Comprehensive effective and efficient global public health surveillance

At a crossroads, global public health surveillance exists in a fragmented state. Slow to detect, register, confirm, and analyze cases of public health significance, provide feedback, and communicate timely and useful information to stakeholders, global surveillance is neither maximally effective nor optimally efficient. Stakeholders lack a globa surveillance consensus policy and strategy; officials face inadequate training and scarce resources

A New Hydrogen Bond Angle/Distance Potential Energy Surface of the Quantum Water Dimer

Summary The relative effects of H-bond angle and O-O distance were examined using a series of quantum mechanical calculations on a water dimer. The geometries were constructed in such a way that H-bond angle and O-O separation were the only two independent variables, and this allowed for calculations of energies and atomic charges as a function of H-bond angle and O-O distance. Our findings show that O-O separation within the range 0.25 nm to 0.40 nm has a lesser effect on system energy and charge as compared to changes in H-bond angle, and that energy as a function of O-O separation behaves very much like a Morse potential for linear H-bonds but not for bent hydrogen bonds. Recent literature in the water dimer field is discussed, as is the application of the current findings to bulk water

A New Hydrogen Bond Angle/Distance Potential Energy Surface of the Quantum Water Dimer

Summary The relative effects of H-bond angle and O-O distance were examined using a series of quantum mechanical calculations on a water dimer. The geometries were constructed in such a way that H-bond angle and O-O separation were the only two independent variables, and this allowed for calculations of energies and atomic charges as a function of H-bond angle and O-O distance. Our findings show that O-O separation within the range 0.25 nm to 0.40 nm has a lesser effect on system energy and charge as compared to changes in H-bond angle, and that energy as a function of O-O separation behaves very much like a Morse potential for linear H-bonds but not for bent hydrogen bonds. Recent literature in the water dimer field is discussed, as is the application of the current findings to bulk water

Progress in HPV vaccination in low- and lower-middle-income countries.

The past 10 years have seen remarkable progress in the global scale-up of human papillomavirus (HPV) vaccinations. Forty-three low- and lower-middle-income countries (LLMICs) have gained experience in delivering this vaccine to young adolescent girls through pilot programs, demonstration programs, and national introductions and most of these have occurred in the last 4 years. The experience of Senegal is summarized as an illustrative country case study. Publication of numerous delivery experiences and lessons learned has demonstrated the acceptability and feasibility of HPV vaccinations in LLMICs. Four areas require dedicated action to overcome remaining challenges to national scaling-up: maintaining momentum politically, planning successfully, securing financing, and fostering sustainability. Advances in policy, programming, and science may help accelerate reaching 30 million girls in LLMICs with HPV vaccine by 2020

Unforeseen Costs of Cutting Mosquito Surveillance Budgets

A budget proposal to stop the U.S. Centers for Disease Control and Prevention (CDC) funding in surveillance and research for mosquito-borne diseases such as dengue and West Nile virus has the potential to leave the country ill-prepared to handle new emerging diseases and manage existing ones. In order to demonstrate the consequences of such a measure, if implemented, we evaluated the impact of delayed control responses to dengue epidemics (a likely scenario emerging from the proposed CDC budget cut) in an economically developed urban environment. We used a mathematical model to generate hypothetical scenarios of delayed response to a dengue introduction (a consequence of halted mosquito surveillance) in the City of Cairns, Queensland, Australia. We then coupled the results of such a model with mosquito surveillance and case management costs to estimate the cumulative costs of each response scenario. Our study shows that halting mosquito surveillance can increase the management costs of epidemics by up to an order of magnitude in comparison to a strategy with sustained surveillance and early case detection. Our analysis shows that the total costs of preparedness through surveillance are far lower than the ones needed to respond to the introduction of vector-borne pathogens, even without consideration of the cost in human lives and well-being. More specifically, our findings provide a science-based justification for the re-assessment of the current proposal to slash the budget of the CDC vector-borne diseases program, and emphasize the need for improved and sustainable systems for vector-borne disease surveillance

Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer.

BACKGROUND: Measuring factors influencing time to presentation is important in developing and evaluating interventions to promote timely cancer diagnosis, yet there is a lack of validated, culturally relevant measurement tools. This study aimed to develop and validate the African Women Awareness of CANcer (AWACAN) tool to measure awareness of breast and cervical cancer in Sub-Saharan Africa (SSA). METHODS: Development of the AWACAN tool followed 4 steps: 1) Item generation based on existing measures and relevant literature. 2) Refinement of items via assessment of content and face validity using cancer experts' ratings and think aloud interviews with community participants in Uganda and South Africa. 3) Administration of the tool to community participants, university staff and cancer experts for assessment of validity using test-retest reliability (using Intra-Class Correlation (ICC) and adjusted Kappa coefficients), construct validity (comparing expert and community participant responses using t-tests) and internal reliability (using the Kuder-Richarson (KR-20) coefficient). 4) Translation of the final AWACAN tool into isiXhosa and Acholi. RESULTS: ICC scores indicated good test-retest reliability (≥ 0.7) for all breast cancer knowledge domains and cervical cancer risk factor and lay belief domains. Experts had higher knowledge of breast cancer risk factors (p 0.7, and lower (0.6) for the cervical cancer risk subscale. CONCLUSION: The final AWACAN tool includes items on socio-demographic details; breast and cervical cancer symptom awareness, risk factor awareness, lay beliefs, anticipated help-seeking behaviour; and barriers to seeking care. The tools showed evidence of content, face, construct and internal validity and test-retrest reliability and are available for use in SSA in three languages.Research reported in this article was jointly supported by the Cancer Association of South Africa (CANSA), the University of Cape Town and the South African Medical Research Council with funds received from the South African National Department of Health, GlaxoSmithKline (GSK) Africa Non-Communicable Disease Open Lab (via a supporting grant Project Number: 023), the United Kingdom Medical Research Council (via the Newton Fund)

Pulmonary impairment after tuberculosis and its contribution to TB burden

<p>Abstract</p> <p>Background</p> <p>The health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs).</p> <p>Methods</p> <p>TB burden was calculated for all culture-confirmed TB patients treated at Tarrant County Public Health between January 2005 and December 2006 using identical methods and life tables as the Global Burden of Disease Study. Years of life-lost were calculated as the difference between life expectancy using standardized life tables and age-at-death from TB. Years lived-with-disability were calculated from age and gender-specific TB disease incidence using published disability weights. Non-fatal health impacts of TB were divided into years lived-with-disability-acute and years lived-with-disability-chronic. Years lived-with-disability-acute was defined as TB burden resulting from illness prior to completion of treatment including the burden from treatment-related side effects. Years lived-with-disability-chronic was defined as TB burden from disability resulting from pulmonary impairment after tuberculosis.</p> <p>Results</p> <p>There were 224 TB cases in the time period, of these 177 were culture confirmed. These 177 subjects lost a total of 1189 DALYs. Of these 1189 DALYs 23% were from years of life-lost, 2% were from years lived-with-disability-acute and 75% were from years lived-with-disability-chronic.</p> <p>Conclusions</p> <p>Our findings demonstrate that the disease burden from TB is greater than previously estimated. Pulmonary impairment after tuberculosis was responsible for the majority of the burden. These data demonstrate that successful TB control efforts may reduce the health burden more than previously recognized.</p

Effect of the look-up line on the gaze and head orientation of elite ice hockey players

A “look-up-line” (LUL) has been proposed for ice hockey, which is an orange 1 m (40 in) warning line (WL) painted on the ice at the base of the boards. The LUL purports to provide an early warning to players to keep their head up prior to, and as they are being checked. We determined if players looked-up more on a rink with the LUL compared to a traditional Control rink. Elite offensive (O) and defensive (D) players competed 1 vs 1, while wearing an eye tracker that recorded their quiet eye (QE) and fixation tracking (F-T) and an electro-goniometer that measured head angle. External cameras recorded skate duration during four skate phases: P1 preparation, P2 decision-making, P3 cut to boards, P4 contact. The QE was the final fixation prior to contact between O and D as they skated toward and across the WL during P3 and P4. Skate phase durations (%) did not differ by rink or rink by position. More QE and F-T occurred on the WL on the LUL rink than on the Control. The expected increase in head angle on the LUL rink did not occur during P3 or P4. Post-hoc results also showed O and D skated further from the boards on the LUL rink, suggesting the players preferred to control the puck on white ice, rather than the orange color of the LUL rink. More research is needed to determine if these results apply to the competitive setting

Varicella-Zoster viruses associated with post-herpetic neuralgia induce sodium current density increases in the ND7-23 Nav-1.8 neuroblastoma cell line

Post-herpetic neuralgia (PHN) is the most significant complication of herpes zoster caused by reactivation of latent Varicella-Zoster virus (VZV). We undertook a heterologous infection in vitro study to determine whether PHN-associated VZV isolates induce changes in sodium ion channel currents known to be associated with neuropathic pain. Twenty VZV isolates were studied blind from 11 PHN and 9 non-PHN subjects. Viruses were propagated in the MeWo cell line from which cell-free virus was harvested and applied to the ND7/23-Nav1.8 rat DRG x mouse neuroblastoma hybrid cell line which showed constitutive expression of the exogenous Nav 1.8, and endogenous expression of Nav 1.6 and Nav 1.7 genes all encoding sodium ion channels the dysregulation of which is associated with a range of neuropathic pain syndromes. After 72 hrs all three classes of VZV gene transcripts were detected in the absence of infectious virus. Single cell sodium ion channel recording was performed after 72 hr by voltage-clamping. PHN-associated VZV significantly increased sodium current amplitude in the cell line when compared with non-PHN VZV, wild-type (Dumas) or vaccine VZV strains ((POka, Merck and GSK). These sodium current increases were unaffected by acyclovir pre-treatment but were abolished by exposure to Tetrodotoxin (TTX) which blocks the TTX-sensitive fast Nav 1.6 and Nav 1.7 channels but not the TTX-resistant slow Nav 1.8 channel. PHN-associated VZV sodium current increases were therefore mediated in part by the Nav 1.6 and Nav 1.7 sodium ion channels. An additional observation was a modest increase in message levels of both Nav1.6 and Nav1.7 mRNA but not Nav 1.8 in PHN virally infected cells