Infection tracking in travellers using a mobile app (ITIT): the pilot study

BACKGROUND: Current surveillance of travellers' health captures only a small proportion of illness events. We aimed to evaluate the usability and feasibility of using an app to enable travellers to self-report illness. METHOD: This pilot study assesses a novel mobile application called Infection Tracking in Travellers (ITIT) that records travel-related symptoms with associated geolocation and weather data. Participants were recruited in three Swiss travel clinics between December 2021 and March 2022. A feedback survey was used to examine app ease of use, and data from the app was used to examine travel and illness patterns as a proof-of-concept for the larger ITIT study. RESULTS: Participants were recruited from Zurich, Basel, and Geneva, with 37 individuals completing a total of 394 questionnaires in 116 locations in Asia, Africa, the Americas, and Europe. Illness symptoms were reported by 41% of participants, 67% of which were respiratory. The post travel questionnaire showed that all participants found the app easy to use and 63% said they would recommend it to others. Several users provided suggestions for improved usability. CONCLUSION: The app fulfilled its function as a research tool linking infection symptoms with geolocation and climate data

linking goal-directed and model-based behavior

In experimental psychology different experiments have been developed to assess goal–directed as compared to habitual control over instrumental decisions. Similar to animal studies selective devaluation procedures have been used. More recently sequential decision-making tasks have been designed to assess the degree of goal-directed vs. habitual choice behavior in terms of an influential computational theory of model-based compared to model-free behavioral control. As recently suggested, different measurements are thought to reflect the same construct. Yet, there has been no attempt to directly assess the construct validity of these different measurements. In the present study, we used a devaluation paradigm and a sequential decision-making task to address this question of construct validity in a sample of 18 healthy male human participants. Correlational analysis revealed a positive association between model-based choices during sequential decisions and goal-directed behavior after devaluation suggesting a single framework underlying both operationalizations and speaking in favor of construct validity of both measurement approaches. Up to now, this has been merely assumed but never been directly tested in humans

Opposing roles for amygdala and vmPFC in the return of appetitive conditioned responses in humans

Learning accounts of addiction and obesity emphasize the persistent power of Pavlovian reward cues to trigger craving and increase relapse risk. While extinction can reduce conditioned responding, Pavlovian relapse phenomena-the return of conditioned responding following successful extinction-challenge the long-term success of extinction-based treatments. Translational laboratory models of Pavlovian relapse could therefore represent a valuable tool to investigate the mechanisms mediating relapse, although so far human research has mostly focused on return of fear phenomena. To this end we developed an appetitive conditioning paradigm with liquid food rewards in combination with a 3-day design to investigate the return of appetitive Pavlovian responses and the involved neural structures in healthy subjects. Pavlovian conditioning (day 1) was assessed in 62 participants, and a subsample (n = 33) further completed extinction (day 2) and a reinstatement test (day 3). Conditioned responding was assessed on explicit (pleasantness ratings) and implicit measures (reaction time, skin conductance, heart rate, startle response) and reinstatement effects were further evaluated using fMRI. We observed a return of conditioned responding during the reinstatement test, evident by enhanced skin conductance responses, accompanied by enhanced BOLD responses in the amygdala. On an individual level, psychophysiological reinstatement intensity was significantly anticorrelated with ventromedial prefrontal cortex (vmPFC) activation, and marginally anticorrelated with enhanced amygdala-vmPFC connectivity during late reinstatement. Our results extend evidence from return of fear phenomena to the appetitive domain, and highlight the role of the vmPFC and its functional connection with the amygdala in regulating appetitive Pavlovian relapse

Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016

BACKGROUND: Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers. OBJECTIVE: To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas. DESIGN: Descriptive, using GeoSentinel records. SETTING: 63 travel and tropical medicine clinics in 30 countries. PATIENTS: Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016. MEASUREMENTS: Frequencies of demographic, trip, and clinical characteristics and complications. RESULTS: Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain–Barre syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death). LIMITATION: Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable. CONCLUSION: These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission

Discontinuing atovaquone/proguanil prophylaxis ad-hoc post-exposure and during-travel dose-sparing prophylactic regimens against P. falciparum malaria: an update with pointers for future research

© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Background: Atovaquone/proguanil (AP) is a highly effective malaria chemoprophylaxis combination. According to current guidelines, AP is taken once daily during, and continued for seven days post exposure. A systematic review by Savelkoel et al. summarised data up to 2017 on abbreviated AP regimens, and concluded that discontinuing AP upon return may be effective, although the available data was insufficient to modify current recommendations. The same applies to other studies evaluating during-travel dose-sparing regimens. Methods: A literature search in Pubmed and Embase was performed including search terms related to AP prophylaxis and pharmacokinetics to search for recent studies on abbreviated AP regimens published since 2017. Results: Since the 2017 review, no new studies assessing discontinuing AP ad-hoc post-exposure prophylaxis have been published. Two new studies were identified assessing other abbreviated AP regimens; one investigated a twice-weekly AP regimen in 32 travellers, and one a three-day AP course in therapeutic dose (1000/400 mg) prior to exposure in 215 travellers. No malaria cases were detected in the study participants adhering to these regimens. Conclusions: Further research would be needed if the research question is considered of sufficient importance to facilitate evidence-based decision-making to modify current guidelines, as efficacy studies in travellers are fraught with confounders. We recommend human challenge trials to study abbreviated AP regimens pertaining to malaria chemoprophylaxis as they allow for rational, subject number, time- and cost-saving trial designs.info:eu-repo/semantics/publishedVersio

The position of mefloquine as a 21st century malaria chemoprophylaxis

BACKGROUND: Malaria chemoprophylaxis prevents the occurrence of the symptoms of malaria. Travellers to high-risk Plasmodium falciparum endemic areas need an effective chemoprophylaxis. METHODS: A literature search to update the status of mefloquine as a malaria chemoprophylaxis. RESULTS: Except for clearly defined regions with multi-drug resistance, mefloquine is effective against the blood stages of all human malaria species, including the recently recognized fifth species, Plasmodium knowlesi. New data were found in the literature on the tolerarability of mefloquine and the use of this medication by groups at high risk of malaria. DISCUSSION: Use of mefloquine for pregnant women in the second and third trimester is sanctioned by the WHO and some authorities (CDC) allow the use of mefloquine even in the first trimester. Inadvertent pregnancy while using mefloquine is not considered grounds for pregnancy termination. Mefloquine chemoprophylaxis is allowed during breast-feeding. Studies show that mefloquine is a good option for other high-risk groups, such as long-term travellers, VFR travellers and families with small children. Despite a negative media perception, large pharmaco-epidemiological studies have shown that serious adverse events are rare. A recent US evaluation of serious events (hospitalization data) found no association between mefloquine prescriptions and serious adverse events across a wide range of outcomes including mental disorders and diseases of the nervous system. As part of an in-depth analysis of mefloquine tolerability, a potential trend for increased propensity for neuropsychiatric adverse events in women was identified in a number of published clinical studies. This trend is corroborated by several cohort studies that identified female sex and low body weight as risk factors. CONCLUSION: The choice of anti-malarial drug should be an evidence-based decision that considers the profile of the individual traveller and the risk of malaria. Mefloquine is an important, first-line anti-malarial drug but it is crucial for prescribers to screen medical histories and inform mefloquine users of potential adverse events. Careful prescribing and observance of contraindications are essential. For some indications, there is currently no replacement for mefloquine available or in the pipeline

Release of copper-amended particles from micronized copper-pressure-treated wood during mechanical abrasion

Background: We investigated the particles released due to abrasion of wood surfaces pressure-treated with micronized copper azole (MCA) wood preservative and we gathered preliminary data on its in vitro cytotoxicity for lung cells. The data were compared with particles released after abrasion of untreated, water (0% MCA)-pressure-treated, chromated copper (CC)-pressure-treated wood, and varnished wood. Size, morphology, and composition of the released particles were analyzed. Results: Our results indicate that the abrasion of MCA-pressure-treated wood does not cause an additional release of nanoparticles from the unreacted copper (Cu) carbonate nanoparticles from of the MCA formulation. However, a small amount of released Cu was detected in the nanosized fraction of wood dust, which could penetrate the deep lungs. The acute cytotoxicity studies were performed on a human lung epithelial cell line and human macrophages derived from a monocytic cell line. These cell types are likely to encounter the released wood particles after inhalation. Conclusions: Our findings indicate that under the experimental conditions chosen, MCA does not pose a specific additional nano-risk, i.e. there is no additional release of nanoparticles and no specific nano-toxicity for lung epithelial cells and macrophages

Pregnancy and Fetal Outcomes After Exposure to Mefloquine in the Pre- and Periconception Period and During Pregnancy

Pregnant women who travel to malarious areas and their clinicians need data on the safety of malaria chemoprophylaxis. The drug safety database analysis of mefloquine exposure in pregnancy showed that the birth defect prevalence and fetal loss in maternal, prospectively-monitored cases were comparable to background rates

The 2009 L’Aquila (Central Italy) Seismic Sequence.

On April 6 (01:32 UTC) 2009 a MW 6.1 normal faulting earthquake struck the axial area of the Abruzzo region in Central Italy. The earthquake heavily damaged the city of L’Aquila and its surroundings, causing 308 casualties, 70,000 evacuees and incalculable losses to the cultural heritage. We present the geometry of the fault system composed by two main normal fault planes, reconstructed by means of seismicity distribution: almost 3000 events with ML≥1.9 occurred in the area during the 2009. The events have been located with a 1D velocity model we computed for the area by using data of the seismic sequence. The mainshock, located at around 9.3 km of depth beneath the town of L’Aquila, activated a 50° (+/- 3) SW-dipping and ~135° NW-trending normal fault with a length of about 16 km. The aftershocks activated the whole 10 km of the upper crust up to the surface. The geometry of the fault is coherent with the mapped San Demetrio-Paganica and Mt. Stabiata normal faults. The whole normal fault system that reached about 50 km of length by the end of December in the NW-trending direction, was activated within the first few days of the sequence when most of the energetic events occurred. The main shock fault plane was activated by a foreshock sequence culminated with a MW 4.0 on the 30th of March (13:38 UTC), showing extensional kinematic with a minor left lateral component. The second major structure, located to the north close to Campotosto village, is controlled by a MW 5.0 which occurred on the same day of the main shock (the 6th of April at 23:15 UTC) and by a MW 5.2 event (9th of April - 00:53 UTC). The fault plane shows a shallower dip angle with respect to the main fault plane, of about 35° with a tendency to flattening towards the deepest portion. Due to the lack of seismicity above 5 km depth, the connection between this structure and the mapped Monti della Laga fault is not straightforward. This northern segment is recognisable for about 12-14 km of length, always NW-trending and forming a right lateral step with the main fault plane. The result is a en-echelon system overlapping for about 6 km. Seismicity pattern also highlights the activation of numerous minor normal fault segments within the whole fault system. The deepest is located at around 13-15 km of depth, south of the L’Aquila mainshock, and it seems to be antithetic to the main fault plane

The 2009 L'Aquila (central Italy) seismic sequence

On April 6 (01:32 UTC) 2009 a MW 6.1 normal faulting earthquake struck the axial area of the Abruzzo region in central Italy. The earthquake heavily damaged the city of L’Aquila and its surroundings, causing 308 casualties, 70,000 evacuees and incalculable losses to the cultural heritage. We present the geometry of the fault system composed of two main normal fault planes, reconstructed by means of seismicity distribution: almost 3000 events with ML≥1.9 occurred in the area during 2009. The events have been located with a 1D velocity model we computed for the area by using data of the seismic sequence. The mainshock, located at around a 9.3 km depth beneath the town of L’Aquila, activated a 50° (+/- 3) SW-dipping and ~135° NW-trending normal fault with a length of about 16 km. The aftershocks activated the whole 10 km of the upper crust up to the surface. The geometry of the fault is coherent with the mapped San Demetrio-Paganica and Mt. Stabiata normal faults. The whole normal fault system that reached about 40 km of length by the end of December in the NW-trending direction, was activated within the first few days of the sequence when most of the energetic events occurred. The main shock fault plane was activated by a foreshock sequence that culminated with a MW 4.0 on March 30 (13:38 UTC), showing extensional kinematics with a minor left lateral component. The second major structure, located to the north close to Campotosto village, is controlled by an MW 5.0 event, which occurred on the same day of the main shock (April 6 at 23:15 UTC), and by an MW 5.2 event (April 9 at 00:53 UTC). The fault plane shows a shallower dip angle with respect to the main fault plane, of about 35° with a tendency to flattening towards the deepest portion. Due to the lack of seismicity above a 5 km depth, the connection between this structure and the mapped Monti della Laga fault is not straightforward. This northern segment is recognisable for about 12-14 km of length, always NW-trending and forming a right lateral step with the main fault plane. The result is a en-echelon system overlapping for about 6 km. The seismicity pattern also highlights the activation of numerous minor normal fault segments within the whole fault system. The deepest is located at around a 13-15 km depth, south of the L’Aquila mainshock, and it seems to be antithetic to the main fault plane