Élaboration d’un programme d’agents de santé communautaires Durant la flambée épidémique du virus Ébola en Sierra Leone

This SSHAP Case Study explores the effective implementation of a community health worker (CHW) programme during the Ebola Virus Disease (EVD) epidemic within a collapsed health system in Port Loko district, Sierra Leone. Fear, misinformation, and distrust meant that a comprehensive community-based response was needed to support effective disease screening and referral to Ebola treatment facilities. Partners in Health (PIH), a health-care non-governmental organisation (NGO) founded in the USA, delivered a CHW programme that provided 250,000 people affected by Ebola in Port Loko district with health system services and linkages required to combat Ebola.Cette étude de cas SSHAP examine la mise en oeuvre efficace d’un programme d’agents de santé communautaires (ASC) durant l’épidémie de maladie à virus Ébola (MVE) dans le cadre d’un système de santé effondré dans le district de Port Loko, en Sierra Leone. La peur, la désinformation, et la méfiance ont engendré la nécessité d’une riposte à base communautaire globale pour soutenir le dépistage efficace de la maladie et l’orientation vers des centres de traitement d’Ébola. Partners in Health (PIH), une organisation de soins de santé non gouvernemental (ONG) fondée aux États- Unis, a mis en oeuvre un programme ASC ayant contribué à fournir des prestations de système de santé et les connexions nécessaires pour lutter contre le virus Ébola à 250 000 personnes touchées par le virus Ébola dans le district de Port Loko.UNICEFUSAI

Characterization of Pro-Inflammatory Flagellin Proteins Produced by Lactobacillus ruminis and Related Motile Lactobacilli

peer-reviewedLactobacillus ruminis is one of at least twelve motile but poorly characterized species found in the genus Lactobacillus. Of these, only L. ruminis has been isolated from mammals, and this species may be considered as an autochthonous member of the gastrointestinal microbiota of humans, pigs and cows. Nine L. ruminis strains were investigated here to elucidate the biochemistry and genetics of Lactobacillus motility. Six strains isolated from humans were non-motile while three bovine isolates were motile. A complete set of flagellum biogenesis genes was annotated in the sequenced genomes of two strains, ATCC25644 (human isolate) and ATCC27782 (bovine isolate), but only the latter strain produced flagella. Comparison of the L. ruminis and L. mali DSM20444T motility loci showed that their genetic content and gene-order were broadly similar, although the L. mali motility locus was interrupted by an 11.8 Kb region encoding rhamnose utilization genes that is absent from the L. ruminis motility locus. Phylogenetic analysis of 39 motile bacteria indicated that Lactobacillus motility genes were most closely related to those of motile carnobacteria and enterococci. Transcriptome analysis revealed that motility genes were transcribed at a significantly higher level in motile L. ruminis ATCC27782 than in non-motile ATCC25644. Flagellin proteins were isolated from L. ruminis ATCC27782 and from three other Lactobacillus species, while recombinant flagellin of aflagellate L. ruminis ATCC25644 was expressed and purified from E. coli. These native and recombinant Lactobacillus flagellins, and also flagellate L. ruminis cells, triggered interleukin-8 production in cultured human intestinal epithelial cells in a manner suppressed by short interfering RNA directed against Toll-Like Receptor 5. This study provides genetic, transcriptomic, phylogenetic and immunological insights into the trait of flagellum-mediated motility in the lactobacilli.This work was supported by a Principal Investigator Award (07/IN.1/B1780) from Science Foundation Ireland to PWOT. BAN was the recipient of an Embark studentship from the Irish Research Council for Science Engineering and Technology. TD and KN were supported by the Alimentary Pharmabiotic Centre, funded by Science Foundation Ireland

