Introducing medical parasitology at the University of Makeni, Sierra Leone

The file attached to this record is the author's final peer reviewed version.Capacity building in Sierra Leone (West Africa) is critical to prevent potential future outbreaks similar to the 2013-16 Ebola outbreak that had devastating effects for the country and its poorly developed healthcare system. De Montfort University (DMU) in the United Kingdom (UK), in collaboration with parasitologists from the Spanish Universities of San Pablo CEU and Miguel Hernández de Elche, is leading a project to build the teaching and research capabilities of medical parasitology at the University of Makeni (UniMak, Sierra Leone). This project has two objectives: a) to introduce and enhance the teaching of medical parasitology, both theoretical and practical; and b) to implement and develop parasitology research related to important emerging human parasites such as Cryptosporidium spp. due to their public health significance. Two UniMak academics, hired to help initiate and implement the research part of the project, shared their culturally sensitive public health expertise to broker parasitology research in communities and perform a comprehensive environmental monitoring study for the detection of different emerging human parasites. The presence of targeted parasites are being studied microscopically using different staining techniques, which in turn have allowed UniMak’s academics to learn these techniques to develop new practicals in parasitology. To train UniMak’s academics and develop both parts of our project, a DMU researcher visited UniMak for two weeks in April 2019 and provided a voluntary short training course in basic parasitology, which is currently not taught in any of their programmes, and was attended by 31 students. These sessions covered basic introduction to medical parasitology and life-cycle, pathogenesis, detection, treatment and prevention of: a) coccidian parasites (Cryptosporidium, Cyclospora and Cystoisospora); b) Giardia intestinalis, Entamoeba and free-living amoebas; c) malaria and d) microsporidia. A theoretical session on common staining techniques was also provided. To facilitate the teaching and learning of these parasites, the novel resource DMU e-Parasitology was used, a package developed by the above participating universities and biomedical scientists from the UK National Health Service (NHS): http://parasitology.dmu.ac.uk/ index.htm. Following the two weeks of training, UniMak’s academics performed different curriculum modifications to the undergraduate programme ‘Public Health: Medical Laboratory Sciences’, which includes the introduction of new practicals in parasitology and changes to enhance the content of medical parasitology that will be subjected to examination. Thus, a new voluntary practical on Kinyoun stain for the detection of coccidian parasites was introduced in the final year module of ‘Medical Bacteriology and Parasitology’; eighteen students in pairs processed faecal samples from pigs provided by the Department of Agriculture and Food Security from a nearby farm. Academics at UniMak used the Kinyoun staining unit (available at http://parasitology.dmu.ac.uk/learn/lab/Kinyoun/story_html5.html; [1]) to deliver this practical. Although our project is at a preliminary stage, it has been shown to be effective in promoting the introduction and establishment of medical parasitology at UniMak and could be viewed as a case-study for other universities in low-income countries to promote the United Nations (UN) Sustainable Development Goals (SDGs) and improve public health understanding of infectious diseases

Novel resources for learning the identification of human-related parasites.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Microscopic detection of human-related parasites in a range of clinical samples remains the cornerstone of parasitological diagnosis despite recent advances in technology and molecular sciences. However, the use of the light microscope for diagnostic purposes requires comprehensive training, skills and parasitology knowledge that it is difficult to appropriately provide to future health professionals due to different challenges including shortages of health science academics, resources, time and specimens for delivering appropriate training. An international teaching innovation team from different European universities, led by De Montfort University (UK), is building a novel resource for learning and teaching parasitology, which is equipped with a Virtual Laboratory and Microscope. In the Virtual Laboratory (http://parasitology.dmu.ac.uk/learn/laboratory.htm), we are building a complete subsection with a series of engaging units for learning different parasitological staining/fresh preparations techniques for detecting common and rare (emerging and re-emerging) human parasites from several taxa: protozoa (mostly cysts, oocysts) and helminths (eggs and organs for parasitological differentiation such as scolex or proglottids for Taenia spp.) and fungi (spores), which will be publicly available in 2019. Examples of staining techniques included are Kinyoun and Trichrome (normal and modified) stain and fresh preparations for investigating eggs as well as more recent techniques such as immunofluorescence. The Virtual Laboratory will also provide resources to undertake appropriate sample (faeces, blood, urine) collection, management and preparation for parasitological diagnosis and the use of different microscopes including the light microscope for parasite analysis. These units will be equipped with short videos of academics and technicians performing the different techniques, which will include audio and subtitles in English, and will be supported by photos, artworks, designs and self-assessment mini-quizzes and exercises, to provide students with the most practical experience possible. Finally, a complete library of digitised clinical slides of different specimens and parasites is provided here: http://parasitology.dmu.ac.uk/learn/microscope.htm. Each virtual slide is provided with the functionality of a microscope, so the user will be able to zoom in and out and explore all of the clinical sample to learn the morphological characteristics of cysts, oocysts, eggs and spores for parasitological diagnosis. When relevant, a variety of virtual slides for the different species for the same parasite will be provided to enhance the identification of parasites to species level in conjunction with a short description and tips for easy identification. The resources that are being created will cover the theoretical foundation and current scientific information so they will be suitable for undergraduate/postgraduate students as well as for more professional training. This paper will present a complete overview of these novel resources that are aimed to help train future professionals in parasitic disease diagnosis with microscopic identification of parasites; these web-based resources could help to overcome current limitations that are eroding the teaching status of parasitology. Finally, different strategies will be presented to facilitate the introduction and use of this novel resource in any human health programme

