Meningococcal Meningitis Surveillance in the African Meningitis Belt, 2004-2013.

BACKGROUND: An enhanced meningitis surveillance network was established across the meningitis belt of sub-Saharan Africa in 2003 to rapidly collect, disseminate, and use district weekly data on meningitis incidence. Following 10 years' experience with enhanced surveillance that included the introduction of a group A meningococcal conjugate vaccine, PsA-TT (MenAfriVac), in 2010, we analyzed the data on meningitis incidence and case fatality from countries reporting to the network. METHODS: After de-duplication and reconciliation, data were extracted from the surveillance bulletins and the central database held by the World Health Organization Inter-country Support Team in Burkina Faso for countries reporting consistently from 2004 through 2013 (Benin, Burkina Faso, Chad, Democratic Republic of Congo, Ghana, Côte d'Ivoire, Mali, Niger, Nigeria, Togo). RESULTS: The 10 study countries reported 341 562 suspected and confirmed cases over the 10-year study period, with a marked peak in 2009 due to a large epidemic of group A Neisseria meningitidis (NmA) meningitis. Case fatality was lowest (5.9%) during this year. A mean of 71 and 67 districts annually crossed the alert and epidemic thresholds, respectively. The incidence rate of NmA meningitis fell >10-fold, from 0.27 per 100,000 in 2004-2010 to 0.02 per 100,000 in 2011-2013 (P < .0001). CONCLUSIONS: In addition to supporting timely outbreak response, the enhanced meningitis surveillance system provides a global overview of the epidemiology of meningitis in the region, despite limitations in data quality and completeness. This study confirms a dramatic fall in NmA incidence after the introduction of PsA-TT

COMPUTER SIMULATIONS OF POSSIBLE FUTURES FOR TWO FLOCKS OF WHOOPING CRANES

We conducted computer simulations using the program VORTEX (version 7) to project population sizes, growth rates, genetic diversity, and probabilities of extinction over the next 100 years for 2 flocks of whooping cranes (Grus americana), the Aransas/Wood Buffalo population and the experimental Florida population. Standard runs based on best estimates of demographic. genetic, and environmental parameter values were used as a baseline to which several alternative scenarios were compared. Results generally supported the conclusion of the earlier Population Viability Assessment (Mirande et al. 1991) that the AransaslWood Buffalo population will continue to grow steadily with less than a 1 % probability of extinction. It was noted, however, that a combination of negative factors such as shrinking habitat and increased probabilities of catastrophes accompanied by increased mortality rates could put this population at risk. Results for the Florida population were less optimistic. The standard run produced a population growth rate (r) of only 0.0026 for the next 100 years, and this shifted down to -0.0001 over a 200-year time frame. Adult mortality in this flock would have to be about 20% lower than the predicted value (10%) in order to raise growth rates to above r = 0.02. Amount and duration of supplementation of the Florida flock had minimal impacts on the long-tenn growth rate of the flock. It is the enduring rates of mortality, breeding, and disease risk that will have major effects on this population. For example, if disease risks tum out to be greater than the best-estimate scenario, this population could face a relatively high risk of extinction (17%). The formula for success in Florida is lower adult mortality, lower age of first breeding, lower disease risk, and higher productivity than the best-guess estimates. Fortunately, there are some potential management interventions (e.g., predator control, vaccines and health monitoring, selective introductions to balance the sex ratio of the flock) that may be able to push the odds in favor of success

Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist)

Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.</p

Relatório de estágio em farmácia comunitária

Relatório de estágio realizado no âmbito do Mestrado Integrado em Ciências Farmacêuticas, apresentado à Faculdade de Farmácia da Universidade de Coimbr

Self-reported social skills impairment explains elevated autistic traits in individuals with generalized social anxiety disorder

