Perspective article: Actions to reconfigure food systems.

There is broad agreement that current food systems are not on a sustainable trajectory that will enable us to reach the Sustainable Development Goals by 2030, particularly in the face of anthropogenic climate change. Guided by a consideration of some food system reconfigurations in the past, we outline an agenda of work around four action areas: rerouting old systems into new trajectories; reducing risks; minimising the environmental footprint of food systems; and realigning the enablers of change needed to make new food systems function. Here we highlight food systems levers that, along with activities within these four action areas, may shift food systems towards more sustainable, inclusive, healthy and climate-resilient futures. These actions, summarised here, are presented in extended form in a report of an international initiative involving hundreds of stakeholders for reconfiguring food systems.

Insulin storage in hot climates without refrigeration: temperature reduction efficacy of clay pots and other techniques.

AIM: Insulin loses potency when stored at high temperatures. Various clay pots part-filled with water, and other evaporative cooling devices, are used in less-resourced countries when home refrigeration is unavailable. This study examined the cooling efficacy of such devices. METHODS: Thirteen devices used in Sudan, Ethiopia, Tanzania, Mali, India, Pakistan and Haiti (10 clay pots, a goat skin, a vegetable gourd and a bucket filled with wet sand), and two identical commercially manufactured cooling wallets were compared. Devices were maintained according to local instructions. Internal and ambient temperature and ambient humidity were measured by electronic loggers every 5 min in Khartoum (88 h), and, for the two Malian pots, in Bamako (84 h). Cooling efficacy was assessed by average absolute temperature difference (internal vs. ambient), and % maximal possible evaporative cooling (allowing for humidity). RESULTS: During the study period, mean ambient temperature and humidity were 31.0°C and 32.0% in Khartoum and 32.9°C and 39.8% in Bamako. All devices reduced the temperature (P < 0.001) with a mean (sd) reduction from 2.7 ± 0.5°C to 8.3 ± 1.0°C, depending on the device. When expressed as % maximal cooling, device efficacy ranged from 20.5% to 71.3%. On cluster analysis, the most efficacious devices were the goat skin, two clay pots (from Ethiopia and Sudan) and the suspended cooling wallet. CONCLUSIONS: Low-cost devices used in less-resourced countries reduce storage temperatures. With more efficacious devices, average temperatures at or close to standard room temperature (20-25°C) can be achieved, even in hot climates. All devices are more efficacious at lower humidity. Further studies are needed on insulin stability to determine when these devices are necessary.

Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction.

OBJECTIVES: The second Primary Angioplasty in Myocardial Infarction (PAMI-II) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty (PTCA), with subsequent discharge from the hospital 3 days later, is safe and cost-effective in low risk patients. BACKGROUND: In low risk patients with myocardial infarction (MI), few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay. METHODS: Patients with acute MI underwent emergency catheterization with primary PTCA when appropriate. Low risk patients (age <70 years, left ventricular ejection fraction >45%, one- or two-vessel disease, successful PTCA, no persistent arrhythmias) were randomized to receive accelerated care (admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [n = 237] or traditional care [n = 234]). RESULTS: Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier (4.2+/-2.3 vs. 7.1+/-4.7 days, p = 0.0001) and had lower hospital costs ($9,658+/-5,287 vs. $11,604+/-6,125 p = 0.002) than the patients who received traditional care. At 6 months, accelerated and traditional care groups had a similar rate of mortality (0.8% vs. 0.4%, p = 1.00), unstable ischemia (10.1% vs. 12.0%, p = 0.52), reinfarction (0.8% vs. 0.4%, p = 1.00), stroke (0.4% vs. 2.6%, p = 0.07), congestive heart failure (4.6% vs. 4.3%, p = 0.85) or their combined occurrence (15.2% vs. 17.5%, p = 0.49). The study was designed to detect a 10% difference in event rates; at 6 months, only a 2.3% difference was measured between groups, indicating an actual power of 0.19. CONCLUSIONS: Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing, and a day 3 hospital discharge strategy, resulting in substantial cost savings.

Exotic stock of Trypanosoma cruzi (Schizotrypanum) capable of development in and transmission by Triatoma protracta protracta from California: public health implications.

A stock of Trypanosoma cruzi was recovered from a Triatoma dimidiata from Tegucigalpa, Honduras. This stock was shown to be capable of development and transmission by native California Triatoma protracta protracta. Isozyme analysis indicated that this T. cruzi is closely related to the Tehuantepec strain and to a lesser extent the Miles' zymodeme 1 strain. The potential public health significance of development and transmission of exotic stocks of T. cruzi by native reduviids is discussed.

Agent of Chagas' disease from Honduran vector capable of developing in California insects: implications for cardiologists.

An exotic strain of Trypanosoma cruzi recovered from Triatoma dimidiata from Tegucigalpa, Honduras, was shown by isoenzyme studies to be closely related to the Miles' zymodeme 1 and laboratory reference strain Tehuantepec. It was injected into Swiss random-bred ICR mice. Clean Triatoma protracta nymphs and adults, which had been captured in Winters, California, fed on inoculated mice and were then examined over a 15-month period. Their feces contained multiplying epimastigote and infective trypomastigote forms of T. cruzi. This shows that exotic strains of T. cruzi can develop and survive for long periods in local California vectors. The increasing number of immigrants from Central America who enter California and other states may have public health implications in regard to the introduction of pathogenic strains that are capable of producing cardiomyopathy. Cardiologists who examine patients with cardiomyopathy from Central and South America should rule out Chagas' disease as a cause, since pathogenic T. cruzi strains are present in most Central and South American countries.