Efficacy and safety of the combination of reduced duration prophylaxis followed by immuno-guided prophylaxis to prevent cytomegalovirus disease in lung transplant recipients (CYTOCOR STUDY): an open-label, randomised, non-inferiority clinical trial

Cytomegalovirus; Immuno-guided prophylaxis; Lung transplantationCitomegalovirus; Profilaxis inmunoguiada; Trasplante de pulmónCitomegalovirus; Profilaxi immuno-guiada; Trasplantament de pulmóINTRODUCTION: Prolonged use of antivirals to prevent the development of cytomegalovirus (CMV) disease in lung transplant patients has been shown to have significant side effects, for which alternatives are being sought to reduce their use. The monitoring of cell immunity against CMV could be an alternative as it has shown to be useful in identifying transplant patients at low risk of infection, who could benefit from shorter prophylaxis. The aim of the CYTOCOR study is to demonstrate that the combination of a reduced prophylaxis strategy with subsequent CMV-specific immunological monitoring would allow CMV infection to be controlled in lung transplant patients as effectively as the usual strategy (prophylaxis followed by pre-emptive therapy), while reducing the side effects of antivirals due to the shorter duration of prophylaxis. METHODS AND ANALYSIS: Phase III randomised, open, multicentre, parallel, non-inferiority clinical trial to study the efficacy and safety of the combination of a prophylaxis strategy up to month +3 post-transplant followed by immuno-guided prophylaxis using the QuantiFERON-CMV technique up to month +12 post-transplant to prevent CMV disease in CMV-seropositive lung transplant recipients. This strategy will be compared with a combination of a usual prophylaxis strategy up to month +6 post-transplant followed by pre-emptive therapy up to month +12. To study the incidence of CMV disease, patients will be followed up to 18 months post-transplantation. A total of 150 patients are expected to be recruited for the study. ETHICS AND PUBLIC DISSEMINATION: The clinical trial has been approved by the Research Ethics Committees and authorised by the Spanish Agency of Medicines and Medical Devices (AEMPS).If the hypothesis of this clinical trial is verified, the dissemination of the results could change clinical practice by increasing knowledge about the safety and efficacy of discontinuing valganciclovir prophylaxis in lung transplant recipients.We would like to acknowledge the support of the Spanish Network for Research in Infectious Disease (REIPI, RD16/0016), the Group for the Study of Infections in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and SCReN (Spanish Clinical Research Network) funded by the ISCIII-Sub-Directorate General for Research Assessment and Promotion through project PT13/0002/0010-PT17/0017/0012 and PT17/0017/0032

Efficacy and safety of the combination of reduced duration prophylaxis followed by immuno-guided prophylaxis to prevent cytomegalovirus disease in lung transplant recipients (CYTOCOR STUDY): an open-label, randomised, non-inferiority clinical trial.

INTRODUCTION: Prolonged use of antivirals to prevent the development of cytomegalovirus (CMV) disease in lung transplant patients has been shown to have significant side effects, for which alternatives are being sought to reduce their use. The monitoring of cell immunity against CMV could be an alternative as it has shown to be useful in identifying transplant patients at low risk of infection, who could benefit from shorter prophylaxis. The aim of the CYTOCOR study is to demonstrate that the combination of a reduced prophylaxis strategy with subsequent CMV-specific immunological monitoring would allow CMV infection to be controlled in lung transplant patients as effectively as the usual strategy (prophylaxis followed by pre-emptive therapy), while reducing the side effects of antivirals due to the shorter duration of prophylaxis. METHODS AND ANALYSIS: Phase III randomised, open, multicentre, parallel, non-inferiority clinical trial to study the efficacy and safety of the combination of a prophylaxis strategy up to month +3 post-transplant followed by immuno-guided prophylaxis using the QuantiFERON-CMV technique up to month +12 post-transplant to prevent CMV disease in CMV-seropositive lung transplant recipients. This strategy will be compared with a combination of a usual prophylaxis strategy up to month +6 post-transplant followed by pre-emptive therapy up to month +12. To study the incidence of CMV disease, patients will be followed up to 18 months post-transplantation. A total of 150 patients are expected to be recruited for the study. ETHICS AND PUBLIC DISSEMINATION: The clinical trial has been approved by the Research Ethics Committees and authorised by the Spanish Agency of Medicines and Medical Devices (AEMPS).If the hypothesis of this clinical trial is verified, the dissemination of the results could change clinical practice by increasing knowledge about the safety and efficacy of discontinuing valganciclovir prophylaxis in lung transplant recipient

