Quantification of the natural history of visceral leishmaniasis and consequences for control

Background Visceral leishmaniasis has been targeted for elimination as a public health problem (less than 1 case per 10,000 people per year) in the Indian sub-continent by 2017. However, there is still a high degree of uncertainty about the natural history of the disease, in particular about the duration of asymptomatic infection and the proportion of asymptomatically infected individuals that develop clinical visceral leishmaniasis. Quantifying these aspects of the disease is key for guiding efforts to eliminate visceral leishmaniasis and maintaining elimination once it is reached. Methods Data from a detailed epidemiological study in Bangladesh in 2002–2004 was analysed to estimate key epidemiological parameters. The role of diagnostics in determining the probability and rate of progression to clinical disease was estimated by fitting Cox proportional hazards models. A multi-state Markov model of the natural history of visceral leishmaniasis was fitted to the data to estimate the asymptomatic infection period and the proportion of asymptomatic individuals going on to develop clinical symptoms. Results At the time of the study, individuals were taking several months to be diagnosed with visceral leishmaniasis, leading to many opportunities for ongoing transmission. The probability of progression to clinical disease was strongly associated with initial seropositivity and even more strongly with seroconversion, with most clinical symptoms developing within a year. The estimated average durations of asymptomatic infection and symptomatic infection for our model of the natural history are 147 days (95 % CI 130–166) and 140 days (95 % CI 123–160), respectively, and are significantly longer than previously reported estimates. We estimate from the data that 14.7 % (95 % CI 12.6-20.0 %) of asymptomatic individuals develop clinical symptoms—a greater proportion than previously estimated. Conclusions Extended periods of asymptomatic infection could be important for visceral leishmaniasis transmission, but this depends critically on the relative infectivity of asymptomatic and symptomatic individuals to sandflies. These estimates could be informed by similar analysis of other datasets. Our results highlight the importance of reducing times from onset of symptoms to diagnosis and treatment to reduce opportunities for transmission

Testing accuracy in 2D and 3D geometric morphometric methods for cut mark identification and classification

The analysis of bone surface modifications (BSMs) is a prominent part of paleoanthropological studies, namely taphonomic research. Behavioral interpretations of the fossil record hinge strongly upon correct assessment of BSMs. With the significant impact of microscopic analysis to the study of BSMs, multiple authors have discussed the reliability of these technological improvements for gaining resolution in BSM discrimination. While a certain optimism is present, some important questions are ignored and others overemphasized without appropriate empirical support. This specifically affects the study of cut marks. A diversity of geometric morphometric approaches applied to the study of cut marks have resulted in the coexistence (and competition) of different 2D and 3D methods. The present work builds upon the foundation of experiments presented by Maté-González et al. (2015), Courtenay et al. (2017) and Otárola-Castillo et al. (2018) to contrast for the first time 2D and 3D methods in their resolution of cut mark interpretation and classification. The results presented here show that both approaches are equally valid and that the use of sophisticated 3D methods do not contribute to an improvement in accuracy

A Novel Approach for the Shape Characterisation of Non-Melanoma Skin Lesions Using Elliptic Fourier Analyses and Clinical Images

[EN] The early detection of Non-Melanoma Skin Cancer (NMSC) is crucial to achieve the best treatment outcomes. Shape is considered one of the main parameters taken for the detection of some types of skin cancer such as melanoma. For NMSC, the importance of shape as a visual detection parameter is not well-studied. A dataset of 993 standard camera images containing different types of NMSC and benign skin lesions was analysed. For each image, the lesion boundaries were extracted. After an alignment and scaling, Elliptic Fourier Analysis (EFA) coefficients were calculated for the boundary of each lesion. The asymmetry of lesions was also calculated. Then, multivariate statistics were employed for dimensionality reduction and finally computational learning classification was employed to evaluate the separability of the classes. The separation between malignant and benign samples was successful in most cases. The best-performing approach was the combination of EFA coefficients and asymmetry. The combination of EFA and asymmetry resulted in a balanced accuracy of 0.786 and an Area Under Curve of 0.735. The combination of EFA and asymmetry for lesion classification resulted in notable success rates when distinguishing between benign and malignant lesions. In light of these results, skin lesions’ shape should be integrated as a fundamental part of future detection techniques in clinical screening.SIJunta de Castilla y Leó

