Risk mapping for HPAI H5N1 in Africa - Improving surveillance for virulent bird flu: Final report and maps

More than 85 percent of households in rural Africa raise poultry for food, income, or both, and many people live in close contact with their birds. The possibility of an epidemic of highly pathogenic avian influenza (HPAI) H5N1 is therefore a major concern. Since 2006 bird fl u has been introduced into at least 11 countries in Africa, and over 600 outbreaks reported. Vigilance is key to limiting the disease but animal health personnel cannot monitor everywhere at once. This risk-mapping project was designed to help prioritize their efforts by showing in which places outbreaks are more likely to occur. A risk map is a complex, computer-generated image that shows the spatial distribution of the predicted risk of a disease. It is based on the spatial distribution of “risk factors” associated with an increased risk of disease, and the relative importance of each of these factors. In the case of virulent bird fl u, risk factors include major transport routes, markets where poultry may be traded, and wetlands with the possibility of contact between poultry and wild birds. Researchers in this project have prepared risk maps for bird fl u in Africa using multi-criteria decision modeling (MCDM). In this way they have integrated data and information from such diverse sources as published scientific literature, maps available in the public domain, field surveys and expert consultations

Amélioration de la surveillance de l’influenza aviaire de type H5N1 - Cartographie du risque d’influenza aviaire de type H5N1 en Afrique: Rapport final et cartes de risqué d’influenza aviaire

Plus de 85% des ménages ruraux en Afrique élèvent la volaille aux fins d’alimentation, de revenu ou les deux, et de nombreuses personnes vivent en contact étroit avec leurs oiseaux. La possibilité d’une épidémie de l’influenza aviaire hautement pathogène (IAHP) de type H5N1 est donc une grande préoccupation. Depuis 2006, la grippe aviaire est apparue dans au moins 11 pays africains et plus de 600 foyers d’épidémie ont été signalés. La vigilance est essentielle en vue de limiter la maladie mais le personnel de santé animale ne peut faire un suivi partout à la fois. Ce projet de cartographie de facteurs de risques a été conçu en vue d’aider à prioriser leurs efforts en indiquant les lieux où il existe un risque très élevé de flambées de la maladie. La cartographie des risques est une image complexe générée par ordinateur qui montre la répartition spatiale des facteurs de risques prévus d’une maladie. Elle est fondée sur la répartition spatiale des « facteurs de risques » associés au risque accru de maladie et à l’importance relative de chacun de ces facteurs. Dans le cas d’une grippe aviaire de type H5N1, les facteurs de risques sont les principales voies de transport, les marchés de volailles et les points d’eau avec possibilité de contact entre les oiseaux domestiques et sauvages. Pour ce projet, les chercheurs ont préparé des cartes de risques de grippe aviaire en Afrique en utilisant la modélisation de décision multicritères (MCDM). De cette façon, ils ont intégré les données et les informations de diverses sources telles que les publications scientifi ques, les cartes disponibles dans le domaine public, les études de terrain et les consultations d’expert

On the multiplicity of the O-star Cyg OB2 #8A and its contribution to the gamma-ray source 3EG J2033+4118

We present the results of an intensive spectroscopic campaign in the optical waveband revealing that Cyg OB2 #8A is an O6 + O5.5 binary system with a period of about 21.9 d. Cyg OB2 #8A is a bright X-ray source, as well as a non-thermal radio emitter. We discuss the binarity of this star in the framework of a campaign devoted to the study of non-thermal emitters, from the radio waveband to gamma-rays. In this context, we attribute the non-thermal radio emission from this star to a population of relativistic electrons, accelerated by the shock of the wind-wind collision. These relativistic electrons could also be responsible for a putative gamma-ray emission through inverse Compton scattering of photospheric UV photons, thus contributing to the yet unidentified EGRET source 3EG J2033+4118.Comment: 8 pages, 4 figures, conference on "The Multiwavelength Approach to Gamma-Ray Sources", to appear in Ap&S

Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied \u201ccountry-specific\u201d factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a \u201cone-size-fits-all\u201d approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Tracheal intubation in traumatic brain injury

Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221

Informed consent procedures in patients with an acute inability to provide informed consent

Purpose: Enrolling traumatic brain injury (TBI) patients with an inability to provide informed consent in research is challenging. Alternatives to patient consent are not sufficiently embedded in European and national legislation, which allows procedural variation and bias. We aimed to quantify variations in informed consent policy and practice. Methods: Variation was explored in the CENTER-TBI study. Policies were reported by using a questionnaire and national legislation. Data on used informed consent procedures were available for 4498 patients from 57 centres across 17 European countries. Results: Variation in the use of informed consent procedur