Designing a combined liothyronine (LT3), L- thyroxine (LT4) trial in symptomatic hypothyroid subjects on LT4 - the importance of patient selection, choice of LT3 and trial design.

Approximately 10%-15% of subjects with hypothyroidism on L-thyroxine (LT4) alone have persistent symptoms affecting their quality of life (QoL). Although the cause is unclear, there is evidence that "tissue T3 lack" may be responsible. If so, combining liothyronine (LT3) with LT4 would be helpful. However, randomized controlled trials (RCT), have not established greater efficacy for the LT3 + LT4 combination in these subjects than for LT4 alone. While the trial design may have been responsible, the use of unphysiological, short-acting LT3 preparations and non-thyroid-specific patient-reported outcome measures (PROMs) may have contributed. We recommend attention to the following aspects of trial design for future RCTs of LT3 + LT4 compared to LT4 alone: (a) Subject selection-(i) measurable symptoms (disadvantages should be recognized); (ii) using a validated thyroid specific PROM such as ThyPRO39 or the Composite scale derived from it; (iii) those taking over 1.2 µg/day or 100 µg/day (for pragmatic reasons) of LT4 defining a population likely without intrinsic thyroid activity who depend on exogenous LT4; (iv) recruiting a preponderance of subjects with autoimmune thyroiditis increasing generalisability; and (v) those with a high symptom load with a greater response to combination therapy e.g. those with the deiodinase 2 polymorphism. (b) The use of physiological LT3 preparations producing pharmacokinetic similarities to T3 profiles in unaffected subjects: two long-acting LT3 preparations are currently available and must be tested in phase 2b/3 RCTs. (c) The superiority of a crossover design in limiting numbers and costs while maintaining statistical power and ensuring that all subjects experienced the investigative medication.

Optimal selection of daily satellite precipitation product based on structural similarity index at 1 km resolution for the Pra catchment, Ghana.

Thirteen satellite precipitation products (SPPs), re-gridded to 1 km resolution, were evaluated in terms of the structural similarity index (SSI) over the Pra catchment in Ghana. Three SPP scenarios were considered: Scenario one (S1) was the original SPPs; Scenario two (S2) was bias-corrected SPPs; and Scenario three (S3) was the better of S1 and S2 for each wet day. For each scenario, the best SPP was selected to constitute the 14th SPP referred to as the BEST SPP. Each SPP was evaluated in terms of SSI against the rain gauge rainfield for each wet day. For S1, the top three SPPs were TMPA, GSMAP and CMORPH; for S2, CMORPH, PERCCS and MSWEP were the top three; and for S3, CMORPH, PERCCS and TMPA came out on top in order of decreasing performance. Bias correction led to improvement in the overall SSI measure (SSIM) for 73% of wet days. The BEST SPP increased the SSIM of the best individual SPP by over 50% for S1, and over 30% for both S2 and S3. Comparing the BEST SPP of the three scenarios, S2 increased the SSIM statistic by 20% over that for S1, and SSIM was further improved by 4% for S3. It is highly recommended to use BEST SPP (S3) to generate the required 1 km × 1 km rainfields for the Pra, or other catchments around the world with a sparse rain gauge network, through conditional merging with rain gauge data as demonstrated.

Integrating GIS and remote sensing for land use/land cover mapping and groundwater potential assessment for climate-smart cocoa irrigation in Ghana.

Although Ghana is a leading global cocoa producer, its production and yield have experienced declines in recent years due to various factors, including long-term climate change such as increasing temperatures and changing rainfall patterns, as well as drought events. With the increasing exposure of cocoa-producing regions to extreme weather events, the vulnerability of cocoa production is also expected to rise. Supplemental irrigation for cocoa farmers has emerged as a viable adaptation strategy to ensure a consistent water supply and enhance yield. However, understanding the potential for surface and groundwater irrigation in the cocoa-growing belt remains limited. Consequently, this study aims to provide decision-support maps for surface and groundwater irrigation potential to aid planning and investment in climate-smart cocoa irrigation. Utilizing state-of-the-art geospatial and remote sensing tools, data, and methods, alongside in-situ groundwater data, we assess the irrigation potential within Ghana's cocoa-growing areas. Our analysis identified a total area of 22,126 km2 for cocoa plantations and 125.2 km2 for surface water bodies within the cocoa-growing regions. The multi-criteria analysis (MCA) revealed that approximately 80% of the study area exhibits moderate to very high groundwater availability potential. Comparing the MCA output with existing borehole locations demonstrated a reasonable correlation, with about 80% of existing boreholes located in areas with moderate to very high potential. Boreholes in very high potential areas had the highest mean yield of 90.7 l/min, while those in low groundwater availability potential areas registered the lowest mean yield of 58.2 l/min. Our study offers a comprehensive evaluation of water storage components and their implications for cocoa irrigation in Ghana. While groundwater availability shows a generally positive trend, soil moisture and surface water have been declining, particularly in the last decade. These findings underline the need for climate-smart cocoa irrigation strategies that make use of abundant groundwater resources during deficit periods. A balanced conjunctive use of surface and groundwater resources could thus serve as a sustainable solution for maintaining cocoa production in the face of climate change.

Financing national scale energy projects in developing countries - An economy-wide evaluation of Ghana's Bui Dam.

Large energy infrastructure can imply special financing arrangements between governments in developing economies and investors or lenders. These arrangements can lead to economy-wide and sector-specific impacts which need to be considered in the project economic evaluation. By considering the case of the Bui Dam in Ghana, we use a macroeconomic approach to determine how the economic performance of critical energy infrastructure manifests during the construction, financing and operation phases. The analysis uses an integrated modelling framework that combines a Computable General Equilibrium (CGE) model of Ghana with a water balance model of the Lower Volta River Basin. The results highlight the importance of including indirect and induced effects, in addition to the direct effects from project operation, as they influence the scale and temporal evolution of the economic impacts. The collateral from the infrastructure loan agreement consisting in cocoa exports to China nearly doubles the project's positive GDP impact and has a significant multiplier effect over urban and rural household income compared to a standard commercial loan. We finish with a discussion of how the proposed investment-oriented modelling framework can contribute to ex-ante strategic assessments of proposed energy infrastructure in developing countries.

Potential effects of warmer worms and vectors on onchocerciasis transmission in West Africa.

Development times of eggs, larvae and pupae of vectors of onchocerciasis (Simulium spp.) and of Onchocerca volvulus larvae within the adult females of the vectors decrease with increasing temperature. At and above 25°C, the parasite could reach its infective stage in less than 7 days when vectors could transmit after only two gonotrophic cycles. After incorporating exponential functions for vector development into a novel blackfly population model, it was predicted that fly numbers in Liberia and Ghana would peak at air temperatures of 29°C and 34°C, about 3°C and 7°C above current monthly averages, respectively; parous rates of forest flies (Liberia) would peak at 29°C and of savannah flies (Ghana) at 30°C. Small temperature increases (less than 2°C) might lead to changes in geographical distributions of different vector taxa. When the new model was linked to an existing framework for the population dynamics of onchocerciasis in humans and vectors, transmission rates and worm loads were projected to increase with temperature to at least 33°C. By contrast, analyses of field data on forest flies in Liberia and savannah flies in Ghana, in relation to regional climate change predictions, suggested, on the basis of simple regressions, that 13-41% decreases in fly numbers would be expected between the present and before 2040. Further research is needed to reconcile these conflicting conclusions.