Using the Minimum Data Set (MDS) to Triage Long Term Care Facilities’ Residents for a Systematic Evacuation in the Case of Mass Casualty Disaster Events

Long Term Care facilities preparedness for disasters has been questioned, and evacuation before or during disasters is crucial for life saving. This thesis attempted to develop a systematic triage methodology based on the use of the Minimum Data Set (MDS), which is a powerful resource for gathering residents’ vital information including physical ability, cognitive functioning, and other health related conditions. Our assumption was that 90% of caregivers’ triage categorization will match with the categorization generated from the MDS dataset. To achieve our objectives and aims, we compared the triage categorization carried out by residents’ caregivers versus the MDS generated triage categories. Overall we did not found a strong agreement between caregivers and MDS triage categorization. However, the triage categorization of both homemakers and cooks versus CNAs yield a substantial correlation. Also we found that the work experience was closely related to the agreement between RN and CNAs versus MDS. In conclusion we think that MDS can be used to generate triage categories for long term care residents to facilitate the systematic evacuation of buildings in the case of mass casualty event. But before that, it will be important to conduct further studies with a large sample size of caregivers and the accessibility to the MDS dataset. The validation of the use of MDS dataset to generate triage categories will hugely help long term care facilities to be prepared for evacuation, because it can be the start point for the development of triage application which can be use on both portable and mobile electronic devices

Pathogen genomics and One Health: a scoping review of current practices in zoonotic disease research

Objectives: Whole-genome sequencing has revolutionised the field of infectious disease surveillance, enabling near real-time detection of pathogens and tracking how infections may spread. Our study aimed to characterise genomic applications to cross-domain zoonotic pathogen transmission at the human-animal and/or human-environment interfaces. Methods: We performed a scoping review of studies that have applied genomic epidemiology to zoonotic disease transmission across One Health domains (human, animal, and environment). We identified 114 records published between 2005 and 2022 which reported multi-domain genomic data of zoonotic pathogens integrated into phylogenetic models. Results: Most studies investigated bacterial pathogens, highlighting key knowledge gaps for other zoonotic agents, particularly arboviruses. Sampling and sequencing efforts varied greatly across domains: the median number and range of pathogen genomes analysed were highest for humans (23; 1-29,586) and lowest for the environment domain (13; 1-956). Genomics was used to track zoonotic disease outbreaks and cross-domain transmission, to improve pathogen surveillance, and to disentangle evolutionary dynamics driving lineage diversification and virulence. Conclusions: Our study highlights current practices and knowledge gaps to guide future study designs and genomic applications to multi-domain and cross-species transmission of zoonoses, with the potential to identify key infection sources and inform interventions for local and global health security

Effects of amodiaquine and artesunate on sulphadoxine-pyrimethamine pharmacokinetic parameters in children under five in Mali

<p>Abstract</p> <p>Background</p> <p>Sulphadoxine-pyrimethamine, in combination with artesunate or amodiaquine, is recommended for the treatment of uncomplicated malaria and is being evaluated for intermittent preventive treatment. Yet, limited data is available on pharmacokinetic interactions between these drugs.</p> <p>Methods</p> <p>In a randomized controlled trial, children aged 6-59 months with uncomplicated <it>falciparum </it>malaria, received either one dose of sulphadoxine-pyrimethamine alone (SP), one dose of SP plus three daily doses of amodiaquine (SP+AQ) or one dose of SP plus 3 daily doses of artesunate (SP+AS). Exactly 100 μl of capillary blood was collected onto filter paper before drug administration at day 0 and at days 1, 3, 7, 14, 21 and 28 after drug administration for analysis of sulphadoxine and pyrimethamine pharmacokinetic parameters.</p> <p>Results</p> <p>Fourty, 38 and 31 patients in the SP, SP+AQ and SP+AS arms, respectively were included in this study. The concentrations on day 7 (that are associated with therapeutic efficacy) were similar between the SP, SP+AQ and SP+AS treatment arms for sulphadoxine (median [IQR] 35.25 [27.38-41.70], 34.95 [28.60-40.85] and 33.40 [24.63-44.05] μg/mL) and for pyrimethamine (56.75 [46.40-92.95], 58.75 [43.60-98.60] and 59.60 [42.45-86.63] ng/mL). There were statistically significant differences between the pyrimethamine volumes of distribution (4.65 [3.93-6.40], 4.00 [3.03-5.43] and 5.60 [4.40-7.20] L/kg; <it>p = 0.001</it>) and thus elimination half-life (3.26 [2.74 -3.82], 2.78 [2.24-3.65] and 4.02 [3.05-4.85] days; <it>p < 0.001</it>). This study confirmed the lower SP concentrations previously reported for young children when compared with adult malaria patients.</p> <p>Conclusion</p> <p>Despite slight differences in pyrimethamine volumes of distribution and elimination half-life, these data show similar exposure to SP over the critical initial seven days of treatment and support the current use of SP in combination with either AQ or AS for uncomplicated <it>falciparum </it>malaria treatment in young Malian children.</p

Overall and Gender-Specific Effects of Intermittent Preventive Treatment of Malaria with Artemisinin-Based Combination Therapies among Schoolchildren in Mali: A Three-Group Open Label Randomized Controlled Trial.

Intermittent preventive treatment of malaria among schoolchildren (IPTsc) reduces clinical malaria, asymptomatic parasitemia, and anemia. The effects of IPTsc by gender have not been studied longitudinally. We investigated overall IPTsc efficacy and conducted a secondary analysis to explore gender-specific differences. We enrolled schoolchildren aged 6-13 years in an open-label, rolling-cohort randomized controlled trial between September 2007 and February 2013 in Kolle, Mali. Annually, schoolchildren received two full-treatment courses of sulfadoxine-pyrimethamine (SP) plus artesunate, or amodiaquine (AQ) plus artesunate, or no malaria treatment as control. We used mixed-effects generalized linear models to estimate differences in treatment outcomes across groups with interaction terms to explore gender-specific differences associated with Plasmodium falciparum infection, hemoglobin, and grade point averages (GPA) based on standardized testing. Overall, 305 students contributed 4,564 observations. Compared with the control, SP plus artesunate and AQ plus artesunate reduced the odds of P. falciparum infection (odds ratio [OR]: 0.33, 95% CI: 0.26-0.43; OR: 0.46, 95% CI: 0.36-0.59). We found strong evidence of increased mean hemoglobin concentrations (g/dL) in the SP plus artesunate group versus control (difference +0.37, 95% CI: 0.13-0.58). Collectively, schoolchildren given AQ plus artesunate had higher mean GPA (difference +0.36, 95% CI: 0.02-0.69) relative to control. Schoolgirls, compared with schoolboys, given SP plus artesunate had greater improvement in GPA (+0.50, 95% CI: -0.02 to 1.02 versus -0.27, 95% CI: -0.71 to 0.16); interaction P = 0.048, respectively. The IPTsc decreases P. falciparum infections in schoolchildren. Treatment regimens that include longer-acting drugs may be more effective at decreasing malaria-related anemia and improving educational outcomes as observed among girls in this setting