Potent Innate Immune Response to Pathogenic Leptospira in Human Whole Blood

Background: Leptospirosis is caused by pathogenic spirochetes of the genus Leptospira. The bacteria enter the human body via abraded skin or mucous membranes and may disseminate throughout. In general the clinical picture is mild but some patients develop rapidly progressive, severe disease with a high case fatality rate. Not much is known about the innate immune response to leptospires during haematogenous dissemination. Previous work showed that a human THP-1 cell line recognized heat-killed leptospires and leptospiral LPS through TLR2 instead of TLR4. The LPS of virulent leptospires displayed a lower potency to trigger TNF production by THP-1 cells compared to LPS of non-virulent leptospires. Methodology/Principal Findings: We investigated the host response and killing of virulent and non-virulent Leptospira of different serovars by human THP-1 cells, human PBMC's and human whole blood. Virulence of each leptospiral strain was tested in a well accepted standard guinea pig model. Virulent leptospires displayed complement resistance in human serum and whole blood while in-vitro attenuated non-virulent leptospires were rapidly killed in a complement dependent manner. In vitro stimulation of THP-1 and PBMC's with heat-killed and living leptospires showed differential serovar and cell type dependence of cytokine induction. However, at low, physiological, leptospiral dose, living virulent complement resistant strains were consistently more potent in whole blood stimulations than the corresponding non-virulent complement sensitive strains. At higher dose living virulent and non-virulent leptospires were equipotent in whole blood. Inhibition of different TLRs indicated that both TLR2 and TLR4 as well as TLR5 play a role in the whole blood cytokine response to living leptospires. Conclusions/Significance: Thus, in a minimally altered system as human whole blood, highly virulent Leptospira are potent inducers of the cytokine response

A JWST/MIRI and NIRCam Analysis of the Young Stellar Object Population in the Spitzer I region of NGC 6822

We present an imaging survey of the Spitzer~I star-forming region in NGC 6822 conducted with the NIRCam and MIRI instruments onboard JWST. Located at a distance of 490 kpc, NGC 6822 is the nearest non-interacting low-metallicity ($\sim$0.2 $Z_{\odot}$) dwarf galaxy. It hosts some of the brightest known HII regions in the local universe, including recently discovered sites of highly-embedded active star formation. Of these, Spitzer I is the youngest and most active, and houses 90 color-selected candidate young stellar objects (YSOs) identified from Spitzer Space Telescope observations. We revisit the YSO population of Spitzer~I with these new JWST observations. By analyzing color-magnitude diagrams (CMDs) constructed with NIRCam and MIRI data, we establish color selection criteria and construct spectral energy distributions (SEDs) to identify candidate YSOs and characterize the full population of young stars, from the most embedded phase to the more evolved stages. In this way, we have identified 129 YSOs in Spitzer I. Comparing to previous Spitzer studies of the NGC 6822 YSO population, we find that the YSOs we identify are fainter and less massive, indicating that the improved resolution of JWST allows us to resolve previously blended sources into individual stars.Comment: 17 pages, 9 figures, 2 tables, to be submitted to ApJ, comments welcom

JWST MIRI and NIRCam Unveil Previously Unseen Infrared Stellar Populations in NGC 6822

NGC 6822 is a nearby (\sim490 kpc) non-interacting low-metallicity (0.2 Z_\odot) dwarf galaxy which hosts several prominent Hii regions, including sites of highly embedded active star formation. In this work, we present an imaging survey of NGC 6822 conducted with the NIRCam and MIRI instruments onboard JWST. We provide a description of the data reduction, source extraction, and stellar population identifications from combined near- and mid-infrared (IR) photometry. Our NIRCam observations reach seven magnitudes deeper than previous JHKs surveys of this galaxy, which were sensitive to just below the tip of the red giant branch (TRGB). These JWST observations thus reveal for the first time in the near-IR the red clump stellar population and extend nearly three magnitudes deeper. In the mid-IR, we observe roughly two magnitudes below the TRGB with the MIRI F770W and F1000W filters. With these improvements in sensitivity, we produce a catalogue of \sim900,000 point sources over an area of \sim 6.0 x 4.3 arcmin2. We present several NIRCam and MIRI colour-magnitude diagrams and discuss which colour combinations provide useful separations of various stellar populations to aid in future JWST observation planning. Finally, we find populations of carbon- and oxygen-rich asymptotic giant branch stars which will assist in improving our understanding of dust production in low-metallicity, early Universe analogue galaxies

