Plasmodium vivax Malaria among Military Personnel, French Guiana, 1998–2008

We obtained health surveillance epidemiologic data on malaria among French military personnel deployed to French Guiana during 1998–2008. Incidence of Plasmodium vivax malaria increased and that of P. falciparum remained stable. This new epidemiologic situation has led to modification of malaria treatment for deployed military personnel

Value of syndromic surveillance within the Armed Forces for early warning during a dengue fever outbreak in French Guiana in 2006

<p>Abstract</p> <p>Background</p> <p>A dengue fever outbreak occured in French Guiana in 2006. The objectives were to study the value of a syndromic surveillance system set up within the armed forces, compared to the traditional clinical surveillance system during this outbreak, to highlight issues involved in comparing military and civilian surveillance systems and to discuss the interest of syndromic surveillance for public health response.</p> <p>Methods</p> <p>Military syndromic surveillance allows the surveillance of suspected dengue fever cases among the 3,000 armed forces personnel. Within the same population, clinical surveillance uses several definition criteria for dengue fever cases, depending on the epidemiological situation. Civilian laboratory surveillance allows the surveillance of biologically confirmed cases, within the 200,000 inhabitants.</p> <p>Results</p> <p>It was shown that syndromic surveillance detected the dengue fever outbreak several weeks before clinical surveillance, allowing quick and effective enhancement of vector control within the armed forces. Syndromic surveillance was also found to have detected the outbreak before civilian laboratory surveillance.</p> <p>Conclusion</p> <p>Military syndromic surveillance allowed an early warning for this outbreak to be issued, enabling a quicker public health response by the armed forces. Civilian surveillance system has since introduced syndromic surveillance as part of its surveillance strategy. This should enable quicker public health responses in the future.</p

Proposal of a framework for evaluating military surveillance systems for early detection of outbreaks on duty areas

<p>Abstract</p> <p>Background</p> <p>In recent years a wide variety of epidemiological surveillance systems have been developed to provide early identification of outbreaks of infectious disease. Each system has had its own strengths and weaknesses. In 2002 a Working Group of the Centers for Disease Control and Prevention (CDC) produced a framework for evaluation, which proved suitable for many public health surveillance systems. However this did not easily adapt to the military setting, where by necessity a variety of different parameters are assessed, different constraints placed on the systems, and different objectives required. This paper describes a proposed framework for evaluation of military syndromic surveillance systems designed to detect outbreaks of disease on operational deployments.</p> <p>Methods</p> <p>The new framework described in this paper was developed from the cumulative experience of British and French military syndromic surveillance systems. The methods included a general assessment framework (CDC), followed by more specific methods of conducting evaluation. These included Knowledge/Attitude/Practice surveys (KAP surveys), technical audits, ergonomic studies, simulations and multi-national exercises. A variety of military constraints required integration into the evaluation. Examples of these include the variability of geographical conditions in the field, deployment to areas without prior knowledge of naturally-occurring disease patterns, the differences in field sanitation between locations and over the length of deployment, the mobility of military forces, turnover of personnel, continuity of surveillance across different locations, integration with surveillance systems from other nations working alongside each other, compatibility with non-medical information systems, and security.</p> <p>Results</p> <p>A framework for evaluation has been developed that can be used for military surveillance systems in a staged manner consisting of initial, intermediate and final evaluations. For each stage of the process parameters for assessment have been defined and methods identified.</p> <p>Conclusion</p> <p>The combined experiences of French and British syndromic surveillance systems developed for use in deployed military forces has allowed the development of a specific evaluation framework. The tool is suitable for use by all nations who wish to evaluate syndromic surveillance in their own military forces. It could also be useful for civilian mobile systems or for national security surveillance systems.</p

Characterization of the Tomato ARF Gene Family Uncovers a Multi-Levels Post-Transcriptional Regulation Including Alternative Splicing

Background: The phytohormone auxin is involved in a wide range of developmental processes and auxin signaling is known to modulate the expression of target genes via two types of transcriptional regulators, namely, Aux/IAA and Auxin Response Factors (ARF). ARFs play a major role in transcriptional activation or repression through direct binding to the promoter of auxin-responsive genes. The present study aims at gaining better insight on distinctive structural and functional features among ARF proteins. Results: Building on the most updated tomato (Solanum lycopersicon) reference genome sequence, a comprehensive set of ARF genes was identified, extending the total number of family members to 22. Upon correction of structural annotation inconsistencies, renaming the tomato ARF family members provided a consensus nomenclature for all ARF genes across plant species. In silico search predicted the presence of putative target site for small interfering RNAs within twelve Sl-ARFs while sequence analysis of the 59-leader sequences revealed the presence of potential small uORF regulatory elements. Functional characterization carried out by transactivation assay partitioned tomato ARFs into repressors and activators of auxin-dependent gene transcription. Expression studies identified tomato ARFs potentially involved in the fruit set process. Genome-wide expression profiling using RNA-seq revealed that at least one third of the gene family members display alternative splicing mode of regulation during the flower to fruit transition. Moreover, the regulation of several tomato ARF genes by both ethylene and auxin, suggests their potential contribution to the convergence mechanism between the signaling pathways of these two hormones. Conclusion: All together, the data bring new insight on the complexity of the expression control of Sl-ARF genes at the transcriptional and post-transcriptional levels supporting the hypothesis that these transcriptional mediators might represent one of the main components that enable auxin to regulate a wide range of physiological processes in a highly specific and coordinated manner

