Antimicrobial Resistance in the Environment: Towards Elucidating the Roles of Bioaerosols in Transmission and Detection of Antibacterial Resistance Genes.

Antimicrobial resistance (AMR) is continuing to grow across the world. Though often thought of as a mostly public health issue, AMR is also a major agricultural and environmental problem. As such, many researchers refer to it as the preeminent One Health issue. Aerial transport of antimicrobial-resistant bacteria via bioaerosols is still poorly understood. Recent work has highlighted the presence of antibiotic resistance genes in bioaerosols. Emissions of AMR bacteria and genes have been detected from various sources, including wastewater treatment plants, hospitals, and agricultural practices; however, their impacts on the broader environment are poorly understood. Contextualizing the roles of bioaerosols in the dissemination of AMR necessitates a multidisciplinary approach. Environmental factors, industrial and medical practices, as well as ecological principles influence the aerial dissemination of resistant bacteria. This article introduces an ongoing project assessing the presence and fate of AMR in bioaerosols across Canada. Its various sub-studies include the assessment of the emissions of antibiotic resistance genes from many agricultural practices, their long-distance transport, new integrative methods of assessment, and the creation of dissemination models over short and long distances. Results from sub-studies are beginning to be published. Consequently, this paper explains the background behind the development of the various sub-studies and highlight their shared aspects.

Exploring polypharmacy with artificial intelligence: data analysis protocol.

BACKGROUND: Polypharmacy is common among older adults and it represents a public health concern, due to the negative health impacts potentially associated with the use of several medications. However, the large number of medication combinations and sequences of use makes it complicated for traditional statistical methods to predict which therapy is genuinely associated with health outcomes. The project aims to use artificial intelligence (AI) to determine the quality of polypharmacy among older adults with chronic diseases in the province of Québec, Canada. METHODS: We will use data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS). QICDSS contains information about prescribed medications in older adults in Quebec collected over 20 years. It also includes diagnostic codes and procedures, and sociodemographic data linked through a unique identification number for each individual. Our research will be structured around three interconnected research axes: AI, Health, and Law&Ethics. The AI research axis will develop algorithms for finding frequent patterns of medication use that correlate with health events, considering data locality and temporality (explainable AI or XAI). The Health research axis will translate these patterns into polypharmacy indicators relevant to public health surveillance and clinicians. The Law&Ethics axis will assess the social acceptability of the algorithms developed using AI tools and the indicators developed by the Heath axis and will ensure that the developed indicators neither discriminate against any population group nor increase the disparities already present in the use of medications. DISCUSSION: The multi-disciplinary research team consists of specialists in AI, health data, statistics, pharmacy, public health, law, and ethics, which will allow investigation of polypharmacy from different points of view and will contribute to a deeper understanding of the clinical, social, and ethical issues surrounding polypharmacy and its surveillance, as well as the use of AI for health record data. The project results will be disseminated to the scientific community, healthcare professionals, and public health decision-makers in peer-reviewed publications, scientific meetings, and reports. The diffusion of the results will ensure the confidentiality of individual data.

Enhancing the mental representations of space used by blind pedestrians, based on an image schemata model.

The configuration of mental representation of space plays a major role in successful navigational activities. Therefore, navigational assistance for pedestrians who are blind should help them to better configure their mental representation of the environment. In this paper, we propose and exploit a computational model for the mental representation of urban areas as an aid to orientation and navigation for visually impaired pedestrians. Our model uses image schemata to capture the spatial semantics and configural elements of urban space necessary for this purpose. These image schemata are schematic structures that are continually requested by individuals in their perception, bodily movement and interaction with surrounding objects. Our proposed model also incorporates a hierarchical structure to provide different levels of detail tied to appropriate spatial perspectives at each scale. We presume that such computational model will help us to develop an appropriate structure of spatial data used to assist the target population. At the end of the paper, we illustrate the utility of our configural model by developing a typical scenario for the navigation of a blind pedestrian in an urban area.

Easier surveillance of climate-related health vulnerabilities through a Web-based spatial OLAP application.

BACKGROUND: Climate change has a significant impact on population health. Population vulnerabilities depend on several determinants of different types, including biological, psychological, environmental, social and economic ones. Surveillance of climate-related health vulnerabilities must take into account these different factors, their interdependence, as well as their inherent spatial and temporal aspects on several scales, for informed analyses. Currently used technology includes commercial off-the-shelf Geographic Information Systems (GIS) and Database Management Systems with spatial extensions. It has been widely recognized that such OLTP (On-Line Transaction Processing) systems were not designed to support complex, multi-temporal and multi-scale analysis as required above. On-Line Analytical Processing (OLAP) is central to the field known as BI (Business Intelligence), a key field for such decision-support systems. In the last few years, we have seen a few projects that combine OLAP and GIS to improve spatio-temporal analysis and geographic knowledge discovery. This has given rise to SOLAP (Spatial OLAP) and a new research area. This paper presents how SOLAP and climate-related health vulnerability data were investigated and combined to facilitate surveillance. RESULTS: Based on recent spatial decision-support technologies, this paper presents a spatio-temporal web-based application that goes beyond GIS applications with regard to speed, ease of use, and interactive analysis capabilities. It supports the multi-scale exploration and analysis of integrated socio-economic, health and environmental geospatial data over several periods. This project was meant to validate the potential of recent technologies to contribute to a better understanding of the interactions between public health and climate change, and to facilitate future decision-making by public health agencies and municipalities in Canada and elsewhere. The project also aimed at integrating an initial collection of geo-referenced multi-scale indicators that were identified by Canadian specialists and end-users as relevant for the surveillance of the public health impacts of climate change. This system was developed in a multidisciplinary context involving researchers, policy makers and practitioners, using BI and web-mapping concepts (more particularly SOLAP technologies), while exploring new solutions for frequent automatic updating of data and for providing contextual warnings for users (to minimize the risk of data misinterpretation). According to the project participants, the final system succeeds in facilitating surveillance activities in a way not achievable with today's GIS. Regarding the experiments on frequent automatic updating and contextual user warnings, the results obtained indicate that these are meaningful and achievable goals but they still require research and development for their successful implementation in the context of surveillance and multiple organizations. CONCLUSION: Surveillance of climate-related health vulnerabilities may be more efficiently supported using a combination of BI and GIS concepts, and more specifically, SOLAP technologies (in that it facilitates and accelerates multi-scale spatial and temporal analysis to a point where a user can maintain an uninterrupted train of thought by focussing on "what" she/he wants (not on "how" to get it) and always obtain instant answers, including to the most complex queries that take minutes or hours with OLTP systems (e.g., aggregated, temporal, comparative)). The developed system respects Newell's cognitive band of 10 seconds when performing knowledge discovery (exploring data, looking for hypotheses, validating models). The developed system provides new operators for easily and rapidly exploring multidimensional data at different levels of granularity, for different regions and epochs, and for visualizing the results in synchronized maps, tables and charts. It is naturally adapted to deal with multiscale indicators such as those used in the surveillance community, as confirmed by this project's end-users.