biomonitors and sentinels, surrogate of Crassostrea rhizophorae for pollution biomonitoring in mangrove-lined coastal systems. Localities were selected along the Nicaraguan coastline in the rainy and dry seasons during 2012-2013: A. tuberculosa and L. grandis were collected in the Pacific, and P. arctata in the Caribbean. The tissue concentration of metals, polycyclic aromatic hydrocarbons (PAHs) and persistent organic pollutants (POPs) were integrated into pollution indices (chemical pollution index -CPI- and pollution load index -PLI-) and biological endpoints (flesh-condition, reproduction, histopathology and stress-on-stress) were determined as biomarkers of ecosystem health disturbance. In the Caribbean, contaminant tissue concentration was low in P. arctata, with some exceptions. Ag, As, Cd, Hg, Ni and V were mainly recorded during dry season, and PAHs and POPs (HCHs, DDTs, AHTN, PCBs and BDE85) during rainy season. Metals and PAHs were not a major threat in the study area; in contrast, high levels of HCHs and DDTs and low-to-moderate levels of musk fragrances and PBDEs were recorded. Minor differences were found in biological parameters albeit during the rainy season the LT50 values were low and seemingly associated to high PLI and CPI values. In the Pacific, the main pollutants recorded in A. tuberculosa and L. grandis were HCHs, DDTs, AHTN and PDBEs in rainy season and Cd in dry season. Although basic research is needed to understand the general biology, ecology and diseases in these Pacific species, biological endpoints comparable to those used in other sentinel bivalves are seemingly suitable biomarkers of health disturbance. Overall, Caribbean P. arctata and Pacific A. tuberculosa and L. grandis seem to be potential target species for pollution monitoring and ecosystem health disturbance assessment in mangrove-lined Nicaraguan coastal systems. Their use together with C. rhizophorae would provide opportunities for common approaches to be applied in inter-ocean countries of the Mesoamerican region.

Stressful life events among homeless people in León (Nicaragua): Quantity, types, timing, and perceived causality

Nicaragua is one of Latin America's least developed countries and has a lack of data on homeless people, a stigmatized group living in extreme poverty. We conducted structured interviews with homeless people living in the city of León (Nicaragua; n = 41) to obtain data on the quantity, types, timing, and perceived causality of stressful life events (SLEs) experienced during their childhood and adolescence as well as throughout their adult lives. The findings showed that our participants had experienced a high number of extremely severe SLEs at very early ages and most of these SLEs occurred before they first became homeless. In terms of the perceived causal relationship between SLEs and homelessness, the interviewees mainly attributed being homeless to material, affective, or relationship factors, or an excessive consumption of alcohol and/or drugs. Suffering from multiple and serious SLEs, largely due to living in socioeconomically disadvantaged environments, appears to be an important vulnerability factor in both becoming homeless and chronic homelessness.

Consequences of the exposure to abuse in the family of origin among victims of intimate partner violence in Nicaragua

Intimate partner violence (IPV) has serious consequences for women, and their vulnerability is increased if their experiences related to abuse occurred at an early age. This study examines the risk of experiencing stressful life events (SLE) during the lives of Nicaraguan victims of IPV in situations of extreme poverty according to their exposure to episodes of violence in their family of origin. In the study participated 136 women victims of IPV living in the marginal areas of the city of León (Nicaragua). They were contacted through the Nicaraguan Commissariat for Women (CW). The results indicate an increased risk of experiencing SLE in the lives of those who suffered abuse in their family of origin and/or witnessed abuse of their mother. Identifying abuse suffered in childhood is a priority because of its consequences, as growing up in environments that tolerate violence may lead to a chronification of subsequent abuse. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Farm-level and community aggregate economic impacts of adopting climate smart agricultural practices in three mega environments

Recent studies highlight a growing concern over the limited adoption of climate smart agricultural (CSA) practices despite their potential benefits on adaptation, mitigation and productivity. Literature indicates several factors behind the lack of adoption including socio-demographic and economic conditions, agro-ecological scales and the nature of the practices. This paper examines to what extent and under which conditions such factors influence the adoption of CSA practices at farm, household and community level across three study sites in different continents: Vietnam, Nicaragua and Uganda. While cost benefit analysis (CBA) is employed to assess the farm-level profitability of CSA practices, the aggregate community impact disaggregated by different groups of farmer typologies with specific socio-economic features is derived from the adoption rate estimated by the relative advantage of practices and the income level of each group. Our main findings show great variation of farm-profitability of CSA practices across scales. Similar practices could generate different profitability depending on crop typologies, input access and prices, household types and local context. Regarding the aggregate profitability of CSA practices at regional scale, we found that under particular conditions, relevant factors of adoption matter to the adoption pattern and thereby affects the ranking. Such conditions include (i) high income inequality, (ii) large profitability gap of prioritized CSA practices, and (iii) large proportion of cost and benefit of the practices in the level of income. This study contributes to enhancing the prioritization process of CSA practices and provides practical guidance for research and policy to tailor the investment to appropriate end-users to assure the greatest impact for the community.