Screening for autism in individuals with generalized social anxiety disorder (GSAD) is complicated by symptom overlap between GSAD and autism spectrum disorder (ASD). We examined the prevalence of self-reported autistic traits within a sample of participants with a diagnosis of GSAD (n = 37) compared to individuals without a GSAD diagnosis (NOSAD; n = 26). Of the GSAD sample participants, 70.84% self-reported autistic traits above a cut-off of 65 on the Autism Quotient-Short (AQ-S) and reported significantly more autistic traits on 3 of 5 AQ-S subscales compared to the NOSAD group. Diagnosis uniquely predicted variation in the social skills subscale above and beyond the other subscales and other predictors. Furthermore, variation in the social skills subscale largely explained group differences on the other subscales. Our results suggest caution in utilizing measures like the AQ-S with clinical populations characterized by social difficulties such as individuals with a GSAD diagnosis

The Core Extrusion Schema - revised: Hiding oneself predicts severity of social interaction anxiety

Cognitive behavioral models of social anxiety disorder (SAD) suggest that fear of negative evaluation is a core fear or vulnerability for SAD. However, why negative evaluation is feared is not fully understood. It is possible that core beliefs contribute to the relationship between fear of negative evaluation and SAD. One of these beliefs may be a core extrusion schema: a constellation of beliefs that one's true self will be rejected by others and therefore one should hide one's true self. In the current study (N = 699), we extended research on the Core Extrusion Schema and created a shortened and revised version of the measure called the Core Extrusion Schema-Revised. The Core Extrusion Schema-Revised demonstrated good factor fit for its two subscales (Hidden Self and Rejection of the True Self) and was invariant across gender and ethnicity. The Hidden Self subscale demonstrated excellent incremental validity within the full sample as well as in participants diagnosed with generalized SAD. Specifically, the Hidden Self subscale may help explain severity of social interaction anxiety. This measure could be used with individuals diagnosed with generalized SAD to design exposures targeting these core beliefs

Modelling control strategies for pneumococcal meningitis outbreaks in the African meningitis belt.

INTRODUCTION: Pneumococcal meningitis outbreaks occur sporadically in the African meningitis belt. Outbreak control guidelines and interventions are well established for meningococcal but not pneumococcal meningitis. Mathematical modelling is a useful tool for assessing the potential impact of different pneumococcal control strategies. This work aimed to estimate the impact of reactive vaccination with pneumococcal conjugate vaccine (PCV) had it been implemented in past African meningitis belt outbreaks and assess their efficiency relative to existing routine infant immunisation with PCV. METHODS & RESULTS: Using recent pneumococcal meningitis outbreaks in Burkina Faso, Chad, and Ghana as case studies, we investigated the potential impact of reactive vaccination. We calculated the number needed to vaccinate to avert one case (NNV) in each outbreak setting and over all outbreaks and compared this to the NNV for existing routine infant vaccination. We extended previous analyses of reactive vaccination by considering longer-term protection in vaccinees over five years, incorporating a proxy for indirect effects. We found that implementing reactive vaccination in previous pneumococcal meningitis outbreaks could have averted up to 10-20 % of outbreak cases, with the biggest potential impact in Brong Ahafo, Ghana (2015-2016) and Goundi, Chad (2009). The NNV, and hence the value of reactive vaccination, varied greatly. 'Large' (80 + cumulative modelled cases per 100,000 population) and/or 'prolonged' (exceeding a response threshold of 10 suspected cases per 100,000 per week for four weeks or more) outbreaks had NNV estimates under 10,000. For routine infant vaccination with PCV, the estimated NNV ranged from 3,100-5,600 in Burkina Faso and 1,500-2,600 in Ghana. IMPLICATIONS: This analysis provides evidence to inform the design of pneumococcal meningitis outbreak response guidelines. Countries should consider reactive vaccination in each outbreak event, together with maintaining routine infant vaccination as the primary intervention to reduce pneumococcal disease burden and outbreak risk

Next generation rapid diagnostic tests for meningitis diagnosis

Rapid diagnostic tests (RDTs) are increasingly recognized as valuable, transformative tools for the diagnosis of infectious diseases. Although there are a variety of meningitis RDTs currently available, certain product features restrict their use to specific levels of care and settings. For this reason, the development of meningitis RDTs for use at all levels of care, including those in low-resource settings, was included in the “Defeating Meningitis by 2030” roadmap. Here we address the limitations of available meningitis RDTs and present test options and specifications to consider when developing the next generation of meningitis RDTs