Using decision analysis to support proactive management of emerging infectious wildlife diseases

Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts even before a disease is detected, and plan subsequent actions that are conditional on disease emergence. We identify four main obstacles to developing proactive management strategies for the newly discovered salamander pathogen Batrachochytrium salamandrivorans (Bsal). Given that uncertainty is a hallmark of wildlife disease management and that associated decisions are often complicated by multiple competing objectives, we advocate using decision analysis to create and evaluate trade-offs between proactive (pre-emergence) and reactive (post-emergence) management options. Policy makers and natural resource agency personnel can apply principles from decision analysis to improve strategies for countering emerging infectious diseases

Using decision analysis to support proactive management of emerging infectious wildlife diseases

Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts even before a disease is detected, and plan subsequent actions that are conditional on disease emergence. We identify four main obstacles to developing proactive management strategies for the newly discovered salamander pathogen Batrachochytrium salamandrivorans (Bsal). Given that uncertainty is a hallmark of wildlife disease management and that associated decisions are often complicated by multiple competing objectives, we advocate using decision analysis to create and evaluate trade-offs between proactive (pre-emergence) and reactive (post-emergence) management options. Policy makers and natural resource agency personnel can apply principles from decision analysis to improve strategies for countering emerging infectious diseases

A manually annotated Actinidia chinensis var. chinensis (kiwifruit) genome highlights the challenges associated with draft genomes and gene prediction in plants

Most published genome sequences are drafts, and most are dominated by computational gene prediction. Draft genomes typically incorporate considerable sequence data that are not assigned to chromosomes, and predicted genes without quality confidence measures. The current Actinidia chinensis (kiwifruit) 'Hongyang' draft genome has 164\ua0Mb of sequences unassigned to pseudo-chromosomes, and omissions have been identified in the gene models

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

The World of Cocos Malay Music and Dance: A Documentary Film on Performing Arts in the Cocos (Keeling) Islands

The Cocos (Keeling) Islands, located halfway between Perth and Sri Lanka and part of Australia’s Indian Ocean Territories, are home to around 400 Cocos Malays and 150 others. Uninhabited until 1826, the islands became a coconut plantation controlled by the Scottish Clunies-Ross family and worked by Malay labourers from 1827 until 1978. In this isolated community there arose a unique and distinctive set of cultural practices, which drew from Malay, Javanese, and (some) Scottish influences. The rhythms of Cocos Malay life involve regular musicking and Islamic religious ritual: on specific occasions, including the week-long celebrations following Hari Raya (Eid al- Fitr), the birthday of the Prophet (Maulud Nabi), and weddings, the community comes together for festive public performances. This film and article present an ethnomusicological survey of Cocos Malay music and dance, based on fieldwork conducted in 2015 and 2016 during the festivities for Hari Raya. Among the genres presented and discussed are: zikir (remembrance of the Prophet), joget (popular Malaysian dance), nasyid (devotional songs), Scottish reels with Scottish dance music, traditional Cocos Malay dance with biola (violin), silat (a martial art), rudat (seated dance) with percussion, and bangsawan (popular theatre). Interviews explore the Cocos Malay biola tradition and projects for its revitalisation, and memories of music and dance for the Nuyar (New Year’s Eve) party that was held in the house of the Clunies-Ross family until the 1990s. The history and modern-day practice of Scottish dancing within this Malay Muslim community form a major focus of the narrative.This study was supported by Australian Research Council Discovery Project DP150103204, 'Malay Music and Dance from the Cocos (Keeling) Islands', based at the University of Melbourne 2015-2019.Peer reviewe

A new explanation for rising rates of anal cancer

Background: Anal intraepithelial neoplasia (AIN) is associated with high-risk human papillomavirus (hrHPV) infection and is a precursor to anal cancer. Factors other than hrHPV are likely to be involved in causing AIN and further study of cofactors is required. Methods: A surgical database of patients having anal warts removed was established at Royal Perth Hospital in 1995 and epidemiological information concerning age, sex, sexual preference, history or clinical evidence of gonorrhoea or chlamydia infection and serological evidence of HIV-1, HSV-2, hepatitis B or C virus infection and syphilis has been prospectively collected since then. Three hundred and fourteen patients underwent 457 operations from June 1995 to November 2016. Histopathology and hrHPV testing using the Digene Hybrid Capture 2 (HC2) method were performed at the time of surgery. Results: hrHPV alone was associated with high-grade squamous epithelial lesions (HSIL) (OR=4.65, p<0.001). Amplification of HSIL risk was found when hrHPV infection occurred with HIV-1 (OR=11.1) or HSV-2 (OR=7.85) infection; current or previous gonorrhoea (OR=6.45) or syphilis (OR=5.58); and some other infections. Conclusions: HrHPV is a sufficient cause of anal HSIL but seropositivity for HIV-1, HSV-2, T. pallidum, HBV, HCV infections and a history of gonorrhoea or chlamydia exert a powerful amplifying factor increasing the risk of HSIL above the risk with hrHPV alone. This pattern of disease in patients with warts is characteristic of a syndemic with potential increased risk of anal carcinoma in men because of rising rates of sexually-transmitted infections