Event-based surveillance during EXPO Milan 2015. Rationale, tools, procedures, and initial results

More than 21 million participants attended EXPO Milan from May to October 2015, making it one of the largest protracted mass gathering events in Europe. Given the expected national and international population movement and health security issues associated with this event, Italy fully implemented, for the first time, an event-based surveillance (EBS) system focusing on naturally occurring infectious diseases and the monitoring of biological agents with potential for intentional release. The system started its pilot phase in March 2015 and was fully operational between April and November 2015. In order to set the specific objectives of the EBS system, and its complementary role to indicator-based surveillance, we defined a list of priority diseases and conditions. This list was designed on the basis of the probability and possible public health impact of infectious disease transmission, existing statutory surveillance systems in place, and any surveillance enhancements during the mass gathering event. This article reports the methodology used to design the EBS system for EXPO Milan and the results of 8 months of surveillance

Infection fatality ratio of SARS-CoV-2 in Italy

We analyzed 5,484 close contacts of COVID-19 cases from Italy, all of them tested for SARS-CoV-2 infection. We found an infection fatality ratio of 2.2% (95%CI 1.69-2.81%) and identified male sex, age >70 years, cardiovascular comorbidities, and infection early in the epidemics as risk factors for death

22Ne and 23Na ejecta from intermediate-mass stars: The impact of the new LUNA rate for 22Ne(p,gamma)23Na

We investigate the impact of the new LUNA rate for the nuclear reaction $^{22}$Ne$(p,\gamma)^{23}$Na on the chemical ejecta of intermediate-mass stars, with particular focus on the thermally-pulsing asymptotic giant branch (TP-AGB) stars that experience hot-bottom burning. To this aim we use the PARSEC and COLIBRI codes to compute the complete evolution, from the pre-main sequence up to the termination of the TP-AGB phase, of a set of stellar models with initial masses in the range $3.0\,M_{\odot} - 6.0\,M_{\odot}$, and metallicities $Z_{\rm i}=0.0005$, $Z_{\rm i}=0.006$, and $Z_{\rm i} = 0.014$. We find that the new LUNA measures have much reduced the nuclear uncertainties of the $^{22}$Ne and $^{23}$Na AGB ejecta, which drop from factors of $\simeq 10$ to only a factor of few for the lowest metallicity models. Relying on the most recent estimations for the destruction rate of $^{23}$Na, the uncertainties that still affect the $^{22}$Ne and $^{23}$Na AGB ejecta are mainly dominated by evolutionary aspects (efficiency of mass-loss, third dredge-up, convection). Finally, we discuss how the LUNA results impact on the hypothesis that invokes massive AGB stars as the main agents of the observed O-Na anti-correlation in Galactic globular clusters. We derive quantitative indications on the efficiencies of key physical processes (mass loss, third dredge-up, sodium destruction) in order to simultaneously reproduce both the Na-rich, O-poor extreme of the anti-correlation, and the observational constraints on the CNO abundance. Results for the corresponding chemical ejecta are made publicly available

Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid

Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24-72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a "control" group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β

Inquérito sorológico de lentiviroses de pequenos ruminantes (Maedi-Visna e artrite-encefalite caprina) no estado de São Paulo

The aim of this study was to carry out the serological occurrence of Maedi-Visna virus (MVV) and CAE virus (CAEV) in ovines and caprines breeding in São Paulo state. The test to detect MVV and CAEV antibodies was agar gel immunodiffusion (AGID). The detection of antibodies against MVV was 0,3% (4/1235) and against CAEV was 15,1% (30/199). Was carried analysis of risk factors associated with the presence of positive property for CAEV and Maedi-Visna. Variables were selected for both diseases, however, when these variables were used in multivariate logistic regression model were not identified risk factors for the infections. The CAEV infection in the São Paulo state has a wide spread and a high prevalence while MVV has low prevalence. It emphasizes the importance of prevention and control measures to reduce CAEV occurrence and prevent the spread of Maedi-Visna.O objetivo deste estudo foi determinar a frequência de animais soropositivos ao vírus da Maedi-Visna (MVV) em ovinos e ao vírus da CAE (CAEV) em caprinos criados no estado de São Paulo. Na pesquisa dos anticorpos séricos anti- MVV e anti-CAEV foi utilizada a técnica de imunodifusão em gel de ágar (IDGA). Dentre os ovinos estudados, 0,3% (4/1235) eram sororreagentes ao MVV e 15,1% caprinos (30/199) ao CAEV. Foi realizada a análise de fatores de risco associados à condição de propriedade positiva para CAEV e Maedi-Visna. Foram selecionadas variáveis para as duas enfermidades, no entanto, quando essas variáveis foram usadas na regressão logística múltipla, não foram identificados fatores de risco para as infecções. A infecção pelo CAEV no estado de São Paulo tem uma ampla disseminação e com uma alta prevalência enquanto que o MVV apresenta baixa prevalência. Ressalta-se a importância de medidas de prevenção e controle para diminuir a ocorrência da CAE e evitar a disseminação da Maedi-Visna

Improved astrophysical rate for the 18O(p,α)15N reaction by underground measurements

The 18O(p,\u3b1)15N reaction affects the synthesis of 15N, 18O and 19F isotopes, whose abundances can be used to probe the nucleosynthesis and mixing processes occurring deep inside asymptotic giant branch (AGB) stars. We performed a low-background direct measurement of the 18O(p,\u3b1)15N reaction cross-section at the Laboratory for Underground Nuclear Astrophysics (LUNA) from center of mass energy Ec.m.=340keV down to Ec.m.=55keV, the lowest energy measured to date corresponding to a cross-section of less than 1 picobarn/sr. The strength of a key resonance at center of mass energy Er=90keV was found to be a factor of 10 higher than previously reported. A multi-channel R-matrix analysis of our and other data available in the literature was performed. Over a wide temperature range, T=0.01\u20131.00GK, our new astrophysical rate is both more accurate and precise than recent evaluations. Stronger constraints can now be placed on the physical processes controlling nucleosynthesis in AGB stars with interesting consequences on the abundance of 18O in these stars and in stardust grains, specifically on the production sites of oxygen-rich Group II grains

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline