SummaryBackgroundRaised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher.MethodsFor this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure.FindingsWe pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence.InterpretationDuring the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.FundingWellcome Trust.

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. MethodsWe used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including

SummaryMycoplasma arthritidis, an agent of chronic proliferative arthritis of rodents, secretes a potent soluble superantigen, MAM, that is active for both murine and human T and B lymphocytes. We now report the complete nucleotide and amino acid sequence of MAM and show it to be distinct from other proteins and not closely related phylogeneticaUy to other superantigens. Two functional domains on MAM are identified based on the ability ofpeptides encompassing these regions to inhibit lymphocyte proliferation by the intact MAM molecule. One of these domains shares short sequences or epitopes with other microbial superantigens. The second domain contains the consensus legume lectin motif-B, which is important for T cell activation by concanavalin (Con) A. MAM and Con A peptides containing this motif are functionally cross reactive, suggesting a novel secondary pathway for T cell activation by MAM. S uperantigens are potent immunomodulatory moleculesthat are produced by a number of pathogenic bacteria (1, 2), endogenous murine retroviruses (3), and may be associated with HIV-1 (4, 5). Superantigens have been hypothesized to play a role in human diseases including Kawasaki's disease, toxic shock syndrome, rheumatoid arthritis, and diabetes (6-8). The Mycoplasma arthritidis mitogen (MAM) ~ (9) is a particularly interesting superantigen as it is produced by an organism that causes spontaneous chronic arthritis in rodents (10). Furthermore, evidence suggests that MAM triggers autoimmune arthritis in collagen-injected mice by activating the specific T cells that drive the inflammatory response (11).MAM is a typical superantigen in that it is presented to murine and human T cells by direct binding to MHC molecules present on accessory cell surfaces and is recognized by specific V~ chain segments of the TCR without MHC restriction (9). Although MAM is much less potent in activating human T cells than are the Staphylococcus aureusderived superantigens, unlike the latter it promotes a strong polyclonal B cell activation in human PBL. This property suggests that MAM may be an ideal model for the study of 1Abbreviations used in this paper: MAM, Mycoplasma arthtitidis mitogen; SEA, SEB, SEC, staphylococcal enterotoxin A, B, and C, respectively. the role of superantigens in the pathogenesis of human autoimmune disease characterized by hypergammaglobulinemia (12). We show here that MAM is a unique protein, phylogenetically distinct from other superantigens, but which contains cross-reactive motifs found in other T cell mitogens. Materials and MethodsCloning and Sequencing of MAM. Degenerate oligonucleotide primers were designed corresponding to the NH 2-and COOHterminal ends of the previously sequenced peptide (13), based upon the codon usage ofMycoplasma capricolum (14). These primers were used to amplify, by PCtL, chromosomal DNA from M. arthritidis strain PG6. The PCIL product was labeled with 32p and used to screen an M. arthtitidis PG6 genomic library constructed in EMBL3 using previously described methods (15). Three clone...

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Background Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods We pooled 1,018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean SBP, mean DBP and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results In 2005-2016, at the same level of population mean SBP and DBP, men and women in south Asia and in central Asia, Middle East and north Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

Horizontal gene transfer has contributed to the global spread of the blaNDM-1 gene. Multiple studies have demonstrated plasmid transfer of blaNDM-1 between Gram-negative bacteria, primarily Enterobacteriaceae species, but conjugational transfer of natural blaNDM-1 plasmids from Enterobacteriaceae into Pseudomonas aeruginosa and Acinetobacter baumannii has not previously been shown. As P. aeruginosa and A. baumannii are both typically strong biofilm formers, transfer of natural blaNDM-1 plasmids could potentially occur more readily in this environment. To determine whether natural blaNDM-1 plasmids could transfer to P. aeruginosa or A. baumannii in biofilms, three clinical and environmental Enterobacteriaceae strains carrying NDM-1-encoding plasmids of different incompatibility types were mated with E. coli J53, producing E. coli J53- blaNDM-1 transconjugants. Subsequently, dual-species biofilms were created using the E. coli J53 transconjugants as plasmid donors and either P. aeruginosa or A. baumannii as recipients. Biofilm transfer of NDM-encoding plasmids to P. aeruginosa and A. baumannii was successful from one and two E. coli J53- blaNDM-1 transconjugants, respectively. This demonstrates the potential for the spread of blaNDM-1, genes to P. aeruginosa and A. baumannii in clinical and environmental settings.

Differences in jurisdictional public health actions have played a significant role in the relative success of local communities in combating and containing the COVID-19 pandemic. We forecast the possible COVID-19 outbreak in one US state (Utah) by applying empirical data from South Korea and Italy, two countries that implemented disparate public health actions. Forecasts were created by aligning the start of the pandemic in Utah with that in South Korea and Italy, getting a short-run forecast based on actual daily rates of spread, and long-run forecast by employing a log-logistic model with four parameters. Applying the South Korea model, the epidemic peak in Utah is 169 cases/day, with epidemic resolution by the end of May. Applying the Italy model, new cases are forecast to exceed 200/day by mid-April, with the potential for 250 new cases a day at the epidemic peak, with the epidemic continuing through the end of August. We identify a 3-month variation in the likely length of the pandemic, a 1.5-fold difference in the number of daily infections at outbreak peak, and a 3-fold difference in the expected cumulative cases when applying the experience of two developed countries in handling this virus to the Utah context.

Natural and man-made disasters will remain a threat to the safety and health of communities in all parts of the world, especially within vulnerable communities in LMICs; however, little research has been done to identify disaster perception, vulnerability, and preparedness in LMIC communities. The current study established that selected communities near Trujillo, Peru recognize a high disaster impact from earthquakes and infection, but are not adequately prepared for potential future disasters. By identifying high-risk demographics, targeted public health interventions are needed to prepare vulnerable communities in the following areas: emergency food supplies, emergency water plan, medical supplies at home, and establishing evacuation plans. Stewart M , Grahmann B , Fillmore A , Benson LS . Rural community disaster preparedness and risk perception in Trujillo, Peru. Prehosp Disaster Med. 2017;32(4):387-392.