Purpose This conceptual paper examines the Caribbean tourism sector, its growth, performance, importance and its vulnerability to climate change. The purpose of this paper is to serve as an introduction to the on-going conversation around climate change and the socioeconomic impacts likely to be experienced in tourism-dependent Caribbean territories. Design/methodology/approach The Caribbean is used as the context of this work. A broad perspective was adopted to paint a picture of the wider implications. The region is represented by a multiplicity of country profiles, both in physical and socio-economic characteristics; this warrants a broad assessment of the issues examined here. Findings This work shows that the Caribbean tourism sectors face significant future threats related to both competitiveness and climate change impacts. For a region so heavily dependent on coastal- and marine-related tourism attractions, adaptation and resilience are critical issues facing Caribbean tourism. An effective approach to building resilience to climate change requires extensive regional cooperation. Research limitations/implications While there is much published on the matter of climate change implications in the general global context, there is considerably less published work specifically examining the likely effects climate change will have on the special socio-economic features of the Caribbean and on the tourism industry in particular. Practical implications The lack of extensive and ongoing research dedicated to climate change implications for Caribbean tourism, while limiting the scope of this work, does highlight a gap and open the door for future work that examines, in greater detail both collectively and on an individual country basis, the climate change implications for tourism industries throughout the region. Social implications Climate change vulnerabilities in the region present a significant threat to economic development, employment and food security among others. Coastal flooding, infrastructural damage and the potential displacement of coastal communities present significant impediments to the quality of life of Caribbean nationals. The social implications necessitate further in-depth study to inform the development of adaptation strategies that may secure the tourism industry and the livelihoods and lifestyles of the people. Originality/value This work is original in its evaluation of the viewpoints of climate change vulnerability specific to the Caribbean tourism sector.

BackgroundPyrazinamide (PZA) is a key component of current and future regimens for tuberculosis (TB). Inclusion of PZA at higher doses and for longer durations may improve efficacy outcomes but must be balanced against the potential for worse safety outcomes.MethodsWe will search for randomised and quasi-randomised clinical trials in adult participants with and without the inclusion of PZA in TB treatment regimens in the Cochrane infectious diseases group’s trials register, Cochrane central register of controlled trials (CENTRAL), MEDLINE, EMBASE, LILACS, the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) international clinical trials registry platform. One author will screen abstracts and remove ineligible studies (10% of which will be double-screened by a second author). Two authors will review full texts for inclusion. Safety and efficacy data will be extracted to pre-piloted forms by one author (10% of which will be double-extracted by a second author). The Cochrane risk of bias tool will be used to assess study quality. The study has three objectives: the association of (1) inclusion, (2) dose and (3) duration of PZA with efficacy and safety outcomes. Risk ratios as relative measures of effect for direct comparisons within trials (all objectives) and proportions as absolute measures of effect for indirect comparisons across trials (for objectives 2 and 3) will be calculated. If there is insufficient data for direct comparisons within trials for objective 1, indirect comparisons between trials will be performed. Measures of effect will be pooled, with corresponding 95% confidence intervals and p values. Meta-analysis will be performed using the generalised inverse variance method for fixed effects models (FEM) or the DerSimonian-Laird method for random effects models (REM). For indirect comparisons, meta-regression for absolute measures against dose and duration data will be performed. Heterogeneity will be quantified through the I2-statistic for direct comparisons and the τ2 statistic for indirect comparisons using meta-regression.DiscussionThe current use of PZA for TB is based on over 60 years of clinical trial data, but this has never been synthesised to guide rationale use in future regimens and clinical trials.Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019138735

Mice were primed and subsequently challenged at various times with subcutaneous injections of sheep erythrocytes, and some characteristics of the secondary responses in the draining brachial and axillary lymph nodes were investigated. It was found that the secondary response within primed nodes was resistant to immunological preemption, a competition-like phenomenon which severely depresses primary responses. Since it was also shown that circulating memory cells could be inhibited by preempting injections of antigen, it was concluded that the resistance of primed nodes to preemption was due to the presence within them of a nonrecirculating subpopulation of memory cells. The size of this population was dependent both on the amount of priming antigen and the time after priming. The observation that the response given by these cells remained unaffected by doses of antigen which could depress a primary response does not favor the view that suppression of immune responses by preemption or antigenic competition is due to a factor which acts directly and indiscriminately on all immunologically competent cells.

The growing global concern for sustainable and alternative tourism development has strengthened the scientific research and management of tourist destinations. In this context, the objective of this study is to characterize the tourism system of the city of San Juan de Los Remedios in order to understand the current problems and design sustainable solutions. It corresponds to a quali-quantitative, applied, deductive and multidisciplinary propositional research, in which the basic principles of strategic tourism planning were implemented. It presents, in a sequential and integrated way, an inventory of the local tourism system, a diagnostic study based on SWOT analysis, and a projective study for the consolidation of sustainable tourism. It concludes that there is favorable potential for urban tourism use, though this is not currently being pursued in a sustainable way; further, there is a lack of regional-territorial cohesion. This situation demands higher levels of strategic planning, as well as the creation of a destination management organization and a tourism observatory at a local-regional level. These approaches would strengthen the holistic management of the territory and lead to the creation of a competitive, multi-purpose, multi-product destination.