Range area matters, and so does spatial configuration: predicting conservation status in vertebrates

The current rapid loss of biodiversity globally calls for improved tools to predict conservation status. Conservation status varies among taxa and is influenced by intrinsic species’ traits and extrinsic factors. Among these predictors, the most consistently recognized and widely available is geographic range area. However, ranges of equal area can have diverse spatial configurations that reflect variation in threatening processes and species’ characteristics (e.g., dispersal ability), and can affect local and regional population dynamics. The aim of this study is to assess if and how the spatial configuration of a species’ range relates to its conservation status. We obtained range maps and two descriptors of conservation status: extinction risk and population trend, from the IUCN for 11,052 species of amphibians, non-marine birds, and terrestrial mammals distributed across the World. We characterized spatial configuration using descriptors of shape and fragmentation (fragment number and size heterogeneity) and used regression analysis to evaluate their role in explaining current extinction risk and population trend. The most important predictor of conservation status was range area, but our analyses also identified shape and fragmentation as valuable predictors. We detected complex relationships, revealed by multiple interaction terms, e.g. more circular shapes were negatively correlated with population trend, and heterogeneity was positively correlated with extinction risk for small range areas but negatively for bigger ranges. Considering descriptors of spatial configuration beyond size improves our understanding of conservation status among vertebrates. The metrics we propose are relatively easy to define (although values can be sensitive to data quality), and unlike other correlates of status, like species’ traits, are readily available for many species (all of those with range maps). We argue that considering spatial configuration predictors is a straightforward way to improve our capacity to predict conservation status and thus, can be useful to promote more effective conservation

Surgical experience and identification of errors in laparoscopic cholecystectomy

BACKGROUND: Surgical errors are acts or omissions resulting in negative consequences and/or increased operating time. This study describes surgeon-reported errors in laparoscopic cholecystectomy. METHODS: Intraoperative videos were uploaded and annotated on Touch SurgeryTM Enterprise. Participants evaluated videos for severity using a 10-point intraoperative cholecystitis grading score, and errors using Observational Clinical Human Reliability Assessment, which includes skill, consequence, and mechanism classifications. RESULTS: Nine videos were assessed by 8 participants (3 junior (specialist trainee (ST) 3-5), 2 senior trainees (ST6-8), and 3 consultants). Participants identified 550 errors. Positive relationships were seen between total operating time and error count (r2 = 0.284, P < 0.001), intraoperative grade score and error count (r2 = 0.578, P = 0.001), and intraoperative grade score and total operating time (r2 = 0.157, P < 0.001). Error counts differed significantly across intraoperative phases (H(6) = 47.06, P < 0.001), most frequently at dissection of the hepatocystic triangle (total 282; median 33.5 (i.q.r. 23.5-47.8, range 15-63)), ligation/division of cystic structures (total 124; median 13.5 (i.q.r. 12-19.3, range 10-26)), and gallbladder dissection (total 117; median 14.5 (i.q.r. 10.3-18.8, range 6-26)). There were no significant differences in error counts between juniors, seniors, and consultants (H(2) = 0.03, P = 0.987). Errors were classified differently. For dissection of the hepatocystic triangle, thermal injuries (50 in total) were frequently classified as executional, consequential errors; trainees classified thermal injuries as step done with excessive force, speed, depth, distance, time or rotation (29 out of 50), whereas consultants classified them as incorrect orientation (6 out of 50). For ligation/division of cystic structures, inappropriate clipping (60 errors in total), procedural errors were reported by junior trainees (6 out of 60), but not consultants. For gallbladder dissection, inappropriate dissection (20 errors in total) was reported in incorrect planes by consultants and seniors (6 out of 20), but not by juniors. Poor economy of movement (11 errors in total) was reported more by consultants (8 out of 11) than trainees (3 out of 11). CONCLUSION: This study suggests that surgical experience influences error interpretation, but the benefits for surgical training are currently unclear

