The microbiomes of 83 preterm very-low-birth-weight (VLBW) infants and clinical covariates were analyzed weekly over the course of their initial neonatal intensive care unit (NICU) stay, with infant growth as the primary clinical outcome. Birth weight significantly correlated with increased rate of weight gain in the first 6 weeks of life, while no significant relationship was observed between rate of weight gain and feeding type. Microbial diversity increased with age and was significantly correlated with weight gain and percentage of the mother’s own milk. As expected, infants who received antibiotics during their NICU stay had significantly lower alpha diversity than those who did not. Of those in the cohort, 25 were followed into childhood. Alpha diversity significantly increased between NICU discharge and age 2 years and between age 2 years and age 4 years, but the microbial alpha diversity of 4-year-old children was not significantly different from that of mothers. Infants who showed improved length over the course of their NICU stay had significantly more volatile microbial beta diversity results than and a significantly decreased microbial maturity index compared with infants who did not; interestingly, all infants who showed improved length during the NICU stay were delivered by Caesarean section. Microbial beta diversity results were significantly different between the time of the NICU stay and all other time points (for children who were 2 or 4 years old and mothers when their children were 2 or 4 years old). IMPORTANCE Preterm infants are at greater risk of microbial insult than full-term infants, including reduced exposure to maternal vaginal and enteric microbes, higher rates of formula feeding, invasive procedures, and administration of antibiotics and medications that alter gastrointestinal pH. This investigation of the VLBW infant microbiome over the course of the neonatal intensive care unit (NICU) stay, and at ages 2 and 4 years, showed that the only clinical variables associated with significant differences in taxon abundance were weight gain during NICU stay (Klebsiella and Staphylococcus) and antibiotic administration (Streptococcus and Bifidobacterium). At 2 and 4 years of age, the microbiota of these VLBW infants became similar to the mothers’ microbiota. The number of microbial taxa shared between the infant or toddler and the mother varied, with least the overlap between infants and mothers. Overall, there was a significant association between the diversity and structure of the microbial community and infant weight and length gain in an at-risk childhood population.

Malaysia has made an ambitious commitment to reduce the intensity of its carbon emissions, notably a 40% reduction (compared to 2005 levels) by 2020 and a 45% reduction (compared to 2005 levels) by 2030. As with other developing countries, Malaysia's challenge is to decarbonize its energy-centric economy in the face of population growth pressures and substantial levels of poverty. Drawing on extensive interviews with both public and private stakeholders, we examine how Malaysia has launched its transition to a decarbonized development path. Based on our multiyear analysis, we identify key breakout factors, including behavioral transformations, institutional shifts, and action by a broad network of actors that have allowed Malaysia to begin decarbonizing its economy. At the same time, we note that federal-state friction, limited government capacity, the absence of a centralized management agency, the lack of international funding, incipient environmental awareness, and numerous barriers to investment in renewable energy reinforce carbon lock-in. Our analysis suggests ways in which other rapidly developing countries can learn from Malaysia's initial successes and challenges.

During the past 60 years, afforestation has transformed Israel's landscape, with forests planted or planned on 10% of the country's land, much of it with less than 300 mm of annual precipitation. After early efforts to establish a successful commercial timber industry failed, recreation and ecosystem services came to dominate forestry policy objectives. Given Israel's status as a 'developing country' under the Kyoto Protocol, forests' economic potential through carbon sequestration has been explored, but has not yet proven to be compelling. Several considerations cooled initial enthusiasm for seeking international carbon credits through afforestation. These include administrative obstacles associated with international accreditation, limited potential economic profitability, and ethical considerations. Rather, a voluntary offsetting program was adopted, allowing donors to plant trees in Israel, that balance individual carbon emissions. Afforestation in drylands exhibit meaningful potential to counteract chronic carbon loss due to land degradation. As trees planted in Israel's semi-arid regions exhibit surprisingly high carbon sequestration properties that are comparable to forests in temperate Europe, the potential for offsetting may become a growing factor in local forestry policy once Israel begins to regulate CO 2 emissions.

Very low birth weight (VLBW) infants (<1500 g) are at risk for poor neurodevelopmental outcomes depending on gestational age (GA), birth weight (BW), and morbidity in early life. The contribution of the gut microbiome is not well understood. Stool samples were collected weekly in the neonatal intensive care unit (NICU) from 24 VLBW infants for 6 weeks after admission and then again at 2 and 4 years of age. The Battelle Development Inventory-2 Screening Test (BDI-2 ST) was administered at 2-and 4-year time points. VLBW infants had dysbiotic microbiota in the NICU that progressed for most to an adult-type microbiota by 4 years of age. The BDI-2 ST results at age of 2 years triggered referral for further testing in 14 toddlers (70%), and by 4 years of age only seven of these 14 continued to require referral. Both NICU infant stool diversity and particular microbial amplicon sequence variants were associated with BDI-2 ST subscales, particularly for cognition, adaptive, and communication subscales, when controlled for GA, BW, and antibiotic exposure. Network analysis of the NICU infant stool microbial ecology showed differences in children needing neurodevelopmental referral. The results of this preliminary study indicate that the neonatal gut microbiome plays a role in early cognitive and behavioral neurodevelopment.

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Problem: During the first years of life, the brain is developing rapidly and is especially vulnerable to the effects of trauma and or stress. Early exposure to such early trauma or stress predisposes young children to mental health problems. The practice of infant mental health (IMH) focuses on preventing negative mental health outcomes in infancy and toddlerhood. Currently, IMH is not standard practice in nursing. To enhance IMH in nursing, this manuscript provides an overview of IMH practice models, discusses nursing implications of each model and presents a model for integrating IMH into nursing practice. Methods: A scoping review was conducted with a literature search utilizing the keywords "infant mental health" AND "models of care" in the PubMed and CINHAL databases from 2002 to 2018. Findings: Twenty of the publications retrieved met search criteria. Among the 20 articles, 10 addressed clinical-based content related to IMH practice and 10 addressed nonclinical-based content associated with IMH educational training, policy development, or system-based models of care.Conclusions: Nurses are well positioned to impact IMH. The model presented provides the nursing process as a practical framework for the integration of IMH in nursing practice that can be expanded upon as IMH evolves.

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Deliberative democracy and public dispute resolution (PDR) have the same goal—to inform and determine the public interest—but they involve different skills and practices. This article considers the ways in which deliberative democratic approaches to policy-related decision-making can be supplemented with tools used in public dispute resolution—specifically, the use of an independent mediator, the well-developed technique of stakeholder assessment, and a new strategy called joint fact-finding, where stakeholders with different interests work together with outside experts to identify common assumptions, gather information together, and formulate and clarify opinions. All are designed to achieve fairer, wiser, more stable and more efficient outcomes.