Multi-trait genome-wide association study identifies new loci associated with optic disc parameters

A new avenue of mining published genome-wide association studies includes the joint analysis of related traits. The power of this approach depends on the genetic correlation of traits, which reflects the number of pleiotropic loci, i.e. genetic loci influencing multiple traits. Here, we applied new meta-analyses of optic nerve head (ONH) related traits implicated in primary open-angle glaucoma (POAG); intraocular pressure and central corneal thickness using Haplotype reference consortium imputations. We performed a multi-trait analysis of ONH parameters cup area, disc area and vertical cup-disc ratio. We uncover new variants; rs11158547 in PPP1R36-PLEKHG3 and rs1028727 near SERPINE3 at genome-wide significance that replicate in independent Asian cohorts imputed to 1000 Genomes. At this point, validation of these variants in POAG cohorts is hampered by the high degree of heterogeneity. Our results show that multi-trait analysis is a valid approach to identify novel pleiotropic variants for ONH

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Surveillance épidémiologique des accidents d'expositions sexuelle au VIH dans les armées en 2000

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Réalisation et évaluation d'un système de surveillance en temps réel pour les forces armées en opérations

Les objectifs que je devais atteindre dans le cadre de cette Thèse étaient de réaliser un démonstrateur de surveillance en temps réel au sein des forces armées et de pratiquer son évaluation, afin de répondre à la question qui m était posée de la faisabilité et de l intérêt de ce type de surveillance en milieu militaire. A partir de ce travail, je devais fournir des propositions pour la généralisation du concept à l ensemble des forces projetées. J ai imaginé et participé au développement du système de surveillance spatiale des épidémies au sein des forces armées en Guyane 2SE FAG , avec l IMTSSA et différents partenaires depuis 2002, ce qui permettait de répondre à un nouvel objectif de l Etat-Major des Armées, fixé après un sommet de Défense de l OTAN. J ai pris en compte des aspects médicaux, technologiques, humains et organisationnels pour développer ce prototype. 2SE FAG a été conçu comme un procédé de surveillance épidémiologique mis en oeuvre à l aide d une communauté de services réseaux basés en Guyane et en métropole. Son développement s inscrivait dans le cadre d un arrangement technique franco-britannique, auquel j ai participé en effectuant entre autres un séjour de 6 mois dans les armées britanniques. J ai réalisé le déploiement de 2SE FAG en Guyane en octobre 2004 et le système a fonctionné sans discontinuité depuis. La juxtaposition des réseaux a permis de produire des données épidémiologiques opérationnelles qui ont fait la preuve de leur utilité, en particulier au moment de l épidémie de dengue du premier semestre 2006. L alerte précoce déclenchée à cette occasion plusieurs semaines avant le système de surveillance réglementaire des forces armées a certainement joué un rôle dans le contrôle de l épidémie en milieu militaire alors que celle-ci explosait en milieu civil. L évaluation représentait un travail fondamental pour fournir un retour d expérience utile et j ai réalisé différentes études en collaboration avec des organismes extérieurs (SACT de Norfolk, ISPED de Bordeaux, LSTM de Liverpool, Cire Antilles Guyane). Cette démarche permettait à la fois d apporter des modifications à 2SE FAG mais aussi de faire évoluer positivement l ensemble des projets du type 2SE du système ASTER. A partir de ces travaux, j ai pu développer et proposer une nouvelle méthode d évaluation des systèmes de surveillance militaires destinés à l alerte précoce pour les forces en opérations extérieures. J ai identifié des améliorations qui sont encore à apporter au système, mais les différents objectifs ont été considérés comme atteints, à savoir la preuve de la faisabilité de la surveillance en temps réel dans les armées, du bénéfice apporté par un tel système et de son caractère interopérable. L intérêt de ces travaux a déjà été souligné par des hautes instances nationales et internationales. J ai réalisé avec les autres co-inventeurs du système une demande de dépôt de brevet au niveau de l INPI le 25 août 2006. La surveillance épidémiologique en temps réel reste un défi d avenir pour les armées modernes. Les enseignements acquis grâce à 2SE FAG constituent déjà un retour d expérience unique au sein des armées de l OTAN. Mais je pense que l effort de recherche et de développement doit rester important, dans une dynamique internationale maîtrisée afin de déboucher sur la production d un système opérationnel et interopérable, adapté aux contraintes actuelles de déploiement des forces et en particulier aux missions multinationales. C est à ce prix que la surveillance en temps réel pourra participer activement en tous temps et en tous lieux à la préservation de la capacité opérationnelle des forces armées.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF