WGS for infection prevention and control in Africa

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Thinking through connections in food and energy transitions

Peer Reviewe

Digital urban nature

Within policy and research debates on the smart city, the urban environment has become an arena of contestation. Claims that digitalisation will render the city more resource-efficient are countered by criticism of the tensions between smart and sustainability practices. Little attention has been paid, however, to the role of nature in digitally mediated urban environments. The flora, fauna and habitats of a city are a void in research and policy on digital urbanism. This paper provides one of the first conceptually grounded, empirical studies of ‘digital urban nature’ in practice. Taking the empirical example of Berlin, the paper demonstrates how a single city can spawn a rich variety of digital nature schemes, develops from this a typology to guide future research and analyses two schemes in depth to illustrate the aspirations and limitations of digital technologies targeting urban nature. The empirical findings are interpreted by bringing into dialogue pertinent strands of urban research: first, between smart environments and urban nature to explore ways of representing nature through digital technologies and, second, between digital and urban commons to interpret changes in the collective and individual use of urban nature. The paper reveals that digital platforms and apps are creating new ways of seeing and experiencing nature in the city, but often cling to conventional, anthropocentric notions of urban nature, with sometimes detrimental effects. More broadly, it suggests that exploring practices of digitalisation beyond the remit of conventional smart city policy can enrich scholarship on digitally mediated human-nature relations in the city.Peer Reviewe

El arraigo local en proyectos energéticos comunitarios. Una perspectiva de emprendimiento social

An increasing number of community energy projects have emerged recently, reflecting diverse sociotechnical configurations in the energy sector. This article is based on an empirical study examining different types of community energy projects such as energy cooperatives, public service utilities and other entrepreneurially oriented initiatives across the European Union. Based on an in-depth analysis of three case studies, the article aims to introduce a social entrepreneurship perspective when discussing the relationship between local embeddedness and different forms of organisation and ownership in community energy. The results indicate that community energy projects can expand beyond the local scale without losing their collective and democratic form of functioning and ownership. Moreover, social movements can act as catalysts for this expansion beyond the local, in a quest for wider social transformation. Social entrepreneurship may provide a suitable analytical lens to avoid the 'local trap' when examining different forms of organisation and ownership in renewable energy, and further explore the question of scaling

Antifungal-Loaded Acrylic Bone Cement in the Treatment of Periprosthetic Hip and Knee Joint Infections : A Review

Little is known about the clinical use of antifungal-loaded acrylic bone cement in the treatment of periprosthetic hip and knee joint infections (PJIs). Hence, we performed a literature search using PubMed/MEDLINE from inception until December 2021. Search terms were “cement” in combination with 13 antifungal agents. A total of 10 published reports were identified, which described 11 patients and 12 joints in which antifungal-loaded cement was employed. All studies were case reports or case series, and no randomized controlled trials were identified. In 6 of 11 patients, predisposing comorbidities regarding the emergence of a fungal PJI were present. The majority of the studies reported on infections caused by Candida species. In six cases (seven joints), the cement was solely impregnated with an antifungal, but no antibiotic agent (amphotericin B, voriconazole, and fluconazole). In the other five joints, the cement was impregnated with both antibiotic(s) and antifungals. Great discrepancies were seen regarding the exact loading dose. Four studies investigated the local elution of antifungal agents in the early postoperative period and observed a local release of antifungals in vivo. We conclude that there is a paucity of data pertaining to the clinical use of antifungal-loaded bone cement, and no studies have assessed the clinical efficacy of such procedures. Future studies are urgently required to evaluate this use of antifungals in PJI

Recent Advances and Potential Future Applications of MALDI-TOF Mass Spectrometry for Identification of Helminths

Helminth infections caused by nematodes, trematodes, and cestodes are major neglected tropical diseases and of great medical and veterinary relevance. At present, diagnosis of helminthic diseases is mainly based on microscopic observation of different parasite stages, but microscopy is associated with limited diagnostic accuracy. Against this background, recent studies described matrixassisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry as a potential, innovative tool for helminth identification and differentiation. MALDI-TOF mass spectrometry is based on the analysis of spectra profiles generated from protein extracts of a given pathogen. It requires an available spectra database containing reference spectra, also called main spectra profiles (MSPs), which are generated from well characterized specimens. At present, however, there are no commercially available databases for helminth identification using this approach. In this narrative review, we summarize recent developments and published studies between January 2019 and September 2022 that report on the use of MALDI-TOF mass spectrometry for helminths. Current challenges and future research needs are identified and briefly discussed

Teaching Medical Microbiology With a Web-Based Course During the COVID-19 Pandemic: Retrospective Before-and-After Study

Background: The COVID-19 pandemic has imposed unprecedented hurdles on health care systems and medical faculties alike. Lecturers of practical courses at medical schools have been confronted with the challenge of transferring knowledge remotely. Objective: We sought to evaluate the effects of a web-based medical microbiology course on learning outcomes and student perceptions. Methods: During the summer term of 2020, medical students at Saarland University, Germany, participated in a web-based medical microbiology course. Teaching content comprised clinical scenarios, theoretical knowledge, and instructive videos on microbiological techniques. Test performance, failure rate, and student evaluations, which included open-response items, for the web-based course were compared to those of the on-site course from the summer term of 2019. Results: Student performance was comparable between both the online-only group and the on-site comparator for both the written exam (n=100 and n=131, respectively; average grade: mean 7.6, SD 1.7 vs mean 7.3, SD 1.8; P=.20) and the oral exam (n=86 and n=139, respectively; average grade: mean 33.6, SD 4.9 vs mean 33.4, SD 4.8; P=.78). Failure rate did not significantly differ between the online-only group and the comparator group (2/84, 2.4% vs 4/120, 3.3%). While lecturer expertise was rated similarly as high by students in both groups (mean 1.47, SD 0.62 vs mean 1.27, SD 0.55; P=.08), students who took the web-based course provided lower scores for interdisciplinarity (mean 1.7, SD 0.73 vs mean 2.53, SD 1.19; P<.001), opportunities for interaction (mean 1.46, SD 0.67 vs mean 2.91, SD 1.03; P<.001), and the extent to which the educational objectives were defined (mean 1.61, SD 0.76 vs mean 3.41, SD 0.95; P<.001). Main critiques formulated within the open-response items concerned organizational deficits. Conclusions: Web-based courses in medical microbiology are a feasible teaching option, especially in the setting of a pandemic, leading to similar test performances in comparison to on-site courses. The lack of interaction and the sustainability of acquired manual skills warrant further research

Syndromic approaches to persistent digestive disorders (≥14 days) in resource-constrained settings : aetiology, clinical assessment and differential diagnostics

Background: Gastrointestinal infections are among the leading causes of morbidity worldwide. In contrast to acute diarrhoea, long-lasting digestive disorders can be defined as persistent diarrhoea (≥14 days) and/or persistent abdominal pain (≥14 days). This clinical syndrome is frequently caused by intestinal infections, but its medical importance in the tropics, the range of causative pathogens and the contribution of neglected tropical diseases remain to be elucidated. Currently employed diagnostic tools for the detection of intestinal pathogens frequently lack sensitivity, and there are only few evidence-based recommendations to guide the clinical management of persistent digestive disorders in resource-constrained settings. Rapid diagnostic tests (RDTs) have become available for the diagnosis of various intestinal pathogens and hold promise to be used even in peripheral healthcare centres with only very limited laboratory infrastructure. More recently, multiplex polymerase chain reaction (PCR) assays targeting gastrointestinal pathogens have been developed, but these tests have yet to be systematically evaluated in the tropics. The current Ph.D. thesis was carried out as part of the NIDIAG project, an international research consortium that aims at developing evidence-based diagnosis-treatment algorithms for persistent digestive disorders and other common clinical syndromes in resource-constrained settings of Africa and Asia. Methods: A systematic review was performed to elucidate the aetiological spectrum of persistent digestive disorders. A study protocol, accompanied by a set of more than 30 standard operating procedures (SOPs), was developed to conduct a multi-country, prospective case-control study to investigate persistent diarrhoea (≥14 days; all individuals aged above 1 year) and persistent abdominal pain (≥14 days; all children and adolescents aged 1-18 years) in Côte d’Ivoire, Indonesia, Mali and Nepal. In the framework of a specific site assessment, a case-control study was performed in Dabou, south Côte d’Ivoire to determine the aetiology and clinical features of persistent diarrhoea. Stool samples were subjected to a host of microscopic techniques, RDTs for Clostridium difficile, Cryptosporidium spp. and Giardia intestinalis, as well as the Luminex® Gastrointestinal Pathogen Panel, a stool-based multiplex PCR. A subsequent study was conducted to assess the diagnostic accuracy of real-time PCR for detection of Strongyloides stercoralis and to compare it to a combination of microscopic methods (Baermann funnel concentration and Koga agar plate). For the first time, a previously validated, urine-based RDT for the diagnosis of Schistosoma mansoni was employed for individual management of patients presenting with digestive disorders to a hospital in Europe. Results: The systematic review identified more than 40 bacterial, parasitic (helminths and intestinal protozoa) and viral pathogens that may potentially cause persistent diarrhoea and persistent abdominal pain. In a subsequent case-control study in southern Côte d’Ivoire, 20 different intestinal pathogens were detected and >50% of all participants had co-infections. Enterotoxigenic Escherichia coli (32%) and Shigella spp. (20%) were the most prevalent bacterial pathogens, while G. intestinalis (29%) and S. stercoralis (10%) were the predominant intestinal protozoon and helminth species, respectively. With regard to infection status, there were few differences between cases and controls. Most patients with persistent diarrhoea lived in rural areas, but clinical signs and symptoms could not distinguish between specific infections. The protocol for the multi-country NIDIAG study on persistent digestive disorders adopted a case-control approach and regular follow-up visits of symptomatic patients to monitor the clinical response to treatment. A diagnostic study in south-central Côte d’Ivoire found that the application of a stool-based real-time PCR for S. stercoralis substantially improved the detection rate of this pathogen, leading to a total prevalence of 21.9%, compared to a prevalence of 10.9% according to stool microscopy. C. difficile could also be detected in stool samples from Côte d’Ivoire (5.4% prevalence according to RDT). Non-toxigenic C. difficile strains predominated and their molecular characteristics differed considerably from those observed in other settings. Prolonged storage without properly maintained cold chain only minimally affected the subsequent recovery of C. difficile and its toxins in stool culture. A point-of-care (POC) test detecting a circulating cathodic antigen (CCA) in urine was successfully utilised to confirm intestinal S. mansoni infection in migrants from Eritrea who presented to a European hospital because of persistent abdominal pain. Conclusions: Persistent digestive disorders are of considerable public health importance in Côte d’Ivoire and elsewhere, with the majority of cases being detected in rural areas. Many different causative agents may give rise to this syndrome and they can be accurately detected by the application of highly sensitive diagnostic techniques. The diversity of the potentially implicated pathogens underscores the need for a syndromic approach to persistent digestive disorders. RDTs are helpful tools for the detection of specific pathogens and may be implemented as part of diagnostic algorithms in endemic areas and in hospitals providing care for migrants and returning travellers. There is an urgent need to develop a stool-based RDT for S. stercoralis. The high asymptomatic carriage rates of intestinal pathogens call for the inclusion of healthy controls in epidemiological studies to define the specific contribution of each pathogen to the syndrome of persistent digestive disorders. Future studies employing metagenomic approaches will provide further insights into the intestinal microbiome of symptomatic patients and healthy controls

Update on Coagulase-Negative Staphylococci—What the Clinician Should Know

Coagulase-negative staphylococci (CoNS) are among the most frequently recovered bacteria in routine clinical care. Their incidence has steadily increased over the past decades in parallel to the advancement in medicine, especially in regard to the utilization of foreign body devices. Many new species have been described within the past years, while clinical information to most of those species is still sparse. In addition, interspecies differences that render some species more virulent than others have to be taken into account. The distinct populations in which CoNS infections play a prominent role are preterm neonates, patients with implanted medical devices, immunodeficient patients, and those with other relevant comorbidities. Due to the property of CoNS to colonize the human skin, contamination of blood cultures or other samples occurs frequently. Hence, the main diagnostic hurdle is to correctly identify the cases in which CoNS are causative agents rather than contaminants. However, neither phenotypic nor genetic tools have been able to provide a satisfying solution to this problem. Another dilemma of CoNS in clinical practice pertains to their extensive antimicrobial resistance profile, especially in healthcare settings. Therefore, true infections caused by CoNS most often necessitate the use of second-line antimicrobial drugs