Comparative Transcriptional and Translational Analysis of Leptospiral Outer Membrane Protein Expression in Response to Temperature

Leptospirosis, caused by Leptospira spp., is a disease of worldwide significance affecting millions of people annually. Bacteria of this species are spread by various carrier animals, including rodents and domestic livestock, which shed the leptospires via their urine into the environment. Humans become infected through direct contact with carrier animals or indirectly via contaminated water or soil. Temperature is a key trigger used by many bacteria to sense changes in environmental conditions, including entry from the environment into the host. This study was the first comprehensive research into changes occurring in the outer membrane of Leptospira in response to temperature and how these changes correlate with gene expression changes. An understanding of the regulation and function of these proteins is important as they may provide an adaptation and survival advantage for the microorganism which may enhance its ability to infect hosts and cause disease. Our data suggest regulation of proteins in the outer membrane which may possibly be a mechanism to minimise interactions with the host immune response

Multi-scale assessment of human-induced changes to Amazonian instream habitats

Context Land use change and forest degradation have myriad effects on tropical ecosystems. Yet their consequences for low-order streams remain very poorly understood, including in the world´s largest freshwater basin, the Amazon. Objectives Determine the degree to which physical and chemical characteristics of the instream habitat of low-order Amazonian streams change in response to past local- and catchment-level anthropogenic disturbances. Methods To do so, we collected field instream habitat (i.e., physical habitat and water quality) and landscape data from 99 stream sites in two eastern Brazilian Amazon regions. We used random forest regression trees to assess the relative importance of different predictor variables in determining changes in instream habitat response variables. Results Multiple drivers, operating at multiple spatial scales, were important in determining changes in the physical habitat and water quality of the sites. Although we found few similarities in modelled relationships between the two regions, we observed non-linear responses of specific instream characteristics to landscape change; for example 20 % of catchment deforestation resulted in consistently warmer streams. Conclusions Our results highlight the importance of local riparian and catchment-scale forest cover in shaping instream physical environments, but also underscore the importance of other land use changes and activities, such as road crossings and upstream agriculture intensification. In contrast to the property-scale focus of the Brazilian Forest code, which governs environmental regulations on private land, our results reinforce the importance of catchment-wide management strategies to protect stream ecosystem integrity

Electron Antineutrino Search at the Sudbury Neutrino Observatory

Upper limits on the \nuebar flux at the Sudbury Neutrino Observatory have been set based on the \nuebar charged-current reaction on deuterium. The reaction produces a positron and two neutrons in coincidence. This distinctive signature allows a search with very low background for \nuebar's from the Sun and other potential sources. Both differential and integral limits on the \nuebar flux have been placed in the energy range from 4 -- 14.8 MeV. For an energy-independent \nu_e --> \nuebar conversion mechanism, the integral limit on the flux of solar \nuebar's in the energy range from 4 -- 14.8 MeV is found to be \Phi_\nuebar <= 3.4 x 10^4 cm^{-2} s^{-1} (90% C.L.), which corresponds to 0.81% of the standard solar model 8B \nu_e flux of 5.05 x 10^6 cm^{-2} s^{-1}, and is consistent with the more sensitive limit from KamLAND in the 8.3 -- 14.8 MeV range of 3.7 x 10^2 cm^{-2} s^{-1} (90% C.L.). In the energy range from 4 -- 8 MeV, a search for \nuebar's is conducted using coincidences in which only the two neutrons are detected. Assuming a \nuebar spectrum for the neutron induced fission of naturally occurring elements, a flux limit of Phi_\nuebar <= 2.0 x 10^6 cm^{-2} s^{-1}(90% C.L.) is obtained.Comment: submitted to Phys. Rev.