An Evaluation of Landmark-Based Methods to Explore Tooth Score Morphology: A Case Study on Felids and Hyenids

Taphonomic studies aim to identify the modifying agents that intervene in bone assemblages found at archaeopaleontological sites. Carnivores may modify, accumulate, or scavenge skeletal parts inflicting tooth marks, including scores, on the cortical surface. Several works have studied tooth score morphology to discern which carnivore group modified the bone assemblages, achieving different results. In the present study, different methods based on the use of landmarks and semilandmarks have been tested to describe and analyze the score profile cross-sections of spotted and brown hyenas, leopards, and lions. According to our results, the already published seven-landmark method is useful in order to differentiate between carnivore species from different families (e.g., felids and hyenids). Meanwhile, felid species (e.g., leopards and lions) cannot be consistently distinguished using any of the methods tested here. In contrast, hyenid species can be morphologically differentiated. On the other hand, the use of semilandmarks does not generally improve morphological characterization and distinction, but low numbers of landmarks and the inclusion of the score’s deepest point might provide the best results when semi-automatic semilandmark models are preferred to avoid sampling biases.The grant IJC2020-043576-I funded by MCIN/AEI/10.13039/501100011033 and the “European Union NextGenerationEU/PRTR” has been awarded to M.C.A. The grant RYC2021-034813-I funded by MCIN/AEI/10.13039/501100011033 and the European Union “NextGenerationEU”/PRTR has been awarded to M.Á.M.-G. During the development of the present work, J.A. was funded by the Euskal Herriko Unibertsitatea [ESPDOC21/05]. L.A.C. is funded by the Spanish Ministry of Science, Innovation and Universities by an FPI Predoctoral grant PRE2019-089411 associated with project RTI2018-099850-B-I0

Heterogeneities in leishmania infantum infection : using skin parasite burdens to identify highly infectious dogs

Background: The relationships between heterogeneities in host infection and infectiousness (transmission to arthropod vectors) can provide important insights for disease management. Here, we quantify heterogeneities in Leishmania infantum parasite numbers in reservoir and non-reservoir host populations, and relate this to their infectiousness during natural infection. Tissue parasite number was evaluated as a potential surrogate marker of host transmission potential. Methods: Parasite numbers were measured by qPCR in bone marrow and ear skin biopsies of 82 dogs and 34 crab-eating foxes collected during a longitudinal study in Amazon Brazil, for which previous data was available on infectiousness (by xenodiagnosis) and severity of infection. Results: Parasite numbers were highly aggregated both between samples and between individuals. In dogs, total parasite abundance and relative numbers in ear skin compared to bone marrow increased with the duration and severity of infection. Infectiousness to the sandfly vector was associated with high parasite numbers; parasite number in skin was the best predictor of being infectious. Crab-eating foxes, which typically present asymptomatic infection and are non-infectious, had parasite numbers comparable to those of non-infectious dogs. Conclusions: Skin parasite number provides an indirect marker of infectiousness, and could allow targeted control particularly of highly infectious dogs

Intensive support for adults with intellectual disability and behaviours that challenge: a survey of provision and service typologies in England

BACKGROUND: Approximately 18% of adults with intellectual disabilities living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy in-patient stays. AIMS: To identify and describe the geographical distribution and characteristics of ISTs, and to develop a typology of IST service models in England. METHOD: We undertook a national cross-sectional survey of 73 ISTs. A hierarchical cluster analysis was performed based on six prespecified grouping factors (mode of referrals, size of case-load, use of outcome measures, staff composition, hours of operation and setting of service). A simplified form of thematic analysis was used to explore free-text responses. RESULTS: Cluster analysis identified two models of IST provision: (a) independent and (b) enhanced provision based around a community intellectual disability service. ISTs aspire to adopt person-centred care, mostly use the framework of positive behaviour support for behaviour that challenges, and report concerns about organisational and wider context issues. CONCLUSIONS: This is the first study to examine the delivery of intensive support to people with intellectual disability and behaviour that challenges. A two-cluster model of ISTs was found to have statistical validity and clinical utility. The clinical heterogeneity indicates that further evaluation of these service models is needed to establish their clinical and cost-effectiveness