Are patterns of sampling effort and completeness of inventories congruent? A test using databases for five insect taxa in the Iberian Peninsula

Evaluating data quality and inventory completeness must be a preliminary step inany biodiversity research, particularly in the case of insects and high biodiversityareas. Yet, this step is often neglected or, at best, assessed only for one insectgroup, and the degree of congruence of sampling effort ffor different insect groupsremains unexplored. We assess the congruence in the spatial distribution of sampling effort for fiveinsect groups (butterflies, caddisflies, dung beetles, moths, and aquatic beetles) inthe Iberian Peninsula. We identify well-surveyed areas for each taxonomic groupand examine the degree to which the patterns of sampling effort can be explainedby a set of variables related to environmental conditions and accessibility. Irrespective of the general lack of reliable inventories, we found a general but lowcongruence in the completeness patterns of the different taxa. This suggests thatthere is not a common geographical pattern in survey effort and that idiosyncraticand contingent factors (mainly the proximity to the workplaces of entomologists)are differentially affecting each group. After many decades of taxonomic and faunistic work, distributional databases ofIberian insects are still in a very preliminary stage, thus limiting our capacity toobtain reliable answers to basic and applied questions. We recommend carrying out long-term, standardised and well-designed entomolog-ical surveys able to generate a reliable image of the distribution of different insect groups. This will allow us to estimate accurately insect trends and better under-stand the full extent of global biodiversity loss.This study has been supported by the projects BioWeb (MINECO:CGL2011-15622-E BOS), BANDENCO (JCMM: POII11-0277-5747)and IBERARTRO (SBPLY/17/180501/000492) founded by European Regional Development Fund (ERDF) through the Consejería de Educación, Ciencia y Cultura, Junta de Comunidades de Castilla-La Mancha. David Sánchez-Fernández is funded by a postdoctoral contract fromthe Spanish Ministry of Science and Innovation (Ramón y Cajal program; RYC2019-027446-IPeer reviewe

Measurement of the ttbar Production Cross Section in ppbar Collisions at sqrt(s)=1.96 TeV using Lepton + Jets Events with Lifetime b-tagging

We present a measurement of the top quark pair ($t\bar{t}$) production cross section ($\sigma_{t\bar{t}}$) in $p\bar{p}$ collisions at $\sqrt{s}=1.96$ TeV using 230 pb$^{-1}$ of data collected by the D0 experiment at the Fermilab Tevatron Collider. We select events with one charged lepton (electron or muon), missing transverse energy, and jets in the final state. We employ lifetime-based b-jet identification techniques to further enhance the $t\bar{t}$ purity of the selected sample. For a top quark mass of 175 GeV, we measure $\sigma_{t\bar{t}}=8.6^{+1.6}_{-1.5}(stat.+syst.)\pm 0.6(lumi.)$ pb, in agreement with the standard model expectation.Comment: 7 pages, 2 figures, 3 tables Submitted to Phys.Rev.Let

Measurement of the ttbar Production Cross Section in ppbar Collisions at sqrt{s} = 1.96 TeV using Kinematic Characteristics of Lepton + Jets Events

We present a measurement of the top quark pair ttbar production cross section in ppbar collisions at a center-of-mass energy of 1.96 TeV using 230 pb**{-1} of data collected by the DO detector at the Fermilab Tevatron Collider. We select events with one charged lepton (electron or muon), large missing transverse energy, and at least four jets, and extract the ttbar content of the sample based on the kinematic characteristics of the events. For a top quark mass of 175 GeV, we measure sigma(ttbar) = 6.7 {+1.4-1.3} (stat) {+1.6- 1.1} (syst) +/-0.4 (lumi) pb, in good agreement with the standard model prediction.Comment: submitted to Phys.Rev.Let

Measurement of the Isolated Photon Cross Section in p-pbar Collisions at sqrt{s}=1.96 TeV

The cross section for the inclusive production of isolated photons has been measured in p anti-p collisions at sqrt{s}=1.96 TeV with the D0 detector at the Fermilab Tevatron Collider. The photons span transverse momenta 23 to 300 GeV and have pseudorapidity |eta|<0.9. The cross section is compared with the results from two next-to-leading order perturbative QCD calculations. The theoretical predictions agree with the measurement within uncertainties.Comment: 7 pages, 5 figures, submitted to Phys.Lett.