The use of tooth marks for new research into identifying and understanding the first domestic dogs in Palaeolithic populations

The domestication of wolves is a topic of great interest. To date, the most accepted hypotheses associate this phenomenon to the end of the Upper Palaeolithic, while many propose an earlier date closer towards the Aurignacian. The latter proposal hinges on extensive research using palaeontological, morphometric, biomolecular-isotopic, genetic data and microwear contributing valuable information to the current debates. Nevertheless, few confront the theoretical reasoning behind this process, analysing the sociocultural implications that link humans with canids. Under this premise the current overview considers the motivation behind this process while proposing new lines of investigation that may help confront these questions across the indirect methods using new technologies applied study of tooth marks of the sites

Services just for men? Insights from a national study of the well men services pilots.

Men continue to have a lower life expectancy in most countries compared to women. Explanations of this gendered health inequality tend to focus on male risk taking, unhealthy lifestyle choices and resistance to seeking help from health services. In the period 2005-2008 the Scottish Government funded a nationwide community health promotion programme aimed at improving men's health, called Well Men Service Pilots (henceforth WMS)

Hyperspectral imaging and robust statistics in non-melanoma skin cancer analysis

Non-Melanoma skin cancer is one of the most frequent types of cancer. Early detection is encouraged so as to ensure the best treatment, Hyperspectral imaging is a promising technique for non-invasive inspection of skin lesions, however, the optimal wavelengths for these purposes are yet to be conclusively determined. A visible-near infrared hyperspectral camera with an ad-hoc built platform was used for image acquisition in the present study. Robust statistical techniques were used to conclude an optimal range between 573.45 and 779.88 nm to distinguish between healthy and non-healthy skin. Wavelengths between 429.16 and 520.17 nm were additionally found to be optimal for the differentiation between cancer types.Gerencia Regional de Salud de Castilla y León (GRS 2139/A/20); Spanish Ministry of Science, Innovation and Universities (PRE2019-089411); Instituto de Salud Carlos III (PI18/00587); Ibderdrola Spain; Junta de Castilla y León (GRS 1837/A/18). This project was funded by the Junta de Castilla y Leon, under the title project HYPERSKINCARE (Ref. GRS 1837/A/18). Lloyd Austin Courtenay is funded by the Spanish Ministry of Science, Innovation and Universities with an FPI Predoctoral Grant (Ref. PRE2019-089411) associated to project RTI2018-099850-B-I00 and the University of Salamanca. Susana Lagüela and Susana del Pozo are both funded by the Iberdrola Spain through the initiative Cátedra Iberdrola VIII Centenario of the University of Salamanca. Javier Cañueto is partially supported by the PI18/00587(Instituto de Salud Carlos III cofinanciado con fondos FEDER) and GRS 2139/A/20 (Gerencia Regional de Salud de Castilla y León

New Geometric Morphometric Insights in Digital Taphonomy: Analyses into the Sexual Dimorphism of Felids through Their Tooth Pits

Recent studies using geometric morphometrics for taphonomy have yielded interesting results, opening new horizons of research in both archaeological and paleontological sites. Here we present the analysis of tooth pits left by male and female individuals of two different carnivore species (Panthera tigris and Panthera pardus) in order to see if sexual dimorphism influences the morphology of tooth pit marks. In the process, 3D-scanning and applied statistics were used. Based on samples derived from two individuals of different sexes, the present results indicate sexual dimorphism in these felid species to not be a conditioning factor of